Everything You Need To Know About Self-Compassion (Interview with Paul Gilbert)

Kimberley: Welcome. This conversation is actually so near and close to my heart. I am so honored to have Jessie Birnbaum and Sandy Robinson here talking about Managing the anxiety of chronic illness and disability. Welcome and thank you both for being here.

Sandy: Thank you for having us.

Kimberley: For those of you who are listening on audio, we are three here today. We’re going to be talking back and forth. I’ll do my best to let you know who’s talking, but if anything, you can look at the transcripts of the show if you’re wondering who’s saying what. But I am so happy to have you guys here. You’re obviously doing some amazing work bringing awareness to those who have an anxiety disorder, specifically health anxiety OCD, panic disorder. These are all very common disorders to have alongside a chronic illness and disability. Jessie, will you go first in just telling us a little bit about your experience of managing these things? 

Jessie: Yeah, of course. I’ve had OCD since I was a little kid but wasn’t diagnosed until around age 14, so it took a little while to get that diagnosis. And then was totally fine, didn’t have any physical limitations, played a lot of sports. And then in 2020, which seems like it would coincide with the pandemic (I don’t think it did), I started getting really physically sick. I started out with these severe headaches and has continued on and morphed into new symptoms, and has been identified as a general chronic illness. I’m still searching for an overall diagnosis, but I’ve seen a lot of different ways in which my OCD has made my chronic illness worse. And then my chronic illness has made my OCD worse, which is really why Sandy and I are so passionate about this topic.

Kimberley: Thank you. Sandy, can you share a little about your experience?

Sandy: Yeah. Just briefly, I was born really prematurely at about 14 weeks early, which was a lot. And then I was born chronically ill with a bowel condition and I also have a physical disability called [02:31 inaudible] palsy. And then I wasn’t diagnosed with OCD until I was 24, but looking back now, knowing what I do about OCD, I think I would say my OCD probably started around age three or something. So, quite young as well.

Kimberley: You guys are talking about illnesses or medical conditions that create a lot of uncertainty in your life, which is so much of the work of managing OCD. Let’s start with you Jessie again. How do you manage the uncertainty of not having a diagnosis or trying to figure that out? Has that been a difficult process for you, or how have you managed that?

Jessie: It has been such a difficult process because that’s what OCD latches onto, the uncertainty of things. That’s been really challenging with not having a specific diagnosis. I can’t say, “Oh, I have Crohn’s disease or Lyme disease,” or something that gives it a name and validates the experience. I feel like I have a lot of intrusive thoughts and my OCD will latch onto not having that diagnosis. So, I’ll have a lot of intrusive thoughts that maybe I’m making it up because if the blood work is coming back normal, then what is it? I’ll have to often fight off those intrusive thoughts and really practice mindfulness and do a lot of ERP surrounding that to really validate my experience and not let those get in the way.

Kimberley: Sandy—I can only imagine, for both of you, that is the case as well—how has your anxiety impacted your ability to manage the medical side of your symptoms?

Sandy: I think that’s an interesting question because I think both my OCD and my medical symptoms are linked. I think when I get really stressed and have prolonged periods of stress, my bowel condition especially gets a lot worse, so that’s tricky. But I think as I’ve gone through ERP, and I’m now in OCD recovery, that a lot of the skills I’ve learned from being chronically ill and disabled my whole life, like planning, being a good self-advocate at the doctors or at the hospital and that flexibility, I think those tools really helped me to cope with the challenges of having additional anxiety on top of those medical challenges.

Kimberley: Right. Of course, and I believe this to be from my own experience of having a chronic illness, the condition itself creates anxiety even for people who don’t have an anxiety disorder. How have you managed that additional anxiety that you’re experiencing? Is there a specific tool or skill that you want to share with people? And then I’ll let Jessie chime in as well.

Sandy: Yeah. I think the biggest thing is, it was realizing that my journey is my journey and it might be a little slower than other people’s because of all the complicating factors, but it’s still a good journey. It’s my journey, so I can’t really wish myself into someone else’s shoes. I’m in my own shoes. I guess the biggest thing is realizing like my OCD isn’t special because I have these complicating factors, even though I myself am special. My OCD is just run-of-the-mill OCD and can still be treated by ERP despite those medical issues as well.

Kimberley: Right. How about you Jessie? What’s your experience of that? 

Jessie: I’d like to add to what Sandy had said too about the skills from ERP really helping. One of the things I feel like I’ve gone through is there’s so much waiting in chronic illness. You’re waiting for the doctors to get back to you, you’re waiting for test results, you’re waiting for the phone schedulers to answer the phone. I feel like I’ve memorized the music for the waiting of all the different doctors. But there’s a lot of waiting, and that’s really frustrating because the waiting is uncertain. You’re just waiting to get an answer, which typically in my case and probably Sandy’s and yours as well, then just adds more uncertainty anyways. 

But I remember one of the tools that’s really helped me is staying in the present, which I’m not great at. But I remember I had to get an MRI where you literally can’t move. There’s only the present. You’re there with your thoughts, your arms are in, you can’t move at all. It was really long. It was like 45 minutes long. I remember just thinking the colors. What do I see? I see blue, I see red. I thought I had to think of things because then my eyes were closed and I was thinking of different shapes of like, “Oh, in the room before, I saw there was a cylinder shape and there was a cube.” That’s really helped me to stay in the present, especially with those really long waiting periods

Kimberley: For sure. The dreaded MRI machine, I can totally resonate with what you’re saying. It’s all mindfulness. It’s either mindfulness or you go down a spiral, right?

Jessie: Exactly.

Kimberley: You guys are talking about skills. Because I think there’s the anxiety of having this chronic illness or a disability or a medical condition. What about how you manage the emotions of it and what kind of emotions show up for you in living with these difficult things that you experience? Sandy, do you want to share a little about the emotional side of having a chronic illness or a disability?

Sandy: Yeah. I think the first thing that shows up for me emotion-wise, or did at least when I started to process the idea that I have a disability and I have these chronic illnesses and it’s going to be a lifelong thing, was I was in my undergraduate university and I really hadn’t thought much about what it’s like to-- I had thought about having a disability, but I hadn’t thought about the fact that I needed to process that this is a lifelong thing and it’s going to be challenging my whole life. I think when I started to process that, the grief really showed up because I had to grieve this life that I thought I should have of being able-bodied or medically healthy or mentally well, I guess. I had to really grieve that. But I think that grief shows up sometimes unexpectedly for me too because sometimes I feel like I moved past this thing that happened. But then because it’s an ongoing process to navigate chronic illness and disability, the grief shows up again at unexpected times. 

I think the other thing too I’ve navigated was a lot of shame around the idea that I should be “normal.” But of course, I can’t really control how I was born and the difficulties I’ve had. I think something that really helps me there is bringing in the self-compassion. I do think that compassion really is an antidote to shame because when you bring something out to the forefront and say, “This is something that I’ve experienced, it was challenging,” but I can still move forward, I think that really helps or at least it helps me. 

Kimberley: Yeah, I agree. Jessie, what are your experiences?

Jessie: I would say the first two words I thought of were frustration and loneliness. I think there’s a lot of frustration in two different ways. The first way being like, why is this happening? First, I had OCD, and then now I have this other thing that I have to deal with. As Sandy was saying before, there’s a lot of self-advocacy that has to happen when you’re chronically ill, or at least that I’ve experienced, where you have to stand up for yourself, you have to finagle your way into doctor’s appointments to get the treatment that you deserve. But there’s also the frustration that both OCD and my chronic illness, I guess, are invisible. I look totally fine. I look like someone else walking down the street who might be completely healthy. I often feel frustrated that as a 23-year-old, a person who is a young adult, I’m having to constantly go to these doctor’s appointments and advocate for myself and practice ERP, which is not always the most fun thing to do. It’s frustrating to constantly have to explain it because you don’t see it. And then that goes together with the loneliness of being a young adult and being pretty much the only person in the doctor’s offices and waiting rooms who isn’t an older adult or who isn’t elderly. And then they get confused and then I get confused. My OCD will then attack that like, “Everyone else is older. What are you doing here?” I would definitely say loneliness, and I just forgot the other thing. Loneliness and frustration. 

Kimberley: I resonate with what you’re saying. I agree with everything both of you are saying. For me too, I had to really get used to feeling judged. I had to get good at feeling judged, even though I didn’t even know if they were judging me. But that feeling that I was being judged, maybe it’s more magical thinking and so forth. But that someone will say like I have to explain to someone why I can’t do something. As I’m explaining it, I have a whole story of what they’re thinking about me, and that was a really difficult part to get through at the beginning of like, “You’re going to have to let them have their opinions about you. Who knows what they’re thinking?” That was a really hard piece for me as well. I love that you both brought in the frustration and the loneliness because I think that’s there. I love that we also bring in the grief, and I agree, Sandy. Jessie, do you agree in terms of that grief wave just comes at the most random times? 

Jessie: Absolutely.

Kimberley: It can be so, so painful. Let’s keep moving forward. Let’s go back to talking about how this interlocking web of how anxiety causes the chronic illness to get worse sometimes, the chronic illness causes anxiety to get worse sometimes. Sandy, have you found any way that you’ve been able to have a better awareness of what’s happening? How do you work to pull them apart or do you not worry about pulling them apart? 

Sandy: Oh, that’s an interesting question. I think I have a few strategies. I do try to write everything down. I make notes upon notes upon notes of, this day I had these symptoms. I do automate a lot of tasks in the fact that I have a medication reminder on my phone, so it reminds me to take my pills instead of just having to remember it off the top of my head. Something that really helps is trying to remember that things that work for other people might actually also work for me too, because it’s like, yeah sure, maybe me as a person, I’m unique and my medical situation is interesting or different or whatever. But a lot of good advice for other people, especially for mental health works for me too, like getting outside. Even if I feel really not great and I’m really tired or in a lot of pain, just like getting outside. Anytime I have my shoes on and I’m just outside even for five minutes, I count that as a win. Drinking a lot of water, for me, helps us too. Of course, I’m wary of saying all this because a lot of people might just say, “Oh well, Jessie and Sandy, they just need to do more yoga and that’ll just cure them.” Of course, it’s not that simple. It’s not a cure at all. But at the same time, I try to remember that at least for me, I have common medical issues that a lot of different people have so I can pull on literature and different things that I’ve worked for other people with my conditions. Maybe other people haven’t had this exact constellation that I do, but I can still pull on the support and resources from other people too.

Kimberley: How about you, Jessie?

Jessie: If I could add there, I’m not as good as differentiating. I can tell, like I know when things are starting to get compulsive, which I actually appreciate that I had had so much ERP training before I got sick because I really know what’s a compulsion, what’s an obsession and I can tease that out. But a lot of my treatment has also been really understanding, like maybe I don’t need to know if this is my chronic illness or if this is my OCD because then that gets compulsive. I’ve had to sit in that uncertainty of maybe it is one, maybe it is the other, but I’m not going to figure it out.

Kimberley: You read my mind because as you were both talking, I was thinking the most difficult part for many people that I see in my practice is trying to figure out and balance between advocating going to the doctor when you need, but also not doing it from a place of being compulsive because health anxiety and OCD can have you into the doctor surgery every second day or every second hour. How are you guys navigating that of advocating, but at the same time, keeping an eye on that compulsivity that can show up? Sandy, do you want to go first? 

Sandy: Yeah. I honestly haven’t figured out the perfect formula between trying to figure out like, is this anxiety around the potential that I might be getting sick again and compulsively trying to get things checked out, and the idea that I might have something actually medically going wrong that needs to be addressed. I find it still challenging to tease those things apart. But I think something that does help is trying to remind myself like, not what is normal, because I don’t think normal really exists but what is in the service of my recovery. I can’t have recovery from my disability or my chronic illnesses, but I can’t have OCD recovery. I’m always still trying to think to myself, how can I move forward in a way that both aligns with my values and allows me to move forwards towards my recovery?

Kimberley: How about you, Jessie?

Jessie: It’s so hard to follow that, Sandy. I love that. I would say, I think it’s tough because a symptom that I have is like, I was never really a big compulsive Googler. But I know in OCD world, it’s like, “Don’t go to Google for medical issues. Google is not your friend.” But for my chronic illness recovery or chronic illness journey, Google’s been important. I’ve had to do a lot of research on what is it that I possibly have. And that really helps me advocate my case to the doctors because I’ve had some great doctors, but they’re not spending hours reading medical journals and trying to figure it out to the extent that I care about it because it’s my situation and I want to figure stuff out. Googling has actually helped me a lot in that regard and joining different Facebook groups and actually hearing from other people what their experiences have been. 

I know Sandy and I started a special interest group, which hopefully we’ll talk about a little later, but someone in the group had mentioned that something that really helps them is the community of their doctors and their therapists working together of, oh, I’m going to wait two days if I have this symptom and if it’s still a symptom that’s really bothering me and my therapist thinks it should be checked out, then I’m going to go to the doctor. Having those people who are experts guiding you and helping you with making sure, no, this isn’t compulsive, this is a real medical thing that needs to be checked out—I thought that was really smart and seemed to work for her, so I’d imagine it would work for other people as well.

Sandy: I guess if I can add--

Kimberley: I have a question about that. Yes, please.

Sandy: Oh, sorry. If I can add one more thing, it would just be that, while there’s so many experts on OCD and ERP and your chronic medical issues or your disability or whatever it is for you, you are the only frontline expert in your own experience of your mind and your body and you are the only one who knows what it’s like to exactly be in that, I guess, space. While I 100% think therapy is important, evidence-based treatments are important, I do also think like remembering when you think like, “Oh, this is really hard,” or “I can’t cope,” actually, you can cope, you’re capable and you know yourself best. I think that’s challenging because I know sometimes in ERP, for people who maybe don’t have other complicated medical challenges, they would say, “Don’t Google.” But I think, as just Jessie has explained, sometimes because we have other chronic stuff going on, we do need to do things to help ourself holistically too.

Kimberley: I love that. I’ll speak from my own experience and if you guys want to weigh in, please do. I had to always do a little intention check before I went down into Google like, okay, am I doing this because anxiety wants me to do it, or am I doing it because this will actually move me towards being more informed, or will this actually allow me to ask better questions to the doctor and so forth? It is a tricky line because Google is the algorithm and the websites are set to sometimes freak you out. There’s always that piece at the bottom that says, “It could be this, this, or this,” or “It could be cancer.” That always used to freak me out because that was something that the doctors were concerned about as well. This might be beyond just Googling, but in terms of many areas, how did you make the decision on whether it was compulsive or not? Jessie?

Jessie: It’s tough too because then you’re down the rabbit hole. You’ve already been Googling it and it’s like, “Or this,” and I’m like, “Well, I have to figure out what that is.” Sometimes it does get a little compulsive and then the self-compassion, and also realizing it like, okay, now it’s getting compulsive and I’m going to stop and go about my day. But another thing that I’ve struggled with is the relationship with doctors. Sandy and I have talked about this before with wanting to be the “perfect” patient. I worry that I’m messaging them too much or I’ll often now avoid messaging them because then I don’t want to be too annoying of a patient. I can’t be the perfect patient if I’m messaging them all the time. It really is, like you said, the intention. Am I messaging them because I want to move forward with this and I want an answer, or am I messaging them because there’s a reason to message them and I need their medical advice? There’s just so much gray in it. Again, not necessarily having that specific answer, it can be very tricky.

Kimberley: It truly can. How about you, Sandy?

Sandy: I think the biggest thing for me, and I’m still trying to figure out the right balance for this, is weighing how urgent is this medical symptom. Am I-- I don’t know, I don’t want to say something that would put someone into a tailspin, but do I have a medical symptom going on right now that needs urgent attention? If so, maybe I should go to my doctors or the ER. Or is the urgency more mental health related, feeling like an OCD need to get that reassurance or need to know, and just separating the urgency of the medical issue that’s going on right this second versus the urgency in my head. 

Kimberley: Amazing. You guys have created a special interest group and I’d like to know a little more about that. I know you have more wisdom to tell and I want to get into that here a little bit more. But before you do, share with us how important that part of creating this special interest group is, how has that benefited, what’s your goals with that? Tell us a little bit about it, whoever wants to go first.

Jessie: Sandy and I actually met in an online OCD support group, and I found those online groups to be really helpful for my OCD recovery and mostly with feeling less shame and stigma. Met some amazing people clearly. And then I remember Sandy had mentioned in one of the different groups that she had a chronic illness. When I was going through my chronic illness journey, I felt really alone. As I was saying before, the loneliness is one of the biggest emotions that I had to deal with. I looked online, and now online support groups are my thing. Let’s just Google chronic illness support groups. I thought it would be as easy as OCD support groups, and it wasn’t. It was very challenging and it was really hard to find one. 

I found one that was state-based. For my state, it was me and three women. I think one was in their eighties, the other two were in their nineties, and they were very sweet. But we were at very different lifestyle changes. We were going through very different experiences. I remember I reached out to Sandy and I said, “Do you have any chronic illness support groups that you’ve been attending?” Even in that group with the elderly women, there were so many things that they were saying that helped them with their chronic illness and my OCD would totally have latched onto all of it. I was like, “I can’t do that with my OCD.” There’s so much overlap that it just seemed like there needed to be this dual chronic illness and OCD. Sandy had said she had the same issue, like it was really hard to find these groups. 

I think we’re really lucky that the International OCD Foundation was such a good partner for us and they were so kind in helping us get this special interest group started. I’m interested to hear what Sandy says, but it’s been so helpful for me to see that there are other people who deal with a lot of these challenges. Of course, I wouldn’t want anyone else to have these experiences, but being able to talk about it, being able to share has just been so helpful. I was really quite amazed to see the outreach we had and how many people struggled with this and that there really weren’t any resources. It’s been pretty amazing for me and I’m really lucky that we’ve been able to have this experience.

Kimberley: Amazing. Sandy?

Sandy: Similar to Jessie, I had found some resources for OCD support groups both locally to me in Ontario and online, and that was great. The sense of community really helped my OCD recovery. But then when it came to the chronic illness disability part, there was just a gap. As Jessie said, we started this special interest group and I think it’s called—Jessie, correct me if I’m wrong—Chronic Illness/Disability Plus OCD is our official title. Basically, it’s for anyone who has a chronic illness or disability and OCD, or is a clinician who’s interested in learning more. Our goals really are to create a community, but also create resources for the wider OCD community to help people who are struggling with chronic illness or disability and OCD or clinicians. 

The sense of community has been great. I think for my own recovery OCD-wise, it’s been really motivating to be able to help found and facilitate this group because it’s showed me that I really don’t have to be in this perfect state of recovery to have something valuable to contribute. I just have to show up in an imperfect way and do my best and that is enough in itself, and that the fact that I don’t have to get an A+ in recovery because that’s not even a thing you can get. I just have to keep trying every single day and try to live my values. I think this SIG’s been a great opportunity to embody those values as well of community and advocacy. It’s just been great.

Kimberley: Oh, I love it so much and it is such an important piece. I actually find the more I felt like I was in community, that in and of itself managed my anxiety. It was very interesting how just being like, “Oh, I’m not alone.” For some reason, my anxiety hated this idea that I was alone in this struggle. I totally just love that you’re getting this group and I’ll make sure that all of the links are in the show notes so people can actually access you guys and get connected. 

I have one extra question before I want to round this out. How do you guys manage the—I’m going to use the word “ridiculous”— “ridiculous” advice you get from people who haven’t been what you’ve been going through? Because I’ve found it actually in some cases to be quite even hilarious, the suggestions I get offered. Again, I know patients and clients have had a really difficult time because they might have been suggested an option, and then their anxiety attaches to like, “Well, you should do that,” and so forth. Sandy, do you want to go first in sharing your experience with “ridiculous” advice?

Sandy: I guess to give a brief example, a practitioner who I’ve worked with for quite a while, who I think is great and a wonderful person and wonderful practitioner, had in the last couple months suggested that maybe I should just try essential oils to manage my bowel condition. What actually was needed was hospitalization and surgery. It’s that kind of advice from both well-meaning practitioners or just people in my life that can be not what you need to hear and maybe not as supportive as they’re hoping it would be. I guess for me, I manage it mostly by saying, “Thank you, that’s a great idea,” even when it’s not really a great idea. I just say to myself or maybe to a support person later, “That was not the best advice.” Just debriefing it with someone I think is really helpful, someone that I trust. 

Jessie: Kimberley, I love this. I think, Sandy, our next SIG, we should ask this and hear all the ridiculous advice that people have been given because it’s true. There’s so many things that are so ridiculous. I’m going to shout out my mom here who I love more than anything in the world, but even my mom who lives with me some of the time and sees what I go through, one time she called me (she’s going to kill me) and she said, “I heard there’s a half-moon at 10:30 AM your time and if you stand outside, it will heal some of your rear rash.” I was like, “What? That’s absurd.” She was like, “I know, I think it’s absurd too, but you need to do this for me.” With that, you see she just wants me to get better. As Sandy was saying, people really want to help and this is a way they think they can help. I’ve also been told like, “Oh, if you mash up garlic and then you put--” it was like this weird recipe, then you want to had it. Just ridiculous things. But people are really well-meaning and they want to help. Unfortunately, those often don’t really help. But now I can laugh about it and now text my mom and be like, “You’ll never guess what so-and-so said,” or text Sandy and we could have a good laugh about it. But that’s what’s nice about community. You’re like, “Wait, should I do this essential oil thing?” And then you realize from others, “No, that’s probably not the best route to go.”

Kimberley: For me, with anxiety, self-doubt is a big piece of the puzzle. Self-doubt is one of the loudest voices. When someone would suggest that, I would have a voice that would say, “It’s not going to hurt you to try.” And then I would feel this immense degree of self-doubt like, “Should I? Should I not? What do you think?” “You could try. You should try.” I’m like, “But I literally don’t have time to go and stand in the sun and do the thing,” or in your example. I would get in my head back and forth on decision-making like, “Should I or shouldn’t I?” “It wouldn’t hurt.” “It sounds ridiculous, but maybe I should.” And that was such a compulsive piece of it that would get me stuck for quite a while. It’s often when it would be from a medical professional because it really would make you question yourself, so I fully resonate with that. Sometimes I wish I could do a hilarious Instagram post on all of the amazing advice I’ve been given throughout the time of having POTS. Some of it’s been ridiculous. 

Let me ask you finally, what advice would you give somebody who has an anxiety disorder and is at first in the beginning stages of not having these symptoms and not knowing what they are? Jessie, will you go first?

Jessie: Yeah. I would say a big thing, as we’ve been talking about, is finding that community whether that be reaching out to us with the SIG or whether that be finding a Facebook group or online group or whatever it may be, because it has helped me so much to reach out and be in a community with others who really understand. There’s nothing like people who truly get it. And then I would say to validate like, this is really tough. Having OCD is tough. Having a chronic illness or disability is tough, and having both is very, very tough. Validate those symptoms too because I think there’s a lot of people that will say, “Oh, you have an anxiety disorder, you’re probably making that up,” and that comes up a lot. Just validating that and really trying to find other people who are going through it because I think that’s just irreplaceable.

Kimberley: Sandy?

Sandy: I think the biggest thing to echo Jessie would be try to find community. I think for me, for my OCD recovery journey, Instagram has particularly been great because there’s so many wonderful OCD advocates or clinicians on Instagram. It’s really a hub for the OCD community. I would say check out Instagram and once you follow a couple of people from the OCD community, the algorithm will show you more so it’s nice that way. I think the other thing is that being disabled or having a chronic illness can really chip away your confidence. Just reminding yourself that you’re doing the best you can in a really hard situation, and it may be a long-term situation, but just because your life is different than other people doesn’t mean that it’s not going to be a great life.

Kimberley: I’m actually going to shift because I wanted to round it out then, but I actually have another question. Recently, we had Dr. Ashley Smith on talking about how to be happy during adversity. I’m curious, I’ll go with you, Sandy, first because you just said, how do you create a wonderful, joyful life while managing not only an anxiety disorder, but also chronic illness or disability? What have you found to be helpful in that concoction per se?

Sandy: I listened to that episode with Dr. Smith and that was a wonderful episode. If people haven’t listened to it, I recommend it. I listened to it twice because I just wanted to go back and pick out the really interesting parts. But I think for me, the combination of finding things that are both meaningful from a values and an acceptance and commitment therapy (ACT) perspective, meaningfulness, finding those things that matter to me, but also finding the things that challenge me. If I’m having a really bad pain day or fatigue day, the things that challenge me might just be getting out of bed, or maybe I’m really depressed and that’s why I can’t get out of bed. Either or, your experience is valid, and just validating your own experience and bringing in that self-compassion and saying, what is something that can challenge me today and bring me a little closer to recovery? Even if it’s going to be a long journey, what’s this one small thing I can do, and break it down for yourself.

Kimberley: Amazing. I love that. What about you, Jessie? 

Jessie: I would say I’ve been able to find new hobbies. I’m still the same person. I’m still doing other things that I found meaningful and this doesn’t. Well, it is a big part of my life. It’s not my entire life. I’m still working and hanging out with friends and doing things that regularly bring me happiness. But just a small example, I said before, I used to play sports and love being really active and that gets a little harder now. But something I found that I really love is paint by numbers because they’re so easy. They’re fun, they’re easy, you don’t have to be super artistic, which is great for me. I’m able to just sit down and do the paint by numbers. Even recently I had friends over and it was like a rainy day and we all did a craft. Even though it was a really high-pain day for me, I was in a flare of medical symptoms, I was still able to engage with things that I find meaningful and live my life.

Kimberley: I love that. Thank you. That’s so important, isn’t it? To round your life out around the disability or the chronic illness or your anxiety. I love that. We talked about those early stages of diagnosis, any other thing that you feel we absolutely have to mention before we finish up? Sandy?

Sandy: I guess to quote someone you’ve had on the podcast before, Rev. Katie, I find her content amazing and she’s just a lovely person. But she always says, you are a special person, but your OCD is not special. Your OCD isn’t fundamentally different or it’s never going to get better. You got to remember that you are the special person and your OCD doesn’t want you to recognize that you are the thing that’s special, not it. Just be able to separate yourself from your anxiety disorder or your chronic illness or your disability, saying, “I’m still me and I’m still awesome, and these things are just one part of me.”

Kimberley: So true. I’m such a massive Katie fan. That’s excellent advice. Jessie?

Jessie: To go the other route, I think you said right with people who are first going through this. I would say we recently did a survey of our SIG, so people who have chronic illness and OCD. We haven’t done all the data yet, but the thing that really stood out was we asked the question like, have you ever felt invalidated by a medical professional or mental health professional, and every single person said yes and then explained. Some people had a lot to say too. I think I’ve really learned in this process that you have to be a self-advocate. It’s very challenging to be an advocate when you’re going through a mental disorder, a physical disability, and/or both. It’s required. Really standing up for yourself because it’s going to be a tough journey and there’s so much light in the journey too. There’s so many positive things and so much “happiness” from the episode before, but there’s also a lot of difficulties that can come from being in the medical world as well as the mental health world and really trying to navigate both of them and putting them together. Really try to advocate for yourself or find someone who could help you advocate for yourself and your case because I think that’ll be really helpful.

Kimberley: So true. You guys are so amazing. Jessie, why don’t you go first, tell us where people can get resources or get in touch with you or the SIG, and then Sandy if you would follow.

Jessie: We have an Instagram account where we’ll post-- we’re experiencing with Canva. We’re really working on Canva and getting some graphics out there about the different things that come up when you have both of these conditions. And then that’s where we post our updates for the special interest group. Sandy, correct me if I’m wrong. @chronically.courageous is our Instagram handle. And then in there, the link is in our bio to sign up for the special interest group. You get put on our email list and then you’ll get all the emails we send with the Zoom links and everything. And then you could also go to the International OCD Foundation’s website and look at the special interest groups there and you’d find ours there.

Sandy: The other thing is we meet twice a month. We meet quite frequently and we’d love to have you. So, please check out our Instagram or get at our email list and we would love you to join.

Kimberley: You guys, you make me so happy. Thank you for coming on the show. I’m so grateful we’re having this conversation. I feel like it’s way overdue, but thank you for doing the work that you’re doing. Thank you so much.

Jessie: Thank you. Sandy: Thanks for having us.

Tips To Manage Anxiety At Work 

1. Don’t aim for no anxiety.
   • Accept that it will be there
2. Don’t judge yourself for having anxiety
   • There is nothing “wrong” with you for having anxiety.
   • You are not “bad” for having anxiety
   • Your worth doesn’t change because of anxiety’s presence
3. Do a Door check (listen to the episode for more information on this)
4. Pull your shoulders back
5. Create a strength-based statement to get you through the hard times
   • “We can do hard things”
   • “This too will pass”
   • “I am stronger than I think I am”
   • “I have done hard things before and I survived”
6. Set small, realistic goals
   • Focus on only one client at a time
   • Do one job or one assignment at a time
   • Have rewards for work well done
7. Implement a consistent and strong self-care plan: Getting exercise and sleep, as well as reducing caffeine and alcohol, is a good start.
8. Begin a Self-Compassion practice
9. You have to name emotions to tame emotions.
10. Bring on that Anxiety, baby! Try to stare your fear in the face as much as you can.

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

Welcome back to another episode of Your Anxiety Toolkit Podcast. Today on the podcast we have a wonderful interview with OCD and mental health advocate Mimi Cole. Mimi is currently working on her graduate degree in counseling and she is here to talk with us today about her lived experience with OCD, scrupulosity, and an eating disorder. Mimi so beautifully states that she wants to share her story in order to increase awareness, education and resources while decreasing the shame and misconceptions surrounding OCD.

Mimi shares her OCD story, specifically her struggles with scrupulosity. She describes how her religion and her religious upbringing became intertwined with perfectionism and OCD. She shares a bit about her exposures for scrupulosity and what motivated her to begin ERP.

Mimi also describes her experience with orthorexia and her obsessions surrounding clean eating and how she feels this became a link between OCD and an eating disorder. We discuss that intersection between body image, clean eating obsessions, restrictive food intake and how these are all connected to OCD. Mimi is currently exploring a research project on eating disorders as a coping mechanism for OCD.

Towards the end of the interview, Mimi shares how she manages her OCD in recovery. She talks about self-compassion and accepting our common humanity as a few tools she uses to help.

This interview is full of such great information particularly about scrupulosity, a theme of OCD that is not often discussed. I found it so uplifting and informative and I think you will as well.

Mimi's instagram @the.lovelybecoming

Mimi's website www.mimi-cole.com

ERP School, BFRB School and Mindfulness School for OCD are open for purchase. Click here for more information.

Additional exciting news! ERP School is now CEU approved which means that it is an accredited course for therapists and mental health professionals to take towards their continuing education credit hours. Please click here for more information.

It's time for a parade!!! 

Hello and welcome back!!! My name is Kimberley Quinlan and this is Your Anxiety Toolkit Podcast, speaking about anything and everything related to anxiety and mindfulness.  Today, in the spirit of the upcoming 4th of July, I wanted to talk about parades!! You know???? Floats and crowds and cheers and lollipops and picnic chairs.   For some, these are some of our greatest memories.

I often use a parade as a metaphor for our thoughts. In fact, I have heard several different clinicians or teachers of eastern philosophy use a parade metaphor to discuss the experience of anxiety, pain, sadness or life, in general.

As I said, for the purpose of this podcast, I am going to use the metaphor in relation to our thoughts.   Lets get straight to it, shall we????

First, I would like you to slowly take a deep breath. If you would like, you can close your eyes, but it is not entirely necessary for this activity.   Again, I would like you to take a breath and imagine yourself at the sidewalk of a street, waiting for a parade to begin. You are sitting or standing behind the yellow ribbon and you have your family and friends with you.   You also have your favorite flavored lollipop in your hand. The morning sun is gently shining of you and the crowd is excited.   This is a great day!

You hear the music start and slowly, you to see the first float approach the crowd lined street.   It slowly approaches you and your friends are waiting patiently to see what it is about and who is on it.   As it gets closer and closer, you experience a sensation of satisfaction. This float it is very appealing and has all of your favorites colors and favorite flowers.   It is simply beautiful! You wave at the children and adults on the float and they smile back at you as they wave.

Up next is a float made out of a trailer bed, with a racecar on it. This float is all about shine and muscle.   The surface of the car is so shiny, you could almost see your reflection in it. Even the trailer bed is sparkling and has sponsorship stickers all over it.   The drivers wave as they rev the car. It is invigorating, but a little loud. Still, you are having a great time. You wave to the two men and one woman on the float who are dressed in their racing outfits and then you slowly turn your head to see what is next.

Coming up next is a very scary looking float. On it, is lots of people and they are yelling at all the spectators. Some a yelling very scary things and others are yelling very mean things. The float is covered in grey and black streamers and there is a cloud of smoke coming from the front of the float. You are surprised to see this float in the parade and wonder, “what is going on?” This float was significantly unpleasant and you angrily consider writing a letter to the parade committee to inquire about the purpose of this float at such a celebratory event.   The float comes and then moves down the street, scaring the people as it passes.  

You have a hard time directing your attention away from the scary, grey and morbid float, but you bring your attention to the approaching city’s marching band that is playing the most festive music as they slowly follow the scary float.   

OK guys, let’s stop there!   What a parade so far, right? There has been beauty, and music, and loud revving car and a float that was quite scary.   It is very similar to our thoughts, am I right? I am sure we can agree that we are sometimes passed by thoughts that bring us much joy. And, in a similar fashion, sometimes our thoughts are down right demoralizing and scary. This imaginary parade is very similar to the way our brain operates. Happy thoughts, scary thoughts, interesting thoughts, maybe thoughts we don’t even notice.  

When we experience thoughts that we enjoy, we often bask in the beauty and festivity of them. The use the metaphor, when looking at the pleasant float, we don’t question why they chose those particular beautiful flowers or what was the purpose of that float.   We watch and enjoy and then we excitedly search for the next float to arrive.

However, when we observe a grey and scary float, we are completely alarmed, we become angry and try to discover who would create such a float. We might even respond my yelling back, thinking that might stop them from shouting OR prevent them from showing up to next years 4th of July parade.   We might also close our eyes and try to pretend the float is not there, or try to think of a previous float that we enjoyed. Simply put, we are being highly reactionary to thoughts that scare us.

This is a particularly troublesome practice.   If we were to experience each of our thoughts as if we were watching floats in a parade, we could see that our experience of the parade is levied on our emotional reaction to each float.   We are completely at the mercy of which float is next.   This can create quite a predicament.   Because we cannot control which float comes out next OR the theme of the float, we are left feeling out of control and anxious about our experience. 

This is true of our thoughts also. We are constantly spectators to a whole range of thoughts that come and go, like floats in a parade.   Going back to the parade metaphor, when being passed by the scary float, you might find yourself trying to get it to pass you quickly. You might even find yourself whispering (or yelling) ”Get outta here!   You have NO place here, in this parade!”  This type of behavior does not make the float pass the crowds faster. It just makes us more frustrated and ruins our 4th of July parade experience. Now, going back to our thoughts, we are going to have a very difficult time if we are fighting what thoughts come and go.

The trick is to create a non-judgmental and accepting attitude towards each and every float. If a float (or a thought) arises that makes us uncomfortable, just notice your experience, similarly to how you did when a pleasant float passed.   For the pleasant float, you noticed satisfaction and the people on the float and how the flowers and colors brought up sensations in your body.

When scary or more difficult thoughts arise, your job is to observe and wave, knowing that that float (or thought) will pass in time also. Sometime we have to acknowledge that just because the float looks scary, doesn’t mean there is actually real danger.   For example, Lots of people LOVE scary movies and will even PAY to go an get scared in a movie theatre, but they can separate their experience of fear and become observers instead of reacting to their fear.

I invite you to move into your day, allowing your mind to be like a parade with many types of floats, meaning, allow all of your thoughts.   I don’t expect you to be fantastic at this. It is like a muscle that must be strengthened. Just practice noticing the temporary fashion of each thought and do not fight them when they are passing you by.   It is the fight that will create your dismay.

Last of all, don’t be afraid to bring your camera to this metaphorical parade!!! Use your zoom to zoom on and out while capturing the ENTIRE scene.   Don’t get too focused on just the floats. The floats alone do not make up the entirety of a parade. The parade also consists of the crowds and their cheers and the streets and most importantly, the lollipops!!

I hope you have enjoyed this episode of My Anxiety Toolkit. My name is Kimberley Quinlan. If you have any thoughts or comments, please feel free to comment in the comment section of my blog.

This podcast is not intended to replace correct professional mental health care. Please speak to a trained mental health professional if you feel you need it.

Have a wonderful day

Welcome. This is Week 4 of the Sexual Health and Anxiety Series. I have loved your feedback about this so far. I have loved hearing what is right for you, what is not right for you, getting your perspective on what can be so helpful. A lot of people are saying that they really are grateful that we are covering sexual health and anxiety because it’s a topic that we really don’t talk enough about. I think there’s so much shame in it, and I think that that’s something we hopefully can break through today by bringing it into the sunlight and bringing it out into the open and just talking about it as it is, which is just all good and all neutral, and we don’t need to judge.

Let’s go through the series so far. In Episode 1 of the series, we did sexual anxiety or sexual performance anxiety with Lauren Fogel Mersy. Number two, we did understanding arousal and anxiety. A lot of you loved that episode, talking a lot about understanding arousal and anxiety. Then last week, we talked about the sexual side effects of anxiety and depression medication or antidepressants with Dr. Sepehr Aziz. That was such a great episode. This week, we’re talking about sexual intrusive thoughts. 

The way that I structured this is I wanted to first address the common concerns people have about sexual health and intimacy and so forth. Now I want to talk about some of the medical pieces and the human pieces that can really complicate things. In this case, it’s your thoughts. The thoughts we have can make a huge impact on how we see ourselves, how we judge ourselves, the meaning we make of it, the identity we give it, and it can be incredibly distressing. My hope today is just to go through and normalize all of these experiences and thoughts and presentations and give you some direction on where you can go from there. Because we do know that your thoughts, as we discussed in the second episode, can impact arousal and your thoughts can impact your sexual anxiety. 

SEXUAL OCD OBSESSIONS

Let’s talk a little bit today about specific sexual intrusive thoughts. Now, sexual intrusive thoughts is also known as sexual obsessions. A sexual obsession is like any other obsession, which is, it is a repetitive, UNWANTED—and let’s emphasize the unwanted piece—sexual thought. There are all different kinds of sexual intrusive thoughts that you can have. For many of you listening, you may have sexual intrusive thoughts and OCD that get together and make a really big mess in your mind and confuse you and bring on doubt and uncertainty, and like I said before, make you question your identity and all of those things. 

In addition to these intrusive thoughts, they often can feel very real. Often when people have these sexual intrusive thoughts, again, we all have intrusive thoughts, but if they’re sexual in nature, when they’re accompanied by anxiety, they can sometimes feel incredibly real, so much so that you start to question everything. 

SEXUAL SENSATIONS

Now, in addition to having sexual intrusive thoughts, some of you have sexual sensations, and we talked a little bit about this in previous episodes. But what I’m really speaking about there is sensations that you would often feel upon arousal. The most common is what we call in the OCD field a groinal response. Some people call it the groinal in and of itself, which is, we know again from previous episodes that when we have sexual thoughts or thoughts that are sexual in nature, we often will feel certain sensations of arousal, whether that be lubrication, swelling, tingling, throbbing. You might simply call it arousal or being turned on. And that is where a lot of people, again, get really confused because they’re having these thoughts that they hate, they’re unwanted, they’re repetitive, they’re impacting their life, they’re associated with a lot of anxiety and uncertainty, and doubt. And then, now you’re having this reaction in your body too, and that groinal response can create a heightened need to engage in compulsions. 

As we know—we talk about this in ERP School, our online course for OCD; we go through this extensively—when someone has an obsession, a thought, an intrusive thought, it creates uncertainty and anxiety. And then naturally what we do is we engage in a compulsion to reduce or remove that discomfort to give them a short-term sense of relief. But then what ends up happening is that short-term relief ends up reinforcing the original obsession, which means you have it more, and then you go back through the cycle. You cycle on that cycle over and over again. It gets so big. It ends up impacting your life so, so much.

INTRUSIVE SEXUAL URGES

Now, let’s also address while we’re here that a lot of you may have intrusive sexual urges. These are also obsessions that we have when you have OCD or OCD-related disorders where you feel like your body is pulling you towards an action to harm someone, to do a sexual act, to some fantasy. You’re having this urge that feels like your body is pulling you like a magnet towards that behavior. Even if you don’t want to do that behavior, or even if that behavior disgusts you and it doesn’t line up with your values, you may still experience these sexual OCD urges that really make you feel like you’re on the cusp of losing control, that you may snap and do that behavior.

This is how impactful these sexual intrusive thoughts can be. This is how powerful they can be in that they can create these layers upon layers. You have the thoughts, then you have the feelings, then you have the sensations, you also have the urges. Often there’s a lot of sexual intrusive images as well, like you see in front of you, like a projector, the image happening or the movie scene playing out that really scares you, concerns you, and so forth. And then all of those layers together make you feel absolutely horrible, terrified, so afraid, so unsure of what’s happening in and of yourself. 

TYPES OF SEXUAL OCD OBSESSIONS

Let’s talk about some specific OCD obsessions and ways in which this plays out. Now, in the OCD field, we call them subtypes. Subtypes are different categories we have of obsessions. They don’t collect all of them. There are people who have a lot of obsessions that don’t fall under these categories, but these subtypes usually include groups of people who experience these subtypes. The reason we do that is, number one, it can be very validating to know that other people are in that subgroup. Number two, it can also really help inform treatment when we have a specific subtype that we know what’s happening, and that can be very helpful and reduce the shame of the person experiencing them. 

1. SEXUAL ORIENTATION OBSESSIONS OR SEXUAL ORIENTATION OCD

It used to be called homosexual OCD. That was because predominantly people who were heterosexual were reporting having thoughts or sexual intrusive thoughts about their sexual orientation—am I gay, am I straight—and really struggling with having certainty about this. Again, now that we’re more inclusive and that I think a lot more people are talking about sexuality, that we have a lot less shame, a lot more education, we scrapped the homosexual OCD or homosexual obsessions or subtype category. Now we have a more inclusive category, which is called sexual orientation OCD. That can include any body of any sexual orientation who has doubt and uncertainty about that. 

Now remember when we started, we talked about the fact that sexual intrusive thoughts are usually unwanted, they’re repetitive and they don’t line up with our values. What we are not talking about here is someone who is actually questioning their sexual orientation. I know a lot of people are. They’re really exploring and being curious about different orientations that appeal to them. That’s way different to the people who have sexual orientation OCD or sexual orientation obsessions. People with OCD are absolutely terrified of this unknown answer, and they feel an incredible sense of urgency to solve it. 

If you experience this, you may actually want to listen back. We’ve got a couple of episodes on this in the past. But it’s really important to understand and we have to understand the nuance here that as you’re doing treatment, we are very careful not to just sweep people under the rug and say, “This is your OCD,” because we want to be informed in knowing that, okay, you also do get to question your sexual orientation. But if it is a presentation of sexual orientation OCD, we will treat it like that and we will be very specific in reducing the compulsions that you’re engaging in so that you can get some relief. That is the first one. 

2. SEXUAL INTRUSIVE THOUGHTS ABOUT FAMILY OR SEXUAL INTRUSIVE THOUGHTS ABOUT INCEST

Incest sexual OCD or that type of subtype is another very common one. But often, again, one that is not talked about enough in fear of being judged, in fear of having too much shame, in fear of being reported. When people have these types of obsessions, they often will have a thought like, “What if I’m attracted to my dad?” Or maybe they’re with their sibling and they experience some arousal for reasons they don’t know. Again, we talked about this in the arousal and anxiety episode, so go back and listen to that if you didn’t. They may experience that, and that is where they will often say, “My brain broke. I feel like I had to solve that answer. I had to figure it out. I need to get complete certainty that that is not the case, and I need to know for sure.” 

The important thing to remember here is a lot of my patients, I will see and they may have some of these sexual intrusive thoughts, but their partners will say, “Yeah, I’ve had the same thoughts.” It’s just that for the person without OCD, they don’t experience that same degree of distress. They blow it off. It doesn’t really land in their brain. It’s just like a fleeting thought. Whereas people with OCD, it’s like the record got stuck and it’s just repeating, repeating, repeating. The distress gets higher. The doubt and uncertainty get higher. Therefore, because of all of this bubbling kettle happening, there’s this really strong urgency to relieve it with compulsions. 

3. SEXUAL INTRUSIVE THOUGHTS ABOUT GOD OR ABOUT A RELIGIOUS LEADER

This is one that’s less common, or should I say less commonly reported. We actually don’t have evidence of how common it is. I think a lot of people have so much shame and are so afraid of sinning and what that means that they may even not report it. But again, this is no different to having thoughts of incest, but this one is particularly focused on having sexual thoughts about God and needing to know what that means and trying to cleanse themselves of their perceived sin, of having that intrusive thought. It can make them question their religion. It can make them feel like they have to stop going to church. They may do a ton of compulsive prayer. They may do a ton of reassurance with certain religious leaders to make sure that they’re not sinning or to relieve them of that uncertainty and that distaste and distress. These are all very common symptoms of people who have sexual intrusive thoughts about God.

4. BESTIALITY OBSESSIONS

These are thoughts about pets and animals, and it’s very common. It’s funny, as we speak, I am recording this with a three-pound puppy sitting on my lap. We just got a three-pound puppy. It is a Malti-Poo puppy dog, and he’s the cutest thing you’ve ever seen. But it’s true that when you have a dog, you’re having to take care of its genitals and wipe it up and its feces and its urine and clean and all the things, and it’s common to have sexual intrusive thoughts about your pet or about your dog or your cat. Some people, again, with bestiality obsessions or bestiality OCD, have a tremendous repetitive degree of these thoughts. They’re very distressing because they love their dog. They would never do anything to hurt their dog, but they can’t stop having these thoughts or these feelings or these sensations, or even these urges.

Again, all these presentations are the same, it’s just that the content is different. We treat them the same when we’re discussing it, but we’re very careful with addressing the high level of shame and embarrassment, humiliation, guilt that they have for these thoughts. Guilt is a huge one with these sexual obsessions. People often feel incredibly guilty as if they’ve done something wrong for having these obsessions. These are a few. 

5. PEDOPHILIA OBSESSIONS

Now, for someone who has intrusive sexual thoughts and feelings and sensations and urges about children (POCD), they tend to be, in my experience, the most distressed. They tend to be, when I see them, the ones who come in absolutely completely taken over with guilt and shame. A lot of the time, they will have completely removed themselves from their child. They feel they’re not responsible. They won’t go near the parks. They won’t go to family’s birthday parties. They’re so insistent on trying to never have these thoughts. Again, I understand. I don’t blame them. But as we know, the more you try not to have a thought, what happens? The more you have it. The more you try and suppress a thought, the more you have it. That can get people in a very stuck cycle. 

SEXUAL OCD  COMPULSIONS

Let’s move on now to really address different sexual OCD compulsions. 

Now, for all sexual obsessions, or what I should say is, for all obsessions in general, there are specific categories of compulsions and these are things again that we do to reduce or remove the discomfort and certainty, dread, doubt, and so forth. 

1. Trigger Avoidance

This is where you avoid the thing that may trigger your obsession or thought. Avoiding your dog, avoiding your child, avoiding your family member, avoiding people of the sexual orientation that you’re having uncertainty about. 

2. Actual Sex Avoidance

We talked about that in the first episode. We talked a lot about how people avoid sex because of the anxiety that being intimate and sexual causes. 

3. Mental Rumination

This is a really common one for sexual intrusive thoughts because you just want to solve like why am I having it? What does it mean? You might be ruminating, what could that mean? And going over and over and over that a many, many time. 

4. Mental Checking

What you can also be doing here is checking for arousal. Next time you’re around, let’s say, a dog and you have bestiality obsessions, you might check to see if you’re aroused. But just checking to see if you’re aroused means that you get aroused. Now that you’re aroused, you’re now checking to see what that means and trying to figure that out and you’re very distressed. 

We can see how often the compulsion that the person does actually triggers more and more and more distress. It may provide you a moment or a fleeting moment of relief, but then you actually have more distress. It usually brings on more uncertainty. We know that the more we try and control life, the more out of control we feel. That’s a general rule. That’s very much the case for these types of obsessive thoughts. 

5. Pornography Use

A lot of people who have sexual orientation OCD in particular, but any of these, they may actually use pornography as a way to get reassurance that they are of a certain sexual orientation, that they are not attracted to the orientation that they’re having uncertainty about, or they’re not attracted to animals or God or a family member because they were aroused watching pornography. That becomes a form of self-reassurance. 

There’s two types of reassurance. One is reassurance where we go to somebody else and say, “Are you sure I wouldn’t do that thing? Are you sure that thing isn’t true? Are you sure I don’t have that? I’m not that bad a person?” The other one is really giving reassurance to yourself, and that’s a very common one with pornography use. 

SEXUAL INTRUSIVE THOUGHTS PTSD 

There are some sexual intrusive thought examples, including specific obsessions and subtypes, and also compulsions. But one sexual intrusive thought example I also wanted to address is not OCD-related; it’s actually related to a different diagnosis, which is called PTSD (post-traumatic stress disorder). Often for people who have been sexually assaulted or molested, they too may experience sexual intrusive thoughts in the form of memories or images of what happened to them or what could have happened to them. Maybe it’s often some version of what happened to them, and that is a common presentation for PTSD. If you are experiencing PTSD, usually, there is a traumatic event that is related to the obsession or the thoughts. They usually are in association or accompanied by flashbacks. There are many other symptoms. I’m not a PTSD specialist, but there’s a high level of distress, many nightmares. You may have flashbacks, as I’ve said. Panic is a huge part of PTSD as well. That is common. If you have had a traumatic event, I would go and see a specialist and help them to make sure that they’ve diagnosed you correctly so that you can get the correct care. 

SEXUAL INTRUSIVE THOUGHTS TREATMENT

If you have OCD and you’re having some of these sexual intrusive thoughts, the best treatment for you to go and get immediately is Exposure and Response Prevention. This is a particular type of cognitive behavioral therapy where you can learn to change your reaction, break yourself out of that cycle of obsessions, anxiety, compulsions, and then feed yourself back into the loop around and around. You can break that cycle and return back to doing the things you want and have a different reaction to the thoughts that you have.

PEOPLE ASK HOW TO STOP SEXUAL INTRUSIVE THOUGHTS? 

Often people will come to me and say, “How do I stop these sexual intrusive thoughts?” I will quickly say to them, “You don’t. The more you try and stop them, the more you’re going to have. But what we can do is we can act very skillfully in intervening, not by preventing the thoughts, but by changing how we relate and respond to those thoughts.” For those of you who don’t know, I have a whole course on this called ERP School. ERP is for Exposure and Response Prevention. I’ll show you how you can do this on your own, or you can reach out to me and we can talk about whether if you’re in the states where we’re licensed, one of my associates can help you one-on-one. If you’re not in a state where I belong, reach out to the IOCDF and see if you can find someone who treats OCD using ERP in your area. Because the truth is, you don’t have to suffer having these thoughts. There is a treatment to help you manage these thoughts and help you be much more comfortable in response to those thoughts. Of course, the truth here is you’re never going to like them. Nobody likes these thoughts. The goal isn’t to like them. The goal isn’t to make them go away. The goal isn’t to prove them wrong even; it’s just to change your reaction to one that doesn’t keep that cycle going. That is the key component when it comes to sexual intrusive thoughts treatment or OCD treatment. That’s true for any subtype of OCD because there are many other subtypes as well. 

That’s it, guys. I could go on and on and on and on about this, but I want to be respectful of your time. The main goal again is just to normalize that these thoughts happen. For some people, it happens more than others. The goal, if you can take one thing away from today, it would be, try not to assign meaning to the duration and frequency of which you have these thoughts. Often people will say, “I have them all day. That has to mean something.” I’m here to say, “Let’s not assign meaning to these thoughts at all. Thoughts are thoughts. They come and they go. They don’t have meaning and we want to practice not assigning meaning to them so we don’t strengthen that cycle.” 

I hope that was helpful for you guys. I know it was a ton of information. I hope it was super, super helpful. I am so excited to continue with this. 

Next week, we are talking about menopause and anxiety, which we have an amazing doctor again. I want to talk about things with people who are really skilled in this area. We have a medical doctor coming on talking about menopause and the impact of anxiety. And then we’re going to talk about PMS and anxiety, and that will hopefully conclude our sexual health and anxiety series. 

Thank you so much for being here. I love you guys so much. Thank you from me and from Theo, our beautiful little baby puppy. I will see you next week.

SUMMARY: 

In This Episode:

• What to do what your chronic illness causes anxiety 
• The Difference between POTS and anxiety. 
• How to manage POTS related anxiety 
• What is an “Adrenaline Surge”? 
• The Treatment for POTS and Anxiety 
• POTS AWARENESS MONTH

Links To Things I Talk About

• http://www.dysautonomiainternational.org/page.php?ID=30
• Overcoming Anxiety and Panic https://www.cbtschool.com/overcominganxiety
• ERP School: https://www.cbtschool.com/erp-school-lp

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EPISODE TRANSCRIPTION

This is Your Anxiety Toolkit - Episode 307. 

Welcome back, everybody. I am so thrilled to be here with you today. As most of you may know, it is OCD Awareness Month or Awareness Week. It’s just passed, and that’s something I’m so passionate about advocating for. But in addition to that, it’s also Postural Orthostatic Tachycardic Syndrome Awareness Month. For those of you who don’t know, I suffer from postural orthostatic tachycardic syndrome. We call it POTS for short. I’ve had multiple people ask me to do an episode about when chronic illnesses cause anxiety, and I thought this is probably the best week to do it. Not only is it awareness week or awareness month for POTS, but I actually have had a little blip in my own recovery in my POTS. So, I wanted to share with you my story and share with you how I’m handling the anxiety and health anxiety and stress and grief of that, and also just address some tools that have worked for me and that I’m hoping will work for you as well. If you have a chronic illness or even if you don’t, I think that these are really core skills that we need to practice just in regards of managing daily stress as well. 

You know what, before we do that, let’s go and do the “I did a hard thing” because this one is actually really touching and I would really like to feature. This was actually an email we received. I love getting your emails. If you guys are not on our newsletter list, please do go and sign up for our newsletter. We do give you access to the whole series. I created a whole website for the six-part mental compulsion series. It will be private just for people who sign up for the newsletter, and it’s got some amazing additional resources, PDFs, links that you really should check out. So, if you want to sign up for that, head on over to CBTSchool.com and you can sign up for our newsletter. 

This person said:

“I took a big leap of leaving my family and moving to China on my own.” Now, I totally resonate with this because I am in America on my own, even though I have my family. Leaving your home country is a big deal. It’s a huge deal. They go on to say, “The only thing, I haven’t been home to see my family in over three years, and I’ve been struggling so much. We hadn’t had a holiday in over two years, and I had been stuck in our complex for months. It was really, really hard. We finally were allowed out of our city, so we decided to go to Yunnan Province.” Hopefully, I pronounce that okay. “I was so worried that my OCD would come in hard and stop me from enjoying this amazing holiday we had planned for. I was strong and I did the hard things, thanks to you. I did a six-day hike at the start of the Himalayas, and I’m like, ‘Holy moly, that is amazing.’ I got engaged on Tiger Leaping Gorge. I ran down a bear and wolf-infested forest, and I slept in a tiny house next to pigs and cows.” What an adventure. “Kimberley, thank you. You have given me strength I needed. You are my inspiration.”

This is what I mean by why I love the “I did a hard thing” because sometimes the hard thing is getting out of bed. Sometimes the hard thing is facing a fear that you know is in your daily life. But sometimes your fear is like living a life according to your values and doing some pretty huge, openhearted things. And so, I absolutely love this “I did a hard thing.” Thank you so much, Leanne, for submitting this because there was something about it that just made me giggle like, holy moly, you really packed in some adventure into a short period of time, and well-deserved after being in a complex for so many months and years. Thank you so much for leaving that here in my inbox. 

Real quick, let’s do the review of the week so that we can head on over. This one is from Young Math Mama and they said:

“BEST podcast for a daily mindset reset. This podcast was recommended to me by my therapist, and it is one of my favorite ‘homework assignments’ to help me have a good mindset and feel inspired to try my best. I’ve learned so much great information from Kimberley, but the most important thing, in my opinion, is that I feel motivated to improve one small thing every time I listen. I’m taking better care of myself, which helps me take better care of my family.”

Literally, Young Math Mama, that is the absolute goal of this. I consider myself part therapist and part coach. I do a lot of coaching in my work and hopefully, I inspire you and motivate you all as well. Thank you so much, Young Math Mama, for submitting, and also Leanna. 

Update On My Pots/Chronic Illness

Okay, so let me give you a little background here. I haven’t shared this with you because I actually didn’t feel it was appropriate at the time for me to share, but I will share it now. As you guys know, I did a whole podcast about health anxiety, and this whole shocking episode where I had to get my teeth removed, one of my teeth got pulled out. Interestingly, since I had that infection in my tooth and I had it removed, almost all of my POTS symptoms went away. And the reason I didn’t want to share that, which is strange in hindsight why I wouldn’t want to share that, is number one, I wasn’t convinced it was long-term. Number two, I was really concerned that saying that would be really disheartening to some people who are still really struggling. Number three, I was a little worried. I had a bit of a placebo effect if I’m not going to lie. The doctor said it could actually help my POTS and then when it did, I was a little bit like, “Oh, is this the placebo?” I was just waiting for the shoe to drop, which is really not good practice. I wish actually now in hindsight I didn’t do that, but that is the way it played out. 

I have actually had an almost full remission. I do have some bad days. I do have some bad blood pressure days. But I was able to stand for the first time in many years. What I mean by “stand” is the day that I actually realized that I was in recovery from that. In the mornings, I always fill up my kids’ drink bottles and we have one of those filters in the fridge. And usually, it takes probably like 45 seconds, maybe a minute to fill up a drink bottle. But because I can’t stand up for very long or I get really dizzy and I can faint, it usually takes me two goes to fill up a drink bottle. I would fill it up for maybe 20 seconds, then I would go sit down just for a minute or two. I could feel myself get less dizzy and then I would go to do it again. 

You Must Find Rhythms

I have found a rhythm in my life, that’s how debilitating it is. But I had found these rhythms and routines in my life to where I could still fill up my kids’ drink bottles and no one needed to know that I was dizzy. I had found routines to mask it and I’d found routines so I could get through the day. And then I started to notice, oh my God, I’m halfway through filling up the drink bottle and I don’t need to sit down. I could actually fill this whole drink bottle without feeling really dizzy and nauseous, which to you might seem like an easy part of the day, but to me, that’s just a luxury I didn’t have for two years. So, I’ve been so thrilled and so overjoyed and actually really protective of my body because I’m like, “Oh my gosh, I’m in recovery. I’m really doing so well.” 

And then really why the “I did a hard thing” segment resonated with me is because when I came back from Australia, I was so happy and just my heart was so full and we hit the ground running. We really hit the ground running. My daughter started middle school, my son started second grade. They’re in two different schools now. My husband had gone back to another job. We’d just had some house remodeling done. The house was a disaster. We’d had a couple of other stressful events happen. About three weeks ago, I had gotten some really scary news about a loved one. I remember sitting on the couch and just being overwhelmed with anxiety. A massive cortisol, adrenaline surge just went through my body because I was really worried the lasted several days and then I didn’t sleep very well for a few days and then I stopped exercising as much as I was and probably didn’t drink enough water, which is all these things are really important if you have POTS. And I had also not kept up with how much salt I need to eat. I need to eat the most disgusting degrees of salt. It’s a common treatment for POTS. Most people are encouraged not to eat a lot of salt. People with POTS usually have to eat an immense amount of salt. 

My Pots Relapse

Unfortunately, I just started to have all of my symptoms returned. All of them I can manage, but the one that I’m struggling with the most is what they call an “adrenaline surge.” It’s common for people who have POTS. It just feels like you’re having a panic attack, but you’re not having a panic attack. You’re not worried about anything. I think that all of the stress and me loosening my recovery treatment is what caused it. But all of a sudden, I remember I woke up at three in the morning and I thought I was having a panic attack, but it was, now I understand, an adrenaline surge. It was just like someone had injected me with adrenaline and cortisol. At that time, I was like, “This makes sense. We’ve just had a couple of some scary things happen and life is pretty stressful. I’m obviously having a panic attack.”

So, first I want to teach you or show you or demonstrate to you that even though I had woken up in the middle of the night with a panic attack, I used every single one of my tools. I was like, “All right, brain, thank you for waking me up and bringing this to my attention in the middle of the night. There is nothing I can do about it right now. I’m just going to let you be there and we’re going to lay here until you’re ready to leave. You don’t have to leave if you don’t want to.” It took about two hours, three hours, which is pretty long and strange. I was like, “This is a bit strange.” 

When Your Chronic Illness Causes Anxiety & Panic

But then the next night, again, all day feeling anxious, on edge, but also using all my tools. Like, “It’s cool, anxiety can come along, no big deal, I’m cool with it” kind of thing. And then next night, wake up in the middle of the night at 11 o’clock because I go to bed pretty early. 11:00 PM, massive panic, adrenaline surge. Oh my gosh. Okay, now what? I get up and I’m like, “Something is up. I’m obviously struggling.” I do what an average person would do, would be like look around and be like, “What’s going on with me? Is there something really anxiety-provoking that’s going on? Should I be worrying about something? Is this a sign?” And then I was like, “No, no, no, I’m going to use my tools.” This happened for several days until I realized this actually could be just generalized anxiety because I do struggle sometimes with generalized anxiety, but I actually think this is a part of my POTS. So, I did some research and spoke to a doctor and yes, it is in fact a part of my POTS symptoms and it’s one that I didn’t have before. 

But the reason I’m sharing this with you today is, this is actually so common for people with chronic illnesses. If you have a chronic illness, there are these weird things that happen to your body and then it’s so easy just to chalk it up as like, “Oh, I’m having a panic attack,” or “I’m having anxiety.” And then you start panicking and having anxiety. If you’re not careful, you’ll start to do hypervigilant behaviors and avoidant behaviors and mental compulsions, and then it’s a full-blown anxiety disorder. 

Pots And Anxiety: The Dreaded Adrenaline Surge

If there’s one thing I have learned from having a chronic illness is to be so skilled with physical sensations that show up in my body because it can seem so similar to anxiety – dizziness, lightheadedness, agitation, feeling like you’re going to faint. These are all symptoms of POTS, but they’re also symptoms of anxiety. POTS and Anxiety can feel almost exactly the same. So, I’ve had to become very, very skilled. And I use the word “skilled” because this is not an innate thing I know. I had to practice what I preach and I had to be very objective, not subjective about what’s going on, and go, “Okay, you’re having dizziness. It could mean that you’re going to faint, but it also could mean you’re anxious.” So, let’s actually be really skilled in how we respond to this. Or you’re having a panic attack. In this case, you’re having a massive adrenaline surge is what they call it in the POTS world. You’re having this adrenaline surge, it could be a panic attack and it could be your POTS. Let’s work at being very logical and wise in our response to it. Let’s not be responding to it as if it’s a catastrophe or that there’s actually danger. 

This has been so key for me. What I have found, and this is literally as we speak this week and I can say to you as we speak right now, I actually am having a massive adrenaline surge as we speak. It is so easy to interpret it as something is wrong, there must be danger, we’ve got to get out of here. But I’m working at just allowing it to be there and going, “Thank you, brain, for setting off this alarm. I understand. I’m going to allow it to be there.”

The reason I’m sharing this with you and the reason I actually had scheduled to do this recording tomorrow, but today’s the perfect day to do it because I’m actually in quite a lot of suffering right now. It’s pretty painful. It’s pretty uncomfortable. I’m at like an eight 8 of 10 anxiety level, maybe even a 9 depending on where I’m at. I’m just actually going to go about my day. As I speak to you, I’m actually in a pretty big degree of suffering and I just want to be completely real with you. The reason, again, that I wanted to record this today is I was getting ready for work and I started to notice, I was putting all these black clothes on because I don’t feel so great. And I was like, “Wait a second, this is how invasive this can be in that I’m actually choosing black clothes. Not that there’s anything wrong with black clothes, but I’m choosing it because my body feels so uncomfortable. What could I do right now to fully embrace joy, fully just embrace the fact that it’s here?” 

Choosing Your Values

I have this bright, yellow dress that’s like a full circle dress. If you did a spin, it would go into a full circle and I love this skirt. I was like, you know what? I’m going to wear my yellow skirt today. Today is a perfect day to wear my yellow skirt, even though my body is having a massive reaction. My body is obviously in some kind of response to something, chronic illness-wise, and my body wants me to panic. My body wants me to be hypervigilant. My body and my brain want me to tighten up my whole body. But I’m going to put on this yellow skirt and I’m going to sit down with my friends, you guys, and I’m going to talk about this thing that I have to handle. 

As I’m sharing about this, I’m just going to pause here for a second because it brings me to tears. I’m in a lot of pain emotionally. But in that pain, if you could see me right now, I actually have a huge smile on my face because I am so grateful that I gave myself the opportunity to practice these skills because they are actually reducing how much suffering I could have. I remember when I first had these symptoms that I did go into hypervigilance and panic because I was like, “Something is seriously wrong. Something is really wrong. We have to fix it. We’ve got to go to the emergency room.” And now I have these skills to where I’m not actually increasing my suffering by doing all of those compulsive behaviors. And that is key when you have a chronic illness. 

Treatment For Pots And Anxiety (and other chronic illnesses)

All the research I have done shows that having a chronic illness requires medical attention and therapy. Cognitive behavioral therapy, I did a whole bunch of research in prep for this, a whole bunch of research. If you have POTS, they recommend cognitive behavioral therapy. That’s because along with having a chronic illness comes anxiety and depression and other emotions. Along with having other chronic illnesses comes anxiety and depression, diabetes, Crohn’s disease, celiac disease. It could be even just having a chronic illness of having a disorder. A mental health disorder also creates a lot of anxiety in your life. This is key. I’m just so grateful that I have the ability to practice these skills and the ability to just sit in the mud. I am just sitting in the mud today. That’s what I’m doing. I’m so grateful that I have those skills and I really want to teach you guys those skills by modeling to you today. So, let’s break it down. 

When you have anxiety, whether it’s in association to a chronic illness or it’s just regular anxiety, what I’m going to encourage you to do is do nothing at all. It’s actually quite easy when you think about it, but it’s actually really hard at the same time, is to do nothing at all different. Today, I am going about my day. I am going to allow my heart rate to go through my chest and beat so hard. I’m going to allow that lightheaded, blood pressure issue that I’m having to be there. I’m going to allow the dizziness to be there. I’m going to allow the raising thoughts to be there. I’m going to still show up in my yellow skirt. If I spin in a circle, it would be a full spinning circle. It would be so beautiful. And I’m going to keep my heart open. If you could see me right now, I’m not hunched up. My hands are soft, my cheeks are soft, my heart is open, my shoulders are dropped. I’m just here for it. I’m allowing it. Is it hard? Yes, it is painful as. Is it exhausting? Yes. Every night this week I’ve been going to bed at seven o’clock and just resting my body because I’m working really, really hard. And my body is exhausted because it’s pumping adrenaline all day long.

These are some ideas I want you to implement into your life if you can. And a lot of it, one thing, of course, I didn’t discuss because it’s just such a part of my practices, I’m also really gentle with myself. Like, “Yeah, Kim, this is rough.” I use the word “suffering.” You even heard me use it. “This is a lot of suffering for you right now, hun. You deserve to go to bed a little early and it’s okay if you don’t show up perfect and you might drop some balls. Yeah, that’s okay.” That’s the main point. 

Pots Awareness Month 

What I will say at the end here is please-- you’re probably hearing some of this and going, “Oh my gosh, maybe I have POTS.” I really want to make sure you know the difference. Given that it’s POTS Awareness Month, postural orthostatic tachycardic syndrome is not an anxiety disorder. It is a disorder of the autonomic nervous system. It does mean that when you stand up, there is changes in your heart rate and in your blood pressure that cause you to faint. Lots of people with POTS can’t stand up at all. So, I’m so grateful for the fact that I can stand up, even though it takes me two goes to fill up a drink bottle. I can stand up better than a lot of people who have postural orthostatic tachycardic syndrome. I can walk. I can exercise. I’ve been building up my exercise routine according to the POTS exercise program. 

Difference Between Anxiety And Pots 

It’s important for you to understand that just having these anxiety symptoms doesn’t mean you have POTS. If you are fainting and you are actually having a really difficult time with nausea and multiple different autonomic nervous system issues, well then definitely go see your doctor and share with them your symptoms. If they think that you are a candidate for maybe getting tested for POTS, the type of test you would need is called a tilt table test. It is usually administered by a cardiologist or a cardiologist nurse. It’s a horrible test, and if you have POTS, it will be very painful and very difficult. But basically, it’s where they put you on a table and then the table tilts up really fast, and then you’re connected to all these cardio nodes, I guess, all over your body and they’re got a blood pressure machine and some people even faint during the test. They raise you and then they drop you down flat and then they raise you and they drop you down flat and they’re monitoring whether there’s shifts in your heart rate and blood pressure. And that is the test that will get you diagnosed for POTS based on whether you meet criteria. It’s a very unpleasant test if you have POTS because it does induce fainting for a lot of people or a severe amount of nausea for a lot of people. But if you are concerned, you can reach out to your doctor and see if you meet the criteria to get that test. 

That’s it. I wanted to share with you what it’s like to have POTS and to share my ups and downs with having POTS. Also, one thing I will say, if you don’t mind and you want to stay with me just for a few more minutes, is having a chronic illness is also a very anxious experience. You never know whether you’re going to have a good day or a bad day. You never know what your symptoms are going to be. For me, I’ve actually been very blessed and the treatments have helped me a lot. For some people they don’t, but for some people, they can’t guarantee they can show up for work tomorrow. They can’t guarantee they can take their kids to the park. They just don’t know. It depends on the day and it depends on their body. So, there’s so much uncertainty with what your body will do and how your body will react. That in and of itself creates a lot of anxiety and uncertainty and it can be very, very depressing. 

For those of you who have severe POTS, they can’t play with their kids. They can’t stand up long enough to run in the park. It can be very, very debilitating. So, if you have a chronic illness and you have anxiety and depression, that doesn’t mean there’s something wrong with you. It actually means it’s a normal natural part of having a chronic illness. I wanted to really make sure I advocated for that because some people think if you have a medical problem, it’s just a medical problem. But often medical problems create mental health problems and we have to look at the whole human. Even though I’m an OCD and Anxiety Specialist, I’m still going to admit to you guys, it still creates anxiety for me. I handle it pretty well, but some days I don’t. Some days I’m very sad about it and have a lot of grief and a lot of anger and a lot of frustration around it and sometimes even jealousy. Just jealous. I wish I could A, B, and C.

I’ll tell you one story. There’s a person on social media and they constantly do their posts while they’re standing at a computer desk. Even just looking at her stand at a computer desk, she’s got one of those standing desks, I have so much envy because I’m like, “I could never ever do that.” Never ever do that unless somebody-- I don’t know. I didn’t even know how I would do it, but-- yeah, a lot of emotions show up. 

All right. So, that’s it for today. I wanted to share with you a whole little update on what happens when your chronic illness causes anxiety. I wanted to highlight that it’s Postural Orthostatic Tachycardic Syndrome Week or Awareness Week. Actually, I think it’s Awareness Month. I hopefully inspired you to lean into your fear and not give it all the power because you’re actually stronger than your anxiety. 

All right. Thank you so much for listening. I know it may have been a bit of a rambling episode, but hopefully, you took a few pieces away from it. I really, really appreciate you checking in. Please do go and leave a review. It is the best gift you can give me because it does allow me to then get trust of other people who are new coming to the podcast, and then we can help some more people. 

Take care and I will talk to you soon.

You Can Be Anxious AND Have Courage!

Courage.  Where do we find it? How do we get it? And, once we get it, how do we keep it?

In this era, being courageous or brave comes with great expectations.   Men are expected to show their “brave face” ALL the time, or they run the risk of being called a “sissy.”   That is a lot of pressure!  Women (and many times men too) are expected to multi-task multiple difficult things at once, but also must look pretty and be smiling while doing it.

But, to top it all off, we humans (men, women and children) with anxiety are often expected to meet all of the above criteria AND keep our anxiety to ourselves.  Where did we get this from?! I cannot tell you how many times I have heard stories about family members or partners or parents who have told someone struggling with anxiety or depression (or another mental health struggle) to “be braver” or “toughen up” or “you gotta be stronger through this.”  While I do understand what they are trying to convey, today’s podcast episode is all about approaching courage and bravery with a new (more reasonable) perspective.

You see, I like to think of bravery and courage as something you can experience WITH anxiety.  I actually think they go beautifully together.  We can feel dreadful fear AND be courageous.  We can feel overwhelming sadness AND be strong.   What we have been told about bravery and courage is all off.  It limits us and makes us feel like we must not try things until we have no fear and we can “hold it together.”

I like to believe that the person who decided to go to the party, despite their tremendous social anxiety, is the brave one.   I believe that the person who does that really hard thing (even if it happens to be easy for other people) is the courageous one.   I believe the one who has a tear running down their face as they face their fear is a brave rock star!

I hope you enjoy this podcast episode and begin to challenge your view of what bravery and courage looks like.  As always, thank you for supporting me with this podcast and with CBT School's online courses.

Enjoy!

This is Your Anxiety Toolkit - Episode 293.

You guys, I’ve totally screwed up. Oh my God, it’s going to be one of those episodes where I laugh a lot. Maybe not. Who knows? 

Alright, I totally screwed up. It’s funny because I have for months been thinking about doing an episode and reminding you guys mostly so I could remind myself that I’m a human being, that I’m going to make mistakes, and it’s one of the biggest lessons that I have had to learn over and over and over and over again. It’s really frustrating, you guys. I’m so frustrated by this fact that humans make mistakes. I don’t like it. It makes me mad. If only we could figure out a way where we don’t and we don’t disappoint people and we don’t screw up. If anyone has figured this out, let me know. Just shoot me an email, tell me your special secret, because I haven’t figured it out yet. So funny. 

Okay. Before we get into it, this is actually pretty much a coincidence and I love when big coincidences happen, but the review of the week is actually from Flashcork. They’re writing a specific review on Episode 193, which I think is really cool because this is by coincidence 293. And they said:

“This episode 193 is just what I needed to hear today. I’m stressed and anxious about my upcoming trip and experiencing racing thoughts. This will help me to manage those feelings and practice by shortening the leash.”

Now, if you haven’t listened to this episode, it is probably one of my most favorite episodes. A lot of my patients and clients have said that this concept has helped them a lot. And so, really go back and listen to 193. If you want to practice being able to be in a place where you can manage those thoughts a little better, go back and check that out. It’s just a metaphor. 

Flashcork says: “It makes sense because it has worked for me walking Sally, my Golden Retriever.”

I make a reference to thoughts being like a dog on a leash. So, you can go back and listen to that anytime.

That’s the review of the week. Thank you, Flashcork. So happy to have you join us. 

The “I did a hard thing” is from Allison. Allison says:

“I’m going to go on a job interview next week after applying to a different job, going through the grueling interviewing process and at the end not being successful. I’m working really hard to believe in myself, screw up my courage to attend this interview and be open-hearted about the new possibilities. It’s hard to pick yourself up and try again, but I’m doing the hard thing of trying again. I’m scared, but I’m proud of myself.”

Allison, you are doing the work. And I’m actually going to take your advice today, Allison, because this is so perfect for the topic of today, which is like, yeah, sometimes we do screw up and we just have to get up and we have to try again. It’s so important. I’m so, so I’m impressed. I’m just so impressed with your courage and thank you so much for sharing that because I think we’ve all experienced it. 

So, Allison, let me tell you my hard thing. I want to preface this with, I think in my-- if I’m being completely authentic with you guys, I think that I’ve somehow, for many years of my adulthood, without me realizing, and in not a super severe way either, it was a very secret underlying compulsion I think I’ve been doing for years that I didn’t even know I was doing until the last couple of years is I was trying to find a way, constantly striving to find a way that I could live in a world where I didn’t make a mistake. Now I understand I’m a human. I don’t think I’m a superwoman. But in my mind, I think I’ve had-- well, I know I have, let’s be honest. I think in my effort to control my emotions that I’ve engaged in these little nuanced secretive behaviors of constantly trying to find the formula where I don’t upset people and I don’t screw up.

Let’s just take a minute because it’s funny for me to say that because how many times during the week with my clients and with you guys and everything I do is about self-compassion and letting go of control. And all along there was this nuanced little secret slither going through my life. And I think that number one, a part of this is true for a lot of people who have anxiety and are high functioning. Because I spoke to a couple of friends about this and they were like, “Yeah, to be--” when you have anxiety, to be high functioning, you have to put in place systems and procedures and routines to keep you going. And it makes sense that we often engage in other little behaviors that make us feel like we’re getting control when we don’t. 

Everybody knows, I even spoke about it a couple of sessions ago, that I am so in love with calendaring. My life has changed since I’ve been more intentional about my calendar. I’m not compulsive about it at all. Because I’m managing two children and two businesses and a chronic illness, if I can be really intentional and effective with my schedule, I can go into the day. I never worry about what I have to get done anymore. Really, I don’t. It was the best change I ever made because I have a system where I write down what I need to do and I throw that list out because I immediately calendar the times that I’m going to do it. So, I know it’s going to get done because it’s in the calendar. And if I don’t get it done, I’ll reschedule it. And I know I’ll get it done. And through the process, I’ve actually built such trust with myself. I know. I know I used to worry that I won’t get things done. I never worry about that anymore because I’ve gotten really good at this process. You guys know what’s going. 

This week is literally the only week of the year where the things on my calendar cannot be rescheduled because my beautiful daughter, who is a delight, she’s growing up to be this absolutely gorgeous human. I wish you could all meet her. She’s just so good. I know I’m biased, but she is just so wonderful. It’s her graduation. She’s graduating elementary school, you guys, and I’m going to have a middle schooler next year.

So, the one thing this year-- because I’m my own boss. I can schedule what I want. The one thing I can’t miss is her graduation. And last week, you know what’s going to happen here I was prepping to present at this conference and I got on the call and then we were doing this rehearsal and she said, “Okay, great. I’ll see you next Friday.” And I was like, “No, no, no, no. It’s the week after.” And she said, “No, no, no it’s next Friday.” And I’m like, “No, no, it’s not. And I’m always right. It’s in my calendar.” And she’s like, “No, it’s really not. It’s next Friday. You agreed to it on this date.” And I realized she’s right.

Now, I said to her, literally, “I cannot do it with this whole thing. I can’t do it. I’ve totally screwed up. This is not something I can reschedule.” And she was like, “Oh, okay.” So, she had to basically message a whole foundation. They had to change everything. They had to try and figure it out. This is where it was so humiliating, is they had to reach out to the person who was going after me, who is a very, very, very well-known person in the OCD community who I respect and don’t know. So, it’s like I have a relationship and had to ask him to reschedule his entire day because I screwed up. 

Now, I know this is not a huge disaster. This is in the grand scheme of things. This is not a huge problem, but I felt so bad. Oh my God, it was so painful. I was in this meeting and to see their faces of just pure annoyance and frustration and anger of like, “What? You got the date wrong?” They were very kind, but I could tell they were annoyed. 

And so, my question to you, because I love questions, is what do we do when we screw up? What do you do when you screwed up? 

Now you might be thinking this isn’t a big deal. I want you to think about a time when you did screw up that’s a big deal for you, and I want you to ask yourself, what did you do when you screw up? 

Immediately for me, this is the reason I wanted to really do this episode, is there was this interesting shift in me this time where-- because I haven’t screwed up this big in a couple of years. This was a pretty huge screw-up. I looked like a complete fall in something that was organized months ago, we’ve been talking about it, emailing back and forth. How did I miss this? I don’t know. But what was fascinating to me is, once upon a time, I would’ve said some very mean things to myself. Really, really mean. And I probably would’ve-- now that I’m noticing it is I would’ve responded, not just with self-criticism, but I would’ve tightened my belt even more with checking behaviors, rechecking, more controlling calendar, like compulsive calendaring. I would’ve overcorrected because I have been known to overcorrect. If you ask my partner, he’ll tell you I often used to overcorrect pretty bad. If I make a mistake, I would-- if I upset someone, I would go overboard trying to get them to like me again. Or I remember I used to-- if I was worried I offended someone, I would like to apologize over and over and over again. I don’t know if you’ve done any of these behaviors. You might want to gently say, “Kimberley, you’re not alone.” I’m kidding. 

But this time what? I notice this shift in me where I was like-- what I say to my son all the time is, “Oh my gosh, I’m such a ding-dong.” I’ll say you’re such a ding-dong and he’ll say you’re such a ding-dong. It’s a funny thing. It’s lighthearted and it’s not critical. It’s just like, “Ding-dong. You’re such ding-dong.” And what was interesting is I responded by went, “Oh my gosh, I’m such a ding-dong,” but it wasn’t-- I said things that sounded critical, but it wasn’t. There was this giggle to it. There was this acceptance of my humanness to it. It was so playful in my response. And I mean, this is a big deal for me because I very much value the respect of the people in my field and I work really hard to get their respect. Not in a people-pleasing way, but it’s a very big value for me. And it was funny. I just went, “Oh my gosh, I’m so sorry. I’m a ding-dong.” And then I said, “What can we do to fix it?” It was just a very transactional thing. Whereas before I would’ve, “Oh my God. I’m so sorry. I’m such an idiot. I can’t believe I did this. You should fire me.” I would just go overcorrect. 

So, let’s come here to the questions because I love the questions. If you’re driving, don’t do this. But if you’re not driving, I’d love for you to actually sit down with a notepad and just journal some of this out. So, when you screw up, what do you do? 

The second question is, is it okay for you? Because it was fine for me, and I want you to actually check-in, is it okay for you to make jokes about yourself? Answer it honestly. If it’s a yes, that’s okay. It can be giggly, nothing too harsh. If no, take that and really follow that out when you do make a mistake. 

Number three, is it helpful to apologize? Yes, of course. When we screw up, we should apologize. But how many times? And how do we apologize? Do we say it in a way that’s very factual, “I’m so sorry, this is a huge inconvenience for you”? Or do we say, “I’m sorry, I’m such a mess, screwed up person. I’ve ruined your day,” and make up a whole story about it? Because a lot of us do that when we screw up. Do you apologize over and over and over? 

Catch how do you respond to try and make it up to them. And that’s a really big one. Because if you find that you’re trying to make it up to them that’s okay. But are you doing it because it equals the degree in which you screwed up or are you doing it just to remove the discomfort you feel about the fact that you’re a human being? Make sure it’s in proportion. So, if you, let’s say, forgot to text somebody about something, you wouldn’t need to buy them a $100 gift card. That’s going overboard. Maybe it depends on the situation, but we’re just making an assumption here. If you forgot someone’s birthday. Well, yeah, you probably need to take them out for dinner and do make a big deal about it. But do you need to do that four times this month or throw them a party that puts you out of pocket? No. Don’t try to make it up to people in a way that actually takes away from your well-being. 

This is the next thing, is-- once I did this, I was really proud of myself. I’m not going to lie. I handled it pretty well, I think, and I was like, “Wow, I’ve made some pretty big growth in here obviously.” What was interesting is, once I hung up from them and I was like, “Oh dear.” I have all of these emotions, which I’ll talk to you here in a second about, I had to ask myself. The next question is, how long am I going to be on the hook for this, meaning from myself? How long am I going to hold myself on the hook? When am I going to let this one go? Because what I could have done is I could have said, “Okay, I made a mistake. It was not a good mistake there.” Obviously, I need to make some changes, but I’m going to beat myself up for the rest of the day. I’m going to ask yourself, how effective is that and is it in proportion with what happened, and is it effective? Really, does it make it less likely that you’ll do it again? The truth is, if I beat myself up all day, it’s not going to reduce the chances of this happening again, because it was a human mistake. And then the last question is, what can I do to resolve this if anything?

But let me come back to the emotions because those questions are very much related to these emotions. When you make a mistake and whether-- let me pose a couple of things to you. It could be something you do to somebody else. It could be something you do to yourself. Meaning if you do a ton of compulsions and you are up all night and now, you’re exhausted, or it’s any mistake you make. You had a huge panic attack and you left the party of your best friend and she’s really mad at you because you left her birthday party. It could be that you were depressed and you just couldn’t show up for your friend this day. So, there are so many ways in which this plays out. It doesn’t just have to be with scheduling.

When we upset other people or our behaviors impact other people, it’s normal to feel strong emotions. That’s normal. Often what we do is when we feel those strong emotions, we respond to them as if we need to squash them immediately, because we’ve told ourselves we can’t tolerate them. Guilt is probably one of the most common, shame being the second. There may be some anxiety related to it as well, or maybe some other emotions as well. But let’s take a look at those emotions and just quickly review how they may actually impact you. 

So, when we feel guilt, guilt is usually you’ve done something wrong, and I had done something wrong. So, guilt was an appropriate emotion. But I always think of guilt-- I’ve done episodes on this in the past. I think of guilt as just a stop sign to ask you, is there anything I can do to fix this now or in the future? Again, just really logical. In this situation, yeah, I can reschedule. I can be honest. I can do what I can to apologize. But beyond that, there isn’t anything else. And so, any residual guilt I feel from there, I must just tolerate. I must compassionately ride the wave of guilt.

Often, I see my clients, and I’ve done this myself, is if guilt is here, I’m going to beat myself up for it. No matter what, that’s the conditions. If guilt is present, I will beat myself up. And I want to invite you to have guilt and just be kind and let it ride. It’ll burn off like a candle. It’ll burn itself out and it’ll slowly dwindle away. 

Guilt is “I did something bad.” Shame is “I am bad.” If you do something and you screw up, and you feel shame, your job is to check-in and recognize that mistakes don’t make you bad. Literally, no mistake. There is not a mistake you could tell me of that makes you bad. Even if there was an absolute catastrophe that happened, mistakes don’t make you bad. You’re a human being. You’re going to make them. And I know, like I said to you, if you figured out how not to be human, please email me. I’ll happily take your email into my inbox and I’ll apply your rules. But the truth is, I know none of you are going to email me because it’s not possible and we have to accept it. We have to accept it. I’m just joking really about the email. 

And so, there is really no place for shame. If you feel shame, same as guilt, write it out compassionately. Give it very little of your attention. Don’t get into the content of what your shame is saying. Write it out and let it go. Meaning, like I said to you, there’s really no point in me dwelling on this because it’s done and I can’t do anything about it. All I can do is be kind to the feelings I’m feeling.

Now, a lot of people will say, “Oh my gosh, I wrote this response on an email or call or I presented, or I was in a party, and now I feel nothing but anxiety because I totally made a mistake.” I’ve had people even say like, “Oh, I was at a party and I passed gas,” or “I said something stupid.” I mean, I could tell you some absolutely ridiculous stories. 

Actually, let me tell you a quick, funny story, because I’ll come back to this, is recently, I attended this creative writing course, but it was actually a writing course for people who are business owners, and they were talking about getting really clear about you and the message you want to give and how to tell stories about it and so forth. And he was asking these questions about, who are you? And what’s something that the people closest to you would say? And I was thinking about it and I don’t think you guys know this about me, but I have, not in my professional life, but in my personal life, I have a way of the most bizarre things happening to me, like silly things. I always find myself in these situations where everyone is like, “Oh, only Kimberley would get put in that situation.” So ridiculous. I can’t even-- one day I think if I really let go, I’ll tell you some ridiculous stories. But if something really bizarre is going to happen, it always happens to me. And so, I just wanted to tell you that, because I want you guys to know that as the podcast is where I get a little more personal and bizarre things totally happen to me all the time. But let me go back. 

So, let’s say you have anxiety. You’re having anxiety about something that happened, and you’re thinking like, “Oh my God.” And your brain is just telling you catastrophe after catastrophe, after catastrophe, all of the worst-case scenarios. The truth is, that’s your brain’s job. Its job is to tell you of all the catastrophes, but it doesn’t mean you need to respond as if they’re all true and happening. And so, again, we go back to these core questions, is how can I stay with the facts that it happened? How can I acknowledge that it is what it is and that I can’t solve it, I can’t make it go away? And how can I act in a way that doesn’t overcorrect again, not over-apologizing, not asking for reassurance, not avoiding those people, not saying too many jokes, and so forth? So, we want to catch that. We want to catch how we go into anxiety and respond in that compulsive way. 

As I said to you at the beginning of this episode, I think that I was for many years doing this very nuanced compulsion of over-checking schedules and even being super neutral and kind to people so that I would never offend them. Stripping my personality down just so I would never harm them or never hurt them, which is not me being authentic, and I can see that now. 

So, these are the things I want you to think about. And then once you identify these strong emotions – again, we’ve looked at guilt, we’ve looked at shame, we’re now looking at anxiety – the job is to ride them out, let the anxiety burn out on its own. We don’t need to tend to it. It happened because we’re human and we’re going to allow it to rise and fall on our own. 

So, here is where I want you now to, number one, give yourself permission to be a human. Humans screw up. It’s a fact. It’s something we have to accept. How can we be in these situations and change the way we react so that we are not beating ourselves up and we’re not overcorrecting for the future? 

The only last thing I’ll say here is, if you’re trying to control what people think about you, you’re never going to win because what they think is a reflection of them. So, here is the last point. I screwed up. It’s just a fact. I put other people out. My mistake is probably going to interrupt some people’s time next week. I don’t like that. That doesn’t line up with my values, but it is what it is. There’s not a lot I can do. But what they think about me is completely a reflection of them. 

So, if let’s say this one person goes, “Oh my gosh, she is such an unorganized person and is horrible,” that really shows the degree in which they’re judgmental. Meaning they haven’t allowed me to show them that I’m more complex than that, that I have many other qualities, and so forth. If they were to say, “Oh my God, you’re fired, you’re terrible,” again, that’s not a fact either. And that’s a reflection of them and their struggle to be flexible and find solutions and so forth. Not that they’re bad, it’s just it’s more of a reflection on them because, in this situation, the people were very kind and they said, “We’ll work it out. We’ll see if we can reschedule you to be later on in the day,” and that it really was a reflection of how flexible they are. 

So, I want you to really remember here that you making a mistake doesn’t make you good or bad. Their judgments about you doesn’t define whether you’re good or bad or that they’re good or bad. It’s just we’re doing the best we can and it’s just it is what it is. 

So, that’s it, guys. We make mistakes. It’s terrible. I know it’s hard. It’s really painful, but can we hold space for the pain and the emotions associated and ride them out without beating ourselves up? That’s the real question. 

Have a wonderful day, everybody.

The Best FREE Mindful Tool Is...

Is Fred In The Refridgerator? Interview with Shala Nicely

If you missed last weeks episode 50 5 Lessons Learned from Hosting Your Anxiety Toolkit

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This is Your Anxiety Toolkit - Episode 197.

Welcome to Your Anxiety Toolkit. I’m your host, Kimberley Quinlan. This podcast is fueled by three main goals. The first goal is to provide you with some extra tools to help you manage your anxiety. Second goal, to inspire you. Anxiety doesn’t get to decide how you live your life. And number three, and I leave the best for last, is to provide you with one big, fat virtual hug, because experiencing anxiety ain’t easy. If that sounds good to you, let’s go.

Welcome back, you guys. So grateful to have this precious time with you. Thank you so much for coming and spending your very, very precious time with me. As we do this together, it’s exciting, we’re almost at 200 episodes. You guys, I cannot believe it. I am pretty, pretty proud of that, I’m not going to lie.

Today’s episode is with the amazing Jon Hershfield. He’s been on the show multiple times and I have been really reflecting and thinking about how important it is for us to practice response prevention and how that is so, so important for everybody who has any type of anxiety, whether that be an anxiety disorder like OCD, social anxiety, specific phobia, generalized anxiety. Even for myself, I’ve been reflecting on any time I’m responding to fear and responding to discomfort. It’s just a topic that I want to continue to address because I think from you guys, I just continue to see how much it’s a struggle for you.

As I thought about continuing education on tools you can use, I thought, who else can I have none other, but Jon Hershfield to talk about using mindfulness to manage compulsions. Now we talk about compulsions like mental compulsions and rumination. We talk about reassurance-seeking, avoidance, any kind of physical compulsion. We also talk about how to practice mindfulness so that it doesn’t become a compulsion. And so I’m just so grateful to have John give us his very valuable time and to talk with you guys about these amazing concepts.

I’m not going to spend too much more time doing the introduction. You guys know how amazing Jon Hershfield is. He has some amazing books. He has The Mindfulness Workbook for OCD, and he has Everyday Mindfulness that he co-authored with Shala Nicely, and The Teen OCD Workbook, and Harm OCD book. He’s just written amazing books. So please do go out and support him. He does share all that information at the end of the show, and I can’t wait for you guys to listen.

In the meantime, please do go and leave a review. It helps us to reach more people. I’m going to be quiet now and let you listen to Jon’s wisdom. Have a wonderful day.

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Kimberley: All right, welcome. I am so happy to have the amazing Jon Hershfield with us again today.

Jon: Thanks for having me. You make me sound like Spiderman of the OCD world.

Kimberley: You are the Spiderman of the OCD world. I love it.

Jon: What does that mean?

Kimberley: Yeah, it’s true. Well, that’s a good thing. I know my son is probably jumping up and down at the idea of me meeting the Spiderman of something. Thank you for coming on. I really wanted to invite you on, of course, because I love the work that you’re doing regarding mindfulness in OCD. I really wanted to talk about how we can use mindfulness, particularly to address compulsion, because a big part of Exposure and Response Prevention is the response prevention piece. I would really love to pick your mind on how you implement mindfulness as a part of that and also address some of the misunderstandings that happen regarding mindfulness.

So, let me first ask you, just for those who don’t know or new to the show, how would you give a definition? How would you explain mindfulness, particularly in the respect of treatment?

Jon: It’s interesting because we all make this same grammatical error. I do it too. We say we use mindfulness as if mindfulness was an act or an action or a thing that you use as opposed to a perspective that you take. So I’m thinking about what mindfulness means. Usually, the definition we hear is “Paying attention to the present moment as it is without judgment and without the desire to change it.” And that’s a great definition. It’s escaping me at the moment who actually coined that exact language, but I think it applies to most mindfulness concepts.

But I don’t like that it starts with the word “paying” because it still implies that you’re doing something. I think mindfulness is actually the perspective that you have when you’re paying attention to the present moment. If you want to play around with the words, it’s really noticing the fullness of the mind – mindfulness, right? It’s a position that you take as opposed to a thing that you do. Right now, I’m sitting here in my desk chair. I’m aware of the sensation of my body in the chair, hearing my voice in the headphones and I have coffee and tasting that coffee. These are all things that I’m noticing and I’m being mindful of.

The other part of mindfulness that I think is important to understand is that, in a state of mindfulness, you’re best able to observe the difference between an experience – I just listed for you a bunch of experiences – and a story. A story is a narrative. It’s the meaning and the webs that we weave around those experiences. So it’s me thinking I’d had too much coffee today, right? That’s a story about the taste of coffee in my mouth right now and its significance, but they’re two separate things.

When we’re treating something like OCD, which is very much about being pulled away by your mind into these narratives, these fear-based narratives – to be able to drop out of the narrative and into the experience would be to take a mindful perspective, or in colloquial terms “to use mindfulness.” But I think a lot of times when we say “using mindfulness,” we associate that with stopping what we’re doing and focusing on the breath, or pulling out an app and doing a meditation, or trying to execute change in our environment by being mindful. When in fact, mindfulness is very much the opposite of that. It’s not about executing change. It’s actually about stepping back and seeing the way things really are.

Kimberley: Right. I love this. So would you say in this perspective that mindfulness is not adding something on, it’s just dropping down into what was already there?

Jon: Yes. I would agree with that.

Kimberley: I like that. So how might we use this, particularly in terms of managing anxiety or uncertainty or any other discomfort? Can you give me a walk-through of what that might sound like or look like for somebody who is practicing mindfulness?

Jon: Well, one of the things you might think about, when somebody feels triggered, something happens. You’ve touched something you think is contaminated or you’ve become aware of an unwanted, intrusive thought, a harming thought, or something like that. Then you have an experience in the brain and in the body that alerts you to the fact that you’re under attack, that you’re distressed, something is wrong and it needs to be fixed.

What most people do is they immediately go into the story of, “This is bad. I’m triggered. I need to get away from this trigger. How do I make this feeling go away? Because it’s unpleasant.” Of course, it’s unpleasant because it’s your brain’s way of trying to help you jump into action to get away from the things that could harm you. So it’s natural that we want to get rid of this feeling.

And then we do these things called compulsions that reliably, in the short term, get rid of these feelings. If you know anything about OCD as you do, it’s like you get stuck in that loop. The more you compulse, the more you really feel the responsibility towards your obsessions as they arise.

In that space, between the trigger and the compulsion, there’s an experience you’re having. A person who has been practicing mindfulness or who is mindfully aware can show up to that experience in the same way they might show up to other experiences, again, without having to make it go away. So you render the compulsion less important because you’re willing to be in the presence of that triggering experience.

If you were to take this to the mat and think about, “Well, what happens when you’re meditating and you get an itch?” what is the instruction? It’s not, “Well, just scratch it so you can be more comfortable.” It’s usually, “Okay, well, notice what itching is like. Notice what it’s like to be sitting, which is what you’re doing, and then have your attention pulled away from the sitting to the sensation of itching, to be able to say, ‘Oh, that’s itching.’”

Now at some point, we all break and we start scratching ourselves all over it because it’s too much, but that’s fine. But that’s not the first instruction. The first instruction is simply notice itching. And then if you’re capable of letting go of that and going back to what you were doing before you got distracted by the itch, you’d go back to your breath or whatever the anchor of your meditation might’ve been.

It’s the same thing in real life. You’re minding your own business. You’re trying to read a book and then you have an intrusive thought that something terrible is going to happen. And then you notice that experience of this mental itching and you’re, “Okay, that’s happening.” And then you have a choice. You can drop down out of that back into your book, or you can dwell on it, ruminate on it, try to figure it out, try to figure out a way to make it go away, and then give yourself permission to go back to your book.

Kimberley: So, we call it in my practice, my staff have called it “itch surfing.”

Jon: Itch surfing. Yeah.

Kimberley: I always laugh when I say “itch surfing.” So, let’s say you have the presence of a thought that’s really concerning, right? It’s triggering. And you’re trying to be mindful, but you’re also not trying to step across the line to where you are ruminating or being compulsive related to that. How might someone differentiate between the two?

Jon: So there’s a couple of things to consider here. One is that a lot of people will say, mindfulness is about watching your thoughts come and go. There’s a good reason why we use that metaphor, that idea of sitting at the bank of the stream and watching the leaves go by. But it’s not really accurate in the sense that it’s more about just noticing thoughts coming and going. Watching thoughts coming and going implies that you’re supposed to sit there and stare at them and give them special attention. You’re supposed to remember, right? It’s a perspective. It’s not an act. You’re supposed to remember like, “Oh yeah, it was a thought coming and going. Okay, that’s cool.” And then let go of it.

Ruminating is when you’re digging up that thought for the purpose of trying to figure it out to digest it. You’re trying to act on the thought and get certainty about it. It’s a very active thing you’re doing when you’re ruminating.

To be mindful would really be the opposite of that. It would be to notice that you’re ruminating and stop. Because the whole point, if you’re being mindful, it’s not that you’re executing change on your environment, but you’re simply noticing what’s coming up. So it was really impossible to be mindful and ruminate at the same time because that would be like being mindful while trying to figure out some problem.

So the instruction would be to notice that urge to ruminate, to notice what’s coming up for you in your body, that experience of, “I really want to figure this out,” and then to allow that experience to be there, and again, drop back down into your anchor. In real life, it’s whatever you were doing before you got distracted. In meditation, it’s whatever your anchor is – the breath, the feeling of your body in the seat.

Kimberley: So it’d be like using the metaphor of, if you’re sitting at the edge of the stream and you’re just watching the leaves come and go, that would be mindfulness. But ruminating or being hyper-aware would be like watching the leaf after it’s way, way, way, way down the river, but you’re still giving that attention and missing what’s right in front of you?

Jon: Yeah. It’s easy to make that mistake because you could feel like you’re being mindful. You could say like, “Well, I’m just watching this leaf and seeing how far it goes.” But in fact, when you’re doing that, you’re missing everything that’s happening in the present moment, all those other leaves that are going by.

A lot of times, people think of themselves as being very negative because they get distracted by negative thoughts, and the thought comes down the stream and they follow it. And while they’re falling, those negative thoughts, all sorts of other nice things are happening – the smell of their breakfast or the warmth of the sun or whatever it might be. But they’re not noticing that stuff because they’re immersed in tracking that negative experience that they had. They think of their lives as being negative instead of thinking of their lives as just being whatever it happens to be in any given moment.

Kimberley: Right. Talk about, if you will, hyper-awareness, because I think sometimes people think they’re being mindful, and I think it’s going to be very similar maybe in your answer, but I just want to be really clear for people who I’ve heard struggle with. They’re trying to be mindful, but it becomes hyper-awareness. Do you have any thoughts on that?

Jon: A lot of this, I think, comes down again to language. Most of us are trained to say things like “Sit with uncertainty,” which sounds like a good idea, but the implication for some is that you’re literally sitting and there’s literally uncertainty in front of you. It’s like sitting on your head and you’re immersed in it and you’re dwelling on it. So it gets translated as “Dwell on uncertainty,” and feel bad as long as you can feel bad.

Actually, I interviewed Jon Abramowitz who some of you may know in a lecture series here at Sheppard Pratt not too long ago. He said he likes to say, “Act with uncertainty instead.” I really like that because to me, that is still mindfulness. You’re doing something, you notice you became distracted, cool. That’s what that’s like. Now I’m going to go back to what I was doing before I got distracted. I’m going to act with the uncertainty instead of sitting, letting the uncertainty sit on my head.

I think it’s such an important distinction because to be mindful of your thought process is to be aware of it. But it’s not the same thing as to be trying to figure it out or be certain about it. That would be the opposite of mindfulness. And so the whole instruction, if you’ve had a lot of experience meditating, it might sound something like you wander away from your anchor and you start trying to figure out what’s wrong with your life. And then you go, “Oh yeah, thinking.” And then you go back to your anchor. No meditation teacher is going to tell you like, “Well, just notice that you’re trying to figure it out and keep trying to figure it out and try to get to some sort of outcome.” That really would go against the larger project.

Kimberley: Yeah. I mean, for me, if I were to explain it, if I were out and about, and let’s say another emotion showed up, like shame or guilt or something, my practice is just to go, “Oh, hi, Shame.” I think actually in the last episode, you were here talking about teens and you were like, “That’s cool, bruh,” or whatever it was, but that’s observing it and allowing it to be there. But then there’s a redirect to the present. Would you agree that’s a method that you use? I mean, again, we’re saying it’s not a doing, but talk to me about whether that’s something that you would apply to.

Jon: I would absolutely apply that. I mean, at the end of the day, we’re coming up with fancier and fancier ways of politely and compassionately saying, “Let it go.” We might have all the different ways of saying “It’s okay to let it go,” where we understand that it’s very painful to have these experiences and that makes it difficult to let it go. We don’t mean let it go, like, “Oh, you’re being silly.” I mean literally, it arrived and you allowed that, and now it’s leaving and you can allow that to let it go.

To become aware that you have an urge to ruminate or an urge to do some other compulsion and to let that urge be a thing, don’t sit there and stare at the urge and wait for it to go away. just be like, “Oh, that’s happening.” Just like shame arises or guilt arises. And then just gently note it and allow it to be, and you don’t have to do anything. It’s really a beautiful thing. The shame and the guilt and the urge to ruminate and the urge to wash, it’ll go away in its own time. You don’t have to be actively involved in it.

Kimberley: Right. It’s like mindfulness underneath there. A major component is non-attachment, to not be attached to it or the story we tell about it or what it means and all the things.

Jon: I mean, if you look at that and the concept of diffusion, they have specific skills for trying to make that happen. I think people can argue over like, “Well, what are the mechanics of building those skills? And could there be some compulsivity involved in that?” I mean, I think there’s some people that certainly could. If you’re going around saying, “It’s just the thought, it’s just the thought, it’s just the thought,” that’s not exactly what we’re getting at when we talk about diffusion. But the end game is diffusion, it’s being able to say, “I’m having a thought that...” What we want is to be able to do that without having to say it, without having to remind ourselves. But instead, simply have the experience that the thought arises much the same way the credits in a movie arise on a screen. Okay, yeah, that is the thought.

And then you get to decide, “Do I want to engage with this or let it go?” If it’s an obsessive thought that you’ve been grappling with, that you’ve decided is your OCD because you keep trying to get certainty about it, well then the instruction is going to be to drop it, not to play with it.

Kimberley: Right. Yeah. I think that this was a lesson for me early in my mindfulness game. Mindfulness is not just that heady, heady meaning like only a cognitive skill. It’s like you talk about dropping down, and it’s a behavioral skill as well. It’s not just sitting still and thinking, thinking, thinking, thinking your way out of discomfort. It’s also a doing. It’s a body thing as well, instead of it just being heady. I think that’s where we get into trouble, right? We start to try to think our way out of problems or our way out of discomfort.

Jon: Look at checking OCD, for example, like OCD where there’s a lot of checking compulsions. What happens is there’s this experience of not being complete, something missing or something being lost. And rather than own that experience and be able to say, “That’s something that just came up for me and I’m willing to allow that,” the instinct is to get rid of that experience by engaging in the checking compulsion. So, mindfulness plays an important role in being able to say, “I’m aware of this urge to check, and that’s fine. I have all kinds of urges throughout the day. I don’t have to give in to this urge.” You don’t have to do anything about it.

Like you were saying, that’s an experience you have in the body, like a sense that the body is craving a change and your willingness to allow that craving. Again, not to sit there and stare at it and wait for it to go away, but just simply just know that it is there and then go onto the next thing.

Kimberley: Right. I think that this is true in so many compulsions. Would you use the same skill? Would you use the same concepts regarding reassurance-seeking compulsions?

Jon: Yeah. Well, reassurance-seeking is really just another form of checking, isn’t it? It’s like you have a sense that you know something, just like you have a sense that your door is locked when you go back to make sure. In the case of reassurance-seeking, you’re going to a person or the internet to try to make sure. But again, it’s that experience of dis-ease, right? Not feeling ease with your experience and wanting to change. Instead of resisting that by doing compulsions, you’re saying, “I’ll allow it.”

I’ve been using this coping skill with the client. I might have mentioned that they prefer “allow” rather than “accept” because accept felt, I don’t know, it felt different to them. We can use whatever language you want, but I liked it. I’ve noticed that as a coping statement. If something comes up, like, “I want to change it,” and they’re like, “Nope, I’ll allow it.” And then now you’re free.

Kimberley: Open the gates to it.

Jon: Yeah.

Kimberley: Right. I like that a lot. The same goes for avoidance, right? Do you want to share how you might drop into mindfulness when it comes to avoiding, whether you’re about to avoid or you’re already in avoidance? What would your thoughts be there?

Jon: Well, it’s like observing your inner magnet, right? Something is pulling you in a direction. It might be pulling you away from something or pulling you towards it. And again, what does that feel like for you? What does that experience in the body? And rather than telling yourself “Accept it, accept it, I got to accept it, and push, push, push, push, push,” can you just notice where the resistance is? Can you let go of that, that part of you that’s resisting? you want to go to this party, but it’s overstimulating and you might say something embarrassing and there’s something there that might be triggering for you or something like that. But you want to go. As you’re approaching it, do you notice that resistance? Do you notice that push-pull in your body? And again, can you allow it? Can you say, “Worth it, investment return, worth it.” Very quickly, not spending a lot of time on it.

Again, I think cognitive therapy gets a bad rap a little bit in the OCD world because it can so easily turn into mental rituals, trying to assess the probabilities and things like that. But just a pinch, like a pinch of salt, a pinch of cognitive therapy where you’re able to say, “Come on now, this is a black and white thinking. I can handle this.” If you’re allowed to do that.

Kimberley: It’s funny that you say that because I was actually just about to ask you, like, go back to your story. Remember at the beginning, you were talking about the stories we tell ourselves. And I think in avoidance, there are so many stories that take us away from mindfulness. So I was actually going to ask you. Do you want to share how you would maybe implement a cognitive skill there?

Jon: So, if you’re being mindful, it means that you’re aware that you’re thinking. And if you can be aware that you’re thinking, you can also be aware of the tone of thinking. This is especially useful if you’re trying to quickly assess. Are you ruminating? Are you engaged in mental rehearsal? Are you thought-neutralizing? What is the mental behavior? If you’re noticing the way that you’re thinking and that tone, you might be able to pick up historically if that tone has been helpful or not, or if it usually ends in you feeling like you have to do compulsions.

Take catastrophizing, for example. You’re saying, “Something in the future is definitely going to go badly and I’m not going to be able to handle it.” Now, if you’re aware and you’re mindful, you know you’re thinking, and then you know that that’s what you’re thinking, and you know that that’s catastrophizing, you can simply say, “Yeah, that’s catastrophizing. I don’t need to do that right now.” Very simple. “I can’t predict the future.” You don’t have to go into “Everything will be fine,” or “The probability is that this is going to go my way.” Again, we want to spend as little time there as possible because we don’t want to get wrapped up in arguing with the OCD, but to just call it out and say like, “I can’t predict the future. I’m going to just go with this and see what happens.” And then when you make that choice, notice what that feels like. Can you allow that or not? And if you can’t, that’s okay. You can go find something else that you can allow.

Kimberley: Right. I will always remember many, many years ago, probably even when we worked together, a client of mine, and they gave me permission to tell this story, but I won’t, of course, disclose any information. But they always said they can feel the shift in their body. And that was them being mindful. They said as if they were holding onto the sides of their chair. So even though they weren’t sitting in a chair, they could feel this shift in their body of clenching. You can’t see me on the video. You can see me on the video, but listeners can’t. But just this wringing of the hands or clinging of the hands, and that her being able to just identify that slight shift in her body was enough to be able to shift out of that avoidance or resistance. I think just being aware and mindful of that, I think, is a big piece of the pie.

Jon: So, it’s knowing the quality and the tone and the texture of your internal experience. That’s essential for being able to pick out and resist mental compulsions. Ruminating is not just thinking about something because you like to think about it. Ruminating is very much like, there’s a puzzle and you’ve put all the pieces together but one, and now you can’t find that one piece that it’s somewhere. Maybe it’s on the floor, it’s under your desk. You know what that feeling is like. It’s so intense. And that mental quality is what’s going on with the person who’s ruminating. And that’s what they have to let go of, or be able to experience to let go of the ruminating.

If you can’t truly appreciate the tone and texture of your mind that “Sometimes when I’m thinking this way, it feels like this, sometimes when I’m thinking this way, it feels like that,” it’s just very difficult to trust yourself enough to call out the mental compulsion as they happen.

Kimberley: Yeah. I love this so much. I think it’s so important that we do address it. So, in all, I know there has-- we have addressed this, but I want to make sure we’re really clear. Do you believe that someone can mindfully ruminate?

Jon: I think it’s an oxymoron because to be mindful is to remember that everything going on inside is an object of attention, and to ruminate is to really engage in a changed behavior. So it’s really the opposite of mindfulness. There are types of meditations like traditional meditation. You have an anchor. You notice when you’re not paying attention to the anchor, you return your attention. Then there’s other types of meditations that might involve free-floating, like free-associating. Notice that this thought then connected to that thought, then connected to that thought. That is a kind of meditation. And you could argue that there’s a kind of mindful awareness of where things are going when you’re doing that. I still wouldn’t call that ruminating though, because ruminating is done with purpose. It’s done with a specific intention. It’s not just watching where your thoughts land.

Now, if you have OCD and you’re learning to meditate, I certainly wouldn’t recommend you do the type of meditation where you just watch your thoughts bounce around each other. But if you’re a more experienced meditator and you want to do that free-associating of watching each thought arise and fall and rise and fall and connect to other thoughts and feelings, that can be fun. But it’s not ruminating. To ruminate would be to intentionally try to figure out or try to get certain about your obsessive content. And I don’t think that there’s any mindful way to do that because it is literally the antithesis of mindfulness, in my opinion.

Kimberley: Right. No, and that’s how I was trained on it as well. I think the thing that I often will say to clients is, anything can become compulsive. Treatment can become compulsive. If you were to technically look at the term, engaging in compulsive treatment isn’t actual treatment because it’s going in the direction of doing compulsions, which is not the technical term for treatment.

Jon: It’s tricky with exposures. For example, I encounter people all the time who are doing checking compulsions but calling them exposures. “I have a fear of something. So I’m going to go over and pretend to do that thing and expose myself to that fear by being in this scary situation. And then it’s going to go away and then I’ll know that I’m not going to do that thing.” Well, that wasn’t an exposure. It might’ve been hard, but it really wasn’t ERP. I usually tell people not to do ERP when they want to. That’s usually suspicious of that. And also to consider what the point of it is. Like, if your OCD is getting between you and some valued behavior, that’s a good reason to go do that ERP. But if it’s not, and it just exists in your head, you don’t have to go ahead and be ready to go find any ERP to do. You’re allowed to just live your life. That’s allowed.

Kimberley: Right.

Jon: Yeah. I think that the other thing that happens with rumination that I think is very confusing and hard for people to appreciate is that, though, I wouldn’t say you can mindfully ruminate. You can certainly be lost in thought and you can certainly ruminate without full awareness of what you’re doing, because a lot of it is habit, right? Rumination, some compulsions, they can become habitual, but most of them are pretty easy to tease apart from habits. But mental behavior is a little bit trickier, I think.

In the same way that a person who’s-- let’s say they have difficulty with biting their nails, and they always bite their nails when in front of the computer. The computer becomes the cue to bite their nails. The hands go up to their face. They start chewing on their nails. They’re not necessarily thinking, “Oh, I’m going to bite my nails now.” It’s just happening. And then they might become aware of it. And if they’re working on it, then they might use a habit blocker or some other strategy that they might remember to be mindful of the urge to bite it and come up with another strategy.

The same thing happens in the mind where if you’re someone who’s used to engaging in compulsive rumination in different contexts of your life, there are going to be things that actually cue you to do it without you paying attention. You might not notice that, but it’s like, “Oh, every time I’m in this chair, I start to ruminate.”

The goal here in terms of improving your mental health situation would be to take ownership of the moment that you become aware of what you’re doing. Not to beat yourself up for ruminating, because again, your mind was like, “Oh, are we sitting in that chair? Okay, sure. Let’s bring up that topic and start reviewing it.” And you can’t take responsibility for something you can’t control.

You might argue, “Okay, well, that’s not really rumination because you’re not the one trying to control it,” but it has all the same words. You’re just lost in this thought of like, “Well, I know this thought must not be true because of this and that, plus my therapist said this and I read in a book, blah, blah, blah, blah.” You don’t know that you’ve left the building. You still think you’re sitting in the chair. But then, boom, you become aware. You suddenly remember, “Wait a minute, I’m a guy sitting in a chair, having a thought, and wait, I’m trying to figure out if my obsessions are true. Nope. Not going to do that. That’s rumination. Okay, good. Where was I?” Let it go.

But I think people can get very self-critical, really hard on themselves, and say, “I can’t stop thinking, I can’t stop ruminating.” In part, some of that is then taking responsibility for something that’s-- it’s just habit. It’s just the brain has been trained to just start revving up the engine. That’s all right. You’ll catch it earlier and earlier and earlier if you practice.

Kimberley: Right. Okay. Is there anything else that you feel we haven’t covered in this area? I mean, of course, we haven’t covered everything, but is there anything that you really want to drive home here in this conversation?

Jon: Well, I guess one thing that’s been on my mind is, we talk a lot about how thoughts aren’t the problem, right? If you’re being mindful, thought as a thought is a thought. And if you have mastery over your OCD, whatever, a thought about what day it is or a thought about hurting your baby, they’re just thoughts. It’s no big deal. And to some extent, that’s true. We don’t treat OCD by treating what thoughts people have. We address how they’re relating to those thoughts and what behaviors they’re choosing in response to that experience.

But in the interest of remembering self-compassion too, I think it’s important to recognize that it may also be the case that people with OCD are more predisposed to the average person to receive certain types of thoughts in a certain way. So even though those thoughts are normal events, it is normal for you to have thoughts about all of the potentials in human existence, all of the different things. We can kill and have sex with all of these things. It’s totally normal to have thoughts about them. But it might also be that when you have that thought, it hits you in a way that immediately generates an urge or a moral responsibility to address it.

And yes, mindfulness can help because it can help. You both recognize the arising of the thought as an object of consciousness and the arising of that desire to do something about it as an object of consciousness. But it’s also worth noting that it’s just hard to have OCD sometimes. And every once in a while, you’re just going to get sucker-punched by it. And that’s not because you’ve done something wrong, it’s because your brain is conditioned or wired to receive some thoughts in that way. And that can be something that you develop mastery over. But I think when we take all of the emphasis on behavior and none of the emphasis on perspective or predisposition, some people feel like they’re not being heard.

Kimberley: Yeah. Thank you for saying that. I think that that’s been largely the feedback I have gotten as well. If people are struggling and they don’t want to struggle, and they’re trying to navigate this thing, that feels like an absolutely crazy puzzle that, like you said, they don’t even have all the pieces. They don’t even have half the pieces yet. So I totally really loved that you said that. I love the idea of compassionate responsibility, which is, we can take responsibility for our experience with the absence of self-criticism. I think we sometimes think that owning this and experiencing this has to mean you have to beat yourself up and that it has to be like “You should’ve done better” kind of thing. But I do not like that.

Jon: Well, you’ve recently written a book on the subject, and I could go on and on about self-compassion. We could do a whole other episode on it. But I do want to end on this note, which is, a lot of what mindfulness means is simply being honest, and we often lie to ourselves about our experiences. We say, “I should have known better,” but when you look at it, there’s no way to have known better, that everything you’ve done is preceded by a thought or an urge or an emotion and we can track this back very, very far. I’m not making the case for no free will or not taking responsibility for anything. I’m just saying self-criticism is inherently dishonest. I say, “I’m a bad person.” That’s a story. That’s not an objective fact. I say, “I feel terrible.” That’s an experience. That’s honest and that’s also mindful.

Kimberley: Right. I love it. Thank you so much. I’m so grateful. I wanted to navigate all this, but I didn’t want to do it on my own. So, thank you for coming on and helping me because you’re just so good at explaining this stuff, and I really appreciate the way that you conceptualize this. So thank you.

Jon: Well, I appreciate you inviting me. I always love hanging out.

Kimberley: Yeah. Are there any projects or things you’ve got going on that you want to share with us?

Jon: Well, right now, we’re working really hard at The Center for OCD and Anxiety at Sheppard Pratt. We have some new team members and so we’re helping a lot of people that way. Not too long ago, we launched the residential program, the OCD program at the retreat here at Sheppard. We’ve had a few people come in and out of that program. It’s really exciting because it’s just a different way of working, working as a team on one or two cases at a time and seeing them every day. That dynamic is new and exciting for us. And then book-wise, the OCD Workbook for Teens is out there. The second edition of Mindfulness Workbook for OCD is out there. I just started working on a new one that I’m co-writing with a friend on how to combine ERP and DBT.

Kimberley: That’s fantastic.

Jon: Yeah. So, dealing with relentless thoughts and painful emotions.

Kimberley: Nice. That would be so important.

Jon: Yeah, I hope so.

Kimberley: Oh, without a doubt, DBT is such an important piece of the work, particularly when those emotions are really strong. So that’s super exciting. We’ll make sure all of those links to that are in the podcast notes so people can check that. Thank you again.

Jon: Thank you.

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Please note that this podcast or any other resources from cbtschool.com should not replace professional mental health care. If you feel you would benefit, please reach out to a provider in your area.

Have a wonderful day, and thank you for supporting cbtschool.com.

Welcome to Your Anxiety Toolkit Podcast. In this week's podcast, I want to talk with you about how I failed 100 times this year. Wait, What?!?! Yes, you heard right! In 2019, I made the goal to fail on purpose 100 times. The goal was to set my goals so high that I was forced to fail. And guess what? I failed 100 times. I possibly failed 1000 times. I failed so many times I lost count.
In this podcast, my hope is to share with you my personal experiment in changing the way that I feel and respond to the thought of failure. 

Here are examples of how I failed 100 times: 

•    I asked a lot of people to come on the podcast.  A lot of people said no.  I knew they would, but I figured it was worth a try.  But, do you know what I learned? I learned that a lot of people I didn’t think would say yes did.  

•    I took a course that was so hard and out of my line of skills and really struggled to complete it. 

•    I started playing the ukulele even though I was so afraid of being terrible at it (which I am). 

•    I pitched a book to a publishing company (more on this later). 

•    I said yes to being Room Mum for both of my kids (knowing I would not be the best at it).

•    I aimed to increase registration for ERP School and we did it. We reached the highest registration yet. 

But here is the thing. I also failed 100 times at things I never set out to fail at. I had to accept in many ways that I cannot push my body to do things that I simply could not do. This was the hardest part about failing. I had to stare my fear of failing at the easy stuff over and over again. 

Here are examples of how I not only failed 100 times, but gave myself permission to fail, even though it hurt so much. 

◆    Remember that course I told you about? I got so sick, I didn’t finish it. I had to drop out and this made me face imperfection and failure head-on.  

◆    I was a less than perfect therapist! I missed sessions with clients, and I double booked clients during times when I was so overwhelmed.   

◆    I gave myself permission to share the struggles I have had with friends. I was so embarrassed to do this, but I am so glad I did.  I learned that when you share your struggles, you actually feel more connected with the people around you.  

But finally, the most important example of how I failed 100 times is the decision I have made to take a month off of the podcast. After much consideration, I have decided to listen to my body and take the month of December to rest, rejuvenate and repair. I fought this decision for a long time, but I know it is what I need.

With that being said, I want to thank you for being so loyal and kind to me. I adore your support. I wish you a very Happy 2019 Holiday! I will be back in January, ready to go. Ready to fail! 

FREE anxiety video training! Learn how to become more intentional with the words you use to describe yourself, your experiences and your future.
Cbtschool.com/thinkwisely

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

SUMMARY:

Quite often, my clients forget to recognize avoidance as a compulsion.  While you might be spending a lot of time in your recovery reducing compulsions such as reassurance-seeking compulsions, behavioral compulsions, and mental compulsions, it is important to recognize that avoidance is also a compulsion.  In this episode, we address why it is important to address the things you are avoiding and find a way to incorporate this into your OCD treatment.

In This Episode:

• Why Avoiding your fear keeps you stuck in the obsessive-compulsive cycle
• What is an avoidant compulsions?
• How to manage avoidant compulsions?

Links To Things I Talk About:

• ERP SCHOOL
• Other podcast episodes about avoidance

Episode Sponsor:

This episode of Your Anxiety Toolkit is brought to you by CBTschool.com.  CBTschool.com is a psychoeducation platform that provides courses and other online resources for people with anxiety, OCD, and Body-Focused Repetitive Behaviors.  Go to cbtschool.com to learn more.

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EPISODE TRANSCRIPTION
This is Your Anxiety Toolkit - Episode 210.

Welcome back, everybody. I am so thrilled to have you here. How are you doing? How is your anxiety? How is your depression? How is your heart? How is your grief? How is your anger? How is your joy? How are you? How is your family? All things that I hope are okay and tender, and there’s a safe place for all of those things to be.

Today’s episode is in inspiration of a session I recently had with a client—a client I’ve seen for some time. We are constantly talking about safety behaviors, ways that we respond to fear. I had mentioned to him that of course, one of the safety behaviors we do are from fear, and in response to fear is avoidance. We avoid things. And he had said, “Oh, I completely forgot about avoidance. I completely forgot that was one of my safety behaviors.” Sometimes we put so much attention on the physical behaviors and the mental compulsions that we forget to check in on what are you avoiding and how avoiding things and fear keep us stuck. So, that’s what we’re talking about today.

Before we do that, let’s first do the review of the week. This is from Ks Steven, and they said:

“Short and sweet. This podcast is one of my highlights of the week. It is short, sweet and so helpful. I look forward to each new episode. Episode 99 on self-compassion has transformed my relationship with myself. As I start each day to face my obsessions, I remind myself it is a beautiful day to do hard things.”

I love that review. Thank you so much. I love that. It basically is exactly what I want this podcast to be. I want it to be short, I want it to be sweet, I want it to be helpful, and I want it to remind you that it is always a beautiful day to do hard things.

Before we get into the episode, we have one more part of the episode that we want to do, which is the “I did a hard thing,” and this is from Anonymous. They said:

“My husband and I have been going through infertility treatments for years. This year, we did IVF and it was triggering, maybe because it felt more “real.” I was panicking that I didn’t feel perfect enough since I struggled with some mental health issues earlier this year. I had the false narrative in my mind and major intrusive thoughts about not being a good mom, ruining my children, fearing postpartum mental health issues. I wanted to cancel our embryo transfer because of all of these intrusive thoughts and fears. But on Monday, I did it afraid and we transferred our embryo. We’ll find out next week if I’m pregnant and I’m so glad I did it.”

Oh my goodness, I cannot tell you how impressed I am. I wish nothing but joy for you. You did that hard thing, and I hope that however that turned out that you are standing by yourself and you are gentle and kind and reminding yourself that you never have to be perfect. Never, never, never. We are not meant to be perfect.

Okay, here we go. Let’s talk about avoidance. I mean, listen, that “I did a hard thing” is exactly what we’re talking about, so we’ll even use that as a reference today.

Fear is scary. Nobody wants to feel it. It’s not fun at all, and instinctually, we go into fight or flight, and flight is a normal human response to fear that has us avoid danger. Now, this instinctual response is what keeps us safe. If a bus is coming for you, you run off the street. That’s what we do. It’s the right thing to do. However, if you are using avoidance on repeat, and if you’re using avoidance to avoid the sensation of fear, not an actual current, real imminent danger, well then chances are you’re going to get stuck.

So I want to be really clear, if you are actually in physical danger, avoidance is not a compulsion. It’s not a safety behavior. But if you’re avoiding thoughts about things or you’re avoiding things because there is a small or a medium probability of something happening, or even maybe even a large probability in some situations, chances are in this case, you’re going to walk away quite unempowered. Because the truth is, life is scary. Life doesn’t always go well. Bad things do happen. It sucks to say, but it’s true. Bad things do happen. And so, it makes sense that we naturally want to avoid lots of things to avoid bad things from happening. But what happens when we do that is life starts to get really, really small. We have to be willing to take some calculated risk, and ideally, the calculating part doesn’t take too much of your time either because we can spend a lot of time ruminating about potential risks, probabilities, uncertainties, and so forth.

So what we want to do and what I want you to do when you’re listening to this and after listening to this is reflect on, what am I avoiding? Is the avoidance helpful and effective? Or is the avoidance impacting my ability to live my life? Is the avoidance impacting my ability to grow and thrive? Is the avoidance impacting my family and their ability to grow and thrive? That’s a big one, because sometimes our fears impact the people we love by no fault of our own. It’s not our fault, but we always want to check in on this stuff.

When you avoid, ask yourself, what specifically am I avoiding? Am I avoiding actual danger? Or am I avoiding fear or other sensations? Because if you’re doing the avoidant behavior to avoid sensations or an emotion or some thoughts, the problem with that is what you suppress often comes more, what you resist often persists. So even your attempt of avoiding it so that you’re not having to endure the discomfort often only increases the frequency and duration of the discomfort or the thought or the feeling or the sensation or the urge. And so, therefore, it’s not effective.

Some people avoid because they don’t want to feel humiliated or embarrassed. But the problem with that is, once we start avoiding, what often happens is people start noticing that you’re avoiding and then you end up feeling humiliated and embarrassed anyway.

So what I’m trying to show you here is, while avoidance does give you some pretty immediate relief, it often has long-term outcomes that aren’t that great that keep you stuck. As the “I did a hard thing” segment that we feature each week and as we see even in the reviews often or almost every time, people who face their fear, even though it’s so painful and so uncomfortable, they leave that experience feeling empowered. They leave the experience saying to themselves, “That wasn’t fun, but at least I know I can do it. Now I have proof that I can. Now I have proof that I survived it.” And with that comes powerful cognitive learning.

One of the best outcomes of ERP (Exposure and Response Prevention) is learning that you can survive really hard things. When we avoid that most of the time, the main thing we learn is when I can avoid bad things for you, but I can’t handle hard things. That’s what we really walk away learning. And our brain knows this. It’s keeping an eye on this. Our brains are very, very smart. They’re keeping track of this. And the more that we avoid, the more disempowered we feel and the more alert and hypervigilant the brain feels. “Oh, I avoided that. What else can I avoid? What else can I avoid?” So that next time you’re put in a situation where you can’t avoid, the chances are that you probably will panic even more.

Panic is a huge one for people where avoidance shows up. It’s a huge time where naturally of course—this is where I want you to practice compassion—you don’t want to have a panic attack. Of course, you don’t want to be uncomfortable. Of course, you want to avoid the discomfort because it’s not fun. No one wants to go through that. I don’t blame you. I do it myself. So we’re never going to be perfect at this. I wouldn’t expect you to be perfect at this. But there is this beautiful inquiry that we can deal with in ourselves or with a therapist or a loved one to go, “This isn’t working for me anymore. I deserve to live a life where fear isn’t running the show. So I’m going to choose to face this fear.” It is a fierce, compassionate action. It is a badass, shoulders back. “I’m going to show up for myself behavior and action.” It takes courage. It takes bravery. It takes a small amount of grit, I’m not going to lie.

But I really want today to be about reminding you that you can do the hard thing. You can ride that wave of discomfort. It will be temporary. It will be hard, but it will rise and fall on its own. And with repetition, if you can gift yourself with the repetition of facing your fears, not avoiding them, you will feel so strong. You will learn that you can tolerate discomfort, that you are able to get through hard things. And so, next time, when you have to do a hard thing, you’ll feel a little less afraid, or in many cases, you’ll feel a significant degree less afraid.

So, I’m going to leave you with that. Compassionately do an inventory on where avoidance shows up in your life. And then do your best to work through each and every one. This is what we do in ERP School. One of the first few modules is identifying what you avoid and then takes you through the steps of one by one by one. We’re going to face each and every one of those fears. You don’t have to have a therapist to do this. It’s ideal, but you don’t have to. We had an episode last week about people who do it on their own. It’s so cool.

So I want to really empower you to, number one, face your fears, but just always remind yourself, avoidance is a safety behavior or a compulsion as well.

All right, I love you. It is a beautiful day to do hard things. I believe in you. I really believe you. I really want you to understand that you have everything you need. It doesn’t have to be perfect. You don’t have to show up perfect. You can face your fears imperfectly and you don’t have to have it all figured out first, just give it a try. Throw yourself in there a little. Be kind. And I hope that this inspires you a little and reminds you that it is a beautiful day to do hard things.

I love you. I believe in you. I hope you have a wonderful day. I hope you’re being tender with your heart. I’m sending you all the love I have from my heart to yours. I’ll see you guys next week.

Welcome back, everybody. Today we’re talking about sleep anxiety relief. We’re talking about how to get a good night’s rest.

Oh, the beauty of a good night’s sleep. I can’t even tell you and I can’t even explain for me personally how much sleep impacts my mental health and my mental health impacts my sleep. Hence why we’re doing this episode today. 

For those of you who are new, my name is Kimberley Quinlan. I’m a marriage and family therapist in the State of California. I have a private practice. I am the developer of an online program called CBTSchool.com. I’m an author and I am the host of this podcast. 

A few weeks ago, a psychiatrist reached out and said, “I have been listening to you for years, not realizing that I work literally down the street from you.” It made me realize that I never introduced myself on the podcast. I just talk and talk and talk and I actually don’t tell people where I am and what I do and what I offer. So that was a really big lesson. 

Let’s talk about sleep anxiety relief. I’m going to tell you a bit of a story first. For years, my daughter has been telling us that she can’t sleep, that she has terrible sleep. She lays awake, staring at the roof. She said she always feels tired during the day and that she “can’t get to sleep” when she tries. We have taken her to the pediatrician and we’ve talked to her about it and checked in, “Are you worrying about anything in particular?” She says, “No, I just worry about getting enough sleep.” Again, she’s saying, “When will I go back to sleep? Will I go back to sleep? Will I wake up at night?” She says she struggles to get comfortable as she settles into bed. 

We took the plunge and took her to a sleep specialist and we were expecting either a sleep disorder diagnosis or a sleep anxiety diagnosis. He did this thorough assessment and asked her all these questions and he was incredible. At the end, he said, “I’m going to tell you, it sounds like you’re getting good sleep. You sound like you sleep very normally for a kid your age and we address some issues that may be happening.” But he said, “A lot of this is about managing anxiety about sleep,” because he tracked like, “You’re getting enough. We will track it during the night. Everything looked good. This is actually about you managing your mind around sleep.” Now I understand that may not be your experience, but this blew me off my feet. I was expecting serious bad news. I have this conversation with my patients so often and it made me feel like, let’s talk about sleep anxiety relief. 

SLEEP ANXIETY SYMPTOMS 

Now, before we talk about sleep anxiety relief, let’s talk about sleep anxiety symptoms because some people who don’t experience this or aren’t sure if they’re experiencing this, I wanted to make sure you feel like you’re in the right place. For those who have sleep anxiety, they experience a lot of anxiety around going to bed or when going to bed. They may report racing thoughts in bed, inability to concentrate when they’re preparing to go to sleep or they’re laying in bed. They might experience a lot of irritability, whether that’s emotional or physical sensations in the body. A lot of jitteriness. There may be also an experience of nervousness or restlessness. They may have feelings of being overwhelmed. Some people report this impending danger or doom as they approach the bed or as they approach bedtime. They may experience a lot of anticipatory anxiety about it. 

There are also some physical sensations or effects of anxiety before bed and that might include some tummy troubles. Kids in particular will report before bed, “My tummy hurts,” and often their tummy hurts is a sign of anxiety. This is true for adults too. They may have an increase in heart rate, which may make them feel like something bad is about to happen. They may have rapid breathing. They may experience sweating. They may experience tense muscles. They may experience trembling, even nausea. These are symptoms that could be your regular day-to-day anxiety, or it could be that you’re specifically managing anxiety related to sleep. 

IS THERE A CURE FOR SLEEP ANXIETY? 

When talking about sleep anxiety relief, often people talk about this idea of a sleep anxiety cure. Now, I’m not going to give you any specific “cure” today because I don’t know your exact case and you would need to be assessed by a doctor. I encourage you to go and see your doctor if you’re struggling with sleep because it is so important. If you need, go and get a referral for a sleep specialist or do some research. There are some amazing books on sleep as well. 

Now, do I consider that we can overcome sleep anxiety? Yes, 100%. I do believe you can get to a place where you have healthy sleep. Again, I’m always very cautious about talking about the word “cure,” but if we were to really address sleep anxiety relief in terms of what you need to practice, I’m going to first always do a ton of psychoeducation with my patients and with you today about sleep hygiene. 

WHAT IS SLEEP HYGIENE? 

Think of sleep hygiene as like, how clean your bedtime routine is. Clean, meaning has it got a lot of stuff that dirty up your sleep routine, or does it free up and clean up your sleep hygiene, sleep routine? I’m not talking here in terms of contamination. I don’t want to get that confused. It’s about making your bedtime routine something that is with ease, and even if there’s anxiety, it’s a routine that you follow and you are pretty consistent with it so that you can start to get better sleep. 

Now, how do we do that? First of all, I strongly recommend you first decide when you want to be asleep by or when you want to be in bed preparing to wind down. Pick an actual time. A lot of people miss this step. They just go, “Oh, I’m going to light candles and I’m going to read and hopefully, I’ll fall asleep when I want to.” That’s fine and that’s good. We will talk about that here in a second. But I’m going to strongly encourage you, pick a time you want to be in bed. And then from there, we work backwards. From one hour minimum, from the time you want to be in bed starting to wind down, you must turn off your tech. I know you want to turn off your podcast right now because you don’t want to turn off your tech that early, but I’m going to stress to you that your phone and your device are causing havoc on your bedtime routine unless you are using it for meditation, soothing music, something that actually deeply calms you. But I’m going to say a minimum of one hour, preferably two, you turn off your tech before that time that you picked. Let’s say you picked 10 PM. That’s the time I pick. All phones, technology should be off by 9:00 PM, even 8:30 or 8:00 is better. 

What you do during that hour is that’s when you start to do the wind-down routine or program. Now this doesn’t have to be compulsive, it doesn’t have to be exact to the minute, but what we’re talking about here is now starting to implement things that bring you to a place of comfort. I understand if you’re having a lot of anxiety, you might still feel it in every single part of the sleep routine. That’s okay, but you’re engaging in behaviors that don’t make your anxiety worse. You might be reading. However, if reading is something that makes you hyper-aroused in an anxiety way, maybe it’s not reading. Maybe it’s meditation, maybe it’s listening to an audiobook, not something that’s going to, again, rev you up and get you going. Something boring, something simple, something a little more monotone. It could be listening to sounds. There are so many free YouTube videos with just sounds of the waterfall or rain or birds or waves. If you have a specific sound that you like, I’m sure you can find it. These are all great options. 

You may also want to engage in a wind-down routine. This is my personal routine, you don’t have to follow it, but without too much being pedantic, I have a routine. I go downstairs. I brush my teeth. I floss my teeth. I wash my face. I then go plug in my devices. I go to bed. I get my Kindle out. I actually am fine with the Kindle as long as you’re not reading something too overwhelming because the lighting is different on a Kindle compared to an iPad that shoots light right into your eyes. I might take a glass of water. I make my bed actually before I go to bed. Meaning it’s pretty messy usually, so it’s something I like to feel like the covers are all neat on me. I then allow a wind-down. That’s just me. My husband doesn’t do any of that. He just brushes his teeth, goes to bed, and starts reading. Not that different, but for me, I have more steps. You can do whatever you think is helpful, but sleep hygiene has to be a piece and you have to work backwards by removing the technology. 

Some people say, “What about if I use my phone for my alarm?” That’s fine, I do too. However, if it’s in your room or it’s next to you, that’s fine as long as you can practice some restraint of not picking it up and going on social media because you can lose hours by just picking up your phone and opening up the Instagram app. You can lose hours. 

One thing I’m going to encourage you to do here is consider we have a course called Time Management for Optimum Mental Health and we talk all about scheduling. I’ll give you a little bit of information that I share during the Time Management course. I personally calendar a lot of my life and I have found that that has been very beneficial for my sleep. The reason being is because I have to wake up at 6:15 to get my kids to school. I used to get to bed whenever I could and then I realized I was massively sleep deprived. When I looked at the calendar and I thought, okay, if I have to be up at 6:15 and if I need a certain amount of sleep (I do better on eight hours), I have to be in bed asleep by 10:15. What am I doing? Going to bed at 10:30, I’m already setting myself up for failure. 

When you’re scheduling, you actually look at your wake-up time and you even plan backwards for that on when you need to be in bed. And then you plan backwards from that on when you need to work on your sleep wind-down program. Again, you don’t have to be pedantic, you don’t have to be too hyper-controlled on this. But doing it a couple of times is life-changing in realizing, at the way I’m going, I’m never going to get enough sleep.

SLEEP ANXIETY REMEDIES

Now, in terms of talking about sleep anxiety help or sleep anxiety relief, there are some additional sleep anxiety remedies you may say that may help you. Let me add here, there’s not a ton of research. I try to only bring research-based stuff to you. But a lot of people say things like oils or candles or deep breathing. I mean, we have research on deep breathing. It can be very beneficial. But you can bring in anything that soothes you, certain sense people love. I have a sister and family members who love those satin pillows. That really helps them. Just get a feeling for textures and sensations that also help you to wind down in the evening. 

SLEEP ANXIETY TREATMENT

Now, if you’re doing these things and you’re still really struggling with sleep anxiety and getting to sleep and insomnia, I would encourage you to look into some kind of sleep anxiety treatment. We do have science-based treatments to manage sleep anxiety or even chronic insomnia. One of those things is mindfulness training. In mindfulness training, what we are doing here is we’re training you to be able to get a hold of your attention. Because as you know, anxiety, if you really let anxiety lead the way, it’s going to ping-pong you to all the worst-case scenarios. It’s like what I said about my daughter. Will I fall asleep? Will I wake up? How long will it take? What if I don’t? 

A lot of people also report anxiety around, “I don’t like the feeling of falling asleep. I feel like I’m losing control or feel going to sleep is scary. I don’t know what’s going to happen.” If you’re someone who’s very hypervigilant, being asleep can actually be very triggering for you. 

Mindfulness trains us to stay present and not engage in all of that drama that our brain creates around all the possible worst-case scenarios. It also allows us to practice non-judgment about the anxiety and about the sensations that we’re experiencing, so we can just be present with them and practice. When I say practice, I mean over and over and over again because this is not easy. Practice being willing to be uncomfortable but keep our mind attending to the present instead of the worst-case scenarios. 

Another piece of this when we’re talking about sleep anxiety treatment is general stress management. Now, if you have an anxiety disorder during the day that also starts to leak into the evenings, particularly if you’re someone who has more anxiety in the evenings, you will need to use a lot of cognitive behavioral therapy to manage that anxiety. Or if you have a lot of stress in your life, maybe your work or your school or your relationships are very stressful in this season, CBT (cognitive behavioral therapy) can be helpful in first looking at your cognition—that’s the cognitive part of CBT—and then also looking at your behaviors.

Now, the cool thing is a lot of the behavior stuff, you and I have already talked about in that sleep hygiene piece. We know that the behavior of being on your phone is not helpful. In addition with sleep hygiene, getting a lot of exercise less than two hours before bed isn’t really great for sleep either because your body’s metabolism is all sped up from that. Those are some behavior changes. Not watching scary movies or very activating movies or books—reading those books is very important behavior changes, or having difficult conversations. 

For me, I have had to learn that if I work after about 7:00 PM, I can’t fall asleep. I need about three to four hours to wind down from work before I can fall asleep. Now that’s not always possible and I understand there’s a lot of privilege that goes with these ideas sometimes, but you just can do the best that you can, and if you can change things, go ahead and try. But those are some behavioral changes you can additionally do. 

Now, if you are somebody who struggles with severe insomnia, in addition to sleep anxiety, because sometimes sleep anxiety goes alongside actual insomnia where biologically you don’t sleep much or you can’t sleep much, there is a specific type of cognitive behavioral therapy that is being scientifically proven to help called CBT-I. That is a specific form of CBT that is directed towards managing sleep anxiety and insomnia. It is really cool, it’s very effective. It’s very hard to get treatment, but if you do some Google searches, you might be able to find a CBT-I specialist in your area.

GIVE ME SOME MORE SLEEP ANXIETY TIPS..

In general now, because I’m trying to move us through this and not give you a full-on lecture, let’s just talk about some general sleep anxiety tips. As you’re approaching bed, the first skill I want you to practice is not tending to the noise that your brain creates about how bad this is going to go. For me, my mindfulness mantra is “not happening now.” I’ve done a whole episode on that in the past, not happening now. Meaning I’m not tending to something that has not yet happened. Until it happens, it does me no benefit by trying to focus on it right now. My brain is going to keep saying, “But what if you don’t? What if it’s bad? What if you’re really tired tomorrow? How is it going to go? What if you wake up? What if you have a panic attack at night and so forth?” I’m just going to say over and over, “You know what, it’s not happening now. I’m tending to what is happening.”

Another sleep anxiety tip I really want you to practice is compassion. Be really gentle with yourself, particularly as you start to practice these behavioral changes, and clean up your sleep hygiene. It takes time. The other thing with compassion is also be kind to yourself when you’re tired because a lot of us are exhausted. You have an anxiety disorder. Maybe it’s making it even harder for you to fall asleep. Then you’re tired, so now you’ve got two problems. Be as gentle and kind as you can. Again, when it comes to self-compassion, check in with yourself. Am I doing and engaging in behaviors that are kind towards me and my long-term goal? I’ll tell you what I used to do. When I had young toddlers, by two o’clock I’d be exhausted because I hadn’t gotten enough sleep, so I’d have a coffee or a tea. But the tea and the coffee then prolonged how much I could get to bed, and it was made later and later. Again, reducing coffee, tea, some energy drinks is another important piece of sleep hygiene and behavioral changes that will benefit you if you struggle with sleep anxiety or insomnia. 

We have mindfulness, we have compassion. These are really important sleep anxiety tools or tips. Another piece here is, as I’ve said before, engage in things that soothe you. If you’re doing exposures, if you’re doing ERP, try not to do them before bed unless you’ve been instructed by your therapist. Sometimes that’s not helpful. Now, that being said, if you have really severe anxiety around sleep, you may need to do exposures around bedtime as the exposure. That is an actual part of CBT-I. Sometimes they even have you set alarms to wake up at 2:14 in the morning and 4:45 in the morning so that you have to practice these skills over and over. That is okay and that is, again, where this can be very paradoxical, but that will be up to you to decide what’s best for you. 

WHAT ABOUT SLEEP ANXIETY MEDICATION? 

Another thing to remember is that there is sleep anxiety medicine. You can talk with your doctor about medicines that can help with sleep, help staying asleep, help you regulate what time. Some people take medication a few half an hour before they go to bed so that it helps ease them into sleep. Please do speak with a psychiatrist or a medical doctor about that because I’m not a doctor, so I’m not going to be giving you medical advice about that. 

Now, before I wrap up, there’s a couple of specific groups of people I also don’t want to miss here. First, I want to address sleep anxiety in association with depression. Sometimes a symptom of depression is insomnia. If that is the case, you could use some of these skills and I encourage you to, but we don’t want to miss the fact that if depression is what’s causing your insomnia or your sleep anxiety, please seek out a CBT therapist because it’s very important that you address that depression. One of the side effects of having depression can be sleepless nights, so I don’t want to miss that. 

Another thing is, a lot of folks with OCD experience obsessions about sleep. Again, as I was mentioning before, it may mean that you do have to do some exposure around sleep and that would be advised to you because the best treatment for OCD is exposure and response prevention. We actually wrote an entire article about this on the website. If you want to go to KimberleyQuinlan-LMFT.com and then type in OCD and insomnia, it will be there. We did a whole article on that just a couple of weeks ago. 

>>>OCD AND INSOMNIA ARTICLE IS HERE<<<

That’s it, guys. That’s what I want you to be really looking at. Please remember, and this is the most important part, the biggest message that our sleep specialist gave my daughter was stop putting so much pressure on yourself to fall asleep because the pressure creates anxiety and the anxiety stops you from sleeping. The best sleep anxiety tip I can give you at the outset of this podcast episode is try to take the pressure off. The truth is, even if you’re not sleeping as long as you’re resting, that is enough. You can’t force yourself to fall asleep. It usually creates more frustration, more anxiety. It just creates a lot of irritability. 

Try to take the pressure off. Give yourself many weeks to get this down. It may take tweaks, it may take some reworking. You may require some help from people and assistance from a medical doctor if you need to. You can also reach out to a sleep anxiety specialist or an insomnia specialist who specialize in sleep deprivation anxiety or sleep deprivation in general. If you need sleep anxiety treatment, there are specific treatments out there for sleep anxiety in adults, children, and teens. 

If you’re wanting to come and work with us again, you can go to our website and we have some amazing therapists who can also help. My hope is, soon I will be bringing out some sleep anxiety-guided meditations for you as well. That’s coming down the pipeline here very soon. 

Please take the pressure off. Please be gentle. Just tweak little things. Again, as we always say, it’s a beautiful day to do hard, repetitive things where we practice and we practice. 

I hope that’s been helpful. I hope you do go on to have a good night’s rest here very soon. I will see you next week.

Am I doing ERP correctly? This is a common roadblock I see every week in my private practice. I think it is a common struggle for people with anxiety and OCD. Today, we will talk about the three common OCD traps people fall into and how you can actually outsmart your OCD and overcome it.

Now, when we're talking about Expsoure & response prevention ERP, we must go over the basics of ERP therapy, so let's talk about what that means before we talk about the specific traps that we can fall into. 

ERP is exposure and response prevention. It's a specific type of cognitive behavioral therapy and is the gold standard treatment for OCD to date. 

And it's a detailed process, right? It's something that we [00:01:00] have to go through slowly. It's a detailed process where we first identify OCD obsessions and OCD intrusive thoughts. So, you'll identify precisely the repetitive, intrusive, and distressing things for you. Once we have a good inventory of your OCD obsessions, we then identify what specific OCD compulsions you are doing now. A compulsion is a behavior that you do to reduce or remove your anxiety, uncertainty, or doubt, or any kind of discomfort that you may be experiencing.

And once we do that, then we can move towards exposing you to your fears. Exposure therapy for OCD involves exposing yourself to those specific obsessions. And then engaging in [00:02:00] response prevention, which is the reduction of using those compulsive safety behaviors. Now, common OCD response prevention will involve reducing physical behaviors, reducing avoidant behaviors, or reducing thought suppression. It's reducing reassurance, seeking, reducing mental compulsions, and in reducing any kind of self-punishment that you're engaging in to beat yourself up for the obsessions that you're having. Then we get you engaged back into doing the things you love to do; getting you back to engaging in your daily life, your daily functioning, the things that you find pleasurable, and your hobbies as soon as possible. 

That's the whole goal of ERP. Right? 

The important thing to remember here is that ERP therapy for OCD is greatly improved by adding in [00:03:00] other treatment modalities, such as acceptance and commitment therapy or mindfulness-based cognitive therapy, DBT, and medication. 

I should have mentioned medication first because most of the science shows that that's one of the most helpful to really augment ERP therapy for OCD. If you want to go deeper into that, I strongly encourage you to check out Exposure and Response Prevention School. I'll show you how to do all of those steps in ERP school, our online course for OCD.

You must know how to do those steps and that you're doing them in a way that's careful and planned so that we're not overwhelming you and throwing you in a direction that you're not quite prepared for; you don't have the tools for yet. And so today, I wanted to discuss three questions that come directly from people who've taken ERP school [00:04:00], and they're really trying to troubleshoot these three common OCD traps that OCD gets them stuck into.

So, let's get to the good stuff now. 

OCD TRAP #1: IF I DON'T ENGAGE WITH AN OBSESSION, AM I THOUGHT SUPPRESSING?  

What if I don't engage with an obsession? Am I thought suppressing? One of our listeners said, “I know what you resist persists. We talk about that in ERP school, but I also know that obsessive thinking and worrying can become compulsive. Is it possible I could be caught in both situations, and how common is this?” 

So I want to really be clear here in what we're saying when we say to practice ERP. So when you have an obsession or the onset of an intrusive thought or intrusive feeling, sensation, urge, it could also be an image.

When you have that,[00:05:00] you're old way of dealing may have been to try and push that thought away with some urgency and aggression.  We call that thought suppression and that's an avoidant compulsion, so yes. This student of mine is correct. That becomes compulsive, right? But we also know if we go into the obsession, try and figure the obsession out, give it too much of our attention.

We're also engaging too much with it in terms of using mental compulsions. That too is a compulsion. So we want to see that these two things can happen. But when we have the thought, and we observe that it's there the obsession, we've noticed it's there. Right? We talked about this in previous episodes of your Anxiety Toolkit podcast.

When you identify it's there and then you say, I am gonna let it be there and still move on. To what you love to do, [00:06:00] what you value that is not resisting it, that is engaging back into what you find important and effective, and valuable for your life. It's not avoidance, it's not thought suppression. Now, if you do that in a way where you're like, oh, I don't want that thought.

I want to engage in what I'm doing. Now you're crossing into that reaction being with . Urgency and resistance, and anytime we're doing anything in a sense of urgency and resistance, well, yes, it may be becoming a compulsion, right? And what we're talking about here, the way to manage this trap, right, is to find middle ground, and it often involves slowing.

Down being a little more thoughtful in how you respond, and that's often using mindfulness. We talk a lot about mindfulness here in your, your anxiety toolkit [00:07:00] in observing, okay, this is happening. I. I'm going to respond in a way without urgency, and I'm going to come back to what I'm practicing. That isn't thought suppression.

It's also not avoidance. It's also not doing a mental compulsion or ruminating. It's what we call occupation. You're engaging back into what you need to be doing. Right, which brings me right to trap number two, which is did I expose myself to the thought enough? 

OCD TRAP #2: DID I EXPOSE MYSELF ENOUGH TO THE FEAR? 

The fear, “Did I expose myself enough to my fear?” and, “if I dont engage with an obsession, am I thought suppressing? These are two very close obsessions. But, there's a nuance difference that I want to ensure we address here.

So the student says, right now when anxiety sets in, I divert my attention to something else to focus on my values. Beautiful. Right? Then usually anxiety will wear off pretty quickly and I choose to move on. The problem is what happens next? So, so far this is beautiful. [00:08:00] Just like what we said they go on to say, my mind immediately points out the fact that I didn't quote, unquote, savor the anxiety or look it in the eye, right?

And that they're doing that to prove they're not scared of it. Or that they can they can tolerate it, right? And so they go on to say, “OCD accuses that my diversion wasn't in fact occupation or being functional and effective, that it was avoidance and, and that I'm avoiding to deal the anxiety feeling that I have. And they then go on to say, this makes me more scared of the intrusive thoughts in the long run.”

So, if we were to break this down, this person had a thought, they responded really effectively. But then, this is the trap. OCD will usually tell you there's a way you're doing this wrong or there's a way that there's an additional thing you haven't addressed yet.

It usually [00:09:00] is like you who I have more to say, have you thought about this? Like it's saying, you know, there's other things you should be worried about. And in this case, they have dealt with it really beautifully. But then OCDs come in and said, no, you didn't look at it long enough. You didn't face it enough.

If you don't face it enough, well then you're gonna keep having this anxious feeling in the long run. And really in that situation, all we need to do, I. Is practice exactly the same tools we use with the first obsession, which is to go maybe, maybe not, but I'm not tending to you. I'm not trying to make this perfect.

I'm going to move forward with what I am going to do and allow the uncertainty that I may or may not have anxiety about this in the future, or I may or may not have looked my fear in the face enough, right? Remember here that O C D. Is always going to try and bring you back into doing [00:10:00] a compulsion to try and get that uncertainty.

And your job is to catch the many ways OCD consistently pulls you out of using effective behaviors and tries to get you to use compulsions. If you can find those trends, you can identify them as, okay, we know what to do when they come.

When it tells me I'm not doing it enough, or I'm not looking at my fear enough, or I'm avoiding it, or whatever, you can go, I'm not tending to that. I'm moving back to my values. Right. Which beautifully now brings us onto the final trap, trap number three, which is, how do I know I'm doing ERP correctly?

OCD TRAP #3: HOW DO I KNOW IF I AM DOING ERP CORRECTLY?   

People often ask, “How do I know if I am doing ERP correctly?” This is a very common one. In fact, I have consulted with dozens of different OCD therapists, including the ones in my private practice. For those of you [00:11:00] who don't know, I have a private practice in Calabasas. We have eight incredible licensed OCD therapists. We are constantly consulting on this kind of question or these traps in particular, and it's often around, how do I know I'm doing this right?

And it makes sense, right? If you're doing ERP therapy, you want to get better, you're here to get the job done, and you want your life back. You're not putting in all this time and paying all this money and investing your valuable resources, um, to just . Have a good time and waste it, right? You're here to get better.

And so it makes sense that you're going to have some anxiety about how well you're doing it, and you're obviously wanting to do it well, like you're someone who is thorough and is invested, so it makes sense that you're going to have this fear. But this is the thing to remember. This is another trap of OCD to try and get you to go back to rumination, right?

To try and figure something out. [00:12:00] Here is the facts. No one does ERP correctly. You are going to do ERP, and you are going to fall and you're going to try again, and you're going to fail again, and you're going to try again, and you may fail again. That is a normal progression of ERP. I tell my patients all the time, you're not backsliding.

Nothing is particularly wrong right now. This is just the normal progression that we get better over time. Just like when we're learning to walk. You stand up, you fall down. It's not like you say, I'm not able to walk, I'll never be able to do it. You get back up, you walk three steps, you fall down, then you get back up, you walk five steps, you fall down.

That's normal, right? We are not going to say to a young baby like, oh, you're not walking correctly. You know, this is bad. You're never gonna be able to walk because you're not walking correctly. No, we're going to say to them, keep going, keep trying. Just keep trying. And with time, those muscles will strengthen.

And you'll be able to stand up and do this work a little longer each time, but do not fall into the trap [00:13:00] of O C D telling you it has to be done perfectly and you have to do mindfulness correctly, and you have to do response prevention correctly, and you can't do any thought suppression or you'll never get better.

That is another trap, and your job is to say, good one, OCD. Thank you for your input, but I'm still over here with the focus of not trying to engage in rumination and trying to get certainty, but to, to move towards my values, to allow fear to be there imperfectly, right imperfectly, knowing that it won't be perfect every time.

You may engage in some compulsions. I'm going to keep saying that that is not particularly a problem. Right. Especially if as you're doing it, you're using your tools and you're doing the best you can, try to just focus on doing one minute at a time and doing it as you can. And we're not here to do it perfectly.

Right? And at the end of the day, if you're someone who struggles [00:14:00] with this thought, like, am I doing it correctly or am I doing it perfectly? You can just say, “Maybe I am. Maybe I'm not. I'm also not getting caught in that trap.” 

So I hope that that has been helpful to really get to know these traps.

And for you, it mightn't be specifically these three common traps. It may be something a little different. That's okay. Your job is to catch these trends, the things that keep pulling you back into rumination, pulling you back into avoidance, pulling you back into reassurance-seeking, and identify them. Come up with another plan.

Again, if you need more help with this, you can use E R P school. It's an online course. It's on demand. You can listen to it and watch it as many times as you want in your PJs. It's there for you to troubleshoot these issues. We have a whole bunch of modules talking about how to troubleshoot these issues, but I wanted to do this publicly because I knew

A lot [00:15:00] of you who don't have access to care are probably struggling with the same thing. So that's it for me today. Thank you so much for being here. I love talking with you about the nitty gritty of how this can, you know the real hard stuff and I hope it's been helpful for you. Please do remember, and I say this at the end of every podcast episode, you know I'm gonna say it.

It is a beautiful day to do hard things. 

Do not let society tell you that you're weak or that you're not supposed to. And it should be easy because that's not real life. I know it's hard to accept that, but we can shift this narrative to a narrative where we can do hard things. We can see ourselves as strong.

We can see ourselves as courageous, and we will do the hard thing because in the long run, we build resilience and freedom that way. Have a wonderful day, everybody, and I can't wait to see you next week.​[00:16:00]

9 Ways to Stop Picking Your Skin This Summer

As summer approaches and the weather gets hotter, many of us are eager to wear shorter sleeves and enjoy the sun. However, this often leads to increased skin exposure and, unfortunately, a greater temptation to pick at our skin. In today's article, we'll explore nine strategies to help you stop picking your skin this summer. These tips have been helpful to many of my clients, and I hope they will be just as beneficial for you.

Understanding Skin Picking

Before we dive into the strategies, it's important to understand what skin picking is. Clinically known as dermatillomania, skin picking is a type of body-focused repetitive behavior (BFRB). People with this condition may pick at their skin, arms, lips, scalp, nails, and even more sensitive areas like the pubic region. It's similar to trichotillomania, which involves hair pulling.

It's crucial to note that skin picking and hair pulling are not forms of self-harm. People who pick their skin are not trying to hurt themselves or seek attention. They often do it because they are either understimulated (bored) or overstimulated (anxious or overwhelmed). Understanding this can provide insight into the strategies we'll discuss.

Strategy #1: Awareness Logs

Awareness logs are a powerful tool in any stage of recovery. By logging every time you have the urge to pick, noting how much you picked, where, and for how long, you gain a better understanding of how this condition impacts your life. Many people find that having to document their behavior reduces the frequency of picking.

Awareness logs are a key component of habit reversal training, a cognitive-behavioral therapy technique specifically designed for BFRBs.

For more information about BFRB School, our online course for skin picking and hair pulling, CLICK HERE

Strategy #2: Keep Your Hands Busy

Engaging in a competing response can help divert your urge to pick. Competing responses might include using fidget toys, holding a stone, or playing with soothing textures. You can find many affordable fidgets online or at dollar stores.

Create a basket of tactile items that you can use to keep your hands busy. Place these items around your house, in your car, and at work to ensure they are easily accessible when you need them.

Strategy #3: Create a Skincare Routine

A good skincare routine can help prevent irritation and dryness that might tempt you to pick. However, it's important not to overdo it, as too much attention to your skin can also trigger picking. Consult with your doctor to develop a routine that keeps your skin healthy without exacerbating your condition.

Strategy #4: Use Physical Barriers

Using physical barriers (called habit blockers) like gloves, band-aids, or long sleeves can prevent you from touching and picking at your skin. Some people find that keeping their nails short or wearing fake nails can reduce the tactile satisfaction of picking. Identify what works best for you and use these barriers consistently.

Strategy #5: Self-Compassion

Practicing self-compassion is vital. Beating yourself up for picking only increases negative emotions like shame and guilt, which can lead to more picking. Instead, practice radical acceptance and reduce self-criticism. This approach can help you feel more motivated and improve your overall well-being.

Strategy #6: Manage Stress and Anxiety

Managing stress and anxiety is crucial, as many people pick their skin to cope with these feelings. Cognitive-behavioral skills can help address faulty cognitions and behaviors that exacerbate stress. Consider taking an online course, like Overcoming Anxiety and Panic, to learn effective stress management techniques.

Strategy #7: Establish a Support System

Having a support system can make a significant difference. Whether it's family, friends, or online support groups like those at BFRB.org, having people to check in with can help you feel less alone and more accountable. Some people find it helpful to text or call a support person when they feel the urge to pick.

Strategy #8: Stay Hydrated and Healthy

Good nutrition and hydration can impact your skin's health. Speak with your doctor about how to maintain healthy skin through diet and hydration. Additionally, consider looking into over-the-counter medications like N-acetylcysteine, which has been shown to help with skin picking. Always consult with your doctor before starting any new supplement.

Strategy #9: Set Realistic Goals and Track Progress

Set achievable goals and track your progress. Instead of aiming to completely stop picking, focus on gradually reducing the behavior by a small percentage each week. Tracking your progress helps you see improvement and identify what strategies are working. Remember, small steps lead to significant changes.

Conclusion

These nine strategies can help you stop picking your skin this summer. Whether you use awareness logs, keep your hands busy with fidgets, or establish a support system, each step you take brings you closer to managing this behavior. Remember to practice self-compassion and set realistic goals. If you need additional support, consider enrolling in courses like BFRB School or Overcoming Anxiety and Panic.

Transcript

Today we’re going to cover nine strategies to stop picking your skin this summer. It’s getting hotter. You want to start wearing shorter sleeves or have your skin exposed to the sun more often, which means you’re more likely to start picking at your skin. Let’s talk about nine strategies that you can use right away. Hopefully, you find them as helpful as my clients have.

Welcome back. I am so excited to talk with you about nine strategies and skills that you can use to stop picking your skin this summer. But before we do that, let’s just first do a little deep dive into what skin picking is. Clinically, we call it “dermatillomania,” and it’s a kind of body-focused repetitive behavior. Often, people with skin picking will pick out their skin, their arms, their lips, their scalp, and their nails. There’s really no limit to where someone can pick their skin. Some people even pick pubic areas under their arms or around their genitals. There is, as I said, no off-topic area that people will pick. It’s completely normal for people to pick in one or all of these areas. It’s similar to a condition called trichotillomania, which is hair pulling. Again, hair pulling is another type of body-focused repetitive behavior, and people may pick at any area where there is skin on their body.

It is important for us to first highlight that skin picking and hair pulling are not self-harm. People who pick their skin aren’t trying to hurt themselves. They’re also not trying to just get attention. They do not want to be damaging their skin or giving their skin abrasions and such. It’s just a part of a condition, and we have a little bit of insight as to why they’re doing it. Often, people with skin picking, or dermatillomania, are skin picking either because they’re understimulated, they’re bored, or we know they may be overstimulated. Maybe they’re very anxious, they’re feeling hyper-reactive to feeling overwhelmed with either emotions, stimulation, or thoughts. We do know that people who engage in this skin-picking behavior are more likely to pick either when they’re overstimulated or understimulated. That’s something to think about, and there is a clue there into some of the strategies that we’re going to use today.

Let’s get to it. Let’s start talking about some of the strategies that you can use to stop picking your skin this summer.

Strategy #1: Awareness Logs

Awareness logs can be so helpful at any stage of recovery. An awareness log is either a piece of paper or a document on your computer or on your phone, where you log every time you have the urge to pick your skin, how much you picked your skin, where you picked your skin, and how long you engaged in skin picking. What this does is, number one, it helps us really understand to what degree this condition is impacting your life. Secondly, people often report that when they have to document it, they’re less likely to engage in the behavior because nobody wants to have to spend all their time logging it as something they don’t want to deal with.

Awareness logs can be a very helpful skill for us in understanding our own condition and our own symptoms, and in addition, they can help us with motivation to slowly reduce this behavior.

Awareness logs are something we use in a very well-known and researched way of using cognitive behavioral therapy, and the type of therapy is called habit reversal training. It’s the specific modality that we use for skin picking and hair pulling, and it is a key component of that cognitive and awareness work.

Strategy #2: Keep Your Hands Busy

Now again, when we’re using habit reversal training, we engage in something called a competing response. A competing response is a behavior that competes with the feeling of picking our skin. Now, a competing response might be fiddles or fidget toys. It could be holding a stone or maybe stroking a feather. It could be playing with other fidgets that we have. The cool news is that you can get so many fidgets online these days for a really low price, or you could easily go to your dollar store and look around for textures that feel beautiful to you, feel soothing to you, or help you with either the understimulation or overstimulation.

What we want to look for here is, what are the specific tactile experiences that you can use to keep your hands busy? We actually have an online course called BFRB School, which is a specific course for people with hair pulling and skin picking, using skills like habit reversal training and cognitive behavioral therapy. We talk all about the core importance of using competing responses.

I often tell my patients and my students to always have a bucket or a basket in the house of different tactile experiences, different tactile things that you can play with objects, so that at that moment, if you’ve identified in your awareness log that you’re feeling bored, you can engage in something that stimulates your creativity, stimulates your awareness. However, if you’re the opposite and you’re feeling overstimulated, you might dig into the basket and find something that’s quite soothing. Maybe it’s more like a silly putty, a gel, or something else that’s more soothing for you.

These competing responses are going to be so important for you in getting very clear on what you need at that moment and having it readily available. I often say to my patients and my students, don’t just have it in one area of the house because, in that moment, you’re still going to want to just pick your skin. What we prefer to do is to have little pieces over the house, in your car, or in your office so that they’re easily accessible. Some people have it on their key rings, some people have it in their purses—whatever works for you.

Again, that awareness log will help us identify specifically where you are when you’re having these urges to pick your skin. And then we can put in competing responses to compete with the skin-picking behavior.

Strategy #3: Create a Skincare Routine That Helps You

This is a little bit of a fine line, though, because we don’t want to engage in a skin routine that has you putting too much attention on your skin because, again, too much attention on your skin is going to mean that you’re more likely to pick your skin. However, we also want to make sure that we are not ignoring your skin, letting it get really dry, especially in the summer. Maybe you’ve had a sunburn or such, and you’ve got some wind chafing or something.

Again, if you have any irritation on your skin that isn’t taken care of with a skin routine, you are more likely to pick at that skin, especially if there’s already an open wound or a scab. If you already have an open wound that you’ve scratched or maybe you bumped into something and you’ve got a little scab there, we want to make sure that we’re engaging in a really healthy skin routine to help that heal and repair so that you’re less likely to go and pick that. I would encourage you to speak with your medical professional about skincare and what would be best for you. Maybe you have a skin condition. Very commonly, people with skin picking do. Speak with your doctor about a skincare routine that will help your skin picking but not be so extensive that it actually makes it worse. I would trust that your doctor will be able to help you in that area.

Strategy #4: Use Physical Barriers

Again, going back to the gold standard treatment for skin picking, which is habit reversal training, we use what we call a habit blocker. This is something that blocks you from the habit of picking, and this can involve anything that stops you from being able to touch your skin.

A lot of patients and students I have had have used things like gloves or band-aids to cover an area that they’re likely to pick. Maybe in the summer, they may wear longer sleeves even though it’s very hot because that actually stops them from getting to the area that they feel an urge to pick. You may also want to keep your nails really thin or cover your nails. Some people keep nails on, like actual fake nails, as a barrier to being able to touch the skin. Maybe it doesn’t give them that same tactile feeling of picking when their nails are medium-length.

What we want to do here is identify for yourself the specific barriers that are helpful. The thing to remember here about skin picking is that everyone is different. Not one strategy that I’ve used for one client is going to be the strategy we use for another client. It’s going to be very much dependent on those awareness logs that you logged out of in that first strategy. Getting clear on specifically what are the triggers that cause you to pick your skin and what specific behaviors and habit blockers are helpful to reduce the skin picking that you feel the urge to engage in.

Strategy #5: Self-Compassion

We have to engage in not beating yourself up, not judging yourself, not punishing yourself if, in fact, you have picked or recently picked despite all of these strategies. Beating yourself up actually does not motivate you to stop picking. In fact, it usually brings up more emotions such as shame, guilt, sadness, anger, and humiliation. Those emotions can send us into overstimulation, making us want to pick again.

Again, we want to engage in a practice of self-compassion. We want to engage in a sense of radical acceptance of ourselves, whether we pick or not. This is so important because we want to reduce our suffering, not make our suffering higher. We do find that people who practice self-compassion tend to have higher levels of motivation, decreased levels of procrastination. They tend to feel better about themselves and have higher self-esteem. They’re more likely to get out there and do the things that they love. Every moment that you’re engaging in in your life is a moment you’re less likely to be picking. It’s very, very important that you practice a self-compassion routine, even if it’s once a day. Anything is better than nothing to reduce that self-criticism where you can.

Strategy #6: Manage Stress and Anxiety 

I cannot stress this enough. It is so important when it comes to skin picking that we manage our stress. Again, a lot of people pick their skin because it is a way in which they can manage their stress. A lot of people with skin picking say once they start picking, they can exit out of reality and go into a trance-like mode where everything disappears and they feel relaxed and in the zone, and it takes away all of the stress. We can now understand why there is actually an urge and a pull towards picking and pulling, because who really wants to stay in stress and anxiety? Of course, it makes total sense. The more we can manage our stress using strategies, skills, and other tools like cognitive behavioral therapy, the less likely we are to use skin picking as a coping strategy.

When it comes to managing stress, again, the most important thing we’re going to do here is what we call cognitive behavioral skills. It’s going to be taking a lot of our cognitions that might be faulty, leading us to have more anxiety, and also looking at our behaviors and the things that we do that may be actually exacerbating the stress and anxiety that we experience.

If you’re someone who struggles with anxiety and stress, I strongly encourage you to check out our online course called Overcoming Anxiety and Panic. We go through all of these steps. You can do it from home, and it may help you to get an idea of what might be some of the things that are triggering your stress response, triggering your anxiety response so that you can manage that, so that then you can move on to manage your skin picking as well.

Strategy #7: Establish a Support System

We want to have a community of people who can support us as we go through these steps. It’s not an easy thing to overcome skin picking, so I really want to encourage you to find a support system, whether that be family or friends, or you can go to BFRB.org. They have a whole array of online support groups that you might be interested in looking at to get support, so you feel like you’re not alone and that you have the support that you need.

Another option here is to also look for accountability bodies. Somebody who mightn’t even have skin picking. They might be a loved one, a friend, a parent, or a sibling—someone who you can check in with when your urge is really high.

A lot of my students have said that it’s been very helpful when they have the urge to text somebody and say, “I have a strong urge. I’m texting you to let you know.” They may have already set up a plan on what to do. Maybe they jump on a phone call together, they might text each other throughout it to help the person ride that wave of the urge. Or maybe that person might encourage them to say, “Hey, you told me to remind you of this one thing if you have this urge.”

Really, the importance of a support group can help you, or a support person can help you not only with feeling less alone, not only with beating yourself up, but also with putting these strategies into action, especially if you let them know about the strategies.

Strategy #8: Stay Hydrated and Healthy

Now again, I’m going to encourage you to speak with your medical doctor about this, but I just wanted to mention because I try to look at you as a holistic, full person, someone who’s not just your skin picking, but also, we want to have a look at things like your health. Take a look at your nutrition. Take a look at your hydration levels.

Again, these things can impact our skin. If, let’s say, you’re having a lot of nutrition that’s causing a lot of breakouts and you’re someone who’s prone to skin picking, those two things together could become a disaster. You want to speak with your doctor or a professional in that area about specific nutrition, things you may want to avoid eating, and how hydrated you need to stay to keep your skin healthy, to reduce the chances of you wanting to pick and pull.

A lot of patients I see, and a lot of students that have come through BFRB School, our online course for skin picking, have reported having skin conditions, acne, or certain things that have impacted how much their skin is irritated, how many pimples they’re having. Now, I’m not assuming that nutrition and hydration are the solution to all of that, but I would encourage you to speak with a doctor and just inquire about what you could do to make sure we’re addressing those skin conditions.

Another thing to know here, and this is like an inside scoop, is that there are specific over-the-counter medications you can get that have been proven to help with skin picking. I’ll leave a link in the show notes for you to take a look, but there is a vitamin that’s called N-acetylcysteine. It is an over-the-counter medication that has very few side effects and has been shown to help people with skin picking. Now again, I’m not a doctor. I would strongly encourage you to speak with your doctor about that, but again, I’m trying to give you as many resources today as we can to help you get to the goal that you want. These are all things that you can take a look at and speak to your doctor about.

Strategy #9: Set Realistic Goals and Make Sure You Track Your Progress 

We want to set realistic goals. I always tell my patients at the beginning of treatment that the goal isn’t to completely stop skin picking, even though most people are coming for that goal. Because what I have found is, when you set that huge goal, it sets you up to fail. It makes you feel so bad if you slip. It makes you feel so much pressure. It’s such a scarier experience than if you say, “Hey, I’m just going to reduce this by 3 to 5 percent each week,” or month or day, whatever is right for you. We want to set realistic goals—goals that can help keep you motivated and goals that make you feel like they're achievable.

We also want to track progress. One of the most important parts of treatment, once we’ve done that first awareness log—and we do this in BFRB School, I do it with my patients as well—is that once we’re off and running, we then track how well we’re doing. How well did you use your tools? What tools didn’t work? How long did you pick for? Where were you? What went wrong?

We are not doing this to beat you up or to scrutinize you; we are doing it from a place of experimenting, gathering information to know specifically what’s getting in the way of your recovery and what your progress looks like. Some people may say, “I’m not making any progress,” but when we actually look at their logs, we’re starting to see progress in these small ways. Remember, small steps lead to medium-sized steps. Medium-sized steps lead to huge changes.

The last strategy is probably the most important. I could have spent a whole podcast episode talking about that. It’s about setting realistic goals and tracking your progress.

Again, if you are struggling with this and you want to take BFRBSchool.com, head on over to CBTSchool.com. You’ll get access to it there. It will take you through all of these steps. We also have modules on self-compassion, mindfulness, and healthy lifestyles that can really help you with this recovery as well. I’d strongly encourage you to consider that as a hopeful strategy as well.

All right, guys, thank you so much. These have been the nine strategies to help you stop skin-picking this summer. I hope you found it helpful, and I’ll see you next week.

Jeremy Quinlan Talks About Panic Disorder and Choosing to Embrace Panic

Welcome back to another episode of Your Anxiety Toolkit Podcast.  Today we have a very special guest.  For me, this is THE most special guest, because this week I had the honor of interviewing my husband about Making the Choice to Embrace Panic.

In this episode, Jeremy tells the story of his Panic Disorder, how panic took so much from him and how he made the choice to embrace panic, instead of run from it.  

I have wanted to record this episode for the longest time, but life, work, family and business always got in the way.  But, on a beautiful spring day, we both sat down while the kids were at school in our lounge room and recorded his story.  

Together, we talked about the fear of flying and how this caused him to exit off many flights in a state of panic.  We also talk about his fear of driving on the highway, fear of getting on elevators, fear of getting on a train or a trolley or a taxi cab, etc.  We also got very deep into the experience of panic disorder and what it felt like to have a panic attack.  Jeremy described his specific experience of panic and how it made him fear he would hurt someone or lose control of his body.  

What I loved the most was how he shared his bumpy journey to recovery.  Jeremy carefully describes what that journey with panic felt like and how he made an intentional decision to “choose life” over running from anxiety, panic, and dread.  He addressed how he came to a place where he could see that he had only two choices: choose to embrace panic or to keep running and let it take over his life. 

I am so excited to share this episode with you, CBT School community.  I hope he inspires you as much as he inspires me.  

Welcome back, everyone!

Welcome back to the Series on Problematic Anxiety-Related Behaviors.

Today, we are talking about Mindfulness-based tools to help with Reassurance Seeking.

For those of you who don’t think this topic applies to you, stick around a little.  You might find that you are employing this behavior, even in slight and tricky ways.

As mentioned in the last episode, there are behaviors that you can reduce, which will result in better outcomes when it comes to anxiety.   Last Week we discussed Avoidance and how this compulsion only makes fear worse.   This week, as we mentioned, we are discussing Reassurance Seeking Compulsions.

So, What is Reassurance Seeking?

Before I give a definition, let me give you some examples and you can see if you resonate with any of these.

Am I doing this right? (Common in Perfectionism)

Did you turn off the stove? Did I turn off the........ (Common in Obsessive Compulsive Disorder)

Are you sure everything will be ok?

Do I look ok? (Common in Body Dysmorphic Disorder, Eating Disorders)

You still love me, right?

Do you think I will fail this test? (Common in Perfectionism)

Do you think I hurt their feelings?

Do you think they are mad at me?

Don't get me wrong.  These are questions that I would consider “appropriate” questions.

However, the problem lies in their frequency and intention.

If you find yourself asking questions repetitively, or you find yourself asking these questions when you know they don’t have the solution/answer, it is probably Reassurance Seeking.

Also, if you find yourself asking these questions when you could be finding the solution yourself, this could be Reassurance Seeking.

And lastly, if you find yourself attempting to find certainty in a situation where there is little to NO certainty, this podcast is for you!

Reassurance Seeking is an action of removing someone's doubts or fears. Reassurance seeking is very common (and problematic) behavior in Anxiety Disorders such as OCD, phobias, panic disorder, Generalize Anxiety Disorder.  It is also common in Body Dysmorphic Disorder and Eating Disorders.

That being said, it applies to us all, in our management of our own anxiety.

The goal is to recognize that we must not reach outside ourselves to remove our doubts and fears.   

Drawing other into our anxiety usually only makes it messier and creates a dynamic where you feel reliant on them to manage your anxiety.   

Also, Reassurance Seeking complicates relationships and can backfire.  People may not give you the response you were looking for and cause you to have even more anxiety.

Often clients report that their partner sometimes is very supportive and answers their questions very well, but over time, then the partner gets annoyed and then it creates friction.  Does this sound familiar?

The goal is to acknowledge your own fears as they arise, either allow them to simply be there using your mindfulness skills or work through them on your own.   

Remember, treat your fears the way you want your brain to interpret them in the future.

In This Episode:

• How to identify what your role is in a relationship
• How to manage a mental illness and set boundaries
• How boundaries are needed when you are in recovery
• How to set boundaries with a loved one during the holiday season.

Links To Things I Talk About:

ERP School: https://www.cbtschool.com/erp-school-lp

Episode Sponsor:

This episode of Your Anxiety Toolkit is brought to you by CBTschool.com.  CBTschool.com is a psychoeducation platform that provides courses and other online resources for people with anxiety, OCD, and Body-Focused Repetitive Behaviors.  Go to cbtschool.com to learn more.

Spread the love! Everyone needs tools for anxiety...

If you like Your Anxiety Toolkit Podcast, visit YOUR ANXIETY TOOLKIT PODCAST to subscribe free and you'll never miss an episode. And if you really like Your Anxiety Toolkit, I'd appreciate you telling a friend (maybe even two).

EPISODE TRANSCRIPTION

This is Your Anxiety Toolkit - Episode 215.

Welcome back, everybody. It is the final episode of Your Anxiety Toolkit for the year 2021. I will not be putting out a podcast next week because it falls right on the holidays, and I really wanted to make sure I give you all time to be with your family instead of listening to my voice. If you are in the holiday season and you want to listen to my voice, there are so many, in fact, there are 214 episodes. You can go back and listen to. I just want to be with my family, and I want you to be with the people you love.

Speaking of people you love, today we’re talking about setting boundaries with loved ones or managing our relationship during the holidays. However, I did a whole episode about this last week. You can go back. It’s episode 214, where we talk about holiday anxiety. We did discuss some of this there as well. So, you can go back and listen there. But for right now, I want us to talk about managing relationships, specifically during the holidays, but this episode can be applied to any old day of the week.

Now, before we get started, we always do the “I did a hard thing.” This one is from Rachel. We do an “I did a hard thing” to motivate you, to remind you that there are more people out there going through what you’re going through. You’re not alone. Rachel shared with us today:

“I have somatic OCD.” For those of you who don’t know what that means, it means that you have OCD about specific sensations that show up in your body. You sometimes feel like you can’t stop noticing them or you’re afraid you will never stop noticing them. Sometimes you’re afraid that the feeling will never go away and it can feel really disorienting.

So, Rachel says: “I have somatic OCD, and I always need to distract myself not to notice them. I’ve been able to drive without the radio or calling anyone and it feels so good.”

Rachel, this is so good. You’re doing what we talk about in ERP School. ERP School is our online course that teaches how to expose ourselves to fears, specifically obsessions for people with OCD, health anxiety, and these types of OCD, like somatic OCD, on how to practice facing our fear. In this case, it was her driving, that without using safety behavior or compulsions. So, in this case, the compulsion would be to have the radio on or calling someone to distract her on her somatic obsession or her sensation. So, Rachel, amazing job, you’re doing the work. You’re doing the exposure and the response prevention.

One thing I want to mention to everybody, if you have OCD or an anxiety disorder, is we must do both. We must face our fears and not do the safety behaviors to reduce or remove that discomfort that we feel when we face our fear. So, you’ve explained this perfectly. Congratulations. I am so proud of you. Love getting the “I did a hard thing’s” from you guys. And so, just so thrilled to get that message from you.

All right, let’s go over to the episode.

It’s the holidays. You’re anticipating the gifts and the food and the time and the travel and all the things, but what’s worse than that is anticipation of the interactions that you’re going to have with certain family members. Now, if you’re listening to this and it’s not the holidays, it’s the same. You’re anticipating going to work, but you’re dreading the interactions. You’re dreading how messy things get. You’re going to school, and you’re dreading how messy things get with the people you have in your life – your students, your classmates, your teacher, your friends, whoever it may be.

I want you to think about your responsibilities. And I talk a lot with my patients and clients about responsibility because it’s a really important part of recovery. When we think about the holidays, we think about a certain event that’s coming up. I’ll often explain to my patients that really all you need to do is you need to focus on your lane. So, I’ve talked about this before on the podcast, but I want you to imagine you’re driving on the highway, you’re in your car, and the only thing you’re responsible for is to not run into other people in their lane and to stay in your lane and to go at a pace that’s right for you and a speed that’s right for you and in a car that’s right for you.

Now, that metaphor is exactly how you’re going to get through the holidays or get through this event that you’ve got coming up. Your job is to take responsibility for you and your lane. Now, sometimes people in the lane next to us come on over into our lane and they want to tell us how to act, and they want to tell us what to do, and they want to impose on you their beliefs. Now, our job is to remind them and set boundaries that that’s not your lane, that’s their lane. And their job is to stay in their lane. And our job is to stay in our lane.

Now, in addition, we have to be careful that we are not popping on over into their lane and telling them how they should be, and telling them how they should act, and trying to take responsibility for their feelings, and trying to prevent them from judging you because that’s their lane. We talked about this in the last episode. Go back and listen to that. But that’s not your job either. It’s not your job to get their approval because that’s their responsibility. How they feel is their responsibility. We can’t control that.

And so, first, before we even talk about setting boundaries, we have to be really clear on what’s in your lane. So, an example for me is, as I go into the holidays, I am going to be really aware of what is my responsibility, how do I want to show up? And then it’s my responsibility to show up in my lane doing so. But it’s also important to catch when I’m-- often we do this. It’s like, “Well, I’m going to do X, Y, and Z because I really want A, B and C to like me.” But that’s your lane. It’s not your responsibility. It’s not your job to get them to approve of you because we don’t have any control of that. And as we talked about last week, their judgment of us is their responsibility. It’s a reflection of them. It’s not a reflection of us.

So, we have to be really careful of really getting clear on how we want to show up and only trying to control us, because we can’t control our family members. They’re going to do what they do. They’re going to act out. They’re going to be up in your lane.

From there, we can set a boundary to protect ourselves from them coming into your lane. So, when we set boundaries, we usually set boundaries when somebody is imposing their stuff onto us. Imagine if someone came into your house and walked in with their shoes on and put dirt all over the carpet, you might say, “Excuse me, please would you take your shoes off?” There’s like a boundary violation. If they come into my house and they start smoking cigarettes, no disrespect or judgment on people who do smoke cigarettes, but I’m going to say, “I’m really sorry, we actually don’t smoke in this house. Can you please put your cigarette out and go out to the back?” And so, that would be me setting a boundary.

Now, a lot of you brought in and you asked questions about this. Last week we addressed a lot of the questions. So, an example, somebody said, “How can I communicate with my family about my OCD and keep my boundaries?” So, what you might do is first ask yourself. If I was going to communicate about my OCD or my anxiety or my depression or my eating disorder or whatever you may have, panic, is ask yourself, are you communicating with it so that they change the way they act because that’s their lane? The only reason we would need to communicate about our stuff is so that we can set a boundary.

Let’s say a really big one that I have had to practice is when family members comment about weight. I had a couple of family members in my childhood who every Christmas would, “Have Merry Christmas, Kimberley, your weight is blank. You’re up a bit. You’re down a bit. You’re bigger, you’re smaller, whatever.” And it was so incredibly painful and so incredibly unhealthy for me. And so, the boundary here would be to say, “I would really prefer that you don’t comment on my way. And if you do, I’m going to remove myself from this interaction.” So, that’s a boundary and it’s respectful and it’s compassionate, and I’m not doing it to harm them or discipline them or pay them back. I’m doing it because it’s a boundary violation, and it’s in my lane. When I’m in my lane, I want to have a really positive idea about my food and my body.

If a family member is telling you how you should act, you might say to them, “Thank you so much for your thoughts. I am going to choose to do it this way. And I would really appreciate if you didn’t comment.  if you’re unable to hold that boundary, I’m going to have to leave,” or you can say whatever you want. You can just set the limit. Sometimes you don’t even need to tell them your boundary. You might just keep it to yourself. Like, “Oh, if they’re going--” if a family member says, “I’m so OCD about stuffing,” or whatever they say, “I’m so OCD about my cooking,” you might just not even need to express the boundary with them. You might gently just get yourself up and walk away. That’s a boundary. Sometimes we don’t have to verbally express boundaries because we can just remove ourselves from the situation and stay in our lane.

Somebody said, “How to say no to things?” So, you’ve decided you don’t want to do something. We talked about this last week in Episode 214. You’ve decided you don’t want to do something. And so, you say to them, “I’m going to bring baked goods. I’m not going to bake them myself. I will buy them at the bakery. No, I’m not going to hand bake them.” Or you might say, “No, I’m not going to go to that Christmas party,” or “No, I am not going to buy gifts this year.” Okay?

Now, that’s you holding your own boundary. Then your job, and again, this is why I shared about the lanes, is your job is to let them have their feelings about it. They’re allowed to have their feelings. They’re even allowed to act out. If they act out and they say something unkind, you may set a boundary with them. But we can’t hold everybody to our standards. Some people are going to act out. They may not have the skills you have. They may be triggered. They may have expectations of you. And that’s okay. They’re allowed to have expectations, but it doesn’t mean you have to do it. You may choose to follow their expectations. We talked about that again last week. But that’s your decision. You have to be responsible for you and saying yes to what matters to you and saying no to what doesn’t matter to you.

Any time you notice resent, show up, that’s usually because you violated your own boundary. You did something you didn’t want to do and you should have said no to. It’s okay. I’m going to keep saying this to you guys. It’s okay to disappoint people. We will disappoint them. It’s either they get disappointed, or you do the thing they want you to do, and then you’re disappointed. And you have to choose. It’s your responsibility to choose. And we do this responsibility work compassionately.

I speak a lot in my book, The Self-Compassion Workbook for OCD, about compassionate responsibility. That’s saying: “I am responsible for me,” but not in a disciplinarian, like you’re responsible for yourself, you’re alone, you’re on your own kind of way. It’s a compassionate act of, “Yes, I get to take responsibility for myself. I get to take care of myself. I get to say no, I get to say yes. I get to make those choices and I’ll do them kindly.”

Somebody asked a question about managing irritability. This is a great one, because our family members and our friends and our loved ones and the people at our Christmas party or our Hanukkah party, our Kwanzaa, they may irritate us. Yeah, it’s okay to feel irritated by our family members. My husband and I always-- we learned this maybe five years ago. We get caught up in it. I’ll be like, “Why are you acting that way?” And he’ll say gently to me, “Kimberley, I’m allowed to feel this way.” And I’m like, “Oh crap, you’re right. I keep forgetting that you’re allowed to feel what you want to feel.” Or he’ll be upset and he’ll be like, “What’s wrong? Why are you being this way?” And I’ll be like, “I’m allowed to feel this way.” And he’s like, “Oh crap, you’re right.”

You’re allowed to be irritable. You’re not allowed to be unkind. I mean, you are, but you have responsibility, There’s consequences. But ideally, let yourself be irritable. Be compassionate with your irritability. Like say, “Yeah, it makes complete sense that I’m irritable. This is hard. It makes complete sense that I’m annoyed. They’ve said something that annoyed me.” Again, they’re allowed to say annoying things. We get to remove ourselves if it doesn’t feel right or we get to express ourselves.” That really hurt my feelings. That made me upset.” This is why you’re allowed to share.

Let’s see. Someone said dealing with a toxic parent. Well, it depends. My answer to that is it depends on whether you’re a minor or an adult. If you’re a minor, it’s hard to remove yourself from a toxic parent. They are your guardian. You’re legally under their care. But you can remove yourself from them physically in terms of going to another room. You can try and share with them. “That was really painful for me to hear that. If you do that again, I’m going to leave the room.” Or you get to make your own boundaries. They may be physical boundaries where you leave. They may be emotional boundaries where you don’t go to them and you don’t share with them if they can’t hold space for you compassionately and respectfully.

If you’re an adult, you can choose to set as many boundaries as hard or as strong, as light as you need. Some people set boundaries with their family members. Like, “You can’t come here without announcing yourself. You must let us know first. You can’t say those things about me or I’m going to leave.” Or you may, again, you don’t even have to say them out loud. If they’re really toxic, you may say to them, “I’m not going to see you anymore if you keep acting like this towards me and my family. I can no longer put myself through that.” You get permission. We don’t get to choose our family, but you don’t have to see them either if they’re really unhealthy for you. You may want to get some therapy around it and have the help of a clinician to help you navigate what’s a right boundary for you. Everybody’s different.

Someone said, “I get really bad depression during the holidays and people have expectations for me to be happy.” Well, that’s their lane. You don’t have to act or be any way. Be kind, be compassionate, but do the best you can. It’s your lane. You got to just do the best you can with what you have.

So, again, I think that’s a really big part of this, is really take care of you because that’s your job. One thing actually, before we finish up, let me mention, it’s no one else’s job to make us feel better either. I know a lot of this today is going to feel like a lot of hard truths, but I promise you, there is so much liberation that comes from this. It’s a hard pill to swallow, but it’s still a really, really good pill. It’s a good pill. It’s a helpful pill. And so, it’s not other people’s job to make us joyful on Christmas either. That’s our job.

I’ll tell you a story, when I was really a young adult, I think it was quite shocking to me that when you’re a kid, everyone throws you a big party. And when you’re an adult, it’s not as big of a deal. And I used to get really offended that people didn’t throw me a massive party until I was like, “Wait, it’s really not their job.” And so, I started doing it for myself, and I have no shame about it. If I know I want to feel special on my birthday, I always organize something really special for myself. For the last three years, except for the year of COVID, I always rent-- you guys, probably know this. I rent an RV and I invite my three best girlfriends and I have a party for myself, and I’m not ashamed about it. I’m happy to celebrate myself. A

If you are feeling like other people’s job is to bring you joy on Christmas, I would say, no, bring yourself joy. Buy yourself a gift. Make your special meal you want to have. Treat yourself and shower yourself with the joy that you want to feel. That’s a huge liberation, a huge freedom. Such a gift.

Okay. So, that’s it. That’s how you set boundaries. You get to set them. It’s your lane. You get to decide. But other people are allowed to have their feelings about it. And that’s okay. That doesn’t mean you’re bad. They can even tell you you’re bad, and that doesn’t mean you’re bad. They can say, “I don’t like you,” and you don’t think you’re doing the right thing and they get to have their opinion, it doesn’t make it a fact.

This is hard work. I am not going to lie, I am still working on this. I’m still learning from this. I still have to practice it every single day. So, be gentle and remind yourself, this is a journey. This is not a destination that you’re like, “Yay, I’m great with boundaries.” It will be something you’ll have to keep practicing. But the holidays are the perfect time to practice them. It’s so important.

My loves, you probably have lots of questions about this. Do go over to social media. I’ll leave links in the bio. If you want to send me questions, I do a live Q and A every second and fourth Monday of the month at 12 o’clock Pacific Standard Time. So, I’m happy to answer your questions there.

Have a beautiful day. Happy 2021. I will be seeing you in 2022, holy macaroni, but I can’t wait. I’m actually really pumped about Your Anxiety Toolkit next year. I’m going to put a ton more effort into it. That’s where I want my attention to be next year.

So, sending you love. Have a wonderful day, and I’ll talk to you soon.

Oh no, wait. Before we finish up, what was I thinking? It is time for the review of the week. This is from IsaacRThorne, and they said:

“Love this show and I look forward to it every Friday.” Sorry, Isaac, I nearly missed you here. “No matter what you struggle with, there’s more than one episode where your mouth will drop open, your eyes will grow wide, and you’ll shout: “That’s totally me!”

Isaac, this is the best review ever. It just brings me so much joy. “Your mouth will drop open, your eyes will grow wide, and you’ll shout, “That’s totally me!” So, I hope this episode was that for you. Thank you so much for your wonderful review.

Please, if you don’t want to give me any gift of the world, it would be to leave me a review on the iTunes app. Thank you so much for your reviews. They bring me joy, but they also help us reach more people. So, thank you, thank you, thank you so much. We are going to give a free pair of Beats headphones to one lucky reviewer when we hit a thousand reviews. We’re on our way. Please go and leave a review. It would be the best, best, best gift you could give me.

Have a wonderful day, everybody. And now I officially say, have a wonderful day and I will see you in the New Year.

SUMMARY: 

In this episode, I addressed a question that was asked of me by a loyal follower.  They asked, “What do I do if the present moment totally sucks? Like, what if I have a migraine , nausea , chills , pain?  Any suggestions ?!”

This is such a great question and one we probably have all asked ourselves or our therapist at some point.  

Links To Things I Talk About:

ERP School: https://www.cbtschool.com/erp-school-lp

Episode Sponsor:
This episode of Your Anxiety Toolkit is brought to you by CBTschool.com.  CBTschool.com is a psychoeducation platform that provides courses and other online resources for people with anxiety, OCD, and Body-Focused Repetitive Behaviors.  Go to cbtschool.com to learn more.

Spread the love! Everyone needs tools for anxiety...If you like Your Anxiety Toolkit Podcast, visit YOUR ANXIETY TOOLKIT PODCAST to subscribe free and you'll never miss an episode. And if you really like Your Anxiety Toolkit, I'd appreciate you telling a friend (maybe even two).

EPISODE TRANSCRIPTION

This is Your Anxiety Toolkit - Episode 303.

Welcome back, everybody. Thank you from the bottom of my heart for being here with me. Thank you for listening. Thank you for supporting me. I know how valuable your time is, and I know there are so many people that you could spend your time with, especially out on the podcast field. So, I am so, so grateful to have you here with me. Really, really, really I am. I hope that you find these episodes incredibly helpful. My hope is to give you bite-size tools so that you can get on with your life and live your best life. I hope this podcast is everything that you wanted to learn. 

This week’s episode, I am totally, totally amped for. The reason being is, it was actually a response to a previous podcast where we talked about being present. Somebody had written back because they subscribe to my newsletter. If you haven’t subscribed to my newsletter, please do so. I will leave a link in the show notes, or you can go over to CBTSchool.com and sign up there. They had responded and said, “But Kimberley, what do I do if the present moment totally sucks?” And they went on to say, “I have a migraine or nausea or chills or pains.” And they said, “What are your suggestions?” I figured, this is probably the question you all have for me. I come on, I share with you tools. And then you guys are probably always going to have a question and this is a really common one. 

WHAT TO DO IF THE PRESENT MOMENT TOTALLY SUCKS

Today, I want to talk about what to do when the present moment totally sucks. Before we do that, let’s first do the “I did a hard thing” segment. This one is from Rachel and they said:

“My thoughts get the best of me. I recently started teaching and I needed to stay long after the students go home. And I decided it just needs to be a busy time to distract me. I use your book to help me with any meditations and I just let my thoughts come and go. It was scary the first time, but now I’m used to it.”

Thank you so much, Rachel. I’m so grateful my book can be of assistance. I think you’re doing some really, really hard work there. So, congratulations on that. 

And then last of all, before we get into the bulk of the episode, let’s first share a review of the week and this is from Meldevs and they said:

“I am so thankful to have found this podcast! Kimberley is such a compassionate, warm, honest, and insightful person for those struggling with anxiety disorders as I do. I have learned more listening to her than I have in my years of therapy. The way that she presents each and every podcast episode so that I feel challenged and understood. Thank you, thank you, thank you for being there for people struggling with anxiety!”

Thank you, Meldevs. That is such a beautiful review, really. That brings me so much joy and I really, really appreciate all your reviews on the podcast, because it helps me to reach more and more people. Meldevs and Rachel, thank you so much for being a part of my community. Let’s get into the episode. 

What do we do when the present moment totally sucks? Let’s break it down. 

When we talk about being present, one of the biggest mistakes we make, and I talk with my patients about this all the time, is we assume that being present means everything feels great. I think we have in our mind that being present is when we are most mindful, when we are most at peace, when we’re most compassionate. And I’ll tell you honestly, that has not been my experience. Oh no.

HOW TO BE PRESENT WHEN ANXIOUS

Being present, the art of being present, the practice of being present in your most mindful sense has never meant being comfortable in my experience, especially as my experience with it as a clinician, especially as my experience of having my own mental illnesses and my own medical illnesses. No, it’s not that. Most of the time, when we need to be present are the times when things totally suck, when we’re in a great deal of distress. Because otherwise, if you’re not in distress, usually, you don’t have to be as present because often you naturally are. 

So, let’s just remember that our brains, when we are uncomfortable, is wired to focus on that discomfort. That’s how we’ve survived all these years. And it’s going to focus on the pain because it is trying to send a message to you to get the pain to go away. But when we have something where the pain won’t go away, have it be migraine, like you said, nausea, chills, discomfort could be also anxiety or intrusive thoughts because we all know we can’t stop those. When we experience those, yes, naturally, you’re going to want to run away from it. But as a part of this team and as part of this community, you guys know and hopefully, I’ve taught you that running away from discomfort only makes it worse. Resisting the pain we feel and the suffering we feel only makes it worse and increases our suffering. So, what do we do? Friends, we settle in. I’ll give you a personal example of when I actually recently had COVID. 

Some people bless your hearts. And also, I’m really still very mad at these people, but still, bless your hearts. I wish this was the case for everybody. But some people have very few symptoms when it comes to having COVID. I am not one of those people. When I have COVID and when I got COVID, I get bone pain. It is like the deepest pain in my bones. It goes right to the center of my bones and it is so painful. My daughter and my husband both had COVID as well. My daughter came in. And I, when I’m in this state where my bones hurt this bad, I’ve had it several times in my life. She said, “Mama, you’re tensing up. Your face is all squished.” I was holding my muscles tight. And thank goodness, because I was in so much pain that I actually needed somebody outside of my body to tell me this was happening because I just was so entrenched in the pain I was feeling that she said, “Mama, you’re all tense.” Thank goodness I’ve taught her that tensing up around pain actually makes it worse. Her and I have had many conversations around this. 

STEP ONE: VALIDATE

And so, I naturally was able to go, “Oh, okay, Kimberley, let’s pause.” Number one, validate. “Hun, you’re in a lot of pain.” You could even say, “This present moment totally sucks.” Or you could say, “Wow, I’m observing that you’re really uncomfortable right now.” So, if that’s you and your present moment really sucks, I’m strongly encouraging you first validating. The alternative would be you go, “It shouldn’t be this way.” But the truth is, it is this way. So, don’t go down the road of fighting it. 

STEP TWO: STOP RESISTING THE PRESENT MOMENT

The second piece is then check for where you are resisting the present moment and how much it sucks. Now I’m going to keep saying the word “sucks” really passionately because it does sometimes really suck, like really suck. And so, when it really sucks, it’s almost like the more it sucks, the more we have to soften around how much it sucks. If you have a migraine, the worse it is, the more you need to soften your brow and close your eyes and soften the environment that you’re in. The more you feel nausea, the more you feel your stomach nodding up. And some of you may feel that just by me mentioning it. The more you feel that, the more you need to soften around that physically by relaxing your muscles and softening your thoughts around it. Meaning now is not the time to beat yourself up for it. Now is not the time. Some people are going, “Yeah, but it’s my fault. I have nausea because I drank too much,” or “I ate too much,” or whatever it may be. Now is not the time to go through that. Now, the facts are, the present moment totally sucks. And so, let’s be gentle around it because our resistance makes it worse. 

If you were like me and you have the chills and you’ve got literal, like feels like every bone in your body is broken, now is not the time to fight that and tense your muscles. Now is the time to soften. If you’re having a full-blown panic attack, first acknowledge, “Okay, I’m noticing I’m having a panic attack.” And then soften around it physically and cognitively in your thoughts. Don’t resist it. 

Now, that being said, let me bring a very important concept to the table. And this actually just came up this morning. So, as many of you know, I have my online business, which is CBTSchool.com, and then I also have a private practice where we see clients. Because I can’t see all the clients that come to me, I have 10 amazing therapists who work for me and who I have trained and who I supervise every single week. We have a meeting every Monday, and we talk about cases. One of my staff was telling me today that one of her patients took what she said literally, which actually is pretty common. She was explaining to her patients that when you have anxiety and panic or discomfort, you sit in the discomfort or sit with the discomfort, or be with the discomfort. And this patient and client took it literally, which is fair. We have to be really descriptive and give lots of steps and explanations. And so, while they were feeling this discomfort, they literally sat in a chair and just stared and suffered. So, if I’ve ever said, sit with your discomfort, please don’t take it literally.

And so, what I want to remember here and what I remind you of, I should say, is once we’ve acknowledged and we stop the resistance to it, we must then reengage in something we value. So, let’s use me as an example. I had COVID. I literally felt like every bone in my body was broken. That doesn’t mean I’m going to get up and go for a run. It doesn’t mean I’m going to get up and see patients because I’m actually in pain. I wasn’t able to. But what I can do is instead of putting my attention on how much it’s painful, I’m going to put my attention onto something else. And it could be as little or as minute as the sound of the leaves rustling outside, the sound of music, the, the smell of the cough medicine I had taken, the taste of the cough medicine I had taken, the touch of the blanket. So, you just get really in touch with that. And then you catch how your mind then keeps offering you thoughts that make you want to reengage back with the pain. 

Now, again, I’ll give you another example. Most of you know, I have a chronic illness. I have postural orthostatic tachycardic syndrome. I am dizzy almost all the time. It’s under control now. I don’t faint nearly as much as I used to. But dizziness is actually a very normal part of my existence, particularly when I’m standing up. And so, my job is to allow it and then to catch when my brain starts to say, “It shouldn’t be this way. This isn’t fair. It’s not good. This is bad. It could be better. Your life could be better.” My brain offers me those thoughts and I choose not to entertain them.

Now, I’m not perfect at this, and this is something I’ve been practicing for a long time, so please be gentle with yourself. My job and your job, when the present moment totally sucks, is to be an observer to our brain. And of course, as I said, at the beginning, it’s going to present to us all the problems and why this shouldn’t be the problem. And you just say, “Thank you for showing up. I totally get what you’re saying, brain. Thank you for being there for me, but I’m going to keep directing my attention to whatever it is in front of me.” 

If you have anxiety and you’re having panic, you’re having high levels of anxiety, I’m going to say to you, ask yourself the question, what can I do or what would I be doing if anxiety wasn’t here right now? And go do those things. Don’t just sit in the discomfort. Only go engage back with life. Do the most that you can with your life WHILE you have anxiety.

Now, let’s also address one other main issue. In no way am I saying to dump toxic positivity on yourself here. In no way am I saying things like, “Oh, you should be happy. The leaves are so beautiful.” Again, like I was saying to you, no, absolutely not. That is not what we’re talking about. 

If you feel sad about this, if you feel down about it, if you feel a little discouraged or irritable, that’s okay. We can also be mindful and acknowledge, “Yeah, I’m feeling really frustrated with how I feel so terrible.” We’re not here when we’re mindful. We’re not here to say it shouldn’t be this way and just be happy about it. No, like I said to you, in my experience being present, my most mindful is actually when things totally suck. And I don’t try and change it that often. In fact, I just try to allow it, bring it in and then add other valuable things into my life. 

Can it be positive? Absolutely, if you want it to be. But if the suffering you’re experiencing is depression or hopelessness or grief or panic, we don’t need to throw a bunch of positivity on there unless it’s really helpful to you. All I’m here trying to do is get you to not fight how painful it is because that usually makes it more painful. And also, we don’t want to thicken the pot of it by going, “You’re right. It does suck. It’s not fair,” and all those things. That can actually often-- we have research to show that that rumination actually makes our suffering worse.

I know I said that was the last thing, but I have one more important thing to say, which is, please, please practice nonjudgment. If you’re going to be mindful, you have to practice nonjudgment. You can’t have mindfulness without nonjudgment. I have a whole episode on that. The whole point here with nonjudgment is, when we say this moment totally sucks, it’s actually a judgment. And I don’t want to take that from you. I don’t want to take that from you. It’s okay. You’re allowed to acknowledge it. But we also want to catch that how sometimes when we’re judgmental, this is good and this is bad, we actually train our brains to send out more anxiety hormones when we have that experience the next time, especially when we tell ourselves it sucks and it shouldn’t be there. So, keep that in mind. 

Anytime I’m going through something difficult, and this is very true of my work that I did around dizziness, with my POTS, is I had to take all the judgment out of it to reduce my suffering around my dizziness. Because the more I judged it, the more I felt completely hopeless and depressed about the situation. The more I felt like, oh, I just don’t have an answer, there is no answer. 

Again, I didn’t say, “Wow, I love dizziness. It’s so positive and wonderful.” I just said, it’s a sensation. I’m going to be gentle. I’m going to acknowledge it and allow it and lean into it, but not give it too much attention. And it’s neither good nor bad. And that was a conscious, intentional decision. Again, be careful that it doesn’t become toxic in that you’re pushing too much positivity on yourself, but again, it’s a balance.

So, there it is. That is what I would encourage you to do when the present moment totally sucks. And as I said, the present moment, especially when you’re suffering, it will totally suck sometimes. But that doesn’t mean you’re going in the wrong direction. It doesn’t mean it’s going to stay that way forever. There’s another piece to catch. 

I am just in love with you guys. I really am. What an amazing, amazing community. Please, if you want to be part of my community, you can go over to Instagram @YourAnxietyToolkit. You can listen to this podcast and go right back to the beginning and listen to the beginning ones. You can go over to Facebook. We actually have a private Facebook group called CBT School Campus. You’re welcome to come and join us there. Thank you. Just love you, love you, love you. 

Have a wonderful day and I’ll talk to you next week.

This is Your Anxiety Toolkit – Episode 298. 

Welcome back, everybody. How are you? It is a beautiful summer day here in California. I love summer. It is very hot, but so happy to be here with you. I’m sitting in my office. I have a cup of tea. I have my little flowers next to me, and I’m just so grateful to have you here with me as well. Thank you for letting me be a part of your journey. I’m so honored. Really, I am. I know you have many options. It’s just an honor to be walking in this journey with you.

Today, I want to talk to you about seven questions you can ask yourself every day. It doesn’t mean you have to ask all of them. They’re just my favorite seven questions. They’re questions I ask myself all the time, the questions I ask my patients all the time. They’re not groundbreaking in that they’re going to change your life, but they will definitely keep you on track. 100%. They’re what I call guidance questions. They’re questions that prompt you to go in the next best direction, take the next best step. So, I can’t wait to share those with you.

Before I do, let’s do the review of the week. This is from Kendall Wetzel. She said:

“Listening to her podcast and following her on Insta--” if you don’t follow me on Instagram, head over to Your Anxiety Toolkit on Instagram. She’s saying, “Following her on Insta has been so great for keeping me in check with my OCD. She’s gentle, positive, and awesome.” Thank you. “So thankful for this free resource.”

Thank you so much, Kendall, for your amazing review. I love your reviews. Thank you for putting in the time to do that for me. It’s a gift. Thank you.

All right. Before we get into the episode, let’s do the “I did a hard thing.” This is from Joy. Joy said today:

“I told my boss I was resigning. It was a hard conversation to have and I overthought everything leading up to it.” Joy, I love that you shared that. We are human beings. We’re doing the best we can with what we have. But Joy goes on to say: “But I did it and it went well. This morning I woke up and I said it is a beautiful day to do hard things and that helped me to get through the day. Thank you.”

Wow, Joy, love it. I mean, such a totally human response. Even though we overthink things, you still did it and that is all that matters. That is all that matters. That is all that matters. So amazing.

All right. Let’s get into these seven questions. Shall we?

All right. I’m actually going to do this pretty quickly, folks. I will leave the questions in the show notes. I strongly encourage you if you’re not driving to sit down and write them out and take some time today to journal on them. Again, it doesn’t have to be all of them. You can make it into a pretty PDF. You could print it out. You could make it into a daily journal, prompts. But these questions, I just sat down and I looked at my computer and I was like, “Okay, what are the questions I commonly ask my patients?” Now, of course, I always ask my patients, how are you doing? I also ask my patients like, how was your week? I didn’t include those questions. Of course, I ask the questions again as guiding questions that lead us towards the whole reason you’re here, which is to live the life you want to live and compassionately.

Alrighty. So, here we go.

Question #1: Does does this behavior line up with my values?

So important. Often, I’ll just speak for myself, but I’m going to probably assume that you are just like me, given that we’re both human beings, but maybe not. Maybe you’re way more evolved than me. But often I find myself doing things that don’t line up with my values, because either society told me to do it or I’m on autopilot and I’m doing what I’ve just always done. And so, therefore, I just keep doing it and I catch myself doing it or I’m trying to avoid some emotion or some fear. So, the question is, does it line up with my values? Often it doesn’t. So, this is a question that guides me. I want you to think of it like your north star or your compass. These are compass questions as they guide you back on track. Does this line up with my values? If it’s a yes, proceed. If it’s a no, we might move our way down the other questions, or you might just want to reflect on that.

Question #2: Does this behavior line up with my long-term goals?

The thing around values is sometimes values will contradict each other. I really value being a good mom, but I also really value being a really good therapist. And sometimes I can’t meet both those values. I can’t be a really good therapist and a really good mom every single day. I can just do the best I can, but sometimes I have to go to work instead of being with my kids. Sometimes I have to be with my kids and I have to cancel a client. So, it’s hard. So, the question I ask myself is, does it line up with my long-term goals? Long-term goals. And I’m talking specifically here in regards to recovery. The last few weeks’ episodes are just about this, is getting clear on your goal, holding yourself accountable. Does this behavior line up with my long-term goals?

Question #3: What is one thing I can do right now that lines up with my long-time goals and my values? 

What’s the one thing, not the big thing? I struggle with this one so hard because I like to knock things out. It feels so good. It’s like a little adrenaline high, and I get discouraged when I can’t. So, I have to keep asking myself, just what’s the one little thing I can do right now in that direction? What’s the one thing? Don’t worry about the 17th thing. Just do the first, next best thing.

Question #4: Is this behavior effective? 

This is similar to the other questions. So, again, you might want to ask yourself all of these. You might get overwhelmed. But this is a question I often ask. I think I’ve mentioned in previous episodes, my 2022 goal is to be more effective. Sometimes I’m doing things and I’m like, “This is not an effective use of my time.” Again, you don’t always have to be effective. Sometimes we just do things for the pleasure of doing them or for the process of doing them, or for the joy of doing them. But is this actually reaching the goal? Is it effective?

Sometimes my mom always to say, excuse me, if I kill this phrase, but she’d say, “You’re jumping over quarters to get to pennies.” She’s talking about saving money. You’re jumping over small amounts of money. Excuse me, you’re jumping over big amounts of money just to save small things. I told you I was going to kill that. I did the best I could. So, you’re jumping over quarters to get to pennies. If you live out of America, you’d say you’re jumping over 10 cents to get to a-- you’re jumping over 10 cents to get to 1 cent. But that’s true too. Are you doing one thing to reduce a little bit of discomfort when you could be doing something that would give you way better outcomes? This is very true of those of you who are doing compulsions. Sometimes we’re doing it and we’re like, “No, I just have to get this certainty. And if I get this certainty, well, then I’ll have relief.” But it’s like, okay, is that effective for your long-term plans? Yes. It reduces your short-term discomfort, but it actually increases your long-term discomfort.

Question #5: How willing am I to be uncomfortable?

This is the big one guys. If you’re going to ask yourself one question in your whole day, this is the one. How willing am I to be uncomfortable? Whether it be that you’re facing your fears on purpose, doing an exposure, how willing am I? Or whether it’s just doing something you have to do that you don’t want to do, like Joy told us this morning, she had to resign. Even if it’s something you have to do, how willing are you to be uncomfortable? How willing are you? Are you in resistance to the fact that this is happening? It’s happening. You’re anxious. You’ve got something hard to do. You can fight it or you can allow it.

Question #6: Can I do this for another 10 seconds? 

Oh, I love this one. I love it. I love it. I love it. Here we go. Can I do this for another 10 seconds?

A client of mine once told me this. I think I’ve done an episode on this before, but it was a client of mine many, many, many years ago who said that they’d heard-- actually, I think it was like Grey’s Anatomy or some TV show. Well, maybe it was some research. They said anybody could do anything for 10 seconds. And so, they would say to themselves while they’re doing their exposure, “Can I do this just for another 10?” And when that 10 seconds is up, “Can I do it just for another 10 seconds?” You may increase it to 30 seconds, a minute, 10 minutes, an hour, or you may reduce it. “Can I do it for five seconds?” But it’s a great question. It really challenges this sort of-- we have these thoughts like I can’t do it anymore. But when you ask yourself, can I do it for another 10 seconds, well, then the script gets flipped.

Question #7: How can I make this fun? 

I mean this, even if it’s doing an exposure that is petrifying and 10 out of 10 anxiety, how can we make this fun?

A part of you is probably throwing your phone against the wall and being like, “What the heck, Kimberley? None of this is fun. I don’t want to do these hard things. Go away.” And that’s fine. It’s a question you don’t have to ask if you don’t want, but I want you to ponder, how can you make it fun? How can you make the hard thing fun?

So, as we look at these questions, these seven questions through the lens of it’s a beautiful day to do hard things-- let’s put it into sentences.

It’s a beautiful day to do hard things that line up with your values, because that was question #1: Does it line up with my values?

It’s a beautiful day to do things that-- excuse me, let me say it’s a beautiful day to do hard things that line up with my long-term goals. That’s question #2.

It’s a beautiful day to do one hard thing. (Question #3)

It’s a beautiful day to do hard things that are effective. (Question #4)

How willing am I to do the hard thing? (Question #5)

It’s a beautiful day to do hard things for 10 more seconds. (Question #6)

And last one, it’s a beautiful day to do hard things, making it fun. So, how would I word that? It’s a beautiful day to do fun, hard things. I’m being silly now. But it’s true.

I really want you to think about these. These are my favorite seven questions that I ask my patients. Try them on. See how they feel. If you like them, proceed. If you don’t, that’s fine. Just drop them. This is where you take what you need and leave what’s not helpful.

I really want to remind you, this is not therapy. So, I’m not tailoring this specifically to your needs. So, if it doesn’t feel right, just leave it. Not everything is for everybody.

All right. I love you. Have a wonderful day. It is a beautiful day to do hard things. Thank you so much for your support. Keep doing the hard things and I will talk to you next week.

SUMMARY:
Today we have Amanda White, an amazing therapist who treats anxiety, eating disorders and substance use. Amanda is coming onto the podcast today to talk about her book, Not Drinking Tonight and how we can all have a healthy relationship with alcohol. Amanda White talks about ways you can address your relationship with alcohol, in addition to drugs, social media and other vices. Amanda White also shares her own experience with alcohol use and abuse and her lived-experience with sobriety.

In This Episode:

• Do you have a healthy relationship with alcohol
• Why we use alcohol and substances to manage anxiety and other strong emotions
• How to build a healthy relationship with alcohol.
• How to manage substance abuse, anxiety and substance use in recovery.
• Tools and tips to manage alcohol use and abuse

Links To Things I Talk About:

Easiest place to get Amanda’s book with all links amandaewhite.com/book
Instagram @therapyforwomen
My therapy practice therapyforwomencenter.com
ERP School: https://www.cbtschool.com/erp-school-lp

Episode Sponsor:

This episode of Your Anxiety Toolkit is brought to you by CBTschool.com. CBTschool.com is a psychoeducation platform that provides courses and other online resources for people with anxiety, OCD, and Body-Focused Repetitive Behaviors. Go to cbtschool.com to learn more.

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Episode Transcription

This is Your Anxiety Toolkit - Episode 219.
Welcome back, everybody. I am thrilled to have you here with me today. You may notice that the podcast looks a little different. That is on purpose. We have decided to update the cover of the podcast. It now has my face on it. There were a lot of people who had reached out and said that the old podcast cover art looked like a gardening podcast. And I thought it was probably time I updated it. So, that was something that I had created years and years and years ago. And I’m so thrilled to have now a very beautiful new cover art.

Okay. This episode is so, so important. I cannot stress to you how overjoyed I was to have the amazing Amanda White on the podcast. She’s a psychotherapist. She’s on Instagram, under the handle Therapy For Women. She’s so empowering. And she talks a lot about your relationship with substance use, particularly alcohol. But in this episode, we talk about many substances. And this is a conversation I feel we need to have more of because there are a lot of people who are trying to manage their anxiety and they end up using alcohol to cope.

Now, this is a complete shame-free episode. In fact, one of the things I love about Amanda is she really does not subscribe to having to do a 100% sobriety method. She really talks about how you can create a relationship with alcohol based on whatever you think is right. And she has a new book out, which I am so excited that she’s going to share with you all about.

Before we get into the episode, I’d first like to do the review of the week. Here we go.

We have this one from Epic 5000 Cloud 9, and they said:

“This podcast has absolutely changed my life and made my recovery journey feel possible. After completing ERP, I felt lost and confused as to why I did not feel ‘better’. Kimberley has given me so many tools to build my self-compassion, grow my mindfulness skills, manage OCD, and do all the hard things.”

So amazing. I’m so grateful to have you in our community. Epic 5000 Cloud 9. So happy to have you be a part of our little wonderful group of badass human beings. I love it.

Let’s go right over to the show and so you can learn all about Amanda and this beautiful, beautiful conversation. Have a wonderful day, everybody.

Kimberley: Okay. Well, thank you, Amanda, for being here. I’m actually so grateful for you because you’ve actually brought to my attention a topic I’ve never talked about. And so, I’m so happy to have you here. Welcome.

Amanda: Thank you so much for having me, Kimberley. I’m excited to chat with you.

Kimberley: Okay. So, tell me a little bit about you first. Like, who are you? What do you do? What’s your mission?

Amanda: Yeah. So, my name is Amanda White. I am a licensed therapist. You might know me on Instagram from Therapy For Women as my handle. I’m also sober and I’m really on a mission to destigmatize sobriety and destigmatize the idea that you can question your relationship with alcohol. And it’s really why my Instagram page and everything I do isn’t sober only focused because I want it to be something where people who maybe aren’t necessarily sober or haven’t thought about it can, in a safe unstigmatized, unpressured way, also explore their relationship with alcohol. And that is what led me to write a book. And my book is called Not Drink Tonight.

Kimberley: So good. So, I already have so many questions. Why wouldn’t one question their relationship with alcohol? Because what I will bring here is a little culture. I’m Australian.

Amanda: Yeah. I was going to say.

Kimberley: I live in America. The culture around drinking is much different. I have some great friends in England, the culture there is much different. So, do you want to share a little bit about why one wouldn’t maybe question their relationship with drinking?

Amanda: Absolutely. I think I can only speak for America specifically, but I know enough people in England and Australia, too, that there is a culture of drinking is good, drinking is normal. We watch our parents or adults drink when we’re young. We think that’s what makes us an adult. If you look at the media, you look at movies, TV shows, it’s what everyone does when they’re stressed. Women pour themselves a glass of wine. Men pour themselves a bourbon. So, I think that we’re just raised in the society that doesn’t ever question their drinking, because alcohol use is so black and white, where you either are normal and you should drink alcohol and it’s what’s expected, or you’re an alcoholic and you should never drink alcohol. And there isn’t a lot of space in between. So, if someone questions their alcohol use, people assume that they’re an alcoholic.

Kimberley: And so, now let me ask, why would we question our relationship? What was that process like for you? Why would we want to do that? Some people haven’t, I think, even considered it. So, can you share a little bit about why we might want to?

Amanda: Absolutely. I think it isn’t talked about enough of how much alcohol really negatively impacts your mental health. For a while, I know doctors used to talk about there are some heart-healthy benefits of alcohol, which new studies say is not true. There really aren’t any benefits to drinking alcohol in terms of our health. But really, I think especially anxiety and alcohol are so intertwined and people don’t talk about it and don’t think about it. And what I want people to know is when you drink alcohol, it’s a depressant and your brain produces chemicals because your brain always wants to be in homeostasis. So, your brain produces anxiety chemicals, like cortisol and stuff like that, to try to rebalance into homeostasis. And after alcohol leaves your body, those anxiety hormones are still in there and it creates the phenomenon where you end up being more anxious after you drink. There’s other mental health effects too. But I feel like, especially on this podcast, it’s so important that people realize how intertwined alcohol and anxiety is.

Kimberley: Right. You know what’s interesting is I do a pretty good amount of assessment with my patients. But really often, I will have seen them for many months before-- and even though I thought I’ve assessed them for substance use and not even abuse, they will then say and realize like, “I think I’m actually using alcohol more than I thought to manage my anxiety.” And I’m always really shocked because I’m like, “I swore I assessed you for this.” But I think it takes some people time during recovery to start to say like, “Wow, I think there is an unhealthy relationship going here.” Is that the case from what you see or is that more my population?

Amanda: No. Absolutely. Because I think it’s easy to lie to yourself. Maybe not even lie, just like not look at it because again, it’s so normalized because we have an idea in our head of what someone with a problem with alcohol looks like. We don’t consider ourselves to have that problem. But just because we aren’t drinking every day or we’re not blacking out or something like that doesn’t mean that we might not be using it to numb, to cope with anxiety, to deal with stress.

Kimberley: Right. You know what’s funny is I-- this could be my personal or maybe it is a cultural thing because I always want to catch whether it’s an Australian thing or a Kimberley thing, is I remember-- I think hearing, but maybe I misinterpreted as a young child that you’re only an alcoholic if you get aggressive when you drink, and that if you’re a happy drunk, you’re not a drunk. You know what I mean? And that it’s not a bad thing. If it makes you happy and it takes the stress away, that’s actually a good coping. So, I remember learning as a teen of like, oh, you get to question what is an alcoholic and what’s substance abuse and what’s not. So, how would you define substance use versus substance abuse? Or do you even use that language?

Amanda: I mean, yes and no. I use it in terms of it exists, and it is part of the DSM. So, it is in terms of, I do diagnose when needed and things like that. A lot of times though, I think the current narrative and I think people spend so much time trying to figure out if it’s use or misuse, that they miss out on the most important question, which to me is, is alcohol making my life better.

Kimberley: Yeah.

Amanda: And if it’s not, if it’s right-- I have exercises in my book and I talk a lot about like, what are the costs of your drinking, and what are the payoffs? And if it’s costing you a lot or it’s costing you more than it’s bringing to your life, I think that is where you should question it. And I think your life can change. You can go through different things in your life and maybe that’s when you can ebb and flow with your questioning of it, especially people get so obsessed with the idea of whether they’re an alcoholic or not. And the term ‘alcoholic’ is completely outdated. It’s not even a diagnosis anymore. It’s now a spectrum. So, to me, that word is just so outdated and unhelpful to think about really.

Kimberley: Right. And even the word ‘abuse’ has a stigma to it too, doesn’t it?

Amanda: Right. In the DSM, it’s alcohol use disorder and it’s mild, moderate and severe. But it’s wild thinking back. I mean, I was in grad school. Oh my gosh, I’m going to date. I don’t even know how long ago, 10 years ago.

Kimberley: Don’t tell them.

Amanda: A certain amount of time ago, I just remember being in ‘addictions class’ as it was called and we were talking about what is the difference between use and abuse and what makes someone an alcoholic. And I think people also get very attached to being dependent. It means it’s abuse. And it takes a lot to become dependent on alcohol physically. So, we’re just missing out on so many people. I say often, we can question so many things in our life. I’m sure you do too with your clients. I question how their sleep habits interact with their mental health. We talk about how getting outside impacts their mental health, all these different factors. But for some reason with alcohol, which is a drug, we don’t question it or we are not allowed to.

Kimberley: Right. Yes. I will address this for the listeners, is I think with my clients, one of the most profound road, like if we come to the edge of the road and we have to decide which direction, the thing that really gets in the way is if I put a name to it, then I have to stop. And that can be, a lot of times, they won’t even want to bring it up – be in fear of saying, well, like you were saying before, is that meaning now-- as soon as I admit to having a problem, does that mean I’m in AA? Is it black and white? I think that there’s so much fear around what it means once we really define whether it’s helpful or problematic. That can be a scary step. What are your thoughts?

Amanda: Yeah, I completely agree. And that’s why I really believe in looking at it as a spectrum, especially I think about disordered eating, right? It’s like, we know that based on studies, if someone engages in disordered eating, they’re more likely to develop an eating disorder. So, in my book, I coined this term ‘disorder drinking’ and how I really think we need that term where people can-- it makes the barrier to question your relationship with alcohol much lower, where I find in my practice because I work with a lot of people with eating disorders. People are very open about saying, “Yeah, I’m maybe engaging in some unhealthy, disordered eating. I don’t know.”

But there’s a whole step there before maybe you recognize that you have an eating disorder, where I really think that that is what we need with alcohol. We need to be able to talk about how, like, yeah, most of us in college engage in disordered drinking. It’s not super healthy, the way that we drink. Or we may go through a period of time in our life because we’re super stressed or something’s going on, where we engage in that. And that doesn’t mean that you have, for sure, a substance use disorder or you’re addicted or you have to never drink again. But I think it’s important to recognize when we start to fall into that so we can change that pattern.

Kimberley: Right. Particularly with COVID. I mean, alcohol consumption is, I think, doubled or something like that in some country. And I think too, I mean, when we’re struggling with COVID that we have less access to good tools and less access to social. So, people are relying on substances and so forth. Yeah. So, what is this solution? There you go. Tell me all your answers. What is their options? How might somebody move into this conversation with themselves or with their partner or with their therapist? What are the steps from here, do you think?

Amanda: Yeah. So, I think that the first step is to try to take a break. I think 30 days is a good starting point. A lot of times, if people just start off by cutting back, they don’t really get any of the positive feel-good benefits of taking a break, which is why I recommend starting with taking a break first. Obviously, I believe in harm reduction. And if you are in a place where you can’t take a break, moderation is definitely a good tool and better than nothing.

Kimberley: Can you tell what harm reduction, for those who don’t know what that means?

Amanda: Yeah. So, harm reduction is the idea that rather than focusing on completely eliminating a behavior or especially completely eliminating a substance is we think about cutting back on that. And I think about specifically, if someone is in an abusive situation, if someone has a lot of trauma going on and alcohol is the one thing that’s keeping them afloat, that to me is like, of course, I’m not going to say you must quit cold turkey or something like that. And even if you’re talking about, alcohol is very dangerous to physically detox from if you are drinking every day, which a lot of people don’t know. In those cases, yeah, it’s really important to get support and detox in a safe environment.

Kimberley: Right. Okay. So, sorry I cut you off. Take a break--

Amanda: No, it’s okay. Yeah. So, that’s what harm reduction is. But yeah, in general, I recommend starting with taking a 30-day break, seeing how that goes, see how your health improves, see how your anxiety might be reduced and improved. And really to me, the goal is to learn how to live your life without being dependent on alcohol. Because if we can’t process our emotions, set boundaries, socialize, go on dates, whatever, without the help of alcohol, we never really have freedom of choice over drinking or not drinking because we need it on some level. So, my whole goal is for people to learn how to do some of those skills so that they don’t have to rely on alcohol, and then they can use alcohol in a healthier way for celebrating or in a way that positively impacts their life and they don’t use it as a crutch.

Kimberley: So, that’s so helpful. I’m pretty well-versed in this, but I wouldn’t say I’m a specialist. So, I’m really curious. So, if somebody is using alcohol or any other substance to manage their anxiety, would you teach them skills before they take the break so that they have the skills for the break or would you just start to take the break and then pick up what gets lost there? What might be some steps and what skills may you teach them?

Amanda: I think it’s a bit of both. I think if you only teach skills before, someone might never take the break, which is fine. But I think if you are only teaching the skills, a lot of times, the skills, I think that’s really good to start before you take the breaks. You can learn how to start dealing with your emotions maybe without drinking, for example. But some of the other stuff like going to a party, without drinking is something where if you don’t actually take that step, it’s probably unlikely that you’re ever going to do it until you’ve pushed yourself to take that break. But in general, yeah. I mean, I think one of the most important ones is learning how to cope with your emotions. People use alcohol all the time, especially alcohol becomes a way to deal with loneliness, to deal with stress, to deal with sadness. And I think--

Kimberley: Social anxiety is a big one.

Amanda: Social anxiety. Absolutely. And I think a lot of us literally don’t know how to process an emotion, say no, set that boundary, take care of themselves on a basic level without drinking. So, those are some of the skills I think are really important to learn.

Kimberley: I mean, yeah. And for a lot of the folks that I see because their anxiety is so high, would you say they’re using it to top off that anxiety to try and reduce it? In the case where if you’re not drinking, you’re having high states of anxiety. Is there any shifts that you would have them go through besides general anxiety management?

Amanda: I think the example I’m thinking of is maybe social anxiety. If there’s a specific instance, right? I know you talk about this a lot on Instagram, like exposures can really, really help with reducing anxiety. And I think there are steps that you can take that are small if you have a lot of social anxiety about going to a party and not drinking, for example, and you’re relying on alcohol to deal with going to a party. I mean, some of the things off the top of my head I can think about are like driving to the place where the party is before it happens, talking to someone who is going to be at the party – taking these small steps to desensitize yourself to it so you can build up your tolerance before you go. Or maybe you go, if this is the first year and you only stay for a short period of time, rather than going from nothing to expecting yourself to go and have fun and stay at the whole party the whole time.

Kimberley: Right. What was your experience, if you don’t mind sharing? What were those 30 days like, or can you share it, put us in your shoes for a little bit?

Amanda: Yeah, absolutely. So, I struggled a lot with an eating disorder and I kept relapsing in my eating disorder when I would drink. And I had said to my therapist at the time, “I think that I might have a problem with alcohol. I don’t know.” And she recommended me do those 30 days. And it was really hard for me. I didn’t actually make it to the first 30 days when I originally tried because I was so afraid of the pushback of friends, of people asking me why, of not being able to be fun. A huge part of my identity at that time was all wrapped up in what people thought of me and going out and being the fun, crazy one.

Kimberley: Yeah. And it’s interesting how the different experience, because I too had an eating disorder. But my eating disorder wouldn’t let me drink.

Amanda: Yeah.

Kimberley: That would be letting go of control, and what if I binge, and what if I ingest too many calories? So, it’s funny how different disorders play out in different ways. It was actually an exposure for me to drink. What we quote, I think I’d heard so many times “empty calories” or something. So, that was a different exposure for me of that. But I can totally see how other people, of course again, it does-- I mean, I think that this is interesting in your book, you talk about the pros and the cons. It does make it easier to be in public. It does “work” in some settings until it doesn’t.

Amanda: Exactly. And I think that’s so important to normalize and it’s part of why I wrote my book because there aren’t many books that are, you’ll get this as a therapist. I can think of many different situations where, like you said, I wouldn’t tell a client, “You should absolutely stop drinking,” because everything is unique. So, I really wanted to write a book that took into account different things and really led the reader through their own journey where they get to discover it for themselves because while there’s amazing books out that I love, there aren’t a ton that talk about this gray area, drinking, this middle lane, this truth that a lot of times you can feel lonely when you don’t drink because you’re left out of certain things. And that can cause more anxiety. So, we have to navigate all of that.

Kimberley: Yeah. It’s interesting too, and I don’t know if I’m getting this research correct. And maybe I’m not, but I’ll just talk from an experiential point. It’s similar with cigarettes, I think. There is something calming about holding the wine glass. Even if it’s got lemonade in it, for me, there’s something celebratory about that. And so, the reason I bring that up is, is that a part of the options for people? Is to explore the areas? It’s funny, I remember my husband many years ago that we talk about cigarettes, because he works in the film industry, and he would say, “The people who smoke cigarettes are the ones who actually get a break because they have to leave set and they get to go outside and sit on something and breathe and have a moment to themselves. If you don’t smoke, you’re lazy if you take a break.” And so, is that a part of it for you in terms of identifying the benefits and bringing that into your life? Like, I still now drink sparkling cider or something, an alcoholic in old champagne glass. My kids are always joking about it. Is that a part of the process?

Amanda: Absolutely. And that’s something that I completely agree with you. I think sometimes we don’t even want an alcoholic beverage. We want a moment. We want a break. We want a feeling different or celebratory, which is why we take out the wine glass that isn’t a regular glass, something like that. And that is why I really believe, I mean, it depends on the person. And sometimes if someone has more severe drinking a non-alcoholic beverage initially could be something that’s triggering for them. But I am a big believer too. And yeah, put it in a fancy glass. If you enjoy a mocktail, drink something different than water, you can explore different options. And I think some people are really surprised at how much it’s not actually about the drink sometimes, it’s the ritual of making a drink or the ritual of using that special glass, or the ritual of drinking something that isn’t water.

Kimberley: Right. Yes. Or even just the ritual of the day ending. I always remember, my parents would be five o’clock, right? And at five o’clock they would have the-- this is a big family tradition, is at five o’clock, you’d bring out the cheese and the crackers and the grapes and the wine. And it was the end of the day. And so, I could imagine, if someone said, “We’re going to take that away,” you’d be like, “No, that’s how I know the day is over. That’s how I move from one thing to the other.” And sometimes we do think black and white. It means you have to take the whole cheese platter away as well, right?

Amanda: Absolutely. We can get almost in our heads of maybe we think we’re more dependent on that cheese platter or the wine or whatever, without realizing that what we really like about it is the ritual.

Kimberley: Yeah. So, you can share it or not, how does your life look now? And for your clients, give me maybe some context of what do people arrive at once they’ve been through this process and how might it be different for different people.

Amanda: Totally. So, I’m completely sober. I don’t drink alcohol. I’ve been sober for seven years. And in terms of how the process looks for me, I drink mocktails. I drink out of wine glasses sometimes. I love going to a bar and seeing sometimes if there’s an alcohol-free option on a menu, I think that’s really fun. And for me initially, when I was thinking about this and working on it, like I said, it was very tied to my eating disorder.

But the biggest thing for me is I used to think, well, I can’t totally stop drinking because that’s black and white, and that’s not freedom. Freedom is being able to decide. And I think what is different and unique compared to an eating disorder, for example, is that alcohol is addictive, right? Unlike food, it is an addictive substance that we can live without. And for me, I used to, or for me, I don’t have to think about it if I don’t drink. When I was trying to moderate, it was a lot of decision fatigue. It’s like, “What am I going to drink? How much am I going to drink? When will I stop? Am I going to drink too much?” It was all of these decisions. And freedom for me now actually is just not drinking and not thinking about if I’m going to drink or not.

So what my life looks like now is I’m sober, I’ve been sober for seven years. I enjoy going out to restaurants and getting alcohol-free drinks and things like that. And I used to be really worried that that was too reductive, that I was too black and white if I just said I wanted to be sober. But the truth is unlike food, alcohol is an addictive substance. When you have one alcoholic beverage, it does create a thirst for itself for most of us.

So, for me, the freedom is actually not worrying about whether I’m going to drink or not. It’s so exhausting for some people, myself included, to be constantly thinking about how much you’re going to drink, if you’re going to drink, when you’re going to drink, what you’re going to drink. And now, the real freedom for me is I don’t drink. I don’t think about it. And that’s the freedom because-- sorry, I just got caught up in what I was saying.

Kimberley: No, I think that that is so beautiful. As you were saying it, I was thinking about me in a Fitbit. I will never be able to wear a Fitbit. Because as soon as I know, I could wear it for day-ish. And day two, I’m all obsessive and compulsive. I just know that about myself. And some people can wear it and be fine, and I can never wear a Fitbit. I just can’t. My brain goes very, like you said, on how many? More or less, what’s happening? And so, I love that you’re saying that, is really knowing your limits and whether it’s-- the Fitbit, it’s not actually the problem, but the Fitbit is what starts a lot of problematic behaviors that I know is just not helpful for me.

Amanda: Yes. And I think it’s important to recognize there are factors that make us more likely to be able to moderate successfully or not, right? The amount of alcohol you’ve drank throughout your life, your past drinking habits, whether you have a history of addiction in your family or substance use, whether you have trauma, whether you have anxiety, all of these things might make it more difficult for you to moderate compared to someone else.

Kimberley: Right. I don’t know if this is helpful for our listeners, but I went sober. My husband and I did for the first year of COVID. What was interesting is then I got put on a medicine where I wasn’t allowed to drink and I felt offended by this medicine because I was like, “But you’re taking my choices away.” And so, I had to go back. Even though I’d made the choice already, I’d had to go back and really address this conversation of like, “Okay, why does that feel threatening to you” and to look at it because a part of me wanted to be like, “No, I’m going to start drinking now just because they told me I’m not allowed.” So, it’s so funny how our brain gets caught up on things around drinking and the rules and so forth. So, I didn’t think of it that way until you’d mentioned it.

Amanda: Yeah, absolutely. And I think that that can be why people rebel against “I’m not an alcoholic” mindset instead of it being a choice, instead of it being “My life is better without drinking.” I often say, my drinking was like Russian roulette. A lot of times it was fine when I drank, but the times where it wasn’t fine, I was not willing to put up with it anymore. And I don’t know whether I could drink successfully or not, but it’s not a risk that I’m willing to take. And it’s not worth it compared to all the benefits that I have from sobriety. And because of that, it really feels like an empowering choice.

Kimberley: Yeah. My last question to you before we hear more about you is, what would you say to the people who are listening, who aren’t ready to have the conversation with themselves about whether it’s helpful or not? I think I learn in a master’s grade the stages of change. You’re in a pre-contemplation stage where you’re like, “I’m not even ready to contemplate this yet.” Do you have any thoughts for people who are so scared to even look at this?

Amanda: Yeah. For people who maybe are in that pre-contemplation, not sure if they want to do the deeper work to question their relationship with alcohol, what I would recommend to them is start by just trying to reduce some of their alcohol intake. They don’t have to stop drinking. They don’t have to even think about whether it’s serving them or not, but there are so many amazing alcohol-free beverages that exist now. I mean there’s alcohol-free beers and wines and all kinds of things. And you could just try swapping one of your alcoholic beverages with that when you go out or at home and just see how that makes you feel.

Kimberley: Yeah. It’s a great response in terms of like, it is. It could be. Would you say that’s more of the harm reduction model?

Amanda: Yeah, absolutely. Or someone who’s not ready or really interested in the big conversation. That’s one of the reasons I really support and like the alcohol-free beverages and stuff like that because it gives people, I think, an easier way to step into it. And sometimes even realizing too, like alcohol-free beverages can taste really good compared to the beverage that has alcohol in it. So, you’re not drinking this for the taste.

Kimberley: Exactly. Sometimes when I have drunk alcohol, I’m like, why am I even drinking this? It’s not delicious.

Amanda: It’s true.

Kimberley: It’s not delicious. I love that you say that about-- I think one of the wins of the world is they are creating more, even just the bottles and the look of them are much nicer than the general or dual looking kind of bottles, which I think is really cool. I love this conversation, and thank you so much for bringing it to me because I do really believe, particularly in the anxiety field, we are not talking about it enough. So, I’m so grateful for you.

Amanda: Absolutely. I’m so glad that I got to chat about it because, yeah, the anxiety connection is huge.

Kimberley: Yeah. Tell me about your book and all about you. Where can people find you?

Amanda: Yeah. So, my book comes out on January 4th. It’s called Not Drinking Tonight. And 2022, because this is out.

Kimberley: Yeah.

Amanda: Sorry if I messed up.

Kimberley: No, no it’s good. So, for people who are listening on replay, it will be out as of 2022.

Amanda: Yeah. It’s called Not Drinking Tonight: A Guide to Creating a Sober Life You Love. It is broken up into three different sections so that you can learn in the first section why you drink, and I go into evolutionary psychology and trauma and shame. In the second part, it’s about reparenting yourself or the tools that you need to stay stopped. So, I talk about boundaries and self-care and all of the things, emotional health, how we take care of our emotions. And then in the last section, I talk about moderation, relapsing, the overlap of alcohol use and other substances or ways we numb. So, really though my book is structured around alcohol. I talk a lot about eating disorders, perfectionism, workaholism, other drugs, because I think a lot of it is the same in that sense.

Kimberley: 100%.

Amanda: So yeah. And you can find me on Instagram at Therapy For Women, or my website is amandaewhite.com.

Kimberley: Amazing. Thank you so much. It’s so great to actually have a conversation with you face to face. Well, as face to face as we can be. So, thank you so much.

Amanda: Thank you. This was so great.

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Okay. And before we get going, I’m sure you got so much out of that episode. Before we get going onto your week, I wanted to share the “I did a hard thing.” This one is for on Paula, and she said:

“I started ERP School earlier this year. While looking into my OC cycle, I was surprised to find out that I had some overt compulsions. I thought they were mostly mental. And that’s when I figured out I had a BFRB. My loved ones had commented on my hair pulling in the past, but I didn’t realize how compulsive it could be. I watched Kimberley’s webinar on BFRBs, and I got inspiration to be creative. I tried to use hand lotion, so it would make my hands sticky and demotivate hair pulling. I also got a fidget toy to keep my hands occupied whenever I felt like pulling. But what worked best was you using a transparent elastic band to tie up the two strands I used to pull. It’s perfect because it creates a physical barrier to pulling, but also a sensory reminder. If my fingers feel the band, I can say to myself, “Oh, the band, that feels different.” And because I’m trying to make a change, way to go me. Thank you, Kimberley, for all the amazing work you do.”

So guys, this is amazing. If you didn’t know, if you go to CBT School, we have a free training for people with BFRBs. If you have OCD, we have a free training for people with OCD. So, head on over to CBT School, and you can get all of the cool resources there.

Have a wonderful day, everybody. And thank you so much for the “I did a hard thing.” That was so cool. I was not expecting that, Paula. Congratulations! You are doing definite hard things.

Have a wonderful day, everybody.

This is Your Anxiety Toolkit - Episode 200.

Oh my stars, you guys, Episode 200. So exciting.

Welcome back to Your Anxiety Toolkit. I am so thrilled to have you here for Episode 200. Oh my stars, you guys, this is a huge deal for me. In fact, let me set you up for today’s episode.

So, in Episode 100. We actually invited all the guests that we had previously had on the podcast and we had a celebration. If you want some fun, you should go over there and listen. It is such a wonderful episode.

I was thinking about what I wanted to do for Episode 200, and I’m not going to lie, nothing landed. Nothing. I just couldn’t bring myself to throw a huge party for it. And I think that’s what I wanted to talk with you guys about today in this episode, which is, who’s suffering? Who’s struggling? Who is having a hard time? Because I know I am, and I’m guessing you are in some way or another. I wanted to use this episode as just a time where we can talk about suffering and we can talk about what that looks like and what that means and what we can do when we’re struggling. And so, let’s talk about that today.

Before we do that, let’s first do two new segments. In fact, one is new and one is a return of an old segment we used to do. And the first one is where I would like to read you a review of the week for the podcast.

This week’s review is from Katie. Thank you so much for your review, and for all of you for writing a review. You guys do know that I’m giving away a pair of free Beats headphones once we hit a thousand reviews. We have a long way to go, but I am committed to getting there. And so, in the meantime, let’s celebrate each of you as we go.

Today’s review is from Katie and she wrote: “This podcast is a great resource that has helped me before I was brave enough to seek treatment. It’s nice to know that I am not alone. The tools and conversation are authentic, helpful, and hopeful. Grateful for Kimberley’s generosity in sharing.”

Thank you, Katie, for leaving a review, and thank you to all of you for leaving a review on the podcast. It helps me to get reach ultimately, and that helps me to help more people with this free resource.

Alright, so the second part of the podcast is a return to the “I did a hard thing” segment. Now, we have actually upgraded this segment. And what we’re going to do from now on is I have a form on my private practice website, where we launched the podcast. It’s called KimberleyQuinlan-lmft.com. If you go over there and you click on Podcast, right there is a way to submit your hard thing. And so, we used to do it on social media and we used to do it via email and it was very, very messy. And so now, you get to submit your “I did a hard thing.” We will take a look at them and we will do one per week. I am so excited.

I really believe that the “I did a hard thing” segment is literally the basis of this podcast. When people tell me or they DM me or they message me, or they tell me in person that they did a hard thing, they tell me as if this is a new concept to them that they’ve never, ever been encouraged to do. They tell me as if it’s life-changing. And that’s why I really feel like this is the core of this whole podcast, which is to come together as a group to do hard things. And maybe the hard thing isn’t something that’s hard for other people. That’s totally okay. That’s the whole point. If it’s hard for you, it’s hard for you. And I love celebrating that because sometimes, out in the world, we don’t have people to celebrate with. And I think that needs to be such a huge piece of the work that we do, and it is such a part of the work that we do here.

So, to get us started, I’m actually going to do the first one. Now, I want to encourage you to think of your hard thing as just something that’s hard for you. And then we can talk about here in a second what that may mean.

So, my hard thing for this episode is this, and I’m so excited to tell you this, is that Your Anxiety Toolkit Podcast hit 1 million listens. 1 million downloads, 1 million times people listen to this podcast and I could not be more excited. And this is why I think this is so important, is because as I went and I learned of this wonderful achievement, immediately, I heard a voice that says, “Yeah, but such and such got there in way quicker time,” or “Yeah, but I know that some people who have way more successful podcasts than you do, they’re going to look at that and they’re going to be like, ‘Oh wow, just a million?’” And immediately, that voice came in.

And so, what I want to encourage you to do is catch that voice when you recognize that you’ve done a hard thing. Because when you can catch the voice, you don’t have to then engage with the voice and go, “Yeah, you’re right. No point really celebrating that because other people got there easier and faster and better and all the things.”

So, here today, I am going to celebrate this milestone. Thank you so much for you guys for supporting me because I never would have gotten there without you. And I want to invite you to go over. I will put a link in the show notes below where you can submit your hard thing, and there will be no judgment here. If your hard thing is getting out of bed, that is a massive win. If your hard thing is going to therapy like Katie’s was, then that is amazing. If your hard thing is doing the 10 out of 10 exposure on your hierarchy list, then that is amazing. And I want to make sure every single week, we are celebrating one of you at least with your “I did a hard thing.”

Okay. So, those are the two segments we needed to get started on. Let’s talk about suffering.

So, here it is, you guys. I know you guys know a lot about my story and I was so lucky to have this beautiful summer where we got away, and I had so much time to heal and rest and be with my kids and it was magical. I’m not saying that to brag. I’m just sort of saying that if you have 10 minutes even to spend with yourself and rest, I cannot promote that enough. The resting is so important when it comes to our recovery.

And then when I returned back to LA, we had to come back and prepare for my children to return to school. The thing that really got to me is– let me just share with you really quickly about our vacation really quick – we decided to leave LA for the summer. We took seven weeks and we got in our SUV and our raft. We didn’t get in our raft. We towed our raft and we brought that around and we traveled eight states over seven weeks. We rafted 65 miles as a family. It was wonderful. We rested, we played, we sang a lot of annoying children’s songs. We listened to a lot of audiobooks, so that was wonderful.

But it was really interesting as we left Oregon down into California. The minute we crossed the border, all of a sudden, we were hit with smoke, and it was like driving into the apocalypse. Smoke was everywhere. We couldn’t see 100 feet in front of us. And the closer we got to LA, the more I noticed my anxiety rising and my sadness increasing and dread and all the feelings. And then I got back to LA and really wanted to spend some time readjusting with my family. But all I could think about was, wow, everybody is suffering so much – COVID numbers and the fires and earthquakes and political issues.

I wanted to really slow down for you guys enough to validate your distress to validate the suffering and struggles you have. Chances are, you’re dealing with all of that on top of some type of mental struggle or medical struggle. And so, I wanted to first just give you permission to take some time and validate that this is hard.

I find that when I speak about suffering with my patients and my clients, a lot of them often diminished their suffering by saying, “Yeah, but other people have it worse,” or “My thoughts are irrational, so I shouldn’t be this distressed,” or “I have a home,” or “Whatever it is, I shouldn’t be sad.”

But I want to remind you of this core important fact, which is, all forms of suffering are enough and are valid. Don’t get into the comparison trap of who’s suffering more and who deserves to suffer more and who deserves help and who doesn’t. You deserve help. This is a very difficult time and we must hold our suffering and our struggles in a warm, nurturing position.

You know, you guys, I always sort of make the joke of imagining you are holding a beautiful, yellow baby chicken and their little bones are like, oh my gosh, toothpicks, but not like toothpicks because they’re so frail. And if you were to hold them, you would be so gentle with the baby chicken. Your touch, your facial expression, your warmth in your voice would be so gentle. I want you to hold your struggles as silly as it seems like a baby chicken. Beautiful, tender, warm, kind, respectful tenderness. I really hope that you can do that.

The other thing I would encourage you to do – and I don’t know if this will help you, it was incredibly helpful for me over the last two years – is to continue to remind yourself that suffering is a part of being a human. Often I get caught – and this was a big lesson for me at the beginning of COVID, which was a part of me, and also when I got diagnosed with postural orthostatic tachycardia syndrome, I know a lot of you have struggled with this when you’ve been diagnosed with a mental disorder, whether that be OCD and eating disorder and anxiety disorder, a depressive mood disorder – is we want to sort of stomp our feet and say, “This shouldn’t have happened to me.” And by all means, please stomp your feet. Please have as much time to grieve that as you need. Again, there’s no reason for us to invalidate our own suffering, but for me, it was really important to remind myself that humans do suffer.

As COVID happened, I had to keep reminding myself, COVID, while it’s a huge issue and as harming so many people, is-- and I noticed I was like, “This shouldn’t be happening. This is wrong.” And I had to keep reminding myself, like, who says, it’s wrong? Who said it wasn’t supposed to happen? Who said that we were supposed to have a life that’s only easy? Who said that we weren’t supposed to struggle with mental illness? When it comes to mental illness, that’s what we would consider internalized ableism, which is, this idea that we should always be in tip-top shape. We should always be thin. We should always be smart. We should always be able. We should always be capable and handle things well. That’s just not human. It’s never been that way. it should never be expected to be this way. You’re allowed to suffer. You’re allowed to have troubles and struggles and pain, and you’re allowed to stumble as you try to navigate that.

And so, what I really want to remind you out when we talk about suffering is really taking away expectations that it was supposed to be easy and that it was supposed to be a free run. Now, I put in a caveat here, which is, you don’t deserve this either. You don’t deserve this suffering. It’s not a form of punishment. I know a lot of people come with that belief that they are being punished for something bad they’ve done. You didn’t do anything wrong. You didn’t ask for this. This is painful stuff. And I really hope that all the compassion practices that we’ve talked about here on this podcast have given you the tools you need to support yourself as we continue to suffer and struggle.

Now, there’s one last thing I want to mention, and that is hope and faith. I have had to wrap my head around these concepts during the last three years. How can I be hopeful when we have global warming or pandemics or hate against minorities? How can we be hopeful about this? This is where I’m going to encourage you to find hope in you, find hope in the community and the support around you. This community, if you haven’t got a supportive community, look and focus in on this community and the people who are doing the hard things and who are searching and struggling and working through what it’s like to have a mental illness. Bring your attention to those who’ve done what you are wishing you could do. There are so many advocates, you guys. I look to them every day. People who have lived experience, who have been through really difficult things and have come out on the other side – I look to them for hope and I use them as a little lighthouse for where I may need to go next. And I hope that I can be that for you.

But I really encourage you. As you’re navigating your suffering in this time, I really encourage you to look to the people who are doing things the way you wish you could and just use them as your shining light. You don’t need to do what they’re doing. You don’t even have to stop there but use them as a beacon of hope that together we can get there and that you will get there, and that together we can hold space for each other’s pain tenderly, compassionately, respectfully. That is my hope for today.

So, that being said, Happy 200th Episodes. I always end the episode by saying: It is a beautiful day to do the hard thing. And I know you’re all struggling. I’m struggling. I get teary just talking about this with you, but every day I say to myself, this is a beautiful day to do the hard thing. I’m just going to do one step at a time. I’m going to ask for help. I’m going to find my community. I’m going to celebrate my wins. if you can maybe put your attention there, I hope you can – maybe that will make the day a little lighter and the suffering a little less difficult to bear.

Have a wonderful day, you guys. I love you. I will see you for the next hundred episodes or more, the next million listens or more. I really am just honored to be on this journey with you.

Have a good day.

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

How To Let Go of the Past

This week’s episode of Your Anxiety Toolkit Podcast is my response to a question that came directly from the online Facebook group CBT School Campus.  It is based upon the following: how to let go of the past.   

This question was one that the online group agreed was incredibly painful and one that was very difficult to approach.  If you aren’t familiar with CBT School Campus, go check it out.  CBT School Campus is an online group of wonderful people who support each other as they do hard things!  The group includes people who are struggling with anxiety, depression and other mental health issues.  Each member is kind, supportive and helpful.  

Here is the question: 

“One of my obsessive regulars is about things from the past that my mind twisted and has blown way out of proportion (at least that’s what my non-OCD support people tell me. Ha!), but the memories cause me immense guilt/shame because I question my motives and wish I hadn’t done it. I do my exposures to try and accept that I may have had the wrong motive, it may have been inappropriate, I may be bothered by it forever, etc. 

My struggle lies in the yucky, depressed, guilty feeling it gives me as it looms and sucks the joy. That often leads to the worry of suicide if I can never get over it. I try to welcome the yuck, keep moving, etc.  Anything specific that has helped you?”

What a great question!  During this podcast, I talk about how we misinterpret events from the past and use past events to calculate or define ourselves, our worth and our value.  This miscalculation (or rating game) can become a compulsion and as you might already know, the more you review yourself, the more you find to be upset about and the worse you feel.  

DON’T FORGET, THIS WEEK IS OCD AWARENESS WEEK!  CLICK HERE FOR INFORMATION.

WE ARE SO THRILLED TO FINALLY BE OFFERING SWAG!  We have an array of t-shirts and tanks for men, women, and children.  Each product has our very own CBT SCHOOL motto, “It is a beautiful day to do hard things.”  Check it out at the following link! https://www.etsy.com/shop/CBTschool

Welcome back, everybody. Today we are talking about Acceptance Scripts with Dr Jon Grayson. 

So happy to be here with you as we tie together our series on imaginals and scripts. Today, we have the amazing Dr. Jon Grayson and he is going to talk about acceptance scripts and the real importance of making sure we use acceptance when we’re talking about scripts and imaginals. I’m so excited to share this episode with you. I think it really does, again, tie together the two other guests that we’ve had on the show in this series. 

For those of you who are listening to this and haven’t listened to the other two episodes of the series, go back two weeks. We’ve got the first one with Krista Reed and she’s talking about scripts and the way she uses them. Then we have Shala Nicely and she talks about her own specific way of using scripts. Again, the reason that I didn’t just have one person and leave it at that is I do think for each person, we have to find specific ways in which we do these skills and tools so we can make it specific to your obsessions and your intrusive thoughts. One explanation or one version or variety of this is probably not enough. I want to really deep dive in this series so that you feel, number one, you have a good understanding of what an imaginal and a script is. Number two, you know how to use them, you know the little nuanced pieces of information that you need to help make sure OCD and your OCD-related disorder doesn’t make it a compulsion because it can. I really wanted to get some groundwork so that you feel confident using imaginal and scripts in your own treatment and your own recovery.

Again, for those of you who are a little lost and feel like you need a better understanding of OCD, of how OCD works, how it keeps you stuck, the cycle of OCD and you want to make your own individual OCD and ERP plan, you can go to CBTSchool.com. We have a full seven-hour course that will walk you through exactly how I do it with my patients, and you can do that at your own pace. It’s an on-demand course. It is not therapy, but it will help you if you don’t have access to therapy or if you’re really just wanting to understand and do a deep dive and understand what ERP is and how you can use it. That is there for you. But if you are someone who is just wanting to get to the good stuff, let’s go over to the episode with Dr. Jon Grayson. Thank you, Dr. Jon Grayson, for coming on the show again. Always a pleasure to have such amazing people who really know their stuff. I’ll enjoy this episode with you. Let’s go.

Kimberley: Welcome, Dr. Jon Grayson. I’m so happy to have you back.

Jon: It is always fun to be with you.

Kimberley: Okay. It’s funny that you are number three, because I probably need you to be number one. Almost all of the scripting I ever learned was from your book. I think that even Shala Nicely came on and spoke about how a lot of what she does is through your book as well. Let’s just talk about the way in which you walk people through an imaginal or a script. Now do you call it imaginal or script? Do you think they’re synonymous? Do you have a different way of explaining it?

Jon: I think jargon-wise, they’re synonymous. I think by definition-- I feel weird saying that by definition because we made it up. I came up with the name “script” because originally, imaginal exposure suggested I’m just dealing with all the horrors and person’s just going to think about it. I changed the name to “script” because I was including both. What are you being exposed to? What might happen and why would you take this risk? Because I feel like the script is not only to get used to the material, but we remind the person, why am I doing this? What am I getting out of taking this horrible risk? Why would I want to live with that? 

WHAT IS AN ACCEPTANCE SCRIPTS/IMAGINALS? 

Integral to the Acceptance Script is the whole idea of learning acceptance. Because too often, I think the biggest problem I see in most therapists is they just jump into doing exposure without making sure the person has done level 1 acceptance, which is “I want to live with uncertainty,” because to say “I want to live with uncertainty” is to say, “I am willing to cope if the worst things happen.” It’s not just this general idea, it’s like going to the extreme. “I’m willing to live, even if this happens. I’m willing to drive a car knowing that I might get paralyzed and disfigured in a car crash.” I think that’s acceptance because if you’re telling me you’re never going to crash in a car and you know that’s true, I guess that’s a nice comforting thought that you might be in for a shock. We’re willing to take that risk. I think across the board, it’s always willing to live with the worst possible. 

Scripts try to encapsulate that. They’re trying to help bring the person not only to confront their fear but remind them of all the ways they want to cope with it. It is not a reassurance thing because let’s face it, the worst thing happening, saying “I’ll cope with the worst” is not really reassuring in a sense because it’s something you really don’t want to happen. But I guess the goal is, first of all, if it happens, you will do something that’s coping or not. 

I think non-acceptance-- God bless you. I’m glad we’re live so people can see you were sneezing. I just didn’t go into a religious ecstasy. I think we see non-acceptance insidiously all over the place without realizing it. In the beginning of the pandemic, so many people were going like, “Well, this can’t last all summer. I can’t deal with that.” That is a statement of avoidance and non-acceptance. I was listening to that and in the back of my mind, it’s like, “Let’s see. Everything they’ve told us makes it seem like this is going on for two years because they’re not finding a vaccine.” Seriously, you can’t take it. You’re not going to do it. What are you going to do? In retrospect, everybody would have to admit, “Well, yeah, it was not fun, it was awful, but I lived through it.”

Acceptance would’ve been, “Well, how am I going to try to make the best of this?” Making the best of it isn’t wonderful, which I guess brings us to the first point about acceptance because I think in the Western world, we make everything glossy and pretty and beautiful. Acceptance is just this wonderful land of zen happiness. It’s like I’m accepting everything is so good and, in reality, the best way to describe acceptance is that it sucks in the short run. In the short run, acceptance means “I’m going to be willing to embrace what seems to me the second-best life. This is what I want, I can have it, I will embrace this.” 

WHY DO WE NEED TO PRACTICE ACCEPTANCE? 

The prime reason to do acceptance is you don’t have a choice. The other world doesn’t exist. In the beginning of the pandemic, Kathy and I were doing our pandemic walk, my wife Kathy. We were doing our pandemic walk. I remember because you’re terrified of everybody and you’re walking looking around. Kathy says to me, “God, this would be such a great day if all this wasn’t happening.” I said to her, “You’re wrong, Kathy,” which for all the listeners should immediately cue them into the idea that being married to a psychologist is not necessarily fun. I said to her, “It is a beautiful day. We’re with each other. Here we are. We’re holding hands, taking a walk. It’s really pretty. We’re going to be spending the whole day together.” The truth is, it is a great day AND it’s horrible that all of this is happening. I think acceptance is always AND. We always talk about letting stuff be there as if it’s very passively like, “Oh, I can just let it be there and not bother me.” No, it’s really horrible.

Let me tell this really horrible story, which I can’t remember if I’ve told on here, but it’s a more graphic description of what acceptance looks like, if I may. A young girl was brought to me, 17, was really in terrible shape. I mean, she had been hospitalized, she had suicide attempts. So anxious, she couldn’t tolerate being in a counsel’s office for more than one hour when she first came in. Her meds were a mess. Over the next three months, we got her meds in line and she really worked incredibly hard considering where she was. And then in December, they asked, could she be in my support group? I said, “Well, it’s not really for kids.” They talked me into things, “We think she’s mature.” First of all, whenever she spoke up in the group, whatever she said would be brilliantly insightful that would just knock everybody out. She did not look old, but nobody could believe she was only 17. 

As the year went on, we were tapering off sessions. The last time I saw her in June, her parents, her and her brother were driving out to the desert outside of LA looking for a vacation getaway place. On their way there, a drunk driver in her third DUI rammed the car and killed my patient Ruby and her 14-year-old brother. I don’t have to tell you how devastated the parents were. I could talk a lot of stories that are amazing about them because I saw them starting about three weeks after their loss. At which point they said, “We want to be more than the parents of dead kids, but we can’t imagine anything else.” I said, “Well, I can tell you what treatment will be like, but it just seems like words.” They agreed it’ll be just words, but it’s just nice to hear there’s something. They coped amazingly well. But the only good thing about coping, in this case, is it’s better than not coping. Maybe that’s true a lot of the time.

After a year and a half, they did buy the place where they were going to that they were looking for that day. They bought it because it made them feel closer to the kids. They didn’t push that away at all. After a year and a half, they were at the place. It was one night where there was a meteor shower. They go, “Oh, we’re going to go out and watch the meteor shower.” They go out at midnight, lay down on their backs and both immediately burst into tears because this 17-year-old, 14-year-old were actually the kind of kids they would’ve happily gone out there with their parents and enjoyed the whole time. I said to the dad, “Was it a pretty meteor shower?” He said, “Yeah.” 

“Are you sorry you saw it?”

“No.”

I said the truth, “It was a beautiful meteor shower AND it’s horrible that your kids were murdered.”

It’s a dark sense of humor and said, “Well, I thought we’d have at least a few moments. I said, “Yeah, that wasn’t happening.” That’s acceptance. They were living in the present. They could enjoy things and there was a hole in their heart. The alternative to that is comparing life to every second of life to how much better it would be. Whenever I compare life to a fantasy, I ruin the present. I have nothing. 

I think the reason for acceptance is to make the best of whatever we can have. I think one of the wonderful things sometimes is that a lot of what we avoid is not something so devastating. It’s maybe more in our head what we’re trying to avoid. But a low probability event is not a no probability event. If that’s what I’m scared of, low odds are comforting because I want no odds. Am I answering your question?

Kimberley: You are. I think it’s a really great opportunity for us to segue. You’ve talked about the first step being to familiarize yourself with uncertainty before doing scripts and acceptance. You’ve beautifully explained this idea. For the listeners, you can also go back. Dr. Grayson has been on the show before. You can listen to it. We’ve talked a lot about that, which is so beautiful and I think very much compliments what you’re saying. Let’s talk about the script that you’re speaking of. Once you’ve done that work of acceptance, how would you--

Jon: I may have to call you Ms. Quinlan since you referred to me as Dr. Grayson. 

Kimberley: No, call me Kimberley. 

HOW CAN WE ACCEPT UNCERTAINTY USING SCRIPTS/IMAGINALS? 

Credit: https://www.instagram.com/p/CmZUliJKhQB/

Jon: When considering how to accept uncertainty, that first step, are you willing to learn to live with uncertainty? That step is variable of talking in therapy for the first session. I’ve had some people take three months before they agree like, it’s not like I really have a choice, and that’s really what we’re getting. What are you losing to that? I can’t remember if I just said this before, but one of the biggest things that I end up teaching therapists who have been around the field for years is do not start exposure until the person has actually agreed that they’re willing to learn to do this because obviously, they can just accept uncertainty. Then we’re done with session 1. It takes one session to three months. The loose measure is to accept uncertainty to say if the worst happens, I will try to live with it and I will try to cope with it. If somebody says to me, “If that happens, I’ll kill myself.” No, no. That’s an avoidance. In this scenario, you are condemned to life. You’re going to have to figure out how to cope no matter how awful. 

In scripting, the idea of a script is not only to provide the imaginal exposure, which is like this terrible thing might happen. Because a lot of times, people go, if you say X might happen, “I don’t want to think about it.” As I said to you in the beginning of the show, I can get any parent into an immediate statement of denial by saying, “What if your kids die,” the response of almost every parent is, “I don’t want to deal with that. I don’t want to think it through.” But if you’re being tortured by the thought, that normal level of denial, which I don’t think is the ideal way to handle it, but you already can’t do it because you keep going into, “What about no, what about no, what about, no?” 

How to write an Acceptance Script

The very first step of how to write an  acceptance script is essentially asking the question, “why would I take this risk?” Because within that statement is part of your answer of why I’m going to pursue acceptance. It is not the same as acceptance, but it’s why I’m being motivated to go after this. 

Kimberley: What would that look like? How would you word that?

Jon: As to why would I take this risk? 

Kimberley: Uh-hmm.

Jon: I’m trying to think of how horrible to go. 

Kimberley: Let’s pick an example because I think examples are helpful. Let’s say someone has relationship OCD and they’re afraid they’re making the wrong choice in their partner.

Jon: You picked one, I think, that’s not necessarily the most horribly devastating consequences on one hand compared to like, am I an old child molester? 

Kimberley: You go there.

Jon: I have a really wonderful acceptance thing I do with that, so we will go there. But with the ROCD, I want to know, am I making this terrible mistake with my spouse? What we’re asking them to accept is never knowing.

Kimberley: You’d just say that in the script? 

Jon: No, because we’ll talk to them and we’ll talk about why like, why am I willing to never know for sure? Because some of it is like they’re looking into a relationship with the thermometer and taking the measure every minute. What’s the temperature now? What’s the temperature now? There’s this fantasy that I should have no questions. I mean, depending on how deep they’re in, I should find no one else attractive, but every moment should be great and I should have no complaints. Well, that is a fantasy marriage. 

Kathy and I took a trip to France and it was an incredible trip. Of course, when you say going to Paris, everybody’s eyes glaze over. We ate at a patisserie every morning, but let’s face it, it’s just a damn croissant. One place had the best café au lait. We were there for two days, but it was great. We saw the Catacombs where we had to wait in line for three hours in the hot sun. Went to a really fine restaurant, but we’re not super foodies, so we’re not necessarily going to like it. The experience can’t just depend on, “This was great food,” or “This is terrible, we just spent a lot of money for what.” We go in knowing that. It was a great vacation. A great vacation. It’s not like every second is great. Three hours in a hot sun, five-hour bus ride to go see the site, but it was still a great vacation. I think a relationship is like that, so I can’t look at that now. 

I think for the person with ROCD, we’re going to say they are not perfect. Like any relationship, we want a hundred things and we’re only getting 70 of them. It should be more than 20, but we’re only getting 70. Are you making a mistake? Now, most people with ROCD can say they don’t want to leave right now or sometimes they want to leave because of the anxiety. It’s like, then you have to stay. I don’t want you talking about all your fears and confessing because if you are wrong, you’re just making this person feel bad for no reason. 

My thought is, you can leave this relationship when you know for two weeks solid you want to leave with no question. No question. You know it is, sure, as you know you’re sitting there because they generally accept that. We have to point out what are the realities of a relationship. Everyone on their wedding day thinks they’re going to be married forever, but that’s wrong 50% of the time. Whomever we marry, my spouse being an exception, 40 years later, they don’t look as good as you did the day you married them. Technically, you were accepting second best in looks 40 years later.

Kimberley: Did you know the rate of divorce is higher in therapists?

Jon: Wow. So, Kathy and I are really against the odds. This is a little scary to you probably. We started dating in 1970 and this year, it’ll be our 50th anniversary. 

Kimberley: Wow. Congratulations.

Jon: Having met at the age of two and started dating then, we don’t really have much significant history before that. You will get angry and there are going to be things they don’t want to do. Yes, you’re going to have to learn to live not knowing that. That’s going to be part of the script, that you don’t get to know. What if you’re making a mistake? Even if you fell wildly happily in love now and you had no question, really nice feeling. If the relationship seems good, no reason to question it. Now of course, if you have ROCD, you’re checking all these reasons. It’s like you’re not ready to leave yet. Yes, when you’re answering your questions, it’s maybe. Even if I feel wonderfully in love with you, it might be that next year or after 20 years ago, I discover you’ve been having a seven-year illicit affair. I discover, “Oh hey, guess what? You’re leaving me.” There are all kinds of things that could go wrong. Or I’ll ask the person in this relationship, if this relationship was good and you felt constant passion affair and next year your spouse suddenly gets a dread disease that’s going to make them really messed up and crippled and sick for the next years, I guess you’re leaving them. Of course, everybody goes like, “No.” But the bottom line is, that’s good, but that’s not going to be what you signed up for. 

How do we make the best of it? I did this one thing with one couple that worked like magic. I’m saying that worked like magic because I’d do it with everyone across the board, but usually, it doesn’t work like this. This was the low probability. Oh my god, this was the killer intervention as opposed to, this is a start for most people. It was such a cute couple, but I’d given him the thing. “This weekend, when you’re spending time with her, I want you to notice whenever you’re having fun, and although part of you wants to compare it to what it should be, I want you to consciously just notice whatever it is, like if it’s 5%.” Because a lot of times, you’re comparing your current feeling to what it should be. There could be good things happening and you don’t even notice because it’s like, “I was just thinking about this, I was just thinking about this.” He had that assignment to notice it, whatever. He came back and he was like, “We had a great weekend. I still don’t know if I love her or not, but if it could be like this forever, I’m good.” Now, that was a rarity, but that was the beginning of acceptance for most people, just noticing, oh, I’m not miserable every second. I agree a two-minute 20% joy isn’t like, oh wow, that makes it all worth it. But it’s stuff that you don’t notice all along. We’re trying to notice the good and the other stuff.

Acceptance is not a decision; trying to learn it is. But when I talk about that couple who lost two kids, when I say it was more than a year for them to get to acceptance and what acceptance means for them is they didn’t compare every moment to what it would be like if their kids were still alive. In fact, I didn’t know this at the time when I told them that everything goes well after a year. You’ll still have a hole in your heart, but you’ll stop comparing every moment to if they were still alive. They just listened. But the dad wrote a book about mourning and he also did a one-man show called Grief, which I wish I could show everyone. But in one of those places, he said that when I told them that, in his mind, he was saying, “F you! I am never going to stop wishing my kids were alive.” And then he wrote that two years later, he’s come to realize it doesn’t do him or his kids any good to wish they were alive.” He’s in acceptance. He still misses them greatly. He can still cry at them, but he’s no longer making that comparison. I’m mentioning it because that takes time. No one expects a couple, three weeks after their kids are murdered, to be in acceptance. The same with anything I have to accept. 

The person with OCD, they have this goal, but getting to that great state where “I’m living with this and it’s okay, I embrace this life” is hard. Luckily, most of the time what they have to accept isn’t devastating in the sense that nobody dies of AIDS. Am I with the wrong person forever? Well, maybe it’s the second-best life, but that’s the life I’m asking you to live for now, because all of us have no choice.

Kimberley: Right. Let’s break it down. 

Jon: I’m sorry.

Kimberley: No, you’re great. 

Jon: Okay. You’re good at being back on target.

Kimberley: I’m a real visual person too. I don’t know if you know that about me, like if I need to see it visually--

Jon: By the way, that’s fantastic because to say something and show it visually just makes it easier for everyone else around you that you’re talking to. I appreciate what you’re going to do.

Kimberley: Okay. Walk me through the visual here. The first step is what? 

Jon: Why would you take this risk?

Kimberley: Okay, what’s the second?

THE SECOND STEP OF ACCEPTANCE SCRIPTS

Jon: The second step of acceptance scripts is, if I do X, here’s a list of the things I’m actually scared might happen. I say actually scared because I want to go, what’s their fear? I can always go beyond even more horrible things, but I need to know what is their actual worst fear.

Kimberley: Right. Let’s say for two if it was relationship OCD, it would be, “I find out I’m in a terrible relationship and I’m stuck with them.” Or if they were having harm obsessions, it would be, “I harm and kill my wife or my grandparent or so forth.” You would write that down.

Jon: Yeah. “Here’s what might happen.”

Kimberley: Okay. What’s step number three?

Jon: If this happens, how would I try to cope with this in a positive way?

Kimberley: That’s key, isn’t it? How would I cope in a positive way?

Jon: Right. And that will often be second best.

Kimberley: Which is acceptance.

Jon: Well, it’s the road to acceptance. Remember, acceptance is not just this logical thing; it’s this emotional thing. I have clients and they appreciate it. It’s like, if we were just doing a therapy test, like say all the right stuff, they could ace therapy right away. They know how to say everything, they can do it. But feeling it takes time and behavior. I not only have to know it; I have to do the work of getting there. I have to go through all this pain. Now, I say, I think going through ERP is as painful as doing rituals. One is just an end of rituals versus endless rituals. I hate to keep going back to this couple, but what I said initially, the only good thing about coping is it was better than not coping. I had told them how well they were coping somewhere in the middle. Again, the dad said, “Wow, I hate to see the other poor bastards,” which was cute. I said, “Yes, but you’ve been in support groups, you’ve seen them.” He suddenly realized, “Whoa, we are coping even though this really sucks.”

Kimberley: In this script—and maybe I’m wrong here, please tell me—I always think of the research around athletes and when they have an injury, there’s research to show that while they’re in the hospital bed with their new hip replacement and whatnot, the sports psychologists are coaching them through visual, imaginal, imagery of them doing the layup again and dunking the ball or turning the corner of the sprinting track or whatever. They’re doing that imagery work to help them play out how they would cope, how they would handle the pain, how they would return. Is that what this process is in step 3? 

Jon: No. Well, that guy or a woman who’s imagining that, does their injury permit that possibility?

Kimberley: Tell me more.

Jon: Are they so injured that they will never be able to do a layup?

Kimberley: No. In this example--

Jon: Or maybe somebody could say the odds are against them, so here’s what you can try to do, and here’s what to expect of how horrible it is to try.” But they might have to say, “You might not get there.” In a marriage, I don’t care how good the marriage is, I cannot say it will definitely work out. I can’t say you will definitely work out your problems. If I’m married for 20 great years, and then we have these three years at hell and I find out that you’ve been cheating on me the last two years, did I make a mistake? Or should I have left you four years ago, how would I know four years ago and should I have not tried, and all these questions that don’t have an answer. All I know is where I am now. 

THE THIRD STEP OF ACCEPTANCE SCRIPTS 

I like to say success is not making the right decision. It’s coping with the consequences of whatever decision you have made. I feel regret is cheating because regret is, again, I’m going into denial as soon as I have a regret. I should have done X. X would’ve been different. I don’t know if it would’ve been better. This failed. X being better is one possibility, but there are a whole lot of other ones where maybe it wouldn’t have been as good. All I can ever do is, what is next? That person in the relationship with ROCD, what do I need to do next? What have I learned? Somebody with ROCD did get divorced and gets into a relationship where they have the ROCD, but it’s such a better relationship. It’s not like you should have gotten out sooner because you know what, maybe if you didn’t go into that other relationship, maybe you wouldn’t have been ready for this one. Maybe you needed to go through your ROCD and go through all the crap to have this good one. Dumping that person sooner and getting into another relationship might have been better, or maybe you would’ve picked worse. We don’t get to know. All we know is what is from this moment on. 

Part of the exposure is, okay, X might happen. What are the possibilities of coping? Again, I think I said, in my scenarios, the person can’t do suicide. They’re condemned to life and say, why I kill myself? That’s just a way of not thinking in the present. I want you to be stuck thinking about how you would try to cope with this. A lot of times, people have been so distant from it that it just seems like a screaming wall. It is like getting a phone call that somebody you love died. The whole world stops, and that’s where people stop thinking. But in the real world, something happens after you get that information. 

Part of the exposure is to go through what happened next, what are some possibilities? I always say to somebody, “I don’t know if I can cope with the worst things that could happen to me, but I know that there are brave people who have. I don’t know if I can be like them, but they’re a model that I hope I will do that.” What if you don’t cope? Well, then I’ll be in deep trouble. My current plan is, the best I can do is I hope I will cope. I don’t want to be paralyzed and disfigured in a car crash. I hope I would cope. I don’t have to know that I’d cope because I’m going to wait till I get there to try to find out. But I might try to imagine it. 

We’re going to imagine what would you actually do. In this relationship, how will I live never knowing? I’m taking the ROCD, how will I live? What if this is wrong? It might be wrong. What’s decent right now? What do you like? Because again, no person is perfect. How do I get into the state of that? Do I ever send people to marital counseling? If I see actual problems, I will, but I am not sending them to marital counseling to get rid of the ROCD. I’m sending them to get rid of actual problems. With or without those problems, they still have ROCD. I’m just eliminating, okay, here’s some definite reasons to get out. But once they’re resolved, then you’re still stuck with the ROCD.

THE FORTH STEP OF ACCEPTANCE SCRIPTS 

Kimberley: Is there a fourth step of acceptance scripts? 

Jon: Kind of. It’s embedded in it, which is part of why I would take this risk, is what’s resulting from not taking this risk? What are the graphic horrible things that keep happening to you because you keep avoiding, including the torture you feel, the hours loss, humiliation from doing things? How are you actually hurting the people you think you love? Because a lot of times in ROCD, they can say they care about the person. I’ll always ask somebody, do you love your kids or love your spouse?” They’ll say, “Yeah.” “Will you do anything for them?” They’ll say yes. I’ll say, “I’m sorry, you’re a liar.” How do you hurt your family and loved ones with your ROCD? Not being present, yelling at them because they didn’t do something, and all the other ways that one might, asking for reassurance endlessly being in pain in the neck. I will point out, you have a choice in your relationship. I’m going beyond ROCD. But you get to pick between, are you going to serve your fear or your love? You keep choosing fear over love. 

Part of acceptance does have to do with what my values are. Who is the person I want to be? Here’s another reason I need to do acceptance, because here’s life without acceptance. Most people who we see, we can say, the idea of trying to not accept and do avoid, I think you’ve done an amazing experiment of checking out that method. I think the results are clear, it sucks, so it’s time to try this other method. It’s like, why am I doing acceptance? Because I think, again, in our society we just make acceptance sounds so wonderful. But that’s just an idea. Why would acceptance actually be worth it? I have to think about why would it actually be worth it. I have to be motivated to do it. And then I’m stuck with this in-between thing that a lot of the time I’m doing a separate, recognizing I am not there yet, which by the way, there’s this great book that this wonderful person wrote on self-compassion, because I need self-compassion during treatment because I’m not where I want to be. It’s like I’m doing this really hard work and it’s not there yet. The best I get to say is, I’m working hard, I see some improvement, but yes, I’m not there yet and mourning. 

Learning to live the second-best life takes time. I keep saying second-best life. I don’t actually mean it in some sense, but that is the feeling that when I’m working towards acceptance, that it is. I think in some cases, it’s not really a second-best life. I think a lot of times, if I overcome a fear, it’s like, this is great. Other times it is. I’ve had some people with a moral OCD about something they’ve done in the past and they’re going through all these contortions to try to convince themself that it’s not really bad even though they actually think it’s bad, but maybe here’s why it’s not bad. Part of the acceptance is, oh yeah, that was a bad shitty thing. You feel guilty about that. What is forgiving yourself mean? Shockingly, almost nobody knows what forgiving yourself means. How are you going to get to that point? But I have to accept, yeah, that was bad. That hurt people or whatever it is by whatever standards. Again, depending on who we’re talking about, it’s like, “Oh, I guess we have to have you accept being as bad as everyone else.” In some other cases, no, that was really bad.

WHAT HAPPENS IF I REFUSE TO ACCEPT? 

Kimberley: It’s great. The last part of the question is, what happens when I refuse to accept? What is the result of not taking this risk or even not accepting this, which is you have additional pain, right? The pain just keeps going and going and going.

Jon: Right. That’s right. End of pain. Endless pain.

Kimberley: Yeah. If they’ve used these somewhat prompts and people can go to your book and work through a lot of them, I know on your website there are a lot of worksheets as well. Once they’re writing these prompts, is there anything else you feel is important for them to know about this process or to be aware of or be prepared for in this process?

Jon: I am pausing. The next revision of the book might be your inspiration. Well, because I know that it is way, way, way, way easier said than done. The core treatment for all OCD is the same. However, I have a completely different set of things I say depending on the presentation, because they each have their own set of things that the individual has to be focused on working to accept and live with. Although I think in my book I attempt. When I talk about each presentation, I do try to go over those and I’ve seen that for many people as helpful. But I also see for many people who’ve read the book, and even though they’ve read it, it ends up different for them to actually have to discuss it out loud. Sometimes it’s because they haven’t been able to think about it without realizing they avoid thinking about it. Sometimes because I think not all the connections are obvious, which I know is a really vague statement. I think I can go on, but I have to wait for you to ask a question. 

Kimberley: Okay. We’re running out of time, so I want to make sure I’m respecting your time.

Jon: Don’t respect my time, by the way. I set aside way extra time. This is on you if we end.

Kimberley: Once you do those questions, you would then walk them through the four steps that you went through with scripting as well. 

Jon: Yes, and some other horrible things because the horrible show, that should have been illegal. Actually, it’s not on anymore. I think you can still find that on YouTube. Toddlers & Tiaras and the crazy mothers who make their little girls try to be in beauty pageants. You know what, if you look at the pictures of the kids, it’s like, oh my God, they’re sexualizing this eight-year-old. But when you say that word, that means you can see what they have done. You recognize the sexual aspect. You know what, if I go and take this picture apart, this horrifies people when I say it. It’s like, if you look at their legs, it’s like, yeah, they have good legs. Now, nobody wants to say that, and it’s like, “Oh.” That’s our first response. But if I have POCD, I see that, “Oh my god, what’s wrong with me?” It’s an acceptance that we can see something and recognize a piece of it. 

I think the most difficult POCD is the people who “I don’t want to be attracted to a 15-year-old.” I can say, if I show you this picture and tell you they’re 18, oh, that’s okay. If I show you the same picture and tell you they’re 15, no, that’s okay. It’s like somehow magically, I find that the picture, the attractive is the picture is right or wrong if I tell you the age, which of course makes no sense. The picture is attractive or not independent of that. It’s accepting, yes, I might find a whole lot of things. Again, what we think makes us accept or not do we act on it. 

Kimberley: It’s interesting because as you know, we just got a new puppy. It’s taking over all of the Quinlan family and our lives. I had a moment where our puppy loves his belly to be scratched and right there is his genitals. I can see the projection of my mind of like, “What if you just touched that? Or what if you pulled that back?” The imagery, I could see myself doing it. Thankfully I have all these skills where I’m able to go, “Oh, there’s a thought.” I did feel that hot, sticky anxiety flow going through.

Jon: If you don’t change diapers regularly, I’m sorry, it’s a weird experience and I don’t care who you are, you’re going to think about that. If you’re changing a little person and there you are, you’re pumping their genitals because you got to clean it up and wipe it, you know what you’re doing and the healthy thing is like, “Okay, weird thoughts. This is normal.” If I have OCD, it’s like, “Why would I even think that?” Well, it’s normal.

Kimberley: It’s funny because I was noticing myself going through some of these imaginal scripting steps myself. Instead of going, “No, no, no, no, no, you wouldn’t, you wouldn’t, you couldn’t. That’s terrible.” It was like, “All right.” This is the last question I want because you’ve given some great examples. As I was having this thought, I noticed the choice—I used the word “choice” on purpose—to get really edgy with it and try not to have it. My body language is all tight and I was gritting my teeth, or I was like, “Kimberley, just let it flow. Let the thoughts come.” As you’re doing this with your patients, is there any piece of you where you are bringing their attention to whether their shoulders are all tight and their jaw is all tight and their hands are all tight, or does that not matter?

Jon: Nothing not matters, maybe, but that’s not always true. I thought you’d enjoy that. I think it depends on how much that’s part of their conscious fear response. I mean, I think if they’re doing their dog and it’s like, “Oh my God, am I excited by this,” the answer I would be working on is, “I’m not really sure. Maybe I am in some deep way. I’m not going to play with the genitals now and that’s the best I get to know.”

Kimberley: Yeah. Agreed. I love this. Thank you. Again, I want you to say, where are the resources that people can go to get your concrete workbooks and your worksheets?

Jon: I love how you make me have so many more books and worksheets. All the paperwork that appears in my book appears for free for anybody on the site FreedomFromOCD.com. In the Kindle and audio version, they couldn’t have those, so I was obsessed to have the Kindle version so I made that available. My book has most of my repertoire except about 20 minutes. Those are the main places. I hate to do this, but most of the time, when it comes to OCD books, I will say to people, there are a bunch of books that I would recommend, I think, that are roughly equal. But I think the one that most agrees with me happens to be mine, so I mention a few of the other good books. There is only one other book seriously that I tell people to get because I think it’s different, and that is your book, which is amazing because generally, I hate books that label themselves “self-compassion” because it’s just a version of be nice to yourself in a lot of words. I feel your book gives these not easy-to-do steps that make it work. Although as I said to you last time, it is just you used too many exclamation points.

Kimberley: I will forever decline your opinion on my exclamation points and my emojis. If you ever text with me, you’ll know that I over emoji and I over exclamation points.

Jon: I’m okay with that in text. 

Kimberley: Thank you for that wonderful compliment. I do agree, yes, I have been blamed for the exclamation mark issue before, but I stand up and I stand with it.

Jon: I like to warn people because I want them to know, oh no, don’t worry. This isn’t as you would put it all flowers and unicorns. It’s a great book with too many exclamation points.

Kimberley: No, it’s funny because my mom helped me edit it while I was in a 14-day quarantine in a Sydney hotel for COVID. She would go through and she would add exclamation marks. She was adding e emojis and hearts and smiley faces and I was like, “Oh, we are going crazy here.”

Jon: Now I know where you got it from.

Kimberley: We’re all love. Thank you for that. It’s a very huge compliment. Thank you so much for being here and talking about this. Again, I love having you on talking just a little deeper into the topic and a bit more abstract, which I think is helpful too. Is there anything else you want to conclude on here?

Jon: I would love to have some really cool, all-summarizing conclusion. The truth is, I can just talk endlessly. I’m just going to thank you for having me on and I am always willing to come talk with you.

Kimberley: I would say, the point that I love that you made today, which I will add for you, is the word AND. The word AND is so important in this conversation.

Jon: That’s a great summary because I think so many of our ideas, it’s not like they’re new, they get refined with time. In a way, something we’ve been saying all along and suddenly there’s this very slightly different way of saying it, but it summarizes it in a way that makes it more understandable, and AND I think does that for a lot of understanding mindfulness and acceptance.

Kimberley: Yeah. Thank you so much.Jon: You take care.

Don't Try Harder, Try Different with Patrick McGrath

Welcome back to another episode of Your Anxiety Toolkit. Today we are discussing Exposure and Response Prevention or ERP.  So what exactly is ERP?  Well, many years ago a psychologist created exposure therapy, which is where we expose people to their fears. If you were afraid of dogs, we would expose you to pictures of dogs and then videos of dogs and then we would probably ask you to go pet a dog, that is exposure therapy. This was found to be highly successful; however, over the course of time, more research suggested that doing exposures alone is good, but it doesn't completely address the whole picture of OCD because OCD does not just involve obsessions, it also involves compulsions. Exposure therapy did not really address compulsions. So a different method was added on and that is the response prevention. You expose yourself to your fear and then you would do response prevention, which would mean you would not engage in the compulsion to remove the discomfort, uncertainty, or  anxiety that you are feeling.

ERP  is a treatment that addresses both the obsession by exposing and the compulsion by doing response prevention. Now, this is groundbreaking and the research has shown that the outcomes are really good, which is wonderful because for many years, we did not have a great treatment for OCD. Since then we have actually added on other modalities to make it even better. We have inhibitory learning, acceptance and commitment therapy, compassion focused therapy, and mindfulness-based cognitive behavioral therapy. All of these additional modalities really help to increase motivation and help to manage your discomfort as it rises and falls.

A lot of people will ask if ERP can work if you do not engage in physical compulsions because as we know many people with OCD will engage in hidden compulsions that no one can see.  Those are typically avoidance and mental compulsions.  From the outside you may never know that they are struggling with mental compulsions all day because they are ruminating and playing out potential scenarios in their minds.  It is so important to identify the mental or avoidant compulsions you are doing and that would be a part of your ERP as well.

So that's ERP in a nutshell. Is it easy? Oh no, it's not easy. Is it hard? Oh yes, it is hard. But what am I about to say, say it with me everybody, it is a beautiful day to do hard things. Can you do hard things? Absolutely.

If you get a moment, please go over to wherever you listen to podcasts, whether that be Apple Podcast, Stitcher, Spotify, Podbean, and leave an honest review. Tell me how you feel about it, whether it's helping you, what you'd like to see. We are going to give away a pair of Beats headphones of your choice of color once we hit a thousand reviews!

ERP School, BFRB School and Mindfulness School for OCD are open for purchase. Click here for more information. Beginning today March 19th and continuing until April 1st, ERP School will be available with bonus material. This will be an amazing training on the motivational skills Kimberley teaches her clients to help them in their treatment and recovery!

Additional exciting news! ERP School is now CEU approved which means that it is an accredited course for therapists and mental health professionals to take towards their continuing education credit hours. Please click here for more information.

I am honored to have Steven C. Hayes, author of A Liberated Mind: How to Pivot Towards What Matters, back on the Your Anxiety Toolkit Podcast. He was on Ep. 83 and is joining us again! There is nothing that makes me happier than to chat with Steven Hayes about the unbelievable work he is doing and I cannot tell you how much I adored his most recent book.

In this week's podcast episode, Steven Hayes addressed how we can reach a liberated mind by improving psychological flexibility and moving away from psychological rigidity.  Not only does Hayes address these important topics using a combination of science and reason, but he also discussed how we can access a liberated mind by practicing compassion and kindness, and by seeking out our own set of values. During this conversation, we touched on some really difficult topics including suicidal ideation, immigration, global warming and other issues that impact the state of the world. Steven Hayes does such a beautiful job teaching us how we can reach be more open to our suffering and be open and flexible with other people’s suffering. 

Steven Hayes also addresses how we overuse problem-solving with our emotions. He talks about how we can create our own “hero’s journey” by choosing a path that feels liberating and freeing, instead of one that is powerless and rigid. 

For more information on Steven Hayes, click below:

Website: https://stevenchayes.com/

TedX: https://www.youtube.com/watch?v=o79_gmO5ppg

To purchase his most recent book: https://www.amazon.com/Liberated-Mind-Pivot-Toward-Matters-ebook/dp/B07LDSPRYM

A book freebie:https://stevenchayes.com/a-liberated-mind/

Steven Universe video - "Here Comes a Thought": https://www.youtube.com/watch?v=dHg50mdODFM

Welcome back, everybody. Today we are talking about a topic that I commonly get asked as a clinician, I commonly get asked as an advocate for anxiety online and so forth, which is how to let go of intrusive thoughts. I think that this is such an interesting question because words matter.

For those of you who know me, you’re going to know that words really do matter when it comes to managing anxiety and we have to get it “right.” When I say “right,” what I’m really saying is our mindset about anxiety and intrusive thoughts and any emotion really that is uncomfortable, we have to approach it with a degree of skill, effectiveness, and wisdom. My hope is to help you move in that direction. I know you’re already in that direction, but hopefully, this episode will be really powerful. I’m going to give you a metaphor that I hope really, really helps you. It really helps me. I’ve talked about it on the podcast before, but I feel like it’s important so I have to talk about it again. 

When we talk about this idea of how to let go of intrusive thoughts, we have to ask, what do we mean by that? Often when people first start seeing me as a clinician or they start seeing my therapist—we have a private practice in Calabasas, California—we commonly will get, “Okay, just I’m here. I’m ready to do the work. Teach me how to let go of intrusive thoughts.” A lot of the beginning stages of treatment is educating on how letting go, meaning not having them anymore or quickly avoiding them or distracting against that, could actually be what’s making your anxiety worse.

For those of you who’ve taken ERP School, which is our online course for OCD. If you’re interested, you can go to CBTSchool.com to learn more about that course. That’s where you can learn how to manage your own OCD. It’s an on-demand course. But we talk a lot about understanding that trying to push thoughts away or suppress thoughts, not having them actually reinforces the problem. I also want to mention, it makes total sense that your goal is to be able to have the thoughts and have no discomfort related. Like I just want to have the thoughts and I don’t want them to bother me, and I just want them to create no suffering at all. I get that. That is a very normal desire to have. But what we want to do here is, when we’re talking about how to “let go” of intrusive thoughts, what we are really talking about is how we can be skillful in how we respond to them, because we know, based on science, that we can’t control our intrusive thoughts. Often there are mechanisms in the brain that’s making it very difficult for you to pump the brakes on thoughts, which is why you’re struggling with so many of them, and they’re happening so repetitively. We know this. 

When I first learned about mindfulness, one of the most important metaphors that just shook me to the core—it really changed the way that I learned to deal with thoughts, feelings, sensations, emotions, urges, and all the things—was to think of my thoughts like water in a stream, and that my mind is this stream of water. As you’re thinking like these beautiful green banks, and there’s the river in the stream, and it’s flowing in one direction. What happens for us when we’re experiencing our mind is we hit a rock in the stream. When we hit that rock, we want to imagine that that rock is a metaphor for an intrusive thought. Here you are, you’re the water. You’re just rolling over all of the banks and commandeering back and forth, and then all of a sudden you hit this very sharp, jagged rock. Of course, your reaction is to get jolted and go, “Oh my goodness, what is this? Why is this here? I’m just trying to get from A to B.” Often what we do is when we hit the rock, we make a huge splash. The splash goes everywhere. We’re like, “Wait, what happened?” When we do this, we actually create a lot of pandemonium for ourselves. 

Now, that’s what we do. But if we were to think about a stream, what does the stream water normally do when it hits a rock? It hits the rock, it notices the shape of the rock, and then it gently goes around them. It doesn’t stop to go, “Is this a good rock or a bad rock? How do I feel about this rock? What does this rock mean about me? Why is there a rock here? There shouldn’t be a rock here.” The water just notices the rock, observes that the rock’s here. It doesn’t make a huge splash. It doesn’t try to go under it. It doesn’t try to stay on the left side of the bank and avoid it. It just notices the rock and it goes around it and it moves on. 

Mindfulness is just that. Mindfulness is observing what shows up from a place of non-judgment, from a place of non-attachment. What I mean by that is that the water’s not attached to what this rock means about them. It doesn’t assign value to the rock. It doesn’t say the river is bad now because we have a jagged rock, or it doesn’t say the river is good because it’s a small rock. It just says “rock” and it goes around it. Mindfulness is also very present. It notices it. It doesn’t stop there and go, “Okay, I’m going to spend a lot of time solving this and I’ll get to the end of the river in my own jolly time.” It is often being moved by gravity, so it just keeps moving. It doesn’t slow down too much for that rock. 

That’s the way I want you to now practice approaching your intrusive thoughts or your emotions, if you’re having other emotions, like strong waves of guilt or shame or sadness and whatever it may be. You’re going to notice the obstacle or the object. Be non-judgmental, not get caught up in a story about what it means about you that there is a rock in your stream of water, and you’re going to go around it. I was going to say quickly, but that’s not actually the right word. You’re going to go around it from a place of not gripping. Not gripping to that rock and so forth. 

Now, here is where the metaphor continues. For those of you who are listening, my guess is, in your stream, in your mind metaphorically, you hit one rock, you go around it, but very, very quickly comes another rock. And then you might practice that and go, “Okay, all right, I did one. I’m going to notice this rock as well. I’m not going to assign value to it. I’m just going to notice it, be aware of it, be non-judgmental of it, and do my best to go around it without making too big of a splash.” You do it the second time. But then what happens? Another rock comes. 

Often what my patients say to me, or like I said to you at the beginning, followers on Instagram or you listeners of the podcast will say, “I get what you’re saying.” One of the most common questions we get in ERP School in the portal where people ask questions is, “I get what you’re saying, but what happens if they just keep coming and coming and they just don’t stop?” That’s where I would say, again, the stream doesn’t get involved in a conversation about what this mean. It just hits the rock and goes around the rock and moves to the next one and the next one and the next one, and it takes one rock at a time. 

What we often do—and I’m the worst at this, I have to admit—is once we’ve hit 4, 5, 6 rocks, we then shift our gaze not on the present moment, but we look down the stream and we go, “Oh my goodness, I see nothing but rocks. This is going to be a bad day. All I could see is my future is going to contain a lot of rocks. I can see them on the horizon, I give up,” which is okay. I want to first really validate you, that is a normal human emotion, a normal human instinct to be like, “I give up, there’s too many rocks.” But our job isn’t to be looking into the future, trying to solve the many rocks that we are going to face. Because as soon as we do that, we lose our skills, we lose our cool, we lose our motivation, we lose our resilience. Just the same as if we looked up the stream where we’ve been and we go, “Oh my gosh, what a terrible day. Look how many rocks I hit today. It was nothing but rocks.” We could get in trouble that way as well. Mindfulness is only paying attention to one rock metaphorically at a time. Staying as present as you can. 

HOW TO GET RID OF INTRUSIVE THOUGHTS? 

Often people will say to me, “Well, how do I get rid of rocks? Isn’t there a way to get rid of rocks?” I love this. What they’re really asking, just in case you lost the metaphor, is they’re asking, how do I get rid of intrusive thoughts? How do I get rid of them? Here is where I think the metaphor is really clever, because when you think of a stream and you think of the rocks in a stream, like the actual stream—our family spends a lot of time rafting; my husband is an amazing raft, I guess you would say, and my kids love it too—what I always think that’s so interesting is when you’re in rapids or ripples, the rocks actually aren’t jagged anymore. Often when rocks have been hit by water enough times, the jaggedness of them gets washed away and the rocks become actually quite smooth. I think it’s such an amazing metaphor here for the work that we do, which is when we are mindful, when we are non-judgmental, when we are present, when we don’t attach it to what it means about us, the thoughts become less powerful, less painful, less jagged, less sharp, less of an ouch. That’s true in science with actual streams on water and for us in our minds too. 

HOW LONG CAN INTRUSIVE THOUGHTS LAST? 

Now, it’s not uncommon for people to be curious about how long intrusive thoughts can last. Because often when we have them, before we’ve learned these skills and before we’ve learned mindfulness, we have them. And then because we are so averse to them and we’re so afraid of them and they’re so painful, it can feel like they last for a very, very long time, and that’s true. They can be so repetitive that it feels like you just don’t get a break. 

But what I have found to be true, as a clinician who’s watched hundreds of clients practice this, is when you start to apply mindfulness, they can be quite fleeting, these intrusive thoughts. They can pass quite quickly. I want to be really honest with you. What I’m not saying is that they will stop returning. Again, I want to really keep reinforcing because that’s not our goal. Our goal isn’t to say, how can we get rid of them as fast as we can, or how can we get them to not be here. I’m not saying that, but I can vouch for this in that when you do practice treating intrusive thoughts like a rock in a stream, they do tend to be less prolonged. Not always. I want to keep saying not always. There will be days where you’ll have lots and lots, there’ll be days when you won’t. Again, we’re going to practice not attributing value or judgment to that. But I have found this to be very true, that when we are really present and we’re kind and we are non-judgmental, it can actually reduce the suffering so, so much

HOW TO LET GO OF OCD INTRUSIVE THOUGHTS and PTSD INTRUSIVE THOUGHTS? 

That’s the metaphor I want you to think about here in regards to how to let go of OCD intrusive thoughts. But I would even go as far as saying, this is the same metaphor I would use when talking with patients who have trauma, and they’re wanting to know how to let go of their PTSD intrusive thoughts because some people with PTSD have intrusive thoughts. I would even go as far as saying that, as I’ve said in the beginning, you can use this skill with any adversity. 

HOW TO LET GO OF INTRUSIVE THOUGHTS RELATED TO DEPRESSION? 

You could use this skill with sadness, you could use this skill with shame, guilt, fear in general. It could be discomfort or some physical sensation of pain that you’re having. We can also let go of these intrusive thoughts related to depression. Noticing a depressive negative thought, seeing it like a rock in the stream, trying to practice non-judgment around that, and moving around it with a sense of kindness and compassion and radical support. That’s what I would love for you to practice. 

I’ve had patients in the past say that they changed the computer screen to a stream just to remind them of that. Or they’ve left a little sticky note on the side of their desk saying thoughts are like a rock in a stream or a rock in a river. There are other ways you could imagine this metaphor as well, but this is the one that I really, really resonate with. If you want to get creative, you can maybe come up with some other forms. But I find it to be so incredible how nature can really teach us about how to be mindful and manage really, really hard things. 

That’s it, guys. That’s what I wanted to share with you. I hope it was helpful. I know this is not easy, by the way. The whole reason I say it’s a beautiful day to do hard things is because this is not easy. This is like hardcore work and I want you to give yourself a lot of claps and hugs and celebrations and high fives for even trying this sometimes in the day.

I really do believe that one rock at a time, even though it mightn’t seem very significant, it accumulates. If you have hit tens or twenties or thirties or hundreds of these rocks, you are on your way. You are doing the work, you are walking the walk, and I really want to celebrate you and honor you for that. 

All right, folks. I hope that was helpful. I am sending you so much love. Keep doing the work. I will see you in a week. Well, you’ll hear me in a week. I hope you’re having a wonderful summer if you’re in the northern hemisphere. I hope you’re having a wonderful winter if you’re in the southern hemisphere, and I will talk to you soon.

Visual Staring OCD (also known as Visual Tourrettic OCD), a complex and often misunderstood form of Obsessive-Compulsive Disorder, involves an uncontrollable urge to stare at certain objects or body parts, leading to significant distress and impairment. In an enlightening conversation with Kimberley, Matt Bannister shares his journey of overcoming this challenging condition, offering hope and practical advice to those grappling with similar issues.

Matt's story begins in 2009, marked by a sense of depersonalization and dissociation, which he describes as an out-of-body experience and likened to looking at a stranger when viewing himself in the mirror. His narrative is a testament to the often-overlooked complexity of OCD, where symptoms can extend beyond the stereotypical cleanliness and orderliness.

Kimberley's insightful probing into the nuances of Matt's experiences highlights the profound impact of Visual Staring OCD on daily life. The disorder manifested in Matt as an overwhelming need to maintain eye contact, initially with female colleagues, out of fear of being perceived as disrespectful. This compulsion expanded over time to include men and intensified to such a degree that Matt felt his mind couldn't function normally.

The social implications of Visual Staring OCD are starkly evident in Matt's recount of workplace experiences. Misinterpretation of his behavior led to stigmatization and gossip, deeply affecting his mental well-being and leading to self-isolation. Matt's story is a poignant illustration of the societal misunderstandings surrounding OCD and its variants.

Treatment and recovery form a significant part of the conversation. Matt emphasizes the role of Cognitive Behavioral Therapy (CBT) and Exposure and Response Prevention (ERP) in his healing process. However, he notes the initial challenges in applying these techniques, underscoring the necessity of a tailored approach to therapy.

Kimberley and Matt delve into the power of community support in managing OCD. Matt's involvement with the IOCDF (International OCD Foundation) community and his interactions with others who have overcome OCD, like Chris Trondsen, provide him with valuable insights and strategies. He speaks passionately about the importance of self-compassion, a concept introduced to him by Katie O'Dunne, and how it transformed his approach to recovery.

A critical aspect of Matt's journey is the realization and acceptance of his condition. His story underscores the importance of proper diagnosis and understanding of OCD's various manifestations, which can be as unique as the individuals experiencing them.

Matt's narrative is not just about overcoming a mental health challenge; it's a story of empowerment and advocacy. His transition from a struggling individual to a professional peer support worker is inspiring. He is now dedicated to helping others navigate their paths to recovery, using his experiences and insights to offer hope and practical advice.

In conclusion, Matt Bannister's journey through the complexities of Visual Staring OCD is a powerful testament to the resilience of the human spirit. His story offers valuable insights into the disorder, challenges misconceptions, and highlights the importance of tailored therapy, community support, and self-compassion in overcoming OCD. For anyone struggling with OCD, Matt's story is a beacon of hope and a reminder that recovery, though challenging, is within reach.

Instagram - matt bannister27

Facebook - matthew.bannister.92

Facebook group - OCD Warrior Badass Tribe

Email :matt3ban@hotmail.com

Kimberley: Welcome back, everybody. Every now and then, there is a special person that comes in and supports me in this way that blows me away. And today we have Matt Bannister, who is one of those people. Thank you, Matt, for being here today. This is an honor on many fronts, so thank you for being here.

Matthew: No, thank you for bringing me on, Kim. This is a huge honor. I’m so grateful to be on this. It’s just amazing. Thank you so, so much. It’s great to be here.

Kimberley: Number one, you have been such a support to me in CBT School and all the things that I’m doing, and I’ve loved hearing your updates and so forth around that. But today, I really want you to come on and tell your story from start to end, whatever you want to share. Tell us about you and your recovery story.

Matthew: Sure. I mean, I would like to start as well saying that your CBT School is amazing. It is so awesome. It’s helped me big time in my recovery, so I recommend that to everyone.

I’m an IOCDF grassroots advocate. I am super passionate about it. I love being involved with the community, connecting with the community. It’s like a big family. I’m so honored to be a part of this amazing community.

My recovery story and my journey started back in 2009, when—this is going to show how old I am right now—I remember talking on MSN. I remember I was talking; my mind went blank in a conversation, and I was like, “Ooh, that’s weird. It’s like my mind’s gone blank.” But that’s like a normal thing. I can just pass it off and then keep going forward. But the thing is with me. It didn’t. It latched on with that. I didn’t know what was going on with me. It was very frightening.

I believe that was a start for me with depersonalization and dissociation. I just had no idea of what it was. Super scary. It was like I started to forget part of my social life and how to communicate with people. I really did start to dissociate a lot when I was getting nervous. And that went on for about three or four years, but it gradually faded naturally.

Kimberley: So you had depersonalization and derealization, and if so, can you explain to listeners what the differences were and how you could tell the differences?

Matthew: Yeah. I think maybe, if I’m right with this, with the depersonalization, it felt like I knew how it was, but I didn’t at the same time. It was like when I was looking in a mirror. It was like looking at a stranger. That’s how it felt. It just felt like I became a shell of myself. Again, I just didn’t know what was happening. It was really, really scary. I think it made it worse. With my former friends at that time, we’d make fun of that, like, “Oh, come on, you’re not used to yourself anymore. You’re not as confident anymore. What’s going on? You used to try and take the [03:19 inaudible] a lot with that.”

With the dissociation, I felt like I was having an out-of-body experience. For me, if I sat in a room and it was really hitting me hard, as if I were anxious, it would feel like I was floating around that room. I couldn’t concentrate. It was very difficult to focus on things, especially if it was at work. It’d be very hard to do so. That came on and off.

Kimberley: Yeah, it’s such a scary feeling. I’ve had it a lot in my life too, and I get it. It makes you start to question reality, question even your mental health. It’s such a scary experience, especially the first time you have it. I remember the first time I was actually with a client when it started.

Matthew: Yeah, it is. Again, it is just a frightening experience. It felt like even when I was walking through places, it was just fog all the time. That’s how it felt. I felt like someone had placed a curse on me. I really believe that with those feelings, and how else can I explain it? But that did eventually fade, luckily, in about, like I said, three to four years, just naturally on its own. When I had those sensations, I got used to that, so I didn’t put as much emphasis on those situations. Then I carried on naturally through that.

Then, well, with going through actually depersonalization, unfortunately, that’s when my OCD did hit. For me, it was with, I believe, relationship OCD because I was with someone at the time. I was constantly always checking on them, seeing if they loved me. Like, am I boring you? Because I thought of depersonalization. I thought I wasn’t being my full authentic self and that you didn’t want to be within me anymore. I would constantly check my messages. If they didn’t put enough kisses on the end of a message, I think, “Oh, they don’t love me as much anymore. Oh no, I have to check.” All the time, even in phone calls, I always made sure to hear that my partner would say, “Oh, I love you back,” or “I love you.” Or as I thought, I did something wrong. Like they’re going off me. I had a spiral, thinking this person was going to cheat on me. It went on and on and on and on with that. But eventually, again, the relationship did fade in a natural way. It wasn’t because of the OCD; it was just how it went.

And then, with relationship OCD, with that, I faded with that. A search with my friends didn’t really affect me with that. Then what I can recall, what I have maybe experienced with OCD, I’ve had sexual orientation OCD. Again, I was questioning my sexuality. I’m heterosexual, and I was in another warehouse, a computer warehouse, and it was all males there. I was getting what I describe as intrusive thoughts of images of doing sexual acts or kissing and stuff like that. I’m thinking, “Why am I getting these thoughts? I know where my sexuality is.”

There’s nothing wrong, obviously, with being homosexual or queer. Nothing wrong with that at all. It’s just like I said, that’s how it fades with me. I mean, it could happen again with someone who’s queer, and it could be getting heterosexual thoughts. They don’t want that because they know they’re comfortable with their sexuality. But OCD is trying to doubt that. But then again, for me, that did actually fade again after about five or six months, just on its own.

And then, fast forward two years later is when the most severe theme of OCD I’ve ever had hit me hard like a ton of bricks. And that for me was Visual Tourettic OCD, known as Staring OCD, known as Ocular Tourettic OCD. And that was horrendous. The stigma I received with this theme was awful.

I remembered the day when it hit me, when I was talking to a female colleague. Like we all do, we all look around the room and we try and think of something to say, but my eyes just landed on the chest, like just an innocent look. I’m like, “Oh my God, why did I do that? I don’t want to disrespect this person in front of me. I treat her as an equal. I treat everyone the same way. I don’t want to feel like she’s being disrespected.” So I heavily maintained eye contact after that. Throughout that conversation, it was fine. It was normal, nothing different. But after that, it really latched onto me big time. The rumination was massive. It was like, you’ve got to make sure you’re giving every single female colleague now eye contact. You have to do it because you know otherwise what stigma you could get. And that went on for months and years, and it progressed to men as well a couple of years later. It felt like my mind can’t function anymore.

I remember again I was sitting next to my friend, who was having a game on the PlayStation. And then I just looked at his lap, just for no reason, just looked at his lap, and he said, “Ooh, I feel cold and want to go and change.” I instantly thought, “Oh my God, is it because he thought I might have stared that I creeped him out?” And then it just seriously latched onto me big time.

As we all know, with this as well, when we think of the pink elephant allergy, it’s like when we don’t think of the pink elephant, what do we do? And that’s what it was very much like with this.

I remember when it started to get really bad, my eyes would die and embarrass somebody part places. It was like the more anxious I felt about not wanting to do it, the more it happened, where me and my good friend, Carol Edwards, call it a tick with the eye movement. So like Tourette, let’s say, when you get really nervous, I don’t know if this is all true. When someone’s really nervous, maybe they might laugh involuntarily, like from the Joker movie, or like someone swearing out loud. This is the same thing with eye movement. Every time I was talking to a colleague face-to-face to face, I was giving them eye contact, my mind would be saying to me, “Don’t look there, don’t look there, don’t look there,” and unfortunately think it would happen. That tick would happen. It would land where I wouldn’t want it to land.

It was very embarrassing because eventually it did get noticed. I remember seeing female colleagues covering their hi vis tops, like across their arms. Men would cover their crotches. They would literally cross their legs very blatantly in front of me. Then I could start to hear gossip. This is when it got really bad, because I really heard the stigma from this. No one confronted me by the way of this face-to-face, but I could hear it crystal clear. They were calling me all sorts, like deviant or creep or a perv. “Have you seen his eyes? Have you seen him looking and does that weird things with his eyes? He checks everyone out.”

It was really soul-destroying because my compulsion was to get away from everyone. I would literally hide across a room. Where no one else was around, I would hide in the cubicles because it was the only place where I wasn’t triggered. It got bad again. It went to my family, my friends, everyone around me. It didn’t happen with children, but it happened with every adult. It was horrendous.

I reached out to therapy. Luckily, I did get in contact with a CBT therapist, but it was talk therapy. But it’s better than nothing. I will absolutely take that. She was amazing. I can’t credit my therapist enough. She was awesome. If this person, maybe this is like grace, you’re amazing, so thank you for that. She was really there for me. It was someone I could really talk to, and it can help me and understand as best as she could.

She did, I believe, further research into what I had. And then that’s when I finally got diagnosed that I had OCD. I never knew this was OCD, and everything else made sense, like, “Oh, this is why I was going through all those things before. It all now makes concrete sense what I was going through.”

Then I looked up the Facebook group called Peripheral Vision/Visual Tourettic OCD. That was a game-changer for me. I finally knew that I wasn’t alone because, with this, you really think you’re alone, and you are not. There are thousands of people with this, or even more. That was truly validating. I was like, “Thank God I’m not the only one.”

But the problem is, I didn’t really talk in that group at first because I thought if other people saw me writing in that group, it’s going to really kill my reputation big time. That would be like the final nail in the coffin. Even though it was a private group, no one could do that. But I didn’t still trust it that much at that time.

I was doing ERP, and I thought great because I’ve researched ERP. I knew that it’s effective. Obviously, it’s the gold standard. But for me, unfortunately, I think I was doing it where I was white-knuckling through exposures. Also, when I was hearing at work, still going back to my most triggering place, ERP, unfortunately, wasn’t working for me because I wasn’t healing. It was like I was going through the trigger constantly. My mind was just so overwhelmed. I didn’t have time to heal.

I remember I eventually self-isolated in my room. I didn’t go anywhere. I locked myself away because I thought I just couldn’t cope anymore. It was a really dark moment. I remember crying. It was just like despair. I was like, “What’s happening to me? Why is all this happening to me?”

Later on, I did have the choice at work. I thought, I can either go through the stillest, hellacious process or I can choose to go on sick leave and give my chance to heal and recover. That’s why I did. And that was the best decision I ever made. I recommend that to anyone who’s going through OCD severely. You always have a choice. You always have a choice. Never pressure yourself or think you’re weak or anything like that, because that’s not the case. You are a warrior. When you’re going through things like this, you are the most strongest person in the world. It takes a lot of courage to confront those demons every single day to never ever doubt yourself with that. You are a strong, amazing individual.

When I did that, again, I could heal. It took me two weeks. Unfortunately, my therapy ended. I only had 10 sessions, but I had to wait another three months for further therapy in person, so I thought, “Oh, at least I do eventually get therapy in person. That’s amazing.”

And then the best thing happened to me. I found the IOCDF community. Everything changed. The IOCDF is amazing. The best community, in my opinion, the world for OCD. My god, I remember when I first went on Ethan’s livestream with Community Conversations. I reached out to Ethan, and he sent me links for OCD-UK. I think OCD Action as well. That was really cool of him and great, and I super appreciate that, and you knew straight away because I remember watching this video with Jonathan Grayson, who is also an amazing guy and therapist, talking about this. I was like, again, this is all that I have.

And then after that, I reached out to Chris Trondsen as the expert. What Chris said was so game-changing to me because he’s gone through this as well and has overcome it. He’s overcome so many severe themes of OCD. I’m like, “This guy is amazing. He is an absolute rock star. Literally like a true champion.” For someone to go through as much as he has and to be where he is today, I can’t ask for any more inspirement from that. It’s just incredible. He gave some advice as well in that livestream when we were talking because I reached out and said, how did you overcome this? He said, “With the staring OCD, well, I basically told myself, while I’m staring, well, I might as well stare anyway.” And that clicked with me because I’m thinking he’s basically saying that he just didn’t give it value anymore. I’m like, “That’s what I’ve been doing all this time. I’ve given so much value, so much importance. That’s why it keeps happening to me.” I’m like, “Okay, I can maybe try and work with this.”

Then I started connecting with Katie O'Dunne, who is also amazing. She was the first person I actually did hear about self-compassion. I’m like, “Yes, why didn’t I learn about this early in my life? Self-compassion is amazing. I need to know all about this.” It makes so much sense. Why’d I keep beating myself up when I treat a friend, like when I talked to myself about this? No, I wouldn’t. I just watched Katie’s streams and watched her videos and Instagram. It was just an eye-opener for me. I was like, “Wow, she’s talking about, like, bring it on mindset as well with this.” When you’re about to face the brave thing, just say, “Bring it on. Just bring on," like The Rock says. "Just bring it. I just love that.

That’s what I did. That’s what I started doing. I connected as well with my friend, Carol Edwards, who is also a former therapist and is the author of many books. One of them was Address Staring OCD. If anyone’s going through this as well, I really recommend that book. Carol is an amazing, amazing person. Such an intelligent woman. When I met Carol, it was like the first time in my life. I was like, “Wow, I’m actually talking to someone who’s got the same theme as me, and a lot of other themes I’ve gone through, she has as well.” We just totally got each other. I was like, “Finally, I’m validated. I can talk to someone who gets it truly.” And that really helped, let’s say, when I started to learn about value-based exposures.

I remember, again, Katie, Elizabeth McIngvale, Ethan, and Chris. I was like, “Yeah, I mean, I’m going to do it that way,” because I just did ERP before I was white-knuckling. I never thought of doing it in a value-based way. So I thought, okay, well, what is OCD taking away that I enjoy most doing? That’s what I did. I created a hierarchy, or like even in my mind. I thought, well, the cinema, restaurants, coffee shops, going to concerts, eventually going on holiday again, seeing my friends, family is most probably most important. I started doing baby steps.

I remember as well, I asked Chris and Liz, how do I open up to this to my family? Because I’ve got to a point where I just can’t hide behind a mask anymore. I need someone else to know who’s really close to me. Chris gave me some amazing advice, and Liz, and they said that if you show documents, articles, videos about this, long as they have a great understanding of mental health and OCD, you should be okay. And that’s what I did. They know I had OCD. I’ve told them I had OCD, but not the theme I had.

When I showed them documents and videos, it was so nerve-racking, I won’t lie. But it was the best thing I ever did because then, when they watched that, they came to me and said, “Why didn’t you tell us about this before? I thought you wouldn’t understand or grasp this.” I know OCD awareness in the UK is not the best, especially with this theme. But they said, “No, after watching that, we’re on your team; we will support you. We are here for you. We will do exposures with you.” And they gave me a massive hug afterwards. I was like, “Oh my God, this is the best scenario for me ever,” because then I can really amplify my recovery. This is where it started really kicking on for me now.

Everything I’ve learned, again, from those videos, watching with the streams from IOCDF, I’ve incorporated. Basically, when I was going to go to the cinema at first, I know that the cinema is basically darkness. When you walk through there, no one’s really going to notice you. Yeah, they might see you in their peripheral vision, but they’re going to be more like concentrating on that movie than me. That was my mindset. I was like, “Well, if I was like the other person and I didn’t have VTO and the other person did, would I be more concentrated on them or the movie?” And for me, it would be obviously the movie. Why would I else? Unless they were doing something really vigorous or dancing in front of me, I’m not going to look. And that’s my mindset.

The deep anxiety was there, I will be honest. It was about 80 percent. But I had my value because I was going to watch a film that I really wanted to watch. I’m a big Marvel fan. It was Black Panther Wakanda, and I really enjoyed that. It was a long movie as well. I went with my friend. We got on very, very well. For me as well, with this trigger, I get triggered when people can move as well next to me. I’m very hyper-vigilant with this. That can include me with the peripheral as well. But even though my eyes say they died, it was, okay, instead of beating myself up, I can tell myself this is OCD. I know what this is. It doesn’t define me. I’m going to enjoy watching this movie as much as I can and give myself that compassion to do so.

After that moment, I was like, “Wow, even though I was still triggered, I enjoyed it. I wasn’t just wanting to get out of there. I enjoyed being there.” And that was starting to be a turning point for me because then I went to places like KFC. I miss KFC. I love my chicken bucket. I won’t lie with that. That was a big value. You got to love the chicken bucket folks. Oh, it was great. Well, I had my parents around me so that they know I was pretty anxious still. But I was there. I was enjoying my chicken again. I was like, “I miss this so much.”

And then the best thing is, as far as I remember, when I left that restaurant, they said to me, “We’re so proud of you.” And that helps so much because when you’re hearing feedback like that, it just gives you a huge pat on the back. It’s like, yeah, I’ve just done a big, scary thing. I could have been caught. I could have been ridiculed. I could have been made fun of. People may have gossiped about me, but I took that leap of faith because I knew it’s better than keep isolating, where in my room, being in prison, not living a life. I deserve to live a life. I deserve to do that. I’m a human being. I deserve to be a part of human society.

After that, my recovery started to progress. I went to my friend Carol to more coffee shops. We started talking about advocacy, powerful stuff, because when you have another reason on a why to recover, that’s a huge one. When you can inspire and empower others to recover, it gives you so much more of a purpose to do it because you want to be like that role model, that champion for the people. It really gives you a great motive to keep going forward with that and that motivation.

And then I went to restaurants with my family for the first time in years, instead of making excuses, instead of compulsion. People would still walk by me in my peripheral, but I had the mindset, like Kate said, “You know what? Just bring it on. Just bring it.” I went in there. I know I was still pretty anxious, and I sat on my phone, and I’m going to tell myself using mindfulness this time that I’m going to enjoy the smell of the food coming in. I’m going to enjoy the conversation with my family instead of thinking of, let’s say, the worst-case scenario. The same with a waiter or waitress coming by. I’m just going to have my order. And again, yeah, my eyes die, they spit in my food—who knows? But I’m going to take that leap of faith because, again, it’s worth it to do this. It is my why to get my life back. That’s why I did it.

Again, I enjoyed that meal, and I enjoyed talking to my family. It was probably the first time in years where I wasn’t proper triggered. I was like, that was my aha moment right there. The first time in years where my eyes didn’t die or anything. I just enjoyed being in a normal situation. It was so great to feel that. So validating.

Kimberley: So the more triggered you were, the harder it was to not stare? Is that how it was?

Matthew: Yes. The more triggered I was going down that rabbit hole, the more, let’s say, it would happen because my eyes would die, like up and down. It would be quite frantic, up and down, up and down. Everyone’s not the same. Everyone’s different with this. But that’s what mine would be like. That’s why I would call it a tick in that sense. But when we feel calm, obviously, and the rumination is not there, or let’s say, the trigger, then it’s got no reason to happen or be very rare when it does. It’s like retraining. I learned to retrain my mind in that sense to incorporate that into doing these exposures.

Again, that’s what was great about opening up to my family. I could practice that at home because then, when I’m sitting with my family, I’d still be triggered to a degree, but they know what I have. They’re not going to judge me or reject me, or anything like that. So my brain healed naturally. The more I sat next to my family, I could bring that with, say, the public again and not feel that trigger. I could feel at ease instead of feeling constantly on edge.

Again, going to coffee shops late, looking around the room, like you say so amazingly, Kim, using your five senses. I did that, like looking around, looking at billboards, smelling the coffee again, enjoying the taste of it, enjoying the conversation, enjoying the surroundings where I am instead of focusing on the prime fear. And that’s what really helped brought me back to the present. Being in the here and the now. And that was monumental. Such a huge tool, and I recommend that to everyone. Mindfulness is very, very powerful for doing, let’s say, your exposures and to maintain recovery. It’s just a game-changer. I can’t recommend that enough.

One of my biggest milestones with recovery when I hit it, the first time again in years, I went to a live rock concert full of 10,000 people. There would be no way a year prior that would I go.

Kimberley: What rock concert? I have to know.

Matthew: Oh, I went to Hollywood Vampires.

Kimberley: Oh, how wonderful! That must have been such an efficient, like, it felt like you crossed a massive marathon finish line to get that thing done.

Matthew: Oh, yeah, it was. It was huge to see, like I say, Alice Cooper, Johnny Depp, and I think—I can’t remember this—Joe Perry from Aerosmith. I can’t remember the drummer’s name, I apologize, but it was great. You know what? I rocked out. I told myself, “I’ve come this far in my journey, I’m going to rock out. I’m going to enjoy myself. I don’t care, let’s say, where my eyes may go, and that’s telling OCD, though. I’m just going to be there in the moment and enjoy rocking out.” And that’s exactly what I did. I rocked out big time. I remember even the lead singer from the prior band pointing at me and waving. I would have been so triggered by that before, but now we’re back in the game, the rock on sign, and it was great.

Kimberley: There’s so much joy in that too, right? You were so willing to be triggered that you rocked out. That’s how willing we were to do that work. It’s so cool, this story.

Matthew: Yeah. The funny part is, well, the guy next to me actually spilled beer all over himself. That would have been so triggering against me before, like somebody’s embarrassing body part places. Whereas this time I just laughed it off and I had a joke with him, and he got the beer. It was like a normal situation—nothing weird or anything. His wife, I remember looking at my peripheral, was just cross-legged. But hey, that’s just a relaxing position like anyone else would do. That’s what I told myself. It’s not because of me thinking, “Oh, he’s a weirdo or a creep.” It’s because she’s just being relaxed and comfortable. That’s just retraining my mind out, and again, refocusing back to the concert and again, rocking out to Alice Cooper, which was amazing.

I really enjoyed it. I just thought it’s just incredible from where I was a year ago without seeing-- got to a point where I set myself, I heard the worst stigma imaginable to go to the other aspect, the whole end of the other tunnel, the light of the tunnel, and enjoy myself and being free. I love what Elizabeth McIngvale says about that, freedom over function. And that’s exactly at that point where that’s where I was. I’m very lucky to this day. That’s why I’ve maintained it.

Sometimes I still do get triggered, but it’s okay because I know it’s OCD. We all know there’s no cure, but we can keep it in remission. We can live a happy life regardless. We just use the tools that we’ve learned. Again, for me, values-based exposure in that way was game-changing. Self-compassion was game-changing.

I forgot to mention my intrusive thoughts with sexual images as well with this, which was very stressing. But when I had those images more and more, it’s basically what I learned again from Katie. I was like, “Yeah, you know what? Bring it on. Bring it on. Let’s see. Turn it up. Turn it up. Crank it up.” Eventually, the images stopped because I wasn’t giving fear factor to it. I was going to put the opposite of basically giving it the talk-to-the-hand analogy, and that worked so well.

I see OCD as well from Harry Potter. I see OCD as the boggart, where when you come from the boggart, it’s going to come to your most scariest thing. But you have that power of choice right there and then to cast the spell and say ridiculous, as it says in the Harry Potter movies, and it will transform into something silly or something that you can transform yourself with compassion and love. An OCD can’t touch you with that. It can’t. It becomes powerless. That’s why I love that scene from that film.

Patrick McGrath says it so well with the Pennywise analogy. The more fear we feed the beast or the monster, the more stronger it becomes. But when we learn to give ourselves self-compassion and love and, again, using mindfulness and value and knowing who we authentically are, truly, it can do nothing. It becomes powerless. It can stay in the backseat, it might try and rear its ugly head again, but you have the more and the power in the world to bring it back, and you can be firmly in that driver’s wheel.

Kimberley: So good. How long did it take you, this process? Was it a short period of time, or did these value-based exposures take some time?

Matthew: Yeah, at first, it took some time to master it, if that makes sense. Again, I was going to start going to more coffee shops with my friend Carol or my family. It did take time. I was still feeling it to a degree, but probably about after a month, it started to really click. And then overall, it took me about-- I started really doing this in December, January time. I went to that concert in July. So about, yeah, six, seven months.

Kimberley: Amazing. Were there any stages where there were blips in the road, bumps on the road? What were they like for you?

Matthew: Yeah. I mean, my eyes did that sometimes. Also, like I said, when I started to do exposures, where I’d walk by myself around town places, it could be very nerve-wracking. I could think I’m walking behind someone that all the might think I’m a stalker and things like that because of the staring. That was hard.

Again, I gave myself the compassion and told myself that it’s just OCD. It doesn’t define who I am. I know what this monster is, even though it’s trying its very best to put me down that rabbit hole. Yeah, that person might turn around and say something, or even look. I have the choice again to smile back, or I can even wave at them if I wanted to do so. It just shows that you really have all the power or choice to just throw some back into OCD space every single time.

Self-compassion was a huge thing that helped smooth out those bumps. Same with mindfulness. When I was getting dissociated, even when I was still getting dissociated, getting really triggered, I would use the mindfulness approach. For example, when I was sitting in pubs, and that was a value to me as well, sometimes that would happen. But I would then use the tools of mindfulness. And that really, really helped collect myself being present back in the here and the now and enjoying what’s in front of me, like having a beer, having something to eat, talking to my friend, instead of thinking like, are they going to see me staring at them weirdly? Or my eyes met out someone, and I don’t know, the waitress might kick me out or something like that. Instead of thinking all those thoughts, I just stay present.

The thing is with this as well, it’s like when you walk down places, people don’t even look at you really anyway. They just go about their business, like we all do. It’s just remembering that and keeping that mindfulness aspect. You can look around where you are, like buildings, trees, the ocean, whatever you like, and you can take that in and relearn. Feel the wind around you. If it’s an ice wind, obviously, that’s freezing right now. The smells—anything, anything if it’s a nice smell, or even if it’s a bad smell. Anything that use your senses that can just bring you back and feel again that peace, something you enjoy, surround yourself with.

Again, when I was seeing my friend Carol, the town I went to called Beverley, it’s a beautiful town, very English. It is just a nice place. That’s what I was doing—looking at the scenery around where I was instead of focusing on my worst worries.

Kimberley: This is so cool. It’s all the tools that we talk about, right? And you’ve put them into practice. Maybe you can tell me if I’m wrong or right about this, but it sounds like you were all in with these skills too. You weren’t messing around. You were ready for recovery. Is that true? Or did you have times where you weren’t all in?

Matthew: Yeah, there were times where I wasn’t all in. I suppose when I was-- I also like to ask yourself with me if I feel unworthy. That is still, I know it’s different to staring OCD and I’m still trying to tackle that sometimes, and that can be difficult. But again, I use the same tools. But with, like I say, doing exposures with VTO, I would say I was all in because I know that if I didn’t, it’s going to be hard to reclaim my life back. I have a choice to act and use the tools that I know that’s going to work because I’ve seen Chris do it. It’s like, “Well, I can do it. I’ve seen Carol do it. That means I can do it. So I’m going to do it.”

That’s what gave me the belief and inspiration to go all in. Because again, reach out to the community with the support. If it was a hard time, I’d reach out. The community are massive. The connection they have and, again, the empowerment and the belief they can give you and the encouragement is just, oh, it’s amazing. It’s game-changing. It can just light you up straight off the bar when you need it most, and then you can go out and face that big scary thing. You can do it. You can overcome it because other people have. That means you can do it. It’s absolutely possible. Having that warrior mindset, as some of my groups—the warrior badass mindset—like to call it, you absolutely go in there with that and you can do it. You can absolutely do it.

Kimberley: I know you’ve shared with me a little bit privately, but can you tell us now what your big agenda is, what your big goal is right now, and the work you’re doing? Because it’s really exciting.

Matthew: Sure, I’d be glad to do it. I am now officially a professional peer support worker. If anyone would love to reach out to me, I am here. It’s my biggest passion. I love it. It’s like the ultimate reward in a career. When you can help someone in their journey and recovery and even empower each other, inspire, motivate, and help with strategies that’s worked for you, you can pass on them tools to someone else who really needs it or is still going through the process where it’s quite sticky with OCD. There’s nothing more rewarding than that. Because for me, when I was at my most severe, when I was in my darkest, darkest place, it felt like a void. I felt like just walking through a blizzard of nothing. Having someone there to speak to who gets it, who truly gets it, and who can be really authentically there for you to really say, “You can do this. I’m going to do it with you. Let’s do it. Like really, let’s do it. Bring it on, let’s do it. Let’s kick this thing’s butt,” it’s huge. You really lay the smackdown on OCD. It’s just massive.

For me, if I had that when I was going through it, again, I had a great therapist, but if I had a peer support worker, if I was aware that they were around—I wasn’t, unfortunately, at that time—I probably would have reached out because it’s a huge tool. It’s amazing. Even if you’re just to connect with someone in general and just have a talk, it can make all the difference. One conversation, I believe, can change everything in that moment of what that person’s darkness may be. So I’m super, super excited with that.

Kimberley: Very, very exciting. Of course, at the end, I’ll have everyone and you give us links on how to get to you. Just so people know what peer support counseling is or peer support is, do they need to have a therapist? Who’s on the team? What is it that they need in order to start peer support?

Matthew: Yeah. I mean, you could have a therapist. I mean, I know peer support workers do work with therapists. I know Chrissie Hodges. I’ve listened to her podcast, and she does that. I think it may be the same with Shannon Shy as well. I’m not too sure. I think as well to the person, what they’re going through, if they would want to at first reach out to a peer support worker that they know truly understands them, that can be great. That peer support like myself can then help them find a therapist. That’s going to really help them with their theme—or not just their theme—an OCD specialist who gets it, who’s going to give them the right treatment. That can be really, really beneficial.

Kimberley: I know that we’ve worked with a lot of peer support, well, some peer support providers, and it was really good because for the people, let’s say, we have set them up with exposures and they’re struggling to do it in their own time, the peer support counselor has been so helpful at encouraging them and reminding them of the tools that they had already learned in therapy.

I think you’re right. I think knowing you’re not alone and knowing someone’s done it, and I think it’s also just nice to have someone who’s just a few steps ahead of you, that can be very, very inspiring for somebody.

Matthew: Absolutely. Again, having a peer support work with a therapist, that’s amazing. Because again, for recovery, that’s just going to amplify massively. It’s like having an infinite gauntlet on your hand against OCD. It’s got no chance down the long run. It’s incredibly powerful. I love that. Again, like you said, Kim, it’s like when someone, let’s say, they know that has reached that mountain top of recovery, and that they look at that and thinking, “Well, I want to do the same thing. I know it would be great to connect with that person,” even learn from them, or again, just to have that connection can make a huge, huge difference to know that they can open up to other people.

Again, for me, it’s climbing up that other mountain top with someone else from the start, but to know I’ve got the experience, I get to climb that mountain top with them.

Kimberley: Yeah, so powerful. Before we finish up, will you tell us where people can get ahold of you if they want to learn more? And also, if there’s anything that you feel we could have covered today that we didn’t, like a main last point that you want to make.

Matthew: Sure. People can reach out to me, and I’m going to try and remember my tags. My Instagram tag is matt_bannister27. I think my Facebook is Matthew.Bannister.92, if you just type in Matthew Bannister. It would be in the show notes as well. You can reach out to me on there. I am at the moment going to create a website, so I will fill more onto that later as well. My email is matt3ban@hotmail.com, which is probably the best way to reach out to me.

Kimberley: Amazing. Anything else you want to mention before we finish up?

Matthew: Everyone listening, no matter what darkness you’re going through, no matter what OCD is putting in your way, you can overcome it. You can do it. As you say brilliantly as well, Kim, it’s a beautiful day to do hard things. You can make that as every day because you can do the hard things. You can do it. You can overcome it, even though sometimes you might think it’s impossible or that it’s too much. You can do it, you can get there. Even if it takes baby steps, you’re allowed to give yourself that compassion and grace to do so. It doesn’t matter how long it takes. Like Keith Smith says so well: “It’s not a sprint; it’s a marathon.” When you reach that finish line, and you will, it’s the most premium feeling. You will all get there. You will all absolutely get there if you’re going through it.

Oh, Kim, I think you’re on mute.

Kimberley: I’m sorry. Thank you so much for being on. For the listeners, I actually haven’t heard your story until right now too, so this is exciting for me to hear it, and I feel so inspired. I love the most that you’ve taken little bits of advice and encouragement from some of the people I love the most on this planet. Ethan Smith, Liz McIngvale, Chris Trondsen, Katie O’Dunne. These are people who I learn from because they’re doing the work as well. I love that you’ve somehow bottled all of their wisdom in one thing and brought it today, which I’m just so grateful for. Thank you so much.

Matthew: You’re welcome. Again, they’re just heroes to me, and yourself as well. Thank you for everything you do as well for the community. You’re amazing.

Kimberley: Thank you. Thank you so much for being here.

Matthew: Anytime.

The Anxiety of Decision Making Is REAL and EXHAUSTING!

Experiencing and managing anxiety is a hard and courageous task.  And you guys know what I am going to say next.  It is a beautiful day to do hard things! One activity that is made difficult by anxiety is the process of making decisions.    Making decisions can be exhausting and brings up a lot for us.

I know it continues to be a really tough time for everyone. I am definitely not immune to those struggles. In taking time off, I came to a realization about why I was having such a hard time. It wasn't about COVID or anxiety or stress. I was struggling because I had been having a mental tantrum inside my own head 24/7. My mental tantrum sounded something like this "It's not fair. This should not be happening. I'm supposed to be healing. This isn't the way it should be. It's not fair." I had no idea I was even doing this. I was having an adult sized tantrum in my head that no one else could see. Now it is important to understand that all of these thoughts are valid. It is a tough time and people are suffering, but the way I was saying it was definitely not validating.

I approached this by turning back to what has been the foundation of my recovery, something I learned about 15 years ago. It is rooted in the principles of Buddhism and that is 'in life there is suffering. It is not the suffering that causes the pain. It is the resistance to the suffering that causes you the pain.' So for me in this situation, my resistance or my mental tantrum was actually what was causing me the most pain.

Recognizing this and having compassion for myself is so important here. And asking myself is there a way that I can take off my stomping shoes and stop resisting the fact that this is a hard time?

We really do have a choice. Do we meet hard times with tantrums and resistance or do we meet those hard times with compassion, validation, consideration and respect? In these moments now when I still find myself throwing that mental tantrum, I simply note it and say "Ok I see what's happening and how am I going to deal with it? Am I going to keep throwing this tantrum or am I going to hold space for the fact that this tantrum is representing how hard things are and how much I am still struggling?"

This has been such a huge lesson for me during COVID-19. I hope it is helpful for you as well as we are all still navigating these difficult and challenging times.

ERP School, BFRB School and Mindfulness School for OCD are open for purchase. Click here for more information.

Additional exciting news! ERP School is now CEU approved which means that it is an accredited course for therapists and mental health professionals to take towards their continuing education credit hours. Please click here for more information.

Welcome back to another episode of Your Anxiety Toolkit Podcast. Today I want to talk about something that is so important to me. This is also something I think we all need a little reminder about from time to time and that is the importance of self-compassion. Today I want to share an exercise on how to practice self-compassion.

I want you to imagine that someone you care about comes to you and says that they are struggling or having a hard time. What is your first reaction likely to be? You probably will say something along the lines of "Oh I'm so sorry. How can I help you?" Now I want you to try this same approach the next time you are struggling. You can learn how to practice self-compassion by treating yourself how you would treat a loved one or even a stranger who is struggling. Stop and say to yourself "Ok you are in pain. Let's tend to that pain." Our work is really to tend to ourselves the way we would tend to others. Respect ourselves the way we respect others. There is no exception to this. You deserve kindness every step of the way.

The awesome thing about self-compassion is that it has been shown to reduce depression and anxiety, improve treatment outcomes and improve quality of life. So let's learn how to practice self-compassion and really honor how we are feeling, giving ourselves the same loving kindness that we show to others.

If you get a moment, please go over to wherever you listen to podcasts, whether that be Apple Podcast, Stitcher, Spotify, Podbean, and leave an honest review. Tell me how you feel about it, whether it's helping you, what you'd like to see. We are going to give away a pair of Beats headphones of your choice of color once we hit a thousand reviews!

ERP School, BFRB School and Mindfulness School for OCD are open for purchase. Click here for more information.

Additional exciting news! ERP School is now CEU approved which means that it is an accredited course for therapists and mental health professionals to take towards their continuing education credit hours. Please click here for more information.

Transcript of Episode 175

Welcome to Your Anxiety Toolkit. I’m your host, Kimberley Quinlan. This podcast is fueled by three main goals. The first goal is to provide you with some extra tools to help you manage your anxiety. Second goal, to inspire you. Anxiety doesn’t get to decide how you live your life. And number three, and I leave the best for last, is to provide you with one big, fat virtual hug, because experiencing anxiety ain’t easy. If that sounds good to you, let’s go.

Welcome back lovely, lovely friends. How are you? How are you doing? Just checking in with you guys. Thank you again for being here with me. Once again, I am so grateful that you choose to spend your time with me. So thank you so much. 

Today’s episode is a little bit of an impromptu, mainly because I recently did an Instagram post, and it’s on a concept I talk about all the time, but it got a lot of traction. It really made me realize that maybe you needed that reminder. I always think it’s interesting when a concept sticks really heavily with people. It makes me realize like, “Oh, okay, that’s where I need to head. That’s the direction that people obviously need help.”

Let me share with you what this concept was. One of the core concepts of self-compassion is to treat yourself how you would treat someone else if they themselves were suffering. What I want to do is, I want you to go with me on a little exercise, just to check in and see if there are any areas that you could up your self-compassion game, because if you’re going to up your self-compassion game, every single goal of mine has been won and we can all go home really, really happy. It’s one of my core missions. A part of my mission statement is to hopefully create a world of people who have anxiety, who stopped to treat themselves better, kinder, more compassionately, more respectfully, just nicer. 

Here’s the exercise. I want you to think back to a time where someone you love deeply was struggling. If you can’t think of a time, just imagine it. Think of someone who you care about, who you genuinely wish well. Think about them coming to you and them saying, “Hey, I’m having a hard time.” 

Now, when someone you love, someone you care for, someone you wish to be well, comes to you and says, “I’m having a hard time. I am suffering,” what is your immediate response? Usually, our immediate response is, “Oh my goodness. That is so painful. I’m so sorry. You’re going through that. How can I help? What can I do to support you?” That’s the best kind of care. 

Now, for those of you who, when I originally asked the question, had a different reaction, that’s fine too. It’s common that when someone else is suffering, sometimes we may feel defensive or we may feel angry because we haven’t got the space for it. Or we may feel resentful because we assume their pain doesn’t compare to our pain. 

If you had any of those reactions, that’s fine. I’m not here to tell you how to feel. And that may be something you want to go and work through because if those reactions were strong, those reactions need to be tended to with self-compassion too. We don’t want to just judge you and go, “Oh, that’s wrong,” and move on. No, no, no. That does not add to a self-compassionate practice. That just takes you away into self-criticism and self-punishment. So we don’t want to do that. Back up a little. We don’t want to do that.

But let’s just go to this genuine innate reaction that most humans, almost all humans, or actually all humans were born with, which is the genuine care to help and take care of each other, which I know is you. I know it’s you deep, deep down. Now, that reaction, that desire, that impulse to go, “Hey, how can I support you?” that is exactly how you need to tend to yourself when you’re suffering, when you’re having a moment of pain.

Disregarding where the pain came from, disregarding whose fault and who’s to blame and how you could have prevented it, I want you to lean towards speaking to yourself, how you would speak to another person or even a stranger. Sometimes we treat strangers better than we do our loved ones. That’s the truth too. But again, I’m not here to judge. I’m not here to tell you how to feel and how to treat others. I’m here to talk about how you can up your self-compassion game. 

When you’re in pain to say, “Hey, I am so sorry you are going through this. How can I be there for you? What do you need? What will get you through this?” And often the person, let’s say we were talking to a loved one, they would have some wisdom for us often. If I were to say like, if my husband came to me and he was venting and he was telling me how much pain he was in, usually he just wants me to listen and be there. Very few people want advice. 

That’s what I try to do for myself. There will be times when I’m in pain, where I need to stop and go, “Okay, Kimberley, you’re in pain. Let’s tend to this, but let’s also work to solve this problem.” The long-term problem, not the short term problem. We don’t want to just get rid of short-term relief. That usually ends up flopping. We end up falling on our butt when we do that or getting stuck in a cycle of problematic behaviors. But we may want to zoom out and go, “Okay, let’s take a really big look at the big problem here.”

Our work is to tend to ourselves like we would tend to others. Treat ourselves as we would treat others. Respect ourselves as we would respect others. There is no exception to this. You cannot give me one reason why you are exempt. 

A lot of my patients and clients will say, “Oh no, but I deserve this. I did this to myself.” It doesn’t matter who you did it to, why you did it, and who’s to blame. You’re in pain. You’re suffering. You may have chosen this suffering or this behavior that caused suffering because you were in pain. There is no exception. You deserve kindness every single way, every single step of the way. 

That’s all I have to say. Put it into practice. Nothing changes if nothing changes. We really want to focus in on this as being our highest priority. 

A little bit of science, self-compassion helps everything. We don’t have scientific evidence of exactly that, but almost we do. It helps with motivation. It helps with anticipatory anxiety. It helps with treatment. It helps with treatment outcomes. It helps with success performance. It helps with quality of life. It reduces depression. It reduces anxiety. It increases quality of life. Go for it. That’s our in sparks. Don’t stop. 

All right. I’m going to say goodbye. Before I do so, I’m going to let you know, again, please do go and leave an honest review wherever you listen to this. I would absolutely love it. It would be the best, best, best thing for me if you could. We are going to give away a pair of Beats headphones of your choosing of color for one lucky person who leaves an honest review. I’m not just saying the people who leave the best ones, but I have loved reading all of the reviews. Thank you so much. It really does help me find other people who need my help. So, go ahead and leave a review if you feel so inclined.

Have a wonderful day, and I’ll talk to you next week.

Please note that this podcast or any other resources from cbtschool.com should not replace professional mental health care. If you feel you would benefit, please reach out to a provider in your area. 

Have a wonderful day, and thank you for supporting cbtschool.com.

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

Helping children navigate the complexities of Obsessive-Compulsive Disorder (OCD) requires a delicate balance of understanding, patience, and empowerment. Natasha Daniels, a renowned expert in this field, shares invaluable insights into how parents can support their children in overcoming OCD with positivity and resilience.

Normalizing OCD:

One of the first steps in supporting children with OCD is normalizing the condition. Both parents and children need to understand that they are not alone in this journey. Natasha emphasizes the importance of taking things one step at a time and not allowing the overwhelming nature of OCD to overshadow the progress being made.

Education is Key:

Understanding OCD is crucial for effective support. Natasha urges parents to educate themselves about the condition, its symptoms, and the most effective treatment approaches. By arming themselves with knowledge, parents can better support their children through the challenges of OCD.

The Concept of "Crushing" OCD:

Natasha introduces the empowering concept of "crushing" OCD.” Instead of viewing OCD as an insurmountable obstacle, children are encouraged to see it as something conquerable. This shift in perspective can be transformative, instilling a sense of empowerment and resilience.

Making Treatment Fun:

To engage children in treatment, Natasha suggests incorporating fun activities. By turning exposures into games or playful challenges, children are more likely to participate actively in their own recovery journey. This approach not only makes treatment more enjoyable but also fosters a positive attitude towards facing fears.

Bravery Points:

Natasha introduces the idea of "bravery points" as a motivational tool for children. By rewarding bravery in facing OCD-related fears, children are incentivized to confront their anxieties and engage in exposure exercises. This gamified approach can be highly effective in encouraging progress.

Adapting for Teens and Adults:

While bravery points may resonate well with children, Natasha also offers insights into adapting these strategies for teenagers and adults. Creative incentives tailored to different age groups can help individuals of all ages stay motivated and committed to their treatment goals.

Creative Exposures:

Incorporating creative exposures into treatment can make confronting fears more engaging and less daunting for children. By turning exposures into interactive experiences, such as games or role-playing exercises, children can develop essential coping skills in a supportive environment.

Collaborative Approach:

Natasha emphasizes the importance of collaboration between parents and children in the treatment process. By working together to develop coping strategies and respond to OCD-related behaviors, families can create a supportive and empowering environment for children with OCD.

Addressing Parenting Challenges:

Managing the emotional challenges of parenting a child with OCD can be overwhelming. Natasha offers insights into coping with feelings of anger, frustration, and helplessness, providing strategies for maintaining patience and support during difficult moments.

Long-Term Perspective:

Supporting children with OCD requires a long-term perspective. Building resilience and fostering a family culture that promotes bravery and resilience are essential for long-term success. By focusing on progress rather than perfection, families can navigate the challenges of OCD with hope and determination.

Conclusion:

Natasha Daniels' insights offer a beacon of hope for families navigating the complexities of OCD. By normalizing the condition, educating themselves, and adopting creative and empowering approaches to treatment, parents can support their children in overcoming OCD with positivity and resilience.

TRANSCRIPTION: 

Kimberley: Welcome everybody. Today we have Natasha Daniels. She's the go to person for the kiddos who are struggling with anxiety and OCD. And I'm so grateful to have her here. We are going to talk about helping your kid crush OCD and how we can make it fun and how we can get them across the finish line. So welcome Natasha.

Natasha:  Thanks for having me. I appreciate it.

Kimberley okay. We've had you on before and I think so much so highly of you. I'm so honored to have you on here again talking. We were talking about kids as well last time but first of all let's just talk about the kiddo, right? The kiddo who has OCD. They're starting this process. Let's sort of even say like they're ready for help, like they want to get better, but at the same [00:01:00] time getting better feels like a huge mountain that they have to climb.

What might you say to the kiddo and the parents at that beginning stage of treatment?

Natasha: A lot of times I think kids don't even realize that they're not alone. They think they have like these really bizarre thoughts and that they'll never be able to stop those bizarre thoughts. So I the first step is really normalizing it for both the parent and the child and letting them know that lots of people have this struggle and that they are able to get through it and have a healthy, productive life. And for parents in particular. about tunnel vision, you know, because it can feel so big. And it's like, let's just, what's your next move? What's your next step that tunnel vision so that the overwhelm doesn't skew your perspective

Kimberley: Yeah, what might be those steps? Like what, what, [00:02:00] what, how would you, how would you have that conversation? I mean, I know for parents, I think there's some relief in getting a diagnosis and being like, Oh, okay, so we know now what this is. And we're here to get treatment and we're assuming this is the right treatment.

But they're still just, you know, it's such a mountain to climb. So what might you say to them?

Natasha: The first step is really educating yourself. I think parents learn a little bit and they just like want to jump into the deep end. They learn a little bit, like, Oh, you shouldn't be accommodating the OCD. So they're like, well, now I don't know what to do because I was doing something that at least help my child in the, in the moment.

But now I'm hearing that that actually makes it worse. And so they start to feel really overwhelmed by the little bit of information they get. So I would say. You know, get some education, whether you read a parent book, or you take a course, or you just watch a bunch of videos, but [00:03:00] like, get some basic foundation of what OCD is because it's going to shift and morph and change and look different. And so understanding, like, lay of the land of like, oh, okay, this is what OCD is. You know, it, it's demanding and it wants me, my child to do or avoid something to get that brief relief. And sometimes that hooks me in and the more they do or avoid that, the bigger it grows, like understanding it would be the first step.

Kimberley: So you wrote an amazing workbook called Crushing OCD Workbook for Kids. Let's talk about this term crushing like crushing OCD and that's sort of the title of our episode as well Like do we want that mindset if we're gonna crush it? Like what does that look like? How does that change our mindset? Do we need to really think of it like crushing it?

Can you kind of share a little bit more about that mindset shift?

Natasha  Yeah. I do use the word crushing a lot. [00:04:00] My courses are all about crushing. My, my book is crushing um, we're not getting rid of. Um, and so. There is a reason why I use crushing versus like overcoming or getting rid of, it is a powerful, kind of aggressive word. And, and I do feel like seeing OCD as kind of like this adversarial thing that you are crushing. Um, 1 can be very therapeutic and empowering for the child, especially when it's externalized and it's personified. So it's this Mr. OCD or this O cloud is us and we're going to crush it. Um, and then physiologically, do see it differently than anxiety. And I think sometimes with anxiety. we talk about, I kind of equate anxiety as like the overreactive lifeguard, and he's trying to, he's trying to look out for you, but just kind of, [00:05:00] he's sending the emergency alarm bells all the time. So maybe he needs some retraining. Maybe we crush him too, but that I think has more flexibility physiologically. Where I feel like OCD is like this foreign thought that's coming into my brain that is so incongruent with who I am, depending on the theme. And there's no part of it that feels like protective or aligned, um, in the way that OCD can show up.

And it's very glitchy, you know, and physiologically, a different part of the brain. And it is. It's a, you know, it's more of a glitch versus an overreactive. So I do feel like about crushing it is a good analogy.

Kimberley Well, I think too it's OCD can be so powerful and make us feel like we have to kind of like gulp down and, and wither it. Right. And so it does kind of require our kiddos to stand up to it. And I think crushing it [00:06:00] really gives that metaphor of like, we're going to stand up to it. We're going to win. This is like, we're going, you know, it's point systems or something like that.

Like who's going to win this baseball match, but we're going to beat it against OCD. So I think that that is really helpful. And I think kids get behind it too, like Kids want to crush things.

Natasha: Yeah. And, and they really need to feel empowered because it is so overpowering more than really any other disorder. It is just, it's they're being bombarded with these thoughts and feelings and to, to sit in a storm. And not do what OCD wants you to do a, is a really brave thing to do. And I do feel like kids can really get behind the idea of overcoming and crushing, not overcoming, but crushing it and feeling empowered that they have more strength than OCD does.

Kimberley: Okay. So in the workbook, you talk about these fun activities and I have found having my own [00:07:00] children, but also being a clinician, if it's not fun, they're not that interested. What's the payoff really? So, so can you share with us some of the fun activities or ways in which we can start to approach this topic with our kids?

Natasha: Yeah, I think anything can be fun and we want our kids to, to have fun and we want to gamify it. So a lot of the workbook talks about One, how to view OCD in a really fun way. So I use a lot of cartoons and a lot of metaphors so they can see it. Um, also talking about incentivizing them and, you know, adding points or bravery points to do, do scary things.

And so it becomes kind of this, Gamified version of, of, of crushing their OCD.

Kimberley: So bravery points. What does that mean?

Natasha: So bravery points can be different for different families. Um, and we use them in my, my house as well for [00:08:00] my own kids with OCD, where we set up kind of like a virtual store. And there are certain things you can have this pretty structured or not structured where you points and, um, you know, kids can do things that OCD will not. Want them to do or do things or not do things that OCD wants them to do, whichever way OCD is working or do exposures they're purposely triggering OCD and then they earn points and they can cash those points in and so Even at my house, you know, my child does not get Roebucks unless he cashes his points in There's like a direct line there.

My daughter doesn't get slime from very expensive place, unless she wants to cash her points in. And those are done through steps that are, that's crushing their anxiety and OCD.

Kimberley: And so I was actually going to ask this in terms of bravery points. This is not just for kids. This is for teens too. So you might be doing this for like, how might this apply to [00:09:00] teens or do we use bravery reward points for teens as well?

Natasha: Yeah. I think it can be used for anyone. I mean, I think even adults can, can gamify their battles with anxiety and OCD. Um, I mean, I've set that up for myself where I've done something that would be really hard. And then I've offered myself incentives, you know, ironically, or not really ironically, but interestingly. Intrinsic incentive does start to happen. You start to get traction. Um, I know for, for the kids that I've worked with in my practice and even my own kids, I've seen the, the pride when they've done something really scary and the relief of like, Oh my gosh, that was not nearly as bad as I thought it was going to be. And then the empowerment. So I kind of want to preface this with. can have these external reinforcers, but they're there to celebrate those brave moves. They're there to make the association of this is really fun, but the internal motivation does start to get some traction down the [00:10:00] road. And so even with teens offer them incentives, and that might look different.

I know, um, I've used this example a lot, like for my older daughter, she would net, she would not be driving today. Absolutely not be driving. If it wasn't for me. ordering her Starbucks. And I would just order her Starbucks and I'd be like, okay, it's ordered, you know, you just need to go pick it up. And she, she has social anxiety as well.

So she'd like, and she feels bad about spending money. So there was all sorts of things that were actually working in my favor. Cause she felt so bad. She's like, mom, you just ordered it. But I said, I wasn't ready to drive. And I was like, you don't have to pick it up. It'll just be sitting there. It'll just be wastey wastey. And she would go there. I mean, she had three. cycles of driving school before I did this.

Natasha: She was well skilled, but I mean, that's a very basic incentive. It was like, I'm going to reward you. Here's an extent, you know, an incentive to go do it. And, you can be creative with teens, [00:11:00] whether it is. I mean, in my practice, I would get like Xbox controls or like one girl wanted a green screen for her YouTube channel. Like, and it was just that weren't like far, far down the road, but little incentives to celebrate and say, you know, you're doing really hard stuff and it doesn't have to be all boring and, and miserable. It can be fun too.

Kimberley: Yeah. In our house, it's Taylor Swift records. We're working our way to get every single one of them. Um, right. And, and, and you get them after you, you know, achieve a certain amount of things. So I think I love this. Um, and I think it, it can, again, it can be age dependent. My son is working towards Pokemon cards as well for different things as well.

So I love that.

Natasha: Yeah.

Kimbelrey: So, okay. So bravery rewards. What about, um, The, the other work of treatment and crushing OCD, are there other [00:12:00] fun activities that you have found to be really powerful, whether it's more in how we educate and conceptualize OCD or get them to do the scary thing?

Natasha: Yeah. I think you can get creative and really anything that you're doing, uh, exposures can be fun as far as creating things that are triggering the OCD on purpose. They don't always have to be serious and boring. Um, you can create. Fun things, um, you can do interesting exposures, whether you create a game and you're playing games around it, like go fish, but you change the go fish to different names related to what they're struggling with.

Or used, like, um, jelly beans, you know, that tastes gross for my child that has, like, metaphobia and issues. And so thinking out of the box, um, in my practice, I would use, like. like two truths and a [00:13:00] lie they had moral OCD. And so we talk about, you know, I'm going to tell you two truths, but one and the, the third one will be a lie and you have to guess which one it is.

And that's a fun game in general, uh, but very overwhelming for someone with moral OCD. And so I think sometimes we think it all has to be serious, but there are a lot of creative ways that we can do exposures that. that can make us laugh. And even when we're responding to our kids, and let's say you don't want to feed the OCD. And so, um, let's just use a concrete example. Like if your child has moral or scrupulosity OCD, and they're always saying, I'm sorry, I'm sorry, I'm sorry. You know, repetitively, that's kind of a compulsive thing and you know that you're not going to feed it. And so you come up with a plan of, I'm not going to accept your sorry. You can even do something silly with that, um, and I've had parents who like, they would say it in a different accent or they would sing it or they'd say, you know, sarcastically, I'm sorry. [00:14:00] You're sorry is not accepted or, you know, like you can, you can even come up with fun, sarcastic things in your response to OCD as long as you're partnering with your child.

Kimberley: Tell me about the partnering though, right? So in an example of where you're like, you know, let's say you use your most funny Donald Duck accent, um, in saying, I don't, I don't want to, you're sorry. Um, um, You know, how, how, what if that doesn't feel like partnering to them? What if that feels like, you know, uh, like a, a betrayal to them or they, they're very invested in getting that compulsion done?

What would you suggest?

Natasha: Yeah. You definitely want to collaborate with your child first and say, you know, I know either they bring it to you or you bring it to them. Like I noticed that when you say this, it's actually your OCD saying that to me. And because I love you, I'm not going to give what OCD wants [00:15:00] anymore. So prefacing it with, I'm noticing that this is a compulsion that I'm part of, and I'm, I love you.

And so I'm not going to be part of that compulsion. And can respond in these ways, how would you like me to be, or how do you, how would you like me to respond so you can partner if they can come up with a creative way? Um, like, for instance, in my case with my son, he said, tell me, say, I'm sorry, is not accepted.

Like, he literally scripted it for me. when I said it in the moment, he wasn't happy with that because then he was panicking and he was feeling overwhelmed. And so he, I don't like when you say that, but that was our agreement. Um, I might pivot in that moment if he's looking really overwhelmed and I might not say anything because maybe it's not a time to be funny or maybe poking back in a really aggressive way isn't being well received in that moment, but that doesn't mean I'm going to feed the OCD.

Okay. you might have a child that doesn't want to partner with you that says, I want you to do this and this makes me feel better. And [00:16:00] why are you being mean? Um, and in that case, humor is not appropriate. You know, you're not going to use humor. You might just say, well, I love you. And so I'm not going to respond and you let them know you're going to respond, but the humor part, if we're the only ones laughing, then it's not really funny. So we have to be very careful about that.

Kimberley: Yeah. So, and I mean, it's true that crushing OCD or any, you know, mental health disorder is like a family affair. And so as a, as a parent, What is the training for them in this sort of idea of crushing it and making it fun? What, what personal work would you recommend they do, um, on their own in their own therapy, whether they're with a parenting coach or a therapist or with each other as partners, what would you suggest a parent do to prep for this [00:17:00] sort of marathon that we're on?

Natasha: It's a great question because there is so much parenting work that, that needs to be done because it's our journey too. And so I feel like the parent journey is unique in and of itself, you know, raising a child with OCD Um, it's not for the faint hearted. So learning, how do you sit in discomfort when your child is sitting in discomfort? you handle your child being triggered and not swooping in and doing what your child's OCD wants? hard to, to be a witness to your child's struggles, to know that in the short term, you can do something. Some of the time. appeases the OCD, but then grows it long term. And so, um, getting your own support or finding your own way to ground or your own coping skills of how do you handle that when you're, when the child's OCD is having a tantrum. Um, and it will try to kind of break you down so that you [00:18:00] give in so that there's work in that area. I think also, how do we handle our own, how do we handle our own mental health when our child is having mental health issues? Because We are not a blank slate. We come with a lens and that lens has our own childhood.

It has our own experiences, has our own mental health issues. And and so we're seeing our child's mental health issues through our lens no one can have a clear lens, but to have some awareness of I'm bringing this to the table, When my child does this, it triggers this for me, which is actually not about my child, but that's about my dad, or that's about my childhood experience. And how do I work through that so that it's not impeding how I'm my child. I'm not dealing with that. Yeah.

Kimberley: Yeah, for sure. What's, what's interesting for me. is I was thinking about this about parenting in general is [00:19:00] sometimes I parent the way my parents parented without even Questioning. Is that the way I want to parent like it'd be sometimes I'll catch myself Parenting my child in the way my parents was when I'm like didn't help me like that wasn't helpful You know what?

I mean? And and it's so automatic. It really takes slowing down and being like wait I'm What did I need during that time? How can I be that for my child? It's so automatic sometimes. And I think that, um, so many parents, I mean, I wish we were given a manual, but like, it's a lot of emotional regulation work of our own to sit while your child is struggling.

Um, especially with anxiety, cause you know, we just, it's so easy to fix it by giving them the compulsion or. You know, so I really feel for the parents that I, you know, that we treat in that it's so much emotional regulation. Would there be a specific [00:20:00] set of tools that you would give them or do you think it's very much dependent on the person?

Natasha: I think it's dependent on the person as far as what they're bringing. What they're bringing in the moment. Um, but I do talk about lovingly detach and, and a lot of times parents hear that and they get concerned because they think detachment means that I'm not present for my child. And it's actually the opposite to me.

It's like, how can I be? 99 percent or 95 percent there for my child. I'm like, I'm an anchor for them and I'm not bringing anything to the equation.

Kimberley: Yeah,

Natasha: And that is hard. And a lot of it actually is this. It may seem really weird, but I feel like a lot of it is building up your skills. Through like mindfulness, you know, how do I stay in the moment?

I'm only eating this food. I'm only petting my dog and that training like that mental training of your brain of like being Literally only in the [00:21:00] moment and learning how to fine tune that is actually a great survival tool because I find that When I'm in the moment with my kids and I have been working on that muscle in my brain, I'm able to not see as much through that lens of my own childhood or my own triggers.

And I'm just like, what does she need from me right now? And that's the question I always tell parents to ask. What do they need from me right now? Like, what is my job in this moment right now? And sometimes it is to ignore them because I know with my daughter, at least, she doesn't like the attention of anxiety.

Like when I can tell clearly she's having an anxiety attack, she doesn't want me to hover. And that's really hard because. Inside, you're feeling really anxious about it, but you know that your anxiety or your, your energy is contagious. And so yourself and be like, in this moment, she needs me to go, you know, about the morning routine and just act like nothing's happening. Or it might be the opposite for your child, right? But knowing it's not about us, what do they need in [00:22:00] that moment? Um, and that is a powerful skill that has to be, it's a daily practice.

Kimberley: and different for each kid.

Natasha: Right. Vastly

Kimberley: Yeah,

Natasha: Yeah.

Kimberley: where it gets complicated. I think he's like because you know, we go Okay, this is the way we do it This is how we do it from now on and then you have another kid and you're like wait that doesn't work for them

Natasha: Yup.

Kimberley: let's shift it up and let's change it I'm wondering if we, you can quickly speak to a couple of emotions that I know show up with parents, you know, cause again, it's as much the parent game as it is the kids game.

So where as clinicians and as parents, where they're to really champion our kids to ride the wave of discomfort and to use their skills and to manage it. What about for the parent they might be experiencing? I know a lot of parents report. anger that shows up at the, you know, when their kid isn't [00:23:00] using their skills and so forth.

Um, do you have any, any advice to them when anger does show up or frustration? Yeah. Yeah. And

Natasha: being angry then we're like, Oh, I responded angrily or I'm feeling frustrated and I shouldn't. And being accepting of the fact that it's okay, it's normal for me to feel angry. This is a frustrating situation and I want to change it and I want to steer the ship and I can't.

Yup. You know, my child's not picking up their part. And so I think just validating that anger, um, which I can be, I think can be sometimes hard because we want to. Kind of we feel guilty about the anger, but then understanding where it's coming from and and again going inward There's so much inward work I think when you're raising a child with anxiety and OCD because it brings out all sorts of stuff for us So asking oh, it's interesting that I'm angry or that made me really [00:24:00] angry or sometimes I'll even say to myself like in my head like Natasha, that was like a huge response. why did you blow up so big on that? That was more than what was actually just happening then. And then do some self diving of like, what was that about it? Oh, that reminded me of this. Or I feel like I'm doing 99 percent of this and he's doing 1%. And what do we, what can we control? And so maybe if I'm feeling that way, then it's a shift of, to pull back. If I'm feeling like I'm doing 99 percent and that's making me angry. I can't control the pace of my child and their ability to use their skills because that's their journey, but I can control invested I am. And so if I'm doing 99 percent of this, then I'm going to pull back a little bit give, you know, invite them to meet me more in the middle.

Kimberley: often I find under the fear is, I mean, so under the anger is the fear that we're going to be managing this for a while, or, you know, the parents grief [00:25:00] of This is interrupted the family system. So I think it's so normal. Um, I agree with you just to normalize that as a normal part of parenting, a kiddo who's struggling.

Um, yeah. Okay. So in terms of getting that kid across the finish line or setting them up better things like setting them up for success, is there anything that you would tell the parents? as a mindset shift, like, you know, again, this is a marathon, not a sprint. What would you tell them in terms of the whole family system?

How, what are skills and tools that they can be using to help set up a system or a family that can help this child crush OCD?

Natasha: Yeah. I think mindset's really important because a lot of times is a perception of, I need to cure this, you know, or we need to get the skills and that they can overcome this and OCD is a chronic [00:26:00] condition. so we're wired, you know, if we're going to have anxiety or OCD, that this is going to pop up possibly in our life periodically. yeah, Yeah. So instead of thinking, like, how do I, you know, get rid of this cold or give them the skills and then we've we're done with this because that sets you and your child up for failure. I think having an idea of I'm going to create a home a family culture where we. Where we know we have the skills. We know what OCD is. We know how to identify it. Um, we live a life of exposures. We live a life of doing brave things. we talk about it and it doesn't have to be, I mean, I think once you're in maintenance, and you've really kind of. Learned all the skills that you have learned. I mean, we live in my house.

It's a, it's a culture of anxiety. And OCD is kind of just part of our family culture. Like we do scary things or my kids might say that was an exposure or they earn points periodically. And so developing that in your, in your family as a system of like, just part of [00:27:00] your family, just the way your family functions and it works can be really helpful.

And there's, there's, Brave things that anyone in the family can do. And so it can be a family affair where I had to go present at work and I didn't really want to present, you know, but I did it. It was really brave. And so using those analogy, using those examples, I think can be really. Normalizing for the child with with OCD.

Kimberley: Yeah. So even, even for the non OCD kiddos, you would use that in terms of if they had to do a violin recital or a math. a national math test or that kind of thing.

Natasha: Yeah, I mean, I think it can go way beyond OCD. It's how to build resilience because really at the crux of OCD is resilience. It's how to sit with discomfort, how to sit with uncertainty of not being 100 percent of something how to how to deal with something that feels uncomfortable and do it anyway.

And so those are those are resiliency [00:28:00] tools that anyone

Kimberley: Yeah. And it's such a great mind shift for everyone because parents are doing exposures. They are doing scary things by not accommodating their child as well. That's an exposure for a parent pretty well. Um, so you can conceptualize it that way. I love that. Yeah. Um, What does it look like? I love that you also mentioned in terms of like this is a long term thing.

Like this is just a family culture thing. This is how we exist in the world. What does it look long term though? You know, do we do, I've had so many parents say to me, I don't want to give, but you know, the, the, um, The bravery points forever. I don't want to over saturate extrinsic motivation. Like, do you have any thoughts on that in terms of long term use of that method?

Natasha: mean, it depends on your child's age and like where they are as far as building up skills. we have it in the background because I don't, [00:29:00] I don't give my kids money for chores, I don't. And so it's just been part of our thing where if they want, I guess what they would call in the UK pocket money, you know, if they want, they want spending money. In general, that really works for me for them to do brave things in general. Um, and so that is just part of the way that we have that now, my 20 year old's not earning like bravery points, you know, across, you know, state lines in California where she's in college, you know, but she's, she's, doing that lifestyle.

And so I don't feel like you necessarily have to have these systems or incentives. Um, you might hit a bump and you might say, you want to earn something to overcome this thing that you're working on. Um, you know, a new struggle that they're having. So you might pull it out periodically for me. I don't want I'm like, I'm trying to teach my kids the idea of earning in general. And so it kind of. Fits well, because it's like, [00:30:00] you're not going to get things for free. And then there's this pride of like, oh, I earned that. Or let me work really hard at something. So you can get very ambiguous about it. You can have it be of just kind of your, your regular family incentives and how you're doing it, or you don't do it at all.

I mean, It does eventually, um, get stale and so you have to either change it up or you take a break from it or your child is motivated by intrinsic motivation that they're feeling really great that they're able to go to school again or sleep on their own or do the things that were overwhelming for them.

Kimberley: Right. Exactly. Yeah. I think that's the beauty is once you've done some exposures, you see that it works. There's a buy in. Um, but that buy in is hard at the beginning, which is why you do have to make it fun. And sometimes you do have to have it be sort of outside motivators to get you there. Yeah.

Excellent. So, um, tell me about [00:31:00] your workbook where people can get it, where people can hear about you. Um, cause I know you have so many awesome resources.

Natasha: Yeah. Well, I wrote, um, OCD workbook for kids because I wanted people to be able to have a book that was very simplistic that would walk them through basically what I would do in a therapy session, or therapy sessions. And so it just kind of walks them through OCD treatment. So it could be a great supplement to therapy.

It could be great for a therapist to use, but it can also be a great standalone. Um, and it's meant for kids to be able to do either on their own or navigate with a parent depending on their age. And starts off with educating them on what is OCD because I told you, I feel like that's so important. Many disguises of OCD, um, normalizing it all the way to understanding how OCD works and then offense and defense about if OCD is knocking versus [00:32:00] knocking on OCD. How to do exposures at home and then how to, how to maintain that. And I also touch on like self esteem as well, because I feel like. OCD can really hurt the self esteem.

So there's a little bit of empowerment and self identity in there as well.

Kimberley: So important too. OCD can be mean, right? So, and knock people down. So I love that you're talking about that. And where can people find out more about you?

Natasha: Um, well they can get the book on Amazon. They can find anything about me at my website at at parenting survival school. com. I mean, nope. At parenting survival, at parenting survival. com too many websites.

Kimberley: No, I understand. I'm in the same boat. Well, thank you so much for coming on and talking about crushing OCD with kids. Is there anything you would leave parents and children with a little bit of inspiration or? One last point that you think that you really [00:33:00] want them to know.

Natasha: Well, I think there's always hope. I mean, I have seen kids in very acute stages of struggling with OCD and I have seen kids make such big project progress. So there is always hope. And our kids are more than our, their OCD and kids with OCD tend to be the most, of the most compassionate, kindhearted, out of the box thinkers.

And, and so I wouldn't even trade that with my own kids because I feel like the, the positive personality traits that, are underneath all those struggles are, are beautiful. So

Kimberley: Yeah.

Natasha: that's important to do.

Track 1: And, and I think from, from my experience is nurture those parts that are not OCD, like what are their hobbies? How can we really build a life around OCD in terms of, you know, the instruments and the hobbies and the talents and the sports and the, you know, the community and that. So forth. So yeah, thank you so much Natasha for coming on.

I am so I [00:34:00] love, I love your book. Thank you for writing it. I know writing a book is no easy feat. So congratulations on your book. Um, and I'm excited because you've got more on the, on the coming down the pipeline. I know you have a memoir coming out, so we'll be having you back on later in the year.

Natasha: appreciate that. Thanks.

• How to manage Postpartum OCD (including thoughts of hurting our children)
• How to help someone with Scrupulocity or Moral Obsessions (including fear of offending God or sinning)
• How to help a son with OCD and Tic Disorder
• How to manage thoughts about Death

What You Say To Yourself Matters.

• Things are bad
• Things aren’t going to get better
• She is the victim. That she has no choices here
• She doesn’t have coping skills/ She will not survive this event

What you can do differently:

I have outlined a step-by-step plan to help you better manage your narrative related to anxiety.  We go into greater detail in the podcast, so enjoy listening!

_______________________

4-point plan to creating a more Mindful Narrative

1. Be objective, not subjective                      See Episode #1: The Skill or Non-Judgment for more info
2. Be in the present moment                         See Episode #8: Skill of Awareness for more info
3. Take responsibility for your experience
4. Practice Uncertainty                                   See Episode #6: The Beginners Mind for more info

_____________________

To help you along with practicing these steps, I have also created a fun PDF that you  can download/print and use at your leisure.

Sign up below to get access to all the Podcast Add-ons!

Enjoy!

This podcast should not replace professional mental health care. This podcast is for education purposes only. If you feel you would benefit by seeing a clinical professional, please contact a professional mental health care provider in your area.

GUILT, SHAME and being “SO OCD” with Shala Nicely

How do you respond when people say, “I am SO OCD?”

How does it feel when you hear someone say "I am so OCD"?

Are people with OCD, “SO OCD?”

How can we manage the shame and guilt that comes with having OCD or another mental health disorder?

Shala’s FAVORITE mindfulness tool:

Dan Harris' 10% Happier book and App.

How to find out more about Shala Nicely

This is Your Anxiety Toolkit - Episode 198.

Welcome to Your Anxiety Toolkit. I’m your host, Kimberley Quinlan. This podcast is fueled by three main goals. The first goal is to provide you with some extra tools to help you manage your anxiety. Second goal, to inspire you. Anxiety doesn’t get to decide how you live your life. And number three, and I leave the best for last, is to provide you with one big, fat virtual hug, because experiencing anxiety ain’t easy. If that sounds good to you, let’s go.

Okay, friends, how are you doing really? How are you doing?

It’s summertime, you guys. Oh my goodness. We’re here. How did this happen? Just to let you know, I will be taking a break as I have done for the last several years over the summer. So I will probably take a few weeks off in July so I can have some time with my kids to really rest and repair and play and be human. It’s such a weird year. And so as I’m recording this, it’s not summer yet, but it’s crazy to think that we’ve landed in summer already of 2021. Am I right? Holy smokes.

Okay, before we get started, as I always say, please do go and leave a review. I will be giving away Beats headphones to one lucky winner when we get a thousand reviews. We’re on our way, guys. So please do go and leave a review. I would so be grateful. It just really helps me strengthen the podcast, and it’s one of my big goals for 2021, is just to really help people with this amazing platform.

All right. So here we go. Today, I am talking about how I am protecting my daughter from an eating disorder. But what I’m really going to be talking about is how we, me and my husband, are protecting my daughter and my son from an eating disorder. The reason I preface that is because, number one, yes, while women are more likely to develop an eating disorder, there is an increase of prevalence of young men and young boys getting and experiencing an eating disorder.

There are many different types of eating disorder. It doesn’t have to be anorexia. They can be binge eating. There’s also types of eating disorders, such as bigorexia, which is around developing muscle. There’s orthorexia. There’s so many kinds of, again, bulimia anorexia, of course, we’ve discussed. There’s so many types and it’s so important that we recognize that this is not just a problem for women and girls.

So let’s talk about it. How myself and my husband are protecting my daughter and my son from an eating disorder. So there are two main things I want to discuss today. Number one is how we talk and number two, how we model. And so I’m going to give you much more detail into how we are doing that and how we’re choosing to do that and the struggles that we’re having.

I, myself, had an eating disorder. So I’m really, really protective of this topic with my children. It’s something I really want to try and protect them from while I know that I can’t entirely protect them. I can do a lot of education to give them everything they need to hopefully not have to go through what I have gone through and what so many people have gone through with eating disorders.

So, first of all, let’s talk about what we talk about. Let’s talk about what we talk about, shall we?

All right. So the first thing, and you guys have heard me say this probably before, the first thing we talk about is diet culture. This is where we identify how our society is teaching us to believe that we should be a certain way. Our bodies should be a certain way. Our skin should be a certain way. Our hair should be a certain way. We should look a certain way. And we want to be able to identify this so we can call the BS on it.

So the reason that I call BS on it is, just because society tells us our body should be a certain way doesn’t mean it’s true. In fact, it’s entirely BS. Your body, my body, my daughter’s body, my son’s body, and my husband’s body – doesn’t have to be any particular way.

Society and diet culture is going to tell us that it should be thin. It’s going to give us all of these messages. “We should be thin. We should be strong. We should be tall. We should be short. We should be eating this certain thing. This product will help us with our metabolism. This product is bad. These foods are good. These foods are bad.” And there’s so many messages that are faulty and proven to be wrong. So, so important. So we talk a lot about this with my children.

When my daughter and I go shopping, which we haven’t done in a long time, but when we see advertisements, when we watch TV shows, when we look in magazines or pitches of books in books, when we look at Barbie dolls, we talk about diet culture. I might say, “What about her body? Let’s talk about Bobby.” And we look at Bobby and I’ll say, “What do you think about her body?” And she’ll be like, “It’s kind of weird. It looks kind of strange.” And I’ll say, “Yeah, why do you think that is?” And she says, “Well her waist is really small.” And I’ll have a conversation with her. We talked to her about, “Do you feel like you need that to be beautiful? No, no, you don’t.”

How might we change this? And I might say to her, “You don’t have to look anything like that. You know that your body is genetically set up to be exactly the way your body is and there’s nothing you need to do any differently about that.” So important.

Same with my son. Look at the action figures. We might say, “Your body doesn’t have to look like that.” That’s diet culture. You don’t have to have a six-pack of abs. He’s only six, but we’re still already having these conversations.

Now, what’s interesting is my husband right now is reading the book to our children, and it was a book that he read when he was a young kid with his parents. It’s interesting because there’s all these references to fat, like fat this and fat boy and fat girl, and she was fat and so forth. We talk about the word “fat.” We talk about, is that a good word or a bad word? No, it’s just a word. It’s a descriptive word. But would we use it to describe somebody else? No. We would use many other things to describe somebody than using that kind of word. Not that there’s anything wrong with the word. It’s just that we don’t want to encourage them to define a person by their body.

We try our hardest not to compliment our children’s body. You might think that’s crazy. Some people go, “Oh, no, no. My child won’t have an eating disorder. I tell them how beautiful they are every day.” I often will educate them and say, “That doesn’t actually prevent anything. In fact, it just adds to that kid and that child thinking that the way they look is important. Because what if their body changes? Then they’re going to be like, ‘Oh no, mom’s always complimenting me on my body, and now my body changed. So does that mean I’m bad?’” So we do our best not to compliment their body or anybody’s body.

I have worked really hard since my own recovery to never congratulate someone for losing weight, which is really hard. In fact, I’ve had one really difficult conversation with our friend where she was saying, “I really just want you to compliment me because I have lost a lot of weight.” And I’ve said to her, “That doesn’t line up with my values. I love you, but I never want to engage in something where you believe your worth is caught up in your body. I just can’t do that. I’m sorry. But I love you and I love everything about you, every part of you, whether your body is in a large body, a small body, a tall body, a short body, whatever color skin. I love you.” And we say the same to the kids. Now, of course, we also don’t ridicule their bodies. We don’t comment on their bodies, their ever-changing bodies, as they, my daughter moves into preadolescence.

We’re still in the talk section. We talk about what we do value. That person is very kind. He has kind eyes. She has a beautiful smile. She radiates love. She is a fun person. She’s very intelligent. My five-year-old son says intelligent a lot. “He is very intelligent. I am very intelligent.” Not that we want to overvalue that either. Because we want to really remind them that unconditionally, we will love them and that their worth is consistent. It doesn’t matter what. It doesn’t matter what. That they’re worth and our love for them is consistent.

And to be honest, I will say there is nothing more powerful than hearing that from a father, particularly if you’re a young woman, a young child like my daughter. For my husband to say, “I love you, no matter what. Don’t ever let a man judge you or comment on your body and you believe what they say, because you’re more than a body.” To teach our son that other girls and other boys are more than a body. To teach him that he’s more than a body. So important.

Now another thing we do is we praise all foods. We celebrate all foods. We are grateful for all foods. We do not have good and bad foods in our family. We don’t talk about things being healthy and unhealthy. While we do very much value health, we really try to help the kids understand that they can listen to their body and our body.

This is the kind of funny story, I’ll tell you. My daughter is going to be 10 and she can outeat anybody. It’s really quite phenomenal. She’s always hungry. And my instinct is to go, “You’ve already eaten. Stop eating. You certainly cannot be hungry.” I’m feeling full and she’s eating double what I have. But I really catch how we talk to her about her food and we celebrate, “Good for you, honey. You’re listening to your body.” She’ll often come to me and say, “Mom, I’m starving. What can I eat?” And we laugh. And she smiles. And I say, “Hun, what do you think I’m going to say?” And she rolls her eyes and she says, “You’re going to say, ‘You can eat whatever you want.’”

Now, of course, we have some rules around this. We don’t encourage and we don’t allow the kids to eat a lot of snacks before a meal. We try to really have them understand the importance of waiting for their meal. But that’s probably 45 minutes at the most. Often my daughter will have a full peanut butter and jelly sandwich 45 minutes before a meal and still eat her whole meal, and we praise her for that.

My son is really, really picky around food. There’s certain things he really, really likes. And interestingly, he has no interest in sweets. If he could choose between salty and a birthday cake, he would choose salty all the time. We encourage him to just listen to his body. I talk to them about me listening to my body. They’ll be like, “Mom let’s go have ice cream.” And I’ll usually sometimes not eat ice cream. That’s not because I’m restricting. I might say, “No, I’m listening to my body. I don’t really need ice cream right now.” And then there’s other days where I’m ordering three scoops of ice cream because I’m really hunkering down for some ice cream. So I try to also teach them that it’s okay to listen to your body as does my husband.

So these are all really, really important things we talk a lot about. And this is the last thing we talk about, which is health. What is health? Is health only eating sugar-free foods? Is health being thin? Is health being tall? No, none of those things. Is healthy eating only organic food? No, absolutely not.

Health is having balance and taking away judgment. We have to remember here too, health is not just physical, it’s mental.

I know people who eat the most “clean diet” and they exercise, but they’re not healthy because emotionally they’ve got a really unhealthy relationship with food and their body. They’re hard on themselves. They beat themselves up. Maybe they binge. So this is the thing to remember. Your definition of health might not be what is the real definition of health.

Now this is really true and I’m going to make sure I have some people on coming here once we get back after the summer on talking about health at every size. This is a crucial conversation we need to have. If you haven’t read yet a book called Health at Every Size, I urge you to. It’s so important to really understand the science behind that and understand the issues we have around how we have stigmatized people in bigger bodies as being unhealthy when we’ve actually got lots of science to prove that you can be really healthy in any size body, that health is not indicated by just your size.

Okay. So now we move on to what we model. This is similar, but very important. So my husband and I have two completely different body sizes. Not that that’s super important, but I feel it’s important for our children to have those two examples and to have family members with different body sizes, where we celebrate every single body, and we do a lot of modeling around that. We do a lot of modeling, celebrating bodies – all the body sizes, shapes, skin colors, nationalities, sexualities. We try to model to our children and normalize differences instead of things being like, “This is good and this is bad.”

We also model, like I’ve mentioned to you, how we eat. We try not to judge each other for what we eat in front of each other. We try to really encourage by modeling like there’s no time you should eat food. A lot of my patients will say like, “Oh, I had a bagel for breakfast so I can’t have a bagel for snack.” And we go, “No, you can eat a bagel for breakfast and for lunch if you want.”

My son loves more than anything to put cream cheese and sprinkles on his bagels in the morning. He loves really sprinkled-up bagels and we allow it. We figured it’s no different than him putting jelly or jam on his bagel. And so we allow it, we allow him to enjoy his food. Given that he’s a kid who doesn’t like a lot of sweets, we’re all for it.

We also model by not saying negative things about our own body. My son is a personal story, but my son once came in and I was getting out of the shower and he said, “Mom, your belly’s all jiggly,” which is most moms’ nightmare. You know what I said? I said, “Yeah, it is. Isn’t it beautiful though, that I had two babies in that belly? Isn’t that cool?” He might say, “Daddy’s belly is big,” or whatever he may say. And we’ll go, “Yeah, isn’t that wonderful? We have so much fun eating food and what a wonderful body. Isn’t it so great that we have our bodies, that our bodies do all these things for us, like pump blood and breathe and digest food and run and hold our hearts and hold our brains and filter nutrients and things like that? Isn’t that incredible?” We model body acceptance and body love.

This has been really helpful for us, particularly because I know a lot of women and men who’ve developed eating disorders because their parents were on a diet all the time, that their parents model these strict diet culture rules, and good and bad rules, and all of this stuff that’s so dangerous for young ears to hear.

Now, we also model this or share one more personal story is, so much of eating disorders is around restriction. Over the last two years, my daughter has had some medical issues where she had to restrict several different food groups and this was really uncomfortable for me. I was very strong against it. I had said to her pediatrician, “I’m very uncomfortable with this. I do not like the idea of her restricting.” And he really coached me through. “You have everything you need to help her protect against this becoming something eating disordered. And just because she needs to do this medically doesn’t mean we have to make it about her body,” which was really helpful for me to hear. And so, yes, she has had to restrict several really important food groups because of some stomach issues that she was having.

And so it’s been a really interesting thing for us to have these conversations around what is a diet and what does that mean and why would we go on a diet and what are some reasons that we probably would not encourage her to go on a diet around and so forth. And so, that has been really, really fascinating to watch her navigate that.

There’s been a couple of times where she said like, “Mommy, I know I’m supposed to check on the ingredient list for certain things.” But she said, “That has made me really uncomfortable having to do that.” And I so appreciated her talking to me about that. And so we came up with basically a strategy that she could know basically what is in certain different foods. And from there, she wouldn’t have to look at the nutrient lists anymore, the ingredient lists. I was so happy that she felt comfortable saying, “This feels not right for me. This feels like it could become a problem.” And so, that has been really, really huge.

I think the only thing I would add from there is, for me as a therapist, but mostly a mom, I’ve had to really allow a lot of space for anxiety around this stuff because I never want my child to have to go through that. I have caught myself being hard on myself and feeling a sense of hyper responsibility, like it’s your job, it’s your job to protect her. I’ve had to really pull back on that as per my conversations with the pediatrician in terms of saying, “Kimberley, you can do what you can do, but you don’t have control. It will be what it will be. You can model and you can talk and you can be the best you can be, but we also have to let go of control and just be uncertain.”

Like I’m always telling you guys, it’s an uncertain thing. There’s no promises that we can do the best that we can. If we make a mistake and we mess up, we apologize and we share and we talk about where that mistake in that era came from, where did we learn it, what triggered us in that moment. And so, that has been really, really important for me as well.

So I hope that that’s being helpful. Those are the main pieces that have helped us as a family to protect our daughter and our son from an eating disorder and body image issues. I do hope that even one point has helped you in navigating this.

If you haven’t, if you’re not the parent of somebody, these are also messages and things that you’ll have to do for yourself, to model to yourself, talk to yourself about. And if not, go and find an eating disorder specialist who can help challenge this and work through the beliefs you have around food and diet culture in your body, and that can be really, really, really helpful.

Okay. I love you all. Have a wonderful, wonderful day. It is a beautiful day to do the really, really hard thing and you’re doing it. I know you are. So, I will talk to you very, very soon.

Have a wonderful, wonderful day.

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Welcome back to another episode of Your Anxiety Toolkit Podcast. Today I wanted to talk to you about something that I have been struggling with recently. So you all know that I made the decision to travel back to Australia to visit my family. This decision caused a good deal of anxiety initially, but I also soon recognized that feelings of hyper-responsibility, such as am I being irresponsible by going home, were popping up as well.

I had to break this down. Why do we have this sense of hyper-responsibility to always do things "right"? That level of responsibility can cause us a tremendous degree of anxiety.  We tend to put expectations that are unrealistic on ourselves to be perfect, good, the fixer of all things broken. So how can we take a step back from that? We actually exist on a spectrum. When you are anxious, maybe you need to recognize that so much of that anxiety is driven from these feelings of hyper-responsibility, from this fear of being irresponsible. That's key, my friends. Just because you feel it doesn't mean it's the truth. Just because you feel irresponsible doesn't mean you are irresponsible.

We sometimes have to check the facts. I'm encouraging you to do a check on this hyper-responsibility and see if you can tone it down to a place that's healthy. You can check yourself as you start to respond in a compulsive or an avoidant or reassuring way and you can say, "Hey, is this being led by hyper-responsibility? And if so, where can I land that's healthy." I want you to challenge yourself in this area. Practice stepping back and letting somebody else be the responsible one for a minute or an hour or a day or a year. Try recognizing that yes you have some responsibilities, but also recognize where that hyper-responsibility may be getting in your way.

ERP School, BFRB School and Mindfulness School for OCD are open for purchase. Click here for more information.

Additional exciting news! ERP School is now CEU approved which means that it is an accredited course for therapists and mental health professionals to take towards their continuing education credit hours. Please click here for more information.

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

Welcome to another episode of Your Anxiety Toolkit. Today I have the pleasure of interviewing Jeff Goldman, a Hollywood executive and the Director of Development for OCD Southern California. In this interview, Jeff shares his very vulnerable story of being tormented by OCD and how it has impacted his family and his career. Jeff shares his highs and lows with us in his very inspirational and honest story. 

In this interview, Jeff Goldman shares his story of having “Just Right” OCD and how the fear of being a failure caused him to become paralyzed with anxiety. Jeff explains that he was diagnosed with OCD at 17 yrs old and has had a long, but inspirational journey to wellness. 

Jeff discusses his struggles with facing treatment and how he needed a lot of support and motivation to work on his mental health. He shares, “I was afraid of changing in spite of hating my life." What comes after that is a recovery story that includes medication, therapy, and family support. 

Some of the tools Jeff uses to help manage his OCD are “you have to name it to tame it”, “feel the pain” and “let the anxiety flood through your body." 

Thank you so much to Jeff Goldman for sharing his amazing story!

Jeff Goldman, Director of Development, OCD SoCal (an affiliate of the IOCDF)
https://ocdsocal.org/
https://iocdf.org/
jeffgoldman.livingwithocd@gmail.com

OCD Gamechangers – Annual Conference
https://www.eventbrite.com/e/3rd-annual-ocd-gamechangers-tickets-82657196901
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Seasonal Affective Disorder (SAD) is REAL and TREATABLE!

Anxiety + Anxiety + Anxiety = Anger

Welcome back to another episode of Your Anxiety Toolkit.  Today I talk about how "you cannot skip the line." This podcast episode is about an event that happened to me a few weeks ago that blew my mind. It pretty much punched me in the gut. Yes, you read that right. It was a hard, hard day. In this episode, I speak about attending a meditation class and being given a very hard lesson. The lesson was, “You cannot skip the line”. Let me tell you more.

In this class, I asked what I thought was a simple question. Without expecting it, the teacher taught me a very important lesson that I think will impact me for quite some time. 

She responded with “There is a lesson for everyone here. It is important that you do not skip the line here. You must do the work. If you haven’t wrestled with this practice over and over, do not come to me for the answers.” 

I was embarrassed. I felt ashamed. I felt called out. I felt anger. 

But, after some time and contemplation, I asked myself, “Is there a pattern here?” And guess what?!  There was. The lesson was that you cannot skip the line to the “know” the answer. When you “skip the line”, you prevent yourself from learning the real process. Knowing will only help for the first time or two. After that, it takes practice and patience. 

In this episode, I will walk you through a 4 step process to help you lean in and do the work instead of just asking questions. 

These steps include being aware that you cannot skip the line and then catching yourself when you are doing such behavior. The steps also involve being honest with yourself when you are engaging in such behavior instead of staying in the unknown. The goal is to be as patient as you can along the way. And lastly, the most important step involves Compassion, Compassion, Compassion. 

I hope this helps you in some way to notice when you are “skipping the line."

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Please check out this excellent blog post by the amazing Shala Nicely, LPC on the problem with saying "I'm so OCD."

Welcome back to another episode of Your Anxiety Toolkit Podcast. We have a lot to tackle in this episode!  We are going to be talking about a really important topic which has a lot of confusion surrounding it.  Today we are going to explore the difference between an intrusive thought and a mental compulsion.
OCD starts with an obsession. This is an intrusive, repetitive, unwanted thought, feeling, sensation or urge that you cannot control this.  Once you've had that intrusive thought, feeling, sensation and urge, you usually feel anxious and uncomfortable because it is unwanted.  You then have this natural instinct to try and remove the discomfort and the uncertainty that you feel. This is what we call a compulsion. Usually we feel some form of relief from the compulsion, but this becomes a problem because it only reinforces to our brain that the thought was important. Your brain continues to send out the alarm that the thought must mean something. Now many of us are aware of the form that physical compulsions can take such as hand-washing, jumping over cracks, moving objects and so forth. Actually one of the most common compulsions is mental and that takes the form of rumination. The problem people run into is that rumination is sometimes hard to identify. That is why I am doing this episode because so many people have asked, how do I differentiate between the intrusive thought and a mental compulsion? And what do I do? We know we should not be blocking thoughts, so how do we stop mental compulsions. If I'm not supposed to suppress my thoughts, what am I supposed to do if I catch myself doing mental compulsions? Is stopping mental compulsions thought suppression?"
I would say, technically, no. But it depends. Let's go straight to the solution. We want to acknowledge that we're having an intrusive thought, feeling, sensation or urge or an image. our job is to do nothing about it. We need to do our best not to solve that uncertainty or remove ourselves from that discomfort. That's our goal. And then our job is to reintegrate ourselves back into a behavior that we were doing, or we would be doing, had we not had this thought. So here is an example. Let's say I'm typing. I have an intrusive thought about whether I'm going to harm my child. So I have this, I'm going to acknowledge that it's there. I'm actually going to practice not trying to make that thought go away. But instead, bring that sensation or thought with me while I type on my computer. As I'm typing, I'm going to notice the sensations of my fingertips on the keyboard. I'm going to notice the smell of the office. I'm going to notice the temperature of the room I'm in. And I'm going to then catch if my mind directs away from this activity towards trying to solve. If I catch myself trying to solve it then I am going to bring my attention back to what I'm doing. I find that if I'm getting caught in some kind of mental rumination, I get down on the ground and I start playing with my son. The OCD may continue to try and get your attention, but you are going to continue with what you are doing and not engage with the thoughts. It is important to remember that compulsions feed you back into a cycle where you will have more obsessions, which will feed you back into having more compulsion's. It's a cycle. We call it the Obsessive Compulsive Cycle. So we really want to sort of be skilled in our ability to identify the difference.  This is really, really hard work. I think about when you're originally first learning anything, everything is really confusing and everything looks kind of the same. When you first start doing it, these are going to look very similar and it's going to be difficult to differentiate the difference, but once you get better at being around this and labeling it and catching it, you will be able to see the differences in these two things, even if it's very, very nuanced or they look very, very similar.

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ERP School, BFRB School and Mindfulness School for OCD are open for purchase. Click here for more information. Coming in March 19th ERP School will be available with bonus material!

Additional exciting news! ERP School is now CEU approved which means that it is an accredited course for therapists and mental health professionals to take towards their continuing education credit hours. Please click here for more information.

Coming March 15th, we are offering our free training, The 10 Things You Absolutely Need to Know About OCD.

Transcript of Ep. 180

This is Your Anxiety Toolkit episode number 180.

Welcome to Your Anxiety Toolkit. I'm your host, Kimberley Quinlan. This podcast is fueled by three main goals. The first goal is to provide you with some extra tools to help you manage your anxiety. Second goal, to inspire you. Anxiety doesn't get to decide how you live your life. And number three, and I leave the best for last, is to provide you with one big fat virtual hug, because experiencing anxiety ain't easy. If that sounds good to you, let's go.

Welcome back, everybody. Hello. Thank you for being here with me. We have a lot to tackle in this episode, so I am going to jump in as quick as I can. I know this is such a huge concept and topic, and there's so much confusion around it. So let's really today talk about the difference between an intrusive thought and a mental compulsion. We also want to figure out which ones we want to work with and which ones we want to allow. We want to talk about the difference between allowing a thought and engaging in a thought. There's so much to cover here. So before we get started, a couple of really exciting things, I really want you to keep an eye out for. On March 15, 2021, we are relaunching the free OCD training. It's called the 10 Things You Absolutely Need to Know About OCD.

It's not called the 10 things you need to know. It's called the 10 Things You Absolutely Need to Know About OCD. I have shared this free training multiple times, tens of thousands of people have taken this training. I've gotten nothing but amazing responses back. And the coolest thing is people even said, "I've watched it before. This is the second or third time I've watched it when you released it. And it really reminded me of these core concepts that we have to remember when we're talking about OCD." So even if you've watched it before, even if you're pretty well versed in OCD, I still encourage you to listen and take the free training. It's just jam packed with information and science and all the good stuff. And even if you're a therapist, I encourage you to take it. So if you're interested, go over to cbtschool.com/10things, or you can click the link in the show notes.

I am so excited to share that with you. Now, one more thing, keep an eye out, because as of March 19th, we are relaunching ERP School with some exciting bonuses, which I will announce in next week's episode. So excited again to share this with you. And what an amazing community, what an amazing opportunity I've had to teach so many people about ERP. And now also teaching therapists. We have now got ERP School approved by The National Association of Social Workers. So if therapists out there, you can actually get CEUs for taking ERP School, which is very, very cool. All right, let's get straight to the show. Let's talk about the difference between an intrusive thought and a mental compulsion first. So the first important piece to remember here, as we pull apart what to do with what thoughts, because that's really what this is about.

We must first understand the foundation of OCD. So OCD starts with an obsession. This is an intrusive, repetitive, unwanted thought, feeling, sensation or urge. It's not just a thought. It could be a sensation. It could be a feeling like de-realization or guilt. It could be a sensation like a feeling in your left finger or feeling in your nose or whatever that may be, everybody's different. But it does start with this intrusive thought. And the thing you must remember here is you cannot control this. This is the first experience of OCD, right? You have the intrusive thought, feeling, sensation or urge, and this is the thing you can't control. So there's a really big point right off the bat. The second piece here is once you've had that intrusive thought, feeling, sensation and urge, you usually feel anxious and uncomfortable and it's unwanted. And so your natural instinct is to do something to remove it.

You'll do it to remove the physical discomfort, the emotional discomfort, the uncertainty that you feel. And that is what we call a compulsion. Now, as many of you know, we know the kind of more mainstream compulsions that are known in our society. Hand-washing, jumping over cracks, moving objects and so forth. But one of the most common compulsions is mental. It's thinking. It's rumination. And that's the thing that's really hard to catch. And that's why I'm doing this episode because so many people have asked, how do I differentiate between that intrusive thought and a mental compulsion? And what do I do? Like I said at the beginning, I'm not supposed to block thoughts, but I'm not supposed to do mental compulsions. And that's thinking too, and what this does, right? So let's go back to the cycle. You have a thought, feeling, sensation and urge.

It makes you uncomfortable. Then you do a compulsion to make it go away. And usually you do get some form of relief. But the problem with this is that then it reinforces that that thought was important. Therefore, your brain continues to send out the fire alarm, the safety alarm, the smoke detector, it sets off all of those alarms in your brain and then sends out more anxiety with more of that thought, feeling, sensation and urge. So let's go back to the main concept. You're not to try and suppress your thoughts because the more that you suppress your intrusive thoughts, the more you have them. I've done full episodes about this in the past. So if you want to go back and listen, suppressing your thoughts will only make them worse. But here is where it gets tricky. People will say again, "If I'm not supposed to suppress my thoughts, what am I supposed to do if I catch myself doing mental compulsions? Is stopping mental compulsion's thought suppression?"

And this is where I would say, technically, no. But it depends. So what we want to do, let's go straight to the solution. We want to acknowledge that we're having an intrusive thought, feeling, sensation or urge or an image, right? It could be an image too. And then our job is to do nothing about it. To do our best not to solve that uncertainty or remove ourselves from that discomfort. That's our goal. And then our job is to reintegrate ourselves back into a behavior that we were doing, or we would be doing, had we not had this thought. So let's say I'm typing. I have an intrusive thought about whether I'm going to harm my child, or I have an intrusive thought about whether I cheated on my partner, or I had an intrusive thought on whether I'm gay or straight, or I had an intrusive thought about harming somebody, or a religious obsession, or a sensation, or a health anxiety sensation.

So I have this, I'm going to acknowledge that it's there. I'm actually going to practice not trying to make that thought go away. But instead, bring that sensation or thought with me while I type on my computer. As I'm typing, I'm going to notice the sensations of my fingertips on the keyboard. I'm going to notice the smell of the office. I'm going to notice the temperature of the room I'm in. And I'm going to then catch if my mind directs away from this activity towards trying to solve. If I catch myself trying to solve, yes, I am going to practice not doing that thinking. I'm going to practice not trying to solve it. And then bring my attention back to what I'm doing. I find that if I'm getting caught in some kind of mental rumination, I get down on the ground and I start playing with my son.

He's really into Lego right now. And so I fully, fully throw myself into this. I do my best to fully engage as best as I can. Now, I'm still going to have the presence of intrusive thoughts because I cannot control that. So it's going to sound a little bit like this. OCD is going to say, "Hey, what about this? What if this happens?" And I'm going to say, "Hi, thought. I'm actually typing an email right now. And that's what I'm going to do. You can be there. I'm going to allow this uncertainty to be here and I'm going to keep typing." So then I start typing. And then OCD will be like, if I were to externalize it, would be to say, "No, no, no, no. This is really important. You really have to figure this out."

And I'll go, "No, thank you. I'm really cool that you're here, but I'm going to type." And then it's going to say, "Hey, Kimberley, this is really important. And if you don't give me your attention, I'm going to... Something really bad is going to happen." And I'm going to go, "Thank you. But I'm writing an email right now." And then you're going to be like, wow, I'm doing pretty good. Look at me go. I'm fully practicing the skill of not engaging in my intrusive thought. And then it's going to say, "Listen..." Let's say I'm impersonating OCD. It's going to say, "Listen, I am not going to stop bugging you until you give me your attention." And I'm going to go, "That's fine. I'm actually going to call your bluff on that. I'm writing this email. You do not get to tell me what to do." And it's not going to give up.

It's going to keep going. "Kimberley, Kimberley, Kimberley, Kimberley, you must pay attention to my thoughts. You must pay attention. I'm trying to alert you to a very big danger." And often this is where people get worn down. They're like, "Oh my gosh, it's not going away. Maybe it is right. Maybe I should do it. Maybe I can't handle this anxiety. Maybe this is too much for me. Maybe it's just easier to do the compulsion." But I'm going to be here with you, urging you to keep allowing that intrusive thought to be there. It will basically roll over and start crying and fall asleep at some point, like a toddler, who's too tired and is rejecting his nap. But all he needs is to nap. It eventually will die down, but you have to be willing to stick and be consistent with not engaging in the pleads of OCD, the urgency of the obsession, the catastrophization of the obsession.

Because it's going to be making it into a... What do they say? A molehill into a mountain. It's going to be making a small problem, a big problem. And what I mean by that is the present of a thought is not dangerous. It doesn't mean it's a fact. It doesn't mean it requires your attention. Some people with OCD have a part of your brain that's going to set this thought on repeat. And because we've tried to suppress it in the past, it is probably going to want to be very, very repetitive. And your job is to do nothing at all. If you do, and I'll say this again, if you do catch yourself doing mental compulsion's, it's okay to stop doing that. That's not thought suppression. As long as you're... You don't want to over-correct. So if you catch yourself doing mental compulsions, don't over-correct by also trying to block the thought.

That's where we get into trouble. Instead, you just do a small correction back to what am I doing? What am I engaging in right now? What do I value? Because we do not value compulsion's. Compulsion's feed you back into a cycle where you will have more obsessions, which will feed you back into having more compulsion's. It's a cycle. We call it the Obsessive Compulsive Cycle. So we really want to sort of be skilled in our ability to identify the difference. If you can't identify the difference it's going to be really hard to know which is which, and how to respond in those moments. And a lot of this is when we're super anxious, it's really hard to think logically. It's really hard to think... Is this true or is it not? Or so forth. It's not even helpful in that moment.

Whereas, it may be like three days later. You're like, "Oh my goodness, what was I thinking? That was a bit strange. I wonder why I got so caught up in that." And that's because when we're anxious, our brain has a difficult time coming up with problem solving that is effective. So the more you can be able to identify it, and I encourage my clients throughout the day is catch yourself doing mental compulsion. Don't beat yourself up, but practice this idea of going, "This is me doing a mental compulsion. This is me having an intrusive thought. This is me having an intrusive thought and wanting to do mental compulsion." And being able to label them so that in the moment when you really are at a nine or a 10 out of 10 of anxiety, or uncertainty, or discomfort, you're able to be more skilled in your response.

Super, super, super important stuff here, guys. But we don't want to shame here. Again, this is really, really hard work. I think about when you're originally first learning anything, everything is really confusing and everything looks kind of the same. I always think of like The Devil Wears Prada, this is a crazy example, but the actress is laughing at these people because they're looking at a belt that looks almost the same, but it's very different in their eyes. And the one main character is like, "They're the same belt." And they look at her like she's crazy. And this is the same, right? When you first start doing it, these are going to look very similar and it's going to be difficult to differentiate the difference. But once you get better at being around this and labeling it and catching it, you will be able to see the differences in these two things, even if it's very, very nuanced or they look very, very similar.

Okay, that's all I'm going to say for now. The tools are the same. If you really want to go back and practice and learn these mindfulness skills you can practice, go back and listen to some of the previous podcast episodes. I actually encourage you to go back and listen to some of the earlier episodes, because in those episodes, I totally, I was laying out this awesome content on how to be mindful. Some of my best podcasts are the very first few ones, which is like back-to-back major skills, major tools. It was laying the foundation for how to be mindful with obsessive thoughts. So go back and listen to those or sign up for the free training coming up or, and you can also sign up for ERP School, which is coming back very, very soon.

We also have Mindfulness School for OCD, which is a course that really deep dives into practicing mindfulness related to obsessions and compulsions. So that's there for you as well. Okay. A lot. Sorry, I'm talking so fast. It's something I'm so passionate about and is something that I really wanted to make sure I covered and get very clear on. I've had a couple of you reach out and really be stressed about figuring out the difference. I'm hoping that's super helpful.

One last thing before we go, please do leave a review. I know I keep begging you at the end of every episode, but it really would mean the world to me. If you get anything from the podcast and you want to give back in any way, I would love a review from you. Your honest review, you don't have to fabricate anything. I really love them. I read every single one. And once we get to 1,000 reviews, we will give away a free pair of Beats headphones so that you can hear me crystal clear in your ears. And you of course can pick the color of your choice with those. So all my love to you.

Please do go and leave a review. I hope today's episode [crosstalk 00:17:05] was helpful. And get excited [crosstalk 00:17:05]. All right, have a good one, guys. All my love to you. It is a beautiful day to do the most beautifully difficult hard things.

Please note that this podcast or any of the resources from the CBTschool.com should not replace professional mental healthcare. If you feel you would benefit, please reach out to a provider in your area. Have a wonderful day. And thank you for supporting CBTschool.com.

SUMMARY: 

In this weeks podcast, we have my dearest friend Shala Nicely talking about how she manages mental compulsions.  In this episode, Shala shares her lived experience with Obsessive Compulsive Disorder and how she overcomes mental rituals.

In This Episode:

• How to reduce mental compulsions for OCD and GAD.
• How to use Flooding Techniques with Mental Compulsions
• Magical Thinking and Mental Compulsions
• BDD and Mental Compulsions

Links To Things I Talk About:

Shalanicely.com
Book: Is Fred in the Refridgerator?
Book: Everyday Mindfulness for OCD
ERP School: https://www.cbtschool.com/erp-school-lp

Episode Sponsor:

This episode of Your Anxiety Toolkit is brought to you by CBTschool.com.  CBTschool.com is a psychoeducation platform that provides courses and other online resources for people with anxiety, OCD, and Body-Focused Repetitive Behaviors.  Go to cbtschool.com to learn more.

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EPISODE TRANSCRIPTION

This is Your Anxiety Toolkit - Episode 284.

Welcome back, everybody. We are on the third video or the third part of this six-part series on how to manage mental compulsions. Last week’s episode with Jon Hershfield was bomb, like so good. And I will say that we, this week, have Shala Nicely, and she goes for it as well. So, I am so honored to have these amazing experts talking about mental compulsions, talking about what specific tools they use. 

So, I’m not going to take too much time of the intro this time, because I know you just want to get to the content. Again, I just want to put a disclaimer. This should not replace professional mental health care. This series is for educational purposes only. My job at CBT School is to give you as much education as I can, knowing that you may or may not have access to care or treatment in your own home. So, I’m hoping that this fills in a gap that maybe we’ve missed in the past in terms of we have ERP School, that’s an online course teaching you everything about ERP to get you started if you’re doing that on your own. But this is a bigger topic. This is an area that I’d need to make a complete new course. But instead of making a course, I’m bringing these experts to you for free, hopefully giving you the tools that you need. 

If you’re wanting additional information about ERP School, please go to CBTSchool.com. With that being said, let’s go straight over to this episode with Shala Nicely. 

Kimberley: Welcome, Shala. I am so happy to have you here.

Shala: I am so happy to be here. Thank you for having me.

Kimberley: Okay. So, I have heard a little bit of your views on this, but I am actually so excited now to get into the juicy details of how you address mental compulsions or mental rituals. First, I want to check in with you, do you call them mental compulsions, rituals, rumination? How do you address them?

Shala: Yeah. All those things. I also sometimes call it mental gymnastics up in your head, it’s all sorts of things you’re doing in your head to try to get some relief from anxiety.

Kimberley: Right. So, if you had a patient or a client who really was struggling with mental compulsions, whether or not they were doing other compulsions as well, how might you address that particular part of their symptomology?

Shala: So, let me answer that by stepping back a little bit and telling you about my own experience with this, because a lot of the way I do it is based on what I learned, trying to manage my own mental rituals. I’ve had OCD probably since I was five or six, untreated until I was 39. Stumbled upon the right treatment when I went to the IOCDF Conference and started doing exposure mostly on my own. I went to Reid Wilson’s two-day group, where I learned how to do it. But the rest of the time, I was implementing on my own. And even though I had quite a few physical compulsions, I would’ve considered myself a primary mental ritualizer, meaning if we look at the majority, my compulsions were up in my head. And the way I think about this is I think that sometimes if you have OCD for long enough, and you’ve got to go out and keep functioning in the world and you can’t do all these rituals so that people could see, because then people will be like, “What’s wrong with you? What are you doing?” you take them inward. And some mental compulsions can take the place of physical compulsions that you’re not able to do for whatever reason because you’re trying to function. And I’d had untreated OCD for so long that most of my rituals were up in my head, not all, but the great majority of them. 

Exposure & Response Prevention for Mental Compulsions

So, when I started to do exposure, what I found was I could do exposure therapy, straight up going and facing my fears, like going and being around things that might be triggering all I wanted, but I wasn’t necessarily getting better because I wasn’t addressing the mental rituals. So, basically, I’m doing exposure without response prevention or exposure with partial response prevention, which can make things either worse or just neutralize your efforts. So, what I did was I figured out how to be in the presence of triggers and not be up in my head, trying to do analyzing, justifying, figuring it out, replaying the situation with a different ending, all the sorts of things that I would do over and over in my head. And the way I did this was I took something I learned from Jonathan Grayson and his book, Freedom From OCD. I know you’re having him on for this series too. And he talked about doing all this ERP scripting, where you basically write out the worst-case scenario, what you think your OCD thinks is going to happen and you write it in either a worst-case way or an uncertainty-focused way. And what I did was after reading his book, I took that concept and I just shortened it down, and anything that my OCD was afraid of, I would just wrap may or may not surround it. 

So, for instance, an example that I use in Is Fred in the Refrigerator?, my memoir, Taming OCD and Reclaiming My Life was that I used to-- when I was walking through stores like Target, if I saw one of those little plastic price tags that had fallen on the ground, if I didn’t pick it up and put it out of harm’s way, I was afraid somebody was going to slip and fall and break their neck. And it would be on some security camera that I just walked on past it and didn’t do anything. So, a typical scrupulosity obsession. And so, going shopping was really hard because I’m cleaning up the store as I’m shopping. And so, what I would do is I would either go to Target, walk past the price tag. And then as I’m just passing the price tag, I would say things. And in Target, I obviously couldn’t do this really out loud, mumble it out loud as best, but I may or may not cause somebody to kill themselves by they’re going to slip and fall on that price tag because I didn’t pick it up. I may or may not be an awful, terrible rotten human being. They may or may not catch me and throw me into jail. I may or may not rot in prison. People may or may not find out what a really bad person I really am. This may or may not be OCD, et cetera, et cetera, et cetera. 

And that would allow me to be present with the obsessions, all the what-ifs – those are basically what-ifs turned into ‘may or may nots’ – without compulsing with them, without doing anything that would artificially lower my anxiety. So, it allowed me to be in the presence of those obsessive thoughts while interrupting the pattern of the mental rituals. And that’s really how I use ‘may or may nots’ and how I teach my clients to use ‘may or may nots’ today is using them to really be mindfully present of what the OCD is worried about while not interacting with that content in a way that’s going to make things worse. So, that’s how I developed it for myself. And I think that-- and that is a tool that I would say is an intermediary tool. So, I use that now in my own recovery. I don’t have to use ’may or may nots’. It’s very often at all. If I get super triggered, which doesn’t happen too terribly often, but if I get super triggered and I cannot get out of my head, I’ll use ’may or may nots’. 

But I think the continuum is that you try to do something to interrupt the mental rituals, which for me is the ’may or may nots’. You can also-- people can write down the scripts, they can do a worst-case scenario. But eventually, what you’re trying to get to is you’re trying to be able to hear the OCD, what-ifs in your head and completely ignore it. And I call that my shoulders back, the way of thinking about things. Just put your shoulders back and you move on with your day. You don’t acknowledge it. 

What I’ll do with clients, I’ll say, “If you had the thought of Blue Martian is going to land on my head, I mean, you wouldn’t even do anything with that thought. That thought would just go in and go out and wouldn’t get any of your attention.” That’s the way we want to treat OCD, is just thoughts can be there. I’m not going to say, “Oh, that’s my OCD.” I’m not going to say, “OCD, I’m not talking to you.” I’m not going to acknowledge it at all. I’m just going to treat it like any other weird thought that we have during the day and move on. 

Your question was, how would you help somebody who comes in with mental rituals? Well, first, I want to understand where are they in their OCD recovery? How long have they been doing these mental rituals? What percentage of their compulsions are mental versus physical? What are the kind of things that their OCD is afraid of? Basically, make a list or a hierarchy of everything they’re afraid of. And then we start working on exposure therapy. And when I have them do exposures, the first exposure I do with people, we’ll find something that’s-- I start in the middle of the hierarchy. You don’t have to, but I try. And I will have them face the fear. But then I’ll immediately ask them, what is your OCD saying right now? And they’ll tell me, and I’ll say, “I want you to repeat after me.” I have them do this, and everyone that I see hates this, but I have them do it. Standing up with their shoulders back like Wonder Woman, because this type of power pose helps them. It changes the chemistry of your body and helps you feel more powerful. 

OCD thinks it’s very powerful. So, I want my clients to feel as powerful as they can. So, I have them stand like Wonder Woman and they repeat after me. Somebody could-- let’s just say we are standing near something red on the floor. And I’ll say, “Well, what is your OCD saying right now?” And they’ll say, “Well, that’s blood and it could have AIDS in it, and I’m going to get sick.” I’ll say, “Well, that may or may not be a spot of blood on the floor. I may or may not get sick and I may or may not get AIDS, but I want to do this. I’m going to stay here. OCD, I want to be anxious, so bring it on.” 

And that’s how we do the exposure, is I ask them what’s in their head. I have them repeat it to me until they understand what the process is. And then I’m having them be in the presence of this and just script, script, script away. That’s what I call it scripting, so that they are in the presence of whatever’s bothering them, but they’re not up in their head. And anytime something comes in their head, I teach them to pull it down into the script. Never let something be circulating in your head without saying it out loud and pulling it into the script. 

I will work on this technique with clients as we’re working on exposures, because eventually what we’ll want to do is instead of going all over the place, “That may or may not be blood, I may or may not get AIDS, I may or may not get sick,” I’ll say, “Okay, of all the things you’ve just said, what does your OCD-- what is your OCD scared of the most? Let’s focus on that.” And so, “I may or may not get AIDS. I may or may not get AIDS. I may or may not have HIV. I may or may not get AIDS,” over again until people start to say, “Oh, okay. I guess I don’t have any control over this,” because what we’re trying to do is help the OCD habituate to the uncertainty. Habituate, I know that’d be a confusing word. You don’t have to habituate in order for exposure to work due to the theory of inhibitory learning, but we’re trying to help your brain get used to the uncertainty here.

Kimberley: And break into a different cycle instead of doing the old rumination cycle. 

Shala: Yes. And so then, I’ll teach people to just find their scariest fear. They say that over and over and over again. Then let’s hit the next one. “Well, my family may or may not survive if I die because if I get a fatal disease and I die and my family may or may not be left destitute,” and then over and over. “My family may or may not be left destitute. My family may or may not be left destitute, whatever,” until we’re hitting all the things that could be circulating in your head. 

Now, some people really don’t need to do that scripting because they’re not up in their head that much. But that’s the minority of people. I think most people with OCD are doing something in their head. And a lot of people aren’t aware of what they’re doing because these mental rituals are incredibly subtle at times. And so, as people, as my clients go out and work on these exposures, I’ll have them tell me how it’s going. I have people fill out forms on my website each day as they’re doing exposures so I can see what’s going on. And if they’re not really up in their head and they don’t really need to do the ‘may or may nots’, great. That’s better. In fact, just go do the exposure and go on with your life. If they’re up in their head, then I have them do the ’may or may nots’. And so, that’s how I would start with somebody. 

And so, what I’m trying to do is I’m giving them what I call a bridge tool. Because people who have been mental ritualizing for a long time, I have found it’s virtually impossible to just stop because that’s what your mind is used to doing. And so, what I’m doing is I’m giving them a competing response. And I’m saying here, instead of mental ritualizing, I’d like you to say a bunch of ’may or may nots’ statements while standing up and say them out loud while looking like Wonder Woman. Everybody rolls their eyes like, “Really?” But that’s what we do as a bridge tool. And so, they’ve lifted enough mental weights, so to speak, with this technique that they can hear the OCD and start to disengage and not interact with it at all. Then we move to that technique.

Flooding Techniques for Mental Rumination

Kimberley: Is there a reason why-- and for some of the listeners, they may have learned this before, but is there a reason why you use ’may or may nots’ instead of worst-case scenarios?

Shala: For me, for my personal OCD recovery journey, what I found with worst-case scenario is I got too lost in the content. I remember doing-- I had had a mammogram, it had come back with some abnormal findings. I spent the whole weekend trying to do scripting about what could happen, and I was using worst-case scenario. Well, I end up in the hospital, I end up with breast cancer, I end up dead. And by the end of the weekend, I was completely demoralized. And I’m like, “Well, I don’t bother because I’m going to be dead, because I have breast cancer.” That’s where my mind took it because I’ve had OCD long enough that if I get a really scary and I start and I play around in the content, I’m going to start losing insight and I’m going to start doing depression as a compulsion, which is the blog we did talk about, where you start acting depressed because you’re believing what the OCD says like, “Oh, well, I might as well just give up, I have breast cancer,” and then becoming depressed, and then acting like it’s true. And then that’s reinforcing the whole cycle. 

So, for me, worst-case scenario scripting made things worse. So, when I stayed in the uncertainty realm, the ‘may or may nots’ that helped because I was trying to help my brain understand, “Well, I may or may not have breast cancer. And if I do, I mean, I’ll go to the doctor, I’ll do what I need to do, but there’s nothing I can do about it right now in my head other than what I’m doing.”

Some people like worst-case scenario and it works fine for them. And I think that works too. I mostly use ’may or may nots’ with clients unless they are unable through numbing that they might be doing. If they’re unable to actually feel what they’re saying, because they’re used to turning it over in their head and pulling the anxiety down officially, and so I can’t get a rise out of the OCD because there’s a lot of really little subtle mental compulsions going on, then I’ll insert some worst-case scenario to get the anxiety level up, to help them really feel the fear, and then pull back into ’may or may nots’. But there’s nothing wrong with worst-case scenario. But for me, that was what happened. And I think if you are prone to depression, if you’re prone to losing insight into your OCD when you’ve got a really big one, I think that’s a risk factor for using that particular type of scripting. 

Magical Thinking and Mental Compulsions 

Kimberley: Right. And I found that they may or may not have worked just as well, except the one thing, and I’m actually curious on your opinion on this and I have not had this conversation, is I find that people who have a lot of magical thinking benefit by worst-case scenario, like their jinxing compulsions and so forth, like the fear of saying it means it will happen. So, saying the worst-case is the best exposure. Is that true for you?

Shala: I have not had to use it much on my own magically. I certainly had a lot of magical thinking. Like, if I don’t hit this green light, then somebody’s going to die. But I think the worst-case scenario, I could actually work well in that, because if you use the worst-case scenario, it can make it seem so ridiculous that it helps people let go of it more easily. And I think you can do that with ’may or may nots’ too. I’ll try to encourage people to use the creativity that they have because everybody with OCD has a ton of creativity. And we know that because the OCD shares your brain and it’s certainly the creative stuff

And to one-up the OCD, you use the scripting to be like, “Gosh, I may or may not get some drug-disease and give it to my entire neighborhood. I may or may not kill off an entire section of my county. We may or may not infect the entire state of Georgia. The entire United States may or may not blow up because I got this one disease. So, they may or may not have to eject me off the earth and make me live on Mars because I’m such a bad person.” This ‘may or may not’ is in all this crazy stuff too, because that’s how to win, is to one up the OCD. It thinks that’s scary, let’s go even scarier. But the scary you get, it also gets a little bit ridiculous after a while. And then the whole thing seems to be a little bit ridiculous. So, I think you can still use that worst-case stuff with may or may not.

Kimberley: Right. Okay. So, I mean, I will always sort of-- I know you really well. I’ve always held you so high in my mind in just how resilient and strong you are in doing this. How might you, or how do you help people who feel completely powerless at even addressing this? For you to say it, it sounds very like you’re just doing it and it’s so powerful. But for those who are really struggling with this idea of like, you said, coming out of your head, can you speak to how you address that in session if someone’s really struggling to engage in ’may or may nots’ and so forth?

Shala: Yeah. Well, thank you for the kind words, first off. I think that it’s really common for people with OCD by the time they get to a therapist to feel completely demoralized, especially if they’ve been to multiple therapists before they get to somebody who does ERP. And so, they feel like they’re the victim at the hands of a very cruel abuser that they can’t get away from. And so, they feel beaten down and they don’t know how to get out of their heads. They feel like they’re trapped in this mental prison. They can’t get out. And if somebody is struggling like that, and they’re doing the ’may or may nots’ and the OCD is reacting, which of course, it will, and coming back at them stronger, which I always warn people, this is going to happen. When you start poking at this, the OCD is going to poke back and poke back even harder, because it wants to get you back in line so it can keep you prisoner. 

So, what I’ll often do in those situations, if I see somebody is really feeling like they have been so victimized, that they’re never going to be able to get over this, is the type of script I have them do is more of an empowerment script, which could sound like this: “OCD, I’m not listening to you anymore. I’m not doing what you want. I am strong. I can do this.” And I might add some ’may or may nots’ in there. “And I want to be anxious. Come on, bring it on. You think that’s scary? Give me something else.” 

I know you’re having Reid Wilson on as part of this too. I learned all that “bring it on” type stuff and pushing for the anxiety from him. And I think helping people say that out loud can be really transformative. I’ve seen people just completely break down in tears of sort of, “Oh my gosh, I could do this,” like tears of empowerment from standing up and yelling at their OCD. 

If people like swearing, I also just have them swear at it, like they would really swear at somebody who had been abusing them if they had a chance, because swearing actually can make you feel more powerful too, and I want to use all the tools we can. So, I think scripting comes in a number of forms. It’s all about really taking what’s in your head, turning it into a helpful self-talk and saying it out loud. And the reason out loud is important for any type of scripting is that if you’re saying it in your head, it’s going to get mixed up with all the jumble of mental ruminating that’s going on. And saying it out loud makes it hard for you to ruminate. It’s not impossible, but it’s hard because you’re saying it. Your brain really is only processing one thing at a time. And so, if you’re talking and really paying attention to what you’re saying, it’s much harder to be up in your head spinning this around. 

And so, adding these empowerment scripts in with the ’may or may nots’ helps people both accept the uncertainty and feel like they can do this, feel like they can stand up to the OCD and say, “You’ve beaten me enough. No more. This is my life. I’m not letting you ruin it anymore. I am taking this back. I don’t care how long it takes. I don’t care what I have to do. I’m going to do this.” And that builds people up enough where they can feel like they can start approaching these exposures.

Kimberley: I love that. I think that is such-- I’ve had that same experience of how powerful empowerment can be in switching that behavior. It’s so important. Now, one thing I really want to ask you is, do you switch this method when you’re dealing with other anxiety disorders – health anxiety, social anxiety, panic disorder? What is your approach? Is there a difference or would you say the tools are the same?

Shala: There’s a slight difference between disorders. I think health anxiety, I treat exactly like OCD. Even some of the examples I gave here were really health anxiety statements. With panic disorder-- and again, I learned this from Reid and you can ask him more about this when you interview him. But with pain disorder, it’s all about, I want to feel more shorter breath, more like their elephant standing on my chest. I want my heart to be faster. But I’m doing this while I’m having people do exercises that would actually create those feelings, like breathing through a little bit of cocktail straw, jogging, turning up a space heater, and blowing it on themselves. So, we’re trying to create those symptoms and then talk out loud and say, “Come on, I want more of this. I want to feel more anxious. Give me the worst panic attack you’ve ever had.” So, it’s all about amping up the symptoms. 

With social anxiety, it’s a little bit different because with social anxiety, I would work on the cognitions first. Whereas with OCD, we don’t work on the cognitions at all, other than I want you to have a different cognitive relationship with your disorder and your anxiety. I want you to want the anxiety. I want you to want the OCD to come and bother you because that gives you an opportunity to practice. That’s the cognitive work with OCD. I do not work on the cognitive work on the content. I’m not going to say to somebody, “Well, the chance you’re going to get AIDS from that little spot of blood is very small.” That’s not going to be helpful 

With social anxiety, we’re actually working on those distorted cognitions at the beginning. And so, a lot of the work with social anxiety is going to be going out and testing those new cognitions, which really turns the exposures into what we call behavioral experiments. It’s more of a cognitive method. We’re going out and saying, “Gosh, my new belief, instead of everybody’s judging me, is, well, everybody is probably thinking about themselves and I’m going to go do some things that my social anxiety wouldn’t want me to do and test out that new belief.” I might have them use that new belief, but also if their anxiety gets really high and they’re having a hard time saying, “Well, that person may or may not be judging me. They may or may not be looking at me funny. They may or may not go home and tell people about me.” But really, we’re trying to do something a little bit different with social anxiety.

Kimberley: And what about with generalized anxiety? With the mental, a lot of rumination there, do you have a little shift in how you respond?

Shala: Yeah. So, it’s funny that the talk that Michelle Massi and others gave at IOCDF-- I think it was at IOCDF this year about what’s the difference between OCD and GAD is they’re really aligned there. I mean, I treat GAD very similarly the way I treat OCD in that people are up in their heads trying to do things. They’re also doing other types of safety behaviors, compulsive safety behaviors, but a lot of people GAD are just up in their head. They’re just worried about more “real-life” things. But again, a lot of OCD stuff can be real-life things. I mean, look at COVID. That was real life. And people’s OCD could wrap itself around that. So, I treat GAD and OCD quite similarly. There are some differences, but in terms of scripting, we call it “worry time” in GAD. It’s got a different name, but it’s basically the same thing.

Kimberley: Right. Okay. Thank you for answering that because I know some folks here listening will be not having OCD and will be curious to see how it affects them. So, is that the practice for you or is there anything else you feel like people need to know going in, in terms of like, “Here is my strategy, here is my plan to target mental rituals”? What would you say?

Shala: So, as I mentioned, I think the ’may or may nots’ are bridge tool that are always available to you throughout your entire recovery. My goal with anybody that I’m working with is to help them get to the point where they can just use shoulders back. And the way that I think about this is what I call my “man in the park” metaphor. So, we’ve all probably been in a park where somebody is yelling typically about the end of the world and all that stuff. And even if you were to agree with some of the things that the person might say from a spiritual or religious standpoint, you don’t run home and go, “Oh my gosh, we got to pack all our things up because it’s the end of the world. We have to get with all of our relatives and be together because we’re all going to die.” We don’t do that. We hear what this guy’s saying, and then we go on with our days, again, even if you might agree with some of the content.

Now, why do we do that? We do that because it’s not relevant in our life. We realize that person probably, unfortunately, has some problems. But it doesn’t affect us. We hear it just like when we might hear birds in the background or a car honking, and we just go on with our day. That’s how we want to treat OCD. What we do when we have untreated OCD is we run up to the man in the park and we say, “Oh my gosh, can I have a pamphlet? Let me read the pamphlet. Oh my gosh, you’re right. Tell me more, tell me more.” And we’re interacting with him, trying to get some reassurance that maybe he’s wrong, that maybe he does really mean the end of the world is coming soon. Maybe it’s going to be like in a hundred years. Eventually, we get to the point where we’re handing out pamphlets for him. “Here, everybody, take one of these.”

What we’re doing with ’may or may nots’ is we’re learning how to walk by the man in the park and go, “The world may or may not be ending. The world may or may not be ending. I’m not taking a pamphlet. The world may or may not be ending.” So, we’re trying to not interact with him. We’re trying to take what he’s saying and hold it in our heads without doing something compulsive that’s going to make our anxiety higher. What we’re trying to do is practice that enough till we can get to the point where we can be in the park with the guy and just go on with our day. We hear him speaking, but we’re really-- it’s just not relevant. It’s just not part of our life. So, we just move on. And we’re not trying to shove him away. It’s just like any other noise or sound or activity that you would just-- it doesn’t even register in your consciousness. That’s what we’re trying to do. 

Now I think another way to think about this is if you think-- say you’re in an art gallery. Art galleries are quiet and there are lots of people standing around, and there’s somebody in there that you don’t like or who doesn’t like you or whatever. You’re not going to walk up to that person and tap on their shoulder and say, “Excuse me, I’m going to ignore you.” You’re just going to be like, “I know that person is there. I’m just going to do what I’m doing.” And I think that’s-- I use that to help people understand this transition, because we’re basically going from ’may or may nots’ where we’re saying, “OCD, I’m not letting you do this to me anymore,” so we are being really aggressive with it, to this being able to be in the same space with it, but we’re not talking to it at all because we don’t need to, because we can be in the presence with the intrusive thoughts that the OCD is reacting to, just like the presence of all the other thousands of thoughts we have each day without interacting with them.

Kimberley: That’s so interesting. I’ve never thought of it that way. 

Shala: And so, that’s where I’m trying to get people because that is the strongest, strongest recovery, is if you can go do the things that you want to do, be in the presence of the anxiety and not do compulsions physical or mental, you don’t give anything for OCD to work with. I have a whole chapter in my memoir about this after I heard Reid say at one of the conferences, “We need to act as though what OCD is saying doesn’t matter.” And that was revolutionary to me to hear that. And that’s what we’re trying to do both physically and mentally. Because if you can have an obsession and focus on what you want to focus on, do what you want to do, you’re not giving OCD anything to work with. And typically, it’ll just drain away. But this takes time. I mean, it has taken me years to learn how to do this, but I went untreated for 35 years too. It may not take you years, but it may. And that’s okay. It’s a process. And I think if you have trouble trying to do shoulders back, man in the park, use ’may or may nots’. You can use the combination. But I think we’re trying to get to the point where you can just be with the OCD and hear it flipping out and just go on with your day.

OCD, BDD, and Mental Rituals 

Kimberley: In your book, you talk about the different voices. There is a BDD voice and an OCD voice. Was it harder or easier depending on the voice? Was that a component for you in that-- because the words and the voice sound a little different. I know in your memoir you give them different names and so forth, which if anyone hasn’t read your memoir, they need to go right now and read it. Do you have any thoughts on that in terms of the different voices or the different ways in which the disorders interact?

Shala: That’s a really great question because yes, I think OCD does shift its voice and shift its persona based on how scared it is. So, if it’s a little bit scared, it’s probably going to speak to you. It’s still going to be not a very nice voice. It might be urgent and pleading. But if it’s super scared, I talk about mine being like the triad of hell, how my OCD will personify into different things based on how scared it is. And if it’s super scared and it’s going to get super big and it’s going to get super loud in your head because it’s trying desperately to help you understand you’ve got to save it because it thinks it’s in danger. That’s all its content. Then I think-- and if you have trouble ignoring it because it’s screaming in your head, like the man in the park comes over with his megaphone, puts it right up against your ear and starts talking, that’s hard to ignore. That’s hard to act like that’s not relevant because it hurts. There’s so much noise. 

That’s when you might have to use a may or may not type approach because it’s just so loud, you can’t ignore it, because it’s so scared. And that’s okay. And again, sometimes I’ll have to use that. Not too terribly often just because I’ve spent a long time working on how to use the shoulder’s back, man in the park, but if I have to use it, I use it. And so, I think your thought about how do I interact with the OCD based on how aggressive it’s being also plays into this.

Kimberley: I love all this. I think this is really helpful in terms of being able to be flexible. I know sometimes we want just the one rule that’s going to work in all situations, but I think you’re right. I think that there needs to be different approaches. And would you say it depends on the person? Do you give them some autonomy over finding what works for them, or what would you say? 

Shala: Absolutely. If people are up in their heads and they don’t want to use ’may or may nots’, I’ll try to use some other things. If I really, really think that that’s what we need right now, is we need scripting, I’ll try to sell them on why. But at the end of the day, it’s always my client’s choice and I do it differently based on every client. For some clients, it might be just more empowering statements. For some clients where it’s more panicky focused, it might be more about bringing on your anxiety. Sometimes it might be pulling self-compassion in and just saying the self-compassion statements out loud. So, it really does vary by person. There’s no one-size-fits-all, but I think, I feel that people need to have something to replace the mental ritualizing with at the beginning that they’ve been doing it for a long time, just because otherwise, it’s like, I’m giving them a bicycle, they’ve never ridden a bicycle before and I won’t give them any training wheels. And that’s really, really hard. Some people can do it. I mean, some people can just be like, “Oh, I’m to stop doing that in my head? Okay, well, I’ll stop doing that in my head.” But most people need something to help them bridge that gap to get to the point where they can just be in the presence with it and not be talking to it in their heads.

Kimberley: Amazing. All right. Any final statements from you as we get close to the end?

Shala: I think that it’s important to, as you’re working on this, really think about what you’re doing in your head that might be subtle, that could be making the OCD worse. And I think talking and being willing to talk about this to therapists about putting it all out there, “Hey, I’m saying this to myself in my head, is that helpful or harmful?” Because OCD therapy can be pretty straightforward. I mean, ERP, go out and face your fears, don’t do rituals. It sounds pretty straightforward. But there is a lot of subtlety to this. And the more that you can root out these subtle mental rituals, the better that your recovery is going to be. 

And know too that if you’ve had untreated OCD for a long time, you can uncover mental rituals, little bitty ones, for years after you get out of therapy. And that’s okay. It doesn’t mean you’re not in recovery. It just means that you are getting more and more insightful and educated about what OCD is. And the more that you can pick those little things out, just the better your recovery will be. But we also don’t want to be perfectionistic about that like, “I must eliminate every single mental ritual that I have or I’m not going to be in a good recovery.” That’s approaching your ERP like OCD would do. And we don’t want to do that. But we do want to be mindful about the subtleties and make sure to try to pull out as many of those subtle things that we might be doing in our heads as possible. 

Kimberley: Amazing. Thank you. Tell us-- again, first, let me just say, such helpful information. And your personal experience, I think, is really validating and helpful to hear on those little nuances. Tell us where people can hear about you and the amazing projects you’ve got going on.

Shala: You can go to ShalaNicely.com and I have lots of free blog posts I’ve written on this. So, there are two blog posts, two pretty extensive blog posts on ’may or may nots’. So, if you go on my website and just search may or may not, it’ll bring up two blog posts about that. If you search on shoulders back or man in the park, you’ll find two blog posts on how to do that technique. I also have a blog post I wrote in the last year or so called Shower Scripting, which is how to do ERP, like just some touch-up scripting in the shower, use that time. So, I would say go to my website and you can find all sorts of free resources. I’ve got two books. You can find on Amazon, Everyday Mindfulness for OCD, Jon Hershfield and I co-wrote. And we talk about ‘may or may nots’ and shoulders back and some of the things in there just briefly. And then my memoir, Is Fred in the Refrigerator?: Taming OCD and Reclaiming My Life, is also on Amazon or bookstores, Audible, and that kind of thing. 

Kimberley: I wonder too, if we could-- I’m going to put links to all these in the show note. I remember you having a word with your OCD, a video?

Shala: Oh yes, that’s true.

Kimberley: Can we link that too?

Shala: Yes. And that one I have under my COVID resources, because I’m so glad you brought that up. When the pandemic started, my OCD did not like it, as many people who have contamination OCD can relate to. And it was pretty scary all the time. And it was making me scared all the time. And eventually, I just wrote it a letter and I’m like, “Dude, we’re not doing this anymore.” And I read it out loud and I recorded it out loud so that people could hear how I was talking to it. 

Kimberley: It was so powerful.

Shala: Well, thank you. And it’s fun to do. I think the more that you can personify your OCD, the more you can think of it as an entity that is within you but is not you, and to recognize that your relationship with it will change over time. Sometimes you’re going to be compassionate with it. “Gosh, OCD, I’m so sorry,” You’re scared we’re doing this anyway. Sometimes you’re going to be aggressive with it. Sometimes you just ignore it. And that changes as you go through therapy, it changes through your life. And I think that recognizing that it’s okay to have OCD and to have this little thing, I think of like an orange ball with big feet and sunglasses is how I think about it when it’s behaving – it makes it less of an adversarial relationship over time and more like I have an annoying little sibling that, gosh, it’s just not going to ever not be there, but it’s fine. We can live together and live in this uncertainty and be happy anyway.

Kimberley: I just love it. Thank you so much for being here and sharing your experience and your knowledge. It’s so wonderful.

Shala: Thank you so much for having me.

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

Welcome back, everybody. Today, we are going to have a discussion, and yes, I understand that I am here recording on my own in my room by myself, so it’s not really a discussion. But I wanted to give you an inside look into a discussion I had, and include you hopefully, on Instagram about a post I made about being busy. 

Now, let me tell you a little bit of the backstory here. What we’re really looking at here is, is being busy a compulsion or an effective behavior? Here’s the backstory. I am an anxious person. Nice to meet you. Everybody knows it, I’m an anxious person. That’s what my natural default is. I have all the tools and practice using all the tools and continue to work on this as a process in my life. Not an end goal, but just a process that I’m always on, and I do feel like I handle it really, really well. In the grand scheme of things, of course, everyone makes mistakes and recovery is an up-and-down climb. We all know that. But one thing I have found over and over and over and over again is my inclination to rely on busyness to manage my anxiety. 

The reason I tell you this over and over is it’s a default to me. When I’m struggling with anything, I tend to busy myself. Even when I had the beginning of an eating disorder, that quickly became a compulsive exercise activity because trying to manage my eating disorder created a lot of anxiety, and one way I could avoid that anxiety and check the eating disorder box was to exercise, move my body. Even though I fully recovered from that, and even though I consider myself to be doing really well mentally overall, I still catch myself relying on work and busyness as a compulsion, as a safety behavior to reduce or remove or avoid my anxiety. 

I made a post on this and it had overwhelming positive responses. Meaning, I agree, there was a lot of like, “Oh, I feel called out or hashtag truth.” A lot of people were resonating with this idea that being busy can be a very sneaky compulsion that we do to run away from fear or uncertainty or discomfort or sadness and so forth. But then some of my followers, my wonderful followers came in hot—when I say “hot,” like really well—with this beautiful perspective on this topic and I really feel like it was valid and important for us to discuss here today.

Let’s talk about that, because I love a good discussion and I love seeing it from both sides. I love getting into the nitty gritty and determining what is what. Let’s talk about me just because it’s easy for me to use an example. Let’s say I have a thought or a feeling of anxiety. Something is bothering me. I’m having anticipatory anxiety or uncertainty about something. My brain wants to solve it, but because I have all these mindfulness tools and CBT tools, I know there’s no point in me trying to solve it. I know there’s no point in me ruminating on it. I’m not going to change it or figure it out. I have that awareness, so I go, “Okay, now I’m going to get back to life,” which is a really wonderful tool. But what I find that I do is I don’t just get back to life. I, with a sense of urgency, will start typing, cleaning, folding laundry, whatever it is, even reading. I will notice this shift in me to do it fast, to do it urgently, to try and get the discomfort to be masked, to be reduced. 

And then, of course, I want to share with you, what I then do is when I catch that is I go, “Okay.” I feel the rev inside me and then I ease up on it. I pump the brakes and I try to return back to that activity without that urgency, without that resistance to the anxiety, or without that hustle mentality. But it is a default that I go to that often I don’t catch until later on down the track. It’s usually until I start to feel a little dizzy, I feel a little lost, a little bit overwhelmed. And then I’m like, “Oh, okay, I’m overusing busyness to manage my anxiety.”

The perspective that I loved was people saying, and one in particular said, “I want us to be really careful around that message because I think that some people can hear this idea that being busy is a compulsion and then start to question their own normal busyness throughout the day.” I’ll use the exact terms because I thought it was so beautifully said. They said, “You have to be pretty careful with how you explain this to some people with OCD because we’re told to lean into our values or live a ‘value-based’ life, and that does require us to be busy,” and I wholeheartedly agree. 

I think that’s where I’m coming from. I want to offer to you guys that I want you to just check in and see if you’re using busyness, this urgent, rushing movement, or frantic experience in your body to avoid discomfort. And if so, that’s good to know. Let’s not judge that. Let’s not beat you up. Let’s not be unkind. Let’s just acknowledge that that is a normal response to having anxiety. In fact, it’s a big part of what’s kept us alive for all these years. That’s true. And we can return back. Once we catch that we’re doing those behaviors, we can return back to staying effective in our skills. But I don’t want you guys to worry that you are overusing busyness. 

I think that the discussion I had online was to say, isn’t this a wonderful opportunity for us to see how anxiety or OCD or any anxiety disorder can make a really healthy behavior into a compulsive behavior? You might flip between the two, it mightn’t be all or nothing. An example of that might be prayer. Prayer is a beautiful practice for those who are spiritual. However, we can sometimes overuse prayer in a compulsive manner in this urgent, frantic, trying to get anxiety to go away manner, and then it’s being misused. 

There may be sometimes you use prayer in this beautiful non-compulsive way and there’ll be other times when you’re absolutely using it as a safety behavior. Same goes for cleaning, same goes for thinking through your problems. There will be times when thinking through problems and solutions is a very effective behavior. However, there will be other times if you’re doing it with a sense of urgency to make the discomfort go away or you’re doing it to try and figure out something that you know you won’t figure out because there’s really no solution to it—that’s something for us to keep an eye out for.

There are so many ways in which this can get blurred. Asking for help and reassurance. It’s not a problem to go to your loved ones and say, “I have this really huge presentation at work, would you let me rehearse it to you and you can give me feedback?” That’s an effective behavior. However, if we are doing that repetitively and we are doing it coming from this desperate place of urgency to get certainty and removal of discomfort, that’s how we may determine whether the behavior is a safety behavior that we want to start to reduce.

I want to just offer this to you. If we’re being honest, this episode isn’t really about just the busyness. It’s being able to, again, for yourself, determine are the behaviors you’re doing being done because they line up with your values? Are they being done with a degree of willingness to also bring anxiety with you? I think that’s a huge piece of the work that I have to catch, which is, okay, I’m rushing, I’m hustling, I’m engaging in busyness just for the sake of trying to get rid of that discomfort. Can I pause and return back to that behavior? Because it might be a behavior or an activity I need to get done. But can I do it with an increased sense of willingness to bring anxiety along for the ride? Can I do it with a sense where I’m not trying to train my brain that anxiety is bad? Can I just say, “Yeah, it’s cool. Anxiety is here, let’s bring it along”? 

I want to, again, reinforce to you guys, it’s okay that you haven’t figured this out because it’s probably ever-changing. There will be times when you are engaging in compulsive busyness and there’ll be other many times in which you’re not. What I would encourage you to do is not to spend too much time trying to figure out which is which, because that can become a compulsion as well. A lot of this is just accepting that nothing is perfect and just moving one step at a time moving forward as you can kindly and compassionately. 

The only other thing I want to address here is this idea of a good distraction and a bad distraction. I think that this has been an argument or a complex discussion in the anxiety field for a long time. When I first was trained as an anxiety specialist, there were all these articles that talked about bad distraction, that distraction is bad and we shouldn’t do it, and we should just have our anxiety and let it be there and then focus on it and so forth. I actually don’t agree with that. In fact, I would go as far as to say, a real mindful practice would be taking the judgment out of destruction in general and saying that distraction is neither good nor bad. What distraction is, is up to you to decide whether it’s helping you and is helpful behavior that brings you closer to your recovery goals or not. I don’t want you to spend too much time trying to figure it out either, again, because I think it gets us caught in this mental loop of, am I doing recovery right? Am I doing my treatment right? Am I using the skills perfectly? 

I think when we get to that point, we’re too far in the weeds and we have to pause and let it be imperfect and let it be uncertain and do our best not to try and solve that one, because often how would we know? There isn’t actually an answer to what’s bad and what’s good. I wouldn’t encourage you to place good and bad labels on those kinds of things because that usually will just keep you in a loop of anxiety anyway. 

That’s just a few ideas on this idea of being overly busy being a compulsion. I really want to make sure I say one more time. I think there is absolutely an opportunity for us to consider that busyness is also neither good nor bad. It just is, and that you for yourself can determine whether it’s helpful for you to stay busy or not. What I will say—and I will use this as an example, I think I actually did a podcast episode on this—not long ago, my parents were voyaging across the Drake Passage, which is a very dangerous body of water that takes you from South America to Antarctica. It’s usually very, very calm or it can be incredibly dangerous to pass the Drake Passage. For the 18 hours that they were passing that, I engaged in a lot of busyness. I would say it wasn’t compulsive either. It was, I knew they were doing something scary. I knew that it would be probably fine, but it was still uncertain. I knew that there was nothing I would do to make my anxiety go down during that 18 hours. I knew I probably wouldn’t get a good sleep because I love them dearly and I want them to have a safe trip. I just said to myself, “I’m going to mindfully go from one activity to another. Because I don’t want to engage in a bunch of mental rumination, I’m just going to gently stay busy.” I think that’s fine. I think that that is effective. In fact, I was very proud of how I handled that. I was able to resist the urge to text them at two in the morning and be like, “Take a photo of the waves. I want to see that you’re okay.” You know what I mean? 

I want to just offer to you that to check in whether your busyness is compulsive, be gentle with yourself either way to discuss with your mental health provider on what is a great way for you to engage in this kind of behaviors and for you to come up with your own protocol on how to determine when you’ve crossed over from being busy into compulsive busyness. That’s it. I think that from there, you can be gentle with yourself and practice being uncertain about what’s right and wrong. 

I hope that was helpful. I’m very much just chatting to you. I didn’t do a whole ton of prep for this. I just wanted to include you in the conversation on “Is being overly busy a compulsion?” I wanted to give you some ideas and things to look out for and I hope that it helps you move forward towards the recovery that you’re looking for. Have a wonderful, wonderful day. If you guys want additional resources from me, you can head over to CBTSchool.com. We have all kinds of online options there for you. If you’re looking for one-on-one therapy, if you live in the state of California or Arizona, you can go to www.kimberleyquinlan-lmft.com and I look forward to chatting with you next week.

Managing Perfectionism and Learning To Be Good Enough (with Kim Foster Carlson)

Welcome to another episode of Your Anxiety Toolkit Podcast!  This week, we talk about all things anxiety and mental health.

Today, I am excited to share with you our guest, Kim Foster Carlson.  Kim Foster Carlson is an award-winning broadcast journalist in San Francisco Bay and the author of the book Good Enough: How to Overcome Fear of Failure and Perfectionism To Live Your Best Life.

There is not a day in my office where I don’t see the debilitating anxiety that is caused by perfectionism.  Perfectionism can prevent us from trying new things, paralyze us when we have to perform, and can cause us to be very hard on ourselves.  In today’s podcast, Kim addressed many of the factors that might cause perfectionism, as well as some super helpful tools to manage it.  The difficult part is that we are constantly being bombarded by unrealistic expectations from our family, our social media accounts, from magazines and from our society’s expectations.

In this interview, Kim and I talk about perfectionism, fear of failure, anxiety and procrastination.

Kim shares her history of being an athlete and how perfectionism and the fear of failure caused her to be very hard on herself.

Kim also shares her story of going to therapy and realizing that perfectionism was the cause of her anger, anxiety and poor coping strategies.  She shared how this was triggered by stressors related to parenting and she was so open about how she got through some very difficult times.  Kim details many mindfulness skills that helped her along the road to becoming a “recovered perfectionist.”

One tip that I loved from today’s episode of Your Anxiety Toolkit was Kim’s example of Steph Curry, a professional basketball player.  Kim emphasized the importance of “finding the joy” (Steph Curry’s phrase) in everything we do by practicing gratitude and by verbally thanking someone every day.  I just loved this idea and this is a tool I am going to adopt myself.

I hope you enjoy this week’s episode.

Let’s talk about your Brain and Anxiety

A Simple way to Understand YOUR Brain and Anxiety

1. Regulate our body (speed up or slow down)
2. Tune in to someone else or something else.
3. Balance our Emotions and use Empathy and compassion
4. Have response flexibility (slows down the time between impulses or urges and an action). Basically, this means that we don’t respond based on pure emotion.
5. Calm our fear: There are inhibitory peptides called gabba that tame our fear and help us interpret the stimuli in a rational, appropriate way. This occurs in the Prefrontal Cortex at the front of the brain.

• Creative Cassidy
• Problem Solving Pete
• Patty the Planner
• Reasonable Renee
• Calming Catarina
• Kind Kelly
• Flexible Felix

1. Bodily mechanisms that are automatic (Breathing, Digestions and Blinking). It is really quite incredible that our whole body can function without us needing to do anything at all.
2. Fight, flight and freeze mechanisms. This is the most important, for today‘s discussion. The downstairs is the Emotional hub of the brain.  We need to be thankful for this part of our brain, as it keeps us safe from real danger. This downstairs area of the brain is what keeps us from touching the hot plate on the stove or not walking out onto a busy highway.

• Fearful Frannie
• Panicky Pete (Fight flight or freeze)
• Sad Sandra
• Furious Frank
• Bossy Benjamin

What happens when we have an Anxiety Disorder?

Discussing Anxiety and the Brain with your Kids

In this podcast:

• Laura Ryan tells her story of overcoming superstitious Obsessions 
• How to manage Whack-a-mole obsessions
• How her family helped to support her as she overcame Superstitious OCD 
• How to get through the hard OCD days
• Perfectionism and Exposure & Response Prevention

Links To Things We Talk About:

• ERP School: https://www.cbtschool.com/erp-school-lp

Episode Sponsor:

This episode of Your Anxiety Toolkit is brought to you by CBTschool.com.  CBTschool.com is a psychoeducation platform that provides courses and other online resources for people with anxiety, OCD, and Body-Focused Repetitive Behaviors.  Go to cbtschool.com to learn more.

Spread the love! Everyone needs tools for anxiety...If you like Your Anxiety Toolkit Podcast, visit YOUR ANXIETY TOOLKIT PODCAST to subscribe free and you'll never miss an episode. And if you really like Your Anxiety Toolkit, I'd appreciate you telling a friend (maybe even two).

EPISODE TRANSCRIPTION

Kimberley Quinlan: Well, welcome, Laura. I am so excited to hear your story today about Overcoming Superstitious Obsessions. Thank you for coming on the show.

Laura Ryan: Thank you so much for having me. I'm so excited to be here.

Kimberley Quinlan:  Yeah, so it's wonderful. I love the stories when I accidentally meet people online, and then we have this cool story that's together, but we're not like not together at all. So I love hearing your story for the first time today, and I love that. I've been a small small part of that journey for you.  Tell me a little about you and your backstory in, you know, the area of recovery.

Laura Ryan:  Yeah. So I definitely would have had OCD my whole life, but it wasn't until I was about 17 or 18 years old that I just stumbled across something on the Internet where I was like Oh yeah, that sounds like me. I've got OCD, but it didn't. It wasn't stopping me from doing anything at that point. So I just ignored it and went on. I had three Uni degrees under my belt. I was working at a publisher and freelancing as a book editor, and then

Laura Ryan:  my family had some health issues, and my sister as well, had some relationship issues, and I don't think I knew what to do with the stress. Um, and OCD crept up. So gradually, it was undetectable, and then sudd,  I found myself at age 22 with crippling compulsions.

OVERCOMING SUPERSTITIOUS OBSESSIONS AND BREATH-HOLDING COMPULSIONS

Laura Ryan:  It was nothing short of torture. It was horrific. I was so ill with OCD that I would come home from a day at work, and I wouldn't even remember the day because I'd spent the whole day in fight or flight. And I had mental sort of thought replacement and breath-holding compulsions. So it was completely invisible to people around me, but it was able to kind of have control over me for the whole day. Like from the second, I woke up to the second. I went to sleep. When I eventually saw a doctor, the psychiatrist was like, Oh, and how often are you affected by these thoughts? And I just didn't understand the question because I was like, Well, every few seconds, I guess.

Laura Ryan:  Yeah, so they were weird. Compulsions, like a lot of Shame around them as well because they were all kind of magical thinking superstitious. Like there was no logical link. They were all like, I'm holding my breath because I think I will magically give someone a disease if I breathe out while looking at them, or Yeah, just weird. We had rules that made absolutely no sense.

Laura Ryan:  which, Also. yeah, it impacted my self-esteem because I've always thought of myself as a Logical person, but these just made no sense.

Laura Ryan:  yeah, I also became stick thin because if I, and it wasn't even anything to do with the food, it was just if you eat this food, the intrusive thought will come true. And I, it just wasn't worth their Stress of eating. and then, there was a point where

Laura Ryan:  I would have conflicting compulsions, so OCD would kind of be like if you do this thing or if you don't do this thing, the intrusive thought will come true, and then I would just stand there paralyzed Like unable to do anything. I don't like to think how long I've spent just standing still, like the pervasive slowness, I think it's called was just Yes, stopped me from. Doing anything? Some nights it would have taken more than an hour to get to bed. It was just I had to touch wood or Rearrange things for so long before I was able to get to sleep. yeah, so I'd been a really

00:05:00

Laura Ryan:  Pleasant child and teenager big people pleaser perfectionist type person, and then all of a sudden I was this irritable, distracted young adult, and I didn't like who I was, and no one in my family knew what was going on with me. Um, and yeah, I was eventually unable to work, and I quit my job. And I was too anxious to Google things. So I looked up OCD on my podcast app, and that was when I found you were a guest on the mental illness happy hour, I think, and you played this game of one-up together, and it was like, It was incredible. It was like it was. Yeah, it was the first time I had

Laura Ryan:  heard of ERP and OCD.

Laura Ryan: Yeah. Sorry, it was the first time I'd heard of ERP and Anxiety treatment that wasn't just meditation or gratitude, which are helpful. But sometimes, when you're in that dark place, the only thing that can get to you. It is something dark itself but also brings that humor as well. I think it is just the most powerful tool you can have when you're there. Then I started looking up Absolutely everything Kimberley Quinlan. I was absolutely your number one fan. You say you had a small part in my story. You had a huge, huge part in my story. Because I was way too unwell to drive. There was no way I would go to my GP and get a mental health care referral. I was not going anywhere near Medical Center. And barely making it out of the house. So, when I found your ERP school to do online, it was nothing short of life-saving. I was able to get enough to go to the GP then and get a referral to see a psychologist.

Laura Ryan:  Yeah.

Kimberley Quinlan: It makes me want to cry, it does. And when can I ask a couple of questions about that when you said There's no way you would have gone to the GP because of the obsessions that held you back or just the shame of it? What was there? Another reason that that was such a huge step for you?

SUPERSTITIOUS OBSESSIONS & SYMPTOMS

Laura Ryan:  It was mainly the superstitious obsessions. If I go there, I'll contract a disease or give someone a disease. Not even in a contaminated way. Just like a magical way. Yeah.

Kimberley Quinlan: Mmm, yeah, yeah, it's funny. I don't know when I'm helping people because you just don't know what you know. Just for those who are listening, the Mental illness happy hour is an amazing podcast, and then the host had no idea what OCD was. And so, we did play a game of one up, which is where we kind of, he said something scary. And then I went up. It was something even scarier and even more gruesome and horrible. Was that something that you started practicing on your own just from that episode? Or did you take up his school to follow the whole process?

Laura Ryan: A bit of both. I kind of took the one up and…

Kimberley Quinlan:  Inflecting.

Laura Ryan: I ran because I think it just helped me. so much immediately, and then ERP school was able to lead me through in a more systematic way. Yeah.

Kimberley Quinlan: Okay. Amazing. Oh, I'm so happy that I could be there. It's not so cool.

Laura Ryan: Yeah, absolutely.

Kimberley Quinlan: It's so cool.

Kimberley Quinlan: Especially you're my Aussie friend too. That just brings me so much joy. So as you and I emailed in preparation for this,  you beautifully and eloquently shared some of the pieces. I would love to hear from you if you spoke briefly about how your OCD evolved. Would you be willing to share a little bit about what that looked like for you?

Laura Ryan: Yeah. Yeah.

Laura Ryan: I had every kind of OCD, so as soon as I started doing ERP, OCD came back with a vengeance with some new topic and…

00:10:00

Laura Ryan: as I think a lot of OCD sufferers know, it can be especially difficult, when a new topic shows up because you don't know what's happening you are unfamiliar with. the sorts of thoughts it's going to throw you, and you don't know how to fight back yet. I remember when it initially switched from this sort of magical thinking superstition to moral OCD. 

Laura Ryan: Hit and run OCD, and I've heard stories about OCD sufferers turning themselves in for crimes they didn't commit, and that was absolutely the kind of thing I felt like doing at that point. I was like

Laura Ryan:   Although usually, I would panic when I was driving, I would constantly be checking in my rearview mirror, recycling, back driving around, again and again, to make sure I hadn't hidden anyone and then,

Laura Ryan:  Yeah, I think it just Really. OCD will fight back.

Laura Ryan:  Yeah, absolutely.

MANAGING WHACK-A-MOLE OBSESSIONS

Kimberley Quinlan: that must have been pretty terrifying for you, though, or demoralizing for you for it to be sort of wack-a-moleing. Whack-a-mole obsessions are when your obsessions are changing from one obsession to another.  Your obsessions will be one up and one down. Switching between obsessions each day or even hour. How did you handle that?

Laura Ryan:  um,

Laura Ryan:  I think, just I think the main thing was staying in touch with the online community and because Every thought you've had, no matter how crazy it is. Someone else has had it, and someone else has probably done a compulsion. That's Like as, or more embarrassing, is something you've done.

Laura Ryan:  Yeah, I always think when I have a thought I met someone else's had this, and then I'll go on like OCD Reddit and find that they have.

Kimberley Quinlan:  Right. Absolutely. So so, that's how it evolved. Wait, you shared. Also, Where are you now? Like what does life look like for you now? Having gone through and know, you'd said You'd moved on to getting treatment. What's life like for you Now? What does recovery look like for you?

Laura Ryan: So, yeah, I spent the better part of two years just really taking the time to get better. I was doing bits of freelance work, but it shouldn't have been because it was taking me way too long. I wish I'd just given myself permission to rest properly. and I don't know whether this was a part of moral OCD or whether I like to think it's just part of who I am. Still, I didn't want to go back into publishing because I Um felt like I wanted to do a job helping other people, and I especially wanted to give back to the healthcare world.

Kimberley Quinlan: It.

Laura Ryan: That helped me so much. When I went, I went to the hospital to do an inpatient OCD program. And the people working in the program were obviously psychologists, psychiatrists, and occupational therapists. And so, I wanted to do a course in OT. But

Laura Ryan:  Then I saw speech-language, pathology, and I've been doing that course for the last two years, and I'm just about to graduate. So, Yeah.

Kimberley Quinlan:  Wow, that's so cool. Does OCD have something to say about you returning to school for that? Like, how did it How did your OCD handle that decision?

Laura Ryan: Oh my gosh, it was so. mad at me for picking something that I needed to do hospital placements to complete. Especially being speech-language. I think they called in America speech-language therapists, in hospitals, at least in Australia, there, they see the people with the Like worst neurodegenerative or the scariest diseases, or they've just had a stroke. Like, really, the most triggering things I could have thought of at the start of my journey. And yeah, and like, you have to like to touch them and would never ever have thought that I could have done this a couple of years ago.

Kimberley Quinlan: Yeah. In ERP school, we talk about your hierarchy, right? Like it would have been a 10 out of 10. I'm guessing you're like doing 10 out of 10…

Laura Ryan: Yeah.

Kimberley Quinlan: it's incredible of all the careers; you picked like your 10 out of 10. That's incredible. Right. Yeah. So was that like a decision? Like I'm doing it as an exposure, or is it just like your values led you there to get to that place?

Laura Ryan:  It was definitely my values and took me. And my therapist, a lot of coaching to get me through. Yeah.

Kimberley Quinlan:  Wow, it's so cool. It's so cool. It's like perfect, right? Because it's so often, I hear of people who have the career that they wanted, and their OCB gets in the way, right? You know, there he'll have health anxiety in there, and us or they have their teacher, but they have thoughts of, or pedophilia obsessions and impacts their work. Like you, you went the other direction where you moved into the career after your treatment which is just so cool. I love that you did that. So one thing you shared, Was what you find hard, and I love that you included that piece in what you find hard. So, would you be willing to share, What do you find hard? We talk about It's a beautiful day to do hard things, but What is it? It's okay that things are still hard. What do you find still hard?

Laura Ryan: Yeah, I find it now that I have so much functionality back compared to where I was not leaving the house to pretty much do everything that I want and need to, I find it hard to find the motivation to do ERP to kick those last mental compulsions, and those things that kind of still follow me around all day. Yeah, I think. I think now it's less about functionality and now more about doing it to get back that quality of life.

Laura Ryan:  which, yeah, I think I often find really hard to  it's much easier to. When you're doing ERP to reason with yourself, oh, I deserve to be able to leave the house and go to the shops. And so that's why I'm doing this thing that feels so awful. But when you're just saying, “Oh, I'm doing this now just because I want to be happy.” It's a lot harder to reason with myself

Kimberley Quinlan: Yeah, it's like you said at the beginning and I've heard that many times that if it's not impeding in your functioning, it is easier to sweep it under the rug and cope and not address the problem. And I've heard that many times. So I think that's a really valid point of, you know, a lot of people will say like there's a really strong. Why are they doing the exposures? There's not a strong why it's hard to do it. How are you learning or starting to practice tools to manage what's worked for you? And what hasn't

Laura Ryan:  'm getting a lot better at being less of a people pleaser and getting better at not putting everyone else before myself filling up my own cup so that I have some to give to everyone else. Yeah, I'm it is hard, but I'm definitely getting better at doing things because

Laura Ryan:  Yeah, if I give myself that, Quality of life. I can be. Even at least I can be if not for me, I can be there better for my family and friends.

Kimberley Quinlan: Yeah. Yeah. Is there you know, if you were to work? I mean, I'm assuming people listening are having similar struggles. Can you walk me through moment to moment how you muster up motivation? Or maybe it's a different experience to get yourself to do. Those exposures? Like, what do their steps involve? Or how do you get to that place?

MOTIVATION FOR ERP

00:20:00

Laura Ryan: Yeah, one of my favorite tools is just before I do anything. So if I'm if I've just driven in the car to go somewhere, I will take one minute before I get out of the car, I will take one minute. and just Kind of have a word with myself and OCD, and I'll be like, right, what's OCD? You're going to throw at me. It's going to say this, and then what will I do? I'm going to do this, and then how's OCD going to push back? And then what am I going to do? Like just having a game plan before you do.

Kimberley Quinlan: If?

Laura Ryan: Functional things for those mental compulsions.

Laura Ryan:  I find it's a really

Laura Ryan:  it's really helpful for me because I don't have to kind of set aside time and find that motivation to do it. I can just kind of plan and make ERP tasks out of, going to the shops or seeing a friend or  things like that.

Kimberley Quinlan: Yeah, that's cool. It's, I think of it, like Olympians or, you know, high-performance athletes as they, they do that same thing. They're high performing, you know, the high performers there, they're rehearsing. You know the strategy to get through that really hard moment. It sounds like you're doing something similar there, which is really cool. I'm fascinated by that, sports psychology piece of it, right? I think that's so cool. All right, you had mentioned, which I thought was fascinating, what OCD gave you. Now, this is sort of a controversial topic…

Kimberley Quinlan:  Okay. So one of the things that you wrote as we were emailing was what OCD gave you right, which I thought was so fascinating because usually, we hear stories are like, I hate OCD, and it's the worst thing ever. And I hate everything about it, and we even know there's some controversy of some people who have sort of misused OCD. I loved what you had to say. So, would you share it? What were your thoughts regarding what OCD gave you?

Laura Ryan:  Yeah, I definitely don't get me wrong. I think OCD is a very unique form of torture, I don't think it's. Yeah, it's horrible. It's absolutely. Yeah, I think. When you said it was one of their Top 10 Most debilitating disorders, you can have either physical or mental. Absolutely. I think it's just Awful. But I think going through treatment gave me this really, really,

Laura Ryan:  I was able to see these incredible sides to my family and friends. they were just so, Incredible at every turn and so accepting of something that's really hard to understand.

Laura Ryan:  and, Yeah, it's also just constant reminders to follow my values. Like if, if you're having a hard day with OCD, the only thing you can use is to get yourself out of that. is to be like, okay, well, What am I doing? What am I valuing? And the treatment is kind of mindfulness and coming back to

Laura Ryan:  What's important? So yeah, I think I'm I'm quite lucky to have those. those treatment principles kind of under my belt because, I think everyone can use them because they're just

00:25:00

Laura Ryan:  Yeah, that's how you have a better life. Yeah.

Kimberley Quinlan: Yeah, that's true. It's so true. And you, you talked about your you had sort of a shift in motivation to sort of take care of your health. Was there a shift in that for you? Once you started going through OCD treatment? That was when further beyond just your mental health,

Laura Ryan:  yeah, it was it kind of turned into adding in. Meditation moving my body a lot.

Laura Ryan:  Yeah, I I remember going down this because I had access to my uni like academic journal database, and I am early on. I went into a lot of obvious research about ERP and OCD. But also SSRIs and exercise.

Laura Ryan:  and I think people found Or some people. And at least for me, I find Like, I'm staying on the SSRIs, but exercise is. As effective for me as those. So if I Do them both. It's like supercharges it so good. Yeah.

Kimberley Quinlan: Yeah. Yeah, absolutely. The research backs that doesn't it? So that's so good.

Laura Ryan:  Yeah.

HOW TO GET THROUGH THE HARD OCD DAYS

Kimberley Quinlan: That's so good. All right, the last thing I question I have for you it's just makes me giggle and smile and feel all good. Inside is tell me a little bit about what gets you through the hard things because that's what this is all about, right? That's what our whole message is. What are some of the things that get you through the hard things and the hard days?

Laura Ryan:  And definitely remembering my sense of humor. And Kind of encouraging the people around you. Because I'm not as. I'm not super comfortable yet telling my family and friends to You know, help me with exposure tasks, but if you can tell them, they help me laugh about these things. They'll They can people can do that, people know how to, and they want to, and it's really good.

Kimberley Quinlan:  Yeah.

Laura Ryan:  Yeah, also, if you go on the go on Reddit and look up Reddit OCD memes,  it's the best. It's so good. It's like and John Hershfield's means they're so good, and they

Laura Ryan: Again they like they get into these really dark awful themes but then we're laughing at them and I think that's just the fastest way to get power over OCD.

Kimberley Quinlan:  Yeah.

Laura Ryan: um, Yeah,…

Kimberley Quinlan: Yeah. Changes the game.

Laura Ryan: it's really cool. Definitely.

Kimberley Quinlan: Doesn't it right when you find? Yeah, it really really does. And you did talk about the game plan Already.

Laura Ryan:  Yeah.

Kimberley Quinlan: You mentioned something called a panic inventory. Do you want to share a little bit about what that is?

Laura Ryan:  Yeah, so I hope it's not a kind of reassurance knowing that I can go back and check it, but I never do. And so when I have an intrusive thought, I just write it down in the notes of my phone and it's stops me from doing things like, checking the police news or asking for reassurance, or like, if I have the thought written down, and it's there, and I can think Laura, you can come back to it like it's there. It's not going anywhere. You can come back to it tomorrow or next week, or even just if you can hold off on doing this compulsion for an hour, the thought will still be there. You can still

Laura Ryan:  Address it. If it still feels urgent, then and yeah, some of them only last a few minutes, some of them last a few days. But I've never come back to a thought a week later still panicking.

Kimberley Quinlan: Mmm, that's cool. It's funny, it makes me think about as With young children, when we're treating young children with OCD, we talk about their OCD box, and they imagine putting their thought up in the box and they leave the box there, not to kind of make the thoughts go away. But just like it's there, you can bring it with you. The box is always with you and…

Laura Ryan: Yeah.

Kimberley Quinlan: we're just not going to let it be there, and we're gonna go about our lives. Anyway, so does it sound like that for you? Is that kind of mindset there? yeah, so that I love that…

00:30:00

Laura Ryan:  Yeah, absolutely.

Kimberley Quinlan: because what you're really doing is you're saying I'm willing to let the thought come with me. And I'm gonna be uncertain about it and sort of staying very present. Like, we'll worry about it later, kind of like not that you're planning to worry about it later but she'll deal with it when it needs to be dealt with which is sounds like never Really okay.

Laura Ryan: Yeah.

Kimberley Quinlan: I love that. I love that. Yeah, okay, cool.

Kimberley Quinlan:  Anything else that you found to be helpful in getting you to where you are today in this really cool story?

PERFECTIONISM AND EXPOSURE & RESPONSE PREVENTION (ERP)

Laura Ryan: Yeah, definitely. I think the Perfectionistic side of me thought that every ERP exposure had to be. 10 out of 10. Full-blown panic attack level, but it's At least for me it's only gonna work for insofar as I'm willing to actually feel what it brings up. So

Laura Ryan: I think they the best exposures for me are the ones that just feel mildly uncomfortable and even to the point where I'm sitting there and I'm like, Oh, am I, Even bothered by this. Like, it's sometimes I feel like I'm lying or…

Kimberley Quinlan:  Mmm.

Laura Ryan: Or I don't have OCD or yeah, I think those tiny. Yeah. Like a hundred. Many exposures are way way better than one, one giant one, at least for me.

Kimberley Quinlan: Wow. That's cool. I'm so glad you brought that up, and because that is actually, interestingly, I'll share with you when I'm supervising my staff. That's probably one of the biggest questions that my staff come with of like, my client seems to be wanting to do these crazy high hard explosions and it feels like it's sort of compulsive in that they're doing these exposures.

Laura Ryan:  Yeah.

Kimberley Quinlan: And I think you're speaking to this really important topic, which is the exposure should Simulate the fear and the uncertainty And so you're saying, I think. But correct me if I'm wrong Doing a small exposure actually simulates in brings on other obsessions and fears along the way. So that's how you're doing your exposures. That's so cool. Is that correct?

Laura Ryan: Yeah. Yeah, absolutely.

Kimberley Quinlan:  Yeah, wow. And we say Any happy school. We talk about doing a b minus effort, right? Like not doing it perfectly and sometimes perfect. You know, purposely making an exposure imperfect has, was that a trigger for you? As you went through this process of trying to make the exposures perfect? Yeah.

Laura Ryan: Yeah. Absolutely. I remember, I came to my first session with my psychologists, like, with a printed out, hierarchy of like this. Yeah. Everything was scored perfectly and I was ready to work from. Yeah. Number one, to number 10 in and cool. According to the research, we should be done in 12 weeks and then I'll say See you later. That was really…

Kimberley Quinlan: You like my schedule,…

Laura Ryan: no, it works.

Kimberley Quinlan: It says right here. This is how dispersed to go. Right, right. Okay. And it didn't work out that way. No, no that would have been hard to take.

Laura Ryan:  Yeah. Yeah.

Kimberley Quinlan: Yeah. Yeah, I have loved hearing your story. I'm so grateful that we got to meet in person and connect. You know, it's sort of a full circle moment for me and I hope you know that you should be so proud of the work you've done and how far you've come.

Laura Ryan: Thank you so much. Yeah, I can't believe I'm talking to you.

Kimberley Quinlan: Yeah. I know,…

Laura Ryan: Yeah, it's awesome.

Kimberley Quinlan: I'm so happy to have you on the show, I really? And that's again, I say it all the time, like it just to know that. That. People can make small but very mighty steps on their own. Is the whole mission here,…

Laura Ryan:  Yeah.

Kimberley Quinlan: right? Is that just even if it's the first step, I'm so happy if that's the step that people take. So I'm so grateful for you for sharing your story.Laura Ryan:  Thank you so much for having me.

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

Hello there everyone and welcome to another episode of Your Anxiety Toolkit Podcast. This week's episode is all about how to prevent Social Anxiety. I know that the title, “How to Prevent Social Anxiety” might sound a little fishy, but in this episode, we are going to look at some groundbreaking new research on social anxiety that might help us to understand the relationship between shyness and social phobia and how to prevent social anxiety in adolescence. In this incredible new finding, researchers found that there is a direct relationship between shyness and social anxiety in pre-adolescents. For the purpose of this episode, we will define shyness as the feeling of apprehension, lack of comfort, or awkwardness. These symptoms will increase, especially when a person is around other people and in new or unfamiliar situations.

This research found that negative social self-cognitions mediate the shyness - social anxiety link, whereas, social interpretation bias does not. Social interpretation bias, by definition, is the tendency to interpret ambiguous situations in a positive or negative fashion. What does this mean in regard to how to prevent social anxiety, you may ask? Basically, if we can teach pre-teens how to interpret themselves in a more positive way, we might be able to reduce the impact of social anxiety in adulthood. This research showed that prevention should address the negative self-cognition of shy (pre-)adolescents.
So examples such as the below statements might be corrected into more logical and objective statements.
◆“I am a fool”
◆“There is something wrong with me”
◆“I look like an idiot” 

More Objective Statements
◆I am not for everyone
◆Just because there was silence, doesn’t mean I am incapable of being in social settings
◆It's ok that they didn’t laugh at my jokes. One person's “funny” isn’t everyone's version of funny.

Link to research.
https://www.sciencedirect.com/science/article/pii/S0193397318302818

The First and Second Arrow

During this podcast, I hope to give you some tools to manage judgment, or what is sometimes called “the second arrow”.   My hope is that this podcast can help you have a more non-judgmental relationship with your body and your body’s experience of anxiety and discomfort.  

Intended for those suffering OCD, Anxiety, Panic, Eating Disorders, Depression, Stress and worry. 

NOTICING with Non Judgment: MEDITATION

Take a long, deep breathe in.   And slowly exhale. Take another. As you breathe in and out, congratulate yourself for taking the time to do this. Just stopping and breathing can be difficult and uncomfortable when you are managing life, anxiety and stress. Good job!

Again, take a nice deep breathe in and slowly exhale. If you find that taking a deep breathe is too uncomfortable, just breathe at a depth and pace that feels good for you. There is no “right” way to do this. 

Now, I want you to continue to breathe in this fashion, but as you breathe, notice where in your body you feel discomfort. Is it in your chest? Your stomach? Your forehead? Your shoulders? Just do a quick inventory and just notice where your discomfort lies.

Once you have identified the areas in which you are uncomfortable, I want you to practice just breathing while you notice these discomforts. Take some time to experience the discomfort.   Try to just be with it, without running away from it.  

Again, good job. This is not easy.

Now, as you notice where your discomfort lies, I now want you to notice if there are any judgments about your experience. These judgments come in the form of thoughts, such as “I cant do this” or “I shouldn’t be this anxious”. Maybe you are having the thought.. “this feeling is awful!” or “I hate that I feel this way and I shouldn’t have to feel this way” . You might start to compare yourself to others, having thoughts like “Most people don’t feel this way, something must be wrong with me”.

These thoughts are all judgments.             Judgments are not facts.         They are usually a person’s personal reflection on an event, often subjective to their beliefs and views. They are often not true at all.

When it comes to judgments, I love the Buddhist parable about the first and second arrow. This parable uses the metaphor that when we experience an event that causes discomfort in us, it is similar to being hit by an arrow.   In this case, we will call that first experience of discomfort “The first arrow”.   The first arrow is something that we cannot control and is challenging, even painful. If we were to look back at our experience at the beginning of this meditation, the “first arrow” would be the physical discomfort you noticed when you first did an inventory of your body.

The second arrow is the judgment that we have about the discomfort we experienced. These judgments are often what reinforces the pain and discomfort. The second arrow is a personal narrative that pulls us into a pattern of faulty thinking about our experience and our ability to tolerate anxiety and the discomfort that is present. 

The sensations and judgments you experienced just a few minutes ago is a great example of this. I invited you to notice your discomfort, and it is common to immediately follow this noticing with a judgment about our experience.     It is the judgments such as “I cant handle this” or “This feeling should not be here” that makes the first event even harder. In fact, we could argue that the judgment is what can keeps the discomfort around….it keeps us feeling fearful, discouraged and sometimes hopeless.

So, lets go back to noticing. Notice again where you are uncomfortable, or remember back to an event that caused you discomfort. When you observe this event or feeling, the first arrow, you might start to notice feel those second arrows coming up again.

 If you were to remove that second arrow, the judgment, you would begin to see that this event or this feeling, is, in fact, just an event or feeling. And also, it is temporary.  

If we strip ourselves of judgment, we can allow this moment to be just what it is; a moment. It is neither good, nor bad.   And now, in THIS very moment, it might be slightly different to the moment you experienced just a few moments ago.

So, to conclude this mediation, I encourage you to go into the day, noticing first and second arrows. You might be surprised how often you are spearing yourself with an arrow that is not necessary.

I will be offering other podcasts that I hope will be helpful for you, so keep checking in. Please feel free to comment below on the blog page

 I hope you have a wonderful day!

Welcome back, everybody. Thank you for joining me again this week. I’m actually really excited to dive into another topic that I really felt was important that we address. For those of you who are new, this actually might be a very steep learning curve because we are specifically talking about a treatment skill or a tool that we commonly use in CBT (Cognitive Behavioral Therapy) and even more specifically, Exposure and Response Prevention. And that is the use of imaginals or what we otherwise call scripts. Some people also use flooding. 

We are going to talk about this because there are a couple of reasons. Number one, for those of you who don’t know, I have an online course called ERP School. In ERP School, it’s for people with OCD, and we talk about how to really get an ERP plan for yourself. It’s not therapy; it’s a course that I created for those who don’t have access to therapy or are not yet ready to dive into therapy, where they can really learn how to understand the cycle of OCD, how to get themselves out of it, and gives you a bunch of skills that you can go and try. Very commonly, we have questions about how to use imaginals and scripts, when to use them, how often to use them, when to stop using them, when they become compulsive and so forth. 

In addition to that, as many of you may not know, I have nine highly skilled licensed therapists who work for me in the state of California and Arizona, where we treat face-to-face clients. We’re actually in Los Angeles. We treat patients with anxiety disorders. I also notice that during my supervision when I’m with my staff, they have questions about how to use imaginals and scripts with the specific clients. Instead of just teaching them and teaching my students, I thought this was another wonderful opportunity to help teach you as well how to use imaginals and why some people misuse imaginals or how they misuse it. I think even in the OCD community, there has been a little bit of a bad rap on using scripts and imaginals, and I have found using scripts and imaginals to be one of the most helpful tools for clients and give them really great success with their anxiety and uncertainty and their intrusive thoughts. 

Here we are today, it is again a start of another very short series. This is just a three-week series, talking about different ways we can approach imaginals and scripts and how you can use it to help manage your intrusive thoughts, and how you can use it to reduce your compulsions. 

It is going to be three weeks, as I said. Today, we are starting off with the amazing Krista Reed. She’s been on the show before and she was actually the one who inspired this after we did the last episode together. She said, “I would love to talk more about imaginals and scripts.” I was like, “Actually, I would too, and I actually would love to get some different perspectives.”

Today, we’re talking with Krista Reed. Next week, we have the amazing Shala Nicely. You guys already know about Shala Nicely. I’m so happy to have her very individual approach, which I use all the time as well. And then finally, we have Dr. Jon Grayson coming in, talking about acceptance with imaginals and scripts. He does a lot of work with imaginals and scripts using acceptance, and I wanted to make sure we rounded it out with his perspective. 

One thing I want you to think about as we move into this series or three-part episode of the podcast is these are approaches that you should try and experiment with and take what you need. I have found that some scripts work really well with some clients and others don’t work so well with other clients. I have found that some scripts do really well with one specific obsession, and that doesn’t do a lot of impact on another obsession that they may have. I want you just to be curious and open and be ready to learn and take what works for you because I think all of these approaches are incredibly powerful. 

Again, in ERP School, we have specific training on how to do three different types of scripts. One is an uncertainty script, one is a worst-case scenario script, and the last is an acceptance script. If you’re really wanting to learn a very structured way of doing these, head on over to CBTSchool.com and you can sign up for ERP School there. But I hope this gets you familiar with it and helps really answer any questions that you may have. 

Alright, let’s get over to the show. Here is Krista Reed.

Kimberley: Welcome back, Krista Reed. I am so happy to have you back on the show.

Krista: Thank you. I am elated to be able to chat with you again. This is going to be great.

Kimberley: Yeah. The cool thing is you are the inspiration for this series.

Krista: Which is so flattering. Thank you. 

IMAGINAL OR SCRIPT?

Kimberley: After our last episode, Krista and I were having a whole conversation and you were saying how much you love this topic. I was like, “Light bulb, this is what we need to do,” because I think the beautiful piece of this is there are different ways in which you can do imaginals, and I wanted to have some people come on and just share how they’re doing it. You can compare and contrast and see what works for you. That being said, number one, do you call it an imaginal, do you call it a script, do you think they’re the same thing, or do you consider them different?

Krista: I do consider them differently because when I think about script, I mean, just the word script is it’s writing, it’s handwriting in my opinion. I mean, scripture is spoken. That’s something a little bit different, but scripting is writing. When I think of an imaginal, that is your imagination. I know that I already shared with you how much I love imaginals because in reality, humans communicate through stories. When we can, using our own imagination, create a story to combat something as challenging as OCD, what a powerful concept. That’s exactly why I just simply love imaginals.

Kimberley: I can feel it and I do too. There’s such an important piece of ERP or OCD recovery or anxiety recovery where it fills in some gaps, right?

Krista: Yes, because imaginals, the whole point, as we know, it’s to imagine the feared object or situation. It could evoke distress, anxiety, disgust. Yet, by us telling those stories, we’re poking the bear of OCD. We’re getting to some of that nitty gritty. Of course, as we know that, not every obsession we can have a real-life or an in vivo exposure. We just simply can’t because of the laws of science, or let’s be real, it might be illegal. But imaginals are also nice for some people that the real-life exposure maybe is too intense and they need a little bit of a warmup or a buy-in to be able to do the in vivo exposure. Imaginal, man, I freaking love them. They’re great. 

Kimberley: They’re the bomb. 

Krista: They really are. 

HOW TO DO IMAGINALS FOR OCD

Kimberley: You inspired this. You had said, “I love to walk your listeners through how to do them effectively. I think I remember you saying, but correct me if I’m wrong, that you had seen some people do them very incorrectly. That you were very passionate because of the fact that some people weren’t being trained well in this. Is that true or did I get that wrong?

Krista: No, you absolutely got it right. Correct and incorrect, I think maybe that is opinion. I’ll say that in my way, I don’t do it that way. That’s a preference. But this is an inception. We’re not putting stories into our clients’ minds. The OCD is putting these stories into our clients’ minds. If you already have a written-out idea of a script, of like fill in the blanks, you are working on some kind of inception, in my opinion. You are saying that this is how your story is supposed to be. That’s so silly. I’m not going to tell you how your story is supposed to be. I don’t know how your imagination works. When we think of just imagination, there’s so many different levels of imagination. 

Let’s say for instance, if I have somebody who comes into my office who is by trade a creative writer, that imaginal is probably going to be very descriptive, have a lot of heavy adjectives. Just the way it’s going to be put together is going to be probably like an art in itself because this is what that person does. If you have somebody who comes in and creativity is not something that is part of a personality trait, and then I have a written fill-in-the-blank thing for them, it’s not going to be authentic for their experience. They’re going to potentially want to do what I, the therapist, might want them to do. It’s not for me to decide how creative or how deep that person is to go. They need to recognize within themselves, is this the most challenging? Is this the best way that you could actually describe that situation? If that answer is yes, it’s my job as a therapist to just say okay.

Kimberley: How would one know if it’s the most descriptive they could be? Is it by just listening to what OCD has to say and letting OCD write the story, but not in a compulsive way? Share with me your thoughts. 

Krista: I think that that’s almost like a double-edged sword because that of itself can almost go meta. How do I know that my story is intense enough? Well, on the surface we can say, “Is it a hard thing to say.” They might say yes, and then we can work through. But if I’m really assessing like, “Is it hard enough, is it hard enough,” and almost begging for them to provide some type of self-reassurance, they might get stuck in that cycle of, is this good enough? Is this good enough? Can it be even more challenging? 

Another thing I love about imaginals is the limit doesn’t exist, because the limit is just however far your imagination can take you. Let’s say that I have a session with a client today and they’re creating an imaginal. I’m just going to give a totally random obsession. Maybe their obsession is, “I am afraid that I’m going to murder my husband in his sleep,” harm OCD type stuff, pretty common stuff that we do with imaginals. They do the imaginal and they’re able in session to work through it. It sounds like it was good. In the session, what they provided was satisfactory to treatment. And then they come back and say, “I got bored with the story,” which a lot of people think that that’s a bad thing. That’s actually a good thing because that’s letting you know that you’re not in OCD’s control of that feared response and you’re actually doing the work. However, they might still have the obsession. I was like, “Okay, so you were able to work through this habituate or get bored of that. Now, let’s create another imaginal with this obsession.” Because it’s all imagination, the stories, you can create as many as you possibly can or as you possibly want to. 

I’m actually going to give you a quote. He’s a current professor right now at Harvard. He is a professor of Cognitive and Educational Studies. If you look this guy up, his name is Dr. Howard Gardner—his work is brilliant. He has this fantastic quote that I think is just a bomb when it comes to imaginal stuff. His quote is: “Stories constitute the single most powerful weapon in a leader’s arsenal.” Think about that. What a powerful statement that is. Isn’t that just fantastic? Because we can hear that as the stories OCD tells us as being hard. Okay, cool story, bro, that is your weapon OCD, but guess what? I’m smarter than you and I brought a way bigger gun and this gun isn’t imaginal and I’m going to go ahead and one up you. If I come back that next week in my therapist’s office and I’m able to get bored with that, I can make a bigger gun.

Kimberley: I love that. It’s true, isn’t it? I often will say, “That’s a good story. Let me show you what I’ve got.” It is so powerful. Oh my gosh. Let’s actually do it. Can you walk us through how you would do an imaginal?

Krista: This is actually something that I created on my own taken from just multiple trainings and ERP learning about imaginals, because one of the things that I was realizing that a lot of clients were really struggling with is almost over-preparing just to do the imaginal. Sometimes they would write out the imaginal and then we would work through that. But what I was finding is sometimes clients were almost too fixated on words, reading it right, being perfect, that they were almost missing out on the fact that these are supposed to be movies in our mind.

Kimberley: Yeah. They intellectualize it.

Krista: Exactly. I created a super simple format. I mean, we really don’t have a lot of setup here. It’s basically along the lines of the Five Ws. What is your obsession and what is your compulsion? Who is going to be in your story? Who is involved? Where is your story taking place? When is your story taking place? And when is already one of those that’s already set because I tell people we can’t do anything in the past; the past has already existed. You really need to be as present as possible. But the thing is that you can also think. For instance, if my obsession is I’m going to murder my husband in his sleep tonight, part of that might be tonight, but part of that might also be, what is going to be my consequence? What is that bad thing that’s going to happen? Because maybe the bad thing isn’t necessarily right now. Maybe that bad thing is going to be I’m not going to have a relationship with my children and what if they have grandchildren? Or what if I’m going to go to hell? That might not necessarily exist in the here and now, but you’re able to incorporate that in the story. When is an interesting thing, but again, never in the past, needs to start in the present, and then move forward. 

And then also, I ask how. How is where I want people to be as descriptive as possible. For instance, if I say, and this is going to sound gritty, you’re fearful that you’re going to murder your husband tonight. Be specific. How are you going to murder your husband? Because that’s one of the things that OCD might want us to do. Maybe it is just hard enough to say, “I’m going to murder my husband.” But again, we’re packing an arsenal here. Do you want to just say that? Because I can almost guarantee you OCD is already telling you multiple different ways that it might happen. Which one of those seems like it might be the hardest? Well, the hardest one for me is smothering my husband with a pillow. Okay, that’s going to be it. That’s literally my setup. That’s literally my setup, is I say that.

Actually, I have one more thing that I have to include. I have all that as a setup and then I say, “Okay, at the very end, you are going to say this line, and it’s, ‘All of this happened because I did not do the compulsion.’” If I were going along with the story of I murdered my husband, I suffocated him with a pillow, and in my mind, the worst thing to happen is I don’t have a relationship with my kids and grandchildren, and the compulsion might be to pray—I’ll just throw that out—the last line might be, “And now, I don’t have a relationship with my children or grandchildren all because I decided to not pray when the thought of murdering my husband came up in my mind.” That is the entire setup. 

And then I have my clients get their phones out and push record. They don’t have to do a video, just an audio is perfectly fine. I know some therapists that’ll do it just once, but I actually do it over and over again. Sometimes it could be a five-minute recording, it could be a 20-minute recording, it could be a 40-minute recording. The reason for that being is if we stop just after one, we might be creating accommodation for that client, because I want my clients to be in that experience. That first time they tell that story after that very brief setup, they’re still piecing together the story. Honestly, it’s really not until about the third or fourth time that they’ve repeated that exact same story that they’re really in it. I am just there and every time they finish—I’ll know they finish because they say, “And this happened all because da da da da da”—I say, “Okay, what’s your number?” That means what’s your SUDS? And they tell me they’re SUDS. I might make a little bit, very, very minimal recommendations. For instance, if they say, “I murdered my husband,” I say, “Okay, so this time I want you to tell me how you murdered your husband.” Again, they say the exact same story, closing their eyes all over again, this time adding in the little bit that I asked for. We do that over and over and over again until we reach 50% habituation. Then they stop recording. That is what they use throughout the week as their homework, and you can add it in so many different ways. 

Again, keeping along with this obsession of “I’m afraid I’m going to kill my husband tonight,” I want you to listen to that with, as you probably have heard this as well, just one AirPod in, earbud, whatever, keep your other ear outside to the world. This is its way to talk back to OCD. Just something along the lines of that. I want you to the “while you’re getting ready for bed.” Because if the fear exists at night and your compulsions exist at night, I want you to listen to that story before you go to bed. It’s already on your mind. You’re already in it, you’re already poking the bear of OCD. It’s like, “Okay, OCD, you’re going to tell me I’m going to kill my husband tonight? Well, I’m going to hear a story about me killing my husband tonight.” Guess what? The bad thing’s going to happen over and over and over again. 

It’s such a powerful, powerful, powerful thing. Because it’s recorded, you can literally listen to it in your car. You can listen to it on a plane. You can listen to it in a waiting room. I mean, there’s no limit. 

Kimberley: It’s funny because, for those of you who are on social media, there was this really big trend not long ago where they’re like what they think I’m listening to versus what I’m actually listening to, and they have this audio of like, “And then she stabbed her with the knife.” It’s exactly that. Everyone thinks you’re just listening to Britney Spears, but you’re listening to your exposure and it’s so effective. It’s so, so effective. I love this. Okay, let’s do it again because I want this to be as powerful as possible. You did a harm exposure. In other episodes, we’ve done a relationship one, we’ve done a pedophile one. Let’s pick another one. Do you have any ideas? 

Krista: What about scrupulosity?

Kimberley: I was just going to say, what about scrupulosity?

Krista: That one is such a common one for imaginals. We hear it very frequently, “I’m going to go to hell,” or even thinking about different other religions like, “Maybe I’m not going to be reincarnated into something that has meaning,” or “It’s going to be a bad thing. Maybe I’m insulting my ancestors,” or just whatever that might be. Let’s say the obsession is—I already mentioned praying—maybe if I don’t read the Bible correctly, I’m going to go to hell. I don’t know. Something along the lines of that. If that’s their obsession, chances are, there’s probably somebody that maybe they have a time where they’re reading the Bible or maybe that we have to add in an in vivo where they’re going to be reading or something like that. A setup could potentially be, what is your obsession? “I’m afraid that any time I read my Bible, I’m not reading it correctly and I’m going to go to hell.” What is your compulsion? “Well, my compulsion is I read it over and over and over again and I reassure myself that I understand it, I’m reading it correctly.” Who’s going to be in your story? This one you might hear just, “Oh, it’s just me.” Really, OCD doesn’t necessarily care too much if anybody else is in this story. Where are you? “I’m in my living room. It’s nighttime. That’s when I read my Bible.” When is this taking place? “Oh, we can do it tonight.” Let’s say it’s tonight. 

Interestingly enough, when you have stuff that’s going to go to hell, that means, well, how are you getting to hell to begin with? Because that’s not just something that can happen. Sometimes in these imaginals, the person has to die in order to get there, or they have to create some type of fantastical way of them getting to hell. 

I actually had a situation, this was several years ago, where the person was like, “Well, death doesn’t scare me, but going to hell scares me,” because, in some cultures and some religions, it’s believed that there are demons living amongst us and so forth. “It’s really scary to think about, what if a demon approaches me and takes me immediately to hell and I don’t get to say goodbye to my family, my family doesn’t know.” Just even like that thought. We were able to incorporate something very similar to that. 

Just to make up an imaginal on the spot, it could be, I’m reading my Bible. I’m in my living room, I’m reading my Bible, and the thought pops up in my brain of, did you read that last verse correctly? I decide to just move on and not worry about reading my Bible correctly. Well then, all of a sudden, I get a knock at the door and there’s these strange men that I’ve never seen in my life, and they tell me that they’re all demons, and that because I didn’t review the Bible correctly, I’m going to go to hell. I would go on and on and probably describe a little bit more about my family not missing me, I don’t get to see my kids grow up, I don’t get to experience life, the travel, and the stuff that’s really important to me, incorporate some of those values. I don’t get to live my value-based life. And then at the very end, I was summoned and taken to hell by demons, all because I had the thought of reading my bible correctly and I decided not to.”

Kimberley: I love it, and I love what I will point out. I think you use the same model as me. We use a lot of “I” statements like “I did this and I did that, and then this happened and then I died,” and so forth. The other thing that we do is always have it in present tense. Instead of going, “And then this happens, and then that happens,” you’re saying as if it’s happening.

Krista: Yeah. Because you want it to feel real to the person. In all honesty, and I wonder what your experience has been, I find some of the most difficult people to do imaginals with our children. Even though you would think, “Oh, they’re so imaginative anyways,” one of the biggest things I really have to remind kids is, I want you to be literally imagining yourself in that moment. Again, I see this with kids more than adults, but I think it just depends on context and perspective. We’ll say, “Well, I know that I’m in my living room,” or “I know that I’m in your office, so this isn’t actually happening to me in this moment.” You almost have to really work them up and figure out, what’s the barrier here? What are you resisting?

Kimberley: That’s a good question. I would say 10 to 20% of clients of mine will report, “I don’t feel anything.” I’ll do a Q and A at the end of this series with common questions, but I’m curious to know what your response is to a client who reads like, “I kill my baby,” or “I hurt my mom,” or “I go to hell,” or “I cheat on my husband,” or whatever it is, but it doesn’t land. What are your thoughts on what to do then?

Krista: A couple of things pop up. One, it makes me wonder what mental compulsions they’re doing. And then it also makes me wonder, are we going in the right direction with the story? Because again, like I mentioned before, if a client comes back and they’ve habituated to one thing, but they’re still having the obsession, well, guess what? We’re just telling stories. Because the OCD narrative is typically not just laser-focused—I mean, it can be laser-focused, but usually, it has branches—you can pick and choose. I’m going to go ahead and guarantee, that person who is terrified of killing their husband ensure they’re not going to see their grandchildren and children. I’m going to go ahead and waiver that there’s probably other things that they’re afraid of missing. 

Kimberley: Yes. That’s what I find too, is maybe we haven’t gotten to the actual consequence that bothers them. I know when I’ve written these for myself, we tend to fall into normal traps of subtypes, like the fear that you’ll harm somebody or so forth. But often clients will reveal like, “I’m actually not so afraid that I’ll harm somebody. I’m really afraid of what my colleagues and family would think of me if I did.” So, we have to include that. Or “I’m afraid of having to make the call to my mom if I did the one thing.” I think that that’s a really important piece to it, is to really double down on the consequence. Do you agree?

Krista: Oh, I agree a hundred percent. You got to figure out what is that core fear. What are you really, really trying to avoid? With harming somebody, is it the consequences that might happen afterwards? Is it the feeling of potentially snapping or losing control? Or is it just knowing that you just flat out, took the life of somebody and that that was something that you were capable of? I mean, there’s so many different themes, looking at what does that feared self like, what does that look like, and maybe we didn’t hit it last time.

Kimberley: Right.

Krista: I know this is going to sound silly and I tell my clients this every once in a while, is I’m not a mind reader. What I’m asking you, is that the most challenging you can go and you’re telling me yes, I’m going to trust you. I tell them, if you are not pushing yourself in therapy to where you can grow, I’m still going to go to bed home and sleep tonight just fine. But I want you to also go home and go to bed and sleep just fine. But if you are not pushing yourself, because we know sleep gets affected super bad, not just sleep, but other areas, you’re probably going to struggle and you might even come back next week with a little bit more guilt or even some shame. I don’t want anybody to have that. I want people to win. I want people to do well in this. I know this stuff is scary, but I’m going to quote somebody. You might know her. Her name is Kimberley Quinlan. She says, “It’s a beautiful day to do hard things.” I like to quote her in my practice every once in a while. 

Kimberley: I love her. Yes, I agree with this. The way you explained it is so beautiful and it’s logical the way you’re explaining it too. It makes sense. I have one more question for you. Recently, I was doing some imaginals with a client and they were very embarrassed about the content of their thoughts. Ashamed and guilty, and horrified by their thoughts. I could see that they were having a hard time, so I gave them a little inch and I went first. I was like, “Alright, I’m going to make an assumption about what yours is just to break the ice.” They were like, “Oh yeah, that’s exactly what it is.” There was a relief on their face in that I had covered the bases. We did all of the imaginal and we recorded it and it was all set. And then at the end I said, “Is there anything that we didn’t include?” They reported, “Yeah, my OCD actually uses much more graphic words than what you use.” I think what was so interesting to me in that moment was, okay, I did them the favor by starting the conversation, but I think they felt that that’s as far as we could go. How far do you go?

Krista: As far as we need. 

Kimberley: Tell me what that means.

Krista: Like I mentioned before, the limit does not exist and I mean, the limit does not exist. This is going to sound so silly. I want you to be like a young Stephen King before he wrote his first novel and push it. Push it and then go there. Guess what? If that novel just doesn’t quite hit it, write another one, and then another one, and let’s see how far you can go. Because OCD is essentially a disorder of the imagination, and you get to take back your imagination by creating the stories that OCD is telling us and twisting it. I mean, what an amazing and powerful thing to be able to do. I’m sure you’re the same in that you know that there’s a lot of specialists that don’t believe in imaginals, don’t like imaginals, especially when it comes to issues with pedophilia OCD. I think we also need to not remind our clients because that would be reassurance, but to tell these specialists, we’re not putting anything into our client’s heads that aren’t there to begin with. Just like you said, if your client is thinking like real sick, nasty core, whatever, guess what? We’re going to be going there. Are you cutting off the heads of babies in your head? Well, we’re going to be talking about stories where you’re cutting off the heads of babies. If that’s what’s going on, we’re going to go there.

Kimberley: What’s really interesting, and this was the example, is we were talking about genitals and sexual organs and so forth. We’re using the politically correct term for them in the imaginal. Great. Such a great exposure. Vagina and penis, great. Until again, they were like, “But my OCD uses much more graphic words for them.” I’m like, “Well, we need to include those words.” Would you agree your imaginals don’t need to be PC?

Krista: I hope my clients watch this, and matter of fact, I’m going to send this to them, just to be like, no, no. Krista’s imaginals with her clients. Well, not my imaginals. Imaginals that are with my clients. Woah, sometimes I’m saying bye to my client. I’m like, “I think I need a shower.”

Kimberley: Again, when people say they don’t like imaginals or they think that it’s not a good practice, I feel like, like you said, if OCD is going to come up with it, it gives an opportunity to empower them, to get ahead of the game, to go there before it gets there so that you can go, “Okay, I can handle it.” I would often say to my clients, “Let’s go as far as we can go, as far as you can go, so that you know that there’s nothing it can come up with that you can’t handle.”

Krista: I think that where it gets even more complex is when we’re hitting some of the taboo stuff. Not only pedophilia, but something like right now that I’m seeing a lot more of in my office is stuff relating to cancel culture. This fear that what if I don’t use somebody’s pronouns correctly? What if I accidentally say an inappropriate racial slur? I will ask in session and I’ll be super real. It’s hard for me to hear this stuff because this goes outside of my values. Of course, it goes outside of their values. OCD knows that. That’s why it’s messing with them. I’ll say, “Okay, so what is the racial slur?” My clients are always like, “You really want me to say it?” I said, “We’re going to say it in the imaginal.” I realized how hard that is to stomach for therapists. But in my brain, the narrative that OCD is pushing, whether it is what society views as OCD or taboo OCD, it doesn’t matter. We still have to get it out. It is still hard for that client. If that’s hard for that client to think of an imaginal or a racial slur, it is almost the exact same amount of distress for somebody maybe with an imaginal that I’m afraid I’m getting food poisoning. 

We, as clinicians, just because we’re very caring and loving people, sometimes we can unintentionally put a hierarchy of distress upon our clients like, okay, I can do this imaginal because this falls with my values, but I don’t know if I can do this imaginal because pedophilia is something that’s hard for me to do and I don’t want to put my client through that. Well, guess what? Your client is already being put through that, whether you like it or not. It’s called OCD.

Kimberley: Right. Suppressing it makes it come on stronger anyway. Love that. I think that the beauty of that is there is a respectful value-based way of doing this work, but still getting ahead of OCD. Is that what you’re saying?

Krista: Absolutely. OCD tries to mess with us and think, what if you could be this person? Well, like I mentioned before, if a story is like a weapon, well, I’m going to tell a story to attack OCD because it’s already doing it to me.

Kimberley: Yeah. Tell us where people can hear more from you, get your resources because this is such great stuff.

Krista: Thank you. I’d say probably the best way to find me and my silly videos would be on my Instagram @anxiouslybalance.

Kimberley: Amazing. And your private practice?

Krista: My private practice, it’s A Peaceful Balance in Wichita, Kansas. The website is apbwichita.com.

Kimberley: Thank you so much. I’m very grateful for you for inspiring this whole series and for also being here as a big piece of the puzzle.

Krista: Thank you. I’m grateful for you that you don’t mind me just like this. I’m grateful for you for letting me talk even though clearly, I’m not very good at it right now. You’re amazing.

Kimberley: No, you’re amazing. Thank you. Really, these are hard topics. Just the fact that you can talk about it with such respect and grace and compassion and education and experience is gold. 

Krista: Thank you. At the end of the day, I really truly want people to get better. I know you truly want people to get better. Isn’t that just the goal?

Kimberley: Yeah. It’s beautiful. Krista: Thank you. 

In the insightful podcast episode featuring Joanna Hardis, author of "Just Do Nothing: A Paradoxical Guide to Getting Out of Your Way," listeners are treated to a deep dive into the concept of distress tolerance and its pivotal role in mental health and personal growth. Joanna Hardis, with her extensive background in treating anxiety disorders such as panic disorder, OCD, and Generalized Anxiety Disorder, shares her professional and personal journey toward understanding and teaching the art of effectively managing internal discomfort without resorting to avoidance or escape tactics.

The discussion begins with an exploration of the title of Joanna's book, "Just Do Nothing," which encapsulates the essence of her therapeutic approach: the intentional practice of stepping back and allowing thoughts, feelings, and sensations to exist without interference. This practice, though seemingly simple, challenges the common impulse to engage with and control our internal experiences, which often exacerbates suffering.

A significant portion of the conversation is dedicated to "distress intolerance," a term that describes the perceived inability to endure negative emotional states. This perception leads individuals to avoid or escape these feelings, thereby increasing vulnerability to a range of mental health issues including anxiety, depression, and substance abuse. Joanna emphasizes the importance of recognizing and altering the self-limiting beliefs and thoughts that fuel distress intolerance.

Practical strategies for enhancing distress tolerance are discussed, starting with simple exercises like resisting the urge to scratch an itch and gradually progressing to more challenging scenarios. This gradual approach helps individuals build confidence in their ability to manage discomfort and makes the concept of distress tolerance applicable to various aspects of life, from parenting to personal goals.

Mindfulness is highlighted as a crucial component of distress tolerance, fostering an awareness of our reactions to discomfort and enabling us to respond with intention rather than impulsivity. The podcast delves into the importance of connecting with our values and reasons for enduring discomfort, which can provide the motivation needed to face challenging situations.

Joanna and Kimberley also touch on the common traps of negative self-talk and judgment that can arise during distressing moments, advocating for a more compassionate and accepting stance towards oneself. The idea of "choice points" from Acceptance and Commitment Therapy (ACT) is introduced, encouraging listeners to make decisions that align with their values and move them forward, even in the face of discomfort.

The episode concludes with a message of hope and empowerment: everyone has the capacity to work on expanding their distress tolerance. By starting with small, manageable steps and gradually confronting more significant challenges, individuals can cultivate a robust ability to navigate life's inevitable discomforts with grace and resilience.

EPISODE HIGHLIGHTS: 

• The Concept of "Just Do Nothing":
  • This core idea revolves around the practice of intentionally not engaging with every thought, feeling, or sensation, especially when they're distressing. It's about learning to observe without action, which can reduce the amplification of discomfort and suffering.
• Understanding Distress Intolerance:
  • Distress intolerance refers to the belief or perception that one cannot handle negative internal states, leading to avoidance or escape behaviors. This concept highlights the importance of recognizing and challenging these beliefs to improve our ability to cope with discomfort.
• Building Distress Tolerance:
  • The podcast discusses practical strategies to enhance distress tolerance, starting with simple exercises like resisting the urge to scratch an itch. The idea is to gradually expose oneself to discomfort in a controlled manner, thereby building resilience and confidence in handling distressing situations.
• Mindfulness and Awareness:
  • Mindfulness plays a crucial role in distress tolerance by fostering an awareness of our reactions to discomfort. This awareness allows us to respond intentionally rather than react impulsively. The practice of mindfulness helps in recognizing when we're "gripping" distressing thoughts or sensations and learning to gently release that grip.
• Aligning Actions with Values:
  • The podcast emphasizes the significance of connecting actions with personal values, even in the face of discomfort. This alignment can motivate us to face challenges and make choices that lead to personal growth and fulfillment, rather than making decisions based on the urge to avoid discomfort.

These concepts together form a comprehensive approach to managing distress and enhancing personal well-being, as discussed by Joanna Hardis in the podcast episode.

TRANSCRIPTION: 

Kimberley: Welcome, everybody, today. We have Joanna Hardis. Joanna wrote an amazing book called Just Do Nothing: A Paradoxical Guide to Getting Out of Your Way. It was a solid gold read. Welcome, Joanna.

Joanna: Thank you. Thank you for having me. Thank you for reading it, too. I appreciate it.

Kimberley: It was a wonderful read and so on point, like science-backed. It was so good, so you should be so proud.

Joanna: Thank you.

Kimberley: Why did you choose the title Just Do Nothing?

Joanna: I mean, it’s super catchy, but more importantly than that, it is really what my work involves on a personal level and on a professional level—learning how to get out of my own way or our own way by leaving our thoughts alone, learning how to leave uncomfortable feelings alone, uncomfortable sensations alone, uncomfortable thoughts alone. Because that’s what creates the suffering—when we get so engaged in them.

Kimberley: Yeah. It’s such a hard lesson. I talk about this with patients all the time. But as I mentioned to you, even my therapist is constantly saying, “You’re going to have to just feel this one.” And my instinct is to go, “Nope. No thanks. There has to be another way.”

Joanna: A hundred percent. Yes. I mean, it really is something on a daily basis. I have to remind myself and work really hard to do.

Kimberley: It is. But it is such powerful work when you do it. 

Joanna: Mm-hmm. 

Kimberley: Early in the book, you talk about this term or this concept called ‘distress intolerance.’ Can you tell us what both of those are and give us some ideas on why this is an important topic?

Joanna: Sure, and this is what got me interested in the book and everything. Distress tolerance is a perception that you can handle negative internal states. And those internal states can be that you feel anxious, that you feel worried, you feel bored, vulnerable, ashamed, angry, sad, mad, off. There’s an A to Z alphabet of those unpleasant and uncomfortable emotional states. And when we have that perception that we can handle it, our behavior aligns, so we tend to do things. 

When we are distress-intolerant, we have a perception—often incorrect—that we cannot handle negative internal states. So then we will either avoid them or escape them or try to figure them out or neutralize them or try to get rid of them, make them stop—all the things that we see in our work every day. 

Before I had my practice in anxiety disorders, I worked over a decade in an eating disorder treatment center, and we know that when someone has really low distress tolerance, they are more vulnerable to developing eating disorders, anxiety disorders, depressive disorders, substance use disorders. So, it’s a really important concept.

Kimberley: It’s such an important concept. And you talk about how the thoughts we have which can determine that. Do you want to share a little bit about that? Because there was a whole chapter in the book about the thoughts you have about your ability to tolerate distress.

Joanna: Sure, and I didn’t answer the second part of your question., I just realized, which will tie into that, which is how it sounds. How it sounds is, “I can’t bear to feel this way, so I’m going to avoid that party,” or “I’m having too good of a day, so I can’t do my homework,” or “I can’t bear if my kids see me anxious, so we’re not going to go to the playground.”

And so, what drives someone’s perception are their thoughts and these thoughts and these self-limiting stories that we all have, and that oftentimes we just buy into as either true, or perhaps at one point, they may have been true, but we’ve outlived them.

Kimberley: Yeah. We’re talking about distress tolerance, and I’m always on the hunt to widen my distress tolerance to be able to tolerate higher levels of distress. And I think what’s interesting is, first, this is more of a question that I don’t know the science behind it, but do you think some people have higher levels of distress which makes them more intolerant, or do you think the intolerance which is what makes the distress feel so painful?

Joanna: I don’t know the research well enough to answer it. Because I think it’s rare that you see -- I mean, this is just one construct. So it’s very hard to isolate it from something like emotional sensitivity or anxiety sensitivity or intolerance for uncertainty, or something else that may be contributing to it.

Kimberley: Yeah. No, I know. It’s just a question I often think about, particularly when I’m with patients. And this is something that I think doesn’t really matter at the end of the day. What matters is—and maybe this will be a question for you—if our goal is to increase our distress tolerance, how might somebody even begin to navigate that?

Joanna: Sure. I love that question. I mean, in the book, I take it down to such a micro level, which is learning how—and I think you’ve talked about it on podcasts—itch serve. So, one of the exercises in the book is learning how you set your timer for five minutes and you get itchy, which of course is going to happen. And it’s learning how to ride out that urge to scratch the itch. So, paying attention to. If you zoom in on the itch, what happens?  What happens when you zoom out? What else can you pay attention to? 

And so when someone learns that process, that is on such a micro level. I often tell patients it’s like a one-pound weight.

Kimberley: Yes.

Joanna: And then what are some two-pound weights that people can use? So then, for many people, it’s their phone. So, it’s perhaps not checking notifications that come in right away. They begin to practice in low-distress situations because I want people to get confident that they know how to zoom in, they know how to zoom out. They know if they’re feeling a sensation, the more that they pay attention to it, the worse it’s going to feel. And so, where else can they put their awareness? What else can they be doing? 

And once they get the hang of it, we introduce more and more distress. So then, it might be their phone, then it might be them intentionally calling up a thought. And we work up that way with adding in, very gradually, more distress or more discomfort. Exercise is a great way, especially if it’s not married to anxiety, to get people interacting with it differently.

Kimberley: Yeah. We use this all the time with anxiety disorders. It’s a different language because we talk about an ERP hierarchy, or your exposure menu, and so forth. But I love that in the book, it’s not just specific to that. It could be like you talked about. It’s for those who have depression. It’s those who have grief. It’s those who have eating disorders. It’s those who have anger. I will even say the concept of distress tolerance to me is so interesting because there’s so many areas of my life where I can practice it. Like my urgency to nag my kids another time to get out the door in time, and I have to catch like, “You don’t need to say it the third time.” Can you tolerate your own discomfort about the time it’s taking them to get out the door? And I think that when we have that attitudinal shift, it’s so helpful.

Joanna: Yes. I find parenting as one of the hardest places for me, but it was also a reminder like the more I keep my mouth shut, the better.

Kimberley: Yeah. And I think that’s really where I was talking before. I found parenting to be quite a triggering process as my kids have gotten older, but so many opportunities for my own personal growth using this exact scenario. Like your fear might come up, and instead of engaging in that fear, I’m actually just going to let it be there and feel it and parent according to my values or act according to my values. And I’ve truly found this to be such a valuable tool.

Joanna: Yes. And I have found what’s been really interesting, when my kids were at home, that was where my distress was. Now that the two of the three are out of the house, my distress is when we’re all together and everyone have a good time. And so, it morphs, because what I tell myself and my perception and the urgency, it changes. It’s still so difficult with them, but it changes based on what’s happening.

Kimberley: Yeah. And I think this is an opportunity for everyone, too. How much do you feel that awareness piece is important in being aware that you are triggered? For the folks listening, of course, you’re on the Your Anxiety Toolkit podcast. Most are listening because they have anxiety. Do you encourage them to be aware of other areas? They can be practicing this. 

Joanna: Yes.

Kimberley: Can you talk to me about that?

Joanna: 100%, because I feel like -- what is that metaphor about the onion? It’s like the layers of an onion. So, people will come, and they’ll think it’s about their anxiety. But this is really about any uncomfortable feeling or uncomfortable sensation. And so. It may be that they’re bored or vulnerable or embarrassed or something else. So, once someone learns how to allow those feelings and do what is important to them or what they need to do while they feel it, then yes, I want them to go and notice where else in their life this is showing up.

Kimberley: Talk to me specifically about how in real-time, because I know that’s what listeners are going to ask. 

Joanna: Of course.

Kimberley: I have this scary thing I want to be able to do, but I don’t want to do it because I’m scared, and I don’t want to feel scared. How might someone practice tolerating their distress in real-time?

Joanna: I’m going to answer two ways. One, I would say that might be something to scale. Sometimes people want to do the thing because doing the thing is like the goal or the sexy thing, but if it’s outside of their window of tolerance, they may not be able to do it. So, it depends on what they want to do. So, I might say, as just a preface, this might be something that people should consider scaling. 

Kimberley: Gradual, you mean?

Joanna: Yes. So, for instance, they want to go to the gym, but they’re scared of fainting on the treadmill or something. Pretty common for what we see. It would be like, scale it back. So it might be going to the parking lot. It might be taking a tour. It might be going and standing on the treadmill. It might be walking on the treadmill. But we have to put it in smaller pieces. 

In the moment that we’re doing something that is difficult, first, we have to notice if we’re starting to grip. I use this “if we’re starting to grip” something. If we’re starting to zoom in on what we don’t like, if we’re starting to zoom in on a sensation we don’t like, a thought we don’t like, a feeling we don’t like, I want people to notice that and you get better at noticing it faster. 

The first thing is you got to notice it, that it’s happening, because that’s going to make it worse. So, you want to be able to notice it. You want to be able to loosen your grip on it. So, that might be finding out what else is going on in my surroundings. So, I’m on the treadmill, I’m walking maybe at a faster pace, and I’m noticing that my heart rate is going up, and I’m starting to zoom into that. What else am I noticing, or what else am I hearing? What else do I see? What else is going on around me? Can we make something else a louder voice?

And so, every time that my brain wants to go back to heart focus, it’s like, no, no. It’s taking it back to something else that’s going on. And it helps to connect with why is this important to do? So, as I’m continuing to say, “I’m okay. I am safe. I’m listening. I’m focusing on my music, and I’m looking out the window," This is really important to do because my health is important. My recovery is important. It becomes that you’re connecting to something that’s important, and the focus is not on what we don’t like because that’s going to make it bigger and stronger.

Kimberley: Right. As you’re doing that, as we’ve already mentioned, someone might be having those can’t thoughts, like I can’t handle it, even if it’s within their window of tolerance, right? It’s reasonable, and it’s an appropriate exposure. How might they manage this ongoing “You can’t do this, this is too hard, it’s too much, you can’t handle it” kind of thinking?

Joanna: I like “This may suck, and I can do it.”

Kimberley: It’s funny. I will tell you, it’s hilarious. In the very beginning of the book, you make some comments about the catchphrases and how you hate them, and so forth. I always laugh because we have a catchphrase over here, but it’s so similar to that in that we always talk about, like it’s a beautiful day to do hard things. And that seems to be so hopeful for people, but I do think sometimes we do get fed, like over positive ways. You have a negative thought, so we respond very positively, right? And so, I like “This is going to suck, and I’m going to do it anyway.”

Joanna: Yes. So you’re acknowledging this may suck, especially if you’re deconditioned, especially if you’re scared. It may suck AND—I always tell people not the BUT—AND I can do it. Even in 30-second increments. So, if someone is like, “I can’t, I cant,” I’ll say, “You can do anything for 30 seconds.” So then we pile on 30 seconds.

Kimberley: Yeah. And that’s such an important piece of it too, which is just taking a temporary mindset of we can just do this for a little tiny bit and then a little tiny bit and then a little tiny bit. 

Joanna: Yes, I love that. I love that.

Kimberley: Why do we do this? What’s the draw? Sell me on why someone wants to do this work.

Joanna: To do...?

Kimberley: Distress tolerance. We talk about this all the time. Why do we want to widen our distress tolerance?

Joanna: Oh my goodness. Oh my gosh. I think once you realize all the little areas that may be impacting one’s life, it just blows your mind. But in a practical sense, people can stay stuck. When people are stuck. This is often a piece. It’s absolutely not the whole reason people are stuck, but this is such a piece of why people get stuck. And so I think for anyone that might feel stuck, perhaps they want a different job or they want to show up differently as a parent or they feel like they are people-pleasers, or they’re having trouble dating because they get super controlling. It can show up in any area of one’s life.

Kimberley: Yeah. For me, the selling point on why I want to do it is because it’s like a muscle—if I don’t continue to grow this muscle, everything feels more and more scary.

Joanna: Oh, sure. Yeah, hundred percent.

Kimberley: The more I go into this mindset of “You can’t handle it and it’s too much, it’s too scary” things start to feel more scary. The world starts to feel more unsafe, whereas that attitude shift, there’s a self-trust that comes with it for me. I trust that I can handle things. Whereas if I’m in the mindset of “I can’t,” I have no self-trust. I don’t trust that I can handle scary things, and then I’m constantly hypervigilant, thinking when the next scary thing's going to happen.

Joanna: Right. Another reason to also practice doing it, if you never challenge it, you don’t get the learning that you can do it.

Kimberley: Yeah. There’s such empowerment with this work.

Joanna: Yes. And you don’t have to do big, scary things. You don’t have to jump out of an airplane to do it or pose naked, because I see that on Instagram now, people who are conquering their fears by doing these. Very Instagram-worthy tasks, which could be very scary. We can do it, just like you say, with not nagging our kids, by choosing what I want to make for dinner versus making so many dinners because I am so scared that I can’t handle it if my kids are upset with me.

Kimberley: Right. And for those who have anxiety, I think from the work I do with my patients is this idea of being uncertain feels intolerable. That feeling. You’re talking about these real-life examples. And for those who are listening with anxiety, I get it. That feeling of uncertainty feels intolerable, but again, that idea of widening your tolerance or increasing your ability to tolerate it in 10-second increments can stop you from engaging in compulsions that can make your disorder worse or avoiding which can make your disorder worse. Do you have any thoughts on that?

Joanna: I 100% agree with you. I always say, let’s demote intolerable to uncomfortable. Because I feel sometimes like I have to know I can’t stand it, I’m crawling out of my skin. But if I’m then able to get some distance from it, that’s the urgency of anxiety.

Kimberley: Yeah. It’s such beautiful work.

Joanna: Yes, and especially the more people do, they’re able to say, “You know what? I can do things.” It may feel intolerable. That diffusion, it may feel intolerable. It’s probably uncomfortable. So, what is the smallest next step I can take in this situation to do what I need to do and not make it worse? That’s a big thing of mine—not making a situation worse.

Kimberley: Yes. And that’s where the do-nothing comes in.

Joanna: Yes. That’s the paradoxical part. 

Kimberley: Yeah. Is there any area of this that you feel like we haven’t covered that’s important to you, that would be an important piece of this work that someone may consider as they’re doing this work on their own?

Joanna: I think and I know that you are a big proponent of this too. I think it’s very hard to do this work without some mindful awareness practice. And I talk about it in the book. It’s just such an enhancer. It enhances treatment, but it also enhances our daily life. So, I can’t say strongly enough that it is so important for us to be able to notice this pattern when we are saying, “Oh my gosh, I can’t take this,” or “I can’t do this.” And then the behavior and to think about what’s the function of me avoiding. But if we’re going so fast and our gas pedal is always to the floor, we don’t have the opportunity to notice.

Kimberley: Yeah, the mindfulness piece is so huge. And even, like you’re saying, the mindfulness piece of the awareness but also the non-judgment in mindfulness. As you’re doing the hard thing, as you’re tolerating distress, you’re not sitting there going, “This sucks and I hate it.” I mean, you’re saying like it will suck, and that's, I think, validating. It validates you, but not staying in “This is the worst, and I hate it, and I shouldn’t be here.” That’s when that suffering does really show up. 

Joanna: Yes. The situation may suck. It doesn’t mean I suck. That was a hard lesson to learn. The situation may, but I don’t have to pour gas on it by saying, “How long is it going to last? Oh my gosh, this feeling’s never going to end. Do I still feel it? Oh my gosh, do I still feel it as much?” All the things that I’m prone to do or my clients are prone to do that extend the suffering.

Kimberley: Make it worse.

Joanna: Yeah, exactly.

Kimberley: It’s a great question, actually. And I often will talk with my patients about it, in the moment, when they’re in distress. Sometimes writing it down, like what can we do that would make this worse? What can we do that will make this better? And sometimes that is doing nothing at all. And you do talk about that in the book.

Joanna: Yeah.

Kimberley: The forward and the backward. 

Joanna: The choice points. Yes.

Kimberley: Can you share just a little bit about that?

Joanna: It’s a concept from ACT (Acceptance and Commitment Therapy) that says, when we have a behavior, a behavior can either move us toward or forward what’s meaningful in our values or can move us away from it. And so, as we’re thinking about doing whatever the hard thing maybe or it may not even be a hard thing; it just may be something you don’t want to do. Thinking about what your why is, what’s the forward move? Why is it meaningful to you? What do you stand to get? What’s on the other side? Because most of us are well versed, and if we give in, that’s an away move. And we have to be able to do this non-judgmentally because some days it’s just not in us, and that’s totally fine. But I want people to be honest with themselves and non-judgmental about whatever decisions they make. But it does help to have a reason that moves us forward.

Kimberley: Absolutely. I think that’s such an important piece of the work. Again, that’s the selling point of why we would want to be uncomfortable. There’s a goal or a why that gets us there.

Joanna: Yeah. And it’s amazing how much pain we will put up with. I mean, think about all the things people like—waxing and some of these exercise classes. It’s amazing because it’s important to someone.

Kimberley: Exactly. And I think that’s a great point too, which is we do tolerate distress every day when we really are clear on what we want. And I think sometimes we have these things like I can’t handle it, but you might even ask like, what are some harder things that I’ve actually tolerated in my lifetime?

Joanna: Yes, exactly because there’s a lot of things you’re so right that we do that are uncomfortable, but it’s worth it because, for whatever reason, it’s worth it.

Kimberley: Yeah, I love this. I have loved chatting with you. I know I’ve asked you this already, but is there any final words you want to share before we learn more about you and where people can get in touch with you?

Joanna: I just want people to know that anybody can do this. It may be that it’s just creating the right scale—a small enough step forward—but anybody can work on this. There are so many areas and ways in which we can strengthen this muscle. And so there is hope. No one is broken. It may be that people just don’t know the next best move.

Kimberley: I love that. Thank you. Where can people hear more about you and get in touch with you?

Joanna: My website is JoannaHardis.com and my Instagram is the same thing, @JoannaHardis. And excitingly, the book just came out in audio yesterday. 

Kimberley: Congratulations. 

Joanna: Thank you. Thank you. 

Kimberley: That’s wonderful. And we can get the book wherever books are sold. 

Joanna: Wherever books are sold, yes.

Kimberley: I really do encourage people to buy it. I think it’s a book you could pick up and read once a year, and I think that there’s messages. You know what I’m saying? There are some books where you could just revisit and take something from, so I would really encourage people to buy the book and just dabble in the many concepts that you share.

Joanna: Wonderful. Thank you.

Kimberley: Yeah. Thank you so much for being on the show. This is such a concept and a topic that I’m really passionate about, and for myself too. I think it’s something I’ll be working on until I’m 99, I think.

Joanna: Me too. I’m with you right there.

Kimberley: There’s always an opportunity where I’m like, “Oh okay. There’s another opportunity for me to grow. All right, let’s get on board. Let’s go back to the school.” So, I think it’s really wonderful. Thank you so much for being here.

Joanna: Thank you so much for having me.

SUMMARY:

Welcome to the first week of this 6-part series on Mental Compulsions.  This week is an introduction to mental compulsions.   Ove the next 6 weeks, we will hear from many of the leaders in our feild on how to manage mental compulsions using many different strategies and CBT techniques.  Next week, we will have Jon Hershfield to talk about how he using mindfulness to help with mental compulsions and mental rituals.

In This Episode:

• What is a mental compulsion?
• Is there a different between a mental compulsion and mental rumination and mental rituals?
• What is a compulsion?
• Types of Mental Compulsions

Links To Things I Talk About:

How to reach Jon https://www.sheppardpratt.org/care-finder/ocd-anxiety-center/
ERP School: https://www.cbtschool.com/erp-school-lp

Episode Sponsor:

This episode of Your Anxiety Toolkit is brought to you by CBTschool.com. CBTschool.com is a psychoeducation platform that provides courses and other online resources for people with anxiety, OCD, and Body-Focused Repetitive Behaviors. Go to cbtschool.com to learn more.

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EPISODE TRANSCRIPTION

This is Your Anxiety Toolkit - Episode 282 and the first part of a six-part series that I am overwhelmed and honored to share with you – all on mental compulsions.

I have wanted to provide a free resource on mental compulsions for years, and I don’t know why, but I finally got enough energy under my wings and I pulled it off and I could not be more excited. Let me tell you why.

This is a six-part series. The next six episodes will be dedicated to managing mental compulsions, mental rituals, mental rumination. I will be presenting today the first part of the training, which is what we call Mental Compulsions 101. It will talk to you about all the different types of mental compulsions, give you a little bit of starter training. And then from there, it gets exciting. We have the most incredible experts in the field, all bringing their own approach to the same topic, which is how do we manage mental compulsions?

We don’t talk about mental compulsions enough. Often, it’s not addressed enough in treatment. It’s usually very, very difficult to reduce or stop mental compulsion. I thought I would bring all of the leaders, not all of them, the ones I could get and the ones that I had the time to squeeze into this six-part series, the ones that I have found the most beneficial for my training and my education for me and my stuff. I asked very similar questions, all with the main goal of getting their specific way of managing it, their little take, their little nuance, fairy tale magic because they do work magic. These people are volunteering their time to provide this amazing resource.

Welcome to number one of a six-part series on mental compulsions. I hope you get every amazing tool from it. I hope it changes your life. I hope you get out your journal and you write down everything that you think will help you and you put it together and you try it and you experiment with it and you practice and you practice because these amazing humans are so good and they bring such wisdom.

I’m going to stop there because I don’t want to go on too much. Of course, I will be starting. And then from there, every week for the next five weeks after this one, you will get a new take, a new set of tools, a new way of approaching it. Hopefully, it’s enough to really get you moving in managing your mental compulsion so you can go and live the life that you deserve, so that you can go and do the things you want without fear and anxiety and mental compulsions taking over your time.

Let’s do this. I have not once been more excited, so let’s do this together. It is a beautiful day to do hard things and so let’s do it together.

Welcome, everybody. Welcome to Mental Compulsions 101. This is where I set the scene and teach you everything you need to know to get you started on understanding mental compulsions, understanding what they are, different kinds, what to do, and then we’re going to move over and let the experts talk about how they personally manage mental compulsions. But before they shared their amazing knowledge and wisdom, I wanted to make sure you all had a good understanding of what a mental compulsion is and really get to know your own mental compulsions so you can catch little, maybe nuanced ways that maybe you’re doing mental compulsions.

I’m going to do this in a slideshow format. If you’re listening to this audio, there will be a video format that you can access as well here very soon. I will let you know about that. But for right now, let’s go straight into the content.

Who is Kimberley Quinlan?

First of all, who am I? My name is Kimberley Quinlan. A lot of you know who I am already. If you don’t, I am a marriage and family therapist in the State of California. I am an Australian, but I live in America and I am honored to say that I am an OCD and Anxiety Specialist. I treat all of the anxiety disorders. I also treat body-focused repetitive behaviors, and we specialize in eating disorders as well. The reason I tell you all that is you probably will find that many different disorders use mental compulsions as a part of their disorder. My hope is that you all feel equally as included in this series.

Now, as well as a therapist, I’m also a mental health educator. I am the owner, the very proud owner of CBTSchool.com. It is an online platform where we offer free and paid resources, educational resources for people who have anxiety disorder orders or want to just improve their mental health. I am also the host of Your Anxiety Toolkit Podcast. You may be watching this in a video format, or you may actually be listening to this because it will also be released. All of this will be offered for free on Your Anxiety Toolkit Podcast as well. I wanted to just give you all of that information before we get started so that you know that you can trust me as we move forward. Here we go.

What is a Mental Compulsion?

First of all, what is a mental compulsion? Well, a mental compulsion is something that we do mentally. The word “compulsion” is something we do, but in this case, we’re talking about not a physical behavior, but a mental behavior. We do it in effort to reduce or remove anxiety, uncertainty, some other form of discomfort, or maybe even disgust. It’s a behavior, it’s a response to a discomfort and you do that response in a way to remove or resist the discomfort that you’re feeling.

Now, we know that in obsessive-compulsive disorder, there are a lot of physical compulsions. A lot of us know these physical compulsions because they’ve been shown in Hollywood movies. Jumping over cracks, washing our hands, moving objects – these are very common physical compulsions – checking stoves, checking doors. Most people are very understanding and acknowledge that as being a part of OCD. But what’s important to know is that a lot of people with OCD don’t do those physical compulsions at all. In fact, 100% of their compulsions are done in their head mentally. Now, this is also very true for people with generalized anxiety. It’s also very true for some people with health anxiety or an eating disorder, many disorders engage in mental compulsions.

Mental Compulsion Vs Mental Ritual?

For the sake of this series, we use the word “mental compulsion,” but you will hear me, as we have guests, you will hear me ask them, do you call them “mental compulsions”? Some people use the word “mental ritual.” Some people use the word “mental rumination.” There are different ways, but ultimately throughout this series, we’re going to mostly consider them one and the same. But again, just briefly, a mental compulsion is something you do inside of your mind to reduce, remove, or resist anxiety, uncertainty, or some form of discomfort that you experience. Let’s keep moving from here.

What is a Compulsion

Now, who does mental compulsions? I’ve probably answered that for you already. Lots of people do mental compulsions. Again, it ranges over a course of many different anxiety disorders and other disorders, including eating disorders. But again, generalized anxiety, social anxiety, phobias, health anxiety, post-traumatic stress disorder. Some of the people with that mental disorder also engage in mental compulsions.

Predominantly, we talk a lot about the practice of mental compulsions for people with obsessive-compulsive disorder. The thing to remember is it’s more common than you think, and you’re probably doing more of them than you guessed. I’m hoping that this 101 training will help you to be able to identify the compulsions you’re doing so that when we go through this series, you have a really good grasp of where you could practice those skills.

Now, often when people find out they’re doing mental compulsions, they can be very hard on themselves and berate and criticize themselves for doing them. I really want to make this a judgment-free and punish-free zone where you’re really gentle with yourself as you go through this series. It’s very important that you don’t use this information as a reason to beat yourself up even more. So let’s make a deal. We’re going to be as kind and non-judgmental as we can, as we move through this process. Compassion is always number one. Do we have a deal? Good.

Types of Mental Compulsions

Here is the big question: Are there different types of mental compulsions? Now, I’m going to proceed with caution here because there is no clear differentiation between the different compulsions. I did a bunch of research. I also wrote a book called The Self-Compassion Workbook For OCD. There is no specific way in which all of the psychological fields agree on what is different types of mental compulsions. There are some guidelines, but there’s no one list.

I want to proceed with caution first by letting you know this list that we use with our patients. Now, as you listen, you may have different names for them. Your therapist may use different terminology. That’s all fine. It doesn’t mean what you have done is wrong or what we are doing is wrong. To be honest with you, this would be a 17-hour training if I were to be as thorough as listing out every single one. For the sake of clarity and simplicity, I’ve put them into 10 different types of mental compulsions. If you have ones that aren’t listed, that doesn’t mean it’s not a mental compulsion. I encourage you to just check in. If you have additional or you have a different name, that’s totally okay. Totally okay. We’re just using this again for the sake of clarity and simplicity. Here we go.

1. Mental Repeating

The first mental compulsion that we want to look at is mental repeating. This is where you repeat or you make a list of individual items or categories. It can also involve words, numbers, or phrases. Often people will do this for two reasons or more, like I said, is they may repeat them for reassurance. They may be repeating to see whether they have relief. They may be repeating them to see if they feel okay. They may be repeating them to see if any additional obsessions arise, or they may be repeating them to unjinx something. Now, that’s not a clinical term, so let’s just put that out there.

What I mean by this is some people will repeat things because they feel like the first time something happened, it was jinx. Like it will mean something bad will happen. It’s been associated with something bad, so they repeat it to unjinx it. We’ll talk more about neutralizing compulsions here in a second, but that’s in regards to mental repeating. You may do it for a completely different reason. Don’t worry too much as we go through this on why you do it. Just get your notepad out and your pencil out and just take note. Do I do any mental repeating compulsions? Not physical. Remember, we’re just talking about mental in this series.

2. Mental Counting

This is where you either count words, count letters, count numbers, or count objects. Again, you will not do this out loud. Well, sometimes you may do it out loud in addition to mental, but we’re mostly talking about things you would do silently in your head. Again, you may do this for a multitude of reasons, but again, we want to just keep tabs. Am I doing any mental counting or mental counting rituals?

3. Neutralization Compulsions or Neutralizing Compulsions

What we’re talking about here is you’re replacing an obsession with a different image or word. Let’s say you are opening your computer. As you opened the computer, you had an intrusive thought that you didn’t like. And so in effort to neutralize that thought, you would have the opposite thought. Let’s say you had a thought, a number. Let’s say you’ve had the number that you feel is a bad number. You may neutralize it by then repeating a positive number, a number that you like, or a safe number. Or you may do a behavior, you may see something being done and you have a negative thought. So then, you recall a different thought or a prayer, it could be also a prayer, to undo that bad feeling or thought or sensation.

Now, when it comes to compulsive prayer, that could be done as a neutralization. In fact, I almost wanted to make prayer its own category, because a lot of people do engage in compulsive prayer, particularly those who have moral and scrupulous obsessions. Again, not to say that all prayer is a compulsion at all, but if you are finding that you’re doing prayer to undo a bad thought or a bad feeling or a bad sensation or a bad urge – when I say bad, I mean unwanted – we would consider that a neutralization or a neutralizing compulsion.

4. Hypervigilance Compulsions

Now again, this is the term we use in my practice. Remember here before we proceed that hypervigilance is an obsession, meaning it can be automatic, unwanted, intrusive, but it can also be a compulsive behavior. It could be both or it could be one. But when I talk about the term “hypervigilance compulsions,” this is also true for people with post-traumatic stress disorder, is it’s a scanning of the environment. It’s a scanning, like looking around. I always say with my clients, it’s like this little set of eyes that go doot, doot, doot, doot really quick, and they’re scanning for danger, scanning for potential fear or potential problems. They also do that when we’re in a hypervigilance compulsion. We may do that with our thoughts. We’re scanning thoughts or we’re scanning sensations like, is this coming? What’s happening? Where am I feeling things?

You may be scanning and doing hypervigilance in regards to feeling like, am I having a good thought or a bad thought or a good feeling or a bad feeling? And then making meaning about that. You may actually also be hypervigilant about your reaction. If let’s say you saw something that usually you would consider concerning and this time you didn’t, you might become very hypervigilant. What does that mean? I need to make sure I always have this feeling because this feeling would mean I’m a good person or only good things will happen.

The last one again is emotions, which emotions and feelings can sometimes go in together. Hypervigilant compulsion is something to keep an eye out. It could be simple as you just being hypervigilant, looking king around. Often this is true for people with driving obsessions or panic disorder. They’re constantly looking for when the next anxiety attack is coming.

5. Mental Reassurance

We can do physical reassurance, which is looking at Google, asking a friend like, are you sure nothing bad will happen? We can do physical, but we can also do mental reassurance, which is mentally checking to confirm an obsession is not or will not become a threat. This is true for basic like we already talked about and some checking and repeating behaviors. You may mentally stare at the doorknob to make sure it is locked. You may mentally check and check for reassurance once, twice, five times, ten times, or more. If the stove is off or that you are not having arousal is another one, or that you are not going to panic. You may be checking to get reassurance mentally that your fear is not going to happen.

Again, some people’s fear is fear itself. The fear of having a panic attack is very common as well. Again, we’re looking for different ways that mentally we are on alert for potential danger or perceived danger.

6. Mental Review

We’ve talked a lot about behaviors that we’re doing in alert of anxiety. Mental review is reviewing and replaying past situations, figuring out the meaning of internal experiences, such as, what is the meaning of the thought I had? What is the meaning of the feeling I had? What is the meaning of that sensation? What does that mean? What is the meaning of an image that just showed up intrusively and repetitively in my mind? What is the meaning of an urge I have?

This is very true for people with harm obsessions or sexual obsessions. When they feel an urge, they may review for hours, what did that mean? What does that mean about me? Why am I having those? And so the review piece can be very painful. All of these are very painful and take many, many hours, because not only are you reviewing the past, which can be hard because it’s hard to get mental clarity of the past, but then you’re also trying to figure out what does that mean about me or the world or the future. So, just things to think about.

To be honest, mental review could cover all of the categories that we’ve covered, because it’s all review in some way. But again, for the sake of clarity and simplicity, I’ve tried to break them up. You may want to break them up in different ways yourself. That is entirely okay. I just wanted to give you a little category here on its own.

7. Mental Catastrophization

This is where you dissect and scrutinize past situations with potential catastrophic scenarios. Now, I made an error here because a lot of people do this about the future as well. But we’ll talk about that here in a little bit.

Mental catastrophization, if you have reviewed the past and you’re going over all of the potential terrible situations. This is very true for people who review like, what did I say? Was that a silly thing to say? Was that a good thing to say? What would they think about me?

Mental catastrophization is reviewing the past, but is also the future and reviewing every possible catastrophic scenario or opportunity that happened. Whether it happened or not, it doesn’t really matter when it comes to mental compulsions. Usually, when someone does a mental compulsion, they’re reviewing maybe’s, the just in case it does happen, I better review it.

8. Mental Solving

Very similar, again, which is anticipating future situations with or without potential what-if scenarios. Very similar to catastrophization compulsions. This is where you’re looking into the future and going, “What if this happens? What if that happens? What if this happens? Well, what if that happens?” and going through multiple, sometimes dozens of scenarios of the worst-case scenarios on what may or may not happen. Again, it usually involves a lot of catastrophizing. But again, these are all safety behaviors. None of this means there’s anything wrong with you or that you’re bad or that you’re not strong.

Remember, our brain is just trying to survive. In the moment when we are doing these, our brain actually thinks it’s coming up with solutions, but what we have to do, and all of the guests will talk about this, is recognize. Most of the time, the problem isn’t actually happening. We’re just having thoughts that it’s happening. Again, this is reviewing thoughts of potential what-if scenarios.

9. Mental Self-Punishment

I talk a lot about this in my book, The Self-Compassion Workbook For OCD. Mental self-punishment is a compulsion, a mental compulsion that is not talked about enough. One is criticizing, withholding pleasure, harshly disciplining yourself for your obsessions or even the compulsions that you’ve done. Often, we do this as a compulsion, meaning we think that if we punish ourselves, that will prevent us from having the obsession or the compulsion in the future. The fact here is beating yourself up actually doesn’t reduce your chances of having thoughts and feelings and sensations and behaviors or urges. But that is why we do them. It’s to catch when you are engaging in criticizing or withholding or punishing compulsions.

10. Mental Comparison

Again, not a very common use of compulsions, but this is one I like to talk about a lot. Most of my patients with OCD and with anxiety will say that they know for certain that they compare more than their friends and family members who do not have anxiety disorders. I’ve put it here just so that you can catch when you are engaging in mental comparison, which is comparing your own life with other people’s life, or comparing your own life with the idea that you thought you should have had for your life. So, an idea of how your life was supposed to be.

This is a compulsive behavior because it’s done again to reduce or remove a feeling or a sensation or a discomfort of anxiety or uncertainty you have around your current situation. It’s really important to catch that as well because there’s a lot of damage that can be done from comparing a lot with other people or from a fantasy that you had about the way your life should or shouldn’t look. Again, we will talk about this in episodes, particularly with Jonathan Grayson. He talks a lot about this one. I just wanted to add that one in as well.

They’re the main top 10 mental compulsions. Again, I want to stress, these are not a conclusive list that is the be-all and end-all. A lot of clinicians may not agree and they may have different ways of conceptualizing them. That is entirely okay. I’m never going to pretend to be the knower of all things. That is just one way that we conceptualize it here at our center with our staff and our clients to help patients identify ways in which they’re behaving mentally.

Something to think about here, though, is you may find some of your compulsions are in more than one category. You might say, “Well, I do mental comparison, but it’s also a self-punishment,” or “I do mental checking, but it’s also a form of reassurance.” That’s okay too. Don’t worry too much about what section it should be under. Again, it’s very fluid. We want you just to be able to document. It doesn’t matter what category it is particularly. I really just wanted this 101 for you to do an inventory and see, “Oh, wow, maybe I’m doing more compulsions than I thought.” Because sometimes they’re very habitual and we are doing them before we even know we’re doing them. I just want to keep reminding you guys it’s okay if it looks a little messy and it’s okay if your list is a little different.

The main question here as we conclude is: How do I stop? Well, the beauty is I have the honor of introducing to you some of the absolute, most amazing therapists and specialists in the planet. I fully wholeheartedly agree with that. While I wish I could have done 20 people, I picked six people who I felt would bring a different perspective, who have such amazing wisdom to share with you on how to manage mental compulsions.

Now, why did I invite more than one person? Because I have learned as a clinician and as a human being, there is not one way to treat something. When I first started CBT School, I was under the assumption that there is only one way to do it and it’s the right way or the wrong way. From there, I have really grown and matured into recognizing that what works for one person may not work for the next person.

As we go through this series, I may be asking very, very similar questions to each person. You will be so amazed and in awe of the responses and how they bring about a small degree of nuance and a little flare of passion and some creativity of each person and bring in a different theme. I’m so honored to have these amazing human beings who are so kind to offer their time, to offer this series, and help you find what works for you.

As you go through, I will continue reminding you, please keep asking yourself, would this work for me? Am I willing to try this? The truth is, all of them are doable for everybody, but you might find for your particular set of compulsions specific tools work better. So trial them, see what works, be gentle, experiment. Don’t give up. It may require multiple tries to really find some little win. Please, just listen, enjoy, take as many notes as you can, because literally, the wisdom that is dropped here is mind-blowing.

I’ve been treating OCD for over a decade and I actually stopped a few things after I learned this and went straight to my staff and said, “We have to make a new plan. Let’s implement this. This is an amazing skill for our clients. Let’s make sure we do it.” Even I, I’m a student of some of these amazing, amazing people.

How do I stop? Stay tuned, listen, learn, take notes, and most importantly, put it into practice. Apply. That’s where the real change happens.

Now, before we finish, please do note this series should not replace professional healthcare. This or any product provided by CBT School should be used for education purposes only, so please take as much as you can. If you feel that you need more support, please reach out to a therapist in your area who can help you use these tools and maybe pick a part. Maybe there’s a few things that you need additional help with, and that is okay.

Thank you, guys. I am so excited to share this with you.

Have a wonderful day.

How To Be Uncertain In the Management of OCD

Welcome to this week's episode of Your Anxiety Toolkit. 

When it comes to the management of anxiety, practicing being uncertain is the key to long-term recovery. We must face our fears and purposely not try to solve what will happen and what we would do if our fear came true.   For anyone attempting this, we can all agree that being uncertain is a very difficult skill to practice.    I have found that while my clients logically are on board with the idea of being uncertain, they still struggle with HOW to be uncertain.  Cognitively, we know the importance of uncertainty, but the actual practice of it might not be something that we are fully on board for. 

Nearly every day, a client or a follower on social media (Instagram, Facebook, Twitter) will ask me HOW to be uncertain.  They might say, “Kimberley, I get that I have to lean into the uncertainty, but HOW do I actually be uncertain?”

In today’s podcast episode, we talk all about how to be uncertain and what major roadblocks might be causing you to bypass uncertainty.   We also talk about some key mindfulness tools to help with the practice of uncertainty when managing strong obsessions and compulsions.   This is a very important concept when it comes to anxiety management, so I would love to hear your thoughts.   

There are a few very exciting events coming up!

The IOCDF is hosting their 1 Million Steps 4 OCD Walk in Calabasas on Saturday, June 1, to increases awareness and raises funds for the IOCDF and its Local Affiliates so they can continue their mission. I will be walking at this one! Click HERE for more information and to register.

Also, the IOCDF Annual Conference will be held in Austin, Texas, from July 19-21.  I will be speaking at this event and love seeing you there!  Click HERE for more information and to buy tickets.

Self-Compassion is a helpful tool for managing shame and blame and negative self-talk.   It is particularly, in my experience, helpful for those struggling with OCD, Panic Disorder, Phobias, Health Anxiety, Body Focused Repetitive Behaviors,  Eating Disorders and Depression.

The Center for Mindful Self Compassion (centerformsc.org) describes self-compassion in the following way-

“Self-compassion involves responding in the same supportive and understanding way you would with a good friend when you have a difficult time, fail, or notice something you don’t like about yourself.”

Self-compassion is Kindness,  Warmth, Gentleness and Care.

When I talk about the practice of self-compassion, I use the metaphor that self-compassion washes away shame and blame like the rain washes away the dirt on our cars. As the rain gently falls, the dirt slowly falls away. Once the rain has come and gone, there is less heaviness and dirt on the car.   It is easier to see out the windows and now you can see the beautiful fields and trees that you pass on your way to work or school.

A part of this metaphor includes this final sentiment.   Even though the rain has come and gone and the car is mostly cleansed of its dirt, there is still slight streaks of the dirt left behind.

As much as I would love to say that self compassion will wash away all of the dirt and dust on the car, this is not realistic.   The tiny little streaks left behind is a reminder that compassion is a job that is never over. It must be practiced over and over, for the years to come.

This podcast offers a meditation that uses the basics of Kristin Neff’s self compassion research, including the three elements of self compassion. For more info go to selfcompassion.org

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

5 SENSES PODCAST

Hello and welcome to Your Anxiety Toolkit.   My name is Kimberley Quinlan.

A big part of my work as a therapist is to help clients tolerate fear and anxiety (or other forms of discomfort such as urges and sometimes pain), instead of doing compulsive behaviors.

In effort to keep this podcast short, I wont go into detail about compulsions. But, if you are wanting more information on compulsive behaviors related to specific anxiety disorders, eating disorders, or Body Focused Repetitive Behaviors, please go to my website under “Areas of specialty”

The reason I decided on this specific topic today is because of the common question asked by clients “If I choose NOT to do these compulsive behaviors, what should I do instead?”.

Well, I like to think of our experience in this life like looking through the lens of a camera. When we are anxious, we often ZOOM in on what is making us anxious or we zoom in to our sensations of anxiety. We FOCUS on the problem. We stay zoomed in, thinking this will solve it.   That makes sense, right? If we could just figure out how to solve the problem, we would then fix the problem, right?   But what if zooming in was not the solution. What if zooming OUT was the solution?? Hmmm, interesting right??

One of my favorite activities for clients (or for myself) when anxious or dealing with discomfort involves just becoming an observer. The following meditation is an exercise of this. It is a meditation of noticing. I like to call it “the 5 senses Mediation. I hope you enjoy it. And feel free to leave a comment in the comment section of the blog that accompanies this podcast.  

OK, I want you to find a place where you can rest, preferably in sitting position, and take a deep breath.   And then another.

You are here because you probably are uncomfortable.  

Something just happened that created a lot of anxiety or distress for you, - or maybe you just finished up doing an exposure.   I can imagine that you are experiencing some pretty uncomfortable feelings. Maybe your stomach is in knots.  Maybe you have a really tight chest or maybe a racing heart rate. Maybe your head is spinning, telling you to “make this anxiety or this feeling go away!” You know from experience that doing a compulsive behavior keeps you in the cycle of anxiety.   So instead, you are here, sitting with your discomfort.

Again, take a deep breath and congratulate yourself for how brave you are.  

After another breath in…and then out, I want you to shift your gaze to your noticing mind. As you breathe in and out. I want you to close your eyes and just notice what it is like for your chest to rise and fall. Continue to breathe at a pace and depth that feels good for you as you observe.  

Now, I want you to shift your attention to what you hear.   What sounds do you hear? Are they pleasant or unpleasant? Try not to get too caught up in your emotions about the noises. Just notice them

You may find that your thoughts drift off, try not to be alarmed or frustrated. This is just your brain doing what it does. Just bring your attention gently back to what you were noticing.   If you find your mind keeps going other directions, that is ok and very normal.   Don’t give it too much attention. Just notice and return back to the meditation.

Again, return to your breath. And now, I want you to notice what you smell? Continue to breathe and observe the scents around you. Did you notice them before? Or are you just now noticing them?

Take another deep breath, and this time notice if there is a particular taste in your mouth. Do you taste the flavors of your most recent meal? Or do you have the freshness of your toothpaste on your tongue as you observe the sensation of taste. What textures do you notice?

So, we have already explored sound, smell and taste. Now I encourage you to gently open your eyes and notice what your see. What shapes do you see? What colors do you see? Are there any particular colors that you enjoy? Or do you notice an aversion to certain colors or textures. Try not to get too caught up in what is the “right” way to observe. Just notice that you are noticing. That is all this is about.

Lastly, I want to you gently close your eyes again and notice your breath again. As you breathe in an out, turn your noticing mind towards the sensation of being pulled down onto the chair by gravity.   Where do you notice the strongest pull of gravity? Is it under your thighs and buttocks as you sit? Or is it under the soles of your feet, if you are standing? Or do you feel a strong pull of gravity under your back, as you recline in your chair? Isn’t it interesting to notice this??? You might also notice what it feels like to touch whatever it is that is close to your hands. What texture do you feel? Is it soft or hard? Maybe crinkly? Maybe spongy. If you like, you might also notice what it feels like for the air to touch your skin, maybe on your arms or on your face. If you find that this creates discomfort for you, gently return to one of the other sensations that you enjoyed.   Remember, there is no pressure with this meditation. It is just about noticing.

Again, return to your breath. Before we wrap up with this meditation, I invite you to slowly open your eyes. Give yourself one last breath, this one a gift for with you just did! Fantastic job!!

As you continue to breath, go into your day using your noticing mind as much as you can. You might work to just observe what flowers you see as you walk to your class? Or you might notice and observe what it feels like for your hands to grip your fork as you eat? OR maybe you just notice your breath, going in and out of your chest.

Enjoy your day!

Please note that this podcast should not be a substitute for professional mental health care. Please speak with a professional mental health care provider for information on what tools would best suit you.

Welcome back to another episode of Your Anxiety Toolkit Podcast.  Today we are so lucky to have Dr. Jonathan Grayson on with us again. Dr. Grayson is a psychologist who has been specializing in the treatment of OCD for more than 40 years. He is also the author of Freedom from Obsessive-Compulsive Disorder and founder of The Grayson LA Treatment Center for Anxiety and OCD.  He is here today to talk to us about magical thinking. I am actually getting asked a lot recently about magical thinking.  People have a lot of questions about what it is and how it relates to OCD and anxiety. Dr. Grayson starts off by giving us his definition of magical thinking.  He explains that magical thinking is really on a continuum. On one end you may have a person without OCD who engages in minor superstitions and on the far end you may have a person with OCD who has magical thinking that is actually interfering in their daily life.  He says that most of the time with OCD, the magical thinking does not seem to have an obvious connection between the fear and the ritual.

Dr. Grayson spends a good amount of time discussing magical thinking in the context of spiritual and religious beliefs as well as how magical thinking relates to scrupulosity.  He also shares his thoughts on scapegoating as a form of magical thinking. He shares with us a bit about how someone can get better and overcome magical thinking.  He says that this is really just about taking the risk of uncertainty similar to all OCD treatment. He says you should ask yourself "Is this magical thinking actually working?  Is it bringing you any peace?"  This episode is full of such wisdom.  I learned a lot myself and I hope you all will find it helpful.

Dr. Grayson's book, Freedom from OCD, is now out as an audiobook!  Click here for more information.

The Grayson LA Treatment Center for Anxiety & OCD

If you get a moment, please go over to wherever you listen to podcasts, whether that be Apple Podcast, Stitcher, Spotify, Podbean, and leave an honest review. Tell me how you feel about it, whether it's helping you, what you'd like to see. We are going to give away a pair of Beats headphones of your choice of color once we hit a thousand reviews!

ERP School, BFRB School and Mindfulness School for OCD are open for purchase. Click here for more information. Beginning today March 19th and continuing until April 1st, ERP School will be available with bonus material. This will be an amazing training on the motivational skills Kimberley teaches her clients to help them in their treatment and recovery!

Additional exciting news! ERP School is now CEU approved which means that it is an accredited course for therapists and mental health professionals to take towards their continuing education credit hours. Please click here for more information.

Transcript

Kimberley Quinlan: Well welcome, I cannot believe this is so exciting. I've been looking forward to this episode all week. We have the amazing. Reverend Katie O’Dunne with us to talk all about scrupulosity and religious obsessions. So welcome, Katie.

Katie O'Dunne: Thank you. I'm so excited to be here and to chat about all things Faith and OCD. So thanks for having me.

Kimberley Quinlan: Yeah, so let me just quickly share in ERP school we have these underneath every training, every video. There's a little question and answer and I'm very confident in answering them, but when it comes to the specifics of religion, I always try to refer to someone who is, like an expert. And so this is so timely because I feel like you are perfect to answer some of these questions. Some of the questions we have here are from, ERP school. A lot of them are from social media and so I'm so excited to chat with you. 

Katie O'Dunne: Thank you.

Kimberley Quinlan: So tell us before we get into the questions, a little about your story and you know why you are here today?

Katie O'Dunne:  Yeah. So I've navigated OCD since before I can remember, but just like maybe a lot of folks listening. I was very private about that for a very long time. I had a lot of shame around, intrusive thoughts. I had a lot of shame around religious obsessions that I had, moral related obsessions, harm obsessions. And this shame particularly came because I was pursuing ministry and OCD really spiked in the midst of me going to graduate school, going to seminary. And when I was in seminary and I started really struggling, I wanted to seek treatment for the first time and was told really by a mentor that it would not help me to do that. In my ministry that I wouldn't pass my psych evaluations and that I shouldn't pursue treatment that I needed to keep that on the down low. So as many of us know, that might not get that effective evidence-based treatment I continued to get sicker

Katie O'Dunne: And had a really pretty full-blown OCD episode in my first role in ministry.

Katie O'Dunne: So I ended up in school chaplaincy working, with lots of students from different faith backgrounds, some of what we'll be talking about today, through an OCD lens. And I was trying to keep my OCD a secret, but in the midst of navigating, some difficult tragedies and traumas with students, my OCD latched on to every aspect of what I was navigating. And particularly in the midst of that, I was experiencing losses and mental health crises with students from different faith backgrounds. And when I came out of my own treatment, where exposure and response prevention, very much saved my life. I felt like, I had an obligation to those students that I worked with to let them know that their chaplain, that their faith leader had gone through mental health treatment and that there was no shame around doing that. And I went from the space, in seminary of being told that I shouldn't seek treatment to a space of having families call me for the first time and say, Oh now we can actually talk to you about what's going on in our life. Can you help us talk with our rabbi or our imam, or our priest about my child's diagnosis? How can we reconcile faith with treatment and that opened the door for me to continue this work in a full-time way. Where moving from those students that I love so much and  now work in the area of faith and OCD full-time helping folks, navigate religious scrupulosity and very much lean into evidence-based treatment while also reconnecting with their faith in ways that are value driven to them and not dictated by OCD.

Kimberley Quinlan: Hmm, it makes me teary. Just to hear you say  that folks were saying, Well, now, I can share with you. That is so interesting to me. You know, I think of a reverend, as like, you can go to them with anything, you know, and for them to say that you're disclosing has open some doors, that's incredible.

Katie O'Dunne: And particularly, I worked really heavily with my Hindu and Muslim students. And we had the chance to do some really awesome mental health initiatives for the South Asian community, where students started then doing projects actually in their own faith communities, and opening up about their own journeys, and then giving other space to do the same. And I really, I think about the work I do now, which is very much across faith traditions around OCD. And every person I work with, I think of those awesomely brave students, who started to come to me after my disclosure and say, Okay, we want help and also we want to share our stories and continues to inspire me.

DOES RELIGIOUS OCD/SCRUPULOSITY SHOW UP BEYOND THE CHRISTIAN RELIGION? 

Kimberley Quinlan: Yeah, so cool!  It leads me to my first question which is, does this for OCD religious scrupulosity, have you found, and I  definitely have,  that It goes outside of just the Christian religion. I know we hear a lot about just the Christian religion, but can you kind of give me your experience with some other religions you've had to work with?

00:05:00

Katie O'Dunne: Yeah. And so I always tell folks OCD is OCD, is OCD. And it always loves to latch on to those things that are the most significant and important to us. So it makes a lot of sense, that, that would happen with our faith tradition, whether you're Christian or Muslim or Buddhist or Sheik, or beyond or even atheist or agnostic can really transform into anything, particularly from what, you might be hearing from faith leaders and I always go back to this idea that OCD is just really gross ice cream with a lot of different gross flavors and those flavors might be in the form of the Christian faith or in the Jewish faith or in the Muslim faith. But the really big commonalities is the fact that it's not about what a person actually believes just like, with everything else with OCD. This is very much egoistonic. It's taking their beliefs. It's twisting them and it's actually pushing them further away from the tradition. So, it's just some examples.

Katie O'Dunne:  That we see, of course, in Christianity, you all might be familiar with obsessions around committing blasphemy against the Holy Spirit, or fear of going to hell or fear of sinning in some way. But we also see lots of different things in Islam, whether that's around not being fully focused during Friday prayers or not doing ritual washing in the appropriate way. In Judaism we see so many different things around dietary restrictions or breaking religious law. What if I'm not praying correctly? Hinduism, even what if I'm pronouncing shlokas or mantras incorrectly? What if I have done something to impact my karma or my dharma? What if I'm focusing too heavily on a particular deity or not engaging in puja correctly. or in Buddhism I see a lot of folks, really focusing on what if I never stop suffering, What if I've impacted my karma in some way? What if I don't have pure intention, alongside that action and…

Kimberley Quinlan: Right.

Katie O'Dunne: then all the way on the other side. We can see with any type of non-theism or atheism, agnosticism humanism What if I believe the wrong thing? What if I'm supposed to believe in God, what if I'll be punished for for not? So there are all different forms and then with any faith, tradition. I mean any form possible. That OCD could latch onto

Kimberley Quinlan: Yeah, absolutely I think there's just some amazing examples I had once a client who felt his frustrations weren't correct.

Katie O'Dunne:  Yes.

Kimberley Quinlan: And got stuck really continue and trying to perfect it so I think it can fall into any of those religions for sure. So you've already touched on this a little bit, but this was one of the questions that came from Instagram. Just basically there was saying like OCD makes me doubt my faith. Like why does it do that? Do you have any thoughts, on a specifically why OCD can make us doubt our faith?

Katie O'Dunne: Yeah. I mean OCD is the doubting disorder and we always say the content is irrelevant, but it definitely doesn't feel like it. I think for anybody navigating OCD, you're most likely in a space of saying I could accept uncertainty about any theme except the one that I have right now and that's very much true with faith. If your faith is something that's significant to you and at the center of your life, it makes sense that OCD would latch on to that and that OCD would twist that particularly…

Kimberley Quinlan:  Right.

Katie O'Dunne: because we really don't have a whole lot of certainty around faith to begin with and where there's a disorder that surrounds uncertainty and and doubt. That makes a lot of sense. And yet it's so so challenging, um, because we want to be able to answer all of these questions without OCD making us question every single thing we believe,

WHEN OCD DOUBTS MY FAITH

Kimberley Quinlan: Mmm. It's sort of like religious obsession. I mean relationship obsessions too in that and you're probably looking at people across the your religious faith hall or wherever going, but they are certain like why can't I get that certainty? Right. But it's like they've accepted a degree of uncertainty for them to feel certain in it. But when you have OCD, it's so hard to accept that uncertainty piece of it.

Katie O'Dunne: I'm so glad you said that I actually get this question a lot. And this, this might be a strange answer for folks to hear from a minister. But I always tell folks, I'm not certain I Have devoted my life to faith traditions. I'm ordained. I'm not certain about anything including about the divine.

Kimberley Quinlan: Yeah.

Katie O'Dunne: I have really strong beliefs, I have strong things that I lead lean into and practices that are meaningful to me. But it doesn't mean that I have certainty. And often, when you hear someone in a faith tradition, say that there are certain, I don't think it means the same thing as what we're thinking, it means from.

00:10:00

Kimberley Quinlan: Yeah. it's Yeah,…

Katie O'Dunne: a different context. They are accepting some level of uncertainty.

Kimberley Quinlan: that's why I compared it to relationship OCD, You're like, but I'm not sure if I love my partner enough and everybody else is really certain but when you really ask them, they're like, No I'm not completely certain,…

Katie O'Dunne: Yeah.

WILL GOD PUNISH ME FOR MY INTRUSIVE THOUGHTS?

Kimberley Quinlan: like I'm just certain for today or whatever it may be. So I think that that is very much a typical trade of OCD in that, it requires 100%, okay? So, so, This is actually really one of the first common questions we get when we're doing psychoeducation with clients. Which is why do I have a fear that God will punish me for my intrusive thoughts? You want to share a little about that.

Katie O'Dunne: Yeah, I mean there are so many, there are so many layers with this and again, latching on to what's the most important but also latching on to particular teachings. Whether it's in a church or a mosque or a synagogue where I always say there are particular scriptures, particular, teachings, particular sermons, where you might hear things that relate to punishment in some way, or relate to rigidity, but I think folks, with OCD hear those, through a very different lens than maybe someone else in that congregation and we might hear something once at age, five or six and for the rest of our lives latch on to this idea that we're doing something wrong or that God is going to punish us, we tend to always see everything through that really, really negative lens and maybe miss all of the other things that we hear about compassion and about love and forgiveness. And I think there's also this layer for individuals with OCD often holding themselves to a higher standard than everyone else and that includes the way that they see God as viewing them. So I'll often ask folks. How do you think, how do you imagine God, viewing a friend in the situation? Just like we might do a self compassion work and they're like, Well, I believe God would be really forgiving of my friend and that they might not be perfect but that they were created to live this beautiful life. And then when asking the same thing about themselves, It's but God called me to be perfect and I have to do all of these things right. I'll ask often ask folks, What does it look like to see yourself through the same loving eyes through which God sees you or which you imagine that God sees those around you which is something we don't often do with OCD.

Kimberley Quinlan: And what would they often say?

Katie O'Dunne: Ah well it's so I'll actually use self-compassion practices to to turn things around. And I'll say I'll ask someone to name three kind things about themselves and then to put their hand over their heart and actually say it through the lens of God saying that to them. So I'll have them say something like The Divine created me to be compassionate, the Divine believes that I am a kind person, the Divine wants me to have this beautiful life and to be a good runner or a good baseball player or whatever that is. And it's always really difficult at the beginning just like any self-compassion practice. And then I'll watch folks start to smile and say Well maybe God does see me in that way.

Kimberley Quinlan: That's lovely.

Katie O'Dunne: Maybe create me in a beautiful way.

DO NOT FEAR…SHOULD I TURN MY FEARS OVER TO GOD?

Kimberley Quinlan: Mmm. That's what it's bringing them. Back to their religion and their faith when they do that, which is so beautiful, isn't it? Mmm. Okay, This question is very similar but I really think it was important to to address is there are some scriptures where people here that they aren't allowed to fear or that they must turn their fears over to God. Do you have any thoughts or you know, responses that you would typically use for that concern?

Katie O'Dunne: Mm-hmm.

Katie O'Dunne:  Yeah, I think, you know, it looks very different across faith traditions and across scriptures and individuals, of course, view Scripture and in very different ways but depending on their denomination, or depending on their sect, but I think sometimes, unfortunately, those scriptures are used out of context. We see this often where there might be a particular verse that's pulled that from a translation perspective isn't necessarily really about anxiety in the same way that we're defining anxiety through an OCD lens or isn't really about intrusive thoughts, in the way that we're defining it through the lens of OCD. And I think it's really unfortunate when we hear religious leaders or folks in communities say, Well, you aren't allowed to fear or if you just prayed a little bit harder, your anxieties would be able to be turned over to God. And I think we're hearing that or they're using that and maybe a different way than the passage was intended. And then we're hearing this through a whole nother another layer where it actually could be flipped. And instead, when you're you're saying, Don't fear. I always tell folks. So what does it look like instead to not fear treatment or to do it  even if you're afraid. To ask God, to give you strength in the midst of that fear  and to approach that in a different way. But I think sometimes those who are taking particular passages out of context, might not fully understand the weight of OCD, or what comes with that condition.

00:15:00

HOW DO I KNOW IF IT IS OCD OR IN LINE WITH THE RULES OF MY FAITH?

Kimberley Quinlan: Right. Right. I love that. Thank you for sharing. That was actually the most common question, I think. So like four or five people off the same question. So I know that's a such an important question that we addressed. Quite a few people also asked how to differentiate like, you know with OCD treatment, it's about sort of understanding and being aware of when OCD is present and how it plays its games, and it's tricks in its tools that it uses. How would people know whether something is OCD or actually in line with the rules of their faith? Do you have any sort of suggestions for people who are struggling with that?

Katie O'Dunne:  Yeah, so I'll actually often show folks a chart when we start to work together and we'll put things in different buckets of what are things that you're doing, because they are meaningful because they bring you hope because they bring you comfort because they bring you joy. And then on the other hand, What are things that you're doing out of fear? Out of anxiety things, that feel urgent things that are really uncomfortable. And of course, there is never any certainty around anything, which is very much one of the tricky parts with with treatment, right? We want to have certainty but I invite folks to really make the assumption that probably those things that bring joy and meaning and hope and passion and connection are the authentic versions of their faith. Versus the things that we're doing out of fear or anxiety. And, you know, I was doing a training, a couple months ago for clinicians in this area and I was, I was talking about how, you know, we don't necessarily want folks to pray out a fear and someone had a really great question. They said. Okay. But if a plane is going down and someone's praying because they're afraid like that's not because it's OCD, I'm like No that's that's very true. But in that situation they are praying because they're afraid to bring meaning and hope they're not praying because they're afraid of not praying and…

Kimberley Quinlan: Yeah.

Katie O'Dunne: there's a very big distinction there. Are you doing the practice? Because you're afraid of not doing it or not or you're afraid of not doing it perfectly, or are you engaging in that practice even in moments that are tough in order to bring you peace and meaning and joy and comfort.

WHEN PRAYER BECOMES A COMPULSION 

Kimberley Quinlan:  And that if that, maybe I've got this wrong so please check me on this, but it feels like too, when people often ask me that similar question but not around compulsive praying of like, but if there is a problem, shouldn't I actually do something about it? And I'm like, Well, this that's a difference between doing something about something when there is an actual problem compared to doing something because maybe something might happen in the future, right? It's such a trick that OCD plays. Is it gets you to do things just in case. So would that be true of that as well?

Katie O'Dunne: Okay. Yeah. And I often tell folks just again because it's just another form of OCD that's latching on to something that significant very similar. I tell folks, if it's really a problem that you need to address, most likely you would do it without asking the question to begin with. But it's I think the unfortunate thing that the other example I give is well, if we think most traditions we think of God as a parent figure and I ask folks, who are our parents to imagine their relationship with their own child, and do you want your child to connect with you throughout the day out of meaning and out of hope and out of genuine, a genuine desire for love or because they're afraid of not talking to you and…

Kimberley Quinlan: Right.

Katie O'Dunne: those are two. Those are two very, very different things.

Kimberley Quinlan:  Right. As it's like a disciplinarian figure. Yeah, that's a really great example. I love that. Yeah. Okay. This is, this was one of the questions that I got, but it's actually one of the cases that I have had in my career, as well, which is around the belief that thoughts are equal to deeds, right? Like that. If I think it, it must mean, I love it, I like it, or I want it or I've done it. Can you give some perspective to that from from specifically related to religious obsessions?

Katie O'Dunne: 

00:20:00

Katie O'DunneYeah this can be really hard for folks and of course with OCD thought actions fusion can be really challenging anyway and there is often, for folks in a faith context this belief that because I had this though, because I had what might be perceived as a sinful thought, I must be committing blasphemy, or I must be committing this particular sin and that can make it really really tought to do diffusion work with you clinician because its like I had this thought it must actually mean that I have done this thing that is in opposition to God and I always tell folks that of course I am not going to reassure you fully that those things are completely separate but I would invite you to lean into the possibility that a thought is just a thought. Just like any other aspect of OCD we have a jillion different thoughts a day that pass into and out of our minds and I actually think from a faith perspective that it is pretty cool that our brains produce alot of different thoughts, that we see things and make different associations. Ill tell folks way to do God we see things and make all sorts of connections. But, having thought doesn't equate to having a particular action even if we are looking on the form of most scriptures. It is really referencing things that we are doing, ways that we are actually engaging with those thoughts and taking that into our actions. And again from the pulpit, you might hear someone talk about thoughts or intrusive thoughts in ways that are not equivalent to how we're talking about them through an OCD lens,…

Kimberley Quinlan:  Mm-hmm.

Katie O'Dunne: something very different and they're really talking about more of an intentional act, in something that you're you're doing, as opposed to what we're thinking about. It's just a biological process of thoughts, moving through your mind.

ARE THOUGHTS EQUAL TO DEEDS?

Kimberley Quinlan:  Right. And and what I be right in clarifying here, is it important to differentiate between a thought you had compared to a thought that's intrusive, is that an important piece or do we not need to go to that level?

Katie O'Dunne: Do you mean, in the religious context? I, I don't know. I mean, I, I'm curious what you think from a clinical I go back to thoughts or thoughts or thoughts and…

Kimberley Quinlan: Yeah.

Katie O'Dunne: they are intrusive because we're labeling them as intrusive. Unfortunately, sometimes in religious context, and I hear this a lot, someone might go to… I hear actually from sermons all the time, where someone is saying that intrusive thoughts or in some way sinful and really what they're thinking are just regular thoughts that people are giving value to and…

Kimberley Quinlan:  Yeah. Yeah.

Katie O'Dunne: it makes it makes it really challenging for folks where they're giving more value to their thoughts and then thinking, well my preacher said that if I have a thought that's quote unquote bad that it means something about me.

EXPOSURE & RESPONSE PREVENTION (ERP) FOR RELIGIOUS OBSESSIONS/SCRUPULOSITY

Kimberley Quinlan:  I think you just hit the nail on the head,  when we apply judgment to a thought as good or bad, then we're in trouble, right. That's when things start to go sticky. Yeah. Okay, excellent. Okay. Let's talk about specific treatment for religious obsessions and exposure examples. I know for those listening we have done an episode with Jud  Steve,  I will link that in the show notes. He did go over some but I just love for you to go over like what are some examples of exposures? And how might we approach exposure and response prevention, specifically related to these religious obsessions?

Katie O'Dunne: Yeah, so his health folks, I'm not I'm not a clinician, but I work alongside a lot of really amazing clinicians in religious scrupulosity to develop exposure hierarchies. And one of the big fears when I'm working with someone is often, how could I possibly engage in exposure and response prevention because what if someone asked me to do something that's in opposition to my faith? And I want to go ahead and just put that on the table right now… I know that's a big fear and I want you to know that a good OCD specialist or an ERP therapist is really gonna work with you not to go against or to oppose your faith. But to do some things that are a little bit uncomfortable in service of you, being able to get back to your faith in a value-driven way.

Katie O'Dunne: I really believe we are never going to be incredibly excited about exposures. When I was on my own exposure and response, prevention journey, I never once walked into the office and said, Yes, I get to do this really scary exposure today. It's gonna be so fun. Well, I guess I did say that because my therapist made me pretend to be excited about exposures, but that's different. That's a different conversation was not necessarily genuine. And so i’ll often ask folks, I know that this isn't something that you want to do, but why don't you want to do it? And if the answer is well, I'm afraid that it might upset God or I'm afraid something bad might happen. That’s probably a good exposure. If the immediate response is Well, no, I'm not gonna do that. No one else in my tradition would do that. That's completely in opposition to everything we believe, probably not something that that we would ask you to do and often clinicians will use the 80/20 rule of what would 80% of the folks within your congregation be willing to do and that can be really helpful working with a faith leader as well or with other folks within your particular sect or denomination to establish that.

00:25:00

Katie O'Dunne:  The same time there. Oh my goodness, so many different exposures that we can go into. But a lot of things that I see folks commonly working on are things like praying imperfectly maybe speaking or speaking of blasphemous thought aloud or thinking through that in an intentional way, writing an aspect of that, not completing ritual washing again and again only doing it once and even thinking through the fact that it might not have been perfect that time or maybe even intentionally diverting your attention in the midst of a prayer. Sometimes for folks who are avoiding Scripture that is intentionally reading that aspect of Scripture and then maybe thinking intentionally about something that they've thought as a bad thought or that they've defined in that way. But again it very much depends for each person and I really want folks to know that it doesn't mean that you are going to be asked to eat something that goes against your dietary restrictions or to deface a religious text. Those are the two things I hear folks, very fearful of and that isn't something that you need to do in order to get better. It's about having conversation and handing over the keys to your clinician to do some uncomfortable stuff in favor of getting back to your faith in a value-driven way.

Kimberley Quinlan: Yeah, I love that. I'll tell a quick story, when I was a new intern treating OCD having no clue really what I was doing. I'm very happy to disclose that was the facts, but I had amazing supervisors and I grew up in an Episcopalian denomination and I had a client who was of similar denomination in the Christian faith. And my supervisor said, Well, okay, you're gonna have him go and say the blasphemous words and in my mind, this being my first case going like are we allowed, like side eye.And he said Okay this is your first go around. I want you to ask your client to go and speak with their religious leader and say, This is what I'm struggling with. AndI have this diagnosis and this is the treatment, it's the gold standard and Kimberley's gonna go with you and do we have permission to proceed and the minister was so wonderful. He said, If that is what's gonna bring you closer to your faith, go as hard as you can. And for me, it was just such a beautiful experience as a new clinician to have. He knew nothing about OCD but he was like if that's what you need to do to get closer, go. Like he had so much Faith himself in, I know it'll bring you to the right place and so it's so beautiful for me and that kind of helped me guide my clients to this day. Like go and get permission speak to your minister if that helps you to move forward, do you have any thoughts on that?

Katie O'Dunne: Oh yes, and this is really my favorite thing that I get to do with folks in addition to working with clinicians and clients and developing exposures, also in faith traditions that are not my own, but then I might have studied make connections to other faith leaders so we can talk about what makes the most sense in this particular set so that someone can fully live into their faith tradition while well, maybe being a little uncomfortable in this moment or doing something tough and I deeply believe whatever that looks like for you, even if the exposure seems a little bit scary, that God can handle our exposures. Across faith traditions. We see the divine as this big, wonderful powerful all knowing force and with everything going on in the world, I deeply believe theologically that the exposure that we're doing over here, which might seem really hard for us, that God can handle that as a way for us to get back to doing the things that we were actually created to do. And in that way, similar to the minister that you talked with that said, Hey, go for it. I'll even tell folks, I see ERP as a spiritual practice because a spiritual practice is defined as anything that helps you to reconnect or get closer with the divine and in that way, doing ERP really does that because it's breaking down the OCD so that you almost stop worshiping OCD and actually reconnect with God in a way that's value driven for you. That's actually what I'm getting ready to start. My doctoral research on is actually redefining ERP as a spiritual practice across faith traditions in ways that are accessible for a diverse population.

Kimberley Quinlan: And that's so beautiful, I love that. Okay, let's see. Okay, This is actually the last question, but this is actually the one I'm most excited to ask. This is actually from someone I deeply care about. They have written in and said, When I get anxious, I try to submit it to God knowing of his love and power. So, by writing a script, which is an ERP practice, for those of you who don't know, it seems I'm in conflict with my religious belief. Do you have any like points, final points, you want to make about that?

00:30:00

Katie O'Dunne: Yeah. So two big things, one going off of what I was just sharing a second ago. I would encourage you to know, or maybe not to know, for sure but, we can lean into uncertainty around this right? But to accept all of the uncertainty, while also leaning in and believing that God can handle this difficult script that you're writing or this difficult exposure that you're doing in favor of you getting to live the life that you were created to live. Not defined by OCD and that you still can pray and ask for God's support as a part of that. I would never ask someone not to continue to connect with God during some of sometimes, the most difficult process of their life which treatment can be, I know it was for me, it was incredibly scary. But rather than asking for reassurance, or asking for God, to undo any of that exposure work we're doing or or saying, oof, disregard this script I just did. We're not, we're not going to do any of those things, but rather, I would invite you to say, in whatever way makes sense to you, Dear God, please help me to lean into the uncertainty, please help me to sit with this discomfort associated with this exposure, on the way to getting back to this big, beautiful, awesome life that you've created me to live. It's really hard right now. This is really tough, but please walk with me as I sit with all of it, helping me not to push away that anxiety, but rather to be with it as I reclaim my life. Amen. Or something of that nature. Yeah.

Kimberley Quinlan:  Yeah, that's beautiful. So thank you, really. I get teary again, this is such a beautiful conversation. Okay, so number one, thank you so much for coming on, really, it's a blessing to have you here and you know, I think this will help so many folks. Is there something that we didn't cover that you you know that point that you just made alone, I feel like it's like mic drop. But is there anything else you want to add before we finish up?

Katie O'Dunne: Yeah, um, and just, and this is a little bit more Christocentric, but I think it goes across faith traditions, I often talk about the recovery Trinity and just to leave folks with this as well. That I deeply believe that it's possible to have faith in yourself, faith in the divine and faith in your treatment all at the same time and that those three pieces coming together, allowing those to be together, actually can be a huge key with religious scrupulosity, and taking a step towards your life during treatment.

Kimberley Quinlan: That's beautiful. And I've never heard that before. That is so beautiful. I'll be sure to get my staff all trained up in that as well. Thank you. oh, Katie,…

Katie O'Dunne: Oh sorry, one more thing. Sorry, as I say that and I know we're closing out. I also always want folks to know that ERP. This is, this really is my last thing. I promise.

Kimberley Quinlan:  Oh no, no. Go for it. You've got the mic go.

Katie O'Dunne:  No. Um that I've worked with a lot of folks across traditions with religious scroup and I would say um a majority of the folks that I've worked with have moved through ERP and at the other side actually have a deeper relationship with their faith then maybe they did before and I would encourage you to hear that that actually leaning into that uncertainty translates far beyond OCD sometimes into a closer relationship with God. And I've worked with folks who have moved through ERP that end up going into ministry because that's meaningful to them in a way that isn't driven by OCD. So just knowing that it doesn't ever mean, you're stepping away from your faith, you're taking actually this leap of faith to reconnect with it in a way that's actually authentic to you.

Kimberley Quinlan: Mmhm. I'm so grateful that you added that. Isn't that some of the truth, with OCD in general, like the more you want certainty, the less of it you have. And the more you let go of it, the more you can kind of have that value driven life. I love it. Okay, I can't thank you enough, really, this has been such a beautiful conversation. I probably nearly cried like four times and I don't, I don't often get to that. It's just so, so beautiful and deep. And I think it's, it's wonderful. Thank you. Where will people hear about, you get to know you reach out to you and so forth.

Katie O'Dunne: Yeah, so folks are more than welcome to reach out to me via Instagram at @RevkRunsBeyondOCD or on my website at RevKatieO'dunne.com. I do lots of work again with clinicians and faith, leaders and clients but also have free weekly faith and OCD support groups along with interfaith prayer services for folks navigating what it means to lean into their faith traditions from a space of uncertainty and an inclusive environment. And then I would also encourage folks to check out our upcoming Faith and OCD conference with the Iocdf in May along with a really awesome resource page that we were so proud to put out last year. I had the chance to work with a really great team of clinicians and faith leaders to create a resource page for all of you to see what scrupulosity might look like in your faith tradition along with resources. So check out all of those wonderful things.

00:35:00

Kimberley Quinlan: Amazing. We will have all that linked in the show notes. Thank you, Katie, really! It's such an honor to have you on the show.Katie O'Dunne: Thank you. This was lovely. Thank you so much.

ONE Day Non-Judgment Challenge

Hello and welcome back to Your Anxiety Toolkit Podcast.  Today we are talking about an interesting challenge.  

You see, recently I was dared to take an entire day to just listen to my body and feel my feelings and sit in peace.  I thought this was a fabulous idea so I shipped my kids and husband away for one day (I never do this BTW)

What quickly arose was one thing that was taking the joy out of what could have been a lovely day.  That thing was Self-judgment.  Self-judgment is the thing that kept bringing me out of simply spending the day with myself. 

“I should be doing this instead” 

“You are being lazy” 

“Why did you choose that activity?” 

“You have to do it this way because that way is a waste of money” 

“You shouldn’t be feeling this way” 

“You don’t deserve this” 

“Why did you do it that way?” 

“Why are you the way you are?

Here are just a few of the self-judgment statements we say to ourselves during the day.  When you see it on paper, it sounds so awful.  Yet, these are things we say to ourselves without hesitation or even awareness sometimes.   

So, I decided to change the focus of the day away from it being a day of freedom and pleasure and towards a day where I practiced non-judgment.  I called it the NON-JUDGMENT CHALLENGE DATE DAY (or #nonjudgmentdateday on social media).  

So, here is the challenge.  Non-Judgment Challenge Day is a day where you go out on your own for a whole day (or an hour or two) and you practice doing things you enjoy doing.  Do something pleasurable or exciting or new.  As you do this, be very aware of the thoughts in your mind.  During this date with yourself, observe your thoughts, both positive and negative, about yourself and the activity you are engaging in.  

Non-Judgment Challenge Day was a complete eye opener for me and I strongly encourage you to try it.   Listen in to this episode of Your Anxiety Toolkit Podcast to hear about my reflections and struggles with my very own Non-Judgment Challenge Day. 

Also, I just wanted to let you know about “What if?”, a collaborative film project by Robin Roblee-Strauss for his senior thesis project at Hampshire College.  “What if?” Is a movie that documents the experiences of living with OCD. The film focuses on the voices of those struggling with OCD as the experts on their own internal experiences and recovery processes. And guess what....you can be involved in its creation! Go to www.whatifocdmovie.com to learn how you can be a part of the project by sharing your story, contributing cinematic or artistic expertise, or donating. By creating a movie with the help of individuals with OCD, Robin hopes to empower sufferers to speak out and show the world a brave and honest look into the struggle with uncertainty and anxiety.

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

Welcome back to another episode of Your Anxiety Toolkit. Today we are going to have a hard conversation and it honestly is causing a little bit of anticipatory anxiety for me. I want to talk to you about the lies we tell ourselves. You might be thinking "I don't tell lies. What are you talking about? I am a good person." So I want you to hear me out for a little bit and I want to share an experience I had this week. I realized that I had been telling a lie to myself and to my family about my choice to continue working so hard.

I really want to take the stigma, the judgment, and the shame out of lies and just admit that we do it. That’s my main hope for today. Let’s just acknowledge that we sometimes lie to ourselves. We lie to other people, and we do it, not because we’re horrible human beings, but because we’re trying to protect ourselves. It’s a safety behavior. We’re trying to protect the story we create, and I had created this whole story of why I had to work so hard.

So I sat down and thought about the lies we tell ourselves and I want to share those with you today. The first lie is "I can't." We have to stop saying “I can’t.” We may want to start replacing it with “I won’t” or “I’m not choosing to”. That is actually a better way of saying the same thing without it being a lie.  The second lie is "I am less worthy than other people." We sometimes tell ourselves that we are less than, but that is a lie. We have to catch ourselves before we buy into that story. The third lie is "Just this one time." As we go to do something, even if we know in our hearts it’s not healthy, by just saying, “Oh, just this once I’ll do it.” That is a lie, because typically is not just this once. The fourth lie is "I should be able to do this by myself." Let's get rid of the word 'should' here. If you need help, it is ok to ask for support. The fifth lie is "I can't upset other people." Actually it is not that you do not want to upset other people, you really do not want to tolerate your discomfort that goes along with hurting other people or making other people upset. 

So there are a few lies we tell ourselves. Think about them. Be very gentle and tender with yourself. Take your time with this. You may want to put your foot in the water and pull it out really quickly because it’s too painful, but then practice. I’ve been doing this for several years and it has very much benefited me. 

If you get a moment, please go over to wherever you listen to podcasts, whether that be Apple Podcast, Stitcher, Spotify, Podbean, and leave an honest review. Tell me how you feel about it, whether it's helping you, what you'd like to see. We are going to give away a pair of Beats headphones of your choice of color once we hit a thousand reviews!

ERP School, BFRB School and Mindfulness School for OCD are open for purchase. Click here for more information.

Additional exciting news! ERP School is now CEU approved which means that it is an accredited course for therapists and mental health professionals to take towards their continuing education credit hours. Please click here for more information.

Transcript Ep. 176

This is Your Anxiety Toolkit - Episode 176.

Welcome to Your Anxiety Toolkit. I’m your host, Kimberley Quinlan. This podcast is fueled by three main goals. The first goal is to provide you with some extra tools to help you manage your anxiety. Second goal, to inspire you. Anxiety doesn’t get to decide how you live your life. And number three, and I leave the best for last, is to provide you with one big, fat virtual hug, because experiencing anxiety ain’t easy. If that sounds good to you, let’s go.

Welcome back, guys. Today is going to be a hard conversation between you and me. Are you ready? Oh my goodness. Thank you for coming. I’m actually really excited about these episodes. 

Some anxiety-provoking. I’m having some anticipatory anxiety. I’m noticing some tightness in my chest, shortness of breath. That’s what we want to do when we’re feeling anxious. We want to just check in, where is it? We want to breathe into it and allow it. We want to honor it. We want to just go, “Yeah, it’s okay to feel this. It’s not my fault, but I’m going to allow it.” And then we want to lean in to do the hard thing. Today, we’re going to do that.

Today, we’re going to talk about the lies that we tell ourselves. Now, your initial reaction might be like, “Huh, I don’t tell lies. I’m a good person. I’m not a liar. Don’t tell me I’m a liar.” That is not what I’m saying, but I am, mainly because I have to tell you something that happened to me this last week because I, myself, am a liar. If you’re not a liar, that’s fine. I am a liar. So, let’s address that. 

This last week, I have been editing, editing, editing, editing. There are so many stages of writing this book. I thought you just wrote a book and sent it in, and were like, “Thank you for letting me write a book. Good luck with finishing it.” It turns out that’s not the case. You write the book. Then they check the book. They send you back notes. You write more. They check it. They send me back notes. You have to change a bunch of stuff. Then you write some more, and you finish the book. You go, “Hooray, I finished the book,” and they go, “Psych, just kidding. Now, we’re going to review the book and edit the book. And then you have to go and fix and correct and approve all the changes we made. And then we’ll do it one more time.” I’m like, “Boo, I didn’t want to do this. That’s not what I signed up for.” Being so naive, that’s what I am. 

Anyway, I’ve been working my butt off. In my private practice, I’m trying to do some really big changes to CBT School and make it much, much better. I’m trying to hire more staff because we’re so busy right now. I really want to make sure we’re not turning people away too. I’m not a specialist care. I want to be a good mom. I want to be able to do podcasts. I want to do social media. I want, I want, I want. And then I get to do this additional book edit. 

Now, on Saturday, I was in a terrible mood. The stress that was overwhelming me was just painful. It was so much. I thought I was being a rock star. I was using all my skills. I was still engaging with my kids. I was breathing. I had meditated. I had taken a walk. I was using all my skills. 

At the very end of the night, my daughter came up and she shared a balm as she often does at the very end of the night like, “Okay, I’m not doing well and I need your support.” Usually, I handle this really well, but on Saturday night, nope, not me. I did not handle it well. My reaction was like, “Come on, you’ve got no problems. I’ve got problems.” Number one, PS, that was not a good response. I don’t encourage you to practice that because that’s not helpful and not kind and not productive.

Of course, I slowed down. I caught myself in my reaction. I am a human. I make mistakes. I caught myself in my reaction. I apologized to her and I sat down and we talked it through and we came up with some solutions. I offered myself self-compassion and her, just like we did in the episode last week. 

And then when she went to bed, my husband sat me down and he said, “You’re working too much. This is not okay. It’s obviously impacting the family.” He said it kindly, but he said, “We try to be as honest as we can with each other.” My reaction was this: PS, it wasn’t great either. So go with me here. I am a, like I said, so much more to learn we’re all on a learning curve. But my reaction was, “How dare you say that? I’m working so hard and I don’t have any choices. It’s not my fault that I have so much work to do. I didn’t ask to do this second edit of the book or the 15th edit of the book. It’s not my fault that the links on the website are broken and blah, blah, blah.” And I stood by my theory. This is where the lie was. I doubled down.

He backed off a little because he could tell I was super triggered, but I doubled down on this lie. And then I had to step back and go, “Okay. That was a lie because I don’t have to work this hard. I don’t have to put this much pressure on myself.” I like to work. I love to work. I love what I do. I love talking to you guys. I love being a therapist. I love having businesses. I really love having a person who does business. I really love the therapy work and I also really love the business side of things. I’m just a bit of a dork that way. I love growing things. I love creating things. 

This whole lie that I was saying, like, “I don’t have a choice,” it’s just ridiculous. It wasn’t true. It was straight up a lie. It got me thinking, well, number one, let me backup. I went to my husband. I said, “I’m so sorry. You’re right. I am working too hard. I am pushing myself too hard. I need to find some better balance. I can’t burn myself down to nothing and have nothing left for you guys at the end of the day,” even though I thought I was using my skills, that’s just not okay.

I will talk about this again next week in a different concept. But I was telling lies when I reacted and I’m sorry about that. It got me thinking, “What other lies do we tell ourselves?” Let’s take the stigma and the judgment and the shame out of lies and just admit that we do it. That’s my main hope for today. Let’s just acknowledge that we sometimes lie to ourselves. We lie to other people, and we do it, not because we’re horrible human beings, but we do it because we’re trying to protect ourselves. 

It’s a safety behavior. We’re trying to protect the story we create, and I had created this whole story. “Oh no, it’s not my fault. I worked so hard because A, B, C, D, and it’s not completely in my control.” It is if I’m going to be honest. Maybe not for you in your case. Maybe you do have a situation where you have to work these certain hours. I’m not talking. I’m just a bit talking specifically to my own lives here. 

So then I thought, “Okay, let’s just go through.” I sat down, got a piece of paper, and I thought, “What are the main lies that I probably tell myself or I’ve heard my patients and clients say to themselves?” I’m going to bang through them really quick. 

1. I can’t. 

This is a lie. Not a good one, not an easy one. Again, when I talk about “I can’t”, I also want to preface that there are certain situations where people can’t do things like certain disabilities, medical disabilities. They can’t run a marathon or so forth. I’m not speaking specifically to that. I’m talking about “I can’t” when it comes to feeling emotions or facing our fears, or doing things that are hard. 

The main reason I say “It’s a beautiful day to do hard things” is to counter the thing I hear the most, which is “I can’t”. Yeah, you can. It’s going to be hard, but you can do hard things. It’s a lie. We tell ourselves.

Now I’m not saying that from a place of criticism or even lacking compassion. There’s deep compassion in what I’m saying here. I’m not saying, “Oh, you can.” I’m not saying it in a condescending way. What I’m saying is, be honest with yourself. It’s not that you can’t. We’re talking here about being honest with yourself so that we can actually solve the problem. 

I can’t solve this problem of overworking until I’m ready to be honest with myself and go, “You know what? You’re right. You’re 100% right.” I have to be honest with myself. I am choosing to work this much and it is impacting my family. That has to change. Let’s say I decided it wasn’t going to change, that’s my prerogative. But at least I have to start by being honest with myself. 

We have to stop saying “I can’t.” We may want to start to replace it with “I won’t” or “I’m not choosing to”. That’s a much more wise way of saying the same thing without it being a lie. Ouch, I know it’s not fun to hear this. I’m saying this to myself. Please don’t feel like I’m bullying you here. I’m also telling myself this, because a part of me wants to go, “No, I can’t. I can’t slow down. I have A, B and C.” It’s like I won’t slow down.

2. I’m less worthy than other people…

Because of my weight, the way I look, my social media, following, my mental disorder, my income.

We tell ourselves these lies all day long, this lie was the absolute basis of the eating disorder I had. I’m less worthy than them. The only way I can get more worthy and be as worthy is if I drop a body size, if I exercise compulsively. For some people, if I can be as popular, or if I could have as much money or have the same car. We tell ourselves it’s a lie, that we’re less than. That’s a lie. We have to catch that we buy into that story, and that when we do, that story can feed many problematic behaviors in our lives. 

3. Just this one time. 

“I’ll just do it one more time. It was no big deal. This one time won’t hurt.” That’s a lie guy. Ouch, I know, right? But we do it all the time. It’s fine. Just this once I won’t do it. Now, let me also stop for a second and go, you’re not going to be perfect. I’m not going to be perfect. We’re humans and we’re going to make mistakes. If there are times where you have fallen off the wagon, or you do a compulsion or you engage in a behavior that’s not helpful, this is not about me saying, “You’re bad for that,” and you get a rap across the knuckles. Absolutely not. We’re talking here about stories we tell ourselves, the lies we tell ourselves. As we go to do something, even if we know in our hearts it’s not healthy, by just saying, “Oh, just this once I’ll do it,” that’s a lie, because it’s not just this once.

I have a dear friend and this dear friend has OCD. I love when I hear this dear friend say, “Kimberley, I’m going to be honest with you. I know I shouldn’t do this, but I am choosing to do a compulsion this time. I know it’s not what’s right for me. I’m going to do it. And then as soon as I do it, I’m going to A, B, C, and D.” That’s the truth. That’s honesty. That’s not saying, “Oh, just this one time. I’m just going to do it once.” What she’s saying here is the truth. “I know I shouldn’t be doing this, but I’m going to do it. And then I’m going to take the consequence for it.” That is so much more healthy for you and honest for you than any other way of saying it.

Some of you may say, “Well, if I say that, then I’ll beat myself up.” Well, a part of telling the truth and not lying is also not beating yourself up for the truth, because the truth is the truth. No matter what you say.

4. I should be able to do this by myself or any other should that you do. 

I hear a lot of people say, “No, I don’t want to get therapy. I should be able to do this by myself.” I want you to recognize that the stigma at play. No, often we need help. We need lots of help. Often people will say, “No, I should be able to do this without medication.” No, that’s not true. That’s you telling yourself a lie because maybe you’re afraid of taking medication. 

These are just ideas, guys. I don’t want you to walk away feeling bad here. I just want you to reflect on, could any of this be possibly true? Maybe even just listening to this is you opening a small door into you being really honest with yourself. I promise you, being honest with yourself will be the most freeing thing you ever do.

When I really made a deal, it was like two years ago, I was like, “You know what? No more easing anyone, Kimberley. Just tell it like it is.” Don’t be mean about it. Don’t criticize yourself. Don’t be unkind. But just be honest with yourself and others, please. 

No more shoulds. “I should do this. I should do that. I should be able to do it by myself.” If you’re struggling to do it by yourself, you need help. It’s very factual. It’s pretty A to B. If you’re struggling to do it for yourself and you need help, there’s absolutely no shame in that. I really hope you can ask for help, whether it be a loved one, buying a book, buying a course, going to therapy, going to a doctor. Whatever it is that you’re trying to succeed with, ask for help. 

Here’s a big one. I have one more to go, then I have a bonus flippity-flop lie for you. I’ll explain it in a second. 

5. I can’t upset other people. 

I often hear clients say, “I can’t do that because it’ll hurt them. It’ll upset them.” No, that’s not the truth. It might be the case. It might be the truth and that is the consequence, but that’s not why you’re not doing it. You’re not doing it because you don’t want to tolerate the discomfort that goes along with hurting other people or making other people upset. 

A lot of this is like teeny tiny details, but I really want to inspire you guys here. Be as honest as you can with each other. It hurts, but it’s better. Then you can actually work with the system. 

Now, here is a flippity flop. When I say flippity-flop lie, it’s often, a lot of my clients will say, “Bad things are going to happen. Bad things can happen. Bad things are going to happen.” Often we will go, “Oh no, that’s just my anxiety talking.” We’re reacting to it in a really negative way. 

I want to flippity-flop lie this one. What I’m saying is, that one’s actually not a lie. Bad things will happen. That is a part of life. We must accept that scary things do sometimes happen in our life. I don’t want you to talk yourself out of that one. Instead, I want you to practice being honest, which is when I’m having the thoughts, “Bad things are going to happen,” I go, “Yes, Kimberley, you’re right.” 

How can we practice being accepting of that? It doesn’t mean all of your thoughts are going to happen. It doesn’t mean if you’ve got an anxiety disorder, your thoughts are on rapid-fire telling you all the 17,000 things have gone wrong. I’m not going to say all those things are correct. But the general idea that bad things will happen is not a lie. I want you to actually settle into that a little bit and be honest with yourself in that, instead of trying to control your life, thinking that that control will protect you from bad things from happening.

See, it’s like a flippity-flop. What I’m saying is it’s not a lie. It’s actually a truth. If you can handle it and respond to it like a truth, then you’re not getting yourself into trouble. I’ll talk more about this next week, I promise. 

So there are a few lies we tell ourselves. Think about them. Be very gentle and tender around these. Take your time with this. You may want to put your foot in the water and pull it out real quick because it’s too painful, but then practice. I’ve been doing this for several years and it has very much benefited me. 

Let me share with you to round the story out. After I had 24 hours to simmer myself down, give myself a talking to, and pull myself out of my own lies, I sat down with my children and I said, “Daddy brought up that he felt I was working too much. How do you feel about it?” I’m not in the business of trying to talk myself into being who I’m not. Interestingly, one said, my son is five and he’s learned the art of expression in his voice, and he went, “Oh yeah.” When I asked, “Do you feel like I work too much?” his response was, “Oh yeah.” So there is an answer. Honesty, thank you, five-year-old. 

My daughter who has more of a need to protect me went, “Uh, kinda, no, but you’re still a great mom and you’re too great and I love that you work hard.” And then her dad was like, “No, please. Mom asked you to just tell her the honest truth and you can be honest with us. How are you feeling about how much mom’s working?” “Yeah, I think she does work a little too much.” “Excellent.” 

Now, my team, the people I care about the most, have shared with me their opinion, whether I like it or not. I hear it. I take it into consideration and I choose whether I’m going to implement it. No more lies. I could go, “My husband is wrong. My kids are wrong. I didn’t even want to know about their opinion because my story is that I have no choice.” I could do that, but that doesn’t help me. It keeps me stuck. It cuts me off from the relationships that matter to me most. So I’m going to choose honesty. Does that make sense? 

Tough conversation, friends. How are you doing? Are you guys all right? Are you having a panic attack over there? Are you breathing okay? Check in. Take care of yourself. None of this is a judgment. This is mostly me giving you real-time on a stuff of my own that I work through. Often when I’m going through something, I want to share it with you because I’m guessing you are going through something similar. I’m trying to be ballsy enough to say, “Hey, let’s just talk about the real stuff. Let’s address the real stuff that impacts our daily lives and our mental health and anxiety.”

I love you so much. Please go and leave a review. We are giving away a pair of free Beats headphones so that you can hear the podcast so clear and wonderfully to one person who leaves a review once we get 1000 reviews for the podcast. So go to wherever you listen, leave your honest review. I would be so, so grateful. I do not take any sponsorships for the podcast. I do not do much sales here at all. This podcast is really here to help people who don’t have access to medical or mental professional care in these areas. Please, if you have a moment, go and leave a review. I would be so, so grateful. 

Have a wonderful day guys. I’ll see you next week.

Please note that this podcast or any other resources from cbtschool.com should not replace professional mental health care. If you feel you would benefit, please reach out to a provider in your area. 

Have a wonderful day, and thank you for supporting cbtschool.com.

SUMMARY: 

In this podcast, Micah Howe addressed his expereince with intensive OCD treatment and the 6 most important turning points of OCD Recovery

1. Compulsions keep OCD going, 
3. I can control my reaction to OCD

4. Worrying is a false sense of control and is not productive

5. Anxiety does not mean something needs solving

6. Find an OCD community

7. Self-compassion helps manage uncertainty

Micah also addressed how to know you are ready for intensive ocd treatment and how he managed his OCD grief. 

Links To Things I Talk About:

https://www.instagram.com/mentalhealthmhe/

ERP School: https://www.cbtschool.com/erp-school-lp

Episode Sponsor:
This episode of Your Anxiety Toolkit is brought to you by CBTschool.com. CBTschool.com is a psychoeducation platform that provides courses and other online courses and resources for people with anxiety, OCD, and Body-Focused Repetitive Behaviors. Go to cbtschool.com to learn more.

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This is Your Anxiety Toolkit - Episode 314.

Welcome back, everybody. Today, we are talking about the major turning points of OCD recovery. This episode is literally how I want to end the year, although we do have more podcasts coming this year before we finish up 2022. But literally, this is like mic drop after mic drop after mic drop. I thoroughly enjoyed interviewing this week’s guest. I’m so honored to share with you this interview with Micah Howe. He’s an OCD advocate and is one of the most inspirational people I know. I just have so much respect and adoration for him. And this episode is literally a bomb. I just can’t, I can’t shout it from the rooftop loud enough.

I’m going to keep this intro very short because I really just want you to hear exactly what he’s saying. And really what we’re talking about here is some ideological shifts that he had, going through intensive treatment and treatment in general, specifically for OCD. But if you don’t have OCD, this is still going to be a powerful punch for your recovery because the tools that he shares that he realized on the end of his recovery are ones that anybody could apply to their recovery. So, let’s just do it. 

Before we move on, let’s quickly do the review of the week. This one is from Tristramshandy1378, and they said:

“I stumbled across your podcast recently. I have been through therapy with Anxiety and panic and I have a high-stress job that I love, but I needed to continue my journey to recovery and be reminded of all the skills that are available to help me along the way. Your online courses for OCD and your amazing podcast reminded me the most important part of the process is to love myself, before, during, and after my episodes of intense anxiety and that every day is a beautiful day to do hard things.”

Oh my gosh, Tristramshandy, this is just so exactly my mission and my model. And so, I’m so grateful for you for leaving a review. 

It sounds like actually Tristramshandy’s review of the week should actually be the “I did a hard thing,” but we have an “I did a hard thing” as well. This one is from Anonymous and they said:

“Hello, Kimberley. Very glad to have this resource. I did a hard thing. I started using public transportation much more often. It helps a lot with agoraphobia. I also significantly decreased media consumption, and that helped me learn to live with my thoughts and generally slowing down to process the information.”

So, thank you so much for Anonymous for sharing that. 

To be honest with you guys, the review of the week and the “I did a hard thing” and this entire episode is like three different “I did a hard thing” segment, so I’ve just so overjoyed that we’re all here doing the hard thing, bringing in the end of the year. This episode is going to be such an amazing resource for you. So, let’s get over to the interview.

Introduction To Micah Howe

Kimberley: Thank you so much for being here, Micah. I am actually so excited to hear this story. So, welcome.

Micah: Yeah, thanks so much. Glad to be here.

Kimberley: Yeah. So, you and I had talked before we came on to record about how you are going, wanting to tell the story about your intensive OCD treatment specifically around OCD. And this is the topic that I find so interesting and something that I actually really am so excited to hear your story. So, would you be able to tell us just in brief what the backstory of your recovery looks like and get us up to date in terms of where you were, what you experienced, as much as you’re willing to share?

Intensive Treatment For Ocd 

Micah: Yeah. So, what had me in intensive treatment – I grew up in rural Iowa and so resources for OCD, particularly evidence-based treatments like ERP, particularly several years ago when I was first starting to show really debilitating symptoms, those sorts of resources were really hard to come by. And so, it took me a long time to find good help. And then once I did find good help, my OCD had gone on unrestrained for so long that I needed a really intensive setting. And so, my OCD started becoming quite debilitating around the age of 18 or 19. The college transition was really hard for me. But by the age of 25, even doing some outpatient therapy, it just wasn’t really putting much of a dent in what I was dealing with. And so, I ended up in a partial hospitalization setting where we were putting full-time job hours into exposures every week. And that’s what it took for me to begin to see breakthrough.

Kimberley: Right. So, what was it like? What were you experiencing? Because I’m sure there are people who are going through treatment who may be feeling similarly. You are doing outpatient once-a-week therapy, were you?

Micah: Yeah. 

How To Know You Are Ready For Intensive Ocd Treatment

Kimberley: And how did or was it you who knew you were ready for in treatment or was it the clinician who advised you to take that next step?

Micah: For the longest time, I had so much stigma about going to a “mental hospital.” Really, I didn’t know what to expect, and just naturally as people, we’re afraid of the unknown. And so, I was pretty resistant. But eventually, a clinician that I was working with really had said, “If you want to get to these goals you’re talking about in any reasonable amount of time, I really think I should recommend that you go to a higher level of care.” And so, that really opened me to this idea of seeking a higher level of care. It was the combination of a clinician recommending it and also my just experience of realizing, this once a week, I mean, we’re very well-intentioned here, but I’m just not getting very far.

Kimberley: And I think so many people are there and the stigma holds them back. There is a lot of stigma attached. Besides that conversation, was there any other shifts you had to make to get your foot in that door, or it was an easy decision once you explained it?

Micah: I hate to say it, but unfortunately, it’s all too common in the world of OCD recovery. But I was another one of those people that I went kicking and screaming. I had to hit rock bottom. It was helpful for a clinician to tell me, “I really think this would be beneficial to you.” It was eye-opening for me to realize, gosh, I’m coming back here every week and I’m just not getting very far. But I think what really pushed me the rest of the way was this very sobering realization that this OCD is going to continue to take as much of my life as I allow it to. If I continue to just do a level of therapy that, at least for me personally, is not getting me where I want to go – if I just continue doing that, hoping that something is going to change, experience was teaching me that OCD is not just going to back off if I don’t do anything different. So, I think that idea of hitting rock bottom, of being tired of chasing the same goals month after month that I wasn’t getting any closer to, that really pushed me to say, “Okay, I’m more afraid of losing my life and opportunities than I am of whatever stigma I might have to shoulder adding to my life’s resume that I spent time in a mental hospital.”

Micah’ Intensive Ocd Treatment Story

Kimberley: Yeah. You had to weigh the pros and the cons and all directions were leading you in that direction. That’s cool. That’s so cool that you were able to do that, make that shift in your mind and make that decision. So, okay, you’re in the door in intensive. Was it what you expected? Tell me about what you expected and how it was different.

Micah: Yeah. And it’s that question that I really appreciate because, for anybody listening that might be considering another level of care that is intimidated, I mean, that’s right where I was. I mean, I didn’t know what to expect. And when I got there, I’ll never forget the biggest thing that really was surprising to me is how calm and inviting and not scary it was. I met a lot of people there and I was like, “Wow, these people are just as genuine as I am. We’re all just trying to get better here.” And I also think, I thought there was going to be-- the other thing that really stuck out to me was I thought there was going to be this really significant talk therapy element. I thought we’re going to-- all these things that I couldn’t figure out in outpatient, these treatment teams at these intensive centers, they’re going to have the answers that my outpatient therapist didn’t have. And it’s actually like, no, they don’t have the answers. They’re actually more encouraging than my outpatient therapist that I live without the answers. 

And so, we’re not really talking through the things that concern me. We’re instead doing this evidence-based really rigorous exposure therapy where I’m not talking about my feelings and my past as much as I’m talking about how I reacted to something they asked me to challenge myself to do that day. And so, just the way they went about helping me get better was so different than the path I thought we were going to go down.

Kimberley: Yeah. Isn’t that interesting? Would you say-- and this is sometimes how I explain it to some clients, but you should actually give me feedback here. I’m as much learning from you as any. Sometimes we say intensive treatment isn’t different, it’s just more. It’s more frequent. It’s more of what you’re doing in session, and that’s a good thing. Was it that for you? Was it just more of what you were doing? Or was there some fundamental differences in the structure of the sessions? How was it different for you?

Micah: Again, yeah. I mean, obviously, I’m not a therapist or a medical doctor, anything. Everything I say on the episode is just from my limited personal experience as a sufferer. But I would say in my experience, when I was doing outpatient therapy, only meeting with a clinician once a week, only doing so many exposures a week, I guess this idea of tolerating uncertainty, I understood it, but I don’t think I bought in as deeply as I bought in when I was in intensive treatment because now, instead of we only have 50 minutes to talk through everything, now my treatment team is like, we’ve got two hours if you need it. And so, we’ve got two and a half hours if you need it. And so, if I was hung up on an exposure that I didn’t want to do, it wasn’t a situation of, “Ah, we’ll get to that next week.” It was like, “We can wait. What’s the issue? What’s getting in the way?” And so, I couldn’t just run out at the end of 50 minutes like I would in an outpatient context. We were there full-time to deal with fears and help me gradually be willing to engage in exposures, that in an outpatient context, I didn’t have to push myself that hard. And it was much harder than outpatient for me, but it also caused progress so much faster because when I ran into a bump, it was like, we’re either going to try to work through it now, or we will be right here tomorrow to keep working on it. And so, there was a consistency that created breakthrough that once a week just wasn’t doing. 

Kimberley: Right. See, that’s so interesting, the mindset shift for you that you had. So, okay, I’ve got lots of questions, but I also want to know, you have come with four main points that I want to make sure you’ve got plenty of time. So, I’ve probably got questions there as well because I always have too many questions.

Micah: Oh, no, that’s great.

The 6 Most Important Turning Points Of OCD Recovery

Kimberley: You had said there were four ideological shifts you had to make during intensive treatment, and I want to highlight those because they’re brilliant. So, would you be kind to share that with us?

Micah: Yeah. Do you want me to just start with the first one or did you want me to list--

Kimberley: Yeah, just lay them on.

1. Anxiety Does Not Mean Something Needs Solving

Micah: There were so many, but for the sake of time, I think when I think about some of those paradigm shifts, some of those ideological shifts that really created a lot of breakthrough for me, the first thing that comes to mind is my treatment team challenging me to accept the notion that anxiety was tolerable and that it was an ordinary part of the human experience. When I started out in treatment, I saw anxiety as a signal that I was doing something wrong in my life, a signal that there was a problem that needed solving. And OCD didn’t exactly know what that problem was, but it had rituals to offer me in the meantime. And so, I just felt like anxiety, it is a catalyst, it is an impetus, it is a sign that something is awry and I’m supposed to be doing something. 

The last thing I thought was, like my treatment team encouraging me, “Micah, what if anxiety is just part of being a person? And what if it doesn’t necessarily mean that life is asking you to do anything to make it go away? And what if your life was actually better tolerating the distress that anxiety created rather than being a fugitive from it your whole life?” And I had never considered that in part because I again thought that it was extraordinary, but also, I had never considered the idea that anxiety could just be tolerated. It was so unique and novel to me because I just saw anxiety as anxiety is something I hate, anxiety is something I find unbearable, and either my life is miserable because it has anxiety in it, or I’m able to live the life I want because I’ve completely eliminated anxiety from my experience. And to be offered something in the middle, that that wasn’t black and white, that was so just revolutionary for me to say, “What if I can’t ever get away from this thing called anxiety? But also, what if I never come to love it either? What if I just live my life just lukewarm to this emotion? Just allowing it to be in my life?” And that was something that prior to my treatment team encouraging me to think that way. There was just nothing in my natural instinct that thought about just letting anxiety be around without reacting to it.

Kimberley: Yeah. So cool. Isn’t that so cool? Okay. So, what’s the next one?

2. Compulsions Keep OCD

Micah: So, the next shift that was extremely meaningful to me – when I was in intensive treatment, we did a lot of ERP, we did some ACT principles, some behavioral activation because I also deal with comorbid depression and hoarding disorder, and we also did a fair amount of thought challenging. And the thought challenging was particularly insightful for me in that as I started to break down some of my rituals, I really had to come face to face with the fact that my rituals were creating very much the antithesis of what my OCD told me those rituals existed to accomplish. Compulsions keep OCD going.

So, for example, scrupulosity was a big issue for me. And my OCD was telling me all of these things you are doing, all of these repeating things you are doing, this is to make you feel closer to God. This is so that you will be more engaged with your faith. This is so that you will be a better Christian. And yet, as I started breaking these things down, I was like, I have never felt so disconnected from my faith as when these rituals have become such a significant part of my experience. And even with my hoarding, it had an effect. I was collecting all of these things to relieve anxiety. And the notion was you’re collecting these things so that when the day comes that you need them, you’ll have them. And yet, the effect was that I had so many things accumulated that when the day came that I thought, oh, that thing would be really great. I couldn’t even find the thing in my mess of things. And so, in reality, there wasn’t much of a difference between not having any of these things and having a basement so full of things that I couldn’t find the things I wanted anyway. 

And so, that thought challenging and really analyzing why am I doing this and what is the difference between how I feel about these rituals versus the reality they’re actually creating in my life? And I was able to see that I am giving up long-term progress towards the person I want to become in exchange for short-term relief of anxiety. And that took me a long time to acknowledge, but once I saw it, it helped me break away from the rituals a little bit easier. 

OCD Grief

Kimberley: I know, isn’t that so true? Is that we feel in the moment the ritual is helping. It’s like, this is a part of the solution. And that’s a big awakening when you’re like, it’s not a part of the solution. At least not the long-term one. That’s that. Was there any OCD grief? Was that a relief or was there some grieving you had to do about that?

Micah: Yeah, I think there was some grieving only in the sense that when you spend all this time doing these things and you’re believing your OCD that these are helping me, these are getting me closer to the person I want to be, there is some grieving in recognizing that there’s a lot of emotional reasoning involved in why I’m doing these things. They make me feel like I’m getting closer to the person that I want to be. But it’s really an illusion because people who are close to God, I don’t associate those people as being people who repeat their prayers so many times because they’re terrified. I associate those people as being people who enjoy the discipline of prayer, who enjoy being in religious services. And so, it was a very odd experience to have to come face to face with the reality that these rituals are making me feel a certain way, but when I look at the results I’m getting over the long term, I’m actually getting farther away from the person I’m wanting to be.

Kimberley: Right. It’s gold, isn’t it? And I’ve seen that recognition and realization in my clients and it’s a tough one, but it’s an important one. Did that come in pretty quick in your intensive treatment or did that take time?

Micah: I think in the first maybe week or two of intensive treatment, I just had my clinicians, because I was resistant to ERP at first. And so, there were a lot of nuggets being dropped that I was just like, “Whoa, I have not thought about that in my whole OCD journey.” So, I would say the real change happened several weeks into intensive treatment, but definitely that first week or two, I was encouraged to think about these rituals and uncertainty and all these different elements involved in recovery from OCD very differently than I ever had before. I mean, I remember one of my first conversations with a therapist at treatment just asking me to think about what do you think a committed Christian is like, what do you think their life looks like? And I had never thought about that before and I realized that doesn’t look anything like my life. And that was really eye-opening for me to be like, I don’t associate being close to God with doing all these things out of fear. I associate it with actually finding meaning in these things. And so, I just had to separate that, just because these things make me feel a certain way.

Another one was, I was so afraid of getting brain cancer and so I did all sorts of Google searching. And I was really challenged to think through, do you think about a healthy person as being someone that’s on Google all the time? Is that what health looks like to you? And of course, the obvious answer was no, but I just had never been encouraged to think that far previously.

Kimberley: Yeah. I’m loving everything you’re saying, so I’m just wondering like, keep going, keep going. What’s number three?

3. I Can Control My Reaction To OCD

Micah: So, the third thing was, if there was anything that I underestimated when I came into intensive treatment, it was my own capacity for change. When I came into intensive treatment, there was a lot of hopelessness, and it was rooted in this idea. My thoughts trouble me deeply. My emotions bother me deeply. I can’t control either of those. And then on top of that, my life circumstances bother me. And although I might be able to change those, I can’t really change them quickly. And so, what hope is there for this getting better? 

The blind spot I had coming into treatment was this idea that even though it’s hard, and even though it doesn’t feel this way often, I do hold the keys to the behaviors that I choose. And my treatment team really worked hard to say, “Micah, it’s a losing battle to try to fight thoughts and emotions that you can’t direct. But what if we focus on the things that you do have some ability to influence, even if it’s hard to do?” 

And so, my life just really began to change, hope began to flood in when I began to buy into this idea that I’m not in control of many of the things I would like to be in control of, but I do have influence over my behavior. And because I’m so caught up in my rituals, I’m really not tapping into that potential at all when I’m coming into treatment. And so, once they started to say, “Micah, we’re not going to sit here and talk you out of your thoughts,” but they exposed me to ERP and concepts like neuroplasticity and this idea that what if we can’t change your life, but we can improve your brain’s ability to react to your life with more helpful behaviors? And I was just blown away because I had just never thought about it. I just thought, well, if we can’t change my thoughts, we can’t change my life. And they flipped that on its head and said, “Well, what if we just tolerate the distress of your thoughts and start living the way you want to live and see what happens?” And I didn’t even know that there was a relationship between cognition and behavior that allowed progress to be created that way. It was unbelievable.

Kimberley: There are all these light bulb moments. All I want to keep asking you, I keep feeling like myself going like, you were receptive to this? You were obviously eventually receptive to this, or did you fight them on this? I’m thinking about my clients and now the people listening, I know they may have been hearing these same things, whether it’s through this podcast or through their therapists, is like OCD has a strong opinion about these concepts too, I’m sure. Was OCD throwing a massive tantrum?

Micah: Yeah, no, for sure. I don’t want to make it sound like I just walked in and they said these things and I was hopping down the lane just like, “Oh, perfect.” It wasn’t that at all. There was a tremendous amount of resistance, but I think that that resistance was weakened faster, both because we were talking every single day for hours at a time and also because, by the time I reached intensive treatment, it was like, if I’m not willing to try these concepts, if I decide I don’t like this and I’m going to check myself out of this place, what am I going to go back to? Where am I going? If I’m not willing to try this, what’s the next thing? And I knew it was just going to be back to more rituals, not getting anywhere. And so, I was open. 

And there were also specific exposures that I’ll never forget. And I don’t think my behavioral specialists necessarily knew the depth of impact some of these exposures would have on me. They knew it would help, but some of them were like, “Wow, that was an unbelievable exposure.” One of them was, they had me watch YouTube videos of people who were explaining their experience of being diagnosed with terminal illnesses. And so, they’re dying and they’re on YouTube and they’re telling their story. And if I could find them of brain cancer, I did brain cancer. But if it was ALS, whatever, they just find a terminal disease, find someone who’s describing what it was like and watch those videos as an imaginative script. And I’ll never forget watching those videos and seeing even people dying of terminal illnesses had moments of laughter and smiles. And I thought to myself, they didn’t get there by sulking in their thoughts. I just realized, when these people know they’re dying, somehow, they decided: I’m going to do things that matter to me even when my brain is probably telling me, “Your life is over. What’s the point?” It just so inspired my confidence that, wow, I do not understand at an anatomical or at a metaphysical level what is involved in living life the way I thought I did. 

I had to be open to this idea that there is a way to choose behaviors, that my thoughts are not exactly supportive, and get places even when I don’t necessarily feel like getting to those places. And I didn’t realize I could just challenge my thoughts by choosing behaviors that mattered to me, even if it scared me to do it. And some of those exposures just really stuck with me in that sense.

Kimberley: I love that. And it is true, isn’t it? You’re doing an exposure to purposely simulate the fear and sometimes there’s a lesson in it. There’s a message-- not a message, but just a lesson. So, that is incredible. And thank you so much for sharing that exposure example because that’s some hard stuff you’re doing. That wasn’t easy.

4. Worrying Is A False Sense Of Control And Is Not Productive

Micah: No, no. It wasn’t. And I think that was also part of the treatment that really was hard for me but has helped me grow so much, is just this idea that that worry doesn’t have any utility to it. My OCD convinced me for so long that by worrying about things, we’re doing something. And it was this magical thinking in a sense that something in the cosmos is happening because I’m here worrying. And really just being able to acknowledge, “Micah, your worrying is not doing anything productive. Your OCD can make you feel all day long, like the energy expenditure.” Well, there’s so much energy expenditure in my worrying. It has to be accomplishing something. Instead of just acknowledging it, it actually doesn’t have to be accomplishing anything and it isn’t. And as blunt and hard as that was to accept, it did help me when they started to offer me this acceptance piece of like, it sucks, but they really encourage me, my treatment team, that Micah, you do have to accept that you are a limited being and that there are answers that your OCD would love to have. And no amount of fretting about it is going to get you those answers. But it is going to chew up your life. It is going to take away opportunities. It is going to keep you out of the present moment. 

And I think-- sorry, I’ll just add two more things real quick, but I think the one thing was this idea. When I first came into treatment and they started offering mindfulness and we did a little bit of yoga, I really didn’t buy that when I got started. I just thought this is not me. But by the time I left treatment, I just found mindfulness for OCD to be the most helpful practice because the reason I didn’t like mindfulness at first is because I thought it was cheesy. But once I really started to buy into what my treatment team was saying, I really recognized at a very brutal level, mindfulness is just recognizing the world for what it actually is, even if I don’t like it. That what I really have as a guarantee is this moment, this breath, this blinking of my eyes. And that’s really all I know for sure. And as terrifying as that statement once was for me, I became much more pro-mindfulness as I became comfortable with accepting that reality about the world.

5. Find An OCD Community

And then the last thing I would say as far as paradigm shifts that really was so impactful for me in intensive treatment was just this idea that uncertainty is a burden that is best shouldered authentically with other people. And what I mean by that is group therapy just meant the world to me when I was in intensive treatment. I grew up in rural Iowa where there’s a lot of stigma and talking about what I was dealing with was really hard. And so, to finally-- instead of just bury all this stuff and pretend that the world is not as uncertain as it really is and just try to get through, it was just so unbelievable to just finally be in a circle of people and we are all just admitting we are terrified of this thing called uncertainty. And I’m terrified of uncertainty related to my health. And you are terrified of uncertainty related to religion, and you are terrified of it related to whether or not you hit somebody on the way here to treatment today or whatever. And to just openly voice our fear of uncertainty. I can’t even explain it, but it just created a human bond to be able to be honest with each other in that way that I never experienced just trying to bury these things and pretend that uncertainty wasn’t as scary as it really was. 

6. Self-Compassion Helps Manage Uncertainty

And I think the other thing it did is it introduced me to self-compassion in a way that I hadn’t really acknowledged before. There’s something unbelievable about, when I talk about how much uncertainty scares me, it’s so hard for me to feel empathy for myself. But as soon as I see another person across the room say it scares them, all of a sudden, it’s like, where’s all this empathy I have for them? When they say it affects them and, “oh, I had to drop out of college because I couldn’t deal with this and I’m scared of this and that,” when I have the same story, I don’t feel much compassion for myself, but when I see someone else have that story, here’s all this compassion. And I walked away from that thinking like, whatever it is that makes me so sympathetic to someone else’s struggles with these things, I need to find more of that for myself.

Kimberley: Is that something that was the switch that went on or is that something you go in and out of being able to do that self-compassion piece?

Micah: I think, if I’m being honest, it really is an in-and-out thing for me. And I think it is related to the camaraderie of other sufferers. Whenever I’m at the conference, gosh, I am like at my all-time annual self-compassion highest because it’s just like, “Ah, yeah.” I remember we’re all a community and it’s like high school musical all over again. We’re all in this together. But when I get back to Iowa and I’m not regularly rubbing shoulders with sufferers, I start comparing myself to non-sufferers a lot, and all of a sudden, this desire to be compassionate towards myself lessons. So, it’s something I have to work on continually to remember that I’m dealing with something that is not easy and a lot of people aren’t dealing with. And it’s just, I work very hard to try to remember the feelings that well up inside of me when I hear somebody that’s not me share their struggle and their recovery and do my best to be like, okay, whatever it is that wells up in me when it’s somebody else, I need to work hard to feel the same way about my own journey. But it’s definitely a process.

Kimberley: Oh my gosh, you’re on fire. These messages are so incredible. And I think it’s exactly like what people need to hear. It’s the pep talk they need. I want to be respectful of your time. Is there anything you want to say about your journey that you think would be helpful or that would be great for you to share?

Micah: Yeah. I think the only other thing I would say, and I say this quite often, but I just think in my journey, I think early on in my journey and especially when I was coming to intensive treatment, I wanted everything to happen fast. I wanted a quick fix. I was hurting so badly that I wanted things to get better so quickly. And I think one of the things that has become a mantra for me personally in my recovery is that my recovery was definitely not immediate, but it has been and continues to be substantial. And I think that’s a truth about my recovery that I’ve really tried to hang onto. Because I’m very much this person that I don’t want to just-- when people are looking for hope in my story, I don’t ever want to just say something that’s hopeful if it isn’t entirely true. And so, the thing I tried to say, at least I can’t say what will be appropriate for someone else’s recovery, but my recovery, it has not been as fast as I wanted it to be. I think it’s so important to be transparent with people and say, I have suffered with this disorder far longer than I ever would’ve wanted to, but my life has become and is continuing to become far more than I once thought it was going to become. And so, there is that bittersweet hope in that, I think, is the most honest and encouraging thing I can say about my experience.

Kimberley: You’re such a shining bright light. Thank you for sharing that. I feel it. I’ve got goosebumps. I love when I get to interview people, I get goosebumps the whole time. I’m so grateful for you sharing all of these wisdoms that you’ve shared, and that’s what they are. They’re just such deep wisdom. Can we hear where people can hear more about you, learn about you? How can people get your stuff?

Micah: Yeah. Right now, I don’t have a ton going. I hope to have more going in the near future. But if people want to reach out to me on Instagram, they can find me at @mentalhealthmhe.

Kimberley: Okay. So amazing. I’ll make sure to link that in the show notes. Micah, it has been such a pleasure. Thank you for sharing all these amazing things. Thank you. Thank you.

Micah: Thank you so much for having me on. This was a wonderful conversation.

Kimberley: Oh, it makes me so happy. Thank you.

TALKING BACK TO ANXIETY

Welcome back, everybody. Today we’re talking about talking back to anxiety, and we’re really talking about the power of positive self-talk. 

Now I know when it comes to this idea of talking back to anxiety, it can get somewhat controversial. In fact, even talking about this idea of positive self-talk can be controversial, and I will be the first to say there is nothing worse than when you’re struggling with something that’s really painful. People say, “Oh, just be positive.” That is not what we’re talking about here today. In fact, I have a personal twist on how I like to consider a positive self-talk. You probably have heard me talk about it before, but I felt like it was time for me to revisit these concepts that I find so incredibly powerful when it comes to talking back to anxiety, or being positive, staying positive, engaging in some form of positive self-talk.

WHAT DOES TALKING BACK TO ANXIETY LOOK LIKE? 

Let’s talk about it. When we consider what we mean, when we say “talking back to anxiety,” what do I really mean by that? First of all, I want to get to one of the controversies. What I’m not saying is that when you have anxiety, you tell it to go away or stop, because we know that when we do that, when we try and suppress anxiety or we try to suppress our intrusive thoughts, it usually means we have more of them. Let’s just get that scientific fact out in the eye. We know that is true. But when we are talking about talking back to anxiety, when I’m talking about it, what I mean is, when you experience anxiety, whether that be in the form of sensations or in thoughts or feelings or images, how do you respond? How do you converse with your anxiety? 

I always make a metaphor with my clients, and I’ve done it here on the podcast before, that I always think of anxiety as this little short Lorax-looking guy that sits on my shoulder. For you, it might look different. But he sits on my shoulder and he’s in a beach chair and he is really lazy and he is wearing sunglasses, and he just wants to mess with me as much as he can, but in the most effective, lazy way. And how does he do that? He does it by knowing exactly what bothers me and throwing that at me first. He’s not going to throw some random thing at me. He’s going to go straight for the thing that he knows I value, because that’s where my anxiety is going to show up the most. And then when he shows up, it’s up to me then to be skilled in how I respond. One of the ways we respond is how we talk back to it.

The first thing I’m going to ask you is, when your anxiety tells you of the thing that you value, talks to you about the thing that scares you, that hits you right in the gut, how do you respond? Do you yell at him and say, “Get off my lawn, you horrible thing.” None of this is bad, I just want you to get to know. How do you respond? You say, “No, no, no, please go away. I don’t want you. I’ll do whatever you say. I’ll do whatever compulsion you tell me to do. I’ll avoid whatever you tell me to avoid if you just quiet down.” 

Some of this, instead of doing that, instead of yelling at anxiety, we yell at ourselves. We say, “What is wrong with you? Why are you always anxious? You’re a loser. You’re bad. What’s wrong with you? Something is seriously broken about you. Why have you got to have anxiety all the time?” You engage in a ton of self-criticism and self-punishment. The ones I just gave you are some negative self-talk examples like, “What’s wrong with you? You’re a loser. You’re such an idiot for having this anxiety. You’re stupid.” I want to remind you that you’re not. This is not about your intelligence; it’s not about who you are, what you are. Your anxiety has nothing to do with any of that. Some of us are just genetically prone to having more anxiety. But we use this negative self-talk. We use this criticism, this self-judgment to try and beat out the anxiety, as if we could beat it out of ourselves. But the facts are, this negative self-talk doesn’t motivate us to change because we were never in control at the start. We can’t control our anxiety and whether it shows up, so that doesn’t work. What we do know that does work is positive self-talk. It is one of the most successful ways of motivating ourselves. 

When anxiety does show up, I want you to explore how you might respond differently to whatever discomfort or whatever form of suffering you’re experiencing. It doesn’t even have to be anxiety. It might be pain, it might be stress, it might be sadness, any emotion. We can actually use these skills with any of these emotions. 

WHAT POSITIVE SELF-TALK IS NOT 

Let’s talk about what I mean by this. What does positive self-talk look like in my definition, not what you may have seen online. Number one, in my definition, positive self-talk—let’s talk about what it actually isn’t—it’s not just positive affirmations. While that’s great, and if that works for you, by all means, keep it. But for me, it never ever lands. I could say the world is safe and good things will happen, and I’m a good person. I could say that all day long and it would not land. It would do nothing for my anxiety. Literally, it just doesn’t. I’ve tried it and it really doesn’t work for me. 

Positive self-talk is also not just telling yourself to be happy or relaxed. That is a huge issue. Because if you’re having anxiety and you’re just telling yourself how you “should feel,” you’re only going to feel judged. You’re only going to feel less in control. You’re only going to feel more hopeless about the situation. 

HOW TO BECOME YOUR OWN KIND COACH 

We’ve talked about what it’s not, and I’m sure there’s other examples that I’ll probably think of here in a minute, but that’s what it’s not. But what it is, is talking to yourself in a voice that I call the kind coach. For those of you who have read The Self-Compassion Workbook for OCD, I talk about this a lot in that workbook, but I also teach this in the course Overcoming Anxiety and Panic, which is learning how to speak to anxiety in a way that motivates us, that leads us more towards our values and our beliefs, that disarms the anxiety. Instead of fighting it, it tends to the fact that you are experiencing something really, really, really uncomfortable. These are key components of overcoming anxiety and panic. In the course, we also go through cognitive changes, behavioral changes, a lot of tools, a lot of mindfulness, a lot of self-compassion. If you’re really wanting to do a deep dive, you can go and check out that course. Go to CBTSchool.com. The course specifically is called Overcoming Anxiety and Panic. But for today, let’s just talk about being a kind coach. 

A kind coach. If you were actually thinking about a coach that you’ve had in the past, or an ideal coach, if you were training for something, a marathon, let’s say, or a competition or something, a kind coach wouldn’t berate you for struggling, because we know, as we’ve already talked about, that beating yourself up and criticizing, it might propel you into some change, but it also creates more anxiety. We are here to try not to make more anxiety just for the sake of making more of it. We know that self-criticism isn’t beneficial. We know that telling someone of their faults and their weaknesses, that only makes us feel worse. It usually sends us into a shame response. When we go into a shame response, the normal human response is to slump over, to get really tired, to feel very unmotivated, to be stuck in this slow-moving body where everything feels heavy. That doesn’t help us. That makes it worse. 

The kind coach knows your challenges, but it also knows your strengths, and it uses your strengths to motivate and propel you towards the thing that you want. Let’s say you’re having anxiety. The kind coach would talk back to anxiety by saying, “I see you’re here. It’s cool. It’s okay that you’re here. I was planning on recording this podcast today at 11 o’clock, and I know you want to tell me about all the terrible things that might happen today, but I agreed that I was going to do this, and it’s really important to me that I do. You could come along, and I’m going to let you be there while I record this podcast.” 

Now, you might hear that none of this is me saying, “I’m going to record this podcast and I’m going to be happy and I’m not going to have any problems with it, and I’m going to finish it. I’m going to feel ecstatic and free and overjoyed.” That’s not what I’m talking about. That’s one example of positive self-talk, but that’s not what I am talking about today, and that’s not what I’m encouraging you to do. I’m encouraging you to learn to be the kind coach for yourself. Meaning you are the one who shows up for you when anxiety shows up. Often when we’re anxious, we step out of that role and we actually go to someone else to try and make us feel better. We go to someone else to reassure us. We go to someone else to soothe us. While there’s nothing wrong with that, we miss an opportunity to be there for ourselves, to be the one who soothes us, to be the one who says, “Hey, I see that you’re going through something hard. I see that this is uncomfortable for you.”

TALKING BACK TO ANXIETY: POSITIVE SELF-TALK EXAMPLES 

Now, to get a little deeper here, if we were really going to talk about positive self-talk examples, we would also include the kind coach reminding us that we can do hard things. When I think of positive self-talk, I don’t think of, “You’re the best, you’re great. Everyone loves you. You’re perfect.” I think of positive self-talk as being it believes in us, it believes in our ability to really settle into hard, uncomfortable things. 

In the world of social media, and a lot of you guys know I’m on Instagram a lot, I constantly see people saying, “The five quick tips for anxiety,” or “Heal your panic attack fast.” They’re selling you on quick fixes and making it easy. I don’t believe that that’s helpful. I think positive self-talk for anxiety shouldn’t be about saying it’s easy and quick to get over. It should be about saying, “You can do this. You can tolerate this. You can ride this wave of discomfort out. I believe you can because you’ve done it before,” or “I believe you can because humans are incredibly resilient. Even if you haven’t done it before, it’s a skill we will learn together.” That’s how a kind coach talks. 

Let’s say you’ve always avoided something and it creates so much anxiety for you. Basically, your brain is saying, “I’ll never be able to do that one thing.” My kind coach, if I really listened, would say, “I know you haven’t been able to do it in the past, but I have seen you in so many other areas overcome different things that you’ve never done, but then you were able to do it with practice and repetition and kindness and support. I do believe this is another opportunity for you to do that.” That’s what my kind coach would say, and this is something you can start to practice for yourself. 

If this is really hard for you, another way of doing it is saying, “What would a loved one say to me in this example?” And then you just practice saying it to yourself. But this is a grand gesture of self-compassion. It’s a grand gesture of encouragement, motivation, positivity that isn’t toxic, because we know that positivity can sometimes be so toxic and dismiss what we’re going through. This is not that.

Now, when we talk about talking back to anxiety, we may also have to practice this idea of talking back to depression too. What I’m going to encourage you to do here is use exactly the same tools. 

TALKING BACK TO DEPRESSION

Let’s talk about it. If you have depression, your brain is telling you these lies like, “You’re terrible. Nothing good is going to happen. There’s no point. You’re useless.” Talking back with positivity like you are the best, again, is not going to land. Saying, “You’re wonderful, you’re really great. Great things are going to happen,” some people find that really beneficial. If that’s you, by all means, keep using it. It’s incredibly powerful. But for a lot of us folks, that won’t land. I find it really much more beneficial to talk back to anxiety and depression with this kind coach voice, someone who coaches us through the depression while it’s there, because it’s going to be there. It is here. There’s no point in telling ourselves just to be happy because it is here. I find it to be so incredibly helpful. 

TALKING BACK TO OCD

Now, in addition, there is also some controversy around talking back to OCD. A lot of people say, “Doesn’t that become compulsive? Doesn’t that get in the way of the actual foundation of ERP?” Well, what I will say is, once again, it depends on how you’re doing it. If you’re talking back to OCD, which we know is a disorder of uncertainty and doubt, if you’re talking back by going bad things won’t happen, “No, you’re fine. Nothing bad is going to happen,” well then yes, you will be engaging in compulsive self-reassurance or reassurance in general. 

But what I’m talking about here when it comes to talking back to anxiety, specifically related to OCD, is the kind coach will say, “I believe you can handle hard things. Just a few more minutes, let’s ride this wave of discomfort out. Can you tolerate another 10 minutes of uncertainty?” Instead of saying it as a question, it might say, “Let’s do it. Let’s try for another two minutes not engaging in that compulsion.” You’re talking to anxiety, you’re talking to depression, you’re talking to OCD, but you’re not doing it in a way that dismisses how hard it is. You’re not doing it in a way that overlooks the actual reality. Meaning you’re not saying, “Just be happy,” or “Just ignore it,” or “Just think about something else.” You’re not doing it in a way that creates compulsive behaviors that keep you stuck. 

The kind coach encourages you to keep trying. It validates that you’ve had a hard time and that this is hard. It reminds you of your strengths, whatever that is. Maybe it tells you you’re resilient or you’ve done it before. It might gently remind you to use your humor if humor is something that you’re really good at doing. It might remind you of any strength you have. It won’t use your challenges against you. It’s radically, absolutely, unconditionally there for you, even on the low days. It encourages you to just go a little further, try a little bit more, but not in our “get down and give me 20 pushups” way like our mean coach would. It’s saying it in a way that feels doable and motivating and kind. 

That’s what I want you to practice. This, guys, is a skill that you have to practice. Meaning you won’t do it for a couple of hours and then feel on top of the world. Again, this is not about ridding you of your reality of true discomfort. It’s something we practice every day during the easy times and the hard times. This is how we talk back to anxiety. This is the power of positive self-talk when used correctly. 

That’s it. That’s what I want you to practice. What I would do with me, because I’m a little bit of a track it kind of girl, is I would encourage you to track it. To track when you were engaging in the kind coach, what did the kind coach say? I would also track when other people act as the kind coach, maybe a loved one, a family member or a boss, a colleague, a friend—really track what it is that they said to you that helped you propel yourself towards behaviors that are positive in your life and use those to help you really strengthen your own kind coach voice. You may also want to track when you get caught up in self-criticism. Because that too, sometimes when you’re tracking it, it helps us be more aware of it. When we’re more aware, we can catch it sooner and intervene sooner. 

That’s what I would encourage you to do. If you don’t like tracking, that’s fine. I don’t want to push you in a direction that doesn’t work for you. As you always know, I just want you to take what’s helpful here and leave what’s not. But this is a skill I really hope that you do engage in and start to practice. 

If you’re interested in any of the courses I’ve mentioned today, please go to CBTSchool.com. You can also go to my private practice website, which is KimberleyQuinlan-LMFT.com. I am a therapist with nine therapists who work for me, helping people with OCD and anxiety. We are in Calabasas. I would love to connect further with you there. 

Have a wonderful day, everybody, and remind yourself that it is a beautiful day to do hard things.

The Content Of Your Thoughts Are Not Important

One of the biggest struggles my clients have is when they get caught up in the belief that their specific intrusive thoughts or fears warrant LOTS of attention and moral weight.   

This is one of the most difficult things to manage when you are struggling with significant anxiety.  We can see that other peoples fears are irrational, but when it comes to our specific fear, we become unglued, confused and reactive.

Here are a few questions that I want you to ask yourself before listening to this podcast.

Have you caught yourself saying any of the following?

1.  “It's easy for you to say to, "just accept the thoughts".   You don’t have thoughts about hurting someone all day like I do (insert here whatever thought you are obsessing or ruminating on).  This thought is WAY worse than other thoughts.”

2. “This isn’t any old thought.  This would destroy my life if this thought came true.”

3. “I know I have to accept the uncertainty, but this isn’t just a thought”

These are all examples of getting caught up in our thoughts content.

When we get caught up in the CONTENT of our thoughts we can get stuck in a cycle of anxiety.

When we give our thoughts all of this attention and value, our brains become hypervigilent and get even more worked up about the presence of these thoughts, feelings, and sensations.  Please note here,  I am in NO WAY telling you this is your fault.  This is just the way our brains work.    We also have be to careful about our narrative about this thought.  If we tell ourselves the thought is "bad", that triggers self-judgment, shame and self-doubt. Then we are off and running, judging ourselves more and putting ourselves down.

Listen to the podcast to hear my FIVE STEPS to help when you are getting caught in the content of your thoughts.

At the end of the podcast, I offer a little Challenge for you.

Observe your thoughts and ask yourself if you could start to make any of these changes in your life.

If you do notice that you are giving too much weight to a thought, try to practice Non-judgment (Ep 1) or Beginners Mind (ep 6) or What you say to yourself Matters (ep 17).

Thank you again for supporting me with this podcast and with CBT Schools online courses.  Please click here to find out more about Mindfulness School for OCD.