Podcasts about body focused repetitive behaviors

In this episode, hosts Dr. Elizabeth McIngvale and Cali Werner explore body-focused repetitive behaviors (BFRBs) like hair-pulling and skin-picking with Dr. Suzanne Mouton-Odum, a leading expert in cognitive-behavioral therapy (CBT). They discuss the science behind BFRBs, the importance of comprehensive treatment, and how to reduce shame while promoting self-regulation. Whether you're a professional, a parent, or someone experiencing these behaviors, this episode is packed with insights and actionable advice to foster understanding and support.Key Points:[0:00] - Introduction to Anxiety and Today's TopicElection Day sets the stage for a candid conversation about anxiety, self-regulation, and the challenges of navigating tense moments.[8:15] - What Are BFRBs and Why Do They Matter?Dr. Mouton-Odum defines BFRBs as self-regulation behaviors and dives into their complexity, including their emotional, sensory, and psychological triggers.[17:50] - Dispelling Myths About Trauma and BFRBsA discussion on why BFRBs are often misunderstood and not always linked to past trauma, emphasizing the importance of targeted treatment.[27:00] - Comprehensive Behavioral Treatment (Comb)Exploring the core principles of Comb therapy, including sensory, cognitive, emotional, motor, and environmental factors.[43:30] - Breaking the Shame Cycle and Promoting AwarenessHow understanding the function of behaviors can reduce shame and foster effective treatment for individuals struggling with BFRBs.Quotable Moments:[7:30] “Anxiety isn't dangerous; it's uncomfortable, but it's part of living.”—Cali Werner[20:45] “You are not the sum of your anxiety, OCD, or hair-pulling. You are a whole human being.”—Dr. Suzanne Mouton-Odum[47:15] “Shame impacts the whole person. Addressing the behavior is just the beginning.”—Dr. Suzanne Mouton-OdumLinks Mentioned: • TLC Foundation for Body-Focused Repetitive Behaviors: www.bfrb.org • Anxiety Society Podcast Website: www.anxietysocietypodcast.comDr. Mouton-Odum's expertise highlights the importance of addressing both the behaviors and the shame associated with BFRBs, while empowering individuals with practical tools. If you or someone you know struggles with BFRBs, this episode provides hope, insight, and actionable strategies. Don't forget to subscribe, and join the Anxiety Society community to continue this important conversation.

In this episode, hosts Ash and Dusty dive into the topic of Body-Focused Repetitive Behaviors (BFRBs), which are common among individuals with ADHD. They discuss behaviors such as skin picking, nail biting, and hair pulling, highlighting how these actions serve as manifestations of underlying hyperactivity and sensory issues. Dusty shares personal anecdotes about her struggles with nail biting and cuticle peeling, emphasizing the importance of understanding the triggers and habitual patterns that lead to these behaviors. Ash adds insights into how daily routines and grooming practices can help mitigate these tendencies by addressing the sensory discomfort that often drives them. The hosts explore practical solutions for managing BFRBs, ranging from habit reversal techniques to the use of fidgets and sensory aids. They emphasize the importance of maintaining a balanced lifestyle with adequate sleep, exercise, and self-care to reduce the occurrence of these behaviors. By engineering a life that aligns with the needs of an ADHD brain, individuals can better manage their attention and reduce stress, ultimately decreasing the frequency of BFRBs. Ash and Dusty encourage listeners to cultivate an awareness of their habits and to implement small changes that can lead to significant improvements in managing repetitive behaviors. Episode links + resources: Join the Community | Become a Patron Our Process: Understand, Own, Translate. About Asher and Dusty For more of the Translating ADHD podcast: Episode Transcripts: visit TranslatingADHD.com and click on the episode Follow us on Twitter: @TranslatingADHD Visit the Website: TranslatingADHD.com

Kate Blake @kate_blake_author grew up in the United States, moved to South Korea then Japan, and now lives in Australia with her husband, daughter, and two rescue dogs. She's had trichotillomania for over 20 years—since she was 13 years old. She recently published the book BFRBs for Kids: A Gentle Introduction to Body-Focused Repetitive Behaviors, an affirming, non-judgmental book for little ones with BFRBs.Get a copy of Kate's book here!—This episode is brought to you by HabitAware. My Keen2 brings awareness to my trichotillomania by giving my wrist a gentle hug or vibration when I'm doing the scanning behavior. Bring awareness into your life by visiting barbaralally.com/habitaware and use code LALLYLOVE for 10% off sitewide!Did you know HabitAware also offers virtual peer coaching? This one-to-one peer-based program will coach you through shifting mindset, practicing healthy strategies and creating your personal roadmap to recovery. To work with me, Ellen or Aneela, head over to habitaware.com/coaching today.—Thank you so much for listening to this episode of Trich Talks.Begin your journey to self-acceptance with trichotillomania by enrolling in my course, Sharing Our Stories. Sharing Our Stories does a deep dive into your relationship with trichotillomania by using my guided journal, My Trichster Diaries, as our workbook. You can learn more at barbaralally.com

In this episode, we explore the use of memantine in treating trichotillomania and skin picking disorder. Could this common Alzheimer's medication be the breakthrough we've been waiting for in managing body-focused repetitive behaviors? Dr. Bob Hudak discusses a promising study that offers new hope for patients struggling with these often-overlooked conditions. Faculty: Robert Hudak, M.D. Host: Richard Seeber, M.D. Learn more about our membership here Earn 0.5 CMEs: Quick Take Vol. 60 Efficacy of Memantine in Treating Trichotillomania and Skin-Picking Disorder

Join your host, Nicole Morris, LMFT and Mental Health Correspondent as she kicks off the annual OC-Related Disorders (OCRDs) Series! Nicole starts with guest experts, Dr. Marla Deibler, PsyD, & Dr. Renae Reinardy, PsyD. Together, they explore the nuances of BFRBs, discussing how these behaviors function as coping mechanisms and the importance of individualized, compassionate treatment. This episode touches on how BFRBs impact individuals and their families, touching on parenting strategies, treatment models and adult relationships. Join the conversation, as we unpack the complex nature of BFRBs, offer valuable insights, resources and a whole lot of hope!

Stacy Nakell, LCSW, explores the importance of skin-based connection in early attachment, the role of touch in physiological and emotional regulation, and the development of body-focused repetitive behaviors like skin-picking and trichotillomania. Interview with Elizabeth Irias, LMFT. Earn CE credit for listening to this episode by joining our low-cost membership for unlimited podcast CE credits for an entire year, with some of the strongest CE approvals in the country (APA, NBCC, ASWB, and more). Learn, grow, and shine with Clearly Clinical Continuing Ed by visiting https://ClearlyClinical.com.

My guest this week is Dr. Marla Deibler, a clinical psychologist who specializes in treating anxiety. We discussed her excellent new book, The BFRB Recovery Workbook (affiliate link). Check out the publisher's website where you can download many free worksheets and resources. Topics we discussed included: When a body-focused repetitive behavior becomes a diagnosable disorder Common physical consequences of BFRBs Behaviors associated with the hair-pulling of trichotillomania, a type of BFRB The buildup of hair in the digestive system (trichobezoar) from ingesting hair What makes BFRBs so hard to stop The rewarding feeling that often accompanies BFRBs Fixing something with a BFRB that doesn't feel quite right Why willpower alone is usually not enough to stop BFRBs Ambivalence in the process of change: wanting to change and not wanting to change The importance of a functional analysis to understand what drives behaviors Wanting to jump to fixing a problematic behavior before understanding it The importance of awareness for treatment Practicing incompatible responses to interrupt the habit of BFRBs The relation of BFRBs to OCD and other types of compulsive behaviors The important role of acceptance and Acceptance and Commitment Therapy (ACT) The problems of using punishment to shape behavior Marla W. Deibler, PsyD, ABPP, is a Licensed Clinical Psychologist, Board-Certified in Behavioral and Cognitive Psychology, and Founder/Executive Director of The Center for Emotional Health of Greater Philadelphia. Marla serves on the Faculty of the Behavior Therapy Training Institute (BTTI) of the International OCD Foundation. She serves as President of the Board of Directors of OCD NJ, the NJ affiliate of the IOCDF, Consultant for the New Jersey Center for Tourette Syndrome, Visiting Clinical Supervisor at the Rutgers University Psychological Services Clinic, and Executive Council member of the ACBS OCD SIG. She is co-author of The BFRB Recovery Workbook: A Step-By-Step Guide to Effective Recovery from Hair Pulling, Skin Picking, Nail Biting, and Other Body-Focused Repetitive Behaviors. Find Marla online at her website.

As you'll discover in this episode, body image or body dysmorphia, as it is often commonly referred to, is not the same as Body Dysmorphic Disorder (BDD). Robyn Stern a LCSW and therapist, joins me to define the key variables and signs that can make a significant difference in identifying, seeking and getting the right kind of effective support. She'll also share her own lived experience with BDD, how to discuss when you have concerns about BDD, and common misconceptions that can cause harm. Parents, this episode is a must-listen as it provides guidance on how to approach conversations about body image and BDD with your teens, ensuring they feel supported and understood. Robin highlights the importance of creating a safe space for open dialogue and seeking professional help when needed.   Robyn Stern is a licensed clinical social worker (LCSW) and therapist providing services since 2012 in Florida, New York, New Jersey, and California. She has double Masters, one in Social Work and the other in Counseling Education. Robyn is also professionally trained in CBT/ERP, ACT, DBT, Habit Reversal Training and Trauma Informed Therapy practice. Quick Links - for more about Robyn and her services, plus additional information on BDD: Website: https://www.rlsterntherapy.com International OCD Foundation(IOCF) on BDD: https://bdd.iocdf.org BDD Foundation, UK: https://bddfoundation.org The TLC Foundation for Body Focused Repetitive Behaviors: https://www.bfrb.org   Parents: Grab a copy of my FREE Parent Guide on spotting unhealthy teen eating behaviors  and how you can help, click here! Website: leslierosecoaching.com for more teen health and wellness info and coaching programs. Instagram: @Leslierosecoaching - DM with comments, questions or guest requests. Before you go: Rate & review my podcast. It helps me reach more parents and teens, seeking relevant youth-specific health and wellness information.  

Imagine a world where children with OCD and Tourette's can manage their symptoms without relying solely on medications. In this episode of Pediatric Meltdown, we explore innovative interventions like Habit Reversal Training and ERP Therapy that offer new hope for young patients. Dr. Lia's guest is a listener's favorite, Dr. Colleen Cullinan. She has a gift for taking you inside the child's mind and telling you exactly what they're thinking. She'll talk about the profound impact of intentional, compassionate care and the crucial role of family support in the treatment process. Tune in to discover effective strategies for tackling the emotional and psychological struggles these children face and how these methods pave the way for lasting improvements. [03:13 -17:21] Understanding Isolation and Negative Reinforcement in Mental HealthConcept of breaking the cycle of negative reinforcement and the importance of compassionate interventions.Connection between emotional regulation in various scenarios and therapies like cognitive behavioral therapy and acceptance and commitment therapy.Discussion on how the brain's problem-solving nature struggles with internal experiences, leading to anxiety.Therapies offer solutions that counter the brain's intuitive problem-solving approach.[17:22 - 29:42] Exposure and Response Prevention (ERP) for OCD Emphasis on intentionally facing fears without engaging in compulsive behaviors.Insights into how ERP can be rewarding for families affected by OCD.Challenges and solutions in treating internal obsessions and related mental compulsions.Significance of ERP in helping individuals understand their fears are not dangerous.[29:43 - 41:52] Nonpharmacologic Therapies for OCD, Tics, and Tourette'sOverview of therapies like exposure and response prevention, habit reversal training, and comprehensive behavioral intervention for tics.Discussion of the non-logical and visceral nature of these behaviors and breaking the cycle of negative reinforcement.Strategies for managing compulsive skin picking, including competing responses and awareness.Practice and gradual exposure to triggers as critical parts of treatment.[41:53 - 55:12] Resources and Tools for Comprehensive Behavioral Intervention for TicsIntroduction to CBIT as a detailed treatment involving awareness building and breaking down tics.Challenges in finding CBIT-trained therapists and resources to locate such providers.Mention of the Tourette Association of America and the TLC Foundation for Body Focused Repetitive Behaviors.University training programs in clinical psychology as potential access points for therapists trained in habit reversal training.[55:13 - 59:58] Closing segment TakeawaysLinks to resources mentioned on the showInternational OCD Foundation: https://iocdf.org Tourette's Association of America: https://tourette.orgTLC Foundation for Body-Focused Repetitive Behaviors https://www.bfrb.orgAACAP Facts for Families OCD:

In this episode of The Healers Café, Manon Bolliger, FCAH, RBHT (facilitator and retired naturopath with 30+ years of practice) speaks with Liz Fisher about how tapping therapy can help in addressing emotional obstacles to reshape the subconscious mind. Liz offers personal anecdotes and useful advice for integrating these practices into everyday routines. For the transcript and full story go to: https://www.drmanonbolliger.com/liz-fisher   Highlights from today's episode include: Liz Fisher  And it's, it's hard to get to the main, the root of the problem without being specific. So the more you know about the condition, or you know, the better it is. Liz Fisher  That's very specific part of me feels like I can't let go of this. It feels like a good friend. It feels like something I've known my whole life, it would be very uncomfortable. Okay, so we can tap on that. But that might not clear the problem. And how that works is we would know if that's the main core issue, or if there are other aspects that come up around that. Liz Fisher  There isn't a, you know, the same answer for everyone. But it works kind of in layers. It's like peeling an onion. So whenever comes up, then we work on it. It might take four sessions for someone it might take, you know, a year, everyone's different.   ABOUT DR DAVID LEMMON, ND Dr David Lemmon is a Naturopathic Doctor and an alumnus of National College of Natural Medicine in Portland, Oregon. He has a deep and abiding faith in the human body and its abilities to heal. His practice emphasis is in supporting his patients through safe and natural treatments for chronic pain, mental health, cancer, autoimmune conditions, and more. He has advanced training in nutrition, herbal medicine, frequency medicine, and homeopathy. He has worked with hundreds of patients throughout the country. He is the author of Natural Home & Herbal Healing, a guided tour through the healing remedies in your home. He invites all to open their hearts and minds to the infinite possibilities of health, balance, and healing that nature has in store. Dr Lemmon approaches health with the basic premise that every human body has unique needs and challenges. By addressing the entire body-mind system, the patient is able to overcome many challenges that were previously thought incurable. Dr David and his wife are the proud parents of 6 children. He has a passion for teaching the principles of health, nature, and empowered living. When not working with patients, he enjoys painting, reading, movies, cooking, martial arts, weight training, hiking, and camping. Core purpose/passion: I am on a mission to impact the lives of over 10,000 cancer patients each year. Website | Facebook | YouTube    ABOUT MANON BOLLIGER, FCAH, RBHT  As a de-registered (2021) board-certified naturopathic physician & in practice since 1992, I've seen an average of 150 patients per week and have helped people ranging from rural farmers in Nova Scotia to stressed out CEOs in Toronto to tri-athletes here in Vancouver.  My resolve to educate, empower and engage people to take charge of their own health is evident in my best-selling books:  'What Patients Don't Say if Doctors Don't Ask: The Mindful Patient-Doctor Relationship' and 'A Healer in Every Household: Simple Solutions for Stress'.  I also teach BowenFirst™ Therapy through and hold transformational workshops to achieve these goals. So, when I share with you that LISTENING to Your body is a game changer in the healing process, I am speaking from expertise and direct experience". Manon's Mission: A Healer in Every Household!  For more great information to go to her weekly blog:  http://bowencollege.com/blog.  For tips on health & healing go to: https://www.drmanonbolliger.com/tips    Follow Manon on Social – Facebook | Instagram | LinkedIn | YouTube | Twitter | Linktr.ee | Rumble   ABOUT THE HEALERS CAFÉ:  Manon's show is the #1 show for medical practitioners and holistic healers to have heart to heart conversations about their day to day lives.   Subscribe and review on your favourite platform: iTunes | Google Play | Spotify | Libsyn | iHeartRadio | Gaana | The Healers Cafe | Radio.com | Medioq |   Follow The Healers Café on FB: https://www.facebook.com/thehealerscafe     Remember to subscribe if you like our videos. Click the bell if you want to be one of the first people notified of a new release.   * De-Registered, revoked & retired naturopathic physician after 30 years of practice in healthcare. Now resourceful & resolved to share with you all the tools to take care of your health & vitality!  

Stacy K. Nakell is a licensed clinical social worker, certified group psychotherapist, certified clinical trauma practitioner, and author. She has spent the past fifteen years in private practice in Austin, TX, providing individual and group psychotherapy to clients struggling with body-focused repetitive behaviors (BFRBs).  In this episode of the Practice of Therapy Podcast, Stacy advocates for recognizing body-focused repetitive behaviors (BFRBs) as distinct from OCD due to their unique characteristics. Frustrated with the sole focus on cognitive behavioral therapy (CBT) by the Trichotillomania Learning Center, she turned to psychodynamic therapy to explore the root causes of her own behaviors, leading her to write "Treatment for Body-Focused Repetitive Behaviors." Her book promotes an integrative psychodynamic approach that combines body awareness and cognitive and behavioral elements and emphasizes the therapeutic relationship. Through a case study, Stacy illustrates how therapy can help patients process trauma and develop self-compassion. She suggests BFRBs often arise in individuals with physiological sensitivity and nervous system dysregulation, worsened by family stress and internalized emotions. Stacy calls for a trauma-informed approach to uncover and address underlying emotions for more effective and lasting treatment. Resources Mentioned In This Episode:  Read the full show notes here The Practice of Therapy Collaborative Use the promo code "GORDON" to get 2 months of Therapy Notes free Treatment for Body-Focused Repetitive Behaviors Stacy's Website Start Consulting with Gordon The PsychCraft Network The Practice of Therapy Community Instagram Mental Health Templates Mental Health Wear

In this show, Stacy Nakell, author of the new and important book, Treatment for Body-Focused Repetitive Behaviors: An Integrative Psychodynamic Approach, provides answers with compassion, theoretical understanding and clinical examples from 20 years of professional experience. Stacy considers the who, what and why of the people who suffer with these behaviors and what happens when they receive help. Using pseudonyms with the permission of former patients, Stacy Nakell draws upon real stories of those who have worked with her to address Body Focused Repetitive Behaviors. She discusses how working together, she and her patients trace the life events and steps that led to the start of their Body Focused Repetitive Behaviors, the struggle to understand the use of this behavior, the development of new regulation skills and the success of slowly giving up what was once as soothing as it was painful. Stacy speaks from a place of personal experience, use of a powerful methodology and an investment in patients that has truly helped them. This show will be informative to those suffering, the professionals who care for them and the families who love them.

In this show, Stacy Nakell, author of the new and important book, Treatment for Body-Focused Repetitive Behaviors: An Integrative Psychodynamic Approach, provides answers with compassion, theoretical understanding and clinical examples from 20 years of professional experience. Stacy considers the who, what and why of the people who suffer with these behaviors and what happens when they receive help. Using pseudonyms with the permission of former patients, Stacy Nakell draws upon real stories of those who have worked with her to address Body Focused Repetitive Behaviors. She discusses how working together, she and her patients trace the life events and steps that led to the start of their Body Focused Repetitive Behaviors, the struggle to understand the use of this behavior, the development of new regulation skills and the success of slowly giving up what was once as soothing as it was painful. Stacy speaks from a place of personal experience, use of a powerful methodology and an investment in patients that has truly helped them. This show will be informative to those suffering, the professionals who care for them and the families who love them.

Tamara Harrison is a counselor based in Seattle, Washington. Her specialty in treating patients lies in OCD, Anxiety, and Body-focused repetitive behaviors (BFRB's). She utilizes Exposure & Response Prevention (ERP) in treating patients suffering from OCD, and Habit Reversal Training (HRT) for patients with BFRB's. Tamara takes on  a warm, understanding, & empathetic approach based on proven techniques to treat her patients. In this episode we talk about:  ◾️ Understanding Body-focused repetitive behaviors and its relation to mental health ◾️ Treating BFRB's with Habit Reversal Training ◾️ Identifying whether or not your movements are BFRB's Find Tamara here: Tamara@evergreenstatecounseling.com psychologytoday.com Find Zach here: zachwesterbeck.com @zach_westerbeck This podcast is made possible by NOCD. NOCD offers effective, affordable, and convenient OCD therapy. NOCD therapists are trained in Exposure Response Prevention, or ERP, therapy, the gold standard treatment for OCD. With NOCD, you can do virtual, live face-to-face video sessions with one of their licensed, specialty-trained therapists, and they accept most major insurance plans. If your insurance isn't covered, mention discount code ZACH100 for a special $100 rate for the next two months. To find out more about NOCD, visit zachwesterbeck.com/virtual-ocd-therapy/ to book a free 15-minute call. Zach Westerbeck is not a licensed medical professional. Zach Westerbeck is not trained in diagnosing psychological or medical conditions. Zach Westerbeck is not a substitute for medical care or medical advice. If you require assistance with any mental health or medical issue, please contact your health care provider for any medical care or medical advice. Zach Westerbeck makes no guarantees of any kind that the information or services provided by Zach Westerbeck will improve the client's situation. This podcast should not be considered medical advice. Please seek professional assistance from a licensed professional. Zach Westerbeck (https://zachwesterbeck.com/virtual-ocd-therapy/) Virtual OCD Therapy - Zach Westerbeck I've partnered with NOCD to bring you effective, affordable and convenient OCD therapy.

    About our guest Adele Dumont is an Australian writer and critic. Her work has appeared in Griffith Review, Meanjin, Southerly, ABR, and Sydney Review of Books. Adele's first book, No Man is an Island, is an account of her experiences teaching English to asylum seekers in detention. Her second book, The Pulling, is a work of memoir charting her experience of trichotillomania. Adele's Twitter Adele's website   Representations  Bezoar by Guadalupe Nettel, translated by Rahul Bery   Resources TrichStop website TLC Foundation for Body-Focused Repetitive Behaviors website   How to find us  Join our private Facebook community Follow us on Instagram Follow us on Twitter Check out our website Shoot us an email to differentlybrainedpodcast@gmail.com Follow our personal stuff - @jacintadietrich & @ruthooftheloch   About the podcast Differently Brained shares the opinions of individuals and does not consider your personal circumstances. Differently Brained exists purely for information purposes and should not be relied on as health or medical advice. Because no brain is the same, please consult your healthcare professional for your personal medical needs. The Differently Brained team acknowledge the traditional custodians of the lands on which we record, edit and stream this podcast. We pay our respects to all First Nations peoples and their Elders part, present and emerging. We extend that respect to all First Nations cultures and their ongoing connection to the lands, waterways and communities.  

Research shows that somewhere between 2 and 6% of the population struggles with BFRBs at a clinical level, which can include behaviors like hair-pulling, skin-picking, and nail-biting (among others). What differentiates BFRBs from other self-grooming behaviors, though, is the unintentional harm they cause to the body and the lack of successful efforts to stop them. To gain a better understanding of these difficult-to-control behaviors that can have detrimental effects on mental and emotional well-being, Michael interviewed clinical psychologists Marla Deibler and Renae Reinardy. If you're looking to recover from body-focused repetitive behavior, Marla and Renae, who coauthored The BFRB Recovery Workbook, are here to provide up-to-date behavioral science and evidence-based tools specifically tailored to meet your individual needs and help you transform your life for the better! Listen and Learn:  What are body-focused repetitive behaviors (BFRBs)?  The stigma and dismissive attitude surrounding BFRBs How prevalent are BFRBs?   WTF: What is the function of BFRBs? The importance of viewing change as a process rather than a final outcome  Techniques for experiencing shame, emotional avoidance, and response prevention How to deal with inevitable setbacks Resources:  Order your copy of The BFRB Recovery Workbook: https://a.co/d/5pFMEGM Marla's Links: Website: https://thecenterforemotionalhealth.com/ Facebook: https://www.facebook.com/thecenterforemotionalhealth Instagram: https://www.instagram.com/ceh_philadelphia/ "X": https://twitter.com/DoctorDeibler LinkedIn: https://www.linkedin.com/in/marla-deibler-psyd-abpp-a220851a/ BlueSky: https://bsky.app/profile/doctordeibler.bsky.social Renae's Links: Lakeside Center for Behavioral Change: https://lakesidecenter.org  Facebook: https://www.facebook.com/r.reinspi Courage Critters: https://couragecritters.com Related Episodes:  167. Get Curious and Change Unhealthy Habits with Judson Brewer 188. Unwinding Anxiety with Judson Brewer 4. Habits: The Science of Behavior Change (Part 1) 5. From Awareness to Action: Behavior Change (Part 2) Learn more about your ad choices. Visit megaphone.fm/adchoices

Join your host, Nicole Morris, LMFT and Mental Health Correspondent, as she welcomes Ruth Golomb, M.Ed., LCPC, BFRB and OCD Specialist, to our family table for Part I of our 2nd Annual OCD-Related Disorder (OCRD) Series! Ruth is an accomplished author, practitioner, and she serves on the Scientific Advisory Board for the TLC Foundation for Body Focused Repetitive Behaviors. And today we're talking all about what BFRB's are, approaches to treatment, and how they impact the fam and loved ones of OCRD warriors. So join the conversation! Because not only is there a lot of helpful learning, but there's lots of HOPE too.

Anita agrees to a suggestion posed by a listener: Explore why the hair-pulling disorder trichotillomania is so taboo. She talks with an artist who started pulling their hair more than two decades ago but only recently told her parents…after publishing part of their story in a national news outlet. A psychologist on the front lines of studying trich treatment talks about the importance of acceptance; and a hairstylist with trich takes us into why her salon is a safe haven for other folks with hair loss. Meet the guests: - Haruka Aoki, a poet and illustrator who published a comic about their trichotillomania journey in The Washington Post, shares what it was like to learn a term for the disorder later in life - Dr. Suzanne Mouton-Odum, a licensed psychologist and board member for the TLC Foundation for Body-Focused Repetitive Behaviors, describes her counseling work with folks who experience trich - Dorin Azérad, a hair loss hairstylist, shares how her ongoing journey with trich shapes the services she offers to other folks with hair loss at her salon Read the transcript | Review the podcast Follow Embodied on X and Instagram Leave us a message for an upcoming episode here! Dive deeper: - Self-Care Provider Directory for folks with BFRB - The TLC Foundation on Trich - Haruka's children's book “Fitting In”

Dr. Laura Chackes, Psy. D. explains what therapists need to understand about treating Body-Focused Repetitive Behaviors (BFRB's). The most common BFRB's being Trichotillomania, aka hair pulling, and Excoriation, aka skin picking.Laura Chackes, founder and owner of The Center for Mindfulness & CBT in St. Louis, is a licensed psychologist who specializes in the treatment of children, adolescents, and adults with OCD and body-focused repetitive behaviors (BFRBs). Dr. Chackes is a leading expert in the treatment of BFRBs such as skin picking and hair pulling. She has been running treatment groups for children, adolescents, and adults in St. Louis for over 10 years, and teaches courses online to adults with BFRBs, as well as to train therapists how to treat these disorders. Her mindfulness-based cognitive behavioral therapy approach has led hundreds of BFRB sufferers to long-term symptom relief.Dr. Chackes is also a fierce advocate working to spread awareness of BFRBs in order to reduce the shame and isolation that comes from the public's lack of knowledge of these disorders. Her Facebook group, Overcoming Skin Picking and Hair Pulling: Help for BFRBs, has connected over 4000 BFRB sufferers, parents, and therapists to learn more about how they can best support one another.OFFERS & HELPFUL LINKS:Dr. Laura Chackes Online Training for Therapists Jennifer Agee coaching pageDestination Continuing Education Facebook communityCounseling Community Instagram

In the realm of mental health treatment, the evolution of therapeutic approaches is an ongoing journey marked by innovation and discovery. One such breakthrough that has been gaining prominence in recent years is Inference-Based Cognitive-Behavioral Therapy (I-CBT). This cutting-edge approach offers a fresh perspective on how we understand and address our obsessional reasoning process. In today's episode of The OCD Whisperer Podcast, we are joined by Amanda Petrik-Gardner, a true expert in the treatment of OCD and related disorders. One of the key points we discuss is the difference between obsessional doubt and reasonable doubt. Amanda really emphasizes the importance of recognizing whether our doubts are based on direct evidence or our imagination running wild. It's all about distinguishing between what's real and what's not. We also touch on the concept of inferential confusion. This is when we arrive at conclusions based on a reasoning process that is based on imagined scenarios, making it difficult to trust our own senses and perceptions. But fear not, because Amanda introduces us to the concept of reality sensing. It's all about regaining that trust in ourselves and our own experiences.   In This Episode [01:19] Obsessional doubt versus reasonable doubt [07:57] Inferential confusion and its resolution [09:12] The role of senses in OCD [11:23] Using reality sensing in therapy [13:19] Comparison of inference-based CBT with exposure therapy [18:57] The role of imagination in OCD [18:45] Resources for learning about CBT [20:03] Accessing the online class "Be OCD Free”.   Notable Quotes [05:27] “We don't tend to act on possibilities until something in the present moment tells us to do so. Once we get that information now, it's reasonable to act on it.”  Amanda  [07:41] “Inferential confusion is a fancy word just to say we are confusing reality for imagination. We're distrusting our senses. We're over-relying on possibilities. We're taking things like facts and using them in and out of context.” - Amanda  [13:43] “If we can change the doubt, then everything that follows after the doubt is resolved. But what I mean by that is after the doubt comes the fear, the anxiety, and then the compulsion. If we can address the doubt from the beginning, then none of the rest even happens.” - Amanda   Our Guest Amanda Petrik-Gardner Amanda Petrik-Gardner, LCPC, LPC, LIMHP, is a seasoned Licensed Clinical Professional Counselor spanning Kansas and Maine, and Licensed Professional Counselor across Arizona, Colorado, Michigan, and Missouri. She's also the creator of the OCD Exposure Coloring Book. With expertise in OCD, anxiety, and Body Focused Repetitive Behaviors, Amanda offers teletherapy in several states including Florida, facilitating transformative counseling.   Resources & Links Kristina Orlova, LMFT https://www.instagram.com/ocdwhisperer/ https://www.youtube.com/c/OCDWhispererChannel https://www.korresults.com/ https://www.onlineocdacademy.com Amanda Petrik-Gardner https://www.amandalcpc.com/ https://www.facebook.com/AnxietyOCDTreatment https://www.instagram.com/anxietyocdtreatment https://twitter.com/AnxietyOCDTx **Disclaimer**   Please note, while our host is a licensed marriage and family therapist specializing in OCD and anxiety disorders in the state of California, this podcast is for educational purposes only and should not be considered a substitute for therapy.   Stay tuned for bi-weekly episodes filled with valuable insights and tips for managing OCD and anxiety. And remember, keep going in the meantime. See you in the next episode!

Chris finishes the series on SCAMP and the Body Focused Repetitive Behaviors. In this episode, he focuses on the last two trigger-categories (Movement and Place) represented in the acronym. This episode was made possible by NOCD. Feel free to reach out with any question you might have to chrisleins04@gmail.com. If you've found OCD Straight Talk helpful, consider giving it a 5-star rating, and subscribing to the podcast for more structured help with your anxiety and OCD-symptoms.

On episode 21 of A Chat with Uma, I speak with Kimberley Quinlan, LMFT! Kimberley is a Licensed Marriage and Family Therapist (LMFT) and public speaker who is the host of Your Anxiety Toolkit podcast, founder of CBT School, and owner of Kimberley Quinlan (A Marriage and Family Therapy Corporation) in Los Angeles, CA.  She is passionate about the treatment of Obsessive-Compulsive Disorder and related disorders, Eating Disorders and Body-Focused Repetitive Behaviors, and provides one-on-one treatment and online courses for those who are struggling in these areas. Advocating for those with mental health disorders is also a huge part of her life mission, and she serves as a global advocate for the International OCD Foundation. She is also the founder of CBTSchool, an online psychoeducation platform where she offers support and research-based educational products to those who cannot access correct care. CBTSchool offers low-cost online courses and FREE resources for OCD, anxiety and BFRB's. She is also the best-selling author of 'The Self-Compassion Workbook for OCD: Lean into Your Fear, Manage Difficult Emotions, and Focus On Recovery' (2021). In this episode, we discuss the following topics (+ timestamps): (00:00:00) Introduction of episode & Kimberley Quinlan, LMFT (00:04:35) How Kimberley became an OCD-specialized therapist (00:10:39) How Kimberley's lived experience with anxiety, eating disorders, and being a personal trainer led her to becoming a mental health therapist; Being an OCD therapist without having OCD (00:13:59): All about self-compassion The events that led to Kimberley's interest & specialization in self-compassion Referenced clinician: Tara Brach Operational definition of self-compassion What self-compassion is & is not How anybody can access self-compassion Research on efficacy of self-compassion in treatment Role of self-compassion in recovery (00:30:22) About Kimberley's book: The Self-Compassion Workbook for OCD: Lean into Your Fear, Manage Difficult Emotions, and Focus On Recovery' (2021) (00:40:57) How Kimberley has made evidence-based OCD treatment education widely accessible through CBT School (00:47:55) Discussion: does an OCD treatment provider need to have lived experience of OCD to provide the best therapeutic care? (00:53:39): Kimberley's experience with chronic illness & having a disability Her journey to a POTS diagnosis How she had to radically change her life & way of operating Acceptance of disabilities & limitations The lessons she's learned from her chronic illness experience Full story on her podcast: episode 124, episode 307 Recommended book: How To Be Sick by Toni Bernhard (01:10:20): Navigating boundaries and finding balance in life Kimberley's experience with developing boundaries How to (attempt to) strike balance amongst incredible busyness Fielding judgment and criticism from social media & large-scale public creation Kimberley's family and children Kimberley's strategies for time management Referenced course: Time Management for Optimum Mental Health (01:20:03) Kimberley's experience as an Australian immigrant; Navigating the grief + anxiety of living across the world from her family (01:23:23) DEEP rapid-fire final questions with Kimberley, and closing out the episode! Connect with Kimberley: Website: https://kimberleyquinlan.com/ Listen To Her Podcast: Your Anxiety Toolkit - all podcast platforms CBT School: Find all courses here Instagram: @YourAnxietyToolkit Book: The Self-Compassion Workbook for OCD: Lean into Your Fear, Manage Difficult Emotions, and Focus On Recovery Kimberley's Clinical Practice: info here Connect with me! My website⁠: ⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠umarchatterjee.com⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠ ⁠Instagram:⁠ ⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠@UmaRChatterjee⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠ Twitter:⁠ ⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠@UmaRChatterjee⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠ TikTok:⁠ ⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠@UmaRChatterjee⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠ Email: ⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠hello@umarchatterjee.com⁠⁠⁠⁠⁠ Have a guest you want on the show? Fill out the ⁠⁠⁠⁠Guest Suggestion Form!⁠ --- Send in a voice message: https://podcasters.spotify.com/pod/show/umarchatterjee/message

Melissa is a licensed professional counsellor who practices in Colorado, Arizona, New Jersey, and Florida. She specializes in treating Obsessive Compulsive Disorder (OCD), Body Focused Repetitive Behaviors such as hair pulling and skin picking, Panic Disorder and High Anxiety, and also provides treatment using Ketamine Assisted Psychotherapy.  She has been featured in PsychCentral and ChoosingTherapy.com Today we will discuss Ketamine Assisted Psychotherapy and emotional suffering. https://countercurrentcbt.com/ https://www.linkedin.com/in/melissakirbyhunter/ @melissahuntertherapy

Though BFRBs are relatively common, people struggling with them often feel ashamed and misunderstood. Suzanne Mouton-Odum, Ph.D., shares current best practice treatment approaches, and how caregivers can lovingly support a child with a BFRB.

Trichotillomania (Trich) affects up to 2% of the population. In today's episode we will learn first hand from a beautiful young woman and her mother on their Trich journey and where they are today with treatment and solutions.Support: The TLC Foundation for Body Focused Repetitive Behaviors https://www.bfrb.org/Connect with us:Kimberly Vaughn, WTS, ITS, CNC, MBA: www.hpihairpartners.comConsultations with Kimberly: https://hpihairpartners.com/consultation-requestNataliia Sanzo, RD, LDN: www.allpurposenutrition.comIG: all.purpose.nutrition https://www.instagram.com/all.purpose.nutrition/Questions/Comments? We look forward to your emails!THLC@hpihairpartners.com

SUMMARY:  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. SUPERSTITIONS 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.

I first met Kimberley as a guest on her incredible podcast, Your Anxiety Toolkit, after the book Perfectly Hidden Depression came out. She's also been on SelfWork to discuss her own book The Self-Compassionate Workbook for OCD  and was an obvious pick to lead off these guest episodes. Why? Because she's not only an expert at treating anxiety and I knew whatever she chose to talk about would be pragmatic and useful from the very moment you heard it – but she's very caring, open, and organized. When I listened to the episode you're about to hear, I found myself much more calm at the end than when I'd begun listening!  You'll learn fun facts, like having the strong urge to poop when you're anxious is quite normal, as well as seven hard-earned but unbeatable steps to help you intervene with your response to anxiety. The point is not to stop anxiety. It's to become aware of your own very unique response to it and choose what Kimberley calls “a values-based response to your anxiety” and to “ride its wave.” Not easy to do. But she's also known for her oft-stated mantra, “Today is a beautiful day to do a hard thing.” Now that's a fabulous mantra for anyone, but especially for those of us struggling with depression and/or anxiety. You can find her through her book, her website where you can find treatment options for many types of anxiety, and her podcast Your Anxiety Toolkit! But she also is founder of the CBTschool.com, an online psycho-education platform that provides online courses for those with Obsessive Compulsive Disorder and Body-Focused Repetitive Behaviors. Vital Links:  Click Here for the fabulous offer from Athletic Greens - now AG1 - with bonus product with your subscription!  Click this link to try out some of the best CBD out there! Ozark Mountain Medicine's CBD products and get 10% off!  You can hear more about this and many other topics by listening to my podcast, SelfWork with Dr. Margaret Rutherford. Subscribe to my website and receive my weekly newsletter including a blog post and podcast! If you'd like to join my FaceBook closed group, then click here and answer the membership questions! Welcome! My new book entitled Perfectly Hidden Depression has been published and you can order here! Its message is specifically for those with a struggle with strong perfectionism which acts to mask underlying emotional pain. But the many self-help techniques described can be used by everyone who chooses to begin to address emotions long hidden away that are clouding and sabotaging your current life. And it's available in paperback, eBook or as an audiobook! Now there's another way to send me a message! You can record by clicking below and ask your question or make a comment. You'll have 90 seconds to do so and that time goes quickly. By recording, you're giving SelfWork (and me) permission to use your voice on the podcast. I'll look forward to hearing from you!  

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

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

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

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

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

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

Anita agrees to a suggestion posed by a listener: Explore why the hair-pulling disorder trichotillomania is so taboo. She talks with an artist who started pulling their hair more than two decades ago but only recently told her parents…after publishing part of their story in a national news outlet. A psychologist on the front-lines of studying trich treatment talks about the importance of acceptance; and a hairstylist with trich takes us into why her salon is a safe haven for other folks with hair loss. Meet the guests: Haruka Aoki, a writer and illustrator who recently published a comic about their trichotillomania journey in The Washington Post, shares what it was like to learn a term for the disorder later in life Dr. Suzanne Mouton-Odum, a licensed psychologist and board member for the TLC Foundation for Body-Focused Repetitive Behaviors, describes her counseling work with folks who experience trich Dorin Azérad, a hair loss hairstylist, shares how her ongoing journey with trich shapes the services she offers to other folks with hair loss at her salon Read the transcript | Review the podcast Follow Embodied on Twitter and Instagram Dive deeper: Self-Care Provider Directory for folks with BFRB The TLC Foundation on Trich Haruka's children's book “Fitting In”

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

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

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

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

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

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

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

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.

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

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

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

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

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

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

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

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