Your Anxiety Toolkit - It's a Beautiful Day to Do Hard Things

By Kimberley Quinlan, LMFT

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With over a million downloads, Your Anxiety Toolkit Podcast delivers compassionate, science-based tools for anyone with Anxiety, Panic, OCD, and other mental health struggles.

Episode Date
Ep. 297 Can You Hold Yourself Accountable Without Being Self-critical?
12:27

This is Your Anxiety Toolkit - Episode 297. 

Welcome back, everybody. How are you really? Just doing a quick check-in.

I love the quick check-in, the drop down into your chest, the drop down into whatever discomfort you may be having. And just take it a minute to actually check-in. So important. How often are you doing this? Hopefully, multiple times every day. 

All right. Today, we are talking about accountability, and this actually came, I was listening to something. I can’t remember even what it was, but someone was having a strong reaction to the word “accountability,” which words matter. They really, really do. But what I think is more important is the meaning in which we place on words. It’s a huge part of diffusing from what we tell ourselves all day. So, the whole point of today is to talk about this important treatment concept or recovery concept. And I’ll come back to why. But it’s so important. It’s so, so important. I’ve got a couple of different views about certain things, so you’ll have to hang with me each. Everyone is so important, but hang with me.

Before we do that, let’s first do the review of the week. This is from Maggie Paulson. Maggie wrote:

“I love this podcast. I’ve never been diagnosed with OCD, but I recognize that I have anxiety. This podcast has helped me to learn more about how my brain works, and her gentle and loving approach to treatment has helped me learn to handle my intrusive thoughts and my anxiety. To say that has improved the quality of my life is an understatement. I’m very grateful for Kimberley and her podcast.”

Thank you, Maggie. You fill up my heart. Thank you so much for your reviews. All of you, even if you just click the five-star review or however many stars you think it deserves. You don’t even have to write a review. You can just give it stars, and that helps me. So, thank you so much. 

All right, drum roll. We have the “I did a hard thing” segment. This is from Anonymous. Anonymous said:

“Today, I manage not to lapse into a behavioral addiction that I’ve been struggling with for over a year. It’s very easy for me to use this addiction as a coping strategy for the stresses in my life. But I realized today that a good life free of this addiction is better than a good feeling that only lasts momentarily.” Oh my gosh, Anonymous, I want to give you a standing applause right now. “Although every day is going to be challenging when it comes to not lapsing into addiction, if I take each day as it comes and have the attitude that it’s a beautiful day to do hard things, I know I can live addiction free.” 

So good. So good, Anonymous. Oh my gosh, lLet me read this line again. It says, “I realized today that a good life free of this addiction is better than a good feeling that only last momentarily.” So much wisdom in that sentence. Amazing. So much wisdom. That is true for all of us. Isn’t it? So true for all of us in that we just-- the real living we want, the real pieces on the other side of that hard thing. So, so true. Thank you so much, Anonymous, and thank you so much to Maggie Paulson for that amazing review. 

Ep 297 Can you hold yourself accountable without being self critical Your anxiety toolkit

All right, folks, here is something I want to first start with. So, we’re talking about, can you hold yourself accountable without being self-critical? That’s a really important question because, and the reason it’s so important for recovery is, unless you’re in an intensive treatment center, where you have services 24/7, chances are, you’re doing a lot of this hard work. You’re doing a lot of these “hard things” on your own. And in order to do a hard thing, you do have to be accountable. You have to generate. If you could see me, you can see me like my arms are moving like cogs are turning. You have to generate motivation to do these hard things, because the truth is, no one wants to do these hard things. That’s why they’re hard. I don’t blame you if you don’t want to do hard things today because hard things suck. I keep saying that lately and I mean it. It’s hard. I don’t want to discount and make this podcast out to be like, “Oh, it’s just easy. Just do these five mindful things and you’re going to be fine.” No, it’s hard work. You have to generate motivation and you have to generate accountability. The accountability is what gets you to do it, even though you don’t want to do it.

And here is the point I want you to really take from this episode. Hopefully, this is a shorter episode, because I know I’ve been going a little longer lately. I’m a bit chatty. I’m chattier lately. I don’t know why. Here is the point. Being accountable is not synonymous with blame and harsh treatment. So, let me put that same concept into different words. Holding yourself accountable doesn’t mean the same as blaming yourself, beating yourself into doing the thing that you said you were going to do. That’s not accountability. Accountability is just holding yourself accountable to do the thing. Saying have some accountability doesn’t mean treat yourself terribly. And as I was saying at the beginning, I had heard something and I don’t even remember where. I’m assuming it was on Instagram. They were saying like, “Don’t tell me to be accountable. That’s just mean. That’s just mean that you would ask me to be accountable.” And I’m over here going, what? No, hun, someone somewhere you’ve picked up the idea or someone’s taught you that accountability means getting whipped and that isn’t true. That’s not true. 

Accountability, we just last session, last episode did 196. It was about, what is your recovery goal? So, we got really clear about what do you want your life to look like. If you haven’t listened to that, please go back and listen to it. So, we got really clear on that. And accountability is saying, I love myself so much, and I love those recovery goals so much that I’m going to do this thing. That’s accountability. I value my well-being so much. I value that goal that I want for myself. I believe in myself so much that I’m going to do that thing. That hard thing. It’s not whipping and beating. It’s not mean words. It’s not saying get off your butt your lazy thing. That’s self-criticism. That’s not accountability. That’s just bullying. That’s self-bullying. 

And so, what I want you to look at is, accountability is simply saying, I’m going to do the thing I said I’m going to do because I deserve it. I deserve the outcome, the dream, the goal, the life that lines up with my values. Accountability isn’t saying, push through no matter what, no matter how much pain you’re in, just like plow through it. Believe me. I’ve been there. I’ve been there. Sometimes you have to do that. I’m not going to say that that’s particularly even wrong because sometimes we do have to push through, but you don’t have to be mean. And it’s asking yourself, how willing am I to show up and do this hard thing so I can get this goal? Exactly like Anonymous said in this “I did a hard thing” segment. That’s accountability. Everything that Anonymous said is accountability. I should have actually-- sorry, Anonymous. I should have just read your “I did a hard thing” and said, “There you go, folks. That’s the episode. That’s what accountability looks like.”

So, it’s accountability. Compassionate accountability will still get you across the finish line. Often when I talk to clients about roadblocks to self-compassion, they’ll say, “Well, I won’t get up and do it if I don’t beat myself up.” Is that you? Maybe I should ask that question. Does that resonate with you? Like, “I won’t get to the gym. I won’t exercise. I won’t do the exposure unless I beat myself up. That’s the only form of transportation to get myself to do the thing.” 

If that’s the case, please make today the day that you start trying something else. I’ll tell you why real quick and then I’m going to finish up. Yes, there are times when being self-critical gets you to do the thing. And if that’s what it takes, it’s up to you. You get to choose. I’m not going to tell you what’s wrong. I’m not going to tell you you are wrong. I don’t want you to feel judgment about that from yourself or from me because we’re all doing the very best we can with what we have. So, that’s totally fine. But if you use that as your only way, the chances are, eventually, it’s going to burn you out. You’re going to start to feel so bad about yourself that you will give up. We’ve got all the research and science to back it. 

So, it’s only short-lived. This is only going to work for a certain amount of time until it stops working. So, let’s use today to try something different. Let’s put eggs in different baskets. Let’s practice compassionate accountability. 

Again, I’ll say it, compassionate accountability is doing the thing that you set out to do, because you love yourself and you love your goals so much that you’re willing to do the hard thing. That’s it. That’s it, friends. That’s all I got to say. 

All right. I love you. Have a wonderful day. I just love you. I’m squeezing my fist. I just love you guys. Thank you for being a part of my community. Thank you for supporting me. I totally understand you have gazillions of options for podcasts and gazillions of people who are probably doing great things. Thank you for letting me be a part of your journey. It’s an honor. Really it is.

Have a wonderful day.

Aug 12, 2022
Ep. 296 What is Your Recovery Goal and Why is it SO Important?
18:47

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:

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. 

296 What is your recovery goal Your anxiety toolkit

 

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.

Aug 05, 2022
Ep. 295 When Fears Show Up in Your Dreams
Jul 29, 2022
Ep. 295 When Your Fears Appear in Your Dreams
18:34

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.

295 When your fears show up in your dreams Your anxiety toolkit

Okay. Let’s talk about dreams. So, again, often people will bring to my attention like, what do I do if my fears show up in my dreams, or even fears you didn’t have right. Like fears that you never considered during the day, but once you go to sleep, it gives it to you, sucks it to you, and whatnot. So, what do we do in this situation?

Most people will report they wake up in a massive ball of sweat, high heart rate. It feels so real. It feels like it actually happened. And it takes some time for that to burn off. It really, really does. Some people say it even takes the whole day to burn off. And so, if that’s the case for you, you’re definitely not alone.

Now, one thing to think about when we’re thinking about dreams is we’ve been fed this belief that dreams are like windows into our soul and that they must mean something, and that some people interpret dreams. In fact, I’ll tell you a story. I’m a clinician, I’m a CBT therapist. I use science-based treatment methods. And I do remember looking for a therapist several years ago actually and asking some colleagues. And one colleague, who knew me really well, referred me to this dream analyst. And I went for the first session. I was like, “This is not going to work for me,” mainly because of exactly what I’m going to tell you.

Now, if you like dream analysis, 100% no judgment. The reason that I had a strong reaction to it is I was going through a very, very anxious time, and I knew that if I engaged in that behavior, it was going to trigger me in ways that I’ll share here very soon.

The way I understand and the way I was trained and the way I’ve researched dreams is dreams, are just thoughts you have at night. So, if you’ve listened to this podcast, you’ll know that during the day, if you have a thought, I’m probably going to tell you, thoughts are thoughts. Don’t give them your attention. Don’t give them too much kudos. And so, dreams are no different. They’re just thoughts that you have while you’re asleep, and do your best not to give them a ton of importance, a ton of weight, a ton of value, because when you do that, you can get in trouble, particularly if they’re anxious thoughts.

Now, let me say here, I am notorious for having the weirdest dreams. My husband often, when we first got married, would sit up in the morning and be like, “Tell me everything you dreamed,” because I dream about like, I once had this dream about turtles and we went scuba diving together. And me and these turtles, they were like cartoon turtles. We’re like going through these tunnels together. Ridiculous stuff. I’ve had dreams of going hot air ballooning with a giraffe, and I have had this dream many, many, many times. I would say tens of times. And so, yeah, sometimes dreams are just silly and crazy. But where they’ve got fear attached or danger attached or catastrophes attached, it can be really hard for us to not get caught up in them.

So, the next question is, is it effective to interpret our dreams? My opinion is there’s nothing wrong with it, but here are the things to look out for. If you have a dream and it’s attached to your obsession and you’re interpreting your dream, it’s a chance that you’re doing compulsions to try and get certainty around that obsession. So, if you’ve already got the fear and the obsession, interpreting the dream actually maybe just reinforcing the fear, giving it too much importance, giving it too much value, and therefore feeding you back into a cycle where you’re going to keep having more of them, and you’re going to keep having anxiety about them, because you’re responding to them as if they’re important and dangerous.

If they’re just random like you wake up, often people say, “I had a dream that a loved one died,” or “I had a dream that a loved one was in an accident or it was my fault or so forth.” If you have that, what I would encourage you to do is look at it curiously. For me, it’s either like a really silly cartoon style dream or it’s that I’m responsible for something, which just is a sort of, if I’m curious about that, I’m like, yeah, that makes sense. I tend to be hyper-responsible. I tend to take responsibility very seriously. So, that makes sense. But I’m not going to go and dig around more than that because now I’m digging around in the content of my fears and giving those fears way, way, way, way too much attention. Way too much attention.

So, is it effective to interpret your dream? It depends. And I will say really clearly, if it is around your obsession, I strongly discourage you from doing it with one caveat, with one exception, which is unless it’s for the purpose of actually doing an exposure that’s scary. So, that would be the one time I would say, yes, it’s cool to interpret your dream. If you’re doing it on purpose in effort to actually induce the actual obsession and fear that you have so that you can practice tolerating the uncertainty and you can practice writing that wave of discomfort.

We can and we do do exposures to the content of your dreams. So, again, if a client has a dream or you have a dream and it’s triggering you, whether it was a part of your old obsession or just a new one, you can choose if it’s really bothering you to do an exposure. You could do an exposure with imaginal exposures. We cover imaginal exposures in ERP School, which you can go and find out about at CBTSchool.com if you’re interested. ERP School is our online course that teaches you how to apply ERP to your obsessions.

So, you could do an imaginal exposure where you write a story about your worst fear coming true and the consequences of that, and you read it over and over and over and you just allow the anxiety to rise and fall. You could do that. Or let’s say if it’s a fear like, not long ago, I had a dream about this one area of the corner of my kid’s school. It was like this really bad thing happened. So, if it’s really bothering me and I’m struggling with reducing my mental compulsions about that. Yeah, I might go into that corner and just sit there and read a book or just wait there for my kids or whatnot. So, yes, you can do exposures to the content of your dreams, particularly again, if they’re really strong, repetitious, and they seem to be persistent.

What we can do in addition to that is apply a ton of mindfulness to the dream content itself. So, this is what this would look like. You wake up, whether it’s from the morning or from a nap. You’ve had a dream. It’s really overwhelming. It feels really real. It might even feel like you’re actually in the moment of this catastrophe or this event. And even though it feels real, we’re actually just going to be mindful of that.

Now, what does mindfulness mean? Let’s do a quick recap. Mindfulness is being present with what’s actually happening. So, within that moment, what’s actually happening is things feel unreal, things feel strange, things feel scary. Your heart might be beating faster. You might be sweating. You might have a tummy ache. So, that’s what’s happening. We’re present with that, but we’re also present with what else is happening. Oh, the birds are chirping. I feel my pajamas against my skin. This is the taste of the coffee I’m drinking. I can smell the coffee as well. We’re just being very mindful of what else is happening, and we’re doing all of that nonjudgmentally.

Key point: We’re doing all of this. We’re having the weird feeling. We’re having the anxiety. We’re smelling the coffee. We’re feeling our feet against the floor and we’re practicing not judging these things as good or bad, even though they might be uncomfortable. When we are acknowledging that they’re here, we’re allowing them. We’re being willing to experience them, not pushing them away, and we’re practicing being non-judgmental.

Now you may need to do this, and this is often our clients will say, “Yeah, I did that, and then it kept bothering me.” And I’ll say, “Well, did you do it again? Could you do it a little longer?” And they’ll go, “Yeah, I did. But then it kept bothering me.” And I’ll joke with them. I try never to be condescending, but I’ll say, “But did you then do it again? Did you keep going?” And that’s the key to mindfulness. Mindfulness, we don’t do these behaviors to make the discomfort go away. We do them moment by moment, minute by minute, 10 seconds by 10 seconds, just to practice being in the presence of this discomfort and giving the discomfort zero of our tension.

Now, the other thing we may want to do here is activate a behavior. So, if you’re feeling totally overwhelmed, totally anxious, everything feels like it really actually happened. A lot of clients will say somebody died in their dream and they actually cry and they’re experiencing grief as if it actually happened. That’s true too. That often happens. We would engage in behavioral activation of going, “If I didn’t have this feeling, what would I be doing?” Such a good question. If I didn’t have this experience, what would I be doing? And go and do that thing.

So, if I didn’t have this dream, I’d be getting up and I’d probably go for a walk or I’d sit down and check my emails or whatever it may be. Make sure you do those things and try not to divert away from the behaviors you would’ve done had you not had this dream. That’s the response prevention piece. If you didn’t have this dream, would you be giving this content your attention?

So, let’s say I had a dream about my child dying, which is devastating, the idea of it. So, when we say I wake up and I feel like it actually happened, my body is telling me it actually happened, even though maybe my child is right in front of me. Then how do I engage with the rest of the day? Am I ruminating about ways to prevent that from happening? Am I actually implementing behaviors to prevent it from happening? Because if I’m doing those things, I’m actually doing compulsions. I’m trying to solve a thought that I had, not an actual thing.

And so, this is why this is so important that we understand that dreams are just thoughts you have at night or during sleep. That doesn’t mean that they’re important and they need to be analyzed and that it’s a sign of something to come, because we wouldn’t do that with an intrusive thought. We’re learning not to do that. So, when we have a thought, we’re learning not to go, “Oh my gosh, that must mean it’s a sign.” We’re learning to undo that reaction and going, “Yeah, thoughts are thoughts.”

So, this is how I want you to maybe consider changing your response to dreams, especially scary dreams. Again, let me be really clear. If you love analyzing dreams and you find it helpful and you don’t find it loops you back into the anxious cycle, wonderful. No problem. I’m definitely not against dream analysis. But for those folks who were anxious, I just want you to know this information, keep it in your back pocket, or maybe even your front pocket for the times when you catch yourself engaging in behaviors that become ineffective.

My word of 2022 is “effective.” I have it written everywhere. It’s a huge part of the decisions I make every day, every minute. Does this keep me in being effective? And so, it’s such a great question when we ask ourselves, is this behavior effective? It won’t always be, you don’t always have to be effective. But sometimes again, when you catch trends that are getting you to be ineffective, we want to see if we can make a change. Okay?

So, that’s Episode 295: When your fears show up in your dreams. I hope it was helpful. Do not forget, it is a beautiful day to do hard things. This work is not easy, friends. This work is actually-- let’s just be real. This work sucks. It really, really does. It’s exhausting. It’s hard. It’s taxing. It beats you down. So, please be gentle. It is a beautiful day to do hard things. Please remind yourself of how brave and strong you are because you’re stronger than you think. And I will see you next week.

Have a wonderful day.

Jul 29, 2022
Ep. 294 Can Correcting Thoughts Become a Compulsion?
24:12

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:

Episode Sponsor:

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

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EPISODE TRANSCRIPTION 

This is Your Anxiety Toolkit - Episode 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. 

294 Can correcting out thoughts become a compulsion Your anxiety toolkit

So, first of all, the big question that my staff bring to me when we’re in supervision, and this was actually inspired by a conversation we had during supervision, was what is the role of correcting distorted thoughts in treatment? So, if someone presents to me a distorted thought, a statement, they might say, “I’m an idiot,” or “What’s the point? I only ruin it and mess it up anyway,” or “I always make mistakes. I never do anything right.” I as the clinician and them as the client may benefit by pausing the session and checking in with them in how true is that statement. Is it really true that you never do anything right? Is it true that you are an idiot? Could we challenge that and could we start to have you practice changing the words you use towards yourself? 

I am a massive, massive advocate for cognitive work because I think that in general, we walk around and we say a whole bunch of stuff that’s not true. I do it too. I actually have put-- in the last 18 months, I have put in massive amounts of time and energy into catching because I was finding I was saying a lot of sweeping generalizations like, “I feel terrible today.” Even though I didn’t feel well, it’s like, okay, I’m saying these words, “I’m so tired.” That was another big one I used to say every day. My husband would ask, “How are you, Kimberley?” “I’m so tired.” And it’s not that that thought was wrong or not true. I was really tired. But I had to check, is it helpful for me to keep saying this? Is there another way that I could maybe reframe this or present this or look at this?

So, yes, there’s definitely a role in challenging and correcting errors in our thinking. And so, it’s important that we first look at what is a thought distortion or a cognitive distortion, or a thought error. It’s usually any thought that’s, number one, not true or not helpful, or keeps you responding in a way that isn’t beneficial. So, again, the thought for me is “I’m so tired.” It’s true. Is it helpful? No. Does saying that actually make me feel a little bombed and a little down? Yes. Could I maybe replace it with something else? That’s up to me. There’s no right or wrong. 

I want to be really clear here in that when we talk about correcting thoughts, we are not saying toxic positivity, like, “Oh, I’m supposed to tell myself I feel fabulous because I don’t.” That’s not what this is about. We don’t do that kind of thing. We just make small little shifts depending on what feels helpful to you. 

So, let’s go through a couple of scenarios. Does correcting thoughts help with depression? Now, based on the research, the treatment for depression is actually really balanced in terms of doing 50% cognitive work and 50% behavioral work. These numbers I’m throwing out aren’t science-based, but just in general, I want you to think about like, yeah, you have to do both. You have to look at correcting the lies that depression tells you, but you also have to look at your behaviors and how can you engage in behaviors that actually make you more fulfilled and happy and not feeling down. 

So, yeah, with depression, we look at a lot of thoughts that are very critical, sweeping generalizations, we look at a lot of thoughts that discount the positive. I thought that’s like discounting the positive like, “Well, yeah, even though I got an A in that test, still, I’m probably going to fail my last year of college.” So, they discount the positive thing and they make another sweeping statement. So, we really want to make sure we’re correcting thoughts when it comes to depression. It’s really important because depression lies. 

Do we correct thoughts when it comes to generalized anxiety? Well, yes, we can. But this is where this topic is so important, is you want to be careful. If you’re spending a lot of time correcting thoughts, there’s always room to correct your thoughts about things. But if you find that you’re trying to correct your thoughts just to reduce or remove your uncertainty, then it’s likely that it’s going to get you stuck in a loop where you have to keep doing that thought correction in a somewhat compulsive way to feel good.

And so, what we want to do here is, yeah, we want to be mindful of our thoughts, and then we may choose whether we want to correct it or not, or whether we just want to observe that I’m having a thought. This goes for depression as well because mindfulness-based cognitive therapy is a huge, huge science-based treatment for depression. So, you’re going to see a trend happening here. So, we always want to observe the thought because it helps us to diffuse from the thought and see it in perspective. And then we can choose to correct it if it’s helpful in that moment. Maybe if you’ve never corrected it before, if it’s a new thought that it’s helpful for you to do a little thought work with. And then again, you’d still do the behavioral piece with generalized anxiety. So, if you’re having a lot of anxiety, you still want to work on not avoiding things and not seeking reassurance and not doing any self-critical behaviors, and so forth. 

So, yes, what I would say is there is some benefit to correcting thoughts. The main thing with this is as long as it’s not the only tool you’re using, because if it’s the only tool you’re using, you’re going to be putting in a lot of work, a lot of time of the day correcting thoughts, and that’s probably going to take you away from living the life you want. Several episodes I did a podcast about your recovery plan and what’s getting in the way. The truth is, if you can identify the things you want to be doing when you’re recovered, once you’ve done that, you can start implementing that right away.

So, I often will check in with myself because I’ve been doing a lot of work too. Okay, I could correct the thought right now, or I could just immediately throw myself into the behavior I want to live by. That’s according to my values. And then I make a decision. What would be most helpful? Should I explore this thought? Or would this be a wonderful time to do my paint by numbers? PS, I love Paint By Numbers. It literally got me through COVID. You have to try it. It’s the coolest thing and it’s so fun. But I ask myself like, do I want to just allow the thought to be there and go do the thing I love? Or would it be helpful for me to correct it? There’s no right answer. But if I’m trying to correct things that I’ve already corrected and that I already know the answer to, yeah, I probably am going to choose to do the Paint By Number, if I’m completely honest. I think that’s a more effective route. You are going to have to think about it and do a little cost-benefit analysis for yourself. 

Then we are going to move over here, and this is very similar. Does correcting thoughts help with obsessive-compulsive disorder? You can see a progression here with depression. Yeah, we do quite a bit of it. Generalized anxiety, a little less because it can sometimes be very repetitive. When it comes to obsessive-compulsive disorder, guys, you have to be very careful about correcting thoughts. Because if you’re correcting thoughts to try and reduce or remove your uncertainty, it will most likely, and I would probably go as far to say, definitely turn into a compulsion that will keep you stuck. Because remember, the treatment of OCD and obsessive-compulsive disorder often involves leaning into discomfort, leaning into uncertainty, leaning into doubt, leaning into tolerating whatever experience of uncertainty and discomfort that you have. 

So, here is what I say to my clients, and this is exactly what I said to my staff. One of my staff had said, “Okay, when do we correct thoughts and when don’t we then?” And here is the thing. If somebody is coming to me and they’re saying something that’s an error in thinking around their ability to cope with discomfort, I would 100% correct that. So, an example would be, if a client says to me, “I can’t handle my discomfort,” I will probably have them challenge that. I might even say, “How do you know? Could this be the first time that you actually do tolerate this discomfort or cope with this pain?” So, I would 100% challenge and correct thoughts around their coping. 

But if someone has a thought, “What if I have a panic attack?” the truth is, trying to correct that is uncertain anyway. You’re not going to be able-- you can’t say, “No, I won’t,” because you don’t know that. You can’t say, “Yes, I will,” because you don’t know that. So, only correct thoughts around your struggle to cope. Never correct thoughts where you’re trying to reduce or remove your uncertainty. That would be my best advice to you. 

Another point here is, if you find you’re correcting the same thought repetitively, chances are, it’s a compulsion or will turn into a compulsion. The reason that I push this so heavily is you’re going to-- here is where I really struggle the most, is you’re going to-- if you’re on Instagram, a lot of you come, listen, you follow me on Instagram. We have an Instagram account called Your Anxiety Toolkit. There are hundreds of accounts that tell you to correct every single thought you have, and I don’t agree with that. I do not agree with that. I think that that is terrible advice. Because number one, you could spend your whole day doing that, particularly if you’ve got bad anxiety or depression. Number two, you could spend your whole day doing the exact same behaviors you did last yesterday and last week that obviously didn’t reduce or remove your discomfort. And the third thing to remember here is we have scientific evidence specifically for obsessive-compulsive disorder, but also for generalized anxiety disorder, that most people who have these disorders, there is a certain set of things happening in their brain where cognitive restructuring just doesn’t stick. The part of their brain that allows them to correct things, there’s a weakness there or there’s this bad connection there, which means if this were to work, it would’ve worked already and they probably wouldn’t suffer because they would go, “Oh yeah, you’re right. That doesn’t make any sense.” And off they go. 

It’s really frustrating because I know a lot of you see your partner or your friend who can quickly correct a thought or quickly do a quick Google search, quickly get reassurance and they’re fine. They get to move on. But the brain of an anxiety disorder is different, specifically the brain of someone with obsessive-compulsive disorder is different. And so, for you, you might get a moment of relief, but then you find the thought comes right back. And so, again, there’s no real point you can. Doing it is like whack-a-mole. If you do it,then discomfort goes away and then it comes back and you do it again. And now you’re just stuck, like weeding weeds that keep growing. 

So, these are the things I want you to think about for yourself. I’m definitely not telling you what you have to do. Again, this is not therapy. But I want you to do a little inventory for yourself and just ask yourself what would be helpful and what’s not.

The last question I have here for myself is, when does correcting thoughts help in recovery? Just like I said before, if it helps you in terms of reducing your self-criticism, increasing your sense of mastery over a task, or increases your ability to feel like you can cope, well then, I think it’s a helpful tool. I’ll give you an example of that. 

I personally hate running payroll. Every month, I have these beautiful 10 and 11 staff. It’s actually more like 13, 14 beautiful staff who work for me. And at the first of every month, I have to run all this payroll stuff. And guys, to be honest, I suck at it. I’m terrible with numbers. I get all the numbers mixed up. It takes me twice as long as it would, but I really do value the importance of me knowing what’s happening in my business. So, I do it. I’m doing it. While I’m doing it, I have a lot of thoughts like, “I can’t do this, I don’t want to do this,” and a lot of like, “Ah, this is too hard” thoughts. 

So, in that situation, I’m correcting my thoughts so that I can embody a sense of like, “No, I’m a really good boss and I’m trying to run a business that helps other people with their life.” And so, I correct my thoughts so that I can embody like, “No, this is important. I want and I’m choosing to do this. This is important for my staff. It’s important for me to get it right. And it’s worth the time.” So, in that situation, correcting the thoughts is really helpful because it helps me with that degree of anxiety. However, if I was having thoughts like, “What if you make a mistake? What if you make a mistake? What if you make a mistake?” correcting my thoughts to like, “You won’t make a mistake or that’s not even true. So, it’s not going to be helpful.” 

So, again, let’s go back. When it will help is when it’s around your coping, when it’s around your capabilities. So, if you’re having a lot of thoughts like you suck and you can’t and you’re not good enough, you’re not strong enough, you’re not wise enough, you’re not courageous enough, yeah, you can correct that into more encouraging statements. But we don’t do it around uncertainties. We don’t do it around uncertainties. That will keep you stuck.

Now the last thing I will say here before we wrap up is, is there a difference between education, reassurance, and assurance? So, let’s just break that down. If a client comes to me and they say, “Oh my gosh, I keep having these horrible intrusive thoughts. Something must be wrong with me,” through the lens of education, I might educate them and say, “Listen, everyone has intrusive thoughts. You’re just like everybody else and you shouldn’t be ashamed. And I really want you to understand that having intrusive thoughts is a normal part of having a really healthy working brain.” I consider that education. And you deserve to get education around things. So, if you have, let’s say, a new illness, it’s okay to go and get educated about the new illness. That’s not a compulsion.

Now, there will be times where you educate yourself and you need to tweak what you know or learn something new, and that is also fine. The thing I would have you as we leave for this episode just continue to think about is the thing that we want to look out for is when it’s called reassurance, which is repetitive over and over attempts to reduce or remove a thought specifically related to your anxiety or your uncertainty. So, that’s the real thing I want you to think about and look out for. Take note. And the other thing I want you to remember is, please don’t beat yourself up if there are days when you do a lot of thought correction and it turns out to be a compulsion. You’re just a human being. There is no right or wrong. Often, I’ll say to a client, they’ll be like, “But what if I do correct a thought?” I’ll say, “You know what, you’re going to have ups and downs. So, try not to get too perfectionistic about this practice.” 

There’s just these general ideas and you’ll know in your body if you’re doing it compulsively. A great and easy way to know if you’re doing something compulsively is, are you doing it with urgency? Are you doing it with an experience of resisting discomfort in your body? Are you doing it to reduce or remove a thought that you’re having? And are you doing it repetitively? Those are things where if you’re doing those things, you will know you’re probably doing a compulsion. And in fact, I encourage you to get really good at catching those things because then you will be one step closer to recovery. 

Alright, my loves, that ends the episode on whether correcting thoughts is a compulsion or not. I’m going to let you really come to a conclusion on your own, or you can go and speak with your clinician and get to the bottom of that for yourself.

Have a wonderful, wonderful day. It is a beautiful day to do hard things, and I will talk to you very, very soon, aka, next week.

Have a good one, everyone.

Jul 22, 2022
Ep. 293 I Screwed Up...What Now?
28:37

This is Your Anxiety Toolkit - Episode 293.

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

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

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

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

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

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

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

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

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

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

Ep 293 I made a mistake Your anxiety toolkit

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

Have a wonderful day, everybody.

Jul 15, 2022
Ep. 292 Uncomfortable Sensations
22:14

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.

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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.

Ep 292 Uncomfortable Sensations Your anxiety toolkit

Now, why do we do this segment? Let’s just go back and look at that. So, most of you know that the thing I say all the time is “It’s a beautiful day to do hard things.” Our brains naturally default to this idea of like, “No, I shouldn’t do the hard thing. I should do the easy thing.” Marketing keeps telling us don’t do the hard thing, do the easy thing. Commercial advertising is always sharing the easy five-step way to do something. And we want to flip the script because while it’s good to have things be easy, when it comes to anxiety and these kind of conditions that we’re often talking about, it’s often important that you stare that scary, hard thing in the face. 

Now, that is the perfect segue into this week’s episode about sensations. Now, at the beginning of the episode, I said it’s crazy that I haven’t done a lot of these episodes because sensations is 20% of the work. Now, why did I say that? In total, the clients that I see and that my staff see in our private practice, they’re coming to us for one of five reasons usually. They either have an intrusive thought that they don’t know what to do with, they have an intrusive feeling that they don’t know what to do with, they have an intrusive urge that they don’t know what to do with, they have an intrusive image that they don’t know what to do with, or they have an intrusive sensation that they don’t know what to do with. Five things. 

99.9% of our patients and of the people that we help come with one of those five problems. It doesn’t matter what you call it. They’re coming with, “This is the experience that I’m having.” That’s so overwhelming and difficult and hard that then they go on to do behaviors to try and manage it, and we teach them how to manage those five things in a way that doesn’t require them to do the behaviors that cause them trouble. 

So, let me give you a little more information about that. So, when we’re talking about sensations, we’re talking about-- let’s first get a definition. What is a sensation? A sensation is a physical feeling or a perception resulting from something that happens or that comes into contact with the body. So, really what we’re saying is a sensation is an experience you have in your body and it’s very specific. So often when I’ll say to a client, “Okay, how can I help?” they’ll say, “Well, I’m anxious.” And I’ll say, “Okay, tell me about your anxiety.” And they’ll then usually go on to say, “Well, I’m having these thoughts,” or “I’m having these feelings,” or “I’m having these urges. I’m having these images,” or “I’m having these sensations, and I don’t like it. They make me uncomfortable.” And when I have them, I do these again, like I said, behaviors that kept me into a ton of trouble. Meaning they’ve got big consequences. 

So, often a sensation we consider to be an obsession, just like an intrusive thought, is an obsession. It’s as relevant. And it’s important if someone has anxiety for us to go, “Okay.” This is a common question. If you were my client, this is a common question I ask. I’ll say, “Imagine that I’m an alien and I’ve never, ever once in my life experienced anxiety, and I want you to tell me what it feels like because it doesn’t make any sense to me.” And often clients will struggle with this because they’ll be like, “Well, I just have anxiety.” And I’ll say, “No, we need to understand what specifically, how do you specifically know you’re anxious?” “Oh, I have tightening in my chest or I have shortness of breath, or I have a lump in my throat or I have these butterflies in my tummy.” So, immediately, once we get that, we’re like, “Okay, now we know what we’re dealing with. Okay, now we have specific sensations and now we can develop tools around them so that when you have them, you don’t either engage in avoidant compulsions or physical compulsions or mental rumination or reassurance or self-punishment.” So important. 

Now, let’s slow down here a little and look at what that looks like for many of my patients and many of you. So, this is not scientific, what I’m about to tell you. This is really just coming off of my stream of consciousness and my experience as a clinician, is I’ve broken them down into four main sensations that my patients report to me. Again, this is not a clinical list. So, I want to preface. I don’t want to ever mislead you into thinking this is scientific. But often one of the sensations that people will feel are physical experiences of anxiety, like I listed. It could be butterflies in your tummy, tightness in your chest, as I just said, and I’ve listed them off. 

The next one is specific sensations around what we call depersonalization and derealization. I’ve done full episodes on those in the past. So, go back and check them out. But this is the experience of this weird feeling. The sensation is like, everything feels strange. I feel like distorted, like I’m in a daydream. It feels very hazy and strange, or I feel like I’m outside of my body. Now while we have words to describe derealization and depersonalization, they are also at their most basic form of sensation, a basic sensation. So, I put that in its own category. 

The next one is similar to anxiety and derealization and to personalization, but I’ve put them under the category of panic. Now, the reason that it’s so important for us to talk about sensations is, people who have panic disorder are very sensitive to the sensations that they have because panic is such a 10 out of 10 anxiety. So, it’s like can’t breathe, racing thoughts, major overwhelmed, dizzy, sweating. These are all sensations. These are all things that we perceive or we experience in our body. 

And then the last one is physical pain. This is a sensation too. When you physically have pain, a tummy ache, that’s also a sensation. 

Now, let’s talk about why I separated those, because I’ll give you a really perfect example of how this gets messy. Most of you know that I have postural orthostatic tachycardia syndrome, which is symptoms of dizziness, lightheadedness, headaches, stomach troubles. And often if you stand for too long, you faint. Now, what does that sound very similar to? You guys are probably laughing at me already. Anxiety. It looks exactly like anxiety except the fainting piece, dizziness, lightheadedness, stomach aches, headaches. So similar. And so, when we have, and this is where it gets difficult, when we have a chronic illness or if we have health anxiety, when we experience a sensation, sometimes we can’t figure out whether it’s real pain and real threat or if it’s anxiety. 

The thing to remember here is the response needs to be similar. So, for me, when I had dizziness and lightheadedness, yes, of course, I’m not going to push myself to a place where I pass out, but I’m going to first stop and go, “Hmm, let me try to dip into these sensations. Instead of catastrophizing them as this is terrible and bad things are going to happen, I wonder what would happen if I just labeled them as a sensation.” 

The thing here is, when we have sensations, and you’re having them right now, believe it or not. It could be an itch. It could be a muscle that’s sore from a workout you had, it could be a stomach ache because you just ate an amazing dinner and you just had a little more than you wish you had, or you’re having anxiety. We all have them. Where we often get into trouble is when we label them as good or bad. So, that’s the main point here first. Are you labeling your sensations as good or bad? 

When I would have my POTS symptoms, I get dizzy. At the beginning, I go, “This is bad, this is bad. Bad things are happening,” which would then give me anxiety, which would make it worse. And now I’ve got this hot mess. Massive hot mess. Same for people with health anxiety. They have tightness in the chest and they go, “Oh my God, I’m dying. I’m having a stroke,” or “I’m having a heart attack.” And when we label it as bad, we get more anxiety, which makes it worse, and now we’re in a cycle. If you’re having a panic disorder and you’re starting to notice that small little tingle of anxiety coming up, this like whoosh of anxiety that whooshes over you when we have a panic attack, and you label this as, “Oh, this is bad, this is terrible. I got to get it to go away,” you can bet your bottom dollar, it’s actually going to feed you more anxiety. So, question whether you are labeling your sensations as good or bad.

Now I’m guessing some of you are thinking, “Well, Kimberley, of course, I’m going to label it as bad. It is bad. It’s terrible. I don’t like it.” And I get you. But we’re here to learn. We’re here to grow. We’re here to recover. So, I want you to think beyond that judgment and look at first the judgment doesn’t help you. Whether it’s true or not, it’s not helpful. It makes it worse. So, let’s work at being nonjudgmental about the sensations that we have. 

The response we have to your sensations can determine whether you get stuck in a cycle of having more discomfort. Let me rephrase that in a different way to make an even bigger point. The response you have to your sensations can determine whether you have anxiety about them in the future. Because if you treat the sensations today like they’re dangerous and harmful and they require immediate emergency, you’re training your brain to perceive those sensations as scary and bad and dangerous. And so next time you have them, your brain is going to send out a whole bunch more anxiety. So important. 

I’ve had my share of panic attacks in my life, but when I have them and if I’m like, “Oh, dear God, please don’t,” I know my brain is going, “What, what, what? What’s wrong, Kimberley? Why are you telling me this is terrible? Okay, it is terrible. I’ll keep sending out anxiety.” But when I can respond by going, “Good one, brain. It’s cool. There’s no amount of sensations I can’t tolerate. It’s fine. I’m going to ride it out.” Again, we don’t know how to bypass it with positivity by going, “It’s great. I love it.” We’re not saying that. But we are saying if we can reframe the sensation as tolerable and manageable, you’re less likely to have anxiety about the sensation tomorrow.

Now, I know a lot of you may be asking, “But how do I know when it’s something to just be uncertain and nonjudgmental about or when I should rush to the hospital and so forth?” Number one, you’ll know. But the other piece, I don’t want to discard you on that one because that’s hard to say, especially if you have anxiety, especially OCD and health anxiety. But the other thing is, for me, if I’m having it and I’ll use me as an example, if I’m having dizziness and lightheadedness, which could be anxiety or it could be my POTS, I just keep on the deferring. I keep on deferring like, “Okay, can I just stay with it nonjudgmental for another few minutes?” If I’m getting to feel really horrible, of course, I’m going to sit down and take a rest. I’m not going to push through and be unkind. But I just keep being curious. Could I it do a little longer? Could I have a little more? Could I be nonjudgmental for another few minutes? 

It’s so important because when it comes to anxiety, the way in which we respond to the sensations is as important as how we respond to intrusive thoughts. Particularly like I said, if you’ve got depersonalization, derealization, panic disorder, physical pain, generalized anxiety, health anxiety, so important. If it’s social anxiety, it’s a big one because a lot of people with social anxiety have an aversion to the sensation of being flushed in their cheeks. But if you respond to your cheeks flushed as bad, you’re probably going to get more of it. It’s paradoxical.

Now, here is one other point I want to make before we finish up, which is there is no sensation you can’t ride out. This was a huge one for me because I’ve had anxiety and I’ve had some pretty bad chronic illnesses. If I go into the day telling myself, “I won’t be able to handle it,” I usually have anxiety about the day. Have you noticed that? I know you can’t answer back, but I really want you to consider the question. Do you notice that in your experience? When you tell yourself “I can’t handle things,” does that actually then create more anxiety for you? And sometimes more depression too, if I can be completely honest. 

Last week, we did a whole episode on depression. I think it’s really important to recognize that. Even I should say other sensations are like depression, that’s that sinking, dark, gray sensation that goes with having depression. I should put that there as the fifth type because that’s a sensation that can be scary too. Grief can be an experience that-- there are sensations associated with grief that feel intolerable. But when we tell ourselves we can’t tolerate them, we actually then create more anxiety and depression. So, these are things to think about when it comes to sensations. 

Now, if you were in an office with me or one of my staff, we are most likely to say, at the end of the day, you’re going to have to say, “Bring it on.” Once you identify the sensation, it really comes to, do you avoid it or do you say it’s a beautiful day to do this hard thing, to experience this hard thing? And so, we would say, “Bring it on.”

Now, in ERP School, we talk about this. I probably should do an episode on this. Let me just actually write myself a note to episode on this. If someone really comes to our office with a stronger aversion to certain sensations, we do what we call interoceptive exposures. We talk about this in ERP School. It’s an online course. But an interoceptive exposure is where we purposely expose you to the sensation that you’re avoiding. 

So, examples might be, if you really don’t like dizziness and you’re doing things to avoid dizziness, we would sit you in our chair and we would spin you around 30 times and then we’d walk the hallway ways with you while you’re dizzy. 

If you’re afraid of shortness of breath, we would give you a very small straw. One of those straws that you use to stir your coffee with, and we would have you practice breathing through that so that you, on purpose, tolerate the feeling of having shortness of breath. 

If you really don’t like the feeling of shortness of breath, like tightness in your chest, we might wrap a bandage around your chest, so tight that it feels like you can’t breathe, just for a few minutes. We’re not here to torture you. But these are examples of interoceptive exposures that we do because not only are we like “Bring it on,” we’re like, “Let’s have more of it.” Let’s practice doing it so we can practice nonjudgment, we can practice non-aversion. We can practice saying I can handle this and learning that we can handle this is cool. So, so cool. That’s the thing. 

So, depending on where you are and how severe you are in your aversion to sensations, there are multiple ways you can respond. I want you just to use this episode as an opportunity for you to check in, where are you in respect to your experience with sensations? Do you have aversion to them? How willing are you to feel them? Questions are my favorite, you guys. You know this about me. So, ask yourself these questions. So important. 

All right. That is it for sensations. I hope that is helpful. I know I took you on a couple of meandering tangents there, but I hope you stayed with me. I love talking to you about this stuff and I hope that that did give you some clarity on how you may handle it in the future. 

All right. I will see you next week. Have a wonderful, wonderful day, and don’t forget, it’s a beautiful day to do hard things. I’ll talk to you later.

Jul 08, 2022
Ep. 291 Tips to Manage Depression
27:24

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:

Episode Sponsor:

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

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EPISODE TRANSCRIPTION

This is Your Anxiety Toolkit Episode 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. 

Ep 291 Tips for managing depression Your anxiety toolkit

 

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.

Jul 01, 2022
Ep. 290 Do I Have to Stop All My Compulsions?
14:18

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.

Do I have to stop all of my compulsions Your anxiety toolkit

 

This week’s episode is about a question, like I said, is it okay to keep doing some of my compulsions? Again, this came from one of the courses that we have. We have two signature courses for OCD. One is ERP School, and then the other one is this Mindfulness School for OCD that teaches mindfulness skills.

Now, the reason I love this question is, they’re asking me as if I am the expert of all things, OCD. And I want to let you in on a little truth here – I am not. You’re probably like, “What is happening? She’s been telling us that she’s an OCD specialist all this time. And now she’s telling me she’s not the expert.” I am not the expert of you. And I want to really make sure that is clear. Anytime someone says, “What should I do? What’s the right thing to do for me?” I try my best not to tell them that is best for them because I’m only telling them what I think is best for them. That doesn’t mean it’s the facts. So, I want to be very clear. I am not the expert in you. You are. You do get to make choices of your own.

That being said-- and I’ll talk more about that here in a second. But that being said, let’s look at the question and just look at it from a perspective of just general concepts of OCD.

Now, in the beginning of ERP School, we have a whole module that explains the cycle of obsessions and compulsions. I draw it out on a big sheet of paper, like this huge sticky note. And it’s actually really funny because I’m trying to squeeze myself into the frame of the video with this huge sticky note. When I think back to it, it makes me giggle. But here let’s take a look.

The thing to remember here regarding this question is, if you have a fear and the fear is what we call egodystonic, meaning it doesn’t line up with your values, you know it’s a fear, and you know it’s probably irrational. If you have this fear and you respond to the fear as if it is dangerous and important and urgent, you actually are keeping your brain afraid of the fear. And you’re continually keeping your brain stuck in a cycle where your brain will set off the metaphorical fire alarm every time it has that fear. When you have fear and it doesn’t line up with your values and you have the insight to see that it’s irrational or that it’s keeping you stuck and it’s not effective for you and not responding anymore, your job is to practice changing your behaviors and your reaction to that thought so that you can train your brain not to set the fire alarm off next time. It may take several times or many times. But again, if you have a fear and you respond to it like it’s important, your brain is going to keep thinking it’s important. If you have a fear or an obsession and you keep responding to it with urgency, your brain is going to keep interpreting that fear as urgent, serious, dangerous, scary things.

So, I’m always going to encourage my patients and my students to always check in on this one golden question, which is, what would the non-anxious me do? Or what would I do if I weren’t afraid of this thought? Or another question is, am I responding from a place of fear, generally? And if that’s the case, then I would encourage my patient to really work at reducing that compulsion because the compulsion keeps the cycle going.

Now, that being said, still, again, I’m going to say, under no circumstances do I get to tell you what to do. Only you will know what’s right for you. And I have had clients, I will say, I’ve had clients where they’ve written out their hierarchy. They’ve gone all the way to the top. And there’s several things at the top where they’re like, “No, I’m actually going to keep these ones. These ones are ones that don’t interfere with my life too much. I’m comfortable. I’m not ready to face them yet. And so, no, I’m going to keep doing them.” And I respect that. Again. I am not the expert on everybody. Everyone gets to make their own value-based decisions. That’s entirely okay.

I always say to them, going to the top of your hierarchy and cutting back on all of the compulsions is, think of it like an insurance policy on your recovery. It’s not going to completely promise you and guarantee that you won’t have obsessions in the future or you won’t have a relapse here or there. No. And that’s okay. That will happen. We’re going to actually have a conversation about that here in the next few weeks on the podcast. But you can help train your brain by marking off all those compulsions.

So, what I’m going to leave you here with-- this is actually not going to be a long podcast, but what I’m going to leave you with is the actual answer to the question. Is it okay if I keep doing some of my compulsions? Yes, it’s okay. You don’t have to be perfect. You don’t have to win all the challenges. And for reasons that are yours, you get to make those decisions. And really that’s your personal decision as well, and-- we don’t say “buy,” we say “and.” And just keep in mind the nature of compulsions. Compulsions keep the cycle going.

Just keep that in mind gently, in a tender place. Put it in your back pocket. And here is the question I’m going to leave you on, is ponder why you don’t want to stop this compulsion. What’s getting in the way? If you’re really honest with yourself, what’s the reason you want to keep doing it? Does doing it keep you aligned with your values? Is there a way to be creative and strategic in this situation where you can slowly reduce the compulsion, even if it’s a baby step? It’s so important just to be pondering and asking yourself questions. I have to always stop and say like, “Okay, Kimberley--” I call myself KQ. Everyone calls me KQ. “KQ, let’s get real. What’s really happening here.?” And I’m not doing it in a mean way. I’m having a heart-to-heart. What’s really happening? What’s really getting in the way? Are you being honest with yourself? And sometimes you have to have really honest conversations to be like, “Oh, I know. I’m totally giving myself stuck here.” And it might take some time before you’re ready, and that’s okay too. Okay?

So, I want you to think about those things. Maybe even write the questions down. Go back and listen, or you can go to the transcript of this podcast. Write those questions down and go back and review them every now and then, because those are questions I ask my patients every single day. Every single day. And the questions I ask myself and the questions I ask my patients are often what defines how successful they are because we’re questioning the status quo. And that’s what gets them better.

Before we finish up, let’s do the review of the week. This is from Robyncox and they said:

“Thank you, Kimberley. I’m not sure how to condense all of my happiness and thanks but I’ll try. I was recommended to listen to your podcast by my therapist (who is just superb and I’m grateful she exists) and I instantly fell in love with your genuine desire to help which seeps through the sound waves.” I love that. “I am hooked on the real-life stories that I can connect to my own experience and have gotten my sister hooked as well who struggles with anxiety as I do. Thank you for your tools and support!”

Thank you, Robin. Again, I love hearing your reviews and I just love hearing that I can be of service and help you and be a part of your day. I love knowing that people are like taking walks, listening to me and we get to have chats together. It’s beautiful. It’s really, really such an honor.

All right. That’s it for Episode 290. That’s a lot of episodes, but I think we’re doing well. I will see you next week for Episode 291 and we will go from there. Oh, one thing to note. By the time you talk to me next time, I will be in Australia. We are going to spend the summer there this year and I could not be more excited. I’ll send you my love from there. Have a great day.

Jun 24, 2022
Ep. 289 Whack a Mole Obsessions
20:06

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. 

Whack a mole Obsessions Your anxiety toolkit

 

Okay, let’s do it. Today, we are talking about Whack-A-Mole obsessions. Now, Whack-A-Mole obsessions is not a clinical term. Let’s just get that out of the way. There is nothing in the DSM or there’s no-- it’s not a clinical scientific term, but it is a term we use in the OCD community. But I think it’s true of the anxiety disorder community. Maybe even the eating disorder community as well, where the fears flip flop from one thing to the other. This may be true too if you have health anxiety. It might be true if you have generalized anxiety, social anxiety, where one day everything, it just feels like this fear is so intense and it’s so important and it must be solved today. It’s so painful. And then for no reason, it goes. And then it gets overshadowed by a different fear or obsession or topic. 

And what can happen in treatment is you can start to treat one, doing exposure. This was actually one of the questions that came up through ERP School, which is our online course that teaches you how to create a plan for yourself to manage OCD. Some people will say, “Oh, I created a hierarchy. I followed the steps in ERP School. I started working on it and I did a few exposures and I did a few marginals. And boom, it just went away and then a new one came or the volume got turned down.” It could be that you addressed it a small amount, and then it went away and got replaced by another. Or it could be that you didn’t even get time to address it and it just went to a different topic. And this is really, really distressing for people, I’m not going to lie, because you’re just constantly whack-a-moling. You know the Whack-A-Mole game? You’re whack-a-moling things that feel super important, super scary, super urgent. 

And so, what I want to do first is just validate and recognize this is not an uncommon situation. If this is happening for you, you are definitely not alone. And it doesn’t mean in any respect that you can’t get better. In fact, there’s a really cool tool, and I’m going to teach it to you here in a second, that you can use. We use it with any obsession. This is not special to Whack-A-Mole obsessions, but you can use it with any exceptions or if things keep changing. But first of all, I just want to recognize it is normal and it’s still treatable. 

What do you do? The thing to remember here is, when you zoom out, and this is what we do as clinicians, our job as clinicians, and I say this to my staff all the time, is to find trends in the person’s behaviors and thinking. And what you will find is, when you’re having Whack-A-Mole obsessions, while the content may be different, when you zoom out, the process is exactly the same. You have a thought, a feeling, a sensation, or an urge that is repetitive, that is uncomfortable, that creates a lot of distress in your life. And of course, naturally, you don’t want that distress. That’s scary. And so, what you do is you do a compulsion to make it go away. It doesn’t matter what the content is. It doesn’t matter what the specific theory is. This is the same trend. And so, when we zoom out, we can see the trend, and then we can go, “Aha. Even though the content is the same, I can still intervene at the same point.” When we talk about this in ERP School, is the intervention point is at the compulsion. 

And so, the work here is the content doesn’t matter. Your job is to catch and be aware, like we’ve talked a lot about mindfulness, is to be aware and identify, “Oh, I’m in the trend. I’m in the cycle.” While the one content has changed, the same behaviors are playing out. So, you catch that. You then practice being willing to be uncomfortable and uncertain about the content, because that’s the same too. The same cycle is happening. The thought and the fear create some anxiety, some sensations, and so forth. 

And then we have an aversion to that. And then our job is to work at not engaging in that compulsion. So, that compulsion might be mental rumination. It might be doing certain behaviors, physical behaviors. It might be reassurance seeking. It might be avoidance. It might be self-punishment. It might be self-criticism. And your job is actually to go, “Okay, it really doesn’t matter.” And I really want to keep saying that to you. If the fear is, what if I have cancer? What if I’m going to hurt someone? What if I’m aroused by this? What if I have sinned? What if things are asymmetrical? What if I got some contaminant? What if I don’t love him enough? It doesn’t matter. What if it is not perfect? What if I fail? It doesn’t matter. I’ve just listed some, but if I didn’t list your obsession, please don’t worry. It’s for every one of these. The content for all of them are equally as important. 

Sometimes what we do is we go, “Oh, that one is okay. But this one is really serious, and we have to pay attention to it.” And so, we have to catch that and go, “No, it’s all content. It’s all--” you could say, some people say it’s all spam, like the spam folder. Because when we get an email, we have emails that we really need to see – events, meetings coming up. And then we always have spam, the stuff that’s like, “Please send me money for Bitcoin,” or something. So, we put that in the spam folder. And so, your job is to catch the trends here, the patterns, and learn how to put those obsessions in the spam folder, no matter what the content.

Now, this does require, and here’s the caveat, or I would say this is the deal-breaker, is it does require a degree of mindfulness in your part to be aware of what’s going on. And this is a practice, like a muscle that you grow. So, what it requires is you have to be able to catch that you are in the content. You have to be able to catch that you are in the cycle that keeps you stuck. And that does require you to be mindful again. And I get it. I’m not saying that you’ll ever be perfect at this because I don’t know anyone who is. There will be times when you’re so caught up in the content and you’ve been doing compulsions for an hour, two hours, two days, two months and you haven’t caught it. And you’re like, “Oops, wait. Oops, I didn’t catch that one.” That’s okay. We don’t beat ourselves up. Then we just go, “All right, I’m at the point where at least I’ve caught it. I’m aware that I’m in the content. I’m aware how this is playing out exactly the way that it played out yesterday, but with a different obsession.” And then you just move on from there. Don’t beat yourself up. But it does require you to strengthen the muscle of being able to catch that you’re in the content. And it’s what we call insight. It’s having the insight to recognize.

Now, insight is something we can strengthen with practice. It’s not just one and done. It’s practice. It’s repetition. I have to do this all the time for myself. While I don’t have OCD, I do have anxiety and I will catch myself going down the rabbit hole with something until I’m like, “Wait, wait, wait, wait, wait, you’ve been here before. It looks exactly like what you did on Tuesday where you’re trying to figure out something that’s not in your control. Kimberley, this is not in your control. You’re trying to control something that isn’t even your business.” And I’ve seen that trend in me. And so, my job is to catch it. Once I can catch it, then I know the steps. I know, “Okay, I got to let this one go. I got to accept the discomfort on this one. I’m going to have to ride this wave of discomfort. I’m going to have to radically be kind to myself.” We know the steps. And once we can get those steps down, it’s about catching it. But this is what we do when the obsessions do keep changing. 

Now, I’m not going to say this is easy because it’s not. And if you require help doing this, reach out to an OCD therapist or an anxiety specialist who knows ERP. Remember here, and I’m telling you this with the deepest, most absolute degree of love, is CBT School, the whole mission of CBT School is to provide you tools and resources for those who don’t have tools and resources. So, if you haven’t got a therapist and you’re finding this really, really helpful, but you’re still struggling, don’t be afraid. It doesn’t mean anything is wrong with you. It just means maybe you need some more professional help. Maybe you have a therapist and you’re listening into this just to get extra tools. Great. Take what you learn and then take what struggles you have and figure that out. 

I really want to stress here, and the reason I bring that up is, when I say this, it isn’t as easy as it sounds and it does require sometimes having somebody else, this is why I go to therapy myself, is even though I know the tools, it’s really nice to have a second set of ears just going, “Wait a second. Sounds like you’re caught up in the content.” If it’s not a therapist, maybe you could have a loved one or even journaling I have found is really helpful in that when you journal it down, and I do this regularly, I then read it, not to judge it, but just to see what trends. And I get a highlighter and I just highlight like, where are the trends? Where am I seeing the same patterns playing out? And that’s where we intervene. 

So, that’s Whack-A-Mole obsessions. That is what to do when your obsessions keep changing. I do hope that that was helpful, not just to validate you, but to give you some skills moving forward. I am so grateful to have you here. Don’t be afraid to let me know what you think. I love, again, getting your feedback via reviews. I urge you to join the newsletter. That will then allow you to reply and give me feedback that way. I love hearing from you all. 

All right. I’m going to sign off and I’ll talk to you very, very soon.

Jun 17, 2022
Ep. 288 What To Do When You Get Bad News
26:45

SUMMARY: 

Today, I share what to do when you get “bad” news.  This episode will share a recent situation I got into where I had to use all of my mindfulness and self-compassion tools.  Check it out!

Episode Sponsor:

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

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

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

 

EPISODE TRANSCRIPTION 

This is Your Anxiety Toolkit - Episode 288. 

Welcome back, everybody. We literally just finished the six-week series on managing mental compulsions. My heart is full, as full as full can be. I am sitting here looking into my microphone and I just have a big, fat smile on my face. I’m just so excited for what we did together, and I felt like it was so huge. I have so many ideas of how I want to do something similar in the future with different areas. And I will.

Thank you so much for your feedback and your reviews. I hope it was as helpful as it was for me, even as a clinician. I found it to be incredibly helpful, even as a supervisor, supervising my staff. I have nine incredible staff who are therapists, who help treat my clients and we constantly keep referring back during supervision of like, “Do you remember what Lisa said? Do you remember what Reid said? Listen, let’s consider what Jon said or Jon Hershfield said, or Shala Nicely said.” It was just so beautiful. I’m so grateful.

If you haven’t listened, go back and listen to it. It’s a six-week series and ugh, it was just so wonderful. I keep saying it was just so wonderful. So, if you go back, I did an introduction, Episode 282. And then from there, it was these amazing, amazing experts who just dropped amazing truth bomb after amazing truth bomb. So, that’s that.

Today, I am going back to the roots of this podcast. And I’m sharing with you-- for those of you who have been listening for a while, we usually start the episode with a segment called the “I did a hard thing” segment. This is where people write in and tell me a hard thing that they’ve done. If you go to my website, which is KimberleyQuinlan-lmft.com. There on the podcast page is a place to submit your “I did a hard thing.” And today’s “I did a hard thing” is from yours truly. I just had to share this story with you. I feel like it’s an important story to tell you guys, and I wanted to share with you that I’m not just talking the talk over here, I’m walking the walk.

So, today’s episode is called When You Get Bad News. I’m just going to leave it at that. Before we get started, I would love to leave you and share with you the review of the week. This is from hannabanana3131, and they said:

“Fantastic mental health podcast. Such an amazing podcast. I have learned so many useful tools for dealing with my anxiety and OCD. And Kimberley is such a loving, compassionate coach - I feel like she’s rooting for me every step of my healing journey,” and she’s left a heart emoji.

Thank you so much, hannabanana. I love, love, love getting your reviews. It does help me so much. So, if you have a moment of time and the podcasts are helpful for you, that is the most helpful thing you can do back. When we get reviews, then when people who are new come over and see it, it actually makes them feel like they can trust the information we’re giving. And in today’s world, trust is important. There is so much noise and so many people talking about OCD and anxiety, and it’s easy to get caught up in nonsense stuff. And so, I really want to build a trust factor with the listeners that I have. So, thank you so much for doing that.

Okay. It’s funny that hannabanana says, “I feel like she’s rooting for me,” because the “I did hard thing” is me talking about my recent experience of having a root canal. Worse than a root canal. So, let me tell you a story now. I’m not just telling you this story to tell you a story. I’m telling you this story because I want to sometimes-- when we do the “I did a hard thing” segment, it’s usually very, very short and to the point, but I’d actually like to walk you through how I got through getting some really bad news. So, let’s talk about it. And I’ll share. I’m not perfect. So, there were times when I was doing well and there was times when I won’t.

So, for those of you who don’t know, which I’m guessing is all of you, I have very bad gums. My gums, I inherited bad gums. It comes in my family. I go in every three months for a gum routine where they do a deep cleaning or they really check my gums to make sure there’s not receding too much. And because of that, I take really good care of my teeth. And because of that, I usually have very little dental issues. I never had a cavity. I’ve never had any cracks or any terrible swollen problems. That just isn’t my problem. My problem is gums and it’s an ongoing issue that I have to keep handling.

So this time, I go in, I get my x-rays, and the doctor comes in. And I have this really hilarious dentist who has not got the best bedside manner, but I do love him and he has been with me through some really tough times that when I found out I have a lesion on my brain, I fully broke down in front of him and he was so kind and gave me his cell phone number. He was just so lovely. But he comes in and he rubs his hands together and says, “What are we doing here today, Kimberley?” And he looks at the x-rays and I kid you not, he says, “Holy crap!” Literally, that was his response, which is pretty funny, I think.

From there, I proceed to go into some version of a panic attack. I’m like, “What? What’s wrong? What do you see? What happened?” And I think that was pretty appropriate for me to do that. So, I want to validate you. When you get big news, it’s normal to go into a fight or flight, like what’s going on, you’re hypervigilant, you’re looking around.

Now, he waited about 45 seconds to answer my question. I just sat there in a state of panic while he stared at the x-rays on the wall. And these 45 seconds, I think, was the longest 45 seconds of my life because he wouldn’t answer me. And I was just like, “Tell me what’s wrong. What’s wrong?” So, he turns around and he says, “Kimberley, you have a dead tooth.” And I’m like, “What? A dead tooth? What does that even mean?” And he says, “You have a tooth infection that is dormant. Do you have any pain? Do you have a headache? What’s going on?” And I’m like, “Nothing, nothing. I’m fine. Everything is fine.” And so, he proceeds to immediately in this urgent, panicky way, call in his nurses, “Bring me this, bring me that, bring me this, bring me that. Bring me this tool, bring me this chemical or medicine or whatever.” And they’re all poking at me and prodding at me and they’re trying to figure it out. And he’s like, “I cannot figure out what this is and why it’s here.” So, bad news. Just straight-up bad news.

Now, the interesting thing about this is, it’s hard to be in communication with someone, particularly when they’re your doctor and they appear to be confused and panicking. Not that he was panicking, but he was acting in this urgent way. That’s a hard position to be in. And if you’ve ever been in a position like that, I want to first validate you. That’s scary. It is a scary moment that your trusted person is also panicking. Just like when you’re on an airplane and it’s really bumpy. But if you see that the air hostesses are giggling and laughing, you’re like, “Okay, it’s all good.” But when you see their faces looking a little nervous, that’s a scary moment. So, first of all, if you’ve been in that position, that’s really, really hard.

What he then proceeded to tell me is, “Kimberley, this tooth has to come out. It has to come out immediately. We cannot wait. It’s going to cost a god-awful amount of money. And this has to happen right away.” Now in my mind, you guys know me, I am really, really strict about scheduling. I have a schedule. I’m not compulsive about it, but I run two businesses. I have a podcast, I have two children. I have a medical illness. I have to manage my mental illnesses all the time. So, I have to be really intentional with my calendar.

So, this idea that immediately, everything has to change was a little alarming to me. But what I remember thinking, and this is one of the tools I want to offer you for today, is being emotionally flexible is a skill. And what we want to do in those moments, and this is what I practiced was, “Okay, Kimberley, this is one of those moments where your skills come in handy. Thank God for them.” How can you be flexible here? Because my mind wanted to go, “You got to pick up the kids and you’ve got to do this and you’ve got to a meeting tomorrow and you’ve got clients and you can’t do this. This can’t happen this week.” But my mind was like, “I’m going to practice flexibility.”

In addition to that, when things change really quickly, we tend to beat ourselves up like, “Such and such is going to hate me. They’re going to be mad at me. They’re going to think I’m a loser for having to change the schedule.” And I just gently said to myself, “Kimberley, we’re going to be emotionally flexible here and we’re going to let everybody have their emotions about it.” So, the kids get to have their emotions about everything changing and my clients get to have their emotions about it too. And having to cancel the meetings, they get to have their emotions. Everyone’s allowed to have their emotions about the fact that many, many things are going to be canceled in the next few days.

And that has been such a work of art for me, but it has been so beautiful for me to say, instead of me going, “No, no, no, I can’t do this,” because I don’t want them to have feelings and I don’t want them to think this about me, now I’m just like, everyone gets to have their feelings. They get to feel disappointed. They get to feel angry. They get to feel annoyed. They get to feel irritated. They get to feel sad. Everybody gets to feel their feelings about it because that’s a part of being a human. That’s one of the tools I want you to think about. Just play with these ideas. You’ve just come off the six-week series. These are some more ideas to play with.

But then from there, I had about 36 hours where I had to wait for this surgery. And during that time, I had to have an x-ray where I was told, and this is the real bad news, is this infection, actually, this is gross. So, trigger warning, guys. The infection actually ate through a part of my jaw bone. I know. Isn’t that crazy? The infection was so bad and it was right at this area where I guess nerves come out of your jaw. There’s this tiny hole right at the front, around the sides where the nerves come out of your jaw and up into your lips and the infection spread and was all over that area. I know that is gross, but it’s also really scary.

So, not only did I have to think about all of the changes, but he, the doctor, the dentist had made me very aware that this surgery has to go really well, and that if he pushes too hard or he pulls too hard with a tooth or he had to put in a-- there’s these words I don’t even know, but like a canal, like some kind of fixture so that he can create a new tooth because I had to have a tooth completely pulled out. He was like, “If I push it in too far, I actually may hit this nerve, which could be very, very bad.”

So, this uncertainty felt horrible to me. And of course, I’m going to have these intrusive thoughts like, “What if I never get to speak again? What if I lose a feeling in my gums and what if he pushes hard and this is terminal? What if, what if, what if, what if?” And so, my skill here, and we’ve learnt this from managing mental compulsions, is bring it back to the present. Until there’s a problem, we don’t solve them. So, that’s what I kept doing. “It’s not happening now. Kimberley, it’s not happening now. It’s not happening now,” even though it’s a real threat, even though it’s going to be something I have to face, because sometimes our fears are like, “What if something happens?” But it’s just a what-if. There’s no actual event that you know for certain is going to happen.

This was like, “Yeah, you’re going to do this in literally 30 hours and all of these risks are here.” You guys have probably got stories like this, where you’ve gone in for some brain surgery or any surgery where there’s a risk, but this risk was pretty huge. He was very concerned. I think appropriately concerned.

So, here I am for 30 hours, managing this stuff where I’m like, “Okay, this could go really well or this could go really bad, like really, really bad.” I giggle just because it makes me nervous just to think about it. That’s a nervous giggle that you just heard me. I don’t know. I often giggle when I’m nervous. But it’s a big deal. So, I, in these moments, had to weigh up, go back to what Lisa Coyne was talking about. I was like, “Okay, values versus fear. Which one do I consult with?” I had reached out to the dentist to say, “You know what, let’s just not do this. I’m not in any pain. Let’s just keep it there. Let’s just not.” And his response was like, “That’s not even an option. If you’ve already got this much damage, this could get worse and be very, very problematic.” So, I didn’t even have the option to back out. I had to do this.

And so, as I proceeded forward, I had to keep being aware like what Jon Hershfield talked about and Dr. Grayson and Dr. Reid Wilson, and Shala. I had to really allow all the intrusive thoughts to come like, “Yup. Possible. Yup, that’s possible too. Yup, that’s possible too. Maybe it does. Maybe it will. Not going to give it my attention right now. I see you’re back again. Good one, bro. Hi there, I see you. I fully accept the uncertainty.” That was me for l30 hours, literally bringing in every tool I have.

The cool thing is it was a hugely busy week. And because I have been really doubling down on my mindfulness skills over the last few months, that actually really helped. Every time I noticed that I was getting anxious, I was like, “Okay, what does the keyboard feel under my fingers?” I have these fiddles that I play with and I’m like, “Okay, what does this feel like? This rubber feel like, or this metal feel like, and so forth?” So, that was really helpful.

The day of the surgery, I go in and I’m fully anxious. I’m going to the bathroom. I’m needing to pee. I feel dizzy. I’m not allowed to be on my medication. Oh, and that’s the other thing, is this maybe the-- what do you call it? The silver lining. Just a little update for you guys, is there is a small chance, because this infection has been here for a long time and we haven’t actually detected it yet, that it may be the reason for all my POTS symptoms. As some of you may know, I have postural orthostatic tachycardia syndrome. It is a chronic illness related to dysautonomia. It causes me to faint and have headaches and nausea and dizziness and blood pooling and it’s the worst. And there is a chance that that might be why. So, I’m half scared and half excited all day, which is a lot to handle.

But as the day is moving forward, I’m getting more and more nervous and I start to feel the urge to start to seek reassurance. I start to observe the urge to Google. I start to observe the urge to ask the doctors many, many, many, many questions. And when I say it, I’m saying that very intentionally. I observed the urge, which is I didn’t do those behaviors. I just noticed the urge that kept showing up. “Ooh, let’s try and get this anxiety to go away. Ooh, let’s try and get that anxiety to go away.” Knowing that when it’s my turn to sit in that chair, I will ask specific questions. So, I’m not saying you can’t ask your doctors questions, but that was key for me, was to observe the urge to seek reassurance, observe the urge to go into avoidance.

I’m not going to make this story too much longer, but what I will say, I want to tell you the funniest part of this story. I’m in the doctor’s office because I had to go in for this very fancy x-ray that does all your nerves because he was afraid he was going to hit one. He’s showing me the x-ray and I’m literally looking at it. He’s showing me cross-sections of my jaw. And you guys, it was so scary. You can see the hole that it’s created. You can see the infection and how it’s deteriorated the bone. It was so scary. And so, he puts his hand on my-- and I’m like, at that point, “Is there any way we could get away with not doing this? Because this is really scary.” He puts his hand on my hand, he says, “I’m going to go and take care of all of these last patients I have so I can give you 100% of my attention and I will be back.”

You guys, this is the funniest thing ever. So, the dental nurse is there watching me. My heart is through the roof. My blood pressure is all over the place. She stands in front of me and she says, “Miss Kimberley, don’t be worried. We’ve watched all the YouTube videos.” And I swear to you, every piece of panic that I had went out the window for that small second and I laughed so hard. She said, “In fact, that’s where the doctor is right now. He’s just going to watch the YouTube video one more time.” And I just died laughing.

Now for some of you, that may have actually been really anxiety-provoking. But for me, it was exactly what I needed. I needed someone to make this so funny. And it was so funny. I swear to you, every time I think of it, the way she says it in her accent was the most hilarious thing ever. It was so perfectly timed. The delivery was perfect and I burst out laughing.

He comes back in-- this is the end of the story. I’m not going to drag it out for too much longer. I promise. But he comes back in, and I just wanted to share with you, because I know last week with Lisa, I had a really emotional moment, and I think it was really tied to this. As he was putting in the IV – because I had to be knocked out. He said he couldn’t take a risk of me moving. So, he knocked me out for the surgery – tears just rolled out of my eyes. And I wasn’t going to be ashamed of it. And what came up for me was, I said, “Please, sir.” I said “Sir,” which I think is so funny, because I know him by his first name. “Please, sir. Please just take care of me.”

And for me, tears were rolling down my face, but that was an act of compassion for myself. Instead of me saying-- because I know two years ago, or even six months ago, I probably would’ve said, “Please, don’t kill me,” or “Promise me nothing bad would happen.” But there was this act of compassion that just flowed out of me, which was like, “Please, sir. Please take care of me.” And it was coming from this deep place of finally in my life, being able to ask to be taken care of. And I’ve been working on this, you guys, for about a year, is having the ability to actually ask for help has been something I’ve really sucked at and it’s something I’ve worked so hard at. And for me, that was groundbreaking, to ask for help.

Now you could say it was me pleading with him, but it wasn’t. It was me. It was an act of compassion. It was an act of saying, “I’m scared. I’m not asking you to take my fear away. I’m just asking you to hold me in a place of kindness and compassion and nurturing and care.” And that for me was profound.

So, I just wanted to share that with you. I know that it might not be as skills-based as some of the other episodes, but I love sharing with you hard things and I love sharing with you that I’m a human, messy human who’s doing the best they can and is imperfect too. But I just wanted to give you a step-by-step one. It’s okay if it’s hard and there are skills that you can use and we can get through hard things. It’s a beautiful day to do hard things, I always say that. And so, I wanted to just record this and share with you the ups and the downs of my week and help you maybe if there’s a time where you’ve gotten bad news on ways that you might manage it.

Now, what I do want to end here with is, I understand my privilege here. I understand my privilege of getting bad news and being able to get medical care and have a lovely dentist and a lovely nurse who makes funny jokes. And sometimes the news doesn’t end well, and I get that. I want to honor you that there is no right way to get bad news. And the grief process of getting bad news is different for everybody. This was more of an anxiety process, but I want to honor to you that if you’re going through some hard thing in your life where you’ve gotten bad news, I want to also offer you the opportunity to grieve that and I want to honor that this is really, really a hard thing to go through. So, I really want to make sure I make space for you with that because my experience is not your experience, I’m sure.

So, that’s it, guys. That’s what to do when you get bad news. That’s my experience of getting bad news and I hope it’s been helpful.

We are embarking on some shifts here with the podcast. I am so inspired to be more focused on just delivering the tools to you and being a safe place for you and being a bright, shiny light for you. And so, I’m doing a lot of exploring on how I can do that. So, if you ever-- again, please do feel-- if you want to give some thoughts, please do reach out, send me an email. If you’re not on my newsletter list, please do go and sign up. I’ll leave you a link in the show notes, or you can go to CBTSchool.com and sign up for the newsletter and you can reply there as well or you can leave a review.

All right. I love you guys. Have a wonderful day. It is a beautiful day to get bad news and do the hard thing. I love you. Have a great day.

Jun 10, 2022
Ep. 287 6-Part Series: Managing Mental Compulsions (with Dr. Lisa Coyne)
48:58

SUMMARY: 

In this episode, we talk with Lisa Coyne about ACT For mental compulsions.  Lisa Coyne addressed how to use Acceptance and Commitment therapy for overcoming mental compulsions. We cover how to identify your values using a fun little trick!

In This Episode:

  • How to use Acceptance & Commitment Therapy to manage mental compulsions
  • How to practice Willingness in regards to reducing mental rituals and mental rumination 
  • A fun little Value Based tool for identifying your values. 
  • How to be curious instead of thinking in a limited way. 

Links To Things I Talk About:

Episode Sponsor:

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

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Managing Mental Compulsions (With Lisa Coyne, PhD) Your anxiety toolkit

 

EPISODE TRANSCRIPTION

This is Your Anxiety Toolkit - Episode 287. 

Welcome back, everybody. I am so excited. We are at Episode 6 of this six-part series of how to manage mental compulsions. You guys, we could not end this series with anyone better than Dr. Lisa Coyne. I don’t know if you’ve heard of Lisa Coyne. I bet you, you probably have. She is the most wonderful human being. 

I have met Lisa, Dr. Lisa Coyne multiple times online, never in person, and just loved her. And this was my first time of actually getting to spend some really precious time with her. And, oh my gosh, my heart exploded like a million times. And you will hear in this episode, you will hear my heart exploding at some point, I’m sure.

I am so honored to finish out the six-part series with Lisa. This series, let me just share with you how joyful it has felt to be able to deliver this as a series, as a back-to-back piece of hope. I’m hoping it has been a piece of hope for you in managing something really, really difficult, which is managing mental compulsions.

Now, as we finish this series up, I may or may not want to do a recap. I’m not sure yet. I’m going to just see where my heart falls, but I want to just really first, as we move into this final part of the series, to remind you, take what you need. You’ve been given literally back-to-back some of the best advice I have ever heard in regards to managing mental compulsions. We’ve got world-renowned experts on this series. You might have either found it so, so educational and so, so helpful while also feeling sometimes a little bit like, “Oh my goodness, there’s so many tools, which one do I use?” 

And I really want to emphasize to you, as we finish this out, again, so beautiful. What a beautiful ending. I almost feel like crying. As we finish it out, I really want to remind you, take what you need, take what’s helpful, or – well, I should say and – try all of them out. Practice with each of the skills and the concepts and the tools. See what happens when you do. Use them as little experiments. Just keep plugging away with these skills and tools. Because number one, they’re all evidence-based. I very carefully picked the experts on this series to make sure that we are bringing you evidence-based, really gold standard treatment. So, that’s been a priority. Just practice with them. Don’t be hard on yourself as you practice them. Remind yourself, this is a long-term journey. These are skills I still practice. I’m sure everyone who’s come on the show, they are still practicing them. And so, I really want to send you off with a sense of hope that you get to play around with these. Be playful with them. Some of them will be we’ve giggled and we’ve laughed and we’ve cried. So, I want you to just be gentle as you proceed and you practice and remind yourself this is a process and a journey. 

That being said, I am going to take you right into this next part of the six-part series with Dr. Lisa Coyne. This is where we bring it home and boy, does she bring it home. I feel like she beautifully ties it all up in a ribbon. And I hope it has been so helpful for you. Really, I do. I want this to be a resource that you share with other people who are struggling. I want to be a resource that you return to when you’re struggling. I want it to be a place where you feel understood and validated. And so, thank you so much for being a part of this amazing series. That being said, let’s get over onto the show, and here is Dr. Lisa Coyne.

------

Kimberley: I literally feel like I’m almost in tears because I know this is going to be the last of the series and I’m so excited. I had just said this is going to bring it home. I’m so excited to have Dr. Lisa Coyne. Welcome.

Lisa: Thank you. It’s so nice to be here with you, Kim. Hi, everyone.

What is a Mental Compulsion? Do you call it a Mental Compulsion or a Mental Ritual? 

Kimberley: Yes. So, first of all, the question I’ve asked everybody, and I really am loving the response is, this is a series on managing mental compulsions, but do you call them mental compulsions, mental rituals, rumination? How do you conceptualize this whole concept?

Lisa: I would say, it depends on the person and it depends on what they’re doing. I call them any number of things. But I think the most important thing, at least for me in how I think about this, is that we come at it from a very behavioral perspective, where we really understand that-- and this is true for probably all humans, but especially so for OCD. I have a little bit of it myself, where I get caught up in the ruminations. But there’s a triggering thought. You might call it a trigger like a recurrent intrusive thought that pops up or antecedent is another word that we think of when we think of behavior analysis. But after that thought comes up, what happens is the person engages in an on-purpose thing, whatever it is that they do in their mind. It could be replacing it with a good thought. It could be an argument with yourself. It could be, “I just need to go over it one more time.” It could be, “I’m going to worry about this so I can solve it in advance.” And that part is the part that we think of as the compulsion. So, it’s a thing we’re doing on purpose in our minds to somehow give us some relief or safety from that initial thought. 

Now the tricky part is this. It doesn’t always feel like it’s something we’re doing on purpose. It might feel so second nature that it too feels automatic. So, part of, I think, the work is really noticing, what does it feel like when you’re engaging in this activity? So, for me, if I’m worrying about something, and worry is an example of this kind of doing in your mind, it comes with a sense of urgency or tightness or “I just have to figure it out,” or “What if I--” and it’s all about reducing uncertainty really. 

So, the trick that I do when I notice it in me is I’ll be like, “Okay, I’m noticing that urgency, that tension, that distress. What am I up to in my head? Am I solving something? Is that--” and then I’ll step back and notice what I’m up to. So, that’s one of my little tricks that I teach my clients.

Kimberley: I love this. Would you say your predominant modality is acceptance and commitment therapy? What would you say predominantly you-- I mean, I know you’re skilled in so many things, but what would you--

Lisa: I would say, it’s funny because, yeah, I guess you would. I mean, I’m pretty skilled in that.  I’m an ACT trainer. Although I did start with CBT and I would say that for OCD, I really stick to ERP. I think of it as the heart of the intervention, but we do it within the context of ACT.

ACT for Mental Compulsions 

Kimberley: Can you tell me what that would look like? I’m just so interested to understand it from that conceptualization. So, you’re talking about this idea. We’ve talked a lot about like, it’s how you respond to your thoughts and how you respond and so forth. And then, of course, you respond with ERP. What does ACT look like in that experience? I’d love to hear right from your mouth.

Lisa: Okay. All right. So, I’m going to do my best here to just say it and then we’ll see if it sounds more like ACT or it sounds more like ERP. And then you’ll see what I mean when I say I do both of them. So, when you think about OCD, when you think about anxiety, or even maybe depression where you’re stuck in rumination, somebody is having an experience. We call it a private event like feeling, thought, belief that hurts, whatever it is. And what they’re doing is everything that they can to get away from that. So, if it’s OCD, there’s a scary thought or feeling, and then there’s a ritual that you do. 

So, to fix that, it’s all about learning to turn towards and approach that thing that’s hard. And there’s different ways you can do that. You can do that in a way where you’re dialing it in and you’re like, “Yeah, I’m going to do the thing,” but you’re doing everything that you can to not feel while you’re doing that. And I think that’s sometimes where people get stuck doing straight-up exposure and response prevention. It’s also hard. 

When I was a little kid, I was really scared to go off the high dive. I tell my clients and my team the story sometimes where it was like a three-meter dive. And I was that kid where I would be like, “I’m going to do it. All the other kids are doing it.” And I would climb up, I’d walk to the end of the board, freak out, walk back, climb down. And I did this so many times one day, and there’s a long line of other kids waiting to get in the water. And they were pissed. So, I got up and I walked out to the end of the board and I was like, “I can’t.” And I turned around to go back. And there was my swim coach at the other side of the board with his arms crossed. I was like, “Oh no.”

Kimberley: “This is not the way I planned.”

How do you apply Acceptance & Commitment Therapy for OCD and Mental Compulsions? 

Lisa: And he is like, “No, you’re going.” And I went, which was amazing. And sometimes you do need that push. But the point is that it’s really hard to get yourself to do those really hard things sometimes when it matters. So, to me, ACT brings two pieces to the table that are really, really important here. You can divide ACT into two sets of processes. There’s your acceptance and mindfulness processes, and then there’s your commitment and valuing processes, which are the engine of ACT, how do we get there? 

So, for the first part, mindfulness is really paying attention on purpose. And if you want to really learn from an exposure, you have to be in your body, you have to be noticing, you have to be willing to allow all of the thoughts and sensations and whatever shows up to show up. And so, ACT is ideal at shaping that skillset for when you’re in the exposure. So, that’s how we think of it that way. 

And then the valuing and commitment is, how do you get yourself off that diving board? There has to be something much more important, bigger, much bigger than your fear to help motivate you for why to do this hard thing. And I think that the valuing piece and really connecting with the things that we most deeply care about is part of what helps with that too. So, I think those two bookends are really, really important. There’s other ways to think about it, but those are the two primary ways that we do ERP, but we do it within an ACT framework.

Using Values to manage Mental Compulsions

Kimberley: Okay. I love this. So, you’re talking about we know what we need to do. We know that rumination isn’t helpful. We know that it creates pain. We know that it keeps us stuck. And we also know, let’s jump to like, we know we have to drop it ultimately. What might be an example of values or commitments that people make specifically for rumination, the solving? Do you have any examples that might be helpful? 

Lisa: Yeah. I’m just thinking of-- there’s a bunch of them, but for example, let’s take, for example, ROCD, relationship OCD. So, let’s say someone’s in a relationship with a partner and they’re not sure if the right partner is. Are they cheating on me? Are they not? Blah, blah, blah, blah. And it’s this like, “But I have to solve if this is the right person or not. Am I going to be safe?” or whatever the particular worry is. And so, one of the things that you can do is once folks notice, they’re trying to solve that. Notice, what’s the effect of that on your actual relationship? How is that actually working? So, there’s this stepping back where an ACT, we would call that diffusion or taking perspective self-as-context, which is another ACT, acceptance, and mindfulness piece. And first of all, notice that. Second of all, pause. Notice what you’re up to. Is the intent here to build a strong relationship, or is the intent to make this uncertainty go away? And then choose. Do I want to work on uncertainty or do I want to work on being a loving partner and seeing what happens? Because there’s so much we’re not in charge of, including what we’re thinking and feeling. But we are in charge of what we choose to do. And so, choosing to be present and see where it goes, and embracing that uncertainty. But the joyfulness of it, I think, is really, really important. So, that would be one example. 

Kimberley: I love that example. Actually, as you were saying, I was thinking about an experience of my own. When your own fears come up around relationship, even you’re ruminating about a conversation or something, you’ve got to stop and be like, “Is this getting in the way here of the actual thing?” It’s so true. Tell me about this joy piece, because it’s not very often you hear the word joy in a conversation about mental compulsions. Tell me about it.

Lisa: Well, when you start really noticing how this is working, and if you’re willing to step back from it, let it be, and stay where you are in that uncertainty, all sorts of new things show up. Stuff you never could have imagined or never could have dreamed. Your whole life could be just popping up all of these possibilities. In that moment you stop engaging with those compulsions, you could go in a hundred different directions if you’re willing to let the uncertainty be there. And I think that that’s really important. 

I want to tell a story, but I have to change the details in my head just for confidentiality. But I’m thinking of a person who I have worked with, who would be stuck and ruminating about, is this the right thing? I could make decisions and how do I-- for example, how do I do this lecture? My slides need to be perfect and ruminating, ruminating, ruminating about how it works. And one day they decided, “Okay, I’m just going to be present and I’m just going to teach.” And they taught with a partner. And the person themself noticed like, “Wow, I felt so much more connected to my students. This was amazing.” And the partner teaching with them was like, “I’ve never seen you so on. That was amazing.” They contacted this joy and like, “This is what it could be like.” And it’s like this freedom shows up for you. And it’s something that we think we know. And OCD loves to know, and it loves to tell you, it knows the whole story about everything. And it’s more what you get back when you stop doing the compulsions if you really, really choose that. It’s so much more than just, “Oh, I’m okay. I noticed that thought.” it’s so much more than that. It’s like, yes, and you get to do all this amazing stuff. 

Kimberley: Right. I mean, it’s funny. I always have my clients in my head. When someone says something, I’m imagining my client going, “But like, but like...” What’s the buts that are coming?

Lisa: And notice that process. But see, that’s it. That’s your mind, that’s their minds jumping back in being like, “See, there it is again.”

Kimberley: Yeah.

Lisa: And what if we just don’t know?

Using Curiosity to Stop Mental Compulsions 

Kimberley: And this is what I love about this. I agree with you. There have been so many times when I’ve dropped myself out of-- I call it being heady and I drop into my body and you get this experience of being like, “Wow.” For me, I can get really simple on like, “Isn’t it crazy that water is clear?” I can go to that place. “Water is clear. That is incredible.” You know what I mean? It’s there to go to that degree. But then, that’s the joy in it for me. It’s like, “Wow, somebody literally figured out how to make this pen work.” That still blows my mind. 

Lisa: I had a moment. I started horseback riding again for the first time in literally-- I’ve ridden on and off once a year or something, but really riding. And actually, it was taking classes and stuff for the first time in 30 years. And they put me in this class and I didn’t know what level it was. I just thought we were just going to walk around and trot and all that stuff. Plus, she starts setting up jumps. And I was like, “Oh my God, this is old body now. This is not going to bounce the way it might have been.” It’s what means all these 15-year-olds in the class.

Kimberley: Wow.

Lisa: I’m third in line and I’m just on the horse absolutely panicking and ruminating like, “Oh my God, am I going to die? Should I do this? What am I going to do? Should I tell her no? But I want it and I don’t know what I’m going to--” and my head was just so loud. And so, the two girls in front of me go. And then I look at the teacher and I go, “Are you sure?” It’s literally the first time I’ve ever done in 30 years. She just went-- she just looked at me. And I noticed that my legs squeezed the horse with all of the stuff rolling around in my head. And I went over the jump and it was, I didn’t die. It was really messy and terrifying. Oh my God, it was so exciting and joyful. And I was so proud of myself. That’s what you get--

Kimberley: And I’ve heard that from so many clients too. 

Lisa: It’s so awesome. 

Kimberley: I always say it’s like base jumping. It’s like you’ve got to jump. And then once you’ve jumped, you just got to be there. And that is true. There is so much exhilaration and sphere that comes from that. So, I love that. What about those who base jump or squeeze the horse and they’re dropping into discomfort that they haven’t even experienced before, like 10 out 10 stuff. Can you walk me through-- is it just the same? Is it the same concept? What would you advise there?

Lisa: So, I think it’s important to notice that when that happens, people are not just experiencing physical sensations and emotions, but it’s also whatever their mind is telling them about it. And I think this is another place where ACT is super helpful to just notice, like your mind is saying, this is 10 out of 10. What does that mean to you? That means like, oh my gosh. And just noticing that and holding it lightly while you’re in that 10 out of 10 moment, I think, is really, really helpful. 

So, for example, I have a really intense fear of heights where I actually freeze. I can’t actually move when I’m on the edge of something. And I had a young client who I’ve worked with for a while. And as an exposure for her, but also for me as her clinician to model, we decided. She wanted me to go rock climbing with her, which is not something I’ve ever done, ever, and also fear of heights. So, I kept telling myself, “Fear of heights, this is going to suck. This is going to be terrible. This is going to be terrible.” And there was also another part of me interested and curious. 

And so, what I would say when you’re in that 10 out of 10 moment, you can always be curious. So, when you’re like, “Oh my gosh, I’m really scared,” the moment you’re unwilling to feel that is the moment it’s going to overwhelm you. And if you can notice it as a thought, “I’m having the thought, I don’t think I can handle this. I don’t think I’m going to survive this,” and notice it and be curious, let’s see what happens. And so, for me, I noticed interestingly, even though I’m terrified of heights, I wasn’t actually scared at all. And that was a shocker, because I was full sure it was going to be the worst thing ever. 

And so, notice the stories your mind tells you about what an experience is going to be and stay curious. You can always be curious. And that’s going to be, I think, your number one tool for finding your way through and how to handle those really big, unexpected, and inevitable surprising moments that happen in life that are really scary for all of us.

Kimberley: Right. And when you say curious, I’m not trying to get too nitpicky on terms, but for me, curiosity is, let’s experiment. I always think of it like life is a science experiment, like let’s see if my hypothesis is true about this rock climbing. Is there a way that you explain curiosity?

Lisa: Yeah. Well, that’s part of it, but it’s also part like what you were describing. Isn’t water cool? It’s more than, is this true or not true? That’s so narrow. You want, “No, really? What does this taste like?” And that’s the mindfulness piece. Really notice all of it. There’s so much. And when you start doing that, you’ll find-- even if you do it outside of exposure, for example, as practice, you start to notice that the present moment is a little bit like Hermione’s purse in Harry Potter, where you think it’s this one thing, and then when you start to expand your awareness, you notice there’s tons of cool stuff. So, in these big, scary moments, what you might see is a sense of purpose or a sense of, “Holy crap, I’m handling this and I didn’t think I could. Wow, this is amazing,” or “I’m really terrified. Oh my gosh, my nose itches.” It could be anything at all. 

But the bottom line is, our bodies were meant to feel and they were meant to experience all the emotions. And so, there is no amount of emotion or fear or anything that we are not built to handle. Emotions are information. And to stay in the storm when it’s such a big storm, when OCD is ramping you up, it teaches the OCD, “Actually, I guess I get to stand down here eventually, I guess I don’t need to freak out about this so much. Huh, interesting. I had no idea.” I don’t know if that’s helpful or not.  

Kimberley: No, it’s so helpful. It is so helpful because I think if you have practiced curiosity, it makes sense. But for someone who maybe has been in mental compulsions for so long, they haven’t really strengthened that curiosity muscle.

Mindfulness for Mental Compulsions

Lisa: That’s so true. So, start small. Don’t start in the storm. Start with waking up in the morning and noticing before you open your eyes, what do you hear? How do the covers feel? Do you hear the birds outside your window? Start with that. And start in little moments, just practicing during the day. Start a conversation with someone you care about, and notice what your mind is saying in response to them, what it’s like to notice their face. Start small, build it up, and then start practicing with little tiny, other kinds of discomfort. Sometimes we’ll tell people like impatience. When you’re waiting in line or in hunger or tiredness, any of those, to just bring your full awareness to that and be like, “What is it like inside this moment right now?” And then you can extend that to, “Okay. So, what if we choose to approach this scary thing? What if we choose to just for a few seconds, notice what it feels like in this uncertain space?” And that’s how you might begin to bring it to rumination, be curious about what was the triggering thought. And then before you start ruminating or before you start doing mental rituals, just notice the first thought, and then you don’t have to answer that question. And there’s different ways to handle that, but curiosity is the beginning. And then stopping the compulsion is ultimately, or undoing it or undermining it in some way is going to be the other important piece.

Kimberley: I’d love to hear more about commitment. I always loved-- when I have multiple clients, we joke about this all the time. They’ll say, “I had these mental compulsions and you would be so proud. I was so proud. I was able to catch it and pull myself back into the present. And yes, it was such a win. And then I had another thought and you’d be so proud of me. I did the same thing. And then I had another thought and...”

Lisa: You’re like, “Was that the show that you just did right there?” It’s sneaky, huh.

Kimberley: And so, I’d love to hear what you’re-- and maybe bring it from an ACT perspective or however you would. It’s like you’re chugging away. “I’m doing good. Look at me go.” But OCD can be so persistent.

Lisa: It’s so tricky. 

Kimberley: And so, is that the commitment piece, do you think? What is that? How would you address that? 

Lisa: So, if I’m getting your question right, you’re asking about, what do we do when OCD hijacks something that you should do and turns it into a ritual? Is that what you’re asking? 

Kimberley: Yes. Or it just is OCD turns up the volume as like, “No, no, no, no. You are going to have to tend to me or I’m not going to stop,” kind of thing.

Lisa: Yes. That is a commitment piece. And it’s funny because there’s different ways that I think about this, but it’s almost like a little child who has a tantrum. If you keep saying yes, every time they make the tantrum bigger, it’s going to end up being a pretty big tantrum. And OCD loves nothing more than a good tantrum.

Kimberley: So true.

Lisa: And so, the thing you have to do is plan for that and go, “Yeah, it’s going to get loud. Yeah, it’s going to say whatever it needs to say, and it’s going to say the worst thing I can think of.” And I have had my clients call this all sorts of different things like first-order thoughts, second-order thoughts, just different variations on the theme where it’s going to ramp up to hook you in. And so, really staying very mindful of that and making a promise to yourself. 

One of my clients who helped us a lot in teaching but also in writing stuff that’s loud, Ethan, I think said it in this really elegant way. He said, make a promise to yourself. That really matters, even if it’s small. It doesn’t matter how big it is. But one of his first ones was, under no circumstances, am I going to do X the compulsion? And keep that promise to yourself because if you-- anybody who ever woke up and didn’t want to get out of the bed in the morning because, “Ah, too tired, it’s too early. I don’t really want to go to the gym.” If you know you’re in that conversation with yourself about, “Well, maybe just one more minute,” you’ve already lost. And so, this is a good place again for that ACT piece of diffusion. Noticing your mind or your OCD or your anxiety is pulling you into, “Ah, let’s just see if we can string you along here.” And so, what needs to happen is just move your feet and put them on the floor. Don’t get into that conversation with yourself. And having that commitment piece, that promise to myself with the added value piece, that really matters.

And one other thing that’s sometimes helpful that I have-- I’ll use this myself, but I also teach my clients, remembering this question: If this is a step towards whatever it is that’s really important, am I willing to allow myself to feel these things? Am I willing? And remembering that as a cue. We’re not here. It’s never about this one exposure. It’s about, this is a step towards this other life that you are fighting for. And every single step is an investment in that other life where you’re getting closer and you’re making it more possible, and just remembering that. I think that that’s a really important piece.

A Values Tool YOU NEED! 

Kimberley: Yeah. It actually perfectly answered the question I had, which is, you’re making a commitment, but what to? And it is that long-term version of you that you’re moving towards or the value that you want to be living by. Would you suggest-- and I’ve done a little bit of work on the podcast about values. Maybe one day we can have you back on and you can share more about that, but would you suggest people pick one value, three values? How might someone-- of course, we all have these values and sometimes OCD can take things from us, or anxiety can take those things from us. How would you encourage someone to move in that direction?

Lisa: Well, actually, do you want to do a fun thing?

Kimberley: I do.

Lisa: Okay. So, let’s do--

Kimberley: I never would say no to that. I would love to. I’m really curious about this fun thing.

Lisa: All right. So, do you like coffee or are you a tea person or neither?

Kimberley: Let’s go tea. I’m an Australian. If I didn’t say tea, I would be a terrible Aussie. 

Lisa: They’ll kick you off. All right. So, Kim, think about in your life a perfect cup of tea, not just a taste, but a moment with someone maybe you cared about or somewhere that was beautiful or after something big or before something big, or just think about what was a really, really amazing important cup of tea that you’ve had in your life.

Kimberley: Oh, it’s so easy. Do I tell you out loud? 

Lisa: Yeah. If you want to, that’d be great. 

Kimberley: I’ll paint you guys a picture. So, I live in America, but my parents live in Australia and they have this beautiful house on a huge ranch. I grew up on a farm. And we’re sitting at their bay window and you’re overlooking green. It’s just rolling hills. And my mom is on my left and my dad is on my right. And it’s like milky and there’s cookies. Well, they call them biscuits. So, yeah. That’s my happy place right there.

Lisa: And I could see it in your face when you’re talking about it. So, where do you-- does that tell you something about what’s really important to you? 

Kimberley: Yes.

Lisa: What does it tell you?

Kimberley: Family and pleasure and just savoring goodness, just slowing down. It’s not about winning a race, it’s just about this savoring. And I think there’s a lot-- maybe something there that I think is important is the green, the nature, the calm of that.

Lisa: Yeah. So, as you talk about that, what are you noticing feeling?

Kimberley: Oh my God, my heart just exploded 12 times. My heart is filled. That was the funnest thing I’ve ever done in my whole life. Funnest is not a word.

Lisa: What if you could build your life around moments like that? Would that be a well of life for you?

Kimberley: I think about that nearly every time I make tea, actually.

Lisa: That’s how you would help your clients, and that’s one way to think about values.

Kimberley: Wow. That is so cool. I feel like you just did a spell on me or something.

Lisa: You just connected with the stuff that’s really important. So, when you think about if I had a hard thing to do, what if it was a step towards more of that in your life?

Kimberley: Yeah.

Lisa: You see? 

Kimberley: It’s so powerful. I’ve never thought that. Oh my God, that was gold. And so, that’s the example. Everyone would use that, coffee or tea.

Lisa: There you go. Just think about it. And it’s funny because we came up with this in our team, maybe three months ago. We keep piloting just new little values exercise, but it’s so funny how compelling it is. just thinking about-- gosh. Anyway, I could tell you about mine, but you get the point. 

Kimberley: And you know what’s so funny too and I will say, and this is completely off topic, there’s a social media person that I follow on Instagram. And every time she does a live-- and for some reason, it’s so funny that you mentioned this, I love what she talks about, but to be honest, I’m not there to watch her talk. The thing that I love the most is that she starts every live with a new tea and she’ll pause the water in front of you. It’s like a mindfulness exercise for me. To be honest, I find myself watching to see whether she’s making tea. Not that this is about tea, but I think there’s something very mindful about those things that where we slow down-- and the water example, she’s pouring it and she’s watching the tea. And for some reason, it’s like a little mini-break in the day for me. 

Lisa: I totally agree. It’s like the whole sky, the cloud, and the tea and the--

Kimberley: Like Thich Nhat Hanh.

Lisa: Yes. I can’t remember the quote, but exactly. 

Kimberley: Yeah. Oh my gosh, I love that example. So good. Well actually, if you don’t mind, can you tell us your tea? Because I just would love to see if there’s a variation. So, what would yours be?

Lisa: It was funny because I think I did coffee the first time I did this, but then recently I just did a workshop in Virginia and I was like, “Oh my gosh, tea.” And what came to mind was, when I took my 17-year-old daughter tracking in the Himalayas to Nepal, because I wanted her. She was graduating from high school and I wanted to show her that you could do anything and she really wanted to go. We both really wanted to go to Ever Space Camp. And every morning after trekking nine, 10, 11 hours a day where you’re freezing cold, you’re exhausted, everything’s hurting, and it’s also amazing and beautiful, the guides would knock at our door and there would be two of them. And one of them would have a tray of little metal cups. And then the other one would say, “Tea? Sugar? Would you like sugar?” And they would make you, they would bring you, and this was how you woke up every morning, a steaming cup of tea. Sometimes the rooms were 20 below zero. And you’d get out of bed and you’d be so grateful for that warm cup of tea. And that was the tea I remembered.

Kimberley: Right. And then the values you pulled from that would be what?

Lisa: That moment, it was about being with my daughter and it was about showing her, modeling courage and modeling willingness and just adventure and this love of being in nature and taking a journey and seeing, “Could we do this? And what would it be like?” And just sharing the experience with her. It’s just beautiful. And the tea is right in the center of that. So, it’s almost not even about the tea, but it’s that moment. It’s that time and that experience. So amazing.

Kimberley: So amazing. Thank you. I’m deeply grateful. That just filled my heart. 

Lisa: I’m so glad. I feel so honored that you have had experience. I love that so much.

Kimberley: I did. I always tell my clients or my kids or whoever is at-- when I was a kid, my mom, every afternoon when I came home from school, she’d say, “What’s the one thing you learn at school today?” And so still, there’s always one thing I learn and I always note it like that’s the one thing I learned today and that was it. What an amazing moment. 

Lisa: I’m so glad. 

Kimberley: Okay. I love this. So, we’ve talked about mindfulness and we’ve talked about commitment. We’ve talked about values and we have talked about the acceptance piece, but if we could have just one more question around the acceptance piece. How does that fit into this model? I’m wondering. 

Lisa: It’s funny because I always feel like that acceptance piece, the word, it means to so many people, I think, tolerance or coping or let’s just make this okay. And it doesn’t mean any of those things. And so, I’ve moved more into thinking of it and describing it as, it’s like a willingness. What is under the hood of acceptance and am I willing? Because you cannot like something and not want something and also be willing to allow it. And it’s almost like this-- again, it involves curiosity about it. It involves squeeze the horse with all the stuff. Get the feet on the floor, even though you’re having an argument that’s in your head. And so, sometimes people think about it as a feeling and sometimes it is, but a lot of times, it’s willingness with your feet. When you think about moms and infants in the middle of the night, I don’t think there was ever a moment when I was like, “Oh yeah, the baby’s crying at 4:00 in the morning. I’m so excited to get up.” I’m feeling in my heart, no. It’s like you’re exhausted and it’s like the last thing you want to do and 100% you’re willing to do it. You choose. And so, that’s the difference. And so, I think people get tangled up, not just thinking of it as tolerance, but also waiting for a feeling of willingness to happen. And that’s not it. It’s a choice.

Kimberley: It’s gold.

Lisa: Yeah, seriously. I mean, it’s the same thing. I learn it every day. Trust me, when I fall out of my gym routine or my running routine and I’m off the willingness, and then I’m like, “Yeah, that’s not it.” And I have to come back to it. So, it’s something we all struggle with. And I think that’s really important to know too, but ultimately, it’s a choice, not a feeling.

Kimberley: Okay. That was perfect. And I’m so happy. Thank you, number one. This is just beautiful for me and I’m sure the gifts just keep going and flowing from this conversation. So, thank you. 

Lisa: Thank you for having me.

Kimberley: Tell me where people can hear more about you and know your work?

Lisa: Well, we’re at the New England Center for OCD and Anxiety in Boston. We have recently opened in New York City and in Ireland. So, if anybody is in Ireland, call us, look us up.

Kimberley: Wow.

Lisa: Yeah. That’s been really fun. And there’s a few books we have. There’s Stuff That’s Loud written by Ben Sedley and myself. There’s our newest book called Stop Avoiding Stuff with Matt Boone and Jen Gregg. And that’s a fun little book. If anybody’s interested in learning about ACT, it’s really written-- the chapters are each standalone and they’re written so that you could read them in about two minutes, and that was on purpose. We wanted something that was really pocket-sized and really simple with actionable skills that you could use right away. And then I have a new book coming out actually really soon. And no one knows this. Actually, I’m announcing this on your show. And I am writing it with my colleague, Sarah Cassidy-O’Connor in Ireland. We are just doing the art for it now and it’s a book on ACT for kids with anxiety and OCD. 

Kimberley: When is this out?

Lisa: Good question. I want to say within the year, but I don’t remember when.

Kimberley: That’s okay. 

Lisa: But look for it and check out our website and check out Stuff That’s Loud website. We’ll post it there and let folks know. But yeah, we’re really excited about it. And it’ll be published by a UK publisher. So, it’s really cute. So, I think the language will be much more like Australia, UK, Ireland for the US, which is really fun because I have a connection to Ireland too. But anyway, there you go. 

Kimberley: It’s so exciting. Congratulations. So needed. It’s funny because I just had a consultation with one of my staff and we were talking about books for kids. And there are some great ones, but this ACT work, I think as I keep saying, there’s skills for life. 

Lisa: It really is.

Kimberley: So important. How many times I’ve taught my child, even not related to anxiety, just the ACT skill, it’s been so important.

Lisa: Yeah. Mine too. I think they’re so helpful. They were just really helpful with flexibility in so many different areas.

Kimberley: Right. I agree. Okay. This is wonderful. Thank you for being on. Like I said, you brought it home. 

Lisa: We’ll have our cups of tea now.

Kimberley: We will

Lisa: So nice to talk to you, Kim. 

Kimberley: Thank you.

Lisa: Thank you.

Jun 03, 2022
Ep. 286 6-Part Series: Managing Mental Compulsions (with Dr. Reid Wilson)
57:42

SUMMARY:

In this week's podcast, we talk with Dr. Reid Wilson.  Reid discussed how to get the theme out of the way and play the moment-by moment game.  Reid shares his specific strategies for managing mental compulsion. You are not going to want to miss one minute of this episode.

Covered in This Episode:

  • Getting your Theme out of the way
  • The importance of shifting your additude
  • Balancing “being aggressive” and implementing mindfulness and acceptance
  • How to play the “moment by moment” game
  • Using strategy to achieve success in recovery
  • OCD and the 6-moment Game
  • Other tactics for Mental compulsions

Links To Things I Talk About:

Reid’s Website anxieties.com
https://www.youtube.com/user/ReidWilsonPhD?app=desktop
DOWNLOAD REID’s WORKBOOK HERE 

Episode Sponsor:

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

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Managing Mental Compulsions (With Dr. Reid Wilson) Your anxiety toolkit

EPISODE TRANSCRIPTION

This is Your Anxiety Toolkit - Episode 286.

Welcome back, everybody. I am so excited. You guys, we are on number five of this six-part series, and this six-part series on Managing Mental Compulsions literally has been one of the highlights of my career. I am not just saying that. I’m just flooded with honor and pride and appreciation and excitement for you. All the feedback has been incredible. So many of you have emailed me or reached out to me on social media just to let me know that this is helping you. And to be honest with you, I can’t thank you enough because this has been something I’ve wanted to do for so long and I’ve really felt that it’s so needed. And it’s just been so wonderful to get that feedback from you. So, thank you so much.

The other plus people I want to be so grateful for are the guests. Each person has brought their special magic to how to manage mental compulsions. And you guys, the thing to remember here is managing mental compulsions is hard work, like the hardest of hard work. And I want to just honor that it is so hard and it is so confusing and it’s such a difficult thing to navigate. And so, to have Jon talking about mental compulsions and mindfulness and Shala talking about her lived experience and flooding, and Dr. Jonathan Grayson talking about acceptance last week. And now, we have the amazing Reid Wilson coming on and sharing his amazing strategies and tools that he uses with his patients with mental rumination, mental compulsions, mental rituals. Literally, I can’t even explain it. It’s just joy. It’s just pure joy that I get to do this with you and be on this journey with you.

I’m going to do this quick. So, I’ll just do a quick introduction. We do have Dr. Reid Wilson here. Now we’ve had Reid on before. Every single guest here, I just consider such a dear friend. You’re going to love this episode. He brings the mic drops. I’m not going to lie. And so, I do hope that you squeeze every little bit of juice out of this episode. Bring your notepad, get your pen, you’re going to need it, and enjoy. Again, have a beautiful day. As I always say, it is a beautiful day to do hard things. Let’s get onto the show.

Kimberley: I am thrilled to have you, Dr. Reid Wilson.

Reid: Thanks. Glad to be here.

Kimberley: Oh my goodness. Okay. I have been so excited to ask you these questions. I am just jumping out of my skin. I’m so really quite interested to hear your approach to mental compulsions. Before we get started, do you call them mental compulsions, mental rituals, mental rumination? How do you--

Reid: Sure. All of the above doesn’t matter to me. I just don’t call it “pure obsessions, pure obsessionals” because I think that’s a misnomer, but we can’t seem to get away from that.

Kimberley: Can you maybe quickly share why you don’t think we can get away from that? Do you want to maybe-- we’d love to hear your thoughts on that. We haven’t addressed that yet in the podcast.

Reid: Well, typically, we would call-- people write to me all the time and probably do that too, say, “I’m a pure obsessional.” Well, that’s ridiculous. Nobody’s a pure obsessional. What it really is, is I have obsessions and then I have mental compulsions. And so, it’s such a misnomer to be using that term. But what I mean is, how we can’t get away from it is it’s just gotten so completely in the lexicon that it would take a lot of effort to try to expel the term.

Getting the theme out of the way

Kimberley: Okay. Thank you for clearing that up, because that’s like not something we’ve actually addressed up until this time. So, I’m so grateful you brought that up. So, I have read a bunch of your staff. I’ve had you on the show already and you’re a very dear friend. I really want to get to all of the main points of your particular work. So, let’s talk first about when we’re managing mental compulsions. We’ll always be talking about that as the main goal, but tell me a little bit about why the theme, we’ve got to get out of the way of that.

Reid: Right. And my opinion is this is one of the most important things for us to do and the most difficult thing to accomplish. It’s really the first thing that needs to be accomplished, which is we have to understand. And you’re going to hear me say this again. This is a mental health disorder and it’s a significant disorder. And if we don’t get our minds straight about what’s required to handle it, we’re going to get beaten down left and right. So, of course, the disorder comes into the mind as something very specific. Focusing on the specific keeps us in the territory of the disorders control. So, we need to understand this is a disorder of uncertainty. This is a disorder of uncertainty that brings distress. So, we have that combination of two things. If we’re going to treat the disorder, we cannot bring our focus on our theme. But the theme is very ingrained in everyone. 

I talk about signal versus noise, and this is how I want to help people make that transition, which is of course, for all of us in all humanity, every worry comes into the prefrontal cortex as a signal. And we very quickly go, “Oh yeah, well, that’s not important. I don’t need to pay attention to that.” And we turn it over to noise and let go of it and keep going. With OCD, the theme, the topic, the checking, and all the mental rituals that we do are perceived and locked down as signals. And if we don’t convert them into noise, we are stuck. 

What I want the client to do is to treat the theme as nothing, and that is a big ask. And not only do we have to treat the theme as nothing, we have to treat it as nothing while we are uncertain, whether it’s nothing or not. So, in advance of an obsession popping up, we really need to dig down during a no problem time and get clear about this. And then we do want to figure out a way to lock that down, which includes “I’m going to act as though this is nothing,” and it has to be accomplished like that. Go ahead.

Kimberley: No. And would you do the same for people, let’s say if they had social anxiety or health anxiety, generalized anxiety? Would you also take the theme out of it?

Reid: Absolutely. But if the theme is in the way, then we need to problem-solve that. So, if we go to health anxiety, okay, I’ve got a new symptom, some pain in the back of my head that I’ve never had before. I have to decide, am I going to go into the physician and have it checked out or am I not? Or am I going to wait a few days and then do it? With that kind of anxiety and fear around health, we have to get closure around “I don’t need to do anything about this.” Sometimes I use something called “postponing.” So, with social anxiety, it can-- I mean, with health anxiety, it can work really well to go, “Well, I’m having this new symptom, do I have to immediately go in and see the physician and get it checked out? Can I wait 24 hours? Yes, I can. I’ve already been diagnosed with health anxiety. So, I know I get confused about this stuff. So, I’m going to wait 24 hours.” So, what does that give us then? Now I have 24 hours to treat the obsession as nothing because I don’t need to focus on it. I’ve already decided, if I’m still worried tomorrow, I’m making an appointment, we’re going in. That gives me the opportunity to work on this worry as an obsession because I’ve already figured it out. The reason we want to do that so diligently is we have to go up one level of abstraction up to the disorder itself. And that’s why we have to get off of this to come up here and work on this.

Kimberley: This is so good. And you would postpone, use that same skill for all the themes as well? I’m just wanting to make sure so people clarify.

Reid: Well, sure. I mean, postponing is a tactic. I wouldn’t say we can do postponing across the board because some people have-- it really depends on what the obsession is and what the thinking ritual is as to whether we can use it. But it’s one of them that can be used.

Shifting your attitude 

Kimberley: Amazing. Tell me about-- I mean, that requires a massive shift in attitude. Can you share a little bit about that?

Reid: Yeah. And if you think about-- I use that term a lot around attitude, but we’ve got some synonyms in attitude. What is my disposition toward this? Have I mentioned mental health disorder? What do I want my orientation to be? How do I want to focus on it? And we want to think about really attitude as technique, as skill set. So, what we know is the disorder wants some very specific things from us. It wants us to be frightened by that topic. It wants us to have that urge to get rid of it and have that urge to get rid of it right now. And so, that begins to give us a sense of what is required to get better. And that again is up here. 

So, why do you do mental counting? Why do you do rehearsal mentally? Why do you try to neutralize through praying? When you look at some of those, the functions of some of those or compulsions and urge to do the compulsions, it is to fill my mind so I don’t get distracted again, it is to reassure myself, it is to make sure everything is going to be okay. It is to get certain. And so, when we know that that is the drive of the disorder, we begin to see, what do we need to do broadly in general? And that is, I need to actually operate paradoxically. If it needs me to do this, feel this, think this, I’m going to do everything I can to manipulate that pattern and do the opposite. It wants me to take this theme seriously, I’m going to work on-- and really it has to be said like that. I’m going to work on not taking it seriously. So, that’s the shift. If we can get a sense of the attitude and the principles that go along with all of that, then moment by moment, we’ll know what to do in those moments.

Do you need to be aggressive with OCD and intrusive thoughts? 

Kimberley: We’ve had guests talking about mindfulness and we will have Lisa Coyne talking about act and Jon Grayson talking about acceptance, and you really talk more about being aggressive. How do you feel about all of those and where do they come together, or where are they separate? How would you apply these different tools for someone with mental compulsions?

Reid: Yeah, sure. Mindfulness is absolutely a skill set that we need to have. Absolutely. We are trying to get perspective. We’re trying to get some distance. We would like to detach. That’s what we’re trying to do. But what are we trying to be mindful of? We’re trying to be mindful of the belief that this topic is important. We’re trying to be mindful of the need to ritualize that is created by the theme. So, the end game is mindfulness and detachment. That’s where we’re going. My opinion is, the opening gambits, the opening moves, it’s very difficult to go from a frightened, terrified, scared, and slide over to neutral and detached. It’s just difficult. 

And so, I think initially, we need to be thinking about a more aggressive approach, which is I’m going to go swing in this pendulum from, “I can’t stand this, this is awful.” I’m going to swing over right past mindfulness over to this more aggressive stance of, “I want this, let’s get going. I’m taking this theme on.” The aggressiveness is a determination of my commitment to do the work. 

And here’s the paradox of it. I’m going to address on the disorder by sitting back. My action is to go, “I’m okay. This is all right.” And that’s a mindful place to get to. But you have to know we’re going after this big, aggressive bully, and it requires an intense amount of determination and you have to access your determination over and over and over again. You don’t just get determined and it’s steady. So, we just got to keep getting back to that. “No, no, I want to do this work. I want to get my outcome picture. I want to have my mind back. I want to go back to school. I want to be able to connect with my family in a loving way, with having one-third of my mind distracted. I want that back very strongly. And therefore, If I have to go through this work to get there, I want to go through this work.” We can maybe talk more about what that whole message of “I want this” means, but here it is, which is, “I want this” is a kind of determination that’s going to help drive the work.

Kimberley: Yeah. Let’s go there because that is so important. So, tell me about “I want this.” Tell me about why that is so important. So, you’ve talked about “I want to get better and I want to overcome this,” and so forth. Tell me more about the “I want this comfort.”

Reid: Well, let’s think about-- you really only have two choices in terms of your reaction to any present moment, either I want this moment, so I’m present to this moment, or I don’t want this moment. It’s very simple in that way. When I don’t want this moment, I’m now resisting this present moment. And what that means practically speaking is, now I’ve taken part of my consciousness, part of my mind that is available for the treatment and I’ve parked it. I’ve taken it offline and actually provoking myself, sticking myself with, “Are you sure you want to do this? Is this really safe? Don’t you think-- maybe we could do this later and not now.” So, there’s a big drive to resist that we need to be aware of. Have I mentioned this yet? This is a mental health disorder that is very tough to treat. I want 100% of my mental capacities available to do the treatment. I’ll never have all of that because I’m always going to have some form of resistance, but I need to get that resistant part of me on the sideline not messing with me, and then let me go forward all like that. 

One of the confusions sometimes people get around this work when I talk about it is it’s not, “Oh, I want to have another obsession right now,” or “I want to have an urge to do my compulsion right now. I want that.” No. What we’re talking about is a present moment. So, if my obsession pops up, if it pops up, I want it. If I’m having that urge to do my compulsion, I want it. And why is that? Because we have to go through it to get to the other side. I have to be present to both the obsessions and the urges to do the compulsions in order to do the treatment. So, that’s the aggressive piece. “Come on, bring it on. Let’s get going. I’m scared of this.” Of course, I don’t want--

Kimberley: I’m just going to ask.

Reid: I don’t want to feel it. I don’t want to, but I’m clear that to do the treatment, it requires me to go through the eye of the needle. If you’re like I am, there’s plenty of days when you don’t want to go to the gym. You don’t really want to work out or sometimes you don’t even want to go to bed as early as you should, but if we want the outcome of that good rest, that workout, then we manifest that in the moment and get moving.

We’re disrupting a pattern. When I talked about postponing, it’s a disruption of this major pattern. If we insert postponing into these obsessions and mental compulsions are impulsive, I have that obsession and I pretty immediately have that urge to do the compulsion. And then I begin doing my mental compulsion. If we slide something in there, that’s what mindfulness does go, “Oh, there it is again. Oh, I’m doing it.” Even if you can’t sustain that, you’ve just modified for a few moments, the pattern that you’ve had no control over. So, that’s where we want to be going. And you know how I sometimes say it is, my job is to-- as the client is to purposely choose voluntarily to go toward what scares the bejesus out of me. I don’t know if you have bejesus over there in California, but in North Carolina, we got bejesus, and you got to go after it.

Kimberley: I think in California, it’s more of a non-kind word.

Reid: Ah, yes. Okay. Well, we won’t even spell it.

The Moment By Moment Game 

Kimberley: That’s okay. So, I have questions. I have so many. When you’re talking about this moment, are you talking about your way of saying the moment-by-moment game? Is that what you’re talking about? Tell me about the moment-to-moment game.

Reid: Sure. I’m sure people hearing this the first time would go, “Well, don’t be-- you’ve lost rapport with me now because you called it a game.” But I’ve been doing this for 35 years, so it’s not like I am not aware of the suffering that goes on here. The only reason to call it a game is simply to help structure our treatment approach.

Kimberley: That’s interesting, because I think of a game as like you’re out to win. There’s a score. That’s what I think of when I--

Reid: That’s what this is. That is actually what this is. 

OCD and the 6 Moment Game 

Kimberley: I don’t think of it as a game like Ring A Rosie kind of stuff. I think of it as like let’s pull our socks up kind of stuff. Is that what you’re referring to?

Reid: We’ve got this mental game that we are-- we’ve been playing this game and always losing. So, we’re already engaged in it. We’re just one down and on the losing end, on the victim end. So, when I talk about it as moment by moment, I want to have, like we’ve been talking about, this understanding of these sets of principles about what needs to happen. It wants me to do this, I’m going to do the opposite, this is paradoxical and so forth. And then we need to manifest it moment by moment. So, how do we do this? I will really talk about six moments and I’ll quickly go through the first three because the first three moments are none of our business. We can’t do anything about them. 

So, moment #1 is just an unconscious stimulus of the obsession, and that’s all. That’s all it is. Moment #2 is that obsession popping up. And moment #3 is my fear reaction to the obsession because obsessions are frightening by their construct. And so, now I’ve got those three moments. As I’m saying, we can’t do anything about those three moments. These three moments are unconsciously mediated. They are built right on into the neurology. 

Now we’ve got in my view three more moments. So, moment #4 is really the foundation of what we do now, what we do next, which is a mindful response. And it is just stepping back in the moment. Suddenly the obsession comes up and I’m anxious and I’m worried about it and I’m having the urge to do the compulsion. And what I want to train myself to do, which can take a little time sometimes, is when I hear my obsession pop up. The way I just described it right there is already a stepping back. When I recognize that I’ve started to obsess and sometimes it takes a while to even recognize it, I want to step back in that moment and just name it. They have that expression, “Name it to tame it.” So, it’s the start of that. So, I’m stepping back in that moment going, “Oh, I’m doing it again,” or, “Oh, there it is.”

Now, the way I think about it, if I can do that and just step back and name it, I just won that moment because I just inserted myself. I insinuated myself into the pattern. OCD doesn’t want you anywhere near this at this moment. It doesn’t want you to be labeling the obsession an obsession. It wants you to be naming the fearful topic of it. So, I’m going to step back in that moment. And if I can accomplish that, great, I’ve won that moment. 

If I can go further in that moment, of course, in the end, we want to be able to do that, moment #5 is taking the position of, “I’m treating this as nothing. There is my obsession. I’m treating it as nothing.” And there’s all kinds of things you can say to yourself that represent that. “This is none of my business. Oh, there it is trying to go after me. Not playing. I’m not playing this game.” Because it really is a game that the disorder has created. And what we’re saying is, “Look, I’m not playing your game anymore. I’m playing my game. And this is what my game looks like.” I’m going to notice it when it pops up, the obsession and the urge to do my compulsion, and I’m going to go, “Not playing,” whatever way I say it. 

And then moment #6, and this is a controversial moment for others. Moment #6, I’m going to turn away from it. I’m going to just redirect my attention, because this is nothing, but it’s drawing my attention. I’m going to treat it as nothing by engaging in some other thought or action that I can find. And even if I can refocus my attention for eight seconds, even if it pops right back up again like, “Where are you going? This is important. You need to pay attention to it,” even if I turn away for eight seconds, I’ve won that moment because I’m no longer responding to this over here. 

Now, why I say this is controversial for some folks is it sounds like distraction. It sounds like, “Oh, you’re not doing exposure. You’re just telling the person to distract themselves. And that’s opposite of what we want to be doing.” I don’t see it that way. 

Kimberley: No, I don’t either. I think it’s healthy to engage in life. 

Reid: And if we think about, what we’re really trying to do is to sit with a generic sense of uncertainty, then this allows us to do it because, in essence, the obsession is a kind of question that is urging you to answer. And when you turn away, engage in something else, you are leaving that question on the table. And that is exposure to pure uncertainty. I just feel like in our field, in exposure, we’re doing so much to ask people to expose themselves to the specifics and drill down about that as a way to change neurology. And we know that’s really the gold standard based on all the research that has been done. But I think it really adds a degree of distress focusing on that specific that maybe we can circumvent. 

Kimberley: Do you see a place for the exposure in some settings? I mean, you’re talking about being aggressive with it. Does that ever involve, like you said, staring your fear in the face purposely?

Reid: Well, yeah. And how do you do that? Well, what you do is you either structure or spontaneously step into circumstances that would tend to provoke the obsession. So, do something that I’ve been avoiding for fear that thought is going to come up or anything that I have been blocking or avoiding out of fear of having the obsession or anything that tends to provoke the obsession. I want to step into those scenes. So, step into the scene, but the next move isn’t like, “Okay, come on obsessions. I need to have an obsession now.” No. If you step into the scene that typically you have an obsession with and you don’t have the obsession, well, that’s cool. That’s fine. That’s progress. That’s great. Now you got to find something else to step into it with. However, most people with thinking rituals, it goes on most of the day anyway. So, we’re going to have a naturalistic exposure just living the day. 

Kimberley: The day is the exposure.

Reid: And for people who are structuring it and you know you’re about to step into a scene where you have the obsession, you can, in that way, be prepared to remind yourself, cue yourself ahead of time what your intention is. The more difficult practice is moving through your day and then getting caught by it. So, you get caught by it and then you start digging to fix the content and it takes a little more time to go, “Oh, I’m doing it again.” We’re doing exposure. This is exposure. You have to do exposure. I’m just saying that there’s a different way to do it instead of sitting down and conjuring up the obsession in order to sit with the distress of the specific.

Kimberley: I’m going to ask you a question that I haven’t asked the others, just because it’s coming up specifically for me. Some clients or some of my therapist clients have reported, “Okay, we’re doing good. We’re doing good. We’re not doing the mental compulsion.” And the obsession keeps popping up. “Come on, just a little. Come on, let’s just work it out.” And they go, “No, no, no, not engaging in you.” And then it comes back up. “No, no, no, not engaging in you.” And much of the time is spent saying, “Not today, not today,” or whatever terminology. And then they become concerned that instead of doing mental compulsions, they’re just spending the whole time saying, “Not today, not today.” And they’re getting concerned. That’s becoming compulsive as well. So, what would you say? Are you feeling like that’s a great technique? Where would you intervene if not?

Reid: Well, I think it’s fine if it is working like we’re describing it, which is not today, turning away, engaging in something else. So, we’ve got to be careful around this “not today” thing if you forget to do--

Kimberley: The thing

Reid: Moment #6, which is find something else to be engaged in. Then you’re going to be-- it’s almost, again, you’re trying to neutralize, “Oh, this is nothing.” So, we want to make sure that we really complete the whole process around that. And the other way that we-- again, mindfulness and acceptance, the way we can get to it is we have the expression of front burner and back burner. So, we want to take the obsessiveness and the urges and just move them to the back burner, which means they can sit there, they can try to distract you, they can try to pull your attention. So, here you are at work and you’re really trying to do right by the disorder, but you’re trying to work, and it’s still coming over here trying to get to you. You’re going to be a little distracted. You’re not going to be performing your work quite as well as you would if your mind were clear. And that is the risk that you need to take. That is the price that you need to pay. And that’s why you need to have that determination and that perspective to be able to say, “Geez, this is hard. This is what I need to be doing.” You have to talk to yourself. You have to. We talk to ourselves all day long. This is thinking, thinking, thinking. So, we know people with thinking rituals are talking about the urges and so forth. And we’ve got to redirect how we talk about it in the moment.

Kimberley: Okay. So good. What I really want to hear about is your ideas around rules. 

Reid: Sure. And again, nobody seems to talk about rules. I’m a very big component or a proponent of rules. And here’s one reason. What are thinking rituals all about? It’s all about thinking, thinking, thinking, thinking, thinking. What do we need to do in the treatment strategy? Well, first off, the disorder is compelling me to fill my mind with thoughts in order to feel safe. I need to come up with a strategy and tactics that reduce my thinking. Then if I don’t reduce my thinking, I’m not going to get stronger. One of the ways to reduce my thinking is to say, “I don’t need to think about this anymore. I’ve already figured out what I need to do.” So, during no problem times, during therapeutic times, whether you’re sitting with your therapist or figuring this out on your own, you come up with literally what we’ve been talking about, “What I need to do when an obsession takes place? And then here’s what I’m going to do next.”

Kimberley: So, you’re making decision--

Reid: I’m going to turn my attention. I’m sorry, go ahead.

Make Decisions Ahead of Time

Kimberley: Sorry. You’re making decisions ahead of time. Is that what you mean?

Reid: Absolutely. You’re making decisions. This is rules of engagement. So, we’re not talking about having to get really specific moment by moment. We’re talking about thinking rituals. So, it’s rules of engagement. Well, simply put, initially, the rule of engagement has to do with those six moments we talked about, which is, okay, when this pops up, this is how I’m going to respond to it. So, we want to have that. All that we’ve talked about decide that ahead of time. And then as I would say, lock it down, lock it down. And now the part of you who is victim to the disorder, when the obsessiveness starts again, when the urge to do the compulsion starts again, I want to have all of me stand behind the rules, because if we don’t have predetermined rules, what is going to run the day? What’s going to win the day? What’s going to win the day in the moment is the disorder shows up. The victim side, the victim to the disorder is also going to show up and it’s going to say, those rules that I was talking about before, “This seems like a bad idea. I don’t think in this circumstance that’s the right thing to do.” So, if we don’t lock it down and we don’t have a hierarchy, which is, what I was saying, we’re not killing off the side of us that gets obsessive and is being controlled by the disorder. But we are elevating the therapeutic voice, “I’ll do that again with my hands.” 

This is a zero-sum game. So, if I bring my attention to what I’ve declared what I need to do now, then by default, my attention toward that messages of my threatened self are going to diminish. And this is what I’ve been talking about with you around determination. You have to be so determined, because it’s so tantalizing. Even if they say this isn’t going to take me very long to complete this mental ritual, and then it’ll be off my plate, and I won’t have to be scared about the outcome of not doing this, why wouldn’t I do that? So, that’s what we’re really competing against in those moments of engagement.

Thinking Strategically

Kimberley: Right. So good. I’m so grateful for what you’re sharing. Okay. I want to really quickly touch on, and I think you have, but I want to make sure I’m really clear in terms of thinking strategically. It sounds like everything you just said is a part of that thinking strategic model. I love the idea that you come into the day, having made your decisions upfront with the rules. You’ve got a plan, you know the steps in the moment. Thinking strategically, tell me if that’s what that is or if there’s something we’ve got to add to it.

Reid: Yeah. So, yes, all that you just said is that, that we’re understanding the principles of treatment based on the principles of what the disorder has intended for us. And then we’re trying to manifest those principles in, how do we act in the moment? How do we engage in that in the moment? The other thing we want to think about in terms of how I think about strategic treatment is we’re looking for the pattern and messing with the pattern. So, I talked earlier about postponing. We insert postponing into the pattern. It’s much easier to add something to a pattern than to try to pull something away. So, if we add postponing or add that beat where I go, “Oh, there’s my obsession,” now we’re starting to mess with the pattern. I’ll give you a couple of-- these are really tactics. Let me tell you about a couple of others and these seem surprisingly ridiculous. Okay, maybe not surprisingly ridiculous. 

Kimberley: Appropriately ridiculous. 

Reid: I’m sure you experience this. I experience a lot where people go, “Look, I’d love to do what you’re saying, but these obsessions are just pounding away at me all day long. I can’t interrupt them. I can’t do it.” What I would like people to be focused on is, what can we do to make keeping the ritual, keeping the obsession more difficult than letting it go? So, we talked about postponing. That doesn’t quite do what I’m saying right now. One of the things I’ll have people do is to sing it. I know, and I’m not going to demonstrate.

Kimberley: Please. I will. 

Reid: And here’s what you do. If I can’t stop my obsessions, I can’t park them, then when I notice – there’s moment #4 – when I notice my obsessions-- and we can do this in a time-limited-- I’m a cognitive therapist, so we do behavioral experiment. So, we can just do an experiment. We can go, “Okay, for the next three days, three weeks, three hours, whatever we decide, anytime I notice the obsession coming up, instead of saying it urgently and anxiously in my mind, I must sing it.” It just means lilting my voice. “Oh my gosh, how am I ever going to get through this? I don’t count the tiles on the ceiling. I’m not sure I can really handle what’s going to happen next. Oh my gosh, I feel so anxious about--” you see why I don’t demonstrate.

Kimberley: Encore, encore.

Reid: SO, it’s just lilting the voice like that. A couple of things are going on. One is obviously we’re disrupting the pattern. But just as important, who in their right mind, having a thought that is threatening, would sing it? So, simply by singing my obsession instead of stating it, I’m degrading the content, I’m degrading the topic. And so, that’s why I would do it. And again, that’s what we were saying. You got to lock it down. You got to go signal versus noise. This is noise. It’s acceptable to me to be doing this. This is very difficult. With such a short period of time, I don’t drill that home as much as I might. This is really, really hard, but it is an intervention.

So, singing it is one thing that I will sometimes have some people do. And the other one is to write it down. And this means literally carrying a notepad with you and a pen throughout your day. And anytime your obsession starts to pop up, you pull that notepad out and you start writing your obsession. And I’m not saying put it in an organized paragraph fashion or a bulleted list or anything like that. We’re talking about stenographer in the courtroom. I want to, in that moment, when I start obsessing, to step back, pull out my notepad, because I said for the next three days, I’m going to do this, and then I’m going to write every single thing that’s popping up in my mind. 

Kimberley: So, it’d be like, “What if you want to kill her? You might want to kill her. There’s a knife. I noticed a knife. Do I want to kill her with a knife? Am I a bad person?”

Reid: Oh, it’s harder than that. It’s harder than that, Kimberley, because you’re not only saying, “Do I want to kill her? There’s the knife. Oh, what did I just say?” Now I got to write, “Oh, what did I just say? Oh, the knife. Oh, the knife. Do I want to kill her with the knife?” So, every utterance, we’re not saying every utterance. And so, there’s going to be a message of, “Did I just say that right? Now I can’t remember what I said. Damn it, damn it.” All of that. Now, again, a couple of things are happening. I’m changing modes of communication. The disorder wants me to do this by thinking. You and I know, you can have an obsessive thought a thousand times in a day. You can’t write it a thousand times. So, now we’re switching from the mode of communication that serves the disorder to a mode of communication that disrupts it. And if I really commit myself to writing this, after a while, now I’m at a choice point. Now when obsession pops up later and I go, “Oh, I’m obsessing again. Well, I can either start writing it,” or “Maybe I can just let it go right now because I don’t want to write it. It’s just so much work. Okay, let me go distract myself.” So, all of a sudden, we’ve done exposure and response prevention without the struggle, because I don’t want to do what I have agreed to do locked down, which is write this. 

So, it empowers. Writing it, just like singing it, empowers me to release it, especially people with thinking rituals. The whole idea of using postponing around the rituals, singing the obsession if I need to, writing down the obsession as tactics to help break things up, and then just keep coming back to what’s our intention here. This is a mental health disorder. I keep getting sucked into the topic. I don’t think I can-- here’s I guess the last thing I would say on my end is, this is it, which is, I don’t know if this is going to work. I don’t know how painful whatever is coming next is going to be by not doing my ritual. I am going to have faith. I mean, this is what happens. You have to have faith and a belief in something and someone outside of your mind, because your mind is contaminated and controlled by the disorder. You can’t keep going up into your thinking and try to figure out how to get out of this wet paper bag. You’re just not-- you can’t. So, you got to have faith and trust. And that’s a giant leap too. Because initially, when we do treatment with people, however we do it, they’ve got to be doing something they don’t know is going to be helpful. 

When people start doing the singing thing or the writing down thing, for instance, after a while, they go, “Wow, that really worked. Okay, I’m going to do that some more.” And that’s what we need. Initially, you just have to have faith and experiment. That’s why we like to do short experiments. I don’t say, “Hey, do this over the next 12 weeks and you’ll get better.” I go, “Look, I know you think this over here, I’m thinking it’s this over here. How about we structure something for the next X number of minutes, hours, days, and just see what you notice if you can feel like you can afford to do that.” 

Kimberley: So good. I’ve just got one question and then I’m going to let you go. I’m going to first ask my question and then I want you to explain, tell us about your course. When you sing the song, I usually have my staff sing it to a song they know, like Happy Birthday or Auld Lang Syne, whatever it may be. You are saying just up and down, “No, no, no,” that kind of thing. Is there a reason for that?

Reid: Well, I don’t want people to have to make a rhyme. I don’t want them to have to--

Kimberley: It’s just for the sake of it.

Reid: I’m totally fine with what you’re saying. Okay, I’m going to-- you can figure it out. It’s like going, “Okay, anytime I hear my obsession come up, I’m going to make my obsession the voice of Minnie Mouse. So, I’m going to degrade it by having to be a little mouse on my shoulder, anything to degrade it.” If you’ve got to set little songs or you ask your client what they would put it to, then yeah. And then in the session, we’re talking about the therapist, demonstrate it and have them practice it with you in order to get it.

Kimberley: Right. I’ve even had clients who are good at accents, like do it in different accents. They bring out--

Reid: You’ve got a good one. You’re really practicing that Australian accent.

Kimberley: Very. I practiced for many years to get this one. All right. You talk about the six-moment game. I’ve had the joy of having taken that course. Can you tell us if that’s what you want to tell us about, about where people can hear about you and all the good stuff you’ve got?

Reid: Sure. Well, I would start with just saying anxieties.com. It’s anxieties, plural, .com. And that’s my website, a free website. It’s got every anxiety disorder and OCD. You’ve got written instruction around how to do some of the work that we’re talking about. And then I’ve got tons of free video clips that people can watch and learn a bunch of stuff. I laid out, in the last two years, a four-hour course, and I filmed it. And so, it is online now. I take people all the way through what I call OCD & the 6-Moment Game: Strategies and Tactics, because I want to empower people in that way. So, I talk about all the stuff that you and I are rushing over right now. It’s got a full written transcript as an eBook, a PDF eBook. I’ve got a workbook that lets people figure out how to do these practices on their own. All of that. In fact, you can get-- I can’t say how to get it at this moment. Maybe you can post something, I don’t know. But I will give anybody the workbook, that’s 37 pages, and it takes you through a bunch of stuff. No cost to you, send it to anybody else you want. 

So, I feel like that, first off, we don’t have enough mental health professionals to treat the people with mental health disorders in this world today. And so, we need to find delivery systems. That will help reach more people. And I believe in Stepped Care. And Stepped Care is a protocol, both in physical medicine and in mental health, which says that first step of Stepped Care and treatment is self-help. And I call it self-help treatment, because the first step is relatively inexpensive, empowering the patient or the client, and giving them directions about how to get stronger. And a certain percentage of people, that will be enough for them. And so, all of us who have written self-help books and so forth, that’s our intention. And now, I’m trying to go one step beyond self-help books to be able to have video that gives people more in-depth. 

What I want is for that first step, the principles that are in that first step, go up to the next step. So, if a self-help course or a book or whatever is not sufficient to finish the work, then you go up one level to maybe a self-help group or a therapeutic group and work further there. And if you can’t complete your work, then go up the next step, which is individual treatment, the next step, which is intensive outpatient treatment, the next step, mixture medications, and so forth. And so, if we can carry a set of principles up, then everybody’s on the same page and you’re not starting all over again. So, I focus on step one. I’m a simple guy.

Kimberley: I’m focused on step one too, which is what you’re doing with me right now, which makes me so happy. I’m so grateful for you for so many reasons.

Reid: Well, I’m happy to be doing this, spending time with you. It’s great. And trying to figure out how to deliver the information concisely. It’s still a work in progress. Thank you for giving me an opportunity.

Kimberley: No, thank you. I’ve loved hearing about all of these major points of your work. I’m so grateful for you. So, thank you so much for coming on again. I didn’t have a coughing fit during this episode like I did the last one.

Reid: Nothing to make fun of you about.

Kimberley: Thank you so much, Reid. You’re just the best.

Reid: Well, great constructing this whole thing. This is what I’m talking about too, is to have a series of us that eventually everybody will see and work their way down and get all these different positions and opinions from people who already do this work. And so, that’s great. You have a choice, so that’s great.

Kimberley: Love it. Thank you.

Reid: Okay. Talk again sometime.

May 27, 2022
Ep. 285 - Managing Mental Compulsions (With Dr. Jon Grayson)
43:03

SUMMARY:
In this weeks podcast, we talk with Dr Jon Grayson about managing mental compulsions. Jon talks about how to use Acceptance to manage strong intrusive thoughts and other obsessions. Jon addressed how to use acceptance with OCD, GAD and other Anxiety disorders.

Covered in This Episode:

  • What is a Mental Compulsion?
  • What is the difference between Mental Rumination and Mental Compulsions?
  • How to use Acceptance for Mental Compulsions
  • How to practice acceptance when the intrusive thoughts are so strong.

Links To Things I Talk About:

Jon’s Book Freedom from Obsessive Compulsive Disorder: A Personalized Recovery Program for Living with Uncertainty
Jon’s Website https://www.laocdtreatment.com/
ERP School: https://www.cbtschool.com/erp-school-lp

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

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EPISODE TRANSCRIPTION

This is Your Anxiety Toolkit Episode - 285.

Welcome back, everybody. We are on episode three of the six-part series. And if you have listened to the previous episodes, I am sure you are just full of information, but hopefully ready to hear some more.

Today, we have Dr. Jonathan Grayson. He’s here to talk about his specific way of managing mental compulsions. As you may know, if you’ve listened before, I strongly urge you to start and go in order. So, first, we started with Mental Compulsions 101. That was with yours truly, myself. Then Jon Hershfield came in. He talked about mindfulness and really went in, gave some incredible tools. Shala Nicely, again, gave some lived experience and really the tools that worked for her. And I have just been mind-blown with both of their expertise. And it doesn’t stop there. We have amazing Dr. Jonathan Grayson today talking about all of the ways that he manages mental compulsions and how he brings specific concepts to help a client be motivated and lean into that response prevention and to reduce those mental compulsions. I am again blown away with how amazing and respectful and kind and knowledgeable these experts are. I just am overwhelmed with joy to share this with you.

Again, please remember this should not replace professional mental health care. We are here at CBT School, who is the host of this series. We’re here to provide you skills and tools, and resources specifically if you don’t have access to those resources. That is a huge part of our mission. So, even though we have ERP School – and that is an online course, you can take it from your home – we wanted to offer this freely because so many people are seeming to be misunderstanding mental compulsions, and it’s an area I really have been excited to share with you in this free series.

So, I’m not going to yammer on anymore. I’m going to let you hear the amazing wisdom of Jonathan Grayson. Have a wonderful day.

Kimberley: Welcome. I am so honored to have you here, Jon Grayson.

Jonathan: It is always a pleasure.

Kimberley: Okay. So, I actually am really, really interested to hear your point of view. As we go through a different episode, I actually am learning things. I thought I knew it all, but I’m learning and learning. So, I’m so excited to get your view on managing mental compulsions or how you address them. My first question is, do you call them mental compulsions, mental rituals, rumination? How do you frame it?

Jonathan: I’m never really too big on jargony, but mental compulsions are mental rituals. And I think that’s trying to-- and I think the thing about mental rituals is some people don’t know they have them. I mean, some people know, but some people will describe it as, “I just obsess, I don’t have rituals.” but then when you listen, they do. And the ritual part is trying to reassure themselves or convince themselves that whatever it is they’re worrying about isn’t. So, they have both the fear part like, “Oh my God, what if this is true? But wait, here’s why it’s not true. Now I know that’s not really true. But what if it is true?” So, that is what I would call mental compulsion or rituals.

Kimberley: Right. How do you-- let’s say you’re sitting across from a patient or a client they are doing either predominantly mental compulsions or that’s a huge part of the symptoms that they have. How would you address in your own way, teaching somebody how to manage mental compulsions?

Jonathan: I think there’s two answers to the question because I never have, and one has to do with what is the content, because I believe every set of mental rituals – I believe it for all forms of OCD, whether there’s a very strong behavioral component or it’s all mental – it has its own set of arguments that we’re going to use. Of course, when I talk about arguments, I know this will be a shock to you, but to me, it always has to do with coping with uncertainty, because I think the purpose of mental compulsions is to deny reality. That is, there is something I don’t want to be true and I keep trying to convince myself it’s not true. 

Now often it’s a low probability. But low probability is not no probability. Sometimes I have clients a little confused, saying like, “I tell myself it’s low probability,” and they actually feel better. Is that okay? And the answer is, it depends. If I’m trying to convince myself, I don’t have to worry about it because it’s a low probability, no, that’s a ritual. If I’m just saying it’s a low probability, I mean, way actually with OCD, it’s very easy because people don’t mind saying it’s low prob they. They like saying it’s low probability, but they don’t want the last sentence to be “But it might happen.” So, it’s like, as long as you’re answering “It might happen,” then you’re dealing with reality because everything is a low probability, even if it’s really small. 

So, one part has to do with the content. And I think for every set of obsessions, there is, what is the content they’re doing? I think in a more general way, the goal of treatment is basically accepting that low probability things might happen. I was recently saying to people that I hope the probability of nuclear war is no worse than that. It was as bad as likely as a worldwide pandemic. Some people would freak out like, “You think there’s going to be a war?” First of all, I know anything, but they were missing the point. It’s like, no, I really mean it’s as likely as a pandemic, which means it’s not likely. However, the thing about the pandemic, low probability things can happen. So yeah, we’re probably okay.

And so, the thing about acceptance that everyone hates is acceptance is second best. We spend so much time talking about how great acceptance is and I really think it’s a disservice in some respects to not point out what acceptance means because it almost always is. Here’s something you don’t want that you might have to live with. If I lose a loved one, we start in denial. And for me, denial is defined as I’m comparing life to a fantasy. I have a woman in a bad relationship and she thinks he really loves the guy, but it’s like, he’d be so good if only he would change X, Y, and Z. And of course, if he changed X, Y, and Z, he would be someone else. So, they’re in love with a fantasy. And when somebody dies, the fantasy is life would be better if they were here. It’s a fantasy because that’s never happening again. So, we have to get them to the point. 

And of course, the thing, the reason I mentioned death is it points out a really important thing about acceptance. You don’t get to just decide, “I’m going to accept.” I lose a loved one. I don’t care how or where you are. You’re starting in denial because you’re missing them and you want them there. And after about a year, if you’ve gone through mourning, you accept it. It’s not like you don’t care they’re gone. You can still cry. You can still miss them. But when you’re doing something you’re enjoying and in the present not comparing to what it would be with that person. 

So, acceptance, I’m pretty sure, always sucks. However, it’s better than fantasy because the fantasies never happen. So, it doesn’t matter if it’s likely or unlikely. It’s just a matter that this is your fear and the thing that’s hard for people to deal with fear is to cope with it. You’re going to say, “How would I try to live with the worst happening?” And people’s initial response to something is, “Yeah, but I don’t want that.” There are multiple reasons that we need to do acceptance. If I’m correct about denial, that’s comparing reality to fantasy. Well, not acceptance means what I want will never happen. So, for me to want that there’s no possibility something will occur is probably not true. I don’t care if it means that maybe this reality doesn’t exist and I’m going to wake up, and some of the things that discover I’ve created all of reality, there’s nothing. I don’t know that that’s likely, but I can’t prove it’s not likely. 

So, I think people go in circles. And you can hear it. The thing about the pandemic, you could hear the regular population denial. Because when I say it’s comparing reality to fantasy, a lot of times that sounds cool. And people don’t quite get what it means, but here are statements of denial early in the pandemic, “Well, this can’t go on more than a few weeks.” Honestly, at the beginning, I was like, “Of course, it’s going on for a few weeks. They have to have a vaccination. They’re telling us that’s two years down the road. This is going on for a long time.”

Kimberley: I was in team two weeks.

Jonathan: Yeah. “It can’t last. I can’t take it.” Saying “I can’t take it,” although you’re expressing the feeling like “I really hate this,” but including in the words “I can’t take it” is a fantasy as if you have a choice. And in a way, luckily, most people who say they can’t take it didn’t kill themselves. It’s proved that they can’t take it. They took it. They kept going on. It’s like, they didn’t want to imagine continuing to live that way. So, acceptance is like, “Yeah, this is going to happen. Yes, it can keep going.” How will you try to cope with the worst? And go on, I’ll shut up. You look like you want to say something.

Kimberley: No, no. I’m following you. I’m really enjoying this. I actually wrote down the word “cope” right at the beginning because I think that that’s such a keyword here. To stay out of the fantasy, would you say that’s true?

Jonathan: Well, yes. The worst might-- I mean, I always feel like if I’m doing therapy and if somebody has intolerance of uncertainty, they don’t like uncertainty, I have to treat that problem. And what I mean by that is we have a lot of therapists who impose their own feelings on the client. If I have a therapist that I have somebody who’s socially anxious and saying, “I’m afraid if I go in a room, some people won’t like me.” Almost every therapist is going to say, “Oh, well, that’s the fact, they might not like you.” But that same patient is like, “I’m afraid if I touch the doorknob, I’m going to get sick.” “Oh no, that won’t happen.” Well, that’s not the issue. Now therapist is-- if I have a problem of threat estimation, that’s fine, but that’s not it. I don’t want to know that it’s a low probability, I want no probability. So, we have to deal with the fact that this is what the person’s afraid of. This is what they fear. 

Somebody will say, “Well, but they don’t have cancer issue. Why should they worry about it?” But let’s face it. If they did have cancer, the focus would be coping with the fact they’re dying. And if they’re afraid of having cancer, I’d say the treatment is the same. Now, the only great thing is they probably won’t have cancer, so it’s not a fear they will have to probably deal with. They want to have the second part of it like, “And I’m dying.” But to be more prepared-- and I think what you’ve done wisely, like hearing that, yes, what you’ve done wisely is you’re talking about the fact that this is not just a nosy problem. This is a problem for everyone, coping with uncertainty. 

I hate to do a plug. It’s okay. It’s a while away. Actually, Liz McIngvale and I, we’re working on a book, talking about-- well, the book is partially-- and we’ll be doing some talks on it. We’re saying that ERP is not the gold standard of treatment for OCD. And we’re going to say that it’s not the gold standard because it’s lacking the gold. It really needs to be ERP plus gold. But that’s awkward because I like to be calling these initials. So, we want to use initials. Do you happen to know the chemical symbol for gold?

Kimberley: F-- no. FE is copper. 

Jonathan: No, that’s iron. 

Kimberley: Iron. 

Jonathan: Yeah. AU.

Kimberley: AU.

Jonathan: The gold standard of treatment--

Kimberley: Like Australia.

Jonathan: Well, no. ERP plus AU. AU as in Accepting Uncertainty.

Kimberley: Oh, my trap.

Jonathan: Yeah. It took me a while to work that around. 

Kimberley: Now you sure it’s not Australia. 

Jonathan: But our point is what we want to write. We want to write a book that’s not only about helping therapists deal with every presentation of OCD and how you deal with the uncertainty problem, but we’re also arguing that it’s a book for everyone that people can learn from OCD, a disorder that intolerance uncertainty is like the core. Because I always feel that our clients who get better, they’re not normal. They are better than normal because they’re coping with uncertainty, because the average person really doesn’t do that. Well, I mean, in the pandemic, you got to see how bad non-sufferers are. So, I think the core of coping with mental obsessions is this. Well, what if the worst happens? And so many people, “I don’t want to think it,” and that leaves us stuck because we’re not stupid. If you say to somebody-- if you get a phone call from police and they say your spouse has died, your first response is you’re just in this shock and you’re just like frozen. And for a lot of things that are bad, that’s the way people stop thinking. It’s like, “I don’t want to think about it.” The thing is, if the police make that call, something happens next. And life goes on. 

And back for clients, I often ask that in a sneaky way. What if this did happen? What would be next? What if he did have-- the doctor says, “Yeah, it can,” so I freak out. What does that look like? “I’d be screaming.” You’re in the doctor’s office, screaming. How long are you going to do that? And then you’re going to go home and you need dinner. What do you do the next day? And even though we’re going through something that sounds terribly scary, people oddly feel better after that. Now, this is first session. It’s not like they’ve done treatment, but they feel better because a statement that is true, you can’t do what you won’t imagine. And I don’t mean this as you would say, in the flowers and unicorns kind of way that you can do anything you can imagine. I do not mean that. But if you won’t even imagine it, you can’t do it. So, what would you do in X situation where it’s like, no. Well, it’s like the world is ending. When we imagine it, it’s not like it’s good. But it’s like, oh, because the feeling that accompanies acceptance is a down, depressing feeling like, “Oh, that could happen.” However, it’s not frantic. Denial is frantic. “That can’t happen. No, no.” Again, everything at least has some low probability. Some things are higher. You could have cancer, yes. Your family could die. Those things are like, they’re there. So, it’s not like I get the choice.

So, the statement of denial is frantic. The statement of acceptance is depressing, but it’s not frantic. And so, I don’t care how bad the disaster is. How would you try to cope? Because in most realities, that’s what you’re going to do. And I could pause at this moment because I don’t know if this would be the point where I would then be shifting to, well, what are the mental compulsives we’re talking about here? Because I think again, each one has its own set of arguments. You’ve heard my general thing. In some ways I think I’m reasonably good at applying it to myself. I think there’s some areas I haven’t been tested in. So, that’s nice. I hope I could be-- I know what I want is possible because I’ve seen people do it. Would I be one of those good people? I can only hope. But at least because I know people have done it, I know it’s possible. I like to believe-- go on, you. Yes.

Kimberley: What does that look like? Can you paint me a picture of a client who does well using this strategy at managing mental compulsions?

Jonathan: A client that I-- there’s a podcast on that, the OC stories, he was afraid of going crazy. And he had had this from age 19 to his late forties. And he had ERP, but ERP was always focused likely and we’re going to focus on going crazy and all this stuff. Know whatever explicit just said to him, the goal of treatment is for you to risk going crazy. I told him that the first session and he began to cry because he’s been spending more than 30 years trying to avoid this. And I’m saying, “Oh yeah, this might happen.” And many people really are able to accept. And I never talk about accepting uncertainty. I talk about learning to accept uncertainty. Because really, if I can talk to you-- if it’s just a decision, we’re done the first session. But most people are convinced of recession. It took about three months to help convince him. And he kept going back and forth. And so, convincing him, we went through a number of things to work on it. 

So, I’m describing it quickly, so it sounds simple. But remember, three months. The first reason, and this is true of almost all rituals, mental compulsions, regardless, you don’t have a choice. All your rituals do not prevent you from going crazy. He’s avoiding places because you’ve got an anxiety attack there, so I’m not going to go there. It’s like, sorry, it’s a biological process that you’re going crazy. That’s doing nothing. So, one is, your rituals don’t work. Two, for pretty much anything, you don’t have a choice. Uncertainty is the fact of life. We talked about what it would look like and he went crazy. And we were going-- and we talked about, well, what’s going to happen? Where are you going to go? He went through all these things. And because he’s logical, at some point it’s like, it could happen. 

And at that point, he’s then able to spend the other work, which is not fun, which is then imagining going crazy and looking at all the things that scare the heck out of him so he could begin to function again. We wanted to treat going crazy, the way most people do this is not their problem. Treat, getting main paralyzed and disfigured in a car crash. We all know it’s possible. Our brilliant plan is generally, I hope it doesn’t happen. I’m not dealing with it until I’m bleeding out, crushed under the metal. To say, “I’m not going to be in a car accident today,” it’s like, really? I can’t say that. So, our goal is to get whatever uncertainties in life there are to be like that. And it doesn’t matter whether I’m afraid of going crazy. I’m afraid that I’m going to be a pedophile. I’m going to slice and dice my wife tonight. I’m going to flunk the test. These people don’t like me. It doesn’t matter what it is. It’s still always the same. I mean, we can talk about odds, but not as simply reassurance because, again, it’s reassurance if I want to know it’s low odds, but if I want it to not be possible, it’s not reassuring. It’s like, it’s probably not this, but it might be how we deal with it is that way. 

The other thing that we look at is, how does it work for you to fight against this uncertainty? What are you losing? And of course, the more pathological the problem is, the worse it is. So, if I have OCD, it could be destroying my life. I’m not only hurting myself, I’m hurting my family. Let’s go how you’re really torturing everybody. And sometimes I think, in that case, we’re looking for reasons to get better. I always like people to look at all the harm they’re doing to themselves and their family. And I think in a brilliant way, just to plug you, I think your book, your new book really partially addresses that because the self-compassion part isn’t just like, okay, be nice to yourself, stop suffering. It’s like, if you’re going to love yourself, what kind of life do you want to make for yourself? What are your values going to be? Because I think we transform this process of coping into something more than simply confronting fear. It becomes something for myself. And secondarily, not as preferable, but sometimes easier to get to – it becomes not only confronting a fear, it becomes an act of love. Because you know what, I’m going to stop being a pain in the ass to my family. I’m now going to put all of us first. 

And so, we’re really going to have-- what are my values, and how does this interfere with my values? And again, it doesn’t have to be as major as I’m dysfunctional, torturing my family with something OCD for any worry. Everybody’s going to be happier if I can cope with my worries better. I mean, my family’s going to be happier because they love me. It’s really nice to see me not freaking out because they don’t have-- because you want to help and there’s no way to help. So, for me to be better and calmer and coping is nice for them. It’s certainly nice for me, and isn’t that what I would prefer in life? And so, when, when my life depends on me having a worry that’s not allowed to happen, I don’t get to enjoy things. 

Another coping thing I do that’s smaller is I will ask people to notice what they’re enjoying, no matter how, whatever level, even 5%. I think many times people will say, “Everything sucks, I don’t enjoy anything because of this problem.” Now that’s not entirely true because in the course of interviewing them, there are a few times I’ll get them to laugh for three seconds. And I admit if laughing three seconds were the goal, wow, that’d be great. But three seconds of laughter isn’t much compared to a life of misery. But the thing is, they don’t even notice that ever. The entire experience has been horrible and it’s like-- and to get them to notice not what it should be, but what it was. 

I once did this with a guy. I sent him to the movies and I said, “Watch the movie, just tell me whatever you enjoyed. I don’t care how little.” And he came back and he said, “It didn’t work. Everything was horrible.” I’m like, “Okay, now tell me about the movie.” So, he was describing the movie to me, it was a war movie, and it is clear, this guy liked the climax. So, I’m like--

Kimberley: Isn’t that funny? The way our brain works?

Jonathan: Yeah. And I said, “That was pretty cool, that climax. Are you sorry you saw that?” “No.” I said, “Okay, you didn’t do my assignment. Notice whatever you enjoyed. I don’t care that it’s not as good as it should have been. You clearly like that.” And it makes a difference because it means a two-hour experience that he comes away believing he had nothing. It would be a slight change to go like, “I enjoyed a little bit of that.” I try to tell people, think of it as like a little while of enjoyment that you don’t notice exists, and we want to expand those. And most people would recognize that in a way, what we’re talking about is a little bit of mindfulness. Like, okay, it sucks. I’m not arguing it doesn’t suck, but a lot of mindfulness. It isn’t like, I’m going to put you in a happy land. It’s like, we were trying to do AND, not OR.

The beginning of the pandemic, Kathy and I, we’re out on our pandemic walk. And she said to me, “This would be such a great day if all this wasn’t going on.” I said, “You’re wrong, Kathy.” We should let you and your listeners know. You don’t know this, but your husband does. Being married to a psychologist is not necessarily fun.

Kimberley: So true.

Jonathan: It is a beautiful day. We’re walking together, it’s beautiful. We’re together, it is beautiful. It is a beautiful day AND it sucks that there’s a pandemic. 

Kimberley: So true. 

Jonathan: Not OR, it’s AND. In a sense, mindfulness is teaching us to live in that world of AND. This is awful AND I can still enjoy stuff, as opposed to it’s either or. And again, some people go like, “Well, that’s awful.” And that’s perfectly true, because we’re going back to what is acceptance. Acceptance sucks. It’s the second-best life. However, what’s really great about the second-best life, the first best doesn’t exist. So, it’s like, yeah, it’s second-best, but it’s this or nothing. So, I think those are a lot of the principles of doing it and I think to do it, it’s like, why would I take this risk? It’s not a risk, but essentially, it’s like, why would I accept living like this, whatever this is? And I don’t have a choice. What am I losing by not living like this? Am I hurting my family? What would life be like if I could be okay with this? Depending who you are, that’s an incredibly amazing change or it’s a minor change. I mean, if I’m a very competent worrier and very successful, we’re talking about way more peace. But if I’m competent, I’m interfering with my life and taking up a lot of time, we’re now making major changes in the quality of life. And as you know, I can obsess or worry about anything from like, “I need to be the best.” And I always ask people, what is so good about best? Because God forbid, you should be mediocre. God forbid, you should be a happy mediocre person than the best person. And so, for some--

Kimberley: Well, that’s still a piece of denial, isn’t it? They have this idea that the best is no pain.

Jonathan: Yeah.

Kimberley: There’s no pain at the top.

Jonathan: Yeah. Right. And generally, there’s some other assumption that-- I don’t know. Somehow, I’m deficient of, I’m not best. So, it’s like the only way I can know. It’s another set of issues. What is it that I fear that I have to cope with? Not being best. Okay, I get you want to be best. Why? Well, best is best. I mean, it’s nice, I guess. When I think about being well-known, I generally think of being well-known as icing. That is, what makes my life great? For me, I love what I’m doing, and what I’m doing is, besides talking a lot because I love talking, but I like working with people, and I just really enjoy it. I have no plans on retiring because I like this too much. That’s almost all year round. Being famous and well-known, that’s about six days a year when I go to conventions. And I say, it’s like icing to indicate I am weak enough. I’ll admit I’m weak enough to really enjoy it. But I also recognize it is nothing. It doesn’t have any substance. And the thing about fame, you’re always going to lose it. You’re never famous enough. And there’s a poem by Shelly that I think really characterizes it. It describes a traveler in an ancient land. It’s come across a huge fallen monument and it’s describing the magnificence of what this had been. And he comes to the base of the statue where these words are written: “My name is Ozymandias, King of Kings; Look on my Works, ye Mighty, and despair!” That’s fame. It’s empty I can gorge, but it doesn’t mean anything because what I enjoy is what I actually do. It’d be sad if my life was like, it’s good six days a year when I can feel it.

Kimberley: Right. And I think what’s important, particularly for the sufferer, is you still have uncertainty in your life.

Jonathan: I don’t know any way to be certain, so I know nothing.

Kimberley: Right. You know what I was reflecting on, and this is just me reflecting, is last year, maybe it was the beginning of this year, I gave myself the exercise to catch the mini toddler tantrums that showed up in my mind.

Jonathan: I love that term. Great. Did you make that up?

Kimberley: I think I did because it--

Jonathan: Take credit. It’s great. Love it.

Kimberley: It feels like a toddler tantrum in my mind.

Jonathan: It’s perfect. It’s that “But I don’t want that.” I love it. Oh, I love it. Go on.

Kimberley: Yeah. I did a whole podcast about it last year because I was just noticing toddler tantrum after toddler tantrum, and I regulate myself really well. But it was showing up. And then as you’re talking, I’m thinking about how that was me resisting acceptance. That toddler tantrum is probably where I have the option to pull out of rumination and be present when I can catch it and be like, “Okay, you’re totally in denial. You’re in a fantasy land.” And so, that really speaks to me as a way to catch when you’re up in that place of rumination.

Jonathan: That’s perfect.

Kimberley: Yeah. For me, that was really powerful. I love that you brought that up because I think that is the bridge. I’m totally out of acceptance when I’m in a toddler tantrum.

Jonathan: Right. Because when you get better, as you’re describing, you can deal that pull of like, “This is what it is. No, no, no.” You can feel that pull back and forth because you don’t get completely lost and it’s like, ah.

Kimberley: Yeah. It was such a visual. I could see it tantruming out. “No, no, no.” And so, I love that you brought that in particularly in this way, like I said, of catching the compulsion. So, thank you. That actually consolidated--

Jonathan: I’m just now obsessing about how I’m going to work this in. We’ll give you credit.

Kimberley: You do. The Kimberly Quinlan “toddler tantrum,” I’m very well-known for it now. No, I am so thankful for you for bringing all this up. Is there-- because I want to be respectful of your time, is there anything else that you want to address when it comes to conceptualizing or managing mental compulsions?

Jonathan: I think that I’m afraid I have to be patient. Again, thinking about death, I don’t get to accept just because I want to. You have some people who try to accept like, “I’m accepting and I’m accepting it.” It’s like, yeah, sorry. I can be working towards learning it. I think sometimes people have an insight. An insight is not like you suddenly know some new piece of information. Insight is something that you basically knew, suddenly it’s true. I had somebody have that the other day when that’s hurting and they felt like it was trivial trying to explain to me what happened, but I already had this concept. I said, “I know. It’s like, you’ve always known you feel like going wrong.” “No, you don’t get it. It’s really true.” So, it was very cool. 

And so, I think it’s a gradual process where I get better at it. And because life is completely uncertain in every which way, there’s always opportunities to practice it, better personal. And you may scare other people. And one client who was very scared of a lot of things, especially of one of their pets dying. As they got uncertain and told, and then they could talk about it pretty calmly with people, “Oh yeah, I think she’s going to die at some point.” And people would be horrified. She could sound so calm, but she was like, not that she likes it and she really doesn’t want it to happen, but she could also think about it and think about life after that. And I think some people mistakenly will say something like, “Oh my God, you’re making life complete miserable. All you’re thinking about is all these nightmares that can happen all the time. That’s terrible.” That’s crazy because-- I thought I’d use a clinical term. Because what happens when I accept uncertainty? 

Somebody else has said this. Unfortunately, I haven’t made it up. I become, in a positive way, hopeless future. And what I mean by hopeless is the way most people who aren’t scared of the car crash, or it’s not like, I’m okay with a car crash. It’s like, what can I do? And when I become hopeless about control, that is when I get to live in the present because I’m no longer in the past or the future. Let’s face it. The truth is that’s all we have. The past of great memories or terrible memories, the future’s hopes, all we have is the present, this moment, my entire life and your entire life with each other. Everything else we like might not be there at this moment. So, I get to have the only thing there is, which is the present. And again, I can’t just decide because you see people do this, “I’m going to live in the present. I’m going to enjoy the present now. Enjoy the present.” It’s like, I have to learn to give things up. 

To steal from this woman who wrote this book of compassion: “To be kind to myself, to let myself learn, to not expect it all at once.” Again, if we were talking OCD, I don’t know why we were talking about that. If we were talking about OCD, every particular variation has its own uncertainties to cope with. Scrupulosity, how do I learn to believe in a God and simultaneously admit I might be wrong? How do I live in a world where probably I’m not going to slice and dice Kathy tonight? But if I do, how would I try to-- what would I do the next step?

When my son was 16 and going out on dates. And of course, he would never be home on time. And Kathy always wanted to call him. And I wouldn’t let her call him not to be nice to him, but I knew as she knew, his cell phone would be on. So, calling somebody you’re worried about in their cell phone on is not going to be comforting. So, she’d go like, “Well, when can I call him?” So, I’d make this mental calculation. Okay, he should be home now. I think he’ll be home in these many minutes. And let me add another half hour and say, you can call him dead. And she could for some reason, which is unusual, she would then go to sleep. And I would go there and I think, “Huh, he’s probably okay. He’s probably not doing anything terrible. Probably nothing terrible is happening to him. But tonight could be the night that our lives change and everything is screwed up forever.” And then I would go to sleep. That’s just the truth.

Kimberley: Yeah. It’s powerful. I’ll be calling you, and my kids are teenagers, saying “Coach me, coach me.”

Jonathan: Yeah. And I will give you the following advice. It gets so much easier when they’re 23. 

Kimberley: Yes, I know.

Jonathan: Until your acceptance is, “Oh yeah,” you’re screwed till then.

Kimberley: It’s true. I’m so grateful for you and your time and all your wisdom. I feel like I’m sitting and just absorbing it all for myself, which I’m loving. 

Jonathan: Thank you.

Kimberley: Tell us, I know you’ve been on the podcast before, but tell us where people can hear more about you and your work. You obviously have a new book, which I did not know about.

Jonathan: Well, we are working on it and we’re at the stage of working it, not procrastinating. We’re at the stage of doing a bunch of presentations on the idea, because I’ve just seen so many treatments fail because it didn’t address uncertainty. Although I always focus on certainty, it really is-- the bottom part of dealing with that is coping with life. It transcends OCD. So, I don’t know. What would you like to know about me?

Kimberley: Where can people find you?

Jonathan: Where can people find me? Easily on the internet. Website is a laocdtreatment.com. But I think my name plus OCD tends to come up a lot. 

Kimberley: Your book?

Jonathan: I have a book. It’s Freedom From OCD. I think there are a lot of good OCD books. Of course, I like mine because I agree with it most. But it’s a little scary when people read it before they see me because it is almost my entire repertoire minus maybe about 40 minutes. I feel like I’m going to be repeating myself, but somehow that doesn’t seem to be a problem. Apparently, hearing it out loud is different than reading it. 

Kimberley: Well, and that’s the whole point, right? I have the same situation as people need to hear it more than once too, in some cases. Not as a form of reassurance, but I think we all need to hear it. Even me today having a little light bulb moment I think is really cool, even though I’ve heard that before. So, I will have your website and your work in the show notes.

Jonathan: Very kind.

Kimberley: Thank you so much for being here and sharing.

Jonathan: I don’t know if you figured it out yet. I know I’ve told you this, but I’ll just repeat it. Probably if you asked me to come on, the answer will always be yes. So, thank you.

Kimberley: I’m so happy. No, I remember you saying that last time. Like I said to you, before we started recording, I have wanted to do this series for quite a while. And I had you right there going. I already put you on the list because I already knew. You told me you would say yes.

Jonathan: And so, apparently, I’m not dishonest or not that dishonest.

Kimberley: Not at all. When I texted to ask you, I actually already had you on the list and scheduled you in.

Jonathan: It was a confidence that you could well have.

Kimberley: Yeah. I’m so grateful. And yes, we will definitely have you on. It’s always a pleasure.

Jonathan: All right. Okay. Take care. Thank you very much.

May 20, 2022
Ep. 284 6-Part Series: Managing Mental Compulsions (with Shala Nicely)
41:43

SUMMARY: 

In this weeks podcast, we have my dearest friend Shala Nicely talking about how she manages mental compulsions.  In this episode, Shala shares her lived experience with Obsessive Compulsive Disorder and how she overcomes mental rituals.

In This Episode:

  • How to reduce mental compulsions for OCD and GAD.
  • How to use Flooding Techniques with Mental Compulsions
  • Magical Thinking and Mental Compulsions
  • BDD and Mental Compulsions

Links To Things I Talk About:

Shalanicely.com
Book: Is Fred in the Refridgerator?
Book: Everyday Mindfulness for OCD
ERP School: https://www.cbtschool.com/erp-school-lp

Episode Sponsor:

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

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EPISODE TRANSCRIPTION

This is Your Anxiety Toolkit - Episode 284.

Welcome back, everybody. We are on the third video or the third part of this six-part series on how to manage mental compulsions. Last week’s episode with Jon Hershfield was bomb, like so good. And I will say that we, this week, have Shala Nicely, and she goes for it as well. So, I am so honored to have these amazing experts talking about mental compulsions, talking about what specific tools they use. 

So, I’m not going to take too much time of the intro this time, because I know you just want to get to the content. Again, I just want to put a disclaimer. This should not replace professional mental health care. This series is for educational purposes only. My job at CBT School is to give you as much education as I can, knowing that you may or may not have access to care or treatment in your own home. So, I’m hoping that this fills in a gap that maybe we’ve missed in the past in terms of we have ERP School, that’s an online course teaching you everything about ERP to get you started if you’re doing that on your own. But this is a bigger topic. This is an area that I’d need to make a complete new course. But instead of making a course, I’m bringing these experts to you for free, hopefully giving you the tools that you need. 

If you’re wanting additional information about ERP School, please go to CBTSchool.com. With that being said, let’s go straight over to this episode with Shala Nicely. 

Managing Mental Compulsions (With Shala Nicely) Your anxiety toolkit

Kimberley: Welcome, Shala. I am so happy to have you here.

Shala: I am so happy to be here. Thank you for having me.

Kimberley: Okay. So, I have heard a little bit of your views on this, but I am actually so excited now to get into the juicy details of how you address mental compulsions or mental rituals. First, I want to check in with you, do you call them mental compulsions, rituals, rumination? How do you address them?

Shala: Yeah. All those things. I also sometimes call it mental gymnastics up in your head, it’s all sorts of things you’re doing in your head to try to get some relief from anxiety.

Kimberley: Right. So, if you had a patient or a client who really was struggling with mental compulsions, whether or not they were doing other compulsions as well, how might you address that particular part of their symptomology?

Shala: So, let me answer that by stepping back a little bit and telling you about my own experience with this, because a lot of the way I do it is based on what I learned, trying to manage my own mental rituals. I’ve had OCD probably since I was five or six, untreated until I was 39. Stumbled upon the right treatment when I went to the IOCDF Conference and started doing exposure mostly on my own. I went to Reid Wilson’s two-day group, where I learned how to do it. But the rest of the time, I was implementing on my own. And even though I had quite a few physical compulsions, I would’ve considered myself a primary mental ritualizer, meaning if we look at the majority, my compulsions were up in my head. And the way I think about this is I think that sometimes if you have OCD for long enough, and you’ve got to go out and keep functioning in the world and you can’t do all these rituals so that people could see, because then people will be like, “What’s wrong with you? What are you doing?” you take them inward. And some mental compulsions can take the place of physical compulsions that you’re not able to do for whatever reason because you’re trying to function. And I’d had untreated OCD for so long that most of my rituals were up in my head, not all, but the great majority of them. 

Exposure & Response Prevention for Mental Compulsions

So, when I started to do exposure, what I found was I could do exposure therapy, straight up going and facing my fears, like going and being around things that might be triggering all I wanted, but I wasn’t necessarily getting better because I wasn’t addressing the mental rituals. So, basically, I’m doing exposure without response prevention or exposure with partial response prevention, which can make things either worse or just neutralize your efforts. So, what I did was I figured out how to be in the presence of triggers and not be up in my head, trying to do analyzing, justifying, figuring it out, replaying the situation with a different ending, all the sorts of things that I would do over and over in my head. And the way I did this was I took something I learned from Jonathan Grayson and his book, Freedom From OCD. I know you’re having him on for this series too. And he talked about doing all this ERP scripting, where you basically write out the worst-case scenario, what you think your OCD thinks is going to happen and you write it in either a worst-case way or an uncertainty-focused way. And what I did was after reading his book, I took that concept and I just shortened it down, and anything that my OCD was afraid of, I would just wrap may or may not surround it. 

So, for instance, an example that I use in Is Fred in the Refrigerator?, my memoir, Taming OCD and Reclaiming My Life was that I used to-- when I was walking through stores like Target, if I saw one of those little plastic price tags that had fallen on the ground, if I didn’t pick it up and put it out of harm’s way, I was afraid somebody was going to slip and fall and break their neck. And it would be on some security camera that I just walked on past it and didn’t do anything. So, a typical scrupulosity obsession. And so, going shopping was really hard because I’m cleaning up the store as I’m shopping. And so, what I would do is I would either go to Target, walk past the price tag. And then as I’m just passing the price tag, I would say things. And in Target, I obviously couldn’t do this really out loud, mumble it out loud as best, but I may or may not cause somebody to kill themselves by they’re going to slip and fall on that price tag because I didn’t pick it up. I may or may not be an awful, terrible rotten human being. They may or may not catch me and throw me into jail. I may or may not rot in prison. People may or may not find out what a really bad person I really am. This may or may not be OCD, et cetera, et cetera, et cetera. 

And that would allow me to be present with the obsessions, all the what-ifs – those are basically what-ifs turned into ‘may or may nots’ – without compulsing with them, without doing anything that would artificially lower my anxiety. So, it allowed me to be in the presence of those obsessive thoughts while interrupting the pattern of the mental rituals. And that’s really how I use ‘may or may nots’ and how I teach my clients to use ‘may or may nots’ today is using them to really be mindfully present of what the OCD is worried about while not interacting with that content in a way that’s going to make things worse. So, that’s how I developed it for myself. And I think that-- and that is a tool that I would say is an intermediary tool. So, I use that now in my own recovery. I don’t have to use ’may or may nots’. It’s very often at all. If I get super triggered, which doesn’t happen too terribly often, but if I get super triggered and I cannot get out of my head, I’ll use ’may or may nots’. 

But I think the continuum is that you try to do something to interrupt the mental rituals, which for me is the ’may or may nots’. You can also-- people can write down the scripts, they can do a worst-case scenario. But eventually, what you’re trying to get to is you’re trying to be able to hear the OCD, what-ifs in your head and completely ignore it. And I call that my shoulders back, the way of thinking about things. Just put your shoulders back and you move on with your day. You don’t acknowledge it. 

What I’ll do with clients, I’ll say, “If you had the thought of Blue Martian is going to land on my head, I mean, you wouldn’t even do anything with that thought. That thought would just go in and go out and wouldn’t get any of your attention.” That’s the way we want to treat OCD, is just thoughts can be there. I’m not going to say, “Oh, that’s my OCD.” I’m not going to say, “OCD, I’m not talking to you.” I’m not going to acknowledge it at all. I’m just going to treat it like any other weird thought that we have during the day and move on. 

Your question was, how would you help somebody who comes in with mental rituals? Well, first, I want to understand where are they in their OCD recovery? How long have they been doing these mental rituals? What percentage of their compulsions are mental versus physical? What are the kind of things that their OCD is afraid of? Basically, make a list or a hierarchy of everything they’re afraid of. And then we start working on exposure therapy. And when I have them do exposures, the first exposure I do with people, we’ll find something that’s-- I start in the middle of the hierarchy. You don’t have to, but I try. And I will have them face the fear. But then I’ll immediately ask them, what is your OCD saying right now? And they’ll tell me, and I’ll say, “I want you to repeat after me.” I have them do this, and everyone that I see hates this, but I have them do it. Standing up with their shoulders back like Wonder Woman, because this type of power pose helps them. It changes the chemistry of your body and helps you feel more powerful. 

OCD thinks it’s very powerful. So, I want my clients to feel as powerful as they can. So, I have them stand like Wonder Woman and they repeat after me. Somebody could-- let’s just say we are standing near something red on the floor. And I’ll say, “Well, what is your OCD saying right now?” And they’ll say, “Well, that’s blood and it could have AIDS in it, and I’m going to get sick.” I’ll say, “Well, that may or may not be a spot of blood on the floor. I may or may not get sick and I may or may not get AIDS, but I want to do this. I’m going to stay here. OCD, I want to be anxious, so bring it on.” 

And that’s how we do the exposure, is I ask them what’s in their head. I have them repeat it to me until they understand what the process is. And then I’m having them be in the presence of this and just script, script, script away. That’s what I call it scripting, so that they are in the presence of whatever’s bothering them, but they’re not up in their head. And anytime something comes in their head, I teach them to pull it down into the script. Never let something be circulating in your head without saying it out loud and pulling it into the script. 

I will work on this technique with clients as we’re working on exposures, because eventually what we’ll want to do is instead of going all over the place, “That may or may not be blood, I may or may not get AIDS, I may or may not get sick,” I’ll say, “Okay, of all the things you’ve just said, what does your OCD-- what is your OCD scared of the most? Let’s focus on that.” And so, “I may or may not get AIDS. I may or may not get AIDS. I may or may not have HIV. I may or may not get AIDS,” over again until people start to say, “Oh, okay. I guess I don’t have any control over this,” because what we’re trying to do is help the OCD habituate to the uncertainty. Habituate, I know that’d be a confusing word. You don’t have to habituate in order for exposure to work due to the theory of inhibitory learning, but we’re trying to help your brain get used to the uncertainty here.

Kimberley: And break into a different cycle instead of doing the old rumination cycle. 

Shala: Yes. And so then, I’ll teach people to just find their scariest fear. They say that over and over and over again. Then let’s hit the next one. “Well, my family may or may not survive if I die because if I get a fatal disease and I die and my family may or may not be left destitute,” and then over and over. “My family may or may not be left destitute. My family may or may not be left destitute, whatever,” until we’re hitting all the things that could be circulating in your head. 

Now, some people really don’t need to do that scripting because they’re not up in their head that much. But that’s the minority of people. I think most people with OCD are doing something in their head. And a lot of people aren’t aware of what they’re doing because these mental rituals are incredibly subtle at times. And so, as people, as my clients go out and work on these exposures, I’ll have them tell me how it’s going. I have people fill out forms on my website each day as they’re doing exposures so I can see what’s going on. And if they’re not really up in their head and they don’t really need to do the ‘may or may nots’, great. That’s better. In fact, just go do the exposure and go on with your life. If they’re up in their head, then I have them do the ’may or may nots’. And so, that’s how I would start with somebody. 

And so, what I’m trying to do is I’m giving them what I call a bridge tool. Because people who have been mental ritualizing for a long time, I have found it’s virtually impossible to just stop because that’s what your mind is used to doing. And so, what I’m doing is I’m giving them a competing response. And I’m saying here, instead of mental ritualizing, I’d like you to say a bunch of ’may or may nots’ statements while standing up and say them out loud while looking like Wonder Woman. Everybody rolls their eyes like, “Really?” But that’s what we do as a bridge tool. And so, they’ve lifted enough mental weights, so to speak, with this technique that they can hear the OCD and start to disengage and not interact with it at all. Then we move to that technique.

Flooding Techniques for Mental Rumination

Kimberley: Is there a reason why-- and for some of the listeners, they may have learned this before, but is there a reason why you use ’may or may nots’ instead of worst-case scenarios?

Shala: For me, for my personal OCD recovery journey, what I found with worst-case scenario is I got too lost in the content. I remember doing-- I had had a mammogram, it had come back with some abnormal findings. I spent the whole weekend trying to do scripting about what could happen, and I was using worst-case scenario. Well, I end up in the hospital, I end up with breast cancer, I end up dead. And by the end of the weekend, I was completely demoralized. And I’m like, “Well, I don’t bother because I’m going to be dead, because I have breast cancer.” That’s where my mind took it because I’ve had OCD long enough that if I get a really scary and I start and I play around in the content, I’m going to start losing insight and I’m going to start doing depression as a compulsion, which is the blog we did talk about, where you start acting depressed because you’re believing what the OCD says like, “Oh, well, I might as well just give up, I have breast cancer,” and then becoming depressed, and then acting like it’s true. And then that’s reinforcing the whole cycle. 

So, for me, worst-case scenario scripting made things worse. So, when I stayed in the uncertainty realm, the ‘may or may nots’ that helped because I was trying to help my brain understand, “Well, I may or may not have breast cancer. And if I do, I mean, I’ll go to the doctor, I’ll do what I need to do, but there’s nothing I can do about it right now in my head other than what I’m doing.”

Some people like worst-case scenario and it works fine for them. And I think that works too. I mostly use ’may or may nots’ with clients unless they are unable through numbing that they might be doing. If they’re unable to actually feel what they’re saying, because they’re used to turning it over in their head and pulling the anxiety down officially, and so I can’t get a rise out of the OCD because there’s a lot of really little subtle mental compulsions going on, then I’ll insert some worst-case scenario to get the anxiety level up, to help them really feel the fear, and then pull back into ’may or may nots’. But there’s nothing wrong with worst-case scenario. But for me, that was what happened. And I think if you are prone to depression, if you’re prone to losing insight into your OCD when you’ve got a really big one, I think that’s a risk factor for using that particular type of scripting. 

Magical Thinking and Mental Compulsions 

Kimberley: Right. And I found that they may or may not have worked just as well, except the one thing, and I’m actually curious on your opinion on this and I have not had this conversation, is I find that people who have a lot of magical thinking benefit by worst-case scenario, like their jinxing compulsions and so forth, like the fear of saying it means it will happen. So, saying the worst-case is the best exposure. Is that true for you?

Shala: I have not had to use it much on my own magically. I certainly had a lot of magical thinking. Like, if I don’t hit this green light, then somebody’s going to die. But I think the worst-case scenario, I could actually work well in that, because if you use the worst-case scenario, it can make it seem so ridiculous that it helps people let go of it more easily. And I think you can do that with ’may or may nots’ too. I’ll try to encourage people to use the creativity that they have because everybody with OCD has a ton of creativity. And we know that because the OCD shares your brain and it’s certainly the creative stuff

And to one-up the OCD, you use the scripting to be like, “Gosh, I may or may not get some drug-disease and give it to my entire neighborhood. I may or may not kill off an entire section of my county. We may or may not infect the entire state of Georgia. The entire United States may or may not blow up because I got this one disease. So, they may or may not have to eject me off the earth and make me live on Mars because I’m such a bad person.” This ‘may or may not’ is in all this crazy stuff too, because that’s how to win, is to one up the OCD. It thinks that’s scary, let’s go even scarier. But the scary you get, it also gets a little bit ridiculous after a while. And then the whole thing seems to be a little bit ridiculous. So, I think you can still use that worst-case stuff with may or may not.

Kimberley: Right. Okay. So, I mean, I will always sort of-- I know you really well. I’ve always held you so high in my mind in just how resilient and strong you are in doing this. How might you, or how do you help people who feel completely powerless at even addressing this? For you to say it, it sounds very like you’re just doing it and it’s so powerful. But for those who are really struggling with this idea of like, you said, coming out of your head, can you speak to how you address that in session if someone’s really struggling to engage in ’may or may nots’ and so forth?

Shala: Yeah. Well, thank you for the kind words, first off. I think that it’s really common for people with OCD by the time they get to a therapist to feel completely demoralized, especially if they’ve been to multiple therapists before they get to somebody who does ERP. And so, they feel like they’re the victim at the hands of a very cruel abuser that they can’t get away from. And so, they feel beaten down and they don’t know how to get out of their heads. They feel like they’re trapped in this mental prison. They can’t get out. And if somebody is struggling like that, and they’re doing the ’may or may nots’ and the OCD is reacting, which of course, it will, and coming back at them stronger, which I always warn people, this is going to happen. When you start poking at this, the OCD is going to poke back and poke back even harder, because it wants to get you back in line so it can keep you prisoner. 

So, what I’ll often do in those situations, if I see somebody is really feeling like they have been so victimized, that they’re never going to be able to get over this, is the type of script I have them do is more of an empowerment script, which could sound like this: “OCD, I’m not listening to you anymore. I’m not doing what you want. I am strong. I can do this.” And I might add some ’may or may nots’ in there. “And I want to be anxious. Come on, bring it on. You think that’s scary? Give me something else.” 

I know you’re having Reid Wilson on as part of this too. I learned all that “bring it on” type stuff and pushing for the anxiety from him. And I think helping people say that out loud can be really transformative. I’ve seen people just completely break down in tears of sort of, “Oh my gosh, I could do this,” like tears of empowerment from standing up and yelling at their OCD. 

If people like swearing, I also just have them swear at it, like they would really swear at somebody who had been abusing them if they had a chance, because swearing actually can make you feel more powerful too, and I want to use all the tools we can. So, I think scripting comes in a number of forms. It’s all about really taking what’s in your head, turning it into a helpful self-talk and saying it out loud. And the reason out loud is important for any type of scripting is that if you’re saying it in your head, it’s going to get mixed up with all the jumble of mental ruminating that’s going on. And saying it out loud makes it hard for you to ruminate. It’s not impossible, but it’s hard because you’re saying it. Your brain really is only processing one thing at a time. And so, if you’re talking and really paying attention to what you’re saying, it’s much harder to be up in your head spinning this around. 

And so, adding these empowerment scripts in with the ’may or may nots’ helps people both accept the uncertainty and feel like they can do this, feel like they can stand up to the OCD and say, “You’ve beaten me enough. No more. This is my life. I’m not letting you ruin it anymore. I am taking this back. I don’t care how long it takes. I don’t care what I have to do. I’m going to do this.” And that builds people up enough where they can feel like they can start approaching these exposures.

Kimberley: I love that. I think that is such-- I’ve had that same experience of how powerful empowerment can be in switching that behavior. It’s so important. Now, one thing I really want to ask you is, do you switch this method when you’re dealing with other anxiety disorders – health anxiety, social anxiety, panic disorder? What is your approach? Is there a difference or would you say the tools are the same?

Shala: There’s a slight difference between disorders. I think health anxiety, I treat exactly like OCD. Even some of the examples I gave here were really health anxiety statements. With panic disorder-- and again, I learned this from Reid and you can ask him more about this when you interview him. But with pain disorder, it’s all about, I want to feel more shorter breath, more like their elephant standing on my chest. I want my heart to be faster. But I’m doing this while I’m having people do exercises that would actually create those feelings, like breathing through a little bit of cocktail straw, jogging, turning up a space heater, and blowing it on themselves. So, we’re trying to create those symptoms and then talk out loud and say, “Come on, I want more of this. I want to feel more anxious. Give me the worst panic attack you’ve ever had.” So, it’s all about amping up the symptoms. 

With social anxiety, it’s a little bit different because with social anxiety, I would work on the cognitions first. Whereas with OCD, we don’t work on the cognitions at all, other than I want you to have a different cognitive relationship with your disorder and your anxiety. I want you to want the anxiety. I want you to want the OCD to come and bother you because that gives you an opportunity to practice. That’s the cognitive work with OCD. I do not work on the cognitive work on the content. I’m not going to say to somebody, “Well, the chance you’re going to get AIDS from that little spot of blood is very small.” That’s not going to be helpful 

With social anxiety, we’re actually working on those distorted cognitions at the beginning. And so, a lot of the work with social anxiety is going to be going out and testing those new cognitions, which really turns the exposures into what we call behavioral experiments. It’s more of a cognitive method. We’re going out and saying, “Gosh, my new belief, instead of everybody’s judging me, is, well, everybody is probably thinking about themselves and I’m going to go do some things that my social anxiety wouldn’t want me to do and test out that new belief.” I might have them use that new belief, but also if their anxiety gets really high and they’re having a hard time saying, “Well, that person may or may not be judging me. They may or may not be looking at me funny. They may or may not go home and tell people about me.” But really, we’re trying to do something a little bit different with social anxiety.

Kimberley: And what about with generalized anxiety? With the mental, a lot of rumination there, do you have a little shift in how you respond?

Shala: Yeah. So, it’s funny that the talk that Michelle Massi and others gave at IOCDF-- I think it was at IOCDF this year about what’s the difference between OCD and GAD is they’re really aligned there. I mean, I treat GAD very similarly the way I treat OCD in that people are up in their heads trying to do things. They’re also doing other types of safety behaviors, compulsive safety behaviors, but a lot of people GAD are just up in their head. They’re just worried about more “real-life” things. But again, a lot of OCD stuff can be real-life things. I mean, look at COVID. That was real life. And people’s OCD could wrap itself around that. So, I treat GAD and OCD quite similarly. There are some differences, but in terms of scripting, we call it “worry time” in GAD. It’s got a different name, but it’s basically the same thing.

Kimberley: Right. Okay. Thank you for answering that because I know some folks here listening will be not having OCD and will be curious to see how it affects them. So, is that the practice for you or is there anything else you feel like people need to know going in, in terms of like, “Here is my strategy, here is my plan to target mental rituals”? What would you say?

Shala: So, as I mentioned, I think the ’may or may nots’ are bridge tool that are always available to you throughout your entire recovery. My goal with anybody that I’m working with is to help them get to the point where they can just use shoulders back. And the way that I think about this is what I call my “man in the park” metaphor. So, we’ve all probably been in a park where somebody is yelling typically about the end of the world and all that stuff. And even if you were to agree with some of the things that the person might say from a spiritual or religious standpoint, you don’t run home and go, “Oh my gosh, we got to pack all our things up because it’s the end of the world. We have to get with all of our relatives and be together because we’re all going to die.” We don’t do that. We hear what this guy’s saying, and then we go on with our days, again, even if you might agree with some of the content.

Now, why do we do that? We do that because it’s not relevant in our life. We realize that person probably, unfortunately, has some problems. But it doesn’t affect us. We hear it just like when we might hear birds in the background or a car honking, and we just go on with our day. That’s how we want to treat OCD. What we do when we have untreated OCD is we run up to the man in the park and we say, “Oh my gosh, can I have a pamphlet? Let me read the pamphlet. Oh my gosh, you’re right. Tell me more, tell me more.” And we’re interacting with him, trying to get some reassurance that maybe he’s wrong, that maybe he does really mean the end of the world is coming soon. Maybe it’s going to be like in a hundred years. Eventually, we get to the point where we’re handing out pamphlets for him. “Here, everybody, take one of these.”

What we’re doing with ’may or may nots’ is we’re learning how to walk by the man in the park and go, “The world may or may not be ending. The world may or may not be ending. I’m not taking a pamphlet. The world may or may not be ending.” So, we’re trying to not interact with him. We’re trying to take what he’s saying and hold it in our heads without doing something compulsive that’s going to make our anxiety higher. What we’re trying to do is practice that enough till we can get to the point where we can be in the park with the guy and just go on with our day. We hear him speaking, but we’re really-- it’s just not relevant. It’s just not part of our life. So, we just move on. And we’re not trying to shove him away. It’s just like any other noise or sound or activity that you would just-- it doesn’t even register in your consciousness. That’s what we’re trying to do. 

Now I think another way to think about this is if you think-- say you’re in an art gallery. Art galleries are quiet and there are lots of people standing around, and there’s somebody in there that you don’t like or who doesn’t like you or whatever. You’re not going to walk up to that person and tap on their shoulder and say, “Excuse me, I’m going to ignore you.” You’re just going to be like, “I know that person is there. I’m just going to do what I’m doing.” And I think that’s-- I use that to help people understand this transition, because we’re basically going from ’may or may nots’ where we’re saying, “OCD, I’m not letting you do this to me anymore,” so we are being really aggressive with it, to this being able to be in the same space with it, but we’re not talking to it at all because we don’t need to, because we can be in the presence with the intrusive thoughts that the OCD is reacting to, just like the presence of all the other thousands of thoughts we have each day without interacting with them.

Kimberley: That’s so interesting. I’ve never thought of it that way. 

Shala: And so, that’s where I’m trying to get people because that is the strongest, strongest recovery, is if you can go do the things that you want to do, be in the presence of the anxiety and not do compulsions physical or mental, you don’t give anything for OCD to work with. I have a whole chapter in my memoir about this after I heard Reid say at one of the conferences, “We need to act as though what OCD is saying doesn’t matter.” And that was revolutionary to me to hear that. And that’s what we’re trying to do both physically and mentally. Because if you can have an obsession and focus on what you want to focus on, do what you want to do, you’re not giving OCD anything to work with. And typically, it’ll just drain away. But this takes time. I mean, it has taken me years to learn how to do this, but I went untreated for 35 years too. It may not take you years, but it may. And that’s okay. It’s a process. And I think if you have trouble trying to do shoulders back, man in the park, use ’may or may nots’. You can use the combination. But I think we’re trying to get to the point where you can just be with the OCD and hear it flipping out and just go on with your day.

OCD, BDD, and Mental Rituals 

Kimberley: In your book, you talk about the different voices. There is a BDD voice and an OCD voice. Was it harder or easier depending on the voice? Was that a component for you in that-- because the words and the voice sound a little different. I know in your memoir you give them different names and so forth, which if anyone hasn’t read your memoir, they need to go right now and read it. Do you have any thoughts on that in terms of the different voices or the different ways in which the disorders interact?

Shala: That’s a really great question because yes, I think OCD does shift its voice and shift its persona based on how scared it is. So, if it’s a little bit scared, it’s probably going to speak to you. It’s still going to be not a very nice voice. It might be urgent and pleading. But if it’s super scared, I talk about mine being like the triad of hell, how my OCD will personify into different things based on how scared it is. And if it’s super scared and it’s going to get super big and it’s going to get super loud in your head because it’s trying desperately to help you understand you’ve got to save it because it thinks it’s in danger. That’s all its content. Then I think-- and if you have trouble ignoring it because it’s screaming in your head, like the man in the park comes over with his megaphone, puts it right up against your ear and starts talking, that’s hard to ignore. That’s hard to act like that’s not relevant because it hurts. There’s so much noise. 

That’s when you might have to use a may or may not type approach because it’s just so loud, you can’t ignore it, because it’s so scared. And that’s okay. And again, sometimes I’ll have to use that. Not too terribly often just because I’ve spent a long time working on how to use the shoulder’s back, man in the park, but if I have to use it, I use it. And so, I think your thought about how do I interact with the OCD based on how aggressive it’s being also plays into this.

Kimberley: I love all this. I think this is really helpful in terms of being able to be flexible. I know sometimes we want just the one rule that’s going to work in all situations, but I think you’re right. I think that there needs to be different approaches. And would you say it depends on the person? Do you give them some autonomy over finding what works for them, or what would you say? 

Shala: Absolutely. If people are up in their heads and they don’t want to use ’may or may nots’, I’ll try to use some other things. If I really, really think that that’s what we need right now, is we need scripting, I’ll try to sell them on why. But at the end of the day, it’s always my client’s choice and I do it differently based on every client. For some clients, it might be just more empowering statements. For some clients where it’s more panicky focused, it might be more about bringing on your anxiety. Sometimes it might be pulling self-compassion in and just saying the self-compassion statements out loud. So, it really does vary by person. There’s no one-size-fits-all, but I think, I feel that people need to have something to replace the mental ritualizing with at the beginning that they’ve been doing it for a long time, just because otherwise, it’s like, I’m giving them a bicycle, they’ve never ridden a bicycle before and I won’t give them any training wheels. And that’s really, really hard. Some people can do it. I mean, some people can just be like, “Oh, I’m to stop doing that in my head? Okay, well, I’ll stop doing that in my head.” But most people need something to help them bridge that gap to get to the point where they can just be in the presence with it and not be talking to it in their heads.

Kimberley: Amazing. All right. Any final statements from you as we get close to the end?

Shala: I think that it’s important to, as you’re working on this, really think about what you’re doing in your head that might be subtle, that could be making the OCD worse. And I think talking and being willing to talk about this to therapists about putting it all out there, “Hey, I’m saying this to myself in my head, is that helpful or harmful?” Because OCD therapy can be pretty straightforward. I mean, ERP, go out and face your fears, don’t do rituals. It sounds pretty straightforward. But there is a lot of subtlety to this. And the more that you can root out these subtle mental rituals, the better that your recovery is going to be. 

And know too that if you’ve had untreated OCD for a long time, you can uncover mental rituals, little bitty ones, for years after you get out of therapy. And that’s okay. It doesn’t mean you’re not in recovery. It just means that you are getting more and more insightful and educated about what OCD is. And the more that you can pick those little things out, just the better your recovery will be. But we also don’t want to be perfectionistic about that like, “I must eliminate every single mental ritual that I have or I’m not going to be in a good recovery.” That’s approaching your ERP like OCD would do. And we don’t want to do that. But we do want to be mindful about the subtleties and make sure to try to pull out as many of those subtle things that we might be doing in our heads as possible. 

Kimberley: Amazing. Thank you. Tell us-- again, first, let me just say, such helpful information. And your personal experience, I think, is really validating and helpful to hear on those little nuances. Tell us where people can hear about you and the amazing projects you’ve got going on.

Shala: You can go to ShalaNicely.com and I have lots of free blog posts I’ve written on this. So, there are two blog posts, two pretty extensive blog posts on ’may or may nots’. So, if you go on my website and just search may or may not, it’ll bring up two blog posts about that. If you search on shoulders back or man in the park, you’ll find two blog posts on how to do that technique. I also have a blog post I wrote in the last year or so called Shower Scripting, which is how to do ERP, like just some touch-up scripting in the shower, use that time. So, I would say go to my website and you can find all sorts of free resources. I’ve got two books. You can find on Amazon, Everyday Mindfulness for OCD, Jon Hershfield and I co-wrote. And we talk about ‘may or may nots’ and shoulders back and some of the things in there just briefly. And then my memoir, Is Fred in the Refrigerator?: Taming OCD and Reclaiming My Life, is also on Amazon or bookstores, Audible, and that kind of thing. 

Kimberley: I wonder too, if we could-- I’m going to put links to all these in the show note. I remember you having a word with your OCD, a video?

Shala: Oh yes, that’s true.

Kimberley: Can we link that too?

Shala: Yes. And that one I have under my COVID resources, because I’m so glad you brought that up. When the pandemic started, my OCD did not like it, as many people who have contamination OCD can relate to. And it was pretty scary all the time. And it was making me scared all the time. And eventually, I just wrote it a letter and I’m like, “Dude, we’re not doing this anymore.” And I read it out loud and I recorded it out loud so that people could hear how I was talking to it. 

Kimberley: It was so powerful.

Shala: Well, thank you. And it’s fun to do. I think the more that you can personify your OCD, the more you can think of it as an entity that is within you but is not you, and to recognize that your relationship with it will change over time. Sometimes you’re going to be compassionate with it. “Gosh, OCD, I’m so sorry,” You’re scared we’re doing this anyway. Sometimes you’re going to be aggressive with it. Sometimes you just ignore it. And that changes as you go through therapy, it changes through your life. And I think that recognizing that it’s okay to have OCD and to have this little thing, I think of like an orange ball with big feet and sunglasses is how I think about it when it’s behaving – it makes it less of an adversarial relationship over time and more like I have an annoying little sibling that, gosh, it’s just not going to ever not be there, but it’s fine. We can live together and live in this uncertainty and be happy anyway.

Kimberley: I just love it. Thank you so much for being here and sharing your experience and your knowledge. It’s so wonderful.

Shala: Thank you so much for having me.

May 13, 2022
Ep. 284 6-Part Series: Managing Mental Compulsions (with Shala Nicely)
41:43

SUMMARY: 

In this weeks podcast, we have my dearest friend Shala Nicely talking about how she manages mental compulsions.  In this episode, Shala shares her lived experience with Obsessive Compulsive Disorder and how she overcomes mental rituals.

In This Episode:

  • How to reduce mental compulsions for OCD and GAD.
  • How to use Flooding Techniques with Mental Compulsions
  • Magical Thinking and Mental Compulsions
  • BDD and Mental Compulsions

Links To Things I Talk About:

Shalanicely.com
Book: Is Fred in the Refridgerator?
Book: Everyday Mindfulness for OCD
ERP School: https://www.cbtschool.com/erp-school-lp

Episode Sponsor:

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

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EPISODE TRANSCRIPTION

This is Your Anxiety Toolkit - Episode 284.

Welcome back, everybody. We are on the third video or the third part of this six-part series on how to manage mental compulsions. Last week’s episode with Jon Hershfield was bomb, like so good. And I will say that we, this week, have Shala Nicely, and she goes for it as well. So, I am so honored to have these amazing experts talking about mental compulsions, talking about what specific tools they use. 

So, I’m not going to take too much time of the intro this time, because I know you just want to get to the content. Again, I just want to put a disclaimer. This should not replace professional mental health care. This series is for educational purposes only. My job at CBT School is to give you as much education as I can, knowing that you may or may not have access to care or treatment in your own home. So, I’m hoping that this fills in a gap that maybe we’ve missed in the past in terms of we have ERP School, that’s an online course teaching you everything about ERP to get you started if you’re doing that on your own. But this is a bigger topic. This is an area that I’d need to make a complete new course. But instead of making a course, I’m bringing these experts to you for free, hopefully giving you the tools that you need. 

If you’re wanting additional information about ERP School, please go to CBTSchool.com. With that being said, let’s go straight over to this episode with Shala Nicely. 

Managing Mental Compulsions (With Shala Nicely) Your anxiety toolkit

Kimberley: Welcome, Shala. I am so happy to have you here.

Shala: I am so happy to be here. Thank you for having me.

Kimberley: Okay. So, I have heard a little bit of your views on this, but I am actually so excited now to get into the juicy details of how you address mental compulsions or mental rituals. First, I want to check in with you, do you call them mental compulsions, rituals, rumination? How do you address them?

Shala: Yeah. All those things. I also sometimes call it mental gymnastics up in your head, it’s all sorts of things you’re doing in your head to try to get some relief from anxiety.

Kimberley: Right. So, if you had a patient or a client who really was struggling with mental compulsions, whether or not they were doing other compulsions as well, how might you address that particular part of their symptomology?

Shala: So, let me answer that by stepping back a little bit and telling you about my own experience with this, because a lot of the way I do it is based on what I learned, trying to manage my own mental rituals. I’ve had OCD probably since I was five or six, untreated until I was 39. Stumbled upon the right treatment when I went to the IOCDF Conference and started doing exposure mostly on my own. I went to Reid Wilson’s two-day group, where I learned how to do it. But the rest of the time, I was implementing on my own. And even though I had quite a few physical compulsions, I would’ve considered myself a primary mental ritualizer, meaning if we look at the majority, my compulsions were up in my head. And the way I think about this is I think that sometimes if you have OCD for long enough, and you’ve got to go out and keep functioning in the world and you can’t do all these rituals so that people could see, because then people will be like, “What’s wrong with you? What are you doing?” you take them inward. And some mental compulsions can take the place of physical compulsions that you’re not able to do for whatever reason because you’re trying to function. And I’d had untreated OCD for so long that most of my rituals were up in my head, not all, but the great majority of them. 

Exposure & Response Prevention for Mental Compulsions

So, when I started to do exposure, what I found was I could do exposure therapy, straight up going and facing my fears, like going and being around things that might be triggering all I wanted, but I wasn’t necessarily getting better because I wasn’t addressing the mental rituals. So, basically, I’m doing exposure without response prevention or exposure with partial response prevention, which can make things either worse or just neutralize your efforts. So, what I did was I figured out how to be in the presence of triggers and not be up in my head, trying to do analyzing, justifying, figuring it out, replaying the situation with a different ending, all the sorts of things that I would do over and over in my head. And the way I did this was I took something I learned from Jonathan Grayson and his book, Freedom From OCD. I know you’re having him on for this series too. And he talked about doing all this ERP scripting, where you basically write out the worst-case scenario, what you think your OCD thinks is going to happen and you write it in either a worst-case way or an uncertainty-focused way. And what I did was after reading his book, I took that concept and I just shortened it down, and anything that my OCD was afraid of, I would just wrap may or may not surround it. 

So, for instance, an example that I use in Is Fred in the Refrigerator?, my memoir, Taming OCD and Reclaiming My Life was that I used to-- when I was walking through stores like Target, if I saw one of those little plastic price tags that had fallen on the ground, if I didn’t pick it up and put it out of harm’s way, I was afraid somebody was going to slip and fall and break their neck. And it would be on some security camera that I just walked on past it and didn’t do anything. So, a typical scrupulosity obsession. And so, going shopping was really hard because I’m cleaning up the store as I’m shopping. And so, what I would do is I would either go to Target, walk past the price tag. And then as I’m just passing the price tag, I would say things. And in Target, I obviously couldn’t do this really out loud, mumble it out loud as best, but I may or may not cause somebody to kill themselves by they’re going to slip and fall on that price tag because I didn’t pick it up. I may or may not be an awful, terrible rotten human being. They may or may not catch me and throw me into jail. I may or may not rot in prison. People may or may not find out what a really bad person I really am. This may or may not be OCD, et cetera, et cetera, et cetera. 

And that would allow me to be present with the obsessions, all the what-ifs – those are basically what-ifs turned into ‘may or may nots’ – without compulsing with them, without doing anything that would artificially lower my anxiety. So, it allowed me to be in the presence of those obsessive thoughts while interrupting the pattern of the mental rituals. And that’s really how I use ‘may or may nots’ and how I teach my clients to use ‘may or may nots’ today is using them to really be mindfully present of what the OCD is worried about while not interacting with that content in a way that’s going to make things worse. So, that’s how I developed it for myself. And I think that-- and that is a tool that I would say is an intermediary tool. So, I use that now in my own recovery. I don’t have to use ’may or may nots’. It’s very often at all. If I get super triggered, which doesn’t happen too terribly often, but if I get super triggered and I cannot get out of my head, I’ll use ’may or may nots’. 

But I think the continuum is that you try to do something to interrupt the mental rituals, which for me is the ’may or may nots’. You can also-- people can write down the scripts, they can do a worst-case scenario. But eventually, what you’re trying to get to is you’re trying to be able to hear the OCD, what-ifs in your head and completely ignore it. And I call that my shoulders back, the way of thinking about things. Just put your shoulders back and you move on with your day. You don’t acknowledge it. 

What I’ll do with clients, I’ll say, “If you had the thought of Blue Martian is going to land on my head, I mean, you wouldn’t even do anything with that thought. That thought would just go in and go out and wouldn’t get any of your attention.” That’s the way we want to treat OCD, is just thoughts can be there. I’m not going to say, “Oh, that’s my OCD.” I’m not going to say, “OCD, I’m not talking to you.” I’m not going to acknowledge it at all. I’m just going to treat it like any other weird thought that we have during the day and move on. 

Your question was, how would you help somebody who comes in with mental rituals? Well, first, I want to understand where are they in their OCD recovery? How long have they been doing these mental rituals? What percentage of their compulsions are mental versus physical? What are the kind of things that their OCD is afraid of? Basically, make a list or a hierarchy of everything they’re afraid of. And then we start working on exposure therapy. And when I have them do exposures, the first exposure I do with people, we’ll find something that’s-- I start in the middle of the hierarchy. You don’t have to, but I try. And I will have them face the fear. But then I’ll immediately ask them, what is your OCD saying right now? And they’ll tell me, and I’ll say, “I want you to repeat after me.” I have them do this, and everyone that I see hates this, but I have them do it. Standing up with their shoulders back like Wonder Woman, because this type of power pose helps them. It changes the chemistry of your body and helps you feel more powerful. 

OCD thinks it’s very powerful. So, I want my clients to feel as powerful as they can. So, I have them stand like Wonder Woman and they repeat after me. Somebody could-- let’s just say we are standing near something red on the floor. And I’ll say, “Well, what is your OCD saying right now?” And they’ll say, “Well, that’s blood and it could have AIDS in it, and I’m going to get sick.” I’ll say, “Well, that may or may not be a spot of blood on the floor. I may or may not get sick and I may or may not get AIDS, but I want to do this. I’m going to stay here. OCD, I want to be anxious, so bring it on.” 

And that’s how we do the exposure, is I ask them what’s in their head. I have them repeat it to me until they understand what the process is. And then I’m having them be in the presence of this and just script, script, script away. That’s what I call it scripting, so that they are in the presence of whatever’s bothering them, but they’re not up in their head. And anytime something comes in their head, I teach them to pull it down into the script. Never let something be circulating in your head without saying it out loud and pulling it into the script. 

I will work on this technique with clients as we’re working on exposures, because eventually what we’ll want to do is instead of going all over the place, “That may or may not be blood, I may or may not get AIDS, I may or may not get sick,” I’ll say, “Okay, of all the things you’ve just said, what does your OCD-- what is your OCD scared of the most? Let’s focus on that.” And so, “I may or may not get AIDS. I may or may not get AIDS. I may or may not have HIV. I may or may not get AIDS,” over again until people start to say, “Oh, okay. I guess I don’t have any control over this,” because what we’re trying to do is help the OCD habituate to the uncertainty. Habituate, I know that’d be a confusing word. You don’t have to habituate in order for exposure to work due to the theory of inhibitory learning, but we’re trying to help your brain get used to the uncertainty here.

Kimberley: And break into a different cycle instead of doing the old rumination cycle. 

Shala: Yes. And so then, I’ll teach people to just find their scariest fear. They say that over and over and over again. Then let’s hit the next one. “Well, my family may or may not survive if I die because if I get a fatal disease and I die and my family may or may not be left destitute,” and then over and over. “My family may or may not be left destitute. My family may or may not be left destitute, whatever,” until we’re hitting all the things that could be circulating in your head. 

Now, some people really don’t need to do that scripting because they’re not up in their head that much. But that’s the minority of people. I think most people with OCD are doing something in their head. And a lot of people aren’t aware of what they’re doing because these mental rituals are incredibly subtle at times. And so, as people, as my clients go out and work on these exposures, I’ll have them tell me how it’s going. I have people fill out forms on my website each day as they’re doing exposures so I can see what’s going on. And if they’re not really up in their head and they don’t really need to do the ‘may or may nots’, great. That’s better. In fact, just go do the exposure and go on with your life. If they’re up in their head, then I have them do the ’may or may nots’. And so, that’s how I would start with somebody. 

And so, what I’m trying to do is I’m giving them what I call a bridge tool. Because people who have been mental ritualizing for a long time, I have found it’s virtually impossible to just stop because that’s what your mind is used to doing. And so, what I’m doing is I’m giving them a competing response. And I’m saying here, instead of mental ritualizing, I’d like you to say a bunch of ’may or may nots’ statements while standing up and say them out loud while looking like Wonder Woman. Everybody rolls their eyes like, “Really?” But that’s what we do as a bridge tool. And so, they’ve lifted enough mental weights, so to speak, with this technique that they can hear the OCD and start to disengage and not interact with it at all. Then we move to that technique.

Flooding Techniques for Mental Rumination

Kimberley: Is there a reason why-- and for some of the listeners, they may have learned this before, but is there a reason why you use ’may or may nots’ instead of worst-case scenarios?

Shala: For me, for my personal OCD recovery journey, what I found with worst-case scenario is I got too lost in the content. I remember doing-- I had had a mammogram, it had come back with some abnormal findings. I spent the whole weekend trying to do scripting about what could happen, and I was using worst-case scenario. Well, I end up in the hospital, I end up with breast cancer, I end up dead. And by the end of the weekend, I was completely demoralized. And I’m like, “Well, I don’t bother because I’m going to be dead, because I have breast cancer.” That’s where my mind took it because I’ve had OCD long enough that if I get a really scary and I start and I play around in the content, I’m going to start losing insight and I’m going to start doing depression as a compulsion, which is the blog we did talk about, where you start acting depressed because you’re believing what the OCD says like, “Oh, well, I might as well just give up, I have breast cancer,” and then becoming depressed, and then acting like it’s true. And then that’s reinforcing the whole cycle. 

So, for me, worst-case scenario scripting made things worse. So, when I stayed in the uncertainty realm, the ‘may or may nots’ that helped because I was trying to help my brain understand, “Well, I may or may not have breast cancer. And if I do, I mean, I’ll go to the doctor, I’ll do what I need to do, but there’s nothing I can do about it right now in my head other than what I’m doing.”

Some people like worst-case scenario and it works fine for them. And I think that works too. I mostly use ’may or may nots’ with clients unless they are unable through numbing that they might be doing. If they’re unable to actually feel what they’re saying, because they’re used to turning it over in their head and pulling the anxiety down officially, and so I can’t get a rise out of the OCD because there’s a lot of really little subtle mental compulsions going on, then I’ll insert some worst-case scenario to get the anxiety level up, to help them really feel the fear, and then pull back into ’may or may nots’. But there’s nothing wrong with worst-case scenario. But for me, that was what happened. And I think if you are prone to depression, if you’re prone to losing insight into your OCD when you’ve got a really big one, I think that’s a risk factor for using that particular type of scripting. 

Magical Thinking and Mental Compulsions 

Kimberley: Right. And I found that they may or may not have worked just as well, except the one thing, and I’m actually curious on your opinion on this and I have not had this conversation, is I find that people who have a lot of magical thinking benefit by worst-case scenario, like their jinxing compulsions and so forth, like the fear of saying it means it will happen. So, saying the worst-case is the best exposure. Is that true for you?

Shala: I have not had to use it much on my own magically. I certainly had a lot of magical thinking. Like, if I don’t hit this green light, then somebody’s going to die. But I think the worst-case scenario, I could actually work well in that, because if you use the worst-case scenario, it can make it seem so ridiculous that it helps people let go of it more easily. And I think you can do that with ’may or may nots’ too. I’ll try to encourage people to use the creativity that they have because everybody with OCD has a ton of creativity. And we know that because the OCD shares your brain and it’s certainly the creative stuff

And to one-up the OCD, you use the scripting to be like, “Gosh, I may or may not get some drug-disease and give it to my entire neighborhood. I may or may not kill off an entire section of my county. We may or may not infect the entire state of Georgia. The entire United States may or may not blow up because I got this one disease. So, they may or may not have to eject me off the earth and make me live on Mars because I’m such a bad person.” This ‘may or may not’ is in all this crazy stuff too, because that’s how to win, is to one up the OCD. It thinks that’s scary, let’s go even scarier. But the scary you get, it also gets a little bit ridiculous after a while. And then the whole thing seems to be a little bit ridiculous. So, I think you can still use that worst-case stuff with may or may not.

Kimberley: Right. Okay. So, I mean, I will always sort of-- I know you really well. I’ve always held you so high in my mind in just how resilient and strong you are in doing this. How might you, or how do you help people who feel completely powerless at even addressing this? For you to say it, it sounds very like you’re just doing it and it’s so powerful. But for those who are really struggling with this idea of like, you said, coming out of your head, can you speak to how you address that in session if someone’s really struggling to engage in ’may or may nots’ and so forth?

Shala: Yeah. Well, thank you for the kind words, first off. I think that it’s really common for people with OCD by the time they get to a therapist to feel completely demoralized, especially if they’ve been to multiple therapists before they get to somebody who does ERP. And so, they feel like they’re the victim at the hands of a very cruel abuser that they can’t get away from. And so, they feel beaten down and they don’t know how to get out of their heads. They feel like they’re trapped in this mental prison. They can’t get out. And if somebody is struggling like that, and they’re doing the ’may or may nots’ and the OCD is reacting, which of course, it will, and coming back at them stronger, which I always warn people, this is going to happen. When you start poking at this, the OCD is going to poke back and poke back even harder, because it wants to get you back in line so it can keep you prisoner. 

So, what I’ll often do in those situations, if I see somebody is really feeling like they have been so victimized, that they’re never going to be able to get over this, is the type of script I have them do is more of an empowerment script, which could sound like this: “OCD, I’m not listening to you anymore. I’m not doing what you want. I am strong. I can do this.” And I might add some ’may or may nots’ in there. “And I want to be anxious. Come on, bring it on. You think that’s scary? Give me something else.” 

I know you’re having Reid Wilson on as part of this too. I learned all that “bring it on” type stuff and pushing for the anxiety from him. And I think helping people say that out loud can be really transformative. I’ve seen people just completely break down in tears of sort of, “Oh my gosh, I could do this,” like tears of empowerment from standing up and yelling at their OCD. 

If people like swearing, I also just have them swear at it, like they would really swear at somebody who had been abusing them if they had a chance, because swearing actually can make you feel more powerful too, and I want to use all the tools we can. So, I think scripting comes in a number of forms. It’s all about really taking what’s in your head, turning it into a helpful self-talk and saying it out loud. And the reason out loud is important for any type of scripting is that if you’re saying it in your head, it’s going to get mixed up with all the jumble of mental ruminating that’s going on. And saying it out loud makes it hard for you to ruminate. It’s not impossible, but it’s hard because you’re saying it. Your brain really is only processing one thing at a time. And so, if you’re talking and really paying attention to what you’re saying, it’s much harder to be up in your head spinning this around. 

And so, adding these empowerment scripts in with the ’may or may nots’ helps people both accept the uncertainty and feel like they can do this, feel like they can stand up to the OCD and say, “You’ve beaten me enough. No more. This is my life. I’m not letting you ruin it anymore. I am taking this back. I don’t care how long it takes. I don’t care what I have to do. I’m going to do this.” And that builds people up enough where they can feel like they can start approaching these exposures.

Kimberley: I love that. I think that is such-- I’ve had that same experience of how powerful empowerment can be in switching that behavior. It’s so important. Now, one thing I really want to ask you is, do you switch this method when you’re dealing with other anxiety disorders – health anxiety, social anxiety, panic disorder? What is your approach? Is there a difference or would you say the tools are the same?

Shala: There’s a slight difference between disorders. I think health anxiety, I treat exactly like OCD. Even some of the examples I gave here were really health anxiety statements. With panic disorder-- and again, I learned this from Reid and you can ask him more about this when you interview him. But with pain disorder, it’s all about, I want to feel more shorter breath, more like their elephant standing on my chest. I want my heart to be faster. But I’m doing this while I’m having people do exercises that would actually create those feelings, like breathing through a little bit of cocktail straw, jogging, turning up a space heater, and blowing it on themselves. So, we’re trying to create those symptoms and then talk out loud and say, “Come on, I want more of this. I want to feel more anxious. Give me the worst panic attack you’ve ever had.” So, it’s all about amping up the symptoms. 

With social anxiety, it’s a little bit different because with social anxiety, I would work on the cognitions first. Whereas with OCD, we don’t work on the cognitions at all, other than I want you to have a different cognitive relationship with your disorder and your anxiety. I want you to want the anxiety. I want you to want the OCD to come and bother you because that gives you an opportunity to practice. That’s the cognitive work with OCD. I do not work on the cognitive work on the content. I’m not going to say to somebody, “Well, the chance you’re going to get AIDS from that little spot of blood is very small.” That’s not going to be helpful 

With social anxiety, we’re actually working on those distorted cognitions at the beginning. And so, a lot of the work with social anxiety is going to be going out and testing those new cognitions, which really turns the exposures into what we call behavioral experiments. It’s more of a cognitive method. We’re going out and saying, “Gosh, my new belief, instead of everybody’s judging me, is, well, everybody is probably thinking about themselves and I’m going to go do some things that my social anxiety wouldn’t want me to do and test out that new belief.” I might have them use that new belief, but also if their anxiety gets really high and they’re having a hard time saying, “Well, that person may or may not be judging me. They may or may not be looking at me funny. They may or may not go home and tell people about me.” But really, we’re trying to do something a little bit different with social anxiety.

Kimberley: And what about with generalized anxiety? With the mental, a lot of rumination there, do you have a little shift in how you respond?

Shala: Yeah. So, it’s funny that the talk that Michelle Massi and others gave at IOCDF-- I think it was at IOCDF this year about what’s the difference between OCD and GAD is they’re really aligned there. I mean, I treat GAD very similarly the way I treat OCD in that people are up in their heads trying to do things. They’re also doing other types of safety behaviors, compulsive safety behaviors, but a lot of people GAD are just up in their head. They’re just worried about more “real-life” things. But again, a lot of OCD stuff can be real-life things. I mean, look at COVID. That was real life. And people’s OCD could wrap itself around that. So, I treat GAD and OCD quite similarly. There are some differences, but in terms of scripting, we call it “worry time” in GAD. It’s got a different name, but it’s basically the same thing.

Kimberley: Right. Okay. Thank you for answering that because I know some folks here listening will be not having OCD and will be curious to see how it affects them. So, is that the practice for you or is there anything else you feel like people need to know going in, in terms of like, “Here is my strategy, here is my plan to target mental rituals”? What would you say?

Shala: So, as I mentioned, I think the ’may or may nots’ are bridge tool that are always available to you throughout your entire recovery. My goal with anybody that I’m working with is to help them get to the point where they can just use shoulders back. And the way that I think about this is what I call my “man in the park” metaphor. So, we’ve all probably been in a park where somebody is yelling typically about the end of the world and all that stuff. And even if you were to agree with some of the things that the person might say from a spiritual or religious standpoint, you don’t run home and go, “Oh my gosh, we got to pack all our things up because it’s the end of the world. We have to get with all of our relatives and be together because we’re all going to die.” We don’t do that. We hear what this guy’s saying, and then we go on with our days, again, even if you might agree with some of the content.

Now, why do we do that? We do that because it’s not relevant in our life. We realize that person probably, unfortunately, has some problems. But it doesn’t affect us. We hear it just like when we might hear birds in the background or a car honking, and we just go on with our day. That’s how we want to treat OCD. What we do when we have untreated OCD is we run up to the man in the park and we say, “Oh my gosh, can I have a pamphlet? Let me read the pamphlet. Oh my gosh, you’re right. Tell me more, tell me more.” And we’re interacting with him, trying to get some reassurance that maybe he’s wrong, that maybe he does really mean the end of the world is coming soon. Maybe it’s going to be like in a hundred years. Eventually, we get to the point where we’re handing out pamphlets for him. “Here, everybody, take one of these.”

What we’re doing with ’may or may nots’ is we’re learning how to walk by the man in the park and go, “The world may or may not be ending. The world may or may not be ending. I’m not taking a pamphlet. The world may or may not be ending.” So, we’re trying to not interact with him. We’re trying to take what he’s saying and hold it in our heads without doing something compulsive that’s going to make our anxiety higher. What we’re trying to do is practice that enough till we can get to the point where we can be in the park with the guy and just go on with our day. We hear him speaking, but we’re really-- it’s just not relevant. It’s just not part of our life. So, we just move on. And we’re not trying to shove him away. It’s just like any other noise or sound or activity that you would just-- it doesn’t even register in your consciousness. That’s what we’re trying to do. 

Now I think another way to think about this is if you think-- say you’re in an art gallery. Art galleries are quiet and there are lots of people standing around, and there’s somebody in there that you don’t like or who doesn’t like you or whatever. You’re not going to walk up to that person and tap on their shoulder and say, “Excuse me, I’m going to ignore you.” You’re just going to be like, “I know that person is there. I’m just going to do what I’m doing.” And I think that’s-- I use that to help people understand this transition, because we’re basically going from ’may or may nots’ where we’re saying, “OCD, I’m not letting you do this to me anymore,” so we are being really aggressive with it, to this being able to be in the same space with it, but we’re not talking to it at all because we don’t need to, because we can be in the presence with the intrusive thoughts that the OCD is reacting to, just like the presence of all the other thousands of thoughts we have each day without interacting with them.

Kimberley: That’s so interesting. I’ve never thought of it that way. 

Shala: And so, that’s where I’m trying to get people because that is the strongest, strongest recovery, is if you can go do the things that you want to do, be in the presence of the anxiety and not do compulsions physical or mental, you don’t give anything for OCD to work with. I have a whole chapter in my memoir about this after I heard Reid say at one of the conferences, “We need to act as though what OCD is saying doesn’t matter.” And that was revolutionary to me to hear that. And that’s what we’re trying to do both physically and mentally. Because if you can have an obsession and focus on what you want to focus on, do what you want to do, you’re not giving OCD anything to work with. And typically, it’ll just drain away. But this takes time. I mean, it has taken me years to learn how to do this, but I went untreated for 35 years too. It may not take you years, but it may. And that’s okay. It’s a process. And I think if you have trouble trying to do shoulders back, man in the park, use ’may or may nots’. You can use the combination. But I think we’re trying to get to the point where you can just be with the OCD and hear it flipping out and just go on with your day.

OCD, BDD, and Mental Rituals 

Kimberley: In your book, you talk about the different voices. There is a BDD voice and an OCD voice. Was it harder or easier depending on the voice? Was that a component for you in that-- because the words and the voice sound a little different. I know in your memoir you give them different names and so forth, which if anyone hasn’t read your memoir, they need to go right now and read it. Do you have any thoughts on that in terms of the different voices or the different ways in which the disorders interact?

Shala: That’s a really great question because yes, I think OCD does shift its voice and shift its persona based on how scared it is. So, if it’s a little bit scared, it’s probably going to speak to you. It’s still going to be not a very nice voice. It might be urgent and pleading. But if it’s super scared, I talk about mine being like the triad of hell, how my OCD will personify into different things based on how scared it is. And if it’s super scared and it’s going to get super big and it’s going to get super loud in your head because it’s trying desperately to help you understand you’ve got to save it because it thinks it’s in danger. That’s all its content. Then I think-- and if you have trouble ignoring it because it’s screaming in your head, like the man in the park comes over with his megaphone, puts it right up against your ear and starts talking, that’s hard to ignore. That’s hard to act like that’s not relevant because it hurts. There’s so much noise. 

That’s when you might have to use a may or may not type approach because it’s just so loud, you can’t ignore it, because it’s so scared. And that’s okay. And again, sometimes I’ll have to use that. Not too terribly often just because I’ve spent a long time working on how to use the shoulder’s back, man in the park, but if I have to use it, I use it. And so, I think your thought about how do I interact with the OCD based on how aggressive it’s being also plays into this.

Kimberley: I love all this. I think this is really helpful in terms of being able to be flexible. I know sometimes we want just the one rule that’s going to work in all situations, but I think you’re right. I think that there needs to be different approaches. And would you say it depends on the person? Do you give them some autonomy over finding what works for them, or what would you say? 

Shala: Absolutely. If people are up in their heads and they don’t want to use ’may or may nots’, I’ll try to use some other things. If I really, really think that that’s what we need right now, is we need scripting, I’ll try to sell them on why. But at the end of the day, it’s always my client’s choice and I do it differently based on every client. For some clients, it might be just more empowering statements. For some clients where it’s more panicky focused, it might be more about bringing on your anxiety. Sometimes it might be pulling self-compassion in and just saying the self-compassion statements out loud. So, it really does vary by person. There’s no one-size-fits-all, but I think, I feel that people need to have something to replace the mental ritualizing with at the beginning that they’ve been doing it for a long time, just because otherwise, it’s like, I’m giving them a bicycle, they’ve never ridden a bicycle before and I won’t give them any training wheels. And that’s really, really hard. Some people can do it. I mean, some people can just be like, “Oh, I’m to stop doing that in my head? Okay, well, I’ll stop doing that in my head.” But most people need something to help them bridge that gap to get to the point where they can just be in the presence with it and not be talking to it in their heads.

Kimberley: Amazing. All right. Any final statements from you as we get close to the end?

Shala: I think that it’s important to, as you’re working on this, really think about what you’re doing in your head that might be subtle, that could be making the OCD worse. And I think talking and being willing to talk about this to therapists about putting it all out there, “Hey, I’m saying this to myself in my head, is that helpful or harmful?” Because OCD therapy can be pretty straightforward. I mean, ERP, go out and face your fears, don’t do rituals. It sounds pretty straightforward. But there is a lot of subtlety to this. And the more that you can root out these subtle mental rituals, the better that your recovery is going to be. 

And know too that if you’ve had untreated OCD for a long time, you can uncover mental rituals, little bitty ones, for years after you get out of therapy. And that’s okay. It doesn’t mean you’re not in recovery. It just means that you are getting more and more insightful and educated about what OCD is. And the more that you can pick those little things out, just the better your recovery will be. But we also don’t want to be perfectionistic about that like, “I must eliminate every single mental ritual that I have or I’m not going to be in a good recovery.” That’s approaching your ERP like OCD would do. And we don’t want to do that. But we do want to be mindful about the subtleties and make sure to try to pull out as many of those subtle things that we might be doing in our heads as possible. 

Kimberley: Amazing. Thank you. Tell us-- again, first, let me just say, such helpful information. And your personal experience, I think, is really validating and helpful to hear on those little nuances. Tell us where people can hear about you and the amazing projects you’ve got going on.

Shala: You can go to ShalaNicely.com and I have lots of free blog posts I’ve written on this. So, there are two blog posts, two pretty extensive blog posts on ’may or may nots’. So, if you go on my website and just search may or may not, it’ll bring up two blog posts about that. If you search on shoulders back or man in the park, you’ll find two blog posts on how to do that technique. I also have a blog post I wrote in the last year or so called Shower Scripting, which is how to do ERP, like just some touch-up scripting in the shower, use that time. So, I would say go to my website and you can find all sorts of free resources. I’ve got two books. You can find on Amazon, Everyday Mindfulness for OCD, Jon Hershfield and I co-wrote. And we talk about ‘may or may nots’ and shoulders back and some of the things in there just briefly. And then my memoir, Is Fred in the Refrigerator?: Taming OCD and Reclaiming My Life, is also on Amazon or bookstores, Audible, and that kind of thing. 

Kimberley: I wonder too, if we could-- I’m going to put links to all these in the show note. I remember you having a word with your OCD, a video?

Shala: Oh yes, that’s true.

Kimberley: Can we link that too?

Shala: Yes. And that one I have under my COVID resources, because I’m so glad you brought that up. When the pandemic started, my OCD did not like it, as many people who have contamination OCD can relate to. And it was pretty scary all the time. And it was making me scared all the time. And eventually, I just wrote it a letter and I’m like, “Dude, we’re not doing this anymore.” And I read it out loud and I recorded it out loud so that people could hear how I was talking to it. 

Kimberley: It was so powerful.

Shala: Well, thank you. And it’s fun to do. I think the more that you can personify your OCD, the more you can think of it as an entity that is within you but is not you, and to recognize that your relationship with it will change over time. Sometimes you’re going to be compassionate with it. “Gosh, OCD, I’m so sorry,” You’re scared we’re doing this anyway. Sometimes you’re going to be aggressive with it. Sometimes you just ignore it. And that changes as you go through therapy, it changes through your life. And I think that recognizing that it’s okay to have OCD and to have this little thing, I think of like an orange ball with big feet and sunglasses is how I think about it when it’s behaving – it makes it less of an adversarial relationship over time and more like I have an annoying little sibling that, gosh, it’s just not going to ever not be there, but it’s fine. We can live together and live in this uncertainty and be happy anyway.

Kimberley: I just love it. Thank you so much for being here and sharing your experience and your knowledge. It’s so wonderful.

Shala: Thank you so much for having me.

May 13, 2022
Ep. 284 6-Part Series: Managing Mental Compulsions (with Shala Nicely)

SUMMARY: 

In this weeks podcast, we have my dearest friend Shala Nicely talking about how she manages mental compulsions.  In this episode, Shala shares her lived experience with Obsessive Compulsive Disorder and how she overcomes mental rituals.

In This Episode:

  • How to reduce mental compulsions for OCD and GAD.
  • How to use Flooding Techniques with Mental Compulsions
  • Magical Thinking and Mental Compulsions
  • BDD and Mental Compulsions

Links To Things I Talk About:

Shalanicely.com
Book: Is Fred in the Refridgerator?
Book: Everyday Mindfulness for OCD
ERP School: https://www.cbtschool.com/erp-school-lp

Episode Sponsor:

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

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EPISODE TRANSCRIPTION

This is Your Anxiety Toolkit - Episode 284.

Welcome back, everybody. We are on the third video or the third part of this six-part series on how to manage mental compulsions. Last week’s episode with Jon Hershfield was bomb, like so good. And I will say that we, this week, have Shala Nicely, and she goes for it as well. So, I am so honored to have these amazing experts talking about mental compulsions, talking about what specific tools they use. 

So, I’m not going to take too much time of the intro this time, because I know you just want to get to the content. Again, I just want to put a disclaimer. This should not replace professional mental health care. This series is for educational purposes only. My job at CBT School is to give you as much education as I can, knowing that you may or may not have access to care or treatment in your own home. So, I’m hoping that this fills in a gap that maybe we’ve missed in the past in terms of we have ERP School, that’s an online course teaching you everything about ERP to get you started if you’re doing that on your own. But this is a bigger topic. This is an area that I’d need to make a complete new course. But instead of making a course, I’m bringing these experts to you for free, hopefully giving you the tools that you need. 

If you’re wanting additional information about ERP School, please go to CBTSchool.com. With that being said, let’s go straight over to this episode with Shala Nicely. 

Managing Mental Compulsions (With Shala Nicely) Your anxiety toolkit

Kimberley: Welcome, Shala. I am so happy to have you here.

Shala: I am so happy to be here. Thank you for having me.

Kimberley: Okay. So, I have heard a little bit of your views on this, but I am actually so excited now to get into the juicy details of how you address mental compulsions or mental rituals. First, I want to check in with you, do you call them mental compulsions, rituals, rumination? How do you address them?

Shala: Yeah. All those things. I also sometimes call it mental gymnastics up in your head, it’s all sorts of things you’re doing in your head to try to get some relief from anxiety.

Kimberley: Right. So, if you had a patient or a client who really was struggling with mental compulsions, whether or not they were doing other compulsions as well, how might you address that particular part of their symptomology?

Shala: So, let me answer that by stepping back a little bit and telling you about my own experience with this, because a lot of the way I do it is based on what I learned, trying to manage my own mental rituals. I’ve had OCD probably since I was five or six, untreated until I was 39. Stumbled upon the right treatment when I went to the IOCDF Conference and started doing exposure mostly on my own. I went to Reid Wilson’s two-day group, where I learned how to do it. But the rest of the time, I was implementing on my own. And even though I had quite a few physical compulsions, I would’ve considered myself a primary mental ritualizer, meaning if we look at the majority, my compulsions were up in my head. And the way I think about this is I think that sometimes if you have OCD for long enough, and you’ve got to go out and keep functioning in the world and you can’t do all these rituals so that people could see, because then people will be like, “What’s wrong with you? What are you doing?” you take them inward. And some mental compulsions can take the place of physical compulsions that you’re not able to do for whatever reason because you’re trying to function. And I’d had untreated OCD for so long that most of my rituals were up in my head, not all, but the great majority of them. 

Exposure & Response Prevention for Mental Compulsions

So, when I started to do exposure, what I found was I could do exposure therapy, straight up going and facing my fears, like going and being around things that might be triggering all I wanted, but I wasn’t necessarily getting better because I wasn’t addressing the mental rituals. So, basically, I’m doing exposure without response prevention or exposure with partial response prevention, which can make things either worse or just neutralize your efforts. So, what I did was I figured out how to be in the presence of triggers and not be up in my head, trying to do analyzing, justifying, figuring it out, replaying the situation with a different ending, all the sorts of things that I would do over and over in my head. And the way I did this was I took something I learned from Jonathan Grayson and his book, Freedom From OCD. I know you’re having him on for this series too. And he talked about doing all this ERP scripting, where you basically write out the worst-case scenario, what you think your OCD thinks is going to happen and you write it in either a worst-case way or an uncertainty-focused way. And what I did was after reading his book, I took that concept and I just shortened it down, and anything that my OCD was afraid of, I would just wrap may or may not surround it. 

So, for instance, an example that I use in Is Fred in the Refrigerator?, my memoir, Taming OCD and Reclaiming My Life was that I used to-- when I was walking through stores like Target, if I saw one of those little plastic price tags that had fallen on the ground, if I didn’t pick it up and put it out of harm’s way, I was afraid somebody was going to slip and fall and break their neck. And it would be on some security camera that I just walked on past it and didn’t do anything. So, a typical scrupulosity obsession. And so, going shopping was really hard because I’m cleaning up the store as I’m shopping. And so, what I would do is I would either go to Target, walk past the price tag. And then as I’m just passing the price tag, I would say things. And in Target, I obviously couldn’t do this really out loud, mumble it out loud as best, but I may or may not cause somebody to kill themselves by they’re going to slip and fall on that price tag because I didn’t pick it up. I may or may not be an awful, terrible rotten human being. They may or may not catch me and throw me into jail. I may or may not rot in prison. People may or may not find out what a really bad person I really am. This may or may not be OCD, et cetera, et cetera, et cetera. 

And that would allow me to be present with the obsessions, all the what-ifs – those are basically what-ifs turned into ‘may or may nots’ – without compulsing with them, without doing anything that would artificially lower my anxiety. So, it allowed me to be in the presence of those obsessive thoughts while interrupting the pattern of the mental rituals. And that’s really how I use ‘may or may nots’ and how I teach my clients to use ‘may or may nots’ today is using them to really be mindfully present of what the OCD is worried about while not interacting with that content in a way that’s going to make things worse. So, that’s how I developed it for myself. And I think that-- and that is a tool that I would say is an intermediary tool. So, I use that now in my own recovery. I don’t have to use ’may or may nots’. It’s very often at all. If I get super triggered, which doesn’t happen too terribly often, but if I get super triggered and I cannot get out of my head, I’ll use ’may or may nots’. 

But I think the continuum is that you try to do something to interrupt the mental rituals, which for me is the ’may or may nots’. You can also-- people can write down the scripts, they can do a worst-case scenario. But eventually, what you’re trying to get to is you’re trying to be able to hear the OCD, what-ifs in your head and completely ignore it. And I call that my shoulders back, the way of thinking about things. Just put your shoulders back and you move on with your day. You don’t acknowledge it. 

What I’ll do with clients, I’ll say, “If you had the thought of Blue Martian is going to land on my head, I mean, you wouldn’t even do anything with that thought. That thought would just go in and go out and wouldn’t get any of your attention.” That’s the way we want to treat OCD, is just thoughts can be there. I’m not going to say, “Oh, that’s my OCD.” I’m not going to say, “OCD, I’m not talking to you.” I’m not going to acknowledge it at all. I’m just going to treat it like any other weird thought that we have during the day and move on. 

Your question was, how would you help somebody who comes in with mental rituals? Well, first, I want to understand where are they in their OCD recovery? How long have they been doing these mental rituals? What percentage of their compulsions are mental versus physical? What are the kind of things that their OCD is afraid of? Basically, make a list or a hierarchy of everything they’re afraid of. And then we start working on exposure therapy. And when I have them do exposures, the first exposure I do with people, we’ll find something that’s-- I start in the middle of the hierarchy. You don’t have to, but I try. And I will have them face the fear. But then I’ll immediately ask them, what is your OCD saying right now? And they’ll tell me, and I’ll say, “I want you to repeat after me.” I have them do this, and everyone that I see hates this, but I have them do it. Standing up with their shoulders back like Wonder Woman, because this type of power pose helps them. It changes the chemistry of your body and helps you feel more powerful. 

OCD thinks it’s very powerful. So, I want my clients to feel as powerful as they can. So, I have them stand like Wonder Woman and they repeat after me. Somebody could-- let’s just say we are standing near something red on the floor. And I’ll say, “Well, what is your OCD saying right now?” And they’ll say, “Well, that’s blood and it could have AIDS in it, and I’m going to get sick.” I’ll say, “Well, that may or may not be a spot of blood on the floor. I may or may not get sick and I may or may not get AIDS, but I want to do this. I’m going to stay here. OCD, I want to be anxious, so bring it on.” 

And that’s how we do the exposure, is I ask them what’s in their head. I have them repeat it to me until they understand what the process is. And then I’m having them be in the presence of this and just script, script, script away. That’s what I call it scripting, so that they are in the presence of whatever’s bothering them, but they’re not up in their head. And anytime something comes in their head, I teach them to pull it down into the script. Never let something be circulating in your head without saying it out loud and pulling it into the script. 

I will work on this technique with clients as we’re working on exposures, because eventually what we’ll want to do is instead of going all over the place, “That may or may not be blood, I may or may not get AIDS, I may or may not get sick,” I’ll say, “Okay, of all the things you’ve just said, what does your OCD-- what is your OCD scared of the most? Let’s focus on that.” And so, “I may or may not get AIDS. I may or may not get AIDS. I may or may not have HIV. I may or may not get AIDS,” over again until people start to say, “Oh, okay. I guess I don’t have any control over this,” because what we’re trying to do is help the OCD habituate to the uncertainty. Habituate, I know that’d be a confusing word. You don’t have to habituate in order for exposure to work due to the theory of inhibitory learning, but we’re trying to help your brain get used to the uncertainty here.

Kimberley: And break into a different cycle instead of doing the old rumination cycle. 

Shala: Yes. And so then, I’ll teach people to just find their scariest fear. They say that over and over and over again. Then let’s hit the next one. “Well, my family may or may not survive if I die because if I get a fatal disease and I die and my family may or may not be left destitute,” and then over and over. “My family may or may not be left destitute. My family may or may not be left destitute, whatever,” until we’re hitting all the things that could be circulating in your head. 

Now, some people really don’t need to do that scripting because they’re not up in their head that much. But that’s the minority of people. I think most people with OCD are doing something in their head. And a lot of people aren’t aware of what they’re doing because these mental rituals are incredibly subtle at times. And so, as people, as my clients go out and work on these exposures, I’ll have them tell me how it’s going. I have people fill out forms on my website each day as they’re doing exposures so I can see what’s going on. And if they’re not really up in their head and they don’t really need to do the ‘may or may nots’, great. That’s better. In fact, just go do the exposure and go on with your life. If they’re up in their head, then I have them do the ’may or may nots’. And so, that’s how I would start with somebody. 

And so, what I’m trying to do is I’m giving them what I call a bridge tool. Because people who have been mental ritualizing for a long time, I have found it’s virtually impossible to just stop because that’s what your mind is used to doing. And so, what I’m doing is I’m giving them a competing response. And I’m saying here, instead of mental ritualizing, I’d like you to say a bunch of ’may or may nots’ statements while standing up and say them out loud while looking like Wonder Woman. Everybody rolls their eyes like, “Really?” But that’s what we do as a bridge tool. And so, they’ve lifted enough mental weights, so to speak, with this technique that they can hear the OCD and start to disengage and not interact with it at all. Then we move to that technique.

Flooding Techniques for Mental Rumination

Kimberley: Is there a reason why-- and for some of the listeners, they may have learned this before, but is there a reason why you use ’may or may nots’ instead of worst-case scenarios?

Shala: For me, for my personal OCD recovery journey, what I found with worst-case scenario is I got too lost in the content. I remember doing-- I had had a mammogram, it had come back with some abnormal findings. I spent the whole weekend trying to do scripting about what could happen, and I was using worst-case scenario. Well, I end up in the hospital, I end up with breast cancer, I end up dead. And by the end of the weekend, I was completely demoralized. And I’m like, “Well, I don’t bother because I’m going to be dead, because I have breast cancer.” That’s where my mind took it because I’ve had OCD long enough that if I get a really scary and I start and I play around in the content, I’m going to start losing insight and I’m going to start doing depression as a compulsion, which is the blog we did talk about, where you start acting depressed because you’re believing what the OCD says like, “Oh, well, I might as well just give up, I have breast cancer,” and then becoming depressed, and then acting like it’s true. And then that’s reinforcing the whole cycle. 

So, for me, worst-case scenario scripting made things worse. So, when I stayed in the uncertainty realm, the ‘may or may nots’ that helped because I was trying to help my brain understand, “Well, I may or may not have breast cancer. And if I do, I mean, I’ll go to the doctor, I’ll do what I need to do, but there’s nothing I can do about it right now in my head other than what I’m doing.”

Some people like worst-case scenario and it works fine for them. And I think that works too. I mostly use ’may or may nots’ with clients unless they are unable through numbing that they might be doing. If they’re unable to actually feel what they’re saying, because they’re used to turning it over in their head and pulling the anxiety down officially, and so I can’t get a rise out of the OCD because there’s a lot of really little subtle mental compulsions going on, then I’ll insert some worst-case scenario to get the anxiety level up, to help them really feel the fear, and then pull back into ’may or may nots’. But there’s nothing wrong with worst-case scenario. But for me, that was what happened. And I think if you are prone to depression, if you’re prone to losing insight into your OCD when you’ve got a really big one, I think that’s a risk factor for using that particular type of scripting. 

Magical Thinking and Mental Compulsions 

Kimberley: Right. And I found that they may or may not have worked just as well, except the one thing, and I’m actually curious on your opinion on this and I have not had this conversation, is I find that people who have a lot of magical thinking benefit by worst-case scenario, like their jinxing compulsions and so forth, like the fear of saying it means it will happen. So, saying the worst-case is the best exposure. Is that true for you?

Shala: I have not had to use it much on my own magically. I certainly had a lot of magical thinking. Like, if I don’t hit this green light, then somebody’s going to die. But I think the worst-case scenario, I could actually work well in that, because if you use the worst-case scenario, it can make it seem so ridiculous that it helps people let go of it more easily. And I think you can do that with ’may or may nots’ too. I’ll try to encourage people to use the creativity that they have because everybody with OCD has a ton of creativity. And we know that because the OCD shares your brain and it’s certainly the creative stuff

And to one-up the OCD, you use the scripting to be like, “Gosh, I may or may not get some drug-disease and give it to my entire neighborhood. I may or may not kill off an entire section of my county. We may or may not infect the entire state of Georgia. The entire United States may or may not blow up because I got this one disease. So, they may or may not have to eject me off the earth and make me live on Mars because I’m such a bad person.” This ‘may or may not’ is in all this crazy stuff too, because that’s how to win, is to one up the OCD. It thinks that’s scary, let’s go even scarier. But the scary you get, it also gets a little bit ridiculous after a while. And then the whole thing seems to be a little bit ridiculous. So, I think you can still use that worst-case stuff with may or may not.

Kimberley: Right. Okay. So, I mean, I will always sort of-- I know you really well. I’ve always held you so high in my mind in just how resilient and strong you are in doing this. How might you, or how do you help people who feel completely powerless at even addressing this? For you to say it, it sounds very like you’re just doing it and it’s so powerful. But for those who are really struggling with this idea of like, you said, coming out of your head, can you speak to how you address that in session if someone’s really struggling to engage in ’may or may nots’ and so forth?

Shala: Yeah. Well, thank you for the kind words, first off. I think that it’s really common for people with OCD by the time they get to a therapist to feel completely demoralized, especially if they’ve been to multiple therapists before they get to somebody who does ERP. And so, they feel like they’re the victim at the hands of a very cruel abuser that they can’t get away from. And so, they feel beaten down and they don’t know how to get out of their heads. They feel like they’re trapped in this mental prison. They can’t get out. And if somebody is struggling like that, and they’re doing the ’may or may nots’ and the OCD is reacting, which of course, it will, and coming back at them stronger, which I always warn people, this is going to happen. When you start poking at this, the OCD is going to poke back and poke back even harder, because it wants to get you back in line so it can keep you prisoner. 

So, what I’ll often do in those situations, if I see somebody is really feeling like they have been so victimized, that they’re never going to be able to get over this, is the type of script I have them do is more of an empowerment script, which could sound like this: “OCD, I’m not listening to you anymore. I’m not doing what you want. I am strong. I can do this.” And I might add some ’may or may nots’ in there. “And I want to be anxious. Come on, bring it on. You think that’s scary? Give me something else.” 

I know you’re having Reid Wilson on as part of this too. I learned all that “bring it on” type stuff and pushing for the anxiety from him. And I think helping people say that out loud can be really transformative. I’ve seen people just completely break down in tears of sort of, “Oh my gosh, I could do this,” like tears of empowerment from standing up and yelling at their OCD. 

If people like swearing, I also just have them swear at it, like they would really swear at somebody who had been abusing them if they had a chance, because swearing actually can make you feel more powerful too, and I want to use all the tools we can. So, I think scripting comes in a number of forms. It’s all about really taking what’s in your head, turning it into a helpful self-talk and saying it out loud. And the reason out loud is important for any type of scripting is that if you’re saying it in your head, it’s going to get mixed up with all the jumble of mental ruminating that’s going on. And saying it out loud makes it hard for you to ruminate. It’s not impossible, but it’s hard because you’re saying it. Your brain really is only processing one thing at a time. And so, if you’re talking and really paying attention to what you’re saying, it’s much harder to be up in your head spinning this around. 

And so, adding these empowerment scripts in with the ’may or may nots’ helps people both accept the uncertainty and feel like they can do this, feel like they can stand up to the OCD and say, “You’ve beaten me enough. No more. This is my life. I’m not letting you ruin it anymore. I am taking this back. I don’t care how long it takes. I don’t care what I have to do. I’m going to do this.” And that builds people up enough where they can feel like they can start approaching these exposures.

Kimberley: I love that. I think that is such-- I’ve had that same experience of how powerful empowerment can be in switching that behavior. It’s so important. Now, one thing I really want to ask you is, do you switch this method when you’re dealing with other anxiety disorders – health anxiety, social anxiety, panic disorder? What is your approach? Is there a difference or would you say the tools are the same?

Shala: There’s a slight difference between disorders. I think health anxiety, I treat exactly like OCD. Even some of the examples I gave here were really health anxiety statements. With panic disorder-- and again, I learned this from Reid and you can ask him more about this when you interview him. But with pain disorder, it’s all about, I want to feel more shorter breath, more like their elephant standing on my chest. I want my heart to be faster. But I’m doing this while I’m having people do exercises that would actually create those feelings, like breathing through a little bit of cocktail straw, jogging, turning up a space heater, and blowing it on themselves. So, we’re trying to create those symptoms and then talk out loud and say, “Come on, I want more of this. I want to feel more anxious. Give me the worst panic attack you’ve ever had.” So, it’s all about amping up the symptoms. 

With social anxiety, it’s a little bit different because with social anxiety, I would work on the cognitions first. Whereas with OCD, we don’t work on the cognitions at all, other than I want you to have a different cognitive relationship with your disorder and your anxiety. I want you to want the anxiety. I want you to want the OCD to come and bother you because that gives you an opportunity to practice. That’s the cognitive work with OCD. I do not work on the cognitive work on the content. I’m not going to say to somebody, “Well, the chance you’re going to get AIDS from that little spot of blood is very small.” That’s not going to be helpful 

With social anxiety, we’re actually working on those distorted cognitions at the beginning. And so, a lot of the work with social anxiety is going to be going out and testing those new cognitions, which really turns the exposures into what we call behavioral experiments. It’s more of a cognitive method. We’re going out and saying, “Gosh, my new belief, instead of everybody’s judging me, is, well, everybody is probably thinking about themselves and I’m going to go do some things that my social anxiety wouldn’t want me to do and test out that new belief.” I might have them use that new belief, but also if their anxiety gets really high and they’re having a hard time saying, “Well, that person may or may not be judging me. They may or may not be looking at me funny. They may or may not go home and tell people about me.” But really, we’re trying to do something a little bit different with social anxiety.

Kimberley: And what about with generalized anxiety? With the mental, a lot of rumination there, do you have a little shift in how you respond?

Shala: Yeah. So, it’s funny that the talk that Michelle Massi and others gave at IOCDF-- I think it was at IOCDF this year about what’s the difference between OCD and GAD is they’re really aligned there. I mean, I treat GAD very similarly the way I treat OCD in that people are up in their heads trying to do things. They’re also doing other types of safety behaviors, compulsive safety behaviors, but a lot of people GAD are just up in their head. They’re just worried about more “real-life” things. But again, a lot of OCD stuff can be real-life things. I mean, look at COVID. That was real life. And people’s OCD could wrap itself around that. So, I treat GAD and OCD quite similarly. There are some differences, but in terms of scripting, we call it “worry time” in GAD. It’s got a different name, but it’s basically the same thing.

Kimberley: Right. Okay. Thank you for answering that because I know some folks here listening will be not having OCD and will be curious to see how it affects them. So, is that the practice for you or is there anything else you feel like people need to know going in, in terms of like, “Here is my strategy, here is my plan to target mental rituals”? What would you say?

Shala: So, as I mentioned, I think the ’may or may nots’ are bridge tool that are always available to you throughout your entire recovery. My goal with anybody that I’m working with is to help them get to the point where they can just use shoulders back. And the way that I think about this is what I call my “man in the park” metaphor. So, we’ve all probably been in a park where somebody is yelling typically about the end of the world and all that stuff. And even if you were to agree with some of the things that the person might say from a spiritual or religious standpoint, you don’t run home and go, “Oh my gosh, we got to pack all our things up because it’s the end of the world. We have to get with all of our relatives and be together because we’re all going to die.” We don’t do that. We hear what this guy’s saying, and then we go on with our days, again, even if you might agree with some of the content.

Now, why do we do that? We do that because it’s not relevant in our life. We realize that person probably, unfortunately, has some problems. But it doesn’t affect us. We hear it just like when we might hear birds in the background or a car honking, and we just go on with our day. That’s how we want to treat OCD. What we do when we have untreated OCD is we run up to the man in the park and we say, “Oh my gosh, can I have a pamphlet? Let me read the pamphlet. Oh my gosh, you’re right. Tell me more, tell me more.” And we’re interacting with him, trying to get some reassurance that maybe he’s wrong, that maybe he does really mean the end of the world is coming soon. Maybe it’s going to be like in a hundred years. Eventually, we get to the point where we’re handing out pamphlets for him. “Here, everybody, take one of these.”

What we’re doing with ’may or may nots’ is we’re learning how to walk by the man in the park and go, “The world may or may not be ending. The world may or may not be ending. I’m not taking a pamphlet. The world may or may not be ending.” So, we’re trying to not interact with him. We’re trying to take what he’s saying and hold it in our heads without doing something compulsive that’s going to make our anxiety higher. What we’re trying to do is practice that enough till we can get to the point where we can be in the park with the guy and just go on with our day. We hear him speaking, but we’re really-- it’s just not relevant. It’s just not part of our life. So, we just move on. And we’re not trying to shove him away. It’s just like any other noise or sound or activity that you would just-- it doesn’t even register in your consciousness. That’s what we’re trying to do. 

Now I think another way to think about this is if you think-- say you’re in an art gallery. Art galleries are quiet and there are lots of people standing around, and there’s somebody in there that you don’t like or who doesn’t like you or whatever. You’re not going to walk up to that person and tap on their shoulder and say, “Excuse me, I’m going to ignore you.” You’re just going to be like, “I know that person is there. I’m just going to do what I’m doing.” And I think that’s-- I use that to help people understand this transition, because we’re basically going from ’may or may nots’ where we’re saying, “OCD, I’m not letting you do this to me anymore,” so we are being really aggressive with it, to this being able to be in the same space with it, but we’re not talking to it at all because we don’t need to, because we can be in the presence with the intrusive thoughts that the OCD is reacting to, just like the presence of all the other thousands of thoughts we have each day without interacting with them.

Kimberley: That’s so interesting. I’ve never thought of it that way. 

Shala: And so, that’s where I’m trying to get people because that is the strongest, strongest recovery, is if you can go do the things that you want to do, be in the presence of the anxiety and not do compulsions physical or mental, you don’t give anything for OCD to work with. I have a whole chapter in my memoir about this after I heard Reid say at one of the conferences, “We need to act as though what OCD is saying doesn’t matter.” And that was revolutionary to me to hear that. And that’s what we’re trying to do both physically and mentally. Because if you can have an obsession and focus on what you want to focus on, do what you want to do, you’re not giving OCD anything to work with. And typically, it’ll just drain away. But this takes time. I mean, it has taken me years to learn how to do this, but I went untreated for 35 years too. It may not take you years, but it may. And that’s okay. It’s a process. And I think if you have trouble trying to do shoulders back, man in the park, use ’may or may nots’. You can use the combination. But I think we’re trying to get to the point where you can just be with the OCD and hear it flipping out and just go on with your day.

OCD, BDD, and Mental Rituals 

Kimberley: In your book, you talk about the different voices. There is a BDD voice and an OCD voice. Was it harder or easier depending on the voice? Was that a component for you in that-- because the words and the voice sound a little different. I know in your memoir you give them different names and so forth, which if anyone hasn’t read your memoir, they need to go right now and read it. Do you have any thoughts on that in terms of the different voices or the different ways in which the disorders interact?

Shala: That’s a really great question because yes, I think OCD does shift its voice and shift its persona based on how scared it is. So, if it’s a little bit scared, it’s probably going to speak to you. It’s still going to be not a very nice voice. It might be urgent and pleading. But if it’s super scared, I talk about mine being like the triad of hell, how my OCD will personify into different things based on how scared it is. And if it’s super scared and it’s going to get super big and it’s going to get super loud in your head because it’s trying desperately to help you understand you’ve got to save it because it thinks it’s in danger. That’s all its content. Then I think-- and if you have trouble ignoring it because it’s screaming in your head, like the man in the park comes over with his megaphone, puts it right up against your ear and starts talking, that’s hard to ignore. That’s hard to act like that’s not relevant because it hurts. There’s so much noise. 

That’s when you might have to use a may or may not type approach because it’s just so loud, you can’t ignore it, because it’s so scared. And that’s okay. And again, sometimes I’ll have to use that. Not too terribly often just because I’ve spent a long time working on how to use the shoulder’s back, man in the park, but if I have to use it, I use it. And so, I think your thought about how do I interact with the OCD based on how aggressive it’s being also plays into this.

Kimberley: I love all this. I think this is really helpful in terms of being able to be flexible. I know sometimes we want just the one rule that’s going to work in all situations, but I think you’re right. I think that there needs to be different approaches. And would you say it depends on the person? Do you give them some autonomy over finding what works for them, or what would you say? 

Shala: Absolutely. If people are up in their heads and they don’t want to use ’may or may nots’, I’ll try to use some other things. If I really, really think that that’s what we need right now, is we need scripting, I’ll try to sell them on why. But at the end of the day, it’s always my client’s choice and I do it differently based on every client. For some clients, it might be just more empowering statements. For some clients where it’s more panicky focused, it might be more about bringing on your anxiety. Sometimes it might be pulling self-compassion in and just saying the self-compassion statements out loud. So, it really does vary by person. There’s no one-size-fits-all, but I think, I feel that people need to have something to replace the mental ritualizing with at the beginning that they’ve been doing it for a long time, just because otherwise, it’s like, I’m giving them a bicycle, they’ve never ridden a bicycle before and I won’t give them any training wheels. And that’s really, really hard. Some people can do it. I mean, some people can just be like, “Oh, I’m to stop doing that in my head? Okay, well, I’ll stop doing that in my head.” But most people need something to help them bridge that gap to get to the point where they can just be in the presence with it and not be talking to it in their heads.

Kimberley: Amazing. All right. Any final statements from you as we get close to the end?

Shala: I think that it’s important to, as you’re working on this, really think about what you’re doing in your head that might be subtle, that could be making the OCD worse. And I think talking and being willing to talk about this to therapists about putting it all out there, “Hey, I’m saying this to myself in my head, is that helpful or harmful?” Because OCD therapy can be pretty straightforward. I mean, ERP, go out and face your fears, don’t do rituals. It sounds pretty straightforward. But there is a lot of subtlety to this. And the more that you can root out these subtle mental rituals, the better that your recovery is going to be. 

And know too that if you’ve had untreated OCD for a long time, you can uncover mental rituals, little bitty ones, for years after you get out of therapy. And that’s okay. It doesn’t mean you’re not in recovery. It just means that you are getting more and more insightful and educated about what OCD is. And the more that you can pick those little things out, just the better your recovery will be. But we also don’t want to be perfectionistic about that like, “I must eliminate every single mental ritual that I have or I’m not going to be in a good recovery.” That’s approaching your ERP like OCD would do. And we don’t want to do that. But we do want to be mindful about the subtleties and make sure to try to pull out as many of those subtle things that we might be doing in our heads as possible. 

Kimberley: Amazing. Thank you. Tell us-- again, first, let me just say, such helpful information. And your personal experience, I think, is really validating and helpful to hear on those little nuances. Tell us where people can hear about you and the amazing projects you’ve got going on.

Shala: You can go to ShalaNicely.com and I have lots of free blog posts I’ve written on this. So, there are two blog posts, two pretty extensive blog posts on ’may or may nots’. So, if you go on my website and just search may or may not, it’ll bring up two blog posts about that. If you search on shoulders back or man in the park, you’ll find two blog posts on how to do that technique. I also have a blog post I wrote in the last year or so called Shower Scripting, which is how to do ERP, like just some touch-up scripting in the shower, use that time. So, I would say go to my website and you can find all sorts of free resources. I’ve got two books. You can find on Amazon, Everyday Mindfulness for OCD, Jon Hershfield and I co-wrote. And we talk about ‘may or may nots’ and shoulders back and some of the things in there just briefly. And then my memoir, Is Fred in the Refrigerator?: Taming OCD and Reclaiming My Life, is also on Amazon or bookstores, Audible, and that kind of thing. 

Kimberley: I wonder too, if we could-- I’m going to put links to all these in the show note. I remember you having a word with your OCD, a video?

Shala: Oh yes, that’s true.

Kimberley: Can we link that too?

Shala: Yes. And that one I have under my COVID resources, because I’m so glad you brought that up. When the pandemic started, my OCD did not like it, as many people who have contamination OCD can relate to. And it was pretty scary all the time. And it was making me scared all the time. And eventually, I just wrote it a letter and I’m like, “Dude, we’re not doing this anymore.” And I read it out loud and I recorded it out loud so that people could hear how I was talking to it. 

Kimberley: It was so powerful.

Shala: Well, thank you. And it’s fun to do. I think the more that you can personify your OCD, the more you can think of it as an entity that is within you but is not you, and to recognize that your relationship with it will change over time. Sometimes you’re going to be compassionate with it. “Gosh, OCD, I’m so sorry,” You’re scared we’re doing this anyway. Sometimes you’re going to be aggressive with it. Sometimes you just ignore it. And that changes as you go through therapy, it changes through your life. And I think that recognizing that it’s okay to have OCD and to have this little thing, I think of like an orange ball with big feet and sunglasses is how I think about it when it’s behaving – it makes it less of an adversarial relationship over time and more like I have an annoying little sibling that, gosh, it’s just not going to ever not be there, but it’s fine. We can live together and live in this uncertainty and be happy anyway.

Kimberley: I just love it. Thank you so much for being here and sharing your experience and your knowledge. It’s so wonderful.

Shala: Thank you so much for having me.

May 13, 2022
Ep. 284 6-Part Series: Managing Mental Compulsions (with Shala Nicely)

SUMMARY: 

In this weeks podcast, we have my dearest friend Shala Nicely talking about how she manages mental compulsions.  In this episode, Shala shares her lived experience with Obsessive Compulsive Disorder and how she overcomes mental rituals.

In This Episode:

  • How to reduce mental compulsions for OCD and GAD.
  • How to use Flooding Techniques with Mental Compulsions
  • Magical Thinking and Mental Compulsions
  • BDD and Mental Compulsions

Links To Things I Talk About:

Shalanicely.com
Book: Is Fred in the Refridgerator?
Book: Everyday Mindfulness for OCD
ERP School: https://www.cbtschool.com/erp-school-lp

Episode Sponsor:

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

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EPISODE TRANSCRIPTION

This is Your Anxiety Toolkit - Episode 284.

Welcome back, everybody. We are on the third video or the third part of this six-part series on how to manage mental compulsions. Last week’s episode with Jon Hershfield was bomb, like so good. And I will say that we, this week, have Shala Nicely, and she goes for it as well. So, I am so honored to have these amazing experts talking about mental compulsions, talking about what specific tools they use. 

So, I’m not going to take too much time of the intro this time, because I know you just want to get to the content. Again, I just want to put a disclaimer. This should not replace professional mental health care. This series is for educational purposes only. My job at CBT School is to give you as much education as I can, knowing that you may or may not have access to care or treatment in your own home. So, I’m hoping that this fills in a gap that maybe we’ve missed in the past in terms of we have ERP School, that’s an online course teaching you everything about ERP to get you started if you’re doing that on your own. But this is a bigger topic. This is an area that I’d need to make a complete new course. But instead of making a course, I’m bringing these experts to you for free, hopefully giving you the tools that you need. 

If you’re wanting additional information about ERP School, please go to CBTSchool.com. With that being said, let’s go straight over to this episode with Shala Nicely. 

Managing Mental Compulsions (With Shala Nicely) Your anxiety toolkit

Kimberley: Welcome, Shala. I am so happy to have you here.

Shala: I am so happy to be here. Thank you for having me.

Kimberley: Okay. So, I have heard a little bit of your views on this, but I am actually so excited now to get into the juicy details of how you address mental compulsions or mental rituals. First, I want to check in with you, do you call them mental compulsions, rituals, rumination? How do you address them?

Shala: Yeah. All those things. I also sometimes call it mental gymnastics up in your head, it’s all sorts of things you’re doing in your head to try to get some relief from anxiety.

Kimberley: Right. So, if you had a patient or a client who really was struggling with mental compulsions, whether or not they were doing other compulsions as well, how might you address that particular part of their symptomology?

Shala: So, let me answer that by stepping back a little bit and telling you about my own experience with this, because a lot of the way I do it is based on what I learned, trying to manage my own mental rituals. I’ve had OCD probably since I was five or six, untreated until I was 39. Stumbled upon the right treatment when I went to the IOCDF Conference and started doing exposure mostly on my own. I went to Reid Wilson’s two-day group, where I learned how to do it. But the rest of the time, I was implementing on my own. And even though I had quite a few physical compulsions, I would’ve considered myself a primary mental ritualizer, meaning if we look at the majority, my compulsions were up in my head. And the way I think about this is I think that sometimes if you have OCD for long enough, and you’ve got to go out and keep functioning in the world and you can’t do all these rituals so that people could see, because then people will be like, “What’s wrong with you? What are you doing?” you take them inward. And some mental compulsions can take the place of physical compulsions that you’re not able to do for whatever reason because you’re trying to function. And I’d had untreated OCD for so long that most of my rituals were up in my head, not all, but the great majority of them. 

 

Exposure & Response Prevention for Mental Compulsions

So, when I started to do exposure, what I found was I could do exposure therapy, straight up going and facing my fears, like going and being around things that might be triggering all I wanted, but I wasn’t necessarily getting better because I wasn’t addressing the mental rituals. So, basically, I’m doing exposure without response prevention or exposure with partial response prevention, which can make things either worse or just neutralize your efforts. So, what I did was I figured out how to be in the presence of triggers and not be up in my head, trying to do analyzing, justifying, figuring it out, replaying the situation with a different ending, all the sorts of things that I would do over and over in my head. And the way I did this was I took something I learned from Jonathan Grayson and his book, Freedom From OCD. I know you’re having him on for this series too. And he talked about doing all this ERP scripting, where you basically write out the worst-case scenario, what you think your OCD thinks is going to happen and you write it in either a worst-case way or an uncertainty-focused way. And what I did was after reading his book, I took that concept and I just shortened it down, and anything that my OCD was afraid of, I would just wrap may or may not surround it. 

So, for instance, an example that I use in Is Fred in the Refrigerator?, my memoir, Taming OCD and Reclaiming My Life was that I used to-- when I was walking through stores like Target, if I saw one of those little plastic price tags that had fallen on the ground, if I didn’t pick it up and put it out of harm’s way, I was afraid somebody was going to slip and fall and break their neck. And it would be on some security camera that I just walked on past it and didn’t do anything. So, a typical scrupulosity obsession. And so, going shopping was really hard because I’m cleaning up the store as I’m shopping. And so, what I would do is I would either go to Target, walk past the price tag. And then as I’m just passing the price tag, I would say things. And in Target, I obviously couldn’t do this really out loud, mumble it out loud as best, but I may or may not cause somebody to kill themselves by they’re going to slip and fall on that price tag because I didn’t pick it up. I may or may not be an awful, terrible rotten human being. They may or may not catch me and throw me into jail. I may or may not rot in prison. People may or may not find out what a really bad person I really am. This may or may not be OCD, et cetera, et cetera, et cetera. 

And that would allow me to be present with the obsessions, all the what-ifs – those are basically what-ifs turned into ‘may or may nots’ – without compulsing with them, without doing anything that would artificially lower my anxiety. So, it allowed me to be in the presence of those obsessive thoughts while interrupting the pattern of the mental rituals. And that’s really how I use ‘may or may nots’ and how I teach my clients to use ‘may or may nots’ today is using them to really be mindfully present of what the OCD is worried about while not interacting with that content in a way that’s going to make things worse. So, that’s how I developed it for myself. And I think that-- and that is a tool that I would say is an intermediary tool. So, I use that now in my own recovery. I don’t have to use ’may or may nots’. It’s very often at all. If I get super triggered, which doesn’t happen too terribly often, but if I get super triggered and I cannot get out of my head, I’ll use ’may or may nots’. 

But I think the continuum is that you try to do something to interrupt the mental rituals, which for me is the ’may or may nots’. You can also-- people can write down the scripts, they can do a worst-case scenario. But eventually, what you’re trying to get to is you’re trying to be able to hear the OCD, what-ifs in your head and completely ignore it. And I call that my shoulders back, the way of thinking about things. Just put your shoulders back and you move on with your day. You don’t acknowledge it. 

What I’ll do with clients, I’ll say, “If you had the thought of Blue Martian is going to land on my head, I mean, you wouldn’t even do anything with that thought. That thought would just go in and go out and wouldn’t get any of your attention.” That’s the way we want to treat OCD, is just thoughts can be there. I’m not going to say, “Oh, that’s my OCD.” I’m not going to say, “OCD, I’m not talking to you.” I’m not going to acknowledge it at all. I’m just going to treat it like any other weird thought that we have during the day and move on. 

Your question was, how would you help somebody who comes in with mental rituals? Well, first, I want to understand where are they in their OCD recovery? How long have they been doing these mental rituals? What percentage of their compulsions are mental versus physical? What are the kind of things that their OCD is afraid of? Basically, make a list or a hierarchy of everything they’re afraid of. And then we start working on exposure therapy. And when I have them do exposures, the first exposure I do with people, we’ll find something that’s-- I start in the middle of the hierarchy. You don’t have to, but I try. And I will have them face the fear. But then I’ll immediately ask them, what is your OCD saying right now? And they’ll tell me, and I’ll say, “I want you to repeat after me.” I have them do this, and everyone that I see hates this, but I have them do it. Standing up with their shoulders back like Wonder Woman, because this type of power pose helps them. It changes the chemistry of your body and helps you feel more powerful. 

OCD thinks it’s very powerful. So, I want my clients to feel as powerful as they can. So, I have them stand like Wonder Woman and they repeat after me. Somebody could-- let’s just say we are standing near something red on the floor. And I’ll say, “Well, what is your OCD saying right now?” And they’ll say, “Well, that’s blood and it could have AIDS in it, and I’m going to get sick.” I’ll say, “Well, that may or may not be a spot of blood on the floor. I may or may not get sick and I may or may not get AIDS, but I want to do this. I’m going to stay here. OCD, I want to be anxious, so bring it on.” 

And that’s how we do the exposure, is I ask them what’s in their head. I have them repeat it to me until they understand what the process is. And then I’m having them be in the presence of this and just script, script, script away. That’s what I call it scripting, so that they are in the presence of whatever’s bothering them, but they’re not up in their head. And anytime something comes in their head, I teach them to pull it down into the script. Never let something be circulating in your head without saying it out loud and pulling it into the script. 

I will work on this technique with clients as we’re working on exposures, because eventually what we’ll want to do is instead of going all over the place, “That may or may not be blood, I may or may not get AIDS, I may or may not get sick,” I’ll say, “Okay, of all the things you’ve just said, what does your OCD-- what is your OCD scared of the most? Let’s focus on that.” And so, “I may or may not get AIDS. I may or may not get AIDS. I may or may not have HIV. I may or may not get AIDS,” over again until people start to say, “Oh, okay. I guess I don’t have any control over this,” because what we’re trying to do is help the OCD habituate to the uncertainty. Habituate, I know that’d be a confusing word. You don’t have to habituate in order for exposure to work due to the theory of inhibitory learning, but we’re trying to help your brain get used to the uncertainty here.

Kimberley: And break into a different cycle instead of doing the old rumination cycle. 

Shala: Yes. And so then, I’ll teach people to just find their scariest fear. They say that over and over and over again. Then let’s hit the next one. “Well, my family may or may not survive if I die because if I get a fatal disease and I die and my family may or may not be left destitute,” and then over and over. “My family may or may not be left destitute. My family may or may not be left destitute, whatever,” until we’re hitting all the things that could be circulating in your head. 

Now, some people really don’t need to do that scripting because they’re not up in their head that much. But that’s the minority of people. I think most people with OCD are doing something in their head. And a lot of people aren’t aware of what they’re doing because these mental rituals are incredibly subtle at times. And so, as people, as my clients go out and work on these exposures, I’ll have them tell me how it’s going. I have people fill out forms on my website each day as they’re doing exposures so I can see what’s going on. And if they’re not really up in their head and they don’t really need to do the ‘may or may nots’, great. That’s better. In fact, just go do the exposure and go on with your life. If they’re up in their head, then I have them do the ’may or may nots’. And so, that’s how I would start with somebody. 

And so, what I’m trying to do is I’m giving them what I call a bridge tool. Because people who have been mental ritualizing for a long time, I have found it’s virtually impossible to just stop because that’s what your mind is used to doing. And so, what I’m doing is I’m giving them a competing response. And I’m saying here, instead of mental ritualizing, I’d like you to say a bunch of ’may or may nots’ statements while standing up and say them out loud while looking like Wonder Woman. Everybody rolls their eyes like, “Really?” But that’s what we do as a bridge tool. And so, they’ve lifted enough mental weights, so to speak, with this technique that they can hear the OCD and start to disengage and not interact with it at all. Then we move to that technique.

Flooding Techniques for Mental Rumination

Kimberley: Is there a reason why-- and for some of the listeners, they may have learned this before, but is there a reason why you use ’may or may nots’ instead of worst-case scenarios?

Shala: For me, for my personal OCD recovery journey, what I found with worst-case scenario is I got too lost in the content. I remember doing-- I had had a mammogram, it had come back with some abnormal findings. I spent the whole weekend trying to do scripting about what could happen, and I was using worst-case scenario. Well, I end up in the hospital, I end up with breast cancer, I end up dead. And by the end of the weekend, I was completely demoralized. And I’m like, “Well, I don’t bother because I’m going to be dead, because I have breast cancer.” That’s where my mind took it because I’ve had OCD long enough that if I get a really scary and I start and I play around in the content, I’m going to start losing insight and I’m going to start doing depression as a compulsion, which is the blog we did talk about, where you start acting depressed because you’re believing what the OCD says like, “Oh, well, I might as well just give up, I have breast cancer,” and then becoming depressed, and then acting like it’s true. And then that’s reinforcing the whole cycle. 

So, for me, worst-case scenario scripting made things worse. So, when I stayed in the uncertainty realm, the ‘may or may nots’ that helped because I was trying to help my brain understand, “Well, I may or may not have breast cancer. And if I do, I mean, I’ll go to the doctor, I’ll do what I need to do, but there’s nothing I can do about it right now in my head other than what I’m doing.”

Some people like worst-case scenario and it works fine for them. And I think that works too. I mostly use ’may or may nots’ with clients unless they are unable through numbing that they might be doing. If they’re unable to actually feel what they’re saying, because they’re used to turning it over in their head and pulling the anxiety down officially, and so I can’t get a rise out of the OCD because there’s a lot of really little subtle mental compulsions going on, then I’ll insert some worst-case scenario to get the anxiety level up, to help them really feel the fear, and then pull back into ’may or may nots’. But there’s nothing wrong with worst-case scenario. But for me, that was what happened. And I think if you are prone to depression, if you’re prone to losing insight into your OCD when you’ve got a really big one, I think that’s a risk factor for using that particular type of scripting. 

Magical Thinking and Mental Compulsions 

Kimberley: Right. And I found that they may or may not have worked just as well, except the one thing, and I’m actually curious on your opinion on this and I have not had this conversation, is I find that people who have a lot of magical thinking benefit by worst-case scenario, like their jinxing compulsions and so forth, like the fear of saying it means it will happen. So, saying the worst-case is the best exposure. Is that true for you?

Shala: I have not had to use it much on my own magically. I certainly had a lot of magical thinking. Like, if I don’t hit this green light, then somebody’s going to die. But I think the worst-case scenario, I could actually work well in that, because if you use the worst-case scenario, it can make it seem so ridiculous that it helps people let go of it more easily. And I think you can do that with ’may or may nots’ too. I’ll try to encourage people to use the creativity that they have because everybody with OCD has a ton of creativity. And we know that because the OCD shares your brain and it’s certainly the creative stuff

And to one-up the OCD, you use the scripting to be like, “Gosh, I may or may not get some drug-disease and give it to my entire neighborhood. I may or may not kill off an entire section of my county. We may or may not infect the entire state of Georgia. The entire United States may or may not blow up because I got this one disease. So, they may or may not have to eject me off the earth and make me live on Mars because I’m such a bad person.” This ‘may or may not’ is in all this crazy stuff too, because that’s how to win, is to one up the OCD. It thinks that’s scary, let’s go even scarier. But the scary you get, it also gets a little bit ridiculous after a while. And then the whole thing seems to be a little bit ridiculous. So, I think you can still use that worst-case stuff with may or may not.

Kimberley: Right. Okay. So, I mean, I will always sort of-- I know you really well. I’ve always held you so high in my mind in just how resilient and strong you are in doing this. How might you, or how do you help people who feel completely powerless at even addressing this? For you to say it, it sounds very like you’re just doing it and it’s so powerful. But for those who are really struggling with this idea of like, you said, coming out of your head, can you speak to how you address that in session if someone’s really struggling to engage in ’may or may nots’ and so forth?

Shala: Yeah. Well, thank you for the kind words, first off. I think that it’s really common for people with OCD by the time they get to a therapist to feel completely demoralized, especially if they’ve been to multiple therapists before they get to somebody who does ERP. And so, they feel like they’re the victim at the hands of a very cruel abuser that they can’t get away from. And so, they feel beaten down and they don’t know how to get out of their heads. They feel like they’re trapped in this mental prison. They can’t get out. And if somebody is struggling like that, and they’re doing the ’may or may nots’ and the OCD is reacting, which of course, it will, and coming back at them stronger, which I always warn people, this is going to happen. When you start poking at this, the OCD is going to poke back and poke back even harder, because it wants to get you back in line so it can keep you prisoner. 

So, what I’ll often do in those situations, if I see somebody is really feeling like they have been so victimized, that they’re never going to be able to get over this, is the type of script I have them do is more of an empowerment script, which could sound like this: “OCD, I’m not listening to you anymore. I’m not doing what you want. I am strong. I can do this.” And I might add some ’may or may nots’ in there. “And I want to be anxious. Come on, bring it on. You think that’s scary? Give me something else.” 

I know you’re having Reid Wilson on as part of this too. I learned all that “bring it on” type stuff and pushing for the anxiety from him. And I think helping people say that out loud can be really transformative. I’ve seen people just completely break down in tears of sort of, “Oh my gosh, I could do this,” like tears of empowerment from standing up and yelling at their OCD. 

If people like swearing, I also just have them swear at it, like they would really swear at somebody who had been abusing them if they had a chance, because swearing actually can make you feel more powerful too, and I want to use all the tools we can. So, I think scripting comes in a number of forms. It’s all about really taking what’s in your head, turning it into a helpful self-talk and saying it out loud. And the reason out loud is important for any type of scripting is that if you’re saying it in your head, it’s going to get mixed up with all the jumble of mental ruminating that’s going on. And saying it out loud makes it hard for you to ruminate. It’s not impossible, but it’s hard because you’re saying it. Your brain really is only processing one thing at a time. And so, if you’re talking and really paying attention to what you’re saying, it’s much harder to be up in your head spinning this around. 

And so, adding these empowerment scripts in with the ’may or may nots’ helps people both accept the uncertainty and feel like they can do this, feel like they can stand up to the OCD and say, “You’ve beaten me enough. No more. This is my life. I’m not letting you ruin it anymore. I am taking this back. I don’t care how long it takes. I don’t care what I have to do. I’m going to do this.” And that builds people up enough where they can feel like they can start approaching these exposures.

Kimberley: I love that. I think that is such-- I’ve had that same experience of how powerful empowerment can be in switching that behavior. It’s so important. Now, one thing I really want to ask you is, do you switch this method when you’re dealing with other anxiety disorders – health anxiety, social anxiety, panic disorder? What is your approach? Is there a difference or would you say the tools are the same?

Shala: There’s a slight difference between disorders. I think health anxiety, I treat exactly like OCD. Even some of the examples I gave here were really health anxiety statements. With panic disorder-- and again, I learned this from Reid and you can ask him more about this when you interview him. But with pain disorder, it’s all about, I want to feel more shorter breath, more like their elephant standing on my chest. I want my heart to be faster. But I’m doing this while I’m having people do exercises that would actually create those feelings, like breathing through a little bit of cocktail straw, jogging, turning up a space heater, and blowing it on themselves. So, we’re trying to create those symptoms and then talk out loud and say, “Come on, I want more of this. I want to feel more anxious. Give me the worst panic attack you’ve ever had.” So, it’s all about amping up the symptoms. 

With social anxiety, it’s a little bit different because with social anxiety, I would work on the cognitions first. Whereas with OCD, we don’t work on the cognitions at all, other than I want you to have a different cognitive relationship with your disorder and your anxiety. I want you to want the anxiety. I want you to want the OCD to come and bother you because that gives you an opportunity to practice. That’s the cognitive work with OCD. I do not work on the cognitive work on the content. I’m not going to say to somebody, “Well, the chance you’re going to get AIDS from that little spot of blood is very small.” That’s not going to be helpful 

With social anxiety, we’re actually working on those distorted cognitions at the beginning. And so, a lot of the work with social anxiety is going to be going out and testing those new cognitions, which really turns the exposures into what we call behavioral experiments. It’s more of a cognitive method. We’re going out and saying, “Gosh, my new belief, instead of everybody’s judging me, is, well, everybody is probably thinking about themselves and I’m going to go do some things that my social anxiety wouldn’t want me to do and test out that new belief.” I might have them use that new belief, but also if their anxiety gets really high and they’re having a hard time saying, “Well, that person may or may not be judging me. They may or may not be looking at me funny. They may or may not go home and tell people about me.” But really, we’re trying to do something a little bit different with social anxiety.

Kimberley: And what about with generalized anxiety? With the mental, a lot of rumination there, do you have a little shift in how you respond?

Shala: Yeah. So, it’s funny that the talk that Michelle Massi and others gave at IOCDF-- I think it was at IOCDF this year about what’s the difference between OCD and GAD is they’re really aligned there. I mean, I treat GAD very similarly the way I treat OCD in that people are up in their heads trying to do things. They’re also doing other types of safety behaviors, compulsive safety behaviors, but a lot of people GAD are just up in their head. They’re just worried about more “real-life” things. But again, a lot of OCD stuff can be real-life things. I mean, look at COVID. That was real life. And people’s OCD could wrap itself around that. So, I treat GAD and OCD quite similarly. There are some differences, but in terms of scripting, we call it “worry time” in GAD. It’s got a different name, but it’s basically the same thing.

Kimberley: Right. Okay. Thank you for answering that because I know some folks here listening will be not having OCD and will be curious to see how it affects them. So, is that the practice for you or is there anything else you feel like people need to know going in, in terms of like, “Here is my strategy, here is my plan to target mental rituals”? What would you say?

Shala: So, as I mentioned, I think the ’may or may nots’ are bridge tool that are always available to you throughout your entire recovery. My goal with anybody that I’m working with is to help them get to the point where they can just use shoulders back. And the way that I think about this is what I call my “man in the park” metaphor. So, we’ve all probably been in a park where somebody is yelling typically about the end of the world and all that stuff. And even if you were to agree with some of the things that the person might say from a spiritual or religious standpoint, you don’t run home and go, “Oh my gosh, we got to pack all our things up because it’s the end of the world. We have to get with all of our relatives and be together because we’re all going to die.” We don’t do that. We hear what this guy’s saying, and then we go on with our days, again, even if you might agree with some of the content.

Now, why do we do that? We do that because it’s not relevant in our life. We realize that person probably, unfortunately, has some problems. But it doesn’t affect us. We hear it just like when we might hear birds in the background or a car honking, and we just go on with our day. That’s how we want to treat OCD. What we do when we have untreated OCD is we run up to the man in the park and we say, “Oh my gosh, can I have a pamphlet? Let me read the pamphlet. Oh my gosh, you’re right. Tell me more, tell me more.” And we’re interacting with him, trying to get some reassurance that maybe he’s wrong, that maybe he does really mean the end of the world is coming soon. Maybe it’s going to be like in a hundred years. Eventually, we get to the point where we’re handing out pamphlets for him. “Here, everybody, take one of these.”

What we’re doing with ’may or may nots’ is we’re learning how to walk by the man in the park and go, “The world may or may not be ending. The world may or may not be ending. I’m not taking a pamphlet. The world may or may not be ending.” So, we’re trying to not interact with him. We’re trying to take what he’s saying and hold it in our heads without doing something compulsive that’s going to make our anxiety higher. What we’re trying to do is practice that enough till we can get to the point where we can be in the park with the guy and just go on with our day. We hear him speaking, but we’re really-- it’s just not relevant. It’s just not part of our life. So, we just move on. And we’re not trying to shove him away. It’s just like any other noise or sound or activity that you would just-- it doesn’t even register in your consciousness. That’s what we’re trying to do. 

Now I think another way to think about this is if you think-- say you’re in an art gallery. Art galleries are quiet and there are lots of people standing around, and there’s somebody in there that you don’t like or who doesn’t like you or whatever. You’re not going to walk up to that person and tap on their shoulder and say, “Excuse me, I’m going to ignore you.” You’re just going to be like, “I know that person is there. I’m just going to do what I’m doing.” And I think that’s-- I use that to help people understand this transition, because we’re basically going from ’may or may nots’ where we’re saying, “OCD, I’m not letting you do this to me anymore,” so we are being really aggressive with it, to this being able to be in the same space with it, but we’re not talking to it at all because we don’t need to, because we can be in the presence with the intrusive thoughts that the OCD is reacting to, just like the presence of all the other thousands of thoughts we have each day without interacting with them.

Kimberley: That’s so interesting. I’ve never thought of it that way. 

Shala: And so, that’s where I’m trying to get people because that is the strongest, strongest recovery, is if you can go do the things that you want to do, be in the presence of the anxiety and not do compulsions physical or mental, you don’t give anything for OCD to work with. I have a whole chapter in my memoir about this after I heard Reid say at one of the conferences, “We need to act as though what OCD is saying doesn’t matter.” And that was revolutionary to me to hear that. And that’s what we’re trying to do both physically and mentally. Because if you can have an obsession and focus on what you want to focus on, do what you want to do, you’re not giving OCD anything to work with. And typically, it’ll just drain away. But this takes time. I mean, it has taken me years to learn how to do this, but I went untreated for 35 years too. It may not take you years, but it may. And that’s okay. It’s a process. And I think if you have trouble trying to do shoulders back, man in the park, use ’may or may nots’. You can use the combination. But I think we’re trying to get to the point where you can just be with the OCD and hear it flipping out and just go on with your day.

OCD, BDD, and Mental Rituals 

Kimberley: In your book, you talk about the different voices. There is a BDD voice and an OCD voice. Was it harder or easier depending on the voice? Was that a component for you in that-- because the words and the voice sound a little different. I know in your memoir you give them different names and so forth, which if anyone hasn’t read your memoir, they need to go right now and read it. Do you have any thoughts on that in terms of the different voices or the different ways in which the disorders interact?

Shala: That’s a really great question because yes, I think OCD does shift its voice and shift its persona based on how scared it is. So, if it’s a little bit scared, it’s probably going to speak to you. It’s still going to be not a very nice voice. It might be urgent and pleading. But if it’s super scared, I talk about mine being like the triad of hell, how my OCD will personify into different things based on how scared it is. And if it’s super scared and it’s going to get super big and it’s going to get super loud in your head because it’s trying desperately to help you understand you’ve got to save it because it thinks it’s in danger. That’s all its content. Then I think-- and if you have trouble ignoring it because it’s screaming in your head, like the man in the park comes over with his megaphone, puts it right up against your ear and starts talking, that’s hard to ignore. That’s hard to act like that’s not relevant because it hurts. There’s so much noise. 

That’s when you might have to use a may or may not type approach because it’s just so loud, you can’t ignore it, because it’s so scared. And that’s okay. And again, sometimes I’ll have to use that. Not too terribly often just because I’ve spent a long time working on how to use the shoulder’s back, man in the park, but if I have to use it, I use it. And so, I think your thought about how do I interact with the OCD based on how aggressive it’s being also plays into this.

Kimberley: I love all this. I think this is really helpful in terms of being able to be flexible. I know sometimes we want just the one rule that’s going to work in all situations, but I think you’re right. I think that there needs to be different approaches. And would you say it depends on the person? Do you give them some autonomy over finding what works for them, or what would you say? 

Shala: Absolutely. If people are up in their heads and they don’t want to use ’may or may nots’, I’ll try to use some other things. If I really, really think that that’s what we need right now, is we need scripting, I’ll try to sell them on why. But at the end of the day, it’s always my client’s choice and I do it differently based on every client. For some clients, it might be just more empowering statements. For some clients where it’s more panicky focused, it might be more about bringing on your anxiety. Sometimes it might be pulling self-compassion in and just saying the self-compassion statements out loud. So, it really does vary by person. There’s no one-size-fits-all, but I think, I feel that people need to have something to replace the mental ritualizing with at the beginning that they’ve been doing it for a long time, just because otherwise, it’s like, I’m giving them a bicycle, they’ve never ridden a bicycle before and I won’t give them any training wheels. And that’s really, really hard. Some people can do it. I mean, some people can just be like, “Oh, I’m to stop doing that in my head? Okay, well, I’ll stop doing that in my head.” But most people need something to help them bridge that gap to get to the point where they can just be in the presence with it and not be talking to it in their heads.

Kimberley: Amazing. All right. Any final statements from you as we get close to the end?

Shala: I think that it’s important to, as you’re working on this, really think about what you’re doing in your head that might be subtle, that could be making the OCD worse. And I think talking and being willing to talk about this to therapists about putting it all out there, “Hey, I’m saying this to myself in my head, is that helpful or harmful?” Because OCD therapy can be pretty straightforward. I mean, ERP, go out and face your fears, don’t do rituals. It sounds pretty straightforward. But there is a lot of subtlety to this. And the more that you can root out these subtle mental rituals, the better that your recovery is going to be. 

And know too that if you’ve had untreated OCD for a long time, you can uncover mental rituals, little bitty ones, for years after you get out of therapy. And that’s okay. It doesn’t mean you’re not in recovery. It just means that you are getting more and more insightful and educated about what OCD is. And the more that you can pick those little things out, just the better your recovery will be. But we also don’t want to be perfectionistic about that like, “I must eliminate every single mental ritual that I have or I’m not going to be in a good recovery.” That’s approaching your ERP like OCD would do. And we don’t want to do that. But we do want to be mindful about the subtleties and make sure to try to pull out as many of those subtle things that we might be doing in our heads as possible. 

Kimberley: Amazing. Thank you. Tell us-- again, first, let me just say, such helpful information. And your personal experience, I think, is really validating and helpful to hear on those little nuances. Tell us where people can hear about you and the amazing projects you’ve got going on.

Shala: You can go to ShalaNicely.com and I have lots of free blog posts I’ve written on this. So, there are two blog posts, two pretty extensive blog posts on ’may or may nots’. So, if you go on my website and just search may or may not, it’ll bring up two blog posts about that. If you search on shoulders back or man in the park, you’ll find two blog posts on how to do that technique. I also have a blog post I wrote in the last year or so called Shower Scripting, which is how to do ERP, like just some touch-up scripting in the shower, use that time. So, I would say go to my website and you can find all sorts of free resources. I’ve got two books. You can find on Amazon, Everyday Mindfulness for OCD, Jon Hershfield and I co-wrote. And we talk about ‘may or may nots’ and shoulders back and some of the things in there just briefly. And then my memoir, Is Fred in the Refrigerator?: Taming OCD and Reclaiming My Life, is also on Amazon or bookstores, Audible, and that kind of thing. 

Kimberley: I wonder too, if we could-- I’m going to put links to all these in the show note. I remember you having a word with your OCD, a video?

Shala: Oh yes, that’s true.

Kimberley: Can we link that too?

Shala: Yes. And that one I have under my COVID resources, because I’m so glad you brought that up. When the pandemic started, my OCD did not like it, as many people who have contamination OCD can relate to. And it was pretty scary all the time. And it was making me scared all the time. And eventually, I just wrote it a letter and I’m like, “Dude, we’re not doing this anymore.” And I read it out loud and I recorded it out loud so that people could hear how I was talking to it. 

Kimberley: It was so powerful.

Shala: Well, thank you. And it’s fun to do. I think the more that you can personify your OCD, the more you can think of it as an entity that is within you but is not you, and to recognize that your relationship with it will change over time. Sometimes you’re going to be compassionate with it. “Gosh, OCD, I’m so sorry,” You’re scared we’re doing this anyway. Sometimes you’re going to be aggressive with it. Sometimes you just ignore it. And that changes as you go through therapy, it changes through your life. And I think that recognizing that it’s okay to have OCD and to have this little thing, I think of like an orange ball with big feet and sunglasses is how I think about it when it’s behaving – it makes it less of an adversarial relationship over time and more like I have an annoying little sibling that, gosh, it’s just not going to ever not be there, but it’s fine. We can live together and live in this uncertainty and be happy anyway.

Kimberley: I just love it. Thank you so much for being here and sharing your experience and your knowledge. It’s so wonderful.

Shala: Thank you so much for having me.

May 13, 2022
Ep. 283 6-Part Series: Managing Mental Compulsions (with Jon Hershfield)
40:32

SUMMARY:

Covered in This Episode:

  • What is a Mental Compulsion? 
  • What is the difference between Mental Rumination and Mental Compulsions? 
  • How to use Mindfulness for Mental Compulsions
  • How to “Label and Abandon” intrusive thoughts and mental compulsions 
  • How to use Awareness logs to help reduce mental rituals and mental rumination 

Links To Things I Talk About:

Links to Jon’s Books https://www.amazon.com/
Work with Jon https://www.sheppardpratt.org/care-finder/ocd-anxiety-center/

Episode Sponsor:

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

To learn about our Online Course for OCD, visit https://www.cbtschool.com/erp-school-lp.

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Managing Mental Compulsions (With Jon Hershfield) Your anxiety toolkit

EPISODE TRANSCRIPTION

I want you to go back and listen to that. That is where I walk you through Mental Compulsions 101. What is a mental compulsion, the types of mental compulsions, things to be looking out for. The reason I stress that you start there is there may be things you’re doing that are mental compulsions and you didn’t realize. So, you want to know those things before you go in and listen to the skills that you’re about to receive. Oh my goodness. This is just so, so exciting. I’m mind-blown with how exciting this is all for me.

First of all, let’s introduce the guest for today. Today, we have the amazing Jon Hershfield. Jon has been on the episode before, even talking about mental compulsions. However, I wanted him to status off. He was so brave. He jumped in, and I wanted him to give his ideas around what is a mental compulsion, how he uses mental compulsion treatment with his clients, what skills he uses. Little thing to know here, he taught me something I myself didn’t know and have now since implemented with our patients over at my clinic of people who struggle with mental compulsions. I’ve also uploaded that and added a little bit of that concept into ERP School, which is our course for OCD, called ERP School. You can get it at CBTSchool.com. 

Jon is amazing. So, you’re going to really feel solid moving into this. He gives some solid advice. Of course, he’s always so lovely and wise. And so, I am just so excited to share this with you. Let’s just get to the show because I know you’re here to learn. This is episode two of the series. Next week we will be talking with Shala Nicely and she will be dropping major truth bombs and major skills as well, as will all of the people on the series. So, I am so, so excited. 

One thing to know as you move into it is there will be some things that really work for you and some that won’t. So, I’m going to say this in every episode intro. So, all of these skills are top-notch science-based skills. Each person is going to give their own specific nuanced way of managing it. So, I want you to go in knowing that you can take what you need. Some things will really be like, yes, that’s exactly what I needed to hear. Some may not. So, I want you to go in with an open mind knowing that the whole purpose of this six-part series is to give you many different approaches so that you can try on what works for you. That’s my main agenda here, is that you can feel like you’ve gotten all the ideas and then you can start to put together a plan for yourself. Let’s go over to the show. I’m so happy you’re here.

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

Jon: Hi, Kimberley. Thanks for having me back.

Difference Between Mental Compulsions and Mental Rumination 

Kimberley: Okay. So, you’re first in line and I purposely had you first in line. I know we’ve had episodes similar to this in the past, but I just wanted to really get your view on how you’re dealing with mental compulsions. First, I want to check in, do you call them “mental compulsions” or do you call it “mental rumination”? Do you want to clarify your own idea?

Jon: Yeah. I say mental compulsions or mental rituals. I use the terms pretty interchangeably. It comes up at the first, usually in the assessment, if not then in the first post-assessment session, when I’m explaining how OCD works and I get to the part we say, and then there’s this thing called compulsions. And what I do is I describe compulsions as anything that you do physically or mentally to reduce distress, and this is the important part, specifically by trying to increase certainty about the content of the obsession. 

Why that’s important is I think we need to get rid of this myth that sometimes shows up in the OCD community that when you do exposures or when you’re triggered, you’re just supposed to freak out and deal with it, and hopefully, it’ll go away on its own. Actually, there are many things you can do to reduce distress that aren’t compulsive, because what makes it compulsive is that it’s acting on the content of the obsession. I mean, there might be some rare exceptions where your specific obsession has to do with an unwillingness to be anxious or something like that. But for the most part, meditation, breathing exercises, grounding exercises, DBT, certain forms of distraction, exercise – these can all reduce your physical experience of distress without saying anything in particular about whether or not the thought that triggered you is true or going to come.

So, once I’ve described that, then hopefully, it opens people up to realize, well, it could really be anything and most of those things are going to be mental. So then, we go through, “Well, what are the different mental ways?” We know the physical ways through washing hands and checking locks and things like that. But what are all the things you’re doing in your mind to convince yourself out of the distress, as opposed to actually working your way through the distress using a variety of distress tolerance skills, including acceptance?

Kimberley: Right. Do you do the same for people with generalized anxiety or social anxiety or other anxiety disorders? Would you conceptualize it the same way?

Mental Compulsions for General Anxiety Disorder vs OCD 

Jon: Yeah. I think for the most part, I mean, I do meet people. Some people who I think are better understood as having generalized anxiety disorder than OCD, and identifying with that concept actually helps them approach this problem that they have of dealing with uncertainty and dealing with worry and dealing with anxiety on close to home, regular everyday issues like finance and work and health and relationships and things like that. And there’s a subsection of that people who, if you treat it like OCD, it’s really helpful. And there’s a subsection if you treat it like OCD, they think, “Oh no, I have some other psychiatric problem I have to worry about right now.”

I’m a fan of treating the individual that the diagnostic terms are there to help us. Fundamentally, the treatment will be the same. What are you doing that’s sending the signal to your brain, that these ideas are threats as opposed to ideas, and how can we change that signal?

Exposure & Response Prevention for Mental Compulsions 

Kimberley: Right. I thank you for clarifying on that. So, after you’ve given that degree of psychoeducation, what do you personally do next? Do you want to share? Do you go more into an exposure option? Do you do more response prevention? Tell me a little bit about it, walk me through how you would do this with a client.

Jon: The first thing I would usually do is ask them to educate me on what it’s really like to be them. And so, that involves some thought tracking. So, we’ll use a trigger and response log. So, I keep it very simple. What’s setting you off and what are you doing? And I’ll tell them in the beginning, don’t try too hard to get better because I want to know what your life is really like, and I’ll start to see the patterns. It seems every time you’re triggered by this, you seem to do that. And that’s where they’ll start to reveal to me things like, “Well, I just thought about it for an hour and then it went away.” And that’s how I know that they’re engaging in mental review and rumination, other things like that. Or I was triggered by the thought that I could be sick and I repeated the word “healthy” 10 times. Okay. So, they’re doing thought neutralization.

Sometimes we’ll expand on that. One of the clinicians in my practice took our thought records and repurposed them as a mental behavior log. So, it’s what set you off. What did you do? What was the mental behavior that was happening at that time? And in some cases, what would’ve been more helpful? Again, I rely more on my patients to tell me what’s going on than on me to tell them “Here’s what’s going on,” so you get the best information.

Logging Mental Rituals 

Kimberley: Right. I love that. I love the idea of having a log. You’re really checking in for what’s going on before dropping everything down. Does that increase their distress? How do they experience that?

Jon: I think a lot of people find it very helpful because first of all, it’s an act of mindfulness to write this stuff down because it’s requiring you to put it in front of you and see it, which is different than having it hit you from inside your head. And so, that’s helpful. They’re seeing it as a thought process. And I think it also helps people come to terms with a certain reality about rumination that it’s not a hundred percent compulsion in the sense that there’s an element of rumination that’s habitual. Your mind, like a puppy, is conditioned to respond automatically to certain things that it’s been reinforced to do. And so, sometimes people just ruminate because they’re alone or sitting in a particular chair. It’s the same reason why people sometimes struggle with hair-pulling disorder, trichotillomania or skin picking. It’s these environmental cues. And then the brain says, “Oh, we should do this now because this is what we do in this situation.” People give themselves a really hard time for ruminating because they’ve been told to stop, but they can’t stop because they find themselves doing it. 

So, what I try to help people understand is like, “Look, you can only control what you can control. And the more that you are aware of, the more you can control. So, this is where you can bring mindfulness into it.” So, maybe for this person, there’s such a ruminator. They’re constantly analyzing, figuring things out. It’s part of their identity. They’re very philosophical. They’re not thinking of it as a compulsion, and many times they’re not thinking of it at all. It’s just happening. And then we increased their awareness, like, “Oh, okay. I got triggered. I left the building for a while. And then suddenly, I realized I was way down the rabbit hole, convinced myself that’s something terrible. So, in that moment I realized I’m supposed to stop, but so much damage has been done because I just spent a really long time analyzing and compulsing and trying to figure it out.” 

So, strategies that increase our awareness of what the mind is doing are extraordinarily helpful because imagine catching it five seconds into the process and being able to say, “Oh, I’m ruminating. Okay, I don’t need to do that right now. I’m going to return my attention to what I was doing before I got distracted.”

Kimberley: Right. I love the idea of this, the log for awareness, because a lot of people say, “Oh, maybe for half an hour a day.” Once they’ve logged it, they’re like, “Wow, it’s four hours a day.” I think it’s helpful to actually recognize this, like how impactful it is on their life. So, I love that you’re doing that piece. You can only control what you can control. What do you do with the stuff you can’t control?

Jon: Oh, you apply heavy doses of self-criticism until you hate yourself enough to never do it again. That’s the other mental ritual that usually happens and people realize, “Oh, I’ve been ruminating,” and they’re angry at themselves. “I should know better.” So, they’re angry at themselves for something they didn’t know they were doing, which is unfair. So, I use the term, I say, “label and abandon.” That’s what you do with all mental rituals. The moment you see it, you give it a name and you drop it. You just drop it on the floor where you were, you don’t finish it up real quick. You don’t analyze too much about it and then drop it. You’re just like, “Oh, I’m holding this thing I must not hold,” and you drop it. Label and abandon.

What people tend to do is criticize then label, then criticize some more and then abandon. And the real problem with that is that the self-criticism is in and of itself another mental ritual. It’s a strategy for reducing distress that’s focused on increasing certainty about the content of the obsession. The obsession, in this case, is “I’m never going to get better.” Now I know I’m going to get better because I’ve told myself that I’m being fooled and that I’ll never do that again. It’s not true. But then you wash your hands. They aren’t really clean either. So, none of our compulsions really work.

Self-Compassion for Mental Compulsions 

Kimberley: Doesn’t have to make sense. 

Jon: Yeah. So, I think bringing self-compassion in the moment to be able to recognize it and recognize the urge to self-criticize and really just say like, “Oh, I’m not going to do that. I caught myself ruminating. Well done.” Same thing we do when we meditate. Some people think that meditation has something to do with relaxation or something to do with controlling your mind. It’s actually just a noticing exercise. Your mind wanders, you notice it. “Oh, look at that, I’m thinking.” Back to the breath. That’s a good thing that you noticed that you wandered. Not, “Oh, I wandered, I can’t focus. I’m bad at meditating.” So, it’s really just changing the frame for how people are relating to what’s going on inside. 

One, eliminating self-criticism just makes life a lot easier. Two, eliminating the self-criticism and including that willingness to just label the thought pattern or the thought process and drop it right where it is. You can start to catch that earlier and earlier and earlier. So, you’re reducing compulsions. And you’ll see that the activity, the neutralizing, the figuring it out, the using your mental strength against yourself instead of in support of yourself, you could see how that’s sending the signal to the brain. “Wait, this is very important. I need to keep pushing it to the forefront.” There’s something to figure out here. This isn’t a cold case in a box, on a shelf somewhere. This is an ongoing investigation and we have to figure it out. How do we know? Because they’re still trying to figure it out.

Kimberley: Right. How much do you think insight has to play here or how much of a role does it play?

Jon: Insight plays a role in all forms of OCD. I mean, it plays a role in everything – insight into our relationships, insight into our career aspirations. I think one of the things I’ve noticed, and this is just anecdotal, is that the higher the distress and the poorer the distress regulation skills, often the lower the insight. Not necessarily the other way around. Some people have low insight and aren’t particularly distressed by what’s going on, but if the anxiety and the distress and the discomfort and disgust are so high that the brain goes into a brownout, I noticed that people switch from trying to get me to reassure them that their fears are untrue to trying to convince me that their fears are true. And to me, that represents an insight drop and I want to help them boost up their insight. And again, I think becoming more aware of your mental activity that is voluntary – I’m choosing to put my mind on this, I’m choosing to figure it out, it didn’t just happen. But in this moment, I’m actually trying to complete the problem, the puzzle – becoming more aware that that’s what you’re doing, that’s how you develop insight. And that actually helps with distress regulation.

Kimberley: Right. Tell me, I love you’re using this word. So, for someone who struggles with distress regulation, what kind of skills would you give a client or use for yourself?

Jon: So, there are many different skills a person could use. And I hesitate to say, “Look, use this skill,” because sometimes if you’re always relying on one skill and it’s not working for you, you might be resistant to using a different skill. In DBT, they have something called tip skills. So, changing in-- drastic changes in temperature, intense exercise, progressive muscle relaxation, pace breathing. These are all ways of shifting your perspective. In a more global sense, I think the most important thing is dropping out of the intellectualization of what’s happening and into the body. So, let’s say the problem, the way you know that you’re anxious is that your muscles are tense and there’s heat in your body and your heart rate is elevated. But there are lots of circumstances in your life where your muscles would be tense and your heart rate will be up and you’ll feel hot, and you might be exercising, for example. 

So, that experience alone isn’t threatening. It’s that experience press plus the narrative that something bad is going to happen and it’s because I’m triggered and it’s because I can’t handle the uncertainty and all this stuff. So, it’s doing two things at once. It’s dropping out of the thought process, which is fundamentally the same thing as labeling and abandoning the mental ritual, and then dropping into the body and saying, “What’s happening now is my hands are sweaty,” and just paying attention to it. Okay, alright, sweaty hands. I can be with sweaty hands. Slowing things down and looking at things the way they are, which is not intellectual, as opposed to looking at things the way they could be, or should be, or might have been, which again is a mental ruminative process.

Kimberley: Right. Do you find-- I have found recently actually with several clients that they have an obsession. They start to ruminate and then somewhere through there, it’s hard to determine what’s in control and what’s not. So, we want to preface it with that. But things get really out of control once they start to catastrophize even more. So, would you call the catastrophization a mental rumination, or would you call it an intrusive thought? How would you conceptualize that with a client? They have the obsession, they start ruminating, and then they start going to the worst-case scenario and just staying there.

Jon: Yeah. There’s different ways to look at it. So, catastrophizing is predicting a negative future and assuming you can’t cope with it, and it’s a way of thinking about a situation. So, it’s investing in a false project. The real project is there’s something unknown about the future and it makes you uncomfortable and you don’t like it. How do you deal with that? That’s worth taking a look at. The false project is, my plane is going to crash and I need to figure out how to keep the plane from crashing. But that’s how the OCD mind tends to work.

So, one way of thinking about catastrophizing is it’s a tone it’s a way-- if you can step back far enough and be mindful of the fact that you’re thinking, you can also be mindful of the fact that there is a way that you’re thinking. And if the way that you’re thinking is catastrophizing, you could say, “Yeah, that’s catastrophizing. I don’t need to do that right now.” 

But I think to your point, it is also an act. It’s something somebody is doing. It’s like, I’m going to see this through to the end and the hopes that it doesn’t end in catastrophe, but I’m also going to steer it into catastrophe because I just can’t help myself. It’s like a hot stove in your head that you just want to touch and you’re like, “Ouch.” And in that case, I would say, yeah, that’s a mental ritual. It’s something that you’re doing. 

I like the concept of non-engagement responses. So, things that you can do to respond to the thought process that aren’t engaging it directly, that are helping you launch off. Because like I said, before you label and abandon. But between the label and abandon, a lot of people feel like they need a little help. They need something to drive a wedge between them and the thought process. Simply dropping it just doesn’t feel enough, or it’s met with such distress because whenever you don’t do a compulsion, it feels irresponsible, and they can’t handle that distress. So, they need just a little boost. 

What do we know about OCD? We know that the one thing you can’t do effectively is defend yourself because then you’re getting into an argument and you can’t win an argument against somebody who doesn’t care what the outcome of the argument is. The OCD just wants to argue. So, any argument, no matter how good it is, the OCD is like, “Great, now we’re arguing again.”

How to Manage Mental Compulsions 

Kimberley: Yeah. “I got you.”

Jon: Yeah. So, what are our options? What are our non-engagement response options? One, which I think is completely undersold, is ignoring it. Just ignoring it. Again, none of these you want to only focus on because they could all become compulsive. And then you’re walking around going, “I’m ignoring it, I’m ignoring it.” And then you’re just actually avoiding it. But it’s completely okay to just choose not to take yourself seriously. You look at your email and it’s things that you want. And then in there is a junk mail that just accidentally got filtered into the inbox instead of the spam box, and mostly what you do is ignore it. You don’t even read the subject of it. You recognize that in the moment, it’s spam and you move on as if it wasn’t even there.

Then there’s being mindful of it. Mindful noting. Just acknowledging it. You take that extra beat to be like, “Oh yeah, there’s that thought.” In act, they would call this diffusion. I’m having a thought that something terrible is going to happen. And then you’re dropping it. So, you’re just stepping back and be like, “Oh, I see what’s going on here. Okay, cool. But I’m not going to respond to it.” And then as we get into more ERP territory, we also have the option of agreeing with the uncertainty that maybe, maybe not. “What do I know? Okay. Maybe the plane is going to crash. I can’t be bothered with this.” But you have to do it with attitude because if you get too involved in the linguistics of it, then it’s like, well, what’s the potential that it’ll happen? And you can’t play that game, the probability game. 

But it is objectively true that any statement that begins with the word “maybe” has something to it. Maybe in the middle of this call, this computer is going to explode or something like that. It would be very silly for me to worry about that, but you can’t deny that the statement is true because it’s possible. It’s maybe. So, just acknowledging that, be like, “Okay, fine. Maybe.” And then dropping it the way you would if you had some thought that you didn’t find triggering and yet was still objectively true. 

And then the last one, which can be a lot of fun, can also be overdone, can also become compulsive, but if done well can make life a little bit more fun, is agreeing with the thought in an exaggerated humorous, sarcastic way. Just blowing it up. So, you’re out doing the OCD. The OCD is very creative, but you’re more creative than the OCD.

Kimberley: Can you give me examples?

Jon: Well, the OCD says your plane is going to crash. He said, your plane is going to crash into a school. Just be done with it, right? And that kind of shock where the bully is expecting you to defend yourself and instead, you just punched yourself in the face. He’s like, “Yeah, you’re weird. I’m not going to bother you anymore.” That’s the relationship one wants with their OCD.

Kimberley: That’s true. I remember in a previous episode we had with, I think it was when you had brought out your team book about saying “Good one bro,” or “brah.”

Jon: “Cool story, brah.” Yeah. 

Kimberley: Cool story brah. And I’ve had many of my patients say that that was also really helpful, is there’s a degree of attitude that goes with that, right?

Jon: Yeah. And because again, it’s just a glitch in the system that, of course, you’re conditioned to respond to it like it’s serious. But once you realize it is, once you get the hint that it’s OCD, you have to shift out of that, “Oh, this is very important, very serious,” and into this like, “This is junk mail.” And if you actually look at your junk mail, none of it is serious. It sounds serious. It sounds like I just inherited a billion dollars from some prince in Nigeria. That sounds very important. I

Kimberley: I get that email every day pretty much. 

Jon: Yeah. But I look at it and immediately I know that it’s not serious, even though the words in it sound very important. 

Kimberley: Yeah. So, for somebody, I’m sitting in the mind of someone who has OCD and is listening right now, and I’m guessing, to those who are listening, you’re nodding and “Yes, this is so helpful. This is so helpful.” And then we may finish the episode and then the realization that “This is really hard” comes. How much coaching, how much encouragement? How do you walk someone through treatment who is finding this incredibly difficult?

Jon: I want to live in your mind. In my mind, let that same audience member is like, “This guy sucks.”

Kimberley: My mind isn’t so funny after we start the recording. So, you’re cool.

Jon: Who is this clown? Again, it’s back to self-compassion. I’m sure people are tired of hearing about it, but it’s simply more objective. It is hard. And if you’re acting like it shouldn’t be hard or you’re doing something wrong as a function, it’s hard because you’re doing something wrong, you’re really confused. How could that be? You could not have known better than to end up here. Everything that brought you here was some other thought or some other feeling, and you’re just responding to your environment. The question is right now where you have some control, what are you going to do with your attention? Right now, you’re noticing, “Oh man, it’s really hard to resist mental rituals. It’s hard to catch them. It’s hard to let go of them. It’s hard to deal with the anxiety of thinking because I didn’t finish the mental ritual. Maybe I missed something and somebody’s going to get hurt or something like that because I didn’t figure it out.” 

It is really hard. I don’t think we should pretend that it’s easy. We should acknowledge that it’s hard. And then we should ask, “Okay, well, I made a decision that I’m going to do this. I’m going to treat my OCD and it looks like the treatment for OCD is I’m going to confront this uncertainty and not do compulsions. So, I have to figure out what to do with the fact that it’s hard.” And then it’s back to the body. How do you know that it’s hard? “Well, I could feel the tension here and I could feel my heart rate and my breath.” So, let’s work with that. How can I relate to that experience that’s coming up in a way that’s actually helpful?

The thing that I’ve been thinking about a lot lately is this idea that the brain is quick to learn that something is dangerous. Something happens and it hurts, and your brain is like, “Yeah, let’s not do that again.” And you might conclude later that that thing really wasn’t as dangerous as you thought. And so, you want to re-engage with it. And you might find that’s really hard to do, which is why exposure therapy is really hard because it’s not like a one-and-done thing. You have to practice it because the brain is very slow to learn that something is safe, especially after it’s been taught that it’s dangerous.  But that’s not a bad thing. You want a brain that does that. You don’t want a brain that’s like, “Yeah, well, I got bit by one dog, but who cares? Let’s go back in the kennel.” You want a brain that’s like, “Hold on. Are you sure about this?”

That whole process of overcoming your fears, I think people, again, they’re way too hard on themselves. It should take some time and it should be slow and sluggish. You look like you’re getting better, and then you slip back a little bit, because it’s really just your brain saying, “Listen, I’m here to keep you safe, and I learned that you weren’t, and you are not following rules. So, I’m pulling you back.” That’s where that is coming from. So, that’s the hard feeling. That’s the hard feeling right there. It’s your brain really trying to get you to say, “No, go back to doing compulsions. Compulsions are keeping you safe.” You have to override that circuit and say, “I appreciate your help. But I think I know something that you don’t. So, I’m going to keep doing this.” And then you can relate to that hard feeling with like, “Good, my brain works. My brain is slow and sluggish to change, but not totally resistant. Over time, I’m going to bend it to my will and it will eventually let go, and either say this isn’t scary anymore or say like, ‘Well, it’s still scary, but I’m not going to keep you from doing it.’”

Kimberley: Right. I had a client at the beginning of COVID I think, and the biggest struggle-- and this was true for a lot of people, I think, is they would notice the thought, notice they’re engaging in compulsions and drop it, to use your language, and then go, “Yay, I did that.” And then they would notice another thought in the next 12 seconds or half a second, and then they would go, “Okay, notice it and drop it.” And then they’d do it again. And by number 14, they’re like, “No, this is--” or it would either be like, “This is too hard,” or “This isn’t working.” So, I’m wondering if you could speak to-- we’ve talked about it being “too hard.” Can you speak to your ideas around “this isn’t working”?

Jon: Yeah. That’s a painful thought. I think that a lot of times, people, when they say it isn’t working, I ask them to be more specific because their definition of working often involves things like, “I was expecting not to have more intrusive thoughts,” or “I was expecting for those thoughts to not make me anxious.” And when you let go of those expectations, which isn’t lowering them at all, it’s just shifting them, asking, well, what is it that you really want to do in your limited time on this earth? You’re offline for billions of years. Now you’re online for, I don’t know, 70 to 100 if you’re lucky, and then you’re offline again. So, this is the time you have. So, what do you want to do with your attention? And if it’s going to be completely focused on your mental health, well, that’s a bummer. You need to be able to yes, notice the thought, yes, notice the ritual, yes, drop them both, and then return to something. 

In this crazy world we’re living in now where we’re just constantly surrounded by things to stimulate us and trigger us and make us think, we have lots of things to turn to that aren’t necessarily healthy, but they’re not all unhealthy either. So, it’s not hard to turn your attention away from something and into a YouTube video or something like that. It is more challenging to shift your attention away from something scary and then bring it to the flavor of your tea. That’s a mindfulness issue. That’s all that is. Why is one thing easier than the other? It’s because you don’t think the flavor of your tea is important. Why? Because you’re just not stimulated by the firing off of neurons in your tongue and the fact that we’re alive on earth and that we’ve evolved over a million years to be able to make and taste tea. That’s not as interesting as somebody dancing to a rap song. I get that, but it could be if you’re paying a different kind of attention.

So, it’s just something to consider when you’re like, “Well, I can’t return to the present because it doesn’t engage me in there.” Something to consider, what would really engage you and what is it about the present that you find so uninteresting? Maybe you should take another look.

Kimberley: Right. For me, I’m just still so shocked that gravity works. Whenever I’m really stuck, I will admit, my rumination isn’t so anxiety-based. I think it’s more when I’m angry, I get into a ruminative place. We can do that similar behavior. So, when I’m feeling that, I have to just be like, “Okay, drop away from, that’s not helpful. Be aware and then drop it.” And then for me, it’s just like, “Wow, the gravity is pulling me down. It just keeps blowing my mind.”

Jon: Yeah. That’s probably a better use of your thought process than continuing to ruminate. But you bring up another point. I think this speaks more closely to your question about when people say it’s not working. I’m probably going to go to OCD jail for this, but I think to some extent, when you get knocked off track by an OCD trigger, because you made me think of it when you’re talking about anger. Like, someone says something to you and makes you angry and you’re ruminating about it. But it’s the same thing in OCD. Something happens. Something triggers you to think like, “I’m going to lose my job. I’m a terrible parent,” or something like that. You’re just triggered. This isn’t just like a little thought, you’re like, “Oh, that’s my OCD.” You can feel it in your bones. It got you. It really got you. 

Now, you can put off ruminating as best you can, but you’re going to be carrying that pain in your bones for a while. It could be an hour, could be a day, could be a couple of days. Now, if it’s more than a couple of days, you have to take ownership of the fact that you are playing a big role in keeping this thing going and you need to change if you want different results. But if it’s less than a couple of days and you have OCD, sometimes all you can do is just own it. “All right, I’m just going to be ruminating a lot right now.” And I’m not saying like, hey, sit there and really try to ruminate. But it’s back to that thing before, like your brain is conditioned to take this seriously, and no matter how much you tell yourself it’s not serious, your brain is going to do what your brain is going to do. And so, can you get your work done? Try to show up for your family, try to laugh when something funny happens on TV, even while there’s this elephant sitting on your chest. And every second that you’re not distracted, your mind is like, “Why did they say that? Why did I do that? What’s going to happen next?” And really just step back from it and say like, “You know what, it’s just going to have to be like this for now.”

What I see people do a lot is really undersell how much that is living with OCD. “I’m not getting better.” I had this happen actually just earlier today. Somebody was telling me, walking me through this story that was just full of OCD minds that they kept stepping on and they kept exploding and they were distressed and everything. And yet, throughout the whole process, the only problem was they were having OCD and they were upset. But they weren’t avoiding the situation. They weren’t asking for reassurance and they weren’t harming themselves in any way. They were just having a rough time because they just had their buttons pushed. It was frustrating because they wouldn’t acknowledge that that is a kind of progress that is living with this disorder, which necessarily involves having symptoms. 

I don’t want people to get confused here and say like, “This is as good as it gets,” or “You should give up hope for getting better.” It’s not about that. Part of getting better is really owning that this is how you show up in the world. You have your assets and your liabilities, and sometimes the best thing to do is just accept what’s going on and work through it in a more self-compassionate way.

Kimberley: Right. I really resonate with that too. I’ve had to practice that a lot lately too of accepting my humanness. Because I think there are times where you catch yourself and you’re like, “No, I should be performing way up higher.” And then you’re like, “No, let’s just accept these next few days are going to be rough.” I like that. I think that that’s actually more realistic in terms of what recovery really might look like. This is going to be a rough couple of days or a rough couple of hours or whatever it may be.

Jon: Yeah. If you get punched hard enough in the stomach and knock the wind out of you, that takes a certain period of time before you catch your breath. And if you get punched in the OCD brain, it takes a certain amount of time before you catch your breath. So, hang on. It will get better. And again, this isn’t me saying, just do as many compulsions as you want. It’s just, you’re going to do some, especially rumination and taking ownership of that, “Oh man, it’s really loud in there. I’ve been ruminating a lot today. I’ll just do the best I can.” That’s going to be a better approach than like, “I’m going to sit and track every single thought and I’m going to burn it to the ground. I’m going to do it every five seconds.” Really, you’re just going to end up ruminating more that way.

Kimberley: Right. And probably beating yourself up more.

Jon: Exactly.

Kimberley: Right. Okay. I feel like that is an amazing place for us to end. Before we do, is there anything you feel like we’ve missed that you just want people to know before we finish up?

Jon: I guess what’s really important to know since we’re talking about mental compulsions is that it’s not separate from the rest of OCD and it’s not harder to treat. People have this idea that, well, if you’re a compulsive hand-washer, you can just stop washing your hands or you can just remove the sink or something like that. But if you’re a compulsive ruminator about whether or not you’re going to harm someone or you’re a good person or any of that stuff, somehow that’s harder to treat. I’ve not found this to be the case. Anecdotally, I haven’t seen any evidence that this is really the case in terms of research. You might be harder on yourself in some ways, and that might make your symptoms seem more severe, but that’s got nothing to do with how hard you are to treat or the likelihood of you getting better.

Most physical rituals are really just efforts to get done what your mental rituals are not doing for you. So, many people who are doing physical rituals are also doing mental rituals and those who aren’t doing physical rituals. Again, some people wash their hands. Some people wash their minds. Many people do both. A lot of this stuff, it has to do with like, “I expect my mind to be one way, and it’s another.” And that thing that’s making it another is a contaminant, “I hate it and I want to go away and I’m going to try to get it to go away.” And that’s how this disorder works.

Kimberley: Right. It’s really, really wonderful advice. I think that it’s actually really great that you covered that because I think a lot of people ask that question of, does that mean that I’m going to only have half the recovery of someone who does physical compulsions or just Googles or just seeks reassurance? So, I think it’s really important. Do you feel like someone can overcome OCD if their predominant compulsion is mental?

Jon: Absolutely. They may even have assets that they are unaware of that makes them even more treatable. I mean, only one way to find out.

Kimberley: Yeah. I’m so grateful to you. Thank you for coming on. This is just filling my heart so much. Thank you.

Jon: Thank you. I always love speaking with you.

Kimberley: Do you want to share where people can find you and all your amazing books and what you’re doing?

Jon: My hub is OCDBaltimore.com. That’s the website for the Center for OCD and Anxiety at Sheppard Pratt, and also the OCD program at The Retreat at Sheppard Pratt. And I’m on Instagram at OCDBaltimore, Twitter at OCDBaltimore. I don’t know what my Facebook page is, but it’s out there somewhere. I’m not hard to find. Falling behind a little bit on my meme game, I haven’t found anything quite funny or inspiring enough. I think I’ve toured through all of my favorite movies and TV shows. And so, I’m waiting for some show that I’m into to inspire me. But someone asked me the other day, “Wait, you stopped with the memes.”
Kimberley: They’re like, nothing’s funny anymore.

Jon: I try not to get into that headspace. Sometimes I do think that way, but yeah, the memes find me. I don’t find them.

Kimberley: I love it. And your books are all on Amazon or wherever you can buy books, I’m imagining.

Jon: Yes. The OCD Workbook For Teens is my most recent one and the second edition of the Mindfulness Workbook for OCD is also a relatively recent one.

Kimberley: Amazing. You’re amazing. Thank you so much.

Jon: Thank you.

May 06, 2022
Ep. 282 6 Part Series: Introduction to Mental Compulsions
31:10

SUMMARY:

Welcome to the first week of this 6-part series on Mental Compulsions.  This week is an introduction to mental compulsions.   Ove the next 6 weeks, we will hear from many of the leaders in our feild on how to manage mental compulsions using many different strategies and CBT techniques.  Next week, we will have Jon Hershfield to talk about how he using mindfulness to help with mental compulsions and mental rituals.

In This Episode:

  • What is a mental compulsion?
  • Is there a different between a mental compulsion and mental rumination and mental rituals?
  • What is a compulsion?
  • Types of Mental Compulsions

Links To Things I Talk About:

How to reach Jon https://www.sheppardpratt.org/care-finder/ocd-anxiety-center/
ERP School: https://www.cbtschool.com/erp-school-lp

Episode Sponsor:

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

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

EPISODE TRANSCRIPTION

This is Your Anxiety Toolkit - Episode 282 and the first part of a six-part series that I am overwhelmed and honored to share with you – all on mental compulsions.

I have wanted to provide a free resource on mental compulsions for years, and I don’t know why, but I finally got enough energy under my wings and I pulled it off and I could not be more excited. Let me tell you why.

This is a six-part series. The next six episodes will be dedicated to managing mental compulsions, mental rituals, mental rumination. I will be presenting today the first part of the training, which is what we call Mental Compulsions 101. It will talk to you about all the different types of mental compulsions, give you a little bit of starter training. And then from there, it gets exciting. We have the most incredible experts in the field, all bringing their own approach to the same topic, which is how do we manage mental compulsions?

We don’t talk about mental compulsions enough. Often, it’s not addressed enough in treatment. It’s usually very, very difficult to reduce or stop mental compulsion. I thought I would bring all of the leaders, not all of them, the ones I could get and the ones that I had the time to squeeze into this six-part series, the ones that I have found the most beneficial for my training and my education for me and my stuff. I asked very similar questions, all with the main goal of getting their specific way of managing it, their little take, their little nuance, fairy tale magic because they do work magic. These people are volunteering their time to provide this amazing resource.

Welcome to number one of a six-part series on mental compulsions. I hope you get every amazing tool from it. I hope it changes your life. I hope you get out your journal and you write down everything that you think will help you and you put it together and you try it and you experiment with it and you practice and you practice because these amazing humans are so good and they bring such wisdom.

I’m going to stop there because I don’t want to go on too much. Of course, I will be starting. And then from there, every week for the next five weeks after this one, you will get a new take, a new set of tools, a new way of approaching it. Hopefully, it’s enough to really get you moving in managing your mental compulsion so you can go and live the life that you deserve, so that you can go and do the things you want without fear and anxiety and mental compulsions taking over your time.

Let’s do this. I have not once been more excited, so let’s do this together. It is a beautiful day to do hard things and so let’s do it together.

Welcome, everybody. Welcome to Mental Compulsions 101. This is where I set the scene and teach you everything you need to know to get you started on understanding mental compulsions, understanding what they are, different kinds, what to do, and then we’re going to move over and let the experts talk about how they personally manage mental compulsions. But before they shared their amazing knowledge and wisdom, I wanted to make sure you all had a good understanding of what a mental compulsion is and really get to know your own mental compulsions so you can catch little, maybe nuanced ways that maybe you’re doing mental compulsions.

I’m going to do this in a slideshow format. If you’re listening to this audio, there will be a video format that you can access as well here very soon. I will let you know about that. But for right now, let’s go straight into the content.

Who is Kimberley Quinlan?

First of all, who am I? My name is Kimberley Quinlan. A lot of you know who I am already. If you don’t, I am a marriage and family therapist in the State of California. I am an Australian, but I live in America and I am honored to say that I am an OCD and Anxiety Specialist. I treat all of the anxiety disorders. I also treat body-focused repetitive behaviors, and we specialize in eating disorders as well. The reason I tell you all that is you probably will find that many different disorders use mental compulsions as a part of their disorder. My hope is that you all feel equally as included in this series.

Now, as well as a therapist, I’m also a mental health educator. I am the owner, the very proud owner of CBTSchool.com. It is an online platform where we offer free and paid resources, educational resources for people who have anxiety disorder orders or want to just improve their mental health. I am also the host of Your Anxiety Toolkit Podcast. You may be watching this in a video format, or you may actually be listening to this because it will also be released. All of this will be offered for free on Your Anxiety Toolkit Podcast as well. I wanted to just give you all of that information before we get started so that you know that you can trust me as we move forward. Here we go.

What is a Mental Compulsion?

First of all, what is a mental compulsion? Well, a mental compulsion is something that we do mentally. The word “compulsion” is something we do, but in this case, we’re talking about not a physical behavior, but a mental behavior. We do it in effort to reduce or remove anxiety, uncertainty, some other form of discomfort, or maybe even disgust. It’s a behavior, it’s a response to a discomfort and you do that response in a way to remove or resist the discomfort that you’re feeling.

Now, we know that in obsessive-compulsive disorder, there are a lot of physical compulsions. A lot of us know these physical compulsions because they’ve been shown in Hollywood movies. Jumping over cracks, washing our hands, moving objects – these are very common physical compulsions – checking stoves, checking doors. Most people are very understanding and acknowledge that as being a part of OCD. But what’s important to know is that a lot of people with OCD don’t do those physical compulsions at all. In fact, 100% of their compulsions are done in their head mentally. Now, this is also very true for people with generalized anxiety. It’s also very true for some people with health anxiety or an eating disorder, many disorders engage in mental compulsions.

Mental Compulsion Vs Mental Ritual?

For the sake of this series, we use the word “mental compulsion,” but you will hear me, as we have guests, you will hear me ask them, do you call them “mental compulsions”? Some people use the word “mental ritual.” Some people use the word “mental rumination.” There are different ways, but ultimately throughout this series, we’re going to mostly consider them one and the same. But again, just briefly, a mental compulsion is something you do inside of your mind to reduce, remove, or resist anxiety, uncertainty, or some form of discomfort that you experience. Let’s keep moving from here.

What is a Compulsion

Now, who does mental compulsions? I’ve probably answered that for you already. Lots of people do mental compulsions. Again, it ranges over a course of many different anxiety disorders and other disorders, including eating disorders. But again, generalized anxiety, social anxiety, phobias, health anxiety, post-traumatic stress disorder. Some of the people with that mental disorder also engage in mental compulsions.

Predominantly, we talk a lot about the practice of mental compulsions for people with obsessive-compulsive disorder. The thing to remember is it’s more common than you think, and you’re probably doing more of them than you guessed. I’m hoping that this 101 training will help you to be able to identify the compulsions you’re doing so that when we go through this series, you have a really good grasp of where you could practice those skills.

Now, often when people find out they’re doing mental compulsions, they can be very hard on themselves and berate and criticize themselves for doing them. I really want to make this a judgment-free and punish-free zone where you’re really gentle with yourself as you go through this series. It’s very important that you don’t use this information as a reason to beat yourself up even more. So let’s make a deal. We’re going to be as kind and non-judgmental as we can, as we move through this process. Compassion is always number one. Do we have a deal? Good.

Types of Mental Compulsions

Here is the big question: Are there different types of mental compulsions? Now, I’m going to proceed with caution here because there is no clear differentiation between the different compulsions. I did a bunch of research. I also wrote a book called The Self-Compassion Workbook For OCD. There is no specific way in which all of the psychological fields agree on what is different types of mental compulsions. There are some guidelines, but there’s no one list.

I want to proceed with caution first by letting you know this list that we use with our patients. Now, as you listen, you may have different names for them. Your therapist may use different terminology. That’s all fine. It doesn’t mean what you have done is wrong or what we are doing is wrong. To be honest with you, this would be a 17-hour training if I were to be as thorough as listing out every single one. For the sake of clarity and simplicity, I’ve put them into 10 different types of mental compulsions. If you have ones that aren’t listed, that doesn’t mean it’s not a mental compulsion. I encourage you to just check in. If you have additional or you have a different name, that’s totally okay. Totally okay. We’re just using this again for the sake of clarity and simplicity. Here we go.

1. Mental Repeating

The first mental compulsion that we want to look at is mental repeating. This is where you repeat or you make a list of individual items or categories. It can also involve words, numbers, or phrases. Often people will do this for two reasons or more, like I said, is they may repeat them for reassurance. They may be repeating to see whether they have relief. They may be repeating them to see if they feel okay. They may be repeating them to see if any additional obsessions arise, or they may be repeating them to unjinx something. Now, that’s not a clinical term, so let’s just put that out there.

What I mean by this is some people will repeat things because they feel like the first time something happened, it was jinx. Like it will mean something bad will happen. It’s been associated with something bad, so they repeat it to unjinx it. We’ll talk more about neutralizing compulsions here in a second, but that’s in regards to mental repeating. You may do it for a completely different reason. Don’t worry too much as we go through this on why you do it. Just get your notepad out and your pencil out and just take note. Do I do any mental repeating compulsions? Not physical. Remember, we’re just talking about mental in this series.

2. Mental Counting

This is where you either count words, count letters, count numbers, or count objects. Again, you will not do this out loud. Well, sometimes you may do it out loud in addition to mental, but we’re mostly talking about things you would do silently in your head. Again, you may do this for a multitude of reasons, but again, we want to just keep tabs. Am I doing any mental counting or mental counting rituals?

3. Neutralization Compulsions or Neutralizing Compulsions

What we’re talking about here is you’re replacing an obsession with a different image or word. Let’s say you are opening your computer. As you opened the computer, you had an intrusive thought that you didn’t like. And so in effort to neutralize that thought, you would have the opposite thought. Let’s say you had a thought, a number. Let’s say you’ve had the number that you feel is a bad number. You may neutralize it by then repeating a positive number, a number that you like, or a safe number. Or you may do a behavior, you may see something being done and you have a negative thought. So then, you recall a different thought or a prayer, it could be also a prayer, to undo that bad feeling or thought or sensation.

Now, when it comes to compulsive prayer, that could be done as a neutralization. In fact, I almost wanted to make prayer its own category, because a lot of people do engage in compulsive prayer, particularly those who have moral and scrupulous obsessions. Again, not to say that all prayer is a compulsion at all, but if you are finding that you’re doing prayer to undo a bad thought or a bad feeling or a bad sensation or a bad urge – when I say bad, I mean unwanted – we would consider that a neutralization or a neutralizing compulsion.

4. Hypervigilance Compulsions

Now again, this is the term we use in my practice. Remember here before we proceed that hypervigilance is an obsession, meaning it can be automatic, unwanted, intrusive, but it can also be a compulsive behavior. It could be both or it could be one. But when I talk about the term “hypervigilance compulsions,” this is also true for people with post-traumatic stress disorder, is it’s a scanning of the environment. It’s a scanning, like looking around. I always say with my clients, it’s like this little set of eyes that go doot, doot, doot, doot really quick, and they’re scanning for danger, scanning for potential fear or potential problems. They also do that when we’re in a hypervigilance compulsion. We may do that with our thoughts. We’re scanning thoughts or we’re scanning sensations like, is this coming? What’s happening? Where am I feeling things?

You may be scanning and doing hypervigilance in regards to feeling like, am I having a good thought or a bad thought or a good feeling or a bad feeling? And then making meaning about that. You may actually also be hypervigilant about your reaction. If let’s say you saw something that usually you would consider concerning and this time you didn’t, you might become very hypervigilant. What does that mean? I need to make sure I always have this feeling because this feeling would mean I’m a good person or only good things will happen.

The last one again is emotions, which emotions and feelings can sometimes go in together. Hypervigilant compulsion is something to keep an eye out. It could be simple as you just being hypervigilant, looking king around. Often this is true for people with driving obsessions or panic disorder. They’re constantly looking for when the next anxiety attack is coming.

5. Mental Reassurance

We can do physical reassurance, which is looking at Google, asking a friend like, are you sure nothing bad will happen? We can do physical, but we can also do mental reassurance, which is mentally checking to confirm an obsession is not or will not become a threat. This is true for basic like we already talked about and some checking and repeating behaviors. You may mentally stare at the doorknob to make sure it is locked. You may mentally check and check for reassurance once, twice, five times, ten times, or more. If the stove is off or that you are not having arousal is another one, or that you are not going to panic. You may be checking to get reassurance mentally that your fear is not going to happen.

Again, some people’s fear is fear itself. The fear of having a panic attack is very common as well. Again, we’re looking for different ways that mentally we are on alert for potential danger or perceived danger.

6. Mental Review

We’ve talked a lot about behaviors that we’re doing in alert of anxiety. Mental review is reviewing and replaying past situations, figuring out the meaning of internal experiences, such as, what is the meaning of the thought I had? What is the meaning of the feeling I had? What is the meaning of that sensation? What does that mean? What is the meaning of an image that just showed up intrusively and repetitively in my mind? What is the meaning of an urge I have?

This is very true for people with harm obsessions or sexual obsessions. When they feel an urge, they may review for hours, what did that mean? What does that mean about me? Why am I having those? And so the review piece can be very painful. All of these are very painful and take many, many hours, because not only are you reviewing the past, which can be hard because it’s hard to get mental clarity of the past, but then you’re also trying to figure out what does that mean about me or the world or the future. So, just things to think about.

To be honest, mental review could cover all of the categories that we’ve covered, because it’s all review in some way. But again, for the sake of clarity and simplicity, I’ve tried to break them up. You may want to break them up in different ways yourself. That is entirely okay. I just wanted to give you a little category here on its own.

7. Mental Catastrophization

This is where you dissect and scrutinize past situations with potential catastrophic scenarios. Now, I made an error here because a lot of people do this about the future as well. But we’ll talk about that here in a little bit.

Mental catastrophization, if you have reviewed the past and you’re going over all of the potential terrible situations. This is very true for people who review like, what did I say? Was that a silly thing to say? Was that a good thing to say? What would they think about me?

Mental catastrophization is reviewing the past, but is also the future and reviewing every possible catastrophic scenario or opportunity that happened. Whether it happened or not, it doesn’t really matter when it comes to mental compulsions. Usually, when someone does a mental compulsion, they’re reviewing maybe’s, the just in case it does happen, I better review it.

8. Mental Solving

Very similar, again, which is anticipating future situations with or without potential what-if scenarios. Very similar to catastrophization compulsions. This is where you’re looking into the future and going, “What if this happens? What if that happens? What if this happens? Well, what if that happens?” and going through multiple, sometimes dozens of scenarios of the worst-case scenarios on what may or may not happen. Again, it usually involves a lot of catastrophizing. But again, these are all safety behaviors. None of this means there’s anything wrong with you or that you’re bad or that you’re not strong.

Remember, our brain is just trying to survive. In the moment when we are doing these, our brain actually thinks it’s coming up with solutions, but what we have to do, and all of the guests will talk about this, is recognize. Most of the time, the problem isn’t actually happening. We’re just having thoughts that it’s happening. Again, this is reviewing thoughts of potential what-if scenarios.

9. Mental Self-Punishment

I talk a lot about this in my book, The Self-Compassion Workbook For OCD. Mental self-punishment is a compulsion, a mental compulsion that is not talked about enough. One is criticizing, withholding pleasure, harshly disciplining yourself for your obsessions or even the compulsions that you’ve done. Often, we do this as a compulsion, meaning we think that if we punish ourselves, that will prevent us from having the obsession or the compulsion in the future. The fact here is beating yourself up actually doesn’t reduce your chances of having thoughts and feelings and sensations and behaviors or urges. But that is why we do them. It’s to catch when you are engaging in criticizing or withholding or punishing compulsions.

10. Mental Comparison

Again, not a very common use of compulsions, but this is one I like to talk about a lot. Most of my patients with OCD and with anxiety will say that they know for certain that they compare more than their friends and family members who do not have anxiety disorders. I’ve put it here just so that you can catch when you are engaging in mental comparison, which is comparing your own life with other people’s life, or comparing your own life with the idea that you thought you should have had for your life. So, an idea of how your life was supposed to be.

This is a compulsive behavior because it’s done again to reduce or remove a feeling or a sensation or a discomfort of anxiety or uncertainty you have around your current situation. It’s really important to catch that as well because there’s a lot of damage that can be done from comparing a lot with other people or from a fantasy that you had about the way your life should or shouldn’t look. Again, we will talk about this in episodes, particularly with Jonathan Grayson. He talks a lot about this one. I just wanted to add that one in as well.

They’re the main top 10 mental compulsions. Again, I want to stress, these are not a conclusive list that is the be-all and end-all. A lot of clinicians may not agree and they may have different ways of conceptualizing them. That is entirely okay. I’m never going to pretend to be the knower of all things. That is just one way that we conceptualize it here at our center with our staff and our clients to help patients identify ways in which they’re behaving mentally.

Something to think about here, though, is you may find some of your compulsions are in more than one category. You might say, “Well, I do mental comparison, but it’s also a self-punishment,” or “I do mental checking, but it’s also a form of reassurance.” That’s okay too. Don’t worry too much about what section it should be under. Again, it’s very fluid. We want you just to be able to document. It doesn’t matter what category it is particularly. I really just wanted this 101 for you to do an inventory and see, “Oh, wow, maybe I’m doing more compulsions than I thought.” Because sometimes they’re very habitual and we are doing them before we even know we’re doing them. I just want to keep reminding you guys it’s okay if it looks a little messy and it’s okay if your list is a little different.

The main question here as we conclude is: How do I stop? Well, the beauty is I have the honor of introducing to you some of the absolute, most amazing therapists and specialists in the planet. I fully wholeheartedly agree with that. While I wish I could have done 20 people, I picked six people who I felt would bring a different perspective, who have such amazing wisdom to share with you on how to manage mental compulsions.

Now, why did I invite more than one person? Because I have learned as a clinician and as a human being, there is not one way to treat something. When I first started CBT School, I was under the assumption that there is only one way to do it and it’s the right way or the wrong way. From there, I have really grown and matured into recognizing that what works for one person may not work for the next person.

As we go through this series, I may be asking very, very similar questions to each person. You will be so amazed and in awe of the responses and how they bring about a small degree of nuance and a little flare of passion and some creativity of each person and bring in a different theme. I’m so honored to have these amazing human beings who are so kind to offer their time, to offer this series, and help you find what works for you.

As you go through, I will continue reminding you, please keep asking yourself, would this work for me? Am I willing to try this? The truth is, all of them are doable for everybody, but you might find for your particular set of compulsions specific tools work better. So trial them, see what works, be gentle, experiment. Don’t give up. It may require multiple tries to really find some little win. Please, just listen, enjoy, take as many notes as you can, because literally, the wisdom that is dropped here is mind-blowing.

I’ve been treating OCD for over a decade and I actually stopped a few things after I learned this and went straight to my staff and said, “We have to make a new plan. Let’s implement this. This is an amazing skill for our clients. Let’s make sure we do it.” Even I, I’m a student of some of these amazing, amazing people.

How do I stop? Stay tuned, listen, learn, take notes, and most importantly, put it into practice. Apply. That’s where the real change happens.

Now, before we finish, please do note this series should not replace professional healthcare. This or any product provided by CBT School should be used for education purposes only, so please take as much as you can. If you feel that you need more support, please reach out to a therapist in your area who can help you use these tools and maybe pick a part. Maybe there’s a few things that you need additional help with, and that is okay.

Thank you, guys. I am so excited to share this with you.

Have a wonderful day.

Apr 29, 2022
Ep. 281 Anxiety and Arousal
27:45

SUMMARY: 

This episode addresses some common questions people have about anxiety and arousal. Oftentimes, we are too afraid to talk about anxiety and arousal, so I thought I would take this opportunity to address some of the questions you may have and take some of the stigma and shame out of discussing anxiety and how it impacts arousal, orgasm, intimacy, and sexual interactions.

In This Episode:

  • How anxiety and arousal impact each other (its a cycle)
  • Arousal Non-Concordance and how it impacts people with anxiety and OCD
  • How to take the shame out of arousal struggles
  • Understanding why anxiety impacts orgasms and general intimacy

Links To Things I Talk About:

Article I wrote about OCD and Arousal Non-Concordance
https://www.madeofmillions.com/articles/whats-going-ocd-arousal

Come as You are By Emily Nagoski, PhD
Come as You Are Workbook By Emily Nagoski, PhD
ERP School: https://www.cbtschool.com/erp-school-lp

Episode Sponsor:

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

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

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

Ep. 281 Anxiety and Arousal

EPISODE TRANSCRIPTION

This is Your Anxiety Toolkit - Episode 281.

Welcome back, everybody. How are you? It is a beautiful sunny day here in California. We’re actually in the middle of a heatwave. It is April when I’m recording this and it is crazy how hard it is, but I’m totally here for it. I’m liking it because I love summer.

Talking about heat, let’s talk about anxiety and arousal today. Shall we? Did you get that little pun? I’m just kidding really.

Today, we’re talking about anxiety and arousal. I don’t know why, but lately, I’m in the mood to talk about things that no one really wants to talk about or that we all want to talk about and we’re too afraid to talk about. I’m just going to go there. For some reason, I’m having this strong urge with the podcast to just talk about the things that I feel we’re not talking about enough. And several of my clients actually were asking like, “What resources do you have?” And I have a lot of books and things that I can give people. I was like, “All right, I’m going to talk about it more.” So, let’s do it together.

Before we do that, let’s quickly do the review of the week. This one is from, let’s see, Jessrabon621. They said:

“Amazing podcast. I absolutely love everything about this podcast. I could listen to Kimberley talk all day and her advice is absolutely amazing. I highly recommend this podcast to anyone struggling with anxiety or any other mental health professional that wants to learn more.”

Thank you so much, Jess.

This week’s “I did a hard thing” is from Anonymous and they say:

“I learned it’s okay to fulfill my emotions and just allow my thoughts and it gave me a sense of peace. Learning self-compassion is my hard thing and I’m learning to face OCD and realize that it’s not my fault. I’m learning to manage and live my life for me like I deserve, and I refuse to let this take away my happiness.”

This is just so good. I talk about heat. This is seriously on fire right here. I love it so much. The truth is self-compassion practice is probably my hard thing too. I think that me really learning how to stand up for myself, be there for myself, be tender with myself was just as hard as my eating disorder recovery and my anxiety recovery. I really appreciate Anonymous and how they’ve used self-compassion as their hard thing.

Let’s get into the episode. Let me preface the episode by we’re talking about anxiety and arousal. If I could have one person on the podcast, it would be Emily Nagoski. I have been trying to get her on the podcast for a while. We will get her on eventually. However, she’s off doing amazing things. Amazing things. Netflix specials, podcasts, documentaries. She’s doing amazing things. So, hopefully, one day. But until then, I want to really highlight her as the genius behind a lot of these concepts.

Emily Nagoski is a doctor, a psychology doctor. She is a sex educator. She has written two amazing books. Well, actually, three or four. But the one I’m referring to today is Come as You Are. It’s an amazing book. But I’m actually in my hand holding the Come as You Are Workbook. I strongly encourage you after you listen to this podcast episode to go and order that book. It is amazing. It’s got tons of activities. It might feel weird to have the book. You can get it on Kindle if you want to have it be hidden, but it’s so filled with amazing information. I’m going to try and give you the pieces that I really want you to take away. If you want more, by all means, go and get the workbook. The workbook is called The Come as You Are Workbook: A Practical Guide to the Science of Sex. The reason I love it is because it’s so helpful for those who have anxiety. It’s like she’s speaking directly to us. She’s like, it’s so helpful to have this context.

Here’s the thing I want you to consider starting off. A lot of people who have anxiety report struggles with arousal. We’re going to talk about two different struggles that are the highlight of today. Either you have no arousal because of your anxiety, or you’re having arousal at particular times that concern you and confuse you and alarm you. You could be one or both of those camps.

So let’s first talk about those who are struggling with arousal in terms of getting aroused. So the thing I want you to think about is commonly-- and this is true for any mental health issue too, it’s true for depression, anxiety disorders, eating disorders, dissociative disorders, all of them really. But the thing I want you to remember, no matter who you are and what your experience is, even if you have a really healthy experience of your own sexual arousal and you’re feeling fine about it, we all have what’s called inhibitors and exciters. Here is an example.

An inhibitor is something that inhibits your arousal. An exciter is something that excites your arousal. Now you’re probably already feeling a ton of judgment here like, “I shouldn’t be aroused by this and I should be aroused by this. What if I’m aroused by this? And I shouldn’t be,” and so forth. I want us to take all the judgment out of this and just look at the content of what inhibits our arousal or excites our arousal. Because sometimes, and I’ll talk about this more, sometimes it’s for reasons that don’t make a lot of sense and that’s okay.

Let’s talk about an inhibitor, something that pumps the brakes on arousal or pleasure. It could be either. There’s exciters, which are the things that really like the gas pedal. They just really bring on arousal, bring on pleasure, and so forth.

We have the content. The content may be first mental or physical, and this includes your health, your physical health. For me, I know when I am struggling with POTS, arousal is just barely a thing. You’re just so wiped out and you’re so exhausted and your brain is foggy. It’s just like nothing. That would be, in my case, an inhibitor. I’m not going to talk about myself a lot here, but I was just using that as an example. You might say your anxiety or your obsession is an inhibitor. It pumps the brakes on arousal. It makes it go away. Worry is one.

It could also be other physical health, like headaches or tummy aches, or as we said before, depression. It could be hormone imbalances, things like that. It’s all as important. Go and speak with your doctor. That’s super important. Make sure medically everything checks out if you’re noticing a dip or change in arousal that’s concerning you.

The next one in terms of content that may either excite you or inhibit you is your relationship. If your relationship is going well, you may or may not have an increase in arousal depending on what turns you on. If your partner smells of a certain smell or stench that you don’t like, that may pump the brakes. But if they smell a certain way that you do really like and really is arousing to you, that may excite your arousal.

It could also be the vibe of the relationship. A lot of people said at the beginning of COVID, there was a lot of fear. That was really, really strong on the brakes. But then all of a sudden, no one had anything to do and there was all this spare time. All of a sudden, the vibe is like, that’s what’s happening. Now, this could be true for people who are in any partnership or it could be just you on your own too. There are things that will excite you and inhibit your arousal if you’re not in a relationship as well, and that’s totally fine. This is for all relationships. There’s no specific kind.

Setting is another thing that may pump the brakes or hit the gas for arousal, meaning certain places, certain rooms, certain events. Did your partner do something that turned you on? Going back to physical, it could also depend on your menstrual cycle. People have different levels of arousal depending on different stages of their menstrual cycle. I think the same is true for men, but I don’t actually have a lot of research on that, but I’m sure there are some hormonal impacts on men as well.

There’s also ludic factors which are like fantasy. Whether you have a really strong imagination, that either pumps the brakes or puts the gas pedal in terms of arousal. It could be like where you’re being touched. Sometimes there’s certain areas of your body that will set off either the gas pedal or the brakes. It could be certain foreplay.

Really what I’m trying to get at here isn’t breaking it down according to the workbook, but there’s so many factors that may influence your arousal.

Another one is environmental and cultural and shame. If arousal and the whole concept of sex is shamed or is looked down on, or people have a certain opinion about your sexual orientation, that too can impact your gas pedal and your brakes pedal. So, I want you to explore this, not from a place of pulling it apart really aggressively and critically, but really curiously and check in for yourself, what arouses me? What presses my brakes? What presses my gas? And just start to get to know that. Again, in the workbook, there’s tons of worksheets for this, but you could also just consider this on your own. Write it down on your own, be aware over the next several days or weeks, just jot down in a journal what you’re noticing.

Now, before we move on, we’ve talked about a lot of people who are struggling with arousal, and they’ve got a lot of inhibitors and brake pushing. There are the other camp who have a lot of gas pedal pushing. I speak here directly to the folks who have sexual obsessions because often if you have sexual obsessions, the fact that your sexual obsession is sexual in nature may be what sets the gas pedal off, and all of a sudden, you have arousal for reasons that you don’t understand, that don’t make sense to you, or maybe go against your values.

I’ve got a quote that I took from the book and from the workbook of Emily Nagoski. Again, none of this is my personal stuff. I’m quoting her and citing her throughout this whole podcast. She says, “Bodies do not say yes or no. They say sex-related or not sex-related.” Let me say it again. “Bodies do not say yes or no. They say sex-related or not sex-related.”

This is where I want you to consider, and I’ve experienced this myself, is just because something arouses you doesn’t mean it brings you pleasure. Main point. We’ve got to pull that apart. Culture has led us to believe that if you feel some groinal response to something, you must love it and want more of it.

An example of this is for people with sexual obsessions, maybe they have OCD or some other anxiety disorder, and they have an intrusive thought about a baby or an animal. Bestiality is another very common obsession with OCD or could be just about a person. It could be just about a person that you see in the grocery store. When you have a thought that is sex-related, sometimes because the context of it is that it’s sex-related, your body may get aroused. Our job, particularly if you have OCD, is not to try and figure out what that means. It’s not to try and resolve like, does that mean I like it? Does that mean I’m a terrible person? What does that mean?

I want you to understand the science here to help you understand your arousal, to help you understand how you can now shift your perspective towards your body and your mind and the pleasure that you experience in the area of sexuality. Again, the body doesn’t say yes or no, they say it’s either sex-related or not sex-related.

Here’s the funny thing, and I’ve done this experiment with my patients before, is if you look at a lamp post or it could be anything, you could look at the pencil you’re holding and then you bring to mind a sexual experience, you may notice arousal. Again, it doesn’t mean that you’re now aroused by pencils or pens. It’s that it was labeled as sex-related, so often your brain will naturally press the accelerator.

That’s often how I educate people, particularly who are having arousal that concerns it. It’s the same for a lot of people who have sexual trauma. They maybe are really concerned about the fact that they do have arousal around a memory or something. And then that concerns them, what does that mean about me? And the thing to remember too is it’s not your body saying yes or no, it’s your body saying sex-related or not sex-related. It’s important to just help remind yourself of that so that you’re not responding to the content so much and getting caught up in the compulsive behaviors.

A lot of my patients in the past have reported, particularly during times when they’re stressed, their anxiety is really high, life is difficult, any of this content we went through, is they may actually have a hard time being aroused at all. Some people have reported not getting an erection and then it completely going for reasons they don’t understand. I think here we want to practice again non-Judgment. Instead, move to curiosity. There’s probably some content that impacted that, which is again, very, very, normal.

this is why when I’m talking with patients – I’ve done episodes on this in the past, and we’ve in fact had sex therapists on the podcast in the past – is they’ve said, if you’ve lost arousal, it doesn’t mean you give up. It doesn’t mean you say, “Oh, well, that’s that.” What you do is you move your attention to the content that pumps the gas. When I mean content, it’s like touch, smell, the relationship, the vibe, being in touch with your body, bringing your attention to the dance that you’re doing, whether it’s with a partner or by yourself, or in whatever means that works for you. You can bring that back. There’s another amazing book called Better Sex Through Mindfulness, and it talks a lot about bringing your attention to one or two sensations. Touch, smell being two really, really great ones.

Again, if your goal is to be aroused, you might find it’s very hard to be aroused because the context of that is pressure. I don’t know about you, but I don’t really find pressure arousing. Some may, and again, this is where I want this to be completely judgment-free. There’s literally no right and wrong. But pressure is usually not that arousing. Pressure is not that pleasurable in many cases, particularly when it’s forceful and it feels like you have to perform a certain way. Again, some people are at their best in performance mode, but I want to just remind you, the more pressure you put on yourself on this idea of ending it well is probably going to make some anxiety. Same with test anxiety. The more pressure you put on yourself to get an A, the more you’re likely to spin out with anxiety. It’s really no different.

So, here is where I want you to catch and ask yourself, is the pressure I put on myself or is the agenda I put on myself actually pumping the brakes for me when it comes to arousal? Is me trying not to have a thought actually in the context of that, does that actually pump the brakes? Because I know you’re trying not to have the thought so that you can be intimate in that moment and engaged in pleasure. But the act of trying not to have the thought can actually pump the brakes. I hope that makes sense. I want you to get really close to understanding what’s going on for you.

Everyone is different. Some things will pump the brakes, some things will pump the accelerator. A lot of the times, thought suppression pumps the brakes. A lot of the times, beating yourself up pumps the brakes. A lot of the time, the more goal, like I have to do it this way, that often pumps the brakes. So, keep an eye out for that. Engage in the exciters and get really mindful and present.

A couple of things here. We’ve talked about erections, that’s for people who struggle with that. It’s also true for women or men with lubrication. Some people get really upset about the fact that there may or may not be a ton of lubrication. Again, we’ve been misled to believe that if you’re not lubricated, you mustn’t be aroused or that you mustn’t want this thing, or that there must be something wrong with you, and that is entirely true. A lot of women, when we study them, they may be really engaged and their gas pedal is going for it, but there may be no lubrication. And it doesn’t mean something is wrong. In those cases, often a sex therapist or a sex educator will encourage you to use lubrication, a lubricant.

Again, some people, I’ve talked to clients and they’re so ashamed of that. But I think it’s important to recognize that that’s just because somebody taught us that, and sadly, it’s a lot to do with patriarchy and that it was pushed on women in particular that that meant they’re like a good woman if they’re really lubricated. And that’s not true. That’s just fake, false. No science. It has no basis in reality.

Now we’ve talked about lubrication. We’ve talked about erection. Same for orgasm. Some people get really frustrated and disheartened that they can’t reach orgasm. If for any reason you are struggling with this, please, I urge you, go and see a sex therapist. They are the most highly trained therapists. They are so sensitive and compassionate. They can talk with you about this and you can target the specific things you want to work on. But orgasm is another one. If you put pressure on yourself to get there, that pumps the brakes often.

What I want you to do, and this is your homework, is don’t focus on arousal. Focus on pleasure. Focus on the thing that-- again, it’s really about being in connection with your partner or yourself. As soon as you put a list of to-dos with it is often when things go wrong. Just focus on being present as much as you can, and in the moment being aware of, ooh, move towards the exciters, the gas pedal things. Move away from the inhibitors. Be careful there. Again, for those of you who have anxiety, that doesn’t mean thought suppress. That doesn’t mean judge your thoughts because that in and of itself is an inhibitor often.

I want to leave you with that. I’m going to in the future do a whole nother episode about talking more about this idea of arousal non-concordance, which is that quote I use like “The bodies don’t say yes or no, they say sex-related or not sex-related.” I’ll do more of that in the future. But for right now, I want it to be around you exploring your relationship with arousal, understanding it, but then putting your attention on pleasure. Being aware of both, being mindful of both.

Most people I know that I’ve talked to about this-- and I’m not a sex therapist. Again, I’m getting all of this directly from the workbook, but most of the clients I’ve talked to about this and we’ve used some worksheets and so forth, they’ve said, when I put all the expectations away and I just focus on this touch and this body part and this smell and this kiss or this fantasy, or being really in touch with your own body, when I just make it as simple as that and I bring it down to just engaging in what feels good – sort of use it as like a north star. You just keep following. That feels good. Okay, that feels good. That doesn’t feel so great. I’ll move towards what feels good – is moving in that direction non-judgmentally and curiously that they’ve had the time of their lives. I really just want to give you that gift. Focus on pleasure. Focus on non-judgmentally and curiously, being aware of what’s current and present in your senses.

That’s all I got for you for today. I think it’s enough. Do we agree? I think it’s enough. I could talk about this all day. To be honest, and I’ve said this so many times, if I had enough time, I would go back and I would become a sex therapist. It is a huge training. Sex therapists have the most intensive, extensive training and requirements. I would love to do it. But one day, I’ll probably do it when I’m 70. And that will be awesome. I’ll be down for that, for sure. I just love this content.

Now, again, I want to be really clear. I’m not a sex therapist. I still have ones to learn. I still have. Even what we’ve covered today, there’s probably nuanced things that I could probably explain better. Again, which is why I’m going to stress to you, go and check out the book. I’m just here to try and get you-- I was thinking about this. Remember, I just recently did the episode on the three-day silent retreat and I was sitting in a meditation. I remember this so clearly. I’m just going to tell you this quick story.

I was thinking. For some reason, my mind was a little scattered this day and something came over with me where I was like, “Wouldn’t it be wonderful if I didn’t just treat anxiety disorders, but I treated the person and the many problems that are associated with the anxiety disorder? Isn’t that a beautiful goal? Isn’t that so? Because it’s not just the anxiety, it’s the little tiny areas in our lives that it impacts.” That’s when I, out of me, as soon as I finished the meditation, I went on to my-- I have this organization board that I use online and it was arousal, let’s talk about pee and poop, which is one episode we recently did. Let’s talk about all the things because anxiety affects it all. We can make little changes in all these areas and little changes. Slowly, you get your life back. I hope this gives you a little bit of your sexual expression back, if I could put it into words. Maybe not expression, but just your relationship with your body and pleasure.

I love you. Thank you for staying with me for this. This was brave work you’re doing. You probably had cringy moments. Hopefully not. Again, none of this is weird, wrong, bad. This is all human stuff.

Finish up, again, do check out the book. Her name is Emily Nagoski. I’ll leave a link in the show notes. One day we’ll get her on. But in the meantime, I’ll hopefully just give you the science that she’s so beautifully given us.

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

Please do leave a review. It helps me so much. If you have a few moments, I would love a review, an honest review from you.

Have a good day.

Apr 22, 2022
Ep. 281 Anxiety and Arousal

SUMMARY: 

This episode addresses some common questions people have about anxiety and arousal. Oftentimes, we are too afraid to talk about anxiety and arousal, so I thought I would take this opportunity to address some of the questions you may have and take some of the stigma and shame out of discussing anxiety and how it impacts arousal, orgasm, intimacy, and sexual interactions.

In This Episode:

  • How anxiety and arousal impact each other (its a cycle)
  • Arousal Non-Concordance and how it impacts people with anxiety and OCD
  • How to take the shame out of arousal struggles
  • Understanding why anxiety impacts orgasms and general intimacy

Links To Things I Talk About:

Article I wrote about OCD and Arousal Non-Concordance
https://www.madeofmillions.com/articles/whats-going-ocd-arousal

Come as You are By Emily Nagoski, PhD
Come as You Are Workbook By Emily Nagoski, PhD
ERP School: https://www.cbtschool.com/erp-school-lp

Episode Sponsor:

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

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EPISODE TRANSCRIPTION

This is Your Anxiety Toolkit - Episode 281.

Welcome back, everybody. How are you? It is a beautiful sunny day here in California. We’re actually in the middle of a heatwave. It is April when I’m recording this and it is crazy how hard it is, but I’m totally here for it. I’m liking it because I love summer.

Talking about heat, let’s talk about anxiety and arousal today. Shall we? Did you get that little pun? I’m just kidding really.

Today, we’re talking about anxiety and arousal. I don’t know why, but lately, I’m in the mood to talk about things that no one really wants to talk about or that we all want to talk about and we’re too afraid to talk about. I’m just going to go there. For some reason, I’m having this strong urge with the podcast to just talk about the things that I feel we’re not talking about enough. And several of my clients actually were asking like, “What resources do you have?” And I have a lot of books and things that I can give people. I was like, “All right, I’m going to talk about it more.” So, let’s do it together.

Before we do that, let’s quickly do the review of the week. This one is from, let’s see, Jessrabon621. They said:

“Amazing podcast. I absolutely love everything about this podcast. I could listen to Kimberley talk all day and her advice is absolutely amazing. I highly recommend this podcast to anyone struggling with anxiety or any other mental health professional that wants to learn more.”

Thank you so much, Jess.

This week’s “I did a hard thing” is from Anonymous and they say:

“I learned it’s okay to fulfill my emotions and just allow my thoughts and it gave me a sense of peace. Learning self-compassion is my hard thing and I’m learning to face OCD and realize that it’s not my fault. I’m learning to manage and live my life for me like I deserve, and I refuse to let this take away my happiness.”

This is just so good. I talk about heat. This is seriously on fire right here. I love it so much. The truth is self-compassion practice is probably my hard thing too. I think that me really learning how to stand up for myself, be there for myself, be tender with myself was just as hard as my eating disorder recovery and my anxiety recovery. I really appreciate Anonymous and how they’ve used self-compassion as their hard thing.

Let’s get into the episode. Let me preface the episode by we’re talking about anxiety and arousal. If I could have one person on the podcast, it would be Emily Nagoski. I have been trying to get her on the podcast for a while. We will get her on eventually. However, she’s off doing amazing things. Amazing things. Netflix specials, podcasts, documentaries. She’s doing amazing things. So, hopefully, one day. But until then, I want to really highlight her as the genius behind a lot of these concepts.

Emily Nagoski is a doctor, a psychology doctor. She is a sex educator. She has written two amazing books. Well, actually, three or four. But the one I’m referring to today is Come as You Are. It’s an amazing book. But I’m actually in my hand holding the Come as You Are Workbook. I strongly encourage you after you listen to this podcast episode to go and order that book. It is amazing. It’s got tons of activities. It might feel weird to have the book. You can get it on Kindle if you want to have it be hidden, but it’s so filled with amazing information. I’m going to try and give you the pieces that I really want you to take away. If you want more, by all means, go and get the workbook. The workbook is called The Come as You Are Workbook: A Practical Guide to the Science of Sex. The reason I love it is because it’s so helpful for those who have anxiety. It’s like she’s speaking directly to us. She’s like, it’s so helpful to have this context.

Here’s the thing I want you to consider starting off. A lot of people who have anxiety report struggles with arousal. We’re going to talk about two different struggles that are the highlight of today. Either you have no arousal because of your anxiety, or you’re having arousal at particular times that concern you and confuse you and alarm you. You could be one or both of those camps.

So let’s first talk about those who are struggling with arousal in terms of getting aroused. So the thing I want you to think about is commonly-- and this is true for any mental health issue too, it’s true for depression, anxiety disorders, eating disorders, dissociative disorders, all of them really. But the thing I want you to remember, no matter who you are and what your experience is, even if you have a really healthy experience of your own sexual arousal and you’re feeling fine about it, we all have what’s called inhibitors and exciters. Here is an example.

An inhibitor is something that inhibits your arousal. An exciter is something that excites your arousal. Now you’re probably already feeling a ton of judgment here like, “I shouldn’t be aroused by this and I should be aroused by this. What if I’m aroused by this? And I shouldn’t be,” and so forth. I want us to take all the judgment out of this and just look at the content of what inhibits our arousal or excites our arousal. Because sometimes, and I’ll talk about this more, sometimes it’s for reasons that don’t make a lot of sense and that’s okay.

Let’s talk about an inhibitor, something that pumps the brakes on arousal or pleasure. It could be either. There’s exciters, which are the things that really like the gas pedal. They just really bring on arousal, bring on pleasure, and so forth.

We have the content. The content may be first mental or physical, and this includes your health, your physical health. For me, I know when I am struggling with POTS, arousal is just barely a thing. You’re just so wiped out and you’re so exhausted and your brain is foggy. It’s just like nothing. That would be, in my case, an inhibitor. I’m not going to talk about myself a lot here, but I was just using that as an example. You might say your anxiety or your obsession is an inhibitor. It pumps the brakes on arousal. It makes it go away. Worry is one.

It could also be other physical health, like headaches or tummy aches, or as we said before, depression. It could be hormone imbalances, things like that. It’s all as important. Go and speak with your doctor. That’s super important. Make sure medically everything checks out if you’re noticing a dip or change in arousal that’s concerning you.

The next one in terms of content that may either excite you or inhibit you is your relationship. If your relationship is going well, you may or may not have an increase in arousal depending on what turns you on. If your partner smells of a certain smell or stench that you don’t like, that may pump the brakes. But if they smell a certain way that you do really like and really is arousing to you, that may excite your arousal.

It could also be the vibe of the relationship. A lot of people said at the beginning of COVID, there was a lot of fear. That was really, really strong on the brakes. But then all of a sudden, no one had anything to do and there was all this spare time. All of a sudden, the vibe is like, that’s what’s happening. Now, this could be true for people who are in any partnership or it could be just you on your own too. There are things that will excite you and inhibit your arousal if you’re not in a relationship as well, and that’s totally fine. This is for all relationships. There’s no specific kind.

Setting is another thing that may pump the brakes or hit the gas for arousal, meaning certain places, certain rooms, certain events. Did your partner do something that turned you on? Going back to physical, it could also depend on your menstrual cycle. People have different levels of arousal depending on different stages of their menstrual cycle. I think the same is true for men, but I don’t actually have a lot of research on that, but I’m sure there are some hormonal impacts on men as well.

There’s also ludic factors which are like fantasy. Whether you have a really strong imagination, that either pumps the brakes or puts the gas pedal in terms of arousal. It could be like where you’re being touched. Sometimes there’s certain areas of your body that will set off either the gas pedal or the brakes. It could be certain foreplay.

Really what I’m trying to get at here isn’t breaking it down according to the workbook, but there’s so many factors that may influence your arousal.

Another one is environmental and cultural and shame. If arousal and the whole concept of sex is shamed or is looked down on, or people have a certain opinion about your sexual orientation, that too can impact your gas pedal and your brakes pedal. So, I want you to explore this, not from a place of pulling it apart really aggressively and critically, but really curiously and check in for yourself, what arouses me? What presses my brakes? What presses my gas? And just start to get to know that. Again, in the workbook, there’s tons of worksheets for this, but you could also just consider this on your own. Write it down on your own, be aware over the next several days or weeks, just jot down in a journal what you’re noticing.

Now, before we move on, we’ve talked about a lot of people who are struggling with arousal, and they’ve got a lot of inhibitors and brake pushing. There are the other camp who have a lot of gas pedal pushing. I speak here directly to the folks who have sexual obsessions because often if you have sexual obsessions, the fact that your sexual obsession is sexual in nature may be what sets the gas pedal off, and all of a sudden, you have arousal for reasons that you don’t understand, that don’t make sense to you, or maybe go against your values.

I’ve got a quote that I took from the book and from the workbook of Emily Nagoski. Again, none of this is my personal stuff. I’m quoting her and citing her throughout this whole podcast. She says, “Bodies do not say yes or no. They say sex-related or not sex-related.” Let me say it again. “Bodies do not say yes or no. They say sex-related or not sex-related.”

This is where I want you to consider, and I’ve experienced this myself, is just because something arouses you doesn’t mean it brings you pleasure. Main point. We’ve got to pull that apart. Culture has led us to believe that if you feel some groinal response to something, you must love it and want more of it.

An example of this is for people with sexual obsessions, maybe they have OCD or some other anxiety disorder, and they have an intrusive thought about a baby or an animal. Bestiality is another very common obsession with OCD or could be just about a person. It could be just about a person that you see in the grocery store. When you have a thought that is sex-related, sometimes because the context of it is that it’s sex-related, your body may get aroused. Our job, particularly if you have OCD, is not to try and figure out what that means. It’s not to try and resolve like, does that mean I like it? Does that mean I’m a terrible person? What does that mean?

I want you to understand the science here to help you understand your arousal, to help you understand how you can now shift your perspective towards your body and your mind and the pleasure that you experience in the area of sexuality. Again, the body doesn’t say yes or no, they say it’s either sex-related or not sex-related.

Here’s the funny thing, and I’ve done this experiment with my patients before, is if you look at a lamp post or it could be anything, you could look at the pencil you’re holding and then you bring to mind a sexual experience, you may notice arousal. Again, it doesn’t mean that you’re now aroused by pencils or pens. It’s that it was labeled as sex-related, so often your brain will naturally press the accelerator.

That’s often how I educate people, particularly who are having arousal that concerns it. It’s the same for a lot of people who have sexual trauma. They maybe are really concerned about the fact that they do have arousal around a memory or something. And then that concerns them, what does that mean about me? And the thing to remember too is it’s not your body saying yes or no, it’s your body saying sex-related or not sex-related. It’s important to just help remind yourself of that so that you’re not responding to the content so much and getting caught up in the compulsive behaviors.

A lot of my patients in the past have reported, particularly during times when they’re stressed, their anxiety is really high, life is difficult, any of this content we went through, is they may actually have a hard time being aroused at all. Some people have reported not getting an erection and then it completely going for reasons they don’t understand. I think here we want to practice again non-Judgment. Instead, move to curiosity. There’s probably some content that impacted that, which is again, very, very, normal.

this is why when I’m talking with patients – I’ve done episodes on this in the past, and we’ve in fact had sex therapists on the podcast in the past – is they’ve said, if you’ve lost arousal, it doesn’t mean you give up. It doesn’t mean you say, “Oh, well, that’s that.” What you do is you move your attention to the content that pumps the gas. When I mean content, it’s like touch, smell, the relationship, the vibe, being in touch with your body, bringing your attention to the dance that you’re doing, whether it’s with a partner or by yourself, or in whatever means that works for you. You can bring that back. There’s another amazing book called Better Sex Through Mindfulness, and it talks a lot about bringing your attention to one or two sensations. Touch, smell being two really, really great ones.

Again, if your goal is to be aroused, you might find it’s very hard to be aroused because the context of that is pressure. I don’t know about you, but I don’t really find pressure arousing. Some may, and again, this is where I want this to be completely judgment-free. There’s literally no right and wrong. But pressure is usually not that arousing. Pressure is not that pleasurable in many cases, particularly when it’s forceful and it feels like you have to perform a certain way. Again, some people are at their best in performance mode, but I want to just remind you, the more pressure you put on yourself on this idea of ending it well is probably going to make some anxiety. Same with test anxiety. The more pressure you put on yourself to get an A, the more you’re likely to spin out with anxiety. It’s really no different.

So, here is where I want you to catch and ask yourself, is the pressure I put on myself or is the agenda I put on myself actually pumping the brakes for me when it comes to arousal? Is me trying not to have a thought actually in the context of that, does that actually pump the brakes? Because I know you’re trying not to have the thought so that you can be intimate in that moment and engaged in pleasure. But the act of trying not to have the thought can actually pump the brakes. I hope that makes sense. I want you to get really close to understanding what’s going on for you.

Everyone is different. Some things will pump the brakes, some things will pump the accelerator. A lot of the times, thought suppression pumps the brakes. A lot of the times, beating yourself up pumps the brakes. A lot of the time, the more goal, like I have to do it this way, that often pumps the brakes. So, keep an eye out for that. Engage in the exciters and get really mindful and present.

A couple of things here. We’ve talked about erections, that’s for people who struggle with that. It’s also true for women or men with lubrication. Some people get really upset about the fact that there may or may not be a ton of lubrication. Again, we’ve been misled to believe that if you’re not lubricated, you mustn’t be aroused or that you mustn’t want this thing, or that there must be something wrong with you, and that is entirely true. A lot of women, when we study them, they may be really engaged and their gas pedal is going for it, but there may be no lubrication. And it doesn’t mean something is wrong. In those cases, often a sex therapist or a sex educator will encourage you to use lubrication, a lubricant.

Again, some people, I’ve talked to clients and they’re so ashamed of that. But I think it’s important to recognize that that’s just because somebody taught us that, and sadly, it’s a lot to do with patriarchy and that it was pushed on women in particular that that meant they’re like a good woman if they’re really lubricated. And that’s not true. That’s just fake, false. No science. It has no basis in reality.

Now we’ve talked about lubrication. We’ve talked about erection. Same for orgasm. Some people get really frustrated and disheartened that they can’t reach orgasm. If for any reason you are struggling with this, please, I urge you, go and see a sex therapist. They are the most highly trained therapists. They are so sensitive and compassionate. They can talk with you about this and you can target the specific things you want to work on. But orgasm is another one. If you put pressure on yourself to get there, that pumps the brakes often.

What I want you to do, and this is your homework, is don’t focus on arousal. Focus on pleasure. Focus on the thing that-- again, it’s really about being in connection with your partner or yourself. As soon as you put a list of to-dos with it is often when things go wrong. Just focus on being present as much as you can, and in the moment being aware of, ooh, move towards the exciters, the gas pedal things. Move away from the inhibitors. Be careful there. Again, for those of you who have anxiety, that doesn’t mean thought suppress. That doesn’t mean judge your thoughts because that in and of itself is an inhibitor often.

I want to leave you with that. I’m going to in the future do a whole nother episode about talking more about this idea of arousal non-concordance, which is that quote I use like “The bodies don’t say yes or no, they say sex-related or not sex-related.” I’ll do more of that in the future. But for right now, I want it to be around you exploring your relationship with arousal, understanding it, but then putting your attention on pleasure. Being aware of both, being mindful of both.

Most people I know that I’ve talked to about this-- and I’m not a sex therapist. Again, I’m getting all of this directly from the workbook, but most of the clients I’ve talked to about this and we’ve used some worksheets and so forth, they’ve said, when I put all the expectations away and I just focus on this touch and this body part and this smell and this kiss or this fantasy, or being really in touch with your own body, when I just make it as simple as that and I bring it down to just engaging in what feels good – sort of use it as like a north star. You just keep following. That feels good. Okay, that feels good. That doesn’t feel so great. I’ll move towards what feels good – is moving in that direction non-judgmentally and curiously that they’ve had the time of their lives. I really just want to give you that gift. Focus on pleasure. Focus on non-judgmentally and curiously, being aware of what’s current and present in your senses.

That’s all I got for you for today. I think it’s enough. Do we agree? I think it’s enough. I could talk about this all day. To be honest, and I’ve said this so many times, if I had enough time, I would go back and I would become a sex therapist. It is a huge training. Sex therapists have the most intensive, extensive training and requirements. I would love to do it. But one day, I’ll probably do it when I’m 70. And that will be awesome. I’ll be down for that, for sure. I just love this content.

Now, again, I want to be really clear. I’m not a sex therapist. I still have ones to learn. I still have. Even what we’ve covered today, there’s probably nuanced things that I could probably explain better. Again, which is why I’m going to stress to you, go and check out the book. I’m just here to try and get you-- I was thinking about this. Remember, I just recently did the episode on the three-day silent retreat and I was sitting in a meditation. I remember this so clearly. I’m just going to tell you this quick story.

I was thinking. For some reason, my mind was a little scattered this day and something came over with me where I was like, “Wouldn’t it be wonderful if I didn’t just treat anxiety disorders, but I treated the person and the many problems that are associated with the anxiety disorder? Isn’t that a beautiful goal? Isn’t that so? Because it’s not just the anxiety, it’s the little tiny areas in our lives that it impacts.” That’s when I, out of me, as soon as I finished the meditation, I went on to my-- I have this organization board that I use online and it was arousal, let’s talk about pee and poop, which is one episode we recently did. Let’s talk about all the things because anxiety affects it all. We can make little changes in all these areas and little changes. Slowly, you get your life back. I hope this gives you a little bit of your sexual expression back, if I could put it into words. Maybe not expression, but just your relationship with your body and pleasure.

I love you. Thank you for staying with me for this. This was brave work you’re doing. You probably had cringy moments. Hopefully not. Again, none of this is weird, wrong, bad. This is all human stuff.

Finish up, again, do check out the book. Her name is Emily Nagoski. I’ll leave a link in the show notes. One day we’ll get her on. But in the meantime, I’ll hopefully just give you the science that she’s so beautifully given us.

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

Please do leave a review. It helps me so much. If you have a few moments, I would love a review, an honest review from you.

Have a good day.

Apr 22, 2022
Ep. 281 Anxiety and Arousal

SUMMARY: 

This episode addresses some common questions people have about anxiety and arousal. Oftentimes, we are too afraid to talk about anxiety and arousal, so I thought I would take this opportunity to address some of the questions you may have and take some of the stigma and shame out of discussing anxiety and how it impacts arousal, orgasm, intimacy, and sexual interactions.

In This Episode:

  • How anxiety and arousal impact each other (its a cycle)
  • Arousal Non-Concordance and how it impacts people with anxiety and OCD
  • How to take the shame out of arousal struggles
  • Understanding why anxiety impacts orgasms and general intimacy

Links To Things I Talk About:

Article I wrote about OCD and Arousal Non-Concordance
https://www.madeofmillions.com/articles/whats-going-ocd-arousal

Come as You are By Emily Nagoski, PhD
Come as You Are Workbook By Emily Nagoski, PhD
ERP School: https://www.cbtschool.com/erp-school-lp

Episode Sponsor:

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

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EPISODE TRANSCRIPTION

This is Your Anxiety Toolkit - Episode 281.

Welcome back, everybody. How are you? It is a beautiful sunny day here in California. We’re actually in the middle of a heatwave. It is April when I’m recording this and it is crazy how hard it is, but I’m totally here for it. I’m liking it because I love summer.

Talking about heat, let’s talk about anxiety and arousal today. Shall we? Did you get that little pun? I’m just kidding really.

Today, we’re talking about anxiety and arousal. I don’t know why, but lately, I’m in the mood to talk about things that no one really wants to talk about or that we all want to talk about and we’re too afraid to talk about. I’m just going to go there. For some reason, I’m having this strong urge with the podcast to just talk about the things that I feel we’re not talking about enough. And several of my clients actually were asking like, “What resources do you have?” And I have a lot of books and things that I can give people. I was like, “All right, I’m going to talk about it more.” So, let’s do it together.

Before we do that, let’s quickly do the review of the week. This one is from, let’s see, Jessrabon621. They said:

“Amazing podcast. I absolutely love everything about this podcast. I could listen to Kimberley talk all day and her advice is absolutely amazing. I highly recommend this podcast to anyone struggling with anxiety or any other mental health professional that wants to learn more.”

Thank you so much, Jess.

This week’s “I did a hard thing” is from Anonymous and they say:

“I learned it’s okay to fulfill my emotions and just allow my thoughts and it gave me a sense of peace. Learning self-compassion is my hard thing and I’m learning to face OCD and realize that it’s not my fault. I’m learning to manage and live my life for me like I deserve, and I refuse to let this take away my happiness.”

This is just so good. I talk about heat. This is seriously on fire right here. I love it so much. The truth is self-compassion practice is probably my hard thing too. I think that me really learning how to stand up for myself, be there for myself, be tender with myself was just as hard as my eating disorder recovery and my anxiety recovery. I really appreciate Anonymous and how they’ve used self-compassion as their hard thing.

Let’s get into the episode. Let me preface the episode by we’re talking about anxiety and arousal. If I could have one person on the podcast, it would be Emily Nagoski. I have been trying to get her on the podcast for a while. We will get her on eventually. However, she’s off doing amazing things. Amazing things. Netflix specials, podcasts, documentaries. She’s doing amazing things. So, hopefully, one day. But until then, I want to really highlight her as the genius behind a lot of these concepts.

Emily Nagoski is a doctor, a psychology doctor. She is a sex educator. She has written two amazing books. Well, actually, three or four. But the one I’m referring to today is Come as You Are. It’s an amazing book. But I’m actually in my hand holding the Come as You Are Workbook. I strongly encourage you after you listen to this podcast episode to go and order that book. It is amazing. It’s got tons of activities. It might feel weird to have the book. You can get it on Kindle if you want to have it be hidden, but it’s so filled with amazing information. I’m going to try and give you the pieces that I really want you to take away. If you want more, by all means, go and get the workbook. The workbook is called The Come as You Are Workbook: A Practical Guide to the Science of Sex. The reason I love it is because it’s so helpful for those who have anxiety. It’s like she’s speaking directly to us. She’s like, it’s so helpful to have this context.

Here’s the thing I want you to consider starting off. A lot of people who have anxiety report struggles with arousal. We’re going to talk about two different struggles that are the highlight of today. Either you have no arousal because of your anxiety, or you’re having arousal at particular times that concern you and confuse you and alarm you. You could be one or both of those camps.

So let’s first talk about those who are struggling with arousal in terms of getting aroused. So the thing I want you to think about is commonly-- and this is true for any mental health issue too, it’s true for depression, anxiety disorders, eating disorders, dissociative disorders, all of them really. But the thing I want you to remember, no matter who you are and what your experience is, even if you have a really healthy experience of your own sexual arousal and you’re feeling fine about it, we all have what’s called inhibitors and exciters. Here is an example.

An inhibitor is something that inhibits your arousal. An exciter is something that excites your arousal. Now you’re probably already feeling a ton of judgment here like, “I shouldn’t be aroused by this and I should be aroused by this. What if I’m aroused by this? And I shouldn’t be,” and so forth. I want us to take all the judgment out of this and just look at the content of what inhibits our arousal or excites our arousal. Because sometimes, and I’ll talk about this more, sometimes it’s for reasons that don’t make a lot of sense and that’s okay.

Let’s talk about an inhibitor, something that pumps the brakes on arousal or pleasure. It could be either. There’s exciters, which are the things that really like the gas pedal. They just really bring on arousal, bring on pleasure, and so forth.

We have the content. The content may be first mental or physical, and this includes your health, your physical health. For me, I know when I am struggling with POTS, arousal is just barely a thing. You’re just so wiped out and you’re so exhausted and your brain is foggy. It’s just like nothing. That would be, in my case, an inhibitor. I’m not going to talk about myself a lot here, but I was just using that as an example. You might say your anxiety or your obsession is an inhibitor. It pumps the brakes on arousal. It makes it go away. Worry is one.

It could also be other physical health, like headaches or tummy aches, or as we said before, depression. It could be hormone imbalances, things like that. It’s all as important. Go and speak with your doctor. That’s super important. Make sure medically everything checks out if you’re noticing a dip or change in arousal that’s concerning you.

The next one in terms of content that may either excite you or inhibit you is your relationship. If your relationship is going well, you may or may not have an increase in arousal depending on what turns you on. If your partner smells of a certain smell or stench that you don’t like, that may pump the brakes. But if they smell a certain way that you do really like and really is arousing to you, that may excite your arousal.

It could also be the vibe of the relationship. A lot of people said at the beginning of COVID, there was a lot of fear. That was really, really strong on the brakes. But then all of a sudden, no one had anything to do and there was all this spare time. All of a sudden, the vibe is like, that’s what’s happening. Now, this could be true for people who are in any partnership or it could be just you on your own too. There are things that will excite you and inhibit your arousal if you’re not in a relationship as well, and that’s totally fine. This is for all relationships. There’s no specific kind.

Setting is another thing that may pump the brakes or hit the gas for arousal, meaning certain places, certain rooms, certain events. Did your partner do something that turned you on? Going back to physical, it could also depend on your menstrual cycle. People have different levels of arousal depending on different stages of their menstrual cycle. I think the same is true for men, but I don’t actually have a lot of research on that, but I’m sure there are some hormonal impacts on men as well.

There’s also ludic factors which are like fantasy. Whether you have a really strong imagination, that either pumps the brakes or puts the gas pedal in terms of arousal. It could be like where you’re being touched. Sometimes there’s certain areas of your body that will set off either the gas pedal or the brakes. It could be certain foreplay.

Really what I’m trying to get at here isn’t breaking it down according to the workbook, but there’s so many factors that may influence your arousal.

Another one is environmental and cultural and shame. If arousal and the whole concept of sex is shamed or is looked down on, or people have a certain opinion about your sexual orientation, that too can impact your gas pedal and your brakes pedal. So, I want you to explore this, not from a place of pulling it apart really aggressively and critically, but really curiously and check in for yourself, what arouses me? What presses my brakes? What presses my gas? And just start to get to know that. Again, in the workbook, there’s tons of worksheets for this, but you could also just consider this on your own. Write it down on your own, be aware over the next several days or weeks, just jot down in a journal what you’re noticing.

Now, before we move on, we’ve talked about a lot of people who are struggling with arousal, and they’ve got a lot of inhibitors and brake pushing. There are the other camp who have a lot of gas pedal pushing. I speak here directly to the folks who have sexual obsessions because often if you have sexual obsessions, the fact that your sexual obsession is sexual in nature may be what sets the gas pedal off, and all of a sudden, you have arousal for reasons that you don’t understand, that don’t make sense to you, or maybe go against your values.

I’ve got a quote that I took from the book and from the workbook of Emily Nagoski. Again, none of this is my personal stuff. I’m quoting her and citing her throughout this whole podcast. She says, “Bodies do not say yes or no. They say sex-related or not sex-related.” Let me say it again. “Bodies do not say yes or no. They say sex-related or not sex-related.”

This is where I want you to consider, and I’ve experienced this myself, is just because something arouses you doesn’t mean it brings you pleasure. Main point. We’ve got to pull that apart. Culture has led us to believe that if you feel some groinal response to something, you must love it and want more of it.

An example of this is for people with sexual obsessions, maybe they have OCD or some other anxiety disorder, and they have an intrusive thought about a baby or an animal. Bestiality is another very common obsession with OCD or could be just about a person. It could be just about a person that you see in the grocery store. When you have a thought that is sex-related, sometimes because the context of it is that it’s sex-related, your body may get aroused. Our job, particularly if you have OCD, is not to try and figure out what that means. It’s not to try and resolve like, does that mean I like it? Does that mean I’m a terrible person? What does that mean?

I want you to understand the science here to help you understand your arousal, to help you understand how you can now shift your perspective towards your body and your mind and the pleasure that you experience in the area of sexuality. Again, the body doesn’t say yes or no, they say it’s either sex-related or not sex-related.

Here’s the funny thing, and I’ve done this experiment with my patients before, is if you look at a lamp post or it could be anything, you could look at the pencil you’re holding and then you bring to mind a sexual experience, you may notice arousal. Again, it doesn’t mean that you’re now aroused by pencils or pens. It’s that it was labeled as sex-related, so often your brain will naturally press the accelerator.

That’s often how I educate people, particularly who are having arousal that concerns it. It’s the same for a lot of people who have sexual trauma. They maybe are really concerned about the fact that they do have arousal around a memory or something. And then that concerns them, what does that mean about me? And the thing to remember too is it’s not your body saying yes or no, it’s your body saying sex-related or not sex-related. It’s important to just help remind yourself of that so that you’re not responding to the content so much and getting caught up in the compulsive behaviors.

A lot of my patients in the past have reported, particularly during times when they’re stressed, their anxiety is really high, life is difficult, any of this content we went through, is they may actually have a hard time being aroused at all. Some people have reported not getting an erection and then it completely going for reasons they don’t understand. I think here we want to practice again non-Judgment. Instead, move to curiosity. There’s probably some content that impacted that, which is again, very, very, normal.

this is why when I’m talking with patients – I’ve done episodes on this in the past, and we’ve in fact had sex therapists on the podcast in the past – is they’ve said, if you’ve lost arousal, it doesn’t mean you give up. It doesn’t mean you say, “Oh, well, that’s that.” What you do is you move your attention to the content that pumps the gas. When I mean content, it’s like touch, smell, the relationship, the vibe, being in touch with your body, bringing your attention to the dance that you’re doing, whether it’s with a partner or by yourself, or in whatever means that works for you. You can bring that back. There’s another amazing book called Better Sex Through Mindfulness, and it talks a lot about bringing your attention to one or two sensations. Touch, smell being two really, really great ones.

Again, if your goal is to be aroused, you might find it’s very hard to be aroused because the context of that is pressure. I don’t know about you, but I don’t really find pressure arousing. Some may, and again, this is where I want this to be completely judgment-free. There’s literally no right and wrong. But pressure is usually not that arousing. Pressure is not that pleasurable in many cases, particularly when it’s forceful and it feels like you have to perform a certain way. Again, some people are at their best in performance mode, but I want to just remind you, the more pressure you put on yourself on this idea of ending it well is probably going to make some anxiety. Same with test anxiety. The more pressure you put on yourself to get an A, the more you’re likely to spin out with anxiety. It’s really no different.

So, here is where I want you to catch and ask yourself, is the pressure I put on myself or is the agenda I put on myself actually pumping the brakes for me when it comes to arousal? Is me trying not to have a thought actually in the context of that, does that actually pump the brakes? Because I know you’re trying not to have the thought so that you can be intimate in that moment and engaged in pleasure. But the act of trying not to have the thought can actually pump the brakes. I hope that makes sense. I want you to get really close to understanding what’s going on for you.

Everyone is different. Some things will pump the brakes, some things will pump the accelerator. A lot of the times, thought suppression pumps the brakes. A lot of the times, beating yourself up pumps the brakes. A lot of the time, the more goal, like I have to do it this way, that often pumps the brakes. So, keep an eye out for that. Engage in the exciters and get really mindful and present.

A couple of things here. We’ve talked about erections, that’s for people who struggle with that. It’s also true for women or men with lubrication. Some people get really upset about the fact that there may or may not be a ton of lubrication. Again, we’ve been misled to believe that if you’re not lubricated, you mustn’t be aroused or that you mustn’t want this thing, or that there must be something wrong with you, and that is entirely true. A lot of women, when we study them, they may be really engaged and their gas pedal is going for it, but there may be no lubrication. And it doesn’t mean something is wrong. In those cases, often a sex therapist or a sex educator will encourage you to use lubrication, a lubricant.

Again, some people, I’ve talked to clients and they’re so ashamed of that. But I think it’s important to recognize that that’s just because somebody taught us that, and sadly, it’s a lot to do with patriarchy and that it was pushed on women in particular that that meant they’re like a good woman if they’re really lubricated. And that’s not true. That’s just fake, false. No science. It has no basis in reality.

Now we’ve talked about lubrication. We’ve talked about erection. Same for orgasm. Some people get really frustrated and disheartened that they can’t reach orgasm. If for any reason you are struggling with this, please, I urge you, go and see a sex therapist. They are the most highly trained therapists. They are so sensitive and compassionate. They can talk with you about this and you can target the specific things you want to work on. But orgasm is another one. If you put pressure on yourself to get there, that pumps the brakes often.

What I want you to do, and this is your homework, is don’t focus on arousal. Focus on pleasure. Focus on the thing that-- again, it’s really about being in connection with your partner or yourself. As soon as you put a list of to-dos with it is often when things go wrong. Just focus on being present as much as you can, and in the moment being aware of, ooh, move towards the exciters, the gas pedal things. Move away from the inhibitors. Be careful there. Again, for those of you who have anxiety, that doesn’t mean thought suppress. That doesn’t mean judge your thoughts because that in and of itself is an inhibitor often.

I want to leave you with that. I’m going to in the future do a whole nother episode about talking more about this idea of arousal non-concordance, which is that quote I use like “The bodies don’t say yes or no, they say sex-related or not sex-related.” I’ll do more of that in the future. But for right now, I want it to be around you exploring your relationship with arousal, understanding it, but then putting your attention on pleasure. Being aware of both, being mindful of both.

Most people I know that I’ve talked to about this-- and I’m not a sex therapist. Again, I’m getting all of this directly from the workbook, but most of the clients I’ve talked to about this and we’ve used some worksheets and so forth, they’ve said, when I put all the expectations away and I just focus on this touch and this body part and this smell and this kiss or this fantasy, or being really in touch with your own body, when I just make it as simple as that and I bring it down to just engaging in what feels good – sort of use it as like a north star. You just keep following. That feels good. Okay, that feels good. That doesn’t feel so great. I’ll move towards what feels good – is moving in that direction non-judgmentally and curiously that they’ve had the time of their lives. I really just want to give you that gift. Focus on pleasure. Focus on non-judgmentally and curiously, being aware of what’s current and present in your senses.

That’s all I got for you for today. I think it’s enough. Do we agree? I think it’s enough. I could talk about this all day. To be honest, and I’ve said this so many times, if I had enough time, I would go back and I would become a sex therapist. It is a huge training. Sex therapists have the most intensive, extensive training and requirements. I would love to do it. But one day, I’ll probably do it when I’m 70. And that will be awesome. I’ll be down for that, for sure. I just love this content.

Now, again, I want to be really clear. I’m not a sex therapist. I still have ones to learn. I still have. Even what we’ve covered today, there’s probably nuanced things that I could probably explain better. Again, which is why I’m going to stress to you, go and check out the book. I’m just here to try and get you-- I was thinking about this. Remember, I just recently did the episode on the three-day silent retreat and I was sitting in a meditation. I remember this so clearly. I’m just going to tell you this quick story.

I was thinking. For some reason, my mind was a little scattered this day and something came over with me where I was like, “Wouldn’t it be wonderful if I didn’t just treat anxiety disorders, but I treated the person and the many problems that are associated with the anxiety disorder? Isn’t that a beautiful goal? Isn’t that so? Because it’s not just the anxiety, it’s the little tiny areas in our lives that it impacts.” That’s when I, out of me, as soon as I finished the meditation, I went on to my-- I have this organization board that I use online and it was arousal, let’s talk about pee and poop, which is one episode we recently did. Let’s talk about all the things because anxiety affects it all. We can make little changes in all these areas and little changes. Slowly, you get your life back. I hope this gives you a little bit of your sexual expression back, if I could put it into words. Maybe not expression, but just your relationship with your body and pleasure.

I love you. Thank you for staying with me for this. This was brave work you’re doing. You probably had cringy moments. Hopefully not. Again, none of this is weird, wrong, bad. This is all human stuff.

Finish up, again, do check out the book. Her name is Emily Nagoski. I’ll leave a link in the show notes. One day we’ll get her on. But in the meantime, I’ll hopefully just give you the science that she’s so beautifully given us.

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

Please do leave a review. It helps me so much. If you have a few moments, I would love a review, an honest review from you.

Have a good day.

Apr 22, 2022
Ep. 280 Does Anxiety Make You Need to Pee or Poop?
22:13

In this week’s podcast episode, we are reflecting on the question, “Does anxiety make you need to pee or poop? Yes, you read that right! Today, we are talking ALL about how anxiety can cause frequent urination and the fear of peeing your pants.

Have you found yourself getting anxious you might need to pee or poop in public which, in turn, makes you need to pee or poop in public?

Bathroom emergencies are way more common than you think. I even share a story of how I, myself, had to handle the urgency to 🏃🏼‍♀️🏃🏿‍♂️ to the restroom.

In This Episode:

Why do we need to pee and poop when we are anxious?
What causes the psychological need to urinate or defecate when anxious?
How to stop anxiety Urination
How to manage a fear of peeing your pants or pooping your pants
How to use mindfulness and self-compassion when experiencing nervous pee syndrome

Links To Things I Talk About:

Overcoming Anxiety and Panic 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 280.

Welcome back, everybody. I am so thrilled to have you here with me again today. Today’s format is going to be a little different. I have fused the “I did the hard thing” with the question that we’re going to address today.

Usually, I sit down to the microphone and I look at my screen and I think about what I want to talk about, and I just start talking about it. To be honest, that is how this show goes. It has always been how this show has gone. But a follower on Instagram reached out to me this week and posed a really great question. So, with her permission, I will anonymously invite you to listen to the question, and then we’re going to talk about some solutions.

The reason I wanted to go word for word is I think you’re probably going to get what she’s saying, because I’ve been in this position. I know most of my clients have been in this position. It’s not the funniest thing to talk about. I mean, I love talking about it, but it’s not the funniest thing for you to talk about, or often people have a lot of shame and embarrassment around this topic. So, I wanted to just, let’s just talk about it.

Now, the reason I say I love to talk about it is, you know probably from previous episodes, I commonly ask my clients pretty personal questions. And often questions are like, are you prioritizing time to pee and poop? Are you holding your pee and poop? My job is to ask the questions that people are often too afraid to bring up. I often ask some personal questions about sexual arousal and things like that, again, because I have been trained to understand there’s a lot of stigma and shame, and embarrassment around these topics. And so I try to de-stigmatize them and take the shame out of them by just addressing them because they’re normal human struggles that we have.

As you may imagine, today, we’re talking about anxiety and pee and poop, and how anxiety can often make us feel like we urgently need to pee or/and poop. That’s the topic of today. I’m going to read you this. It’s a two-part question. I’m going to address them separately, but all from the same situation. It said: “Kim, I hope you are well. I was reading your post yesterday about the hardest part of facing your fear.”

To give you some backstory, I did a post on what the hardest things about facing fears are. I posed this question to Instagram and everyone wrote in. And using the results of what everyone wrote in, I created a post. And number seven was physical symptoms, especially bowel issues, and it really resonated with me.

Why do we need to pee and poop when we are anxious?

“You have said before that when you get feelings of discomfort, to just sit with it and do nothing.” That’s a common theme I talk about, is if you have discomfort, do nothing at all. You just sit with it. “But when it comes to bowel issues or needing to urinate due to anxiety, I get confused at what to do. Should I be sitting with it or going to the loo because that’s what my body needs? There are sort of two parts to my anxiety. With this, I’ll give you an example.” She said, “This weekend, I’m going to a christening and I get anxious for these types of events, like christenings, weddings, theater, anywhere where there is lots of people and they sit together in a certain way. I feel anxious about needing to go to the bathroom. It’s almost like I’m anxious of the symptom of anxiety.”

Yes. Now this is exactly what it is like for so many people, and it’s a really great question. Here is my response. Naturally, it’s a normal part of the human instinct to need to pee and poop when you’re anxious. Hundreds of thousands of years ago, when we were faced with danger or some kind of threat, in order to get away from that threat, usually you needed to be able to run many, many, many miles in a very short period of time. Now, we have cars and planes to get away from danger, or we have technology to help us to get away from danger. But back we needed to run that long-distance and exert a lot of energy. And so naturally, our bodies get rid of weight and waste so that you can be prepared to run a long distance away from the threat. Often the easiest way to get rid of that waste and weight is to defecate (to go poop) and to urinate, which is to go pee, or in some cases, throw up. Some people when they’re anxious, because their brain has detected danger, whether there’s danger or not, you may do one of those three things. That’s a very, very normal approach to the fight, flight, and freeze.

So, in this case, let’s say your brain has set off a false alarm and is saying there’s going to be lots of people there, and what if you need to pee and poop? So now you’re afraid of the symptom of anxiety like they’ve asked. What do you do? So here is my answer to that.

When we have any symptoms of anxiety – increase in heart rate, sweating, lots of racing, thoughts, it could be tummy ache, it could be the need to urinate – yeah, we do want to practice the art of sitting with it, meaning tolerating it without reacting to it in an aversive way, meaning trying to resist it, make it go away, how can we remove this discomfort from our life? When we do that, we get into a cycle where you’re constantly trying to get rid of discomfort and that keeps you stuck.

In this situation, yeah. If you have a slight urge to urinate or to go to the bathroom, if you’re able to, do try to tolerate that discomfort. However, if there’s a strong urge to go to the bathroom, there is absolutely nothing wrong with going to the bathroom. What I would say to you is it depends. The answer is it depends, and it’s a very personal one.

I will tell you a story personally. I know it was probably TMI, but I remember when I was becoming an American citizen, I was overwhelmingly anxious about this situation. I was afraid of everything. I was afraid of the test. I was really emotional about becoming an American. I felt like I was denouncing my country. I was so anxious about the security process. I was so afraid that I was going to mess up and get into some legal trouble, even though I’d done everything by the book. It was really, really overwhelming. The minute I got in line, which were these thousands of people in line, I needed to go to the bathroom, like right now, it had to happen. So, in that instance, yes, I’m going to ask somebody where the bathroom is and I’m going to go to the bathroom. So, I did okay. TMI, but we’re talking about it. Everybody pees and poops, so I’m not embarrassed.

Now, as soon as I got back in line, I lost my spot. I was at the back of the line again. My husband was with me. “Uh-oh, I need to go to the bathroom again.” I already know, I’ve probably dropped a lot of that weight. My brain thinks that there’s a major danger when there’s not. So, my job then is I could have easily gotten out of line again to try and get rid of that discomfort and that fear and that uncomfortableness in my stomach. But because I knew I’d already gone, my job was, I really need to get into this security building as a government building. I can’t keep getting out of line. My work then was to practice seeing if I could just hold that feeling.

Now I’m not here at all saying or suggesting that you should hold for long periods of time or even to be where you’re tolerating an experience of pain. Again, it depends. The answer is, it depends. If you’ve already gone, can you hold on? If let’s say you’re holding on and you’re like, “Oh no, it’s definitely coming, I need to go,” by all means, go. That’s not a compulsion. It’s just you listening to your body. It’s you giving yourself permission to just go with the flow and again, it’s a wonderful exposure of giving your body’s permission to run the show.

How to stop Anxiety Urination?

I think the answer is, listen to your body, see what you can do. Again, we always want to be experimenting with tolerating discomfort for long periods or as long as you can. Bit for no reason should you hold for long periods of time and put yourself in additional pain.

Now that being said, if you’re going to the bathroom, just to remove your anxiety about going to the bathroom, or you’re going to the bathroom to remove your anxiety of whether or not you will pee or poop your pants, that’s a different story. If you’re going to the bathroom to relieve anxiety, not physical, like actual urgency to go to the bathroom, well then yes, you’re giving into fear. We don’t want to let fear win, particularly when your brain is telling us there’s danger when there’s not.

A perfect example, I’m becoming a citizen. I have to take a test. There’s no real danger. The worst thing that could happen is I fail the test or I don’t bring a paper or something. In this case for the ceremony, the worst thing that could happen is you would need to go to the bathroom, right? Or even if you maybe-- again, the worst thing that could happen is you would have to go. But if fear is saying, “Oh no, no, there is really bad possible, maybe possible maybes,” because fear does that, it always gives you the possible maybes – then no, we would not go to the bathroom just to relieve anxiety.

If a lot of people, specifically those with panic disorder, they are very, very afraid of the sensations of anxiety. So, your job is actually, if that’s the case, to practice leaning in and having those sensations, tolerating those sensations. Or if you’re going to do exposure and response prevention, even better, you would purposely try to create the scenario so that you could simulate the anxiety and practice tolerating it that way.

So, my answer, I know, isn’t direct. It is, it depends. But when it does come to fear, it’s always going to be the same – do not let fear make your choices. Do no.

The next part of the question, I think, is another part of this, which I think is really important. So, they said, the second part is, “If I do need it and I have to leave the room during the ceremony, I wonder what people will think of me. I feel like I’m being a disruption. Also, if I have to move past anyone, I sit down, I feel like a nuisance. And then too, so often at the end of the seat--” so they sit at the end of the seat, excuse me, just in case. “Some of my compulsions, safety behaviors around this are needing to know where the nearest toilet is, going multiple times beforehand. Or I may do a certain number of pelvic floor squeezes whilst in the toilet.” They said, “Sorry if this is a long message, I just wanted to explain fully. I think the main thing I’m asking you is, should I be sitting with the feeling or not? If you do not see this up, the rest is just saying about the message.”

There we go. I think there’s so much great opportunity here for exposure and really willingness to be uncomfortable. The first thing is, everyone pees and poops. There is no shame in needing to go to the bathroom. I have a lot of clients who, when they’re anxious, they got to go. They got to go. It’s not anxiety. They’ve got to go to the bathroom or there’s going to be an accident. Not the fear. It’s like, “No, it’s actually coming.” If that’s the case, your job is to give yourself permission to be a human with anxiety and to be gentle and compassionate toward yourself that yes, sometimes people need to leave ceremonies.

If someone behind you is judging you for needing to leave, that is a full reflection on them. It means nothing about you. Human beings are allowed to come and go as they please. If they need to pee and poop, that is their right. What I would encourage you to do is, this is like a social anxiety sort of talk, and we’ve got some podcasts on social anxiety, but your job is to give other people permission to judge us and do nothing about it. Do nothing. Do nothing about their judgment, because their judgment is a full reflection of them and their beliefs, not of us.

The next part is they’ve gone over a ton of safety behaviors – checking the toilet, going multiple times. I would strongly-- if it were my client and you guys do what’s right for you always, take what you need, leave the rest. But if it were my client or if it were myself, I would strongly suggest other than otherwise not doing these behaviors. We don’t want to be doing behaviors. This goes for every topic. We don’t want to be doing behaviors just in case, that just in case behaviors keep us stuck in a cycle of anxiety, that just in case behaviors validate your fear as if your fear is true and important and a fact. We don’t want to do that. We can’t do that because when we do that, we keep the fear cycling.

So, I would actually encourage you to not check for bathrooms, not go to the bathroom before, unless of course you genuinely need to, not just because of fear. If for some reason you have the need, practice saying “I can have it.” If the feeling is the pressure is down in that bowel and that pelvic area, that won’t kill you either.

I always think of when I’m on an airplane to Australia, you know what happens? You get on the plane, you put your bags away. You’re getting ready. And then they say, preparing for takeoff, the seatbelt light comes on, and then immediately you need to go pee. And you can’t get up. They won’t you, so you hold it. People hold it all the time. Again, we don’t want you to push you through pain, but you can hold it. Be really honest with yourself. Nothing terrible is going to happen. If it’s really urgent, of course, I mean, even on a plane, if you’re really going to pee or poop your pants, they’re going to let you stand up. They’re not going to make you sit in the chair. Try not to be doing these behaviors. Practice tolerating the discomfort of other people possibly judging you.

One thing to keep in mind here too is when-- let’s say you go back to my story, I had to leave the line. I could have done a lot of mind reading, which is a cognitive distortion, which is going, “Oh, they think this and he thinks that, and she thinks that about me.” That’s all mind reading. You don’t actually know what they’re thinking. They might be thinking, what a beautiful dress you’re wearing, or they might be thinking, man, I can’t wait for this ceremony to be over. You have no idea, they might be thinking about something so different. So, it’s important that we also practice not mind reading what people think about us.

There you have it. These urgencies to go are normal. Everyone pees and poops. That’s just the facts. It doesn’t matter whether you do it once a day or 20 times a day, depending on if you’re anxious. Give yourself to not be perfect.

A lot of times, we also talk about when people are doing exposures or they’re having a panic attack, they’re like, “Ah, it’s not just the panic attack. I don’t want people to see me having a panic attack,” or “It’s not just the anxiety. I don’t want to have to cry in public.” The work here is you’re a human being. If you’re a human being, you won’t be perfect. If you’re holding yourself to a standard where you, number one, aren’t allowed to cry, you’re not allowed to pee, you’re not allowed to poop, you’re not allowed to disrupt other people, Well, that’s a lot of expectations you’re putting on yourself. That’s a lot of pressure that you just created in your head. No one else is expecting perfection from you. So, maybe adjust the expectations there as well.

Now the last thing I will address, which isn’t specifically to the pee and the poop, is some people get a lot of gas when they’re anxious. They have a strong urgency to pass gas. This is very common for people who have irritable bowel syndrome, same with getting diarrhea or needing to pee or poo. This is very common. If you have IBS, please do speak with a doctor. Let them know that you’re struggling with this. There’s nothing to be ashamed of. They can, of course, diagnose you, make sure they maybe get you some help in those areas. Again, if you need to pass gas, no different. Humans pass gas. It’s not something to be completely ashamed of. Is it embarrassing? Yes, it is. But you do what you have to do. You just have to get through.

I’ve heard so many people tell me stories of their most anxious moment being made more difficult because they had no choice, but to pass gas during that. And if that’s the case for you as well, again, I think any human who ridicules someone for needing to pass gas, which is such a human thing, I think we pass gas 17 times on average a day. Everyone, not select people, everyone, anyone who passed judgment on you for that is probably may want to step up their ability to be compassionate and empathic. Again, it’s not about you, it’s about them. So, be super, super gentle with yourself.

I think I hit my limit of how many times I said pee and poop, and now we’ve added in pass gas and we’ve even used the “diarrhea” word, which I think is epic. I think I’ve checked all the boxes for today’s episode. So, I hope that it was helpful for you. I genuinely hope that it just dropped some of the anxiety and judgment you have about yourself in regards to the urgency to need to go and pee and poop.

If I were to summarize it, I would say it’s very common to need to urinate, go to the bathroom or even pass gas. Lots of people have even diarrhea, very, very strong diarrhea. If that is the case for you, do what you need to do as best as you can. It’s okay if you need to go to the restroom. No problem. If you’re only going to reduce your anxiety about needing to go, I encourage you to try and challenge that some. Again, we do not want to give all of our power to fear. We actually want to ignore fear and give it none of our attention. If you can do that, you’re doing amazing hard work.

I love you all so much. Thank you for holding space for me as we talk about all things, bowel-related and urination-related. Even though it’s uncomfortable, it is so important for us to be having these conversations. I hope again, it was helpful for you, and thank you for holding space for me as we talk about these things together.

All right. I love you all. I hope you’re having an amazing, amazing week. I hope you’re being kind to yourself and really opening your heart to your own suffering instead of shutting it down because you’re suffering matters. It deserves to be held tenderly.

It is a beautiful day to do hard things. I cannot finish an episode without saying it. I encourage you, if you’ve gotten this far in the episode, to practice the hard things as much as you can every single day.

Have a wonderful day, everyone.

Apr 15, 2022
Ep. 279 A Quick Self-Compassion Check-in
14:19

In todays podcast episode, together we do a self-compassion check in.  First, we address what is self-compassion and then, we check in on our needs.  Mindful Self-Compassion involves first, being aware of what we need and what needs tending to.  In this episode, we also walk through a self-compassion meditation together.

In This Episode:

  • What is Self-Compassion?
  • What do I need?
  • How can I give myself self-compassion right now?
  • Self-compassion meditation.

Links To Things I Talk About: https://read.amazon.com/kp/embed?asin=B08WGW9XCZ&preview=newtab&linkCode=kpe&ref_=cm_sw_r_kb_dp_XSDYJ2MCRJBYEFCPS5NF&tag=cbtschool-20 ERP School: https://www.cbtschool.com/erp-school-lp

Episode Sponsor:

This episode of Your Anxiety Toolkit is brought to you by CBTschool.com. CBTschool.com is a psychoeducation platform that provides courses and other online resources for people with anxiety, OCD, and Body-Focused Repetitive Behaviors. Go to cbtschool.com to learn more. Spread the love! Everyone needs tools for anxiety... If you like Your Anxiety Toolkit Podcast, visit YOUR ANXIETY TOOLKIT 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 279. Welcome back, everybody. Today on Your Anxiety Toolkit podcast, we are talking about self-compassion. We’re doing a self-compassion check-in. It’s been a little while since we’ve checked in on how are you doing with your self-compassion practice. Now, today, we have added a little meditation for you just to supercharge your self-compassion practice. That is my agenda for today. We haven’t done a ton of check-ins lately because life just seems to get away from us. For those of you who do not know, in 2020, I wrote a book called The Self-Compassion Workbook For OCD. It was the joy of life and the biggest challenge of my life business-wise. It was such a huge agenda to have on my plate just as 2020 and COVID breakthrough, but I’m so grateful it’s out. When it was released, I had a lot of stuff out about self-compassion. And then I haven’t checked in with you guys on how you’re doing. So that’s what today is about. Now, before we get into the episode, let’s do the “I did a hard thing” for the week. We always check-in and someone submits the thing that they’ve done that is hard, because what we like to say is “It’s a beautiful day to do hard things.” And today’s is from Anonymous. They said: “I’ve recently been diagnosed with OCD and struggled my whole life with anxiety. Unfortunately, until now I was never properly diagnosed until I was 45. I have started working with a new therapist and we are focusing on ERP. At first, I couldn’t even tell her about my fears and intrusive thoughts. I have harm OCD among other various categories. Now, we are doing imaginals around some of the things I never thought I could even address, and I’m so proud of myself.” I’m proud of you too. “It is changing my life. I cannot tell you how important it is to get a proper diagnosis and never give up. You will get better. You just have to get the right help and be willing to do the hard things.” Anonymous, you are giving me the chills. Now, for those of you who don’t have access – anonymous has access to a therapist – if you don’t have access to a therapist, we do have an online course called ERP School. An ERP School is an online course that will teach you how to practice ERP at home, in your pajamas, all the skills that you need to get you started. Now, it does require you to be self-motivated. But if you are self-motivated and you are ready to learn, head on over to CBTSchool.com and you can get all the information there. All right, let’s go over to the show. It’s self-compassion check-in time.

WHAT IS SELF-COMPASSION?

What is Self-Compassion? It means how have you been treating yourself? Remember, self-compassion is ultimately treating yourself with the same that you would treat somebody else. So, if somebody else came to you and said, “I’m struggling with A, B, and C,” what would you say to them? How would you treat them? How would you respond to them? How would your body language change? Would your voice lower? Would your voice soften? Would you give them a hug if that was appropriate? Would you soften your eyes and let them know that everything was going to be okay, and that you had their back unconditionally? That is how you would treat yourself. So my question is, how are you doing with this? I want you to check in regularly, way more regularly than we are here today. But I want you to check in with yourself preferably every day or multiple times a day and ask yourself, how am I doing? And then we’re going to move into, and I know a lot of you remember this from previous episodes, but I want you to ask yourself the golden self-compassion question, which is, what do I need right now? What do I need? Let’s do this together. I want you to find a comfortable place. If you’re driving, please do not close your eyes. You may listen along. If you’re not driving, you may close your eyes. You may rest your shoulders. You may bring a gentle smile to your face. And I want you just to slowly bring your attention to your breath. And when I say breath, I don’t mean the physical rise and fall of your chest. I want you to bring your attention to the air that is going in and out of your body. You breathe in... The air goes into your lungs, replenishes, restores you. And then you breathe out air. And I want you to become familiar with this air as it enters your body and exits your body, replenishing you, supporting you, feeding you. And as you bring your attention to this air, I want you to gently slowly drop down into where you are and ask yourself, what is it that I need right now? If you notice being bombarded by many, many thoughts, that’s okay. Just tend to one at a time. Each one of them, each one of those thoughts gets a moment. And you are going to use your wise mind to decide which ones you’re going to tend to. As you ask yourself “What do I need right now,” you may notice your mind sharing with you, “I need rest. I need a moment. I need to laugh. I need food. I need to pee. I need water. I need to be kind to myself.” And take one at a time and take stock in acknowledging nonjudgmentally that that’s what you need. Nonjudgmentally, which means we’re not going to judge that we need it. We’re not going to treat ourselves poorly because we need it. We’re just going to acknowledge that’s what we need. Now, if you notice that your mind is coming up with other things like criticisms, a list of things to do, it might be telling you, you should be doing something different and more productive, they’re the thoughts that we maybe don’t tend to because you’re tending to those all day. Now is the time to check in for what you need. Say, “I’ll be right with you later, thoughts. Right now, it’s time to nourish me, to fill my cup so I can go and do those things later.” We breathe in air... And we breathe out air. Now we bring our attention to those needs and ask ourselves, is there anything we can tend to right now? Maybe the softening of your shoulders. Maybe to let go of the to-do list. Maybe to celebrate the wins that you’ve had today or yesterday or whenever. What do I need? Sometimes it’s to cry. Sometimes it’s to feel our feelings. Sometimes it’s to validate our own feelings and that’s our job. That’s our job. What a wonderful opportunity and a wonderful job we have, which is to be our first line of support and care, that we deserve that. Maybe you’re surprised by what’s showing up in what you need. Maybe you’re surprised that you need something and it’s something that you don’t usually need. That’s okay, too. Just be curious and open to that voice inside you. Now, if you’re struggling to identify what you need, I want you to just gently remind yourself that the wish to be compassionate towards yourself is self-compassion enough. If it doesn’t land and you don’t have this powerful experience or gentle experience, and for you, it’s actually quite gritty and edgy, that’s okay. Just the intention of being here and asking is so wonderful. I often think of my husband. If I went to him and he was struggling, and I said, “Is there anything I can do to support you?” he may not be ready to ask for my help. But just me offering it, the intention of being there to support means so much. And we can be that for ourselves. So again, take a deep breath in... And breathe out. And just give it one last time. Is there anything you can offer me in how I could support me? Which is you. Or is there anything you need? You might even offer it to your body parts if there’s particular areas struggling. Mind, what do you need? Tummy, what do you need? Foot, what do you need? Neck, what do you need? Now, as you’ve done this, I hope that you have been kind and non-judgmental, and non-critical. But if you are, I still want you to see this as a win. The check-ins can be so rich even when they’re bumpy. We’re going to slowly open our eyes... We’re going to bring our awareness to what’s around us and come grounded into the present again. And I hope that it’s the check-in you needed. I hope that you got to explore your needs, which are important, and then nothing to be embarrassed or ashamed of. It’s okay to have needs. In fact, it’s normal and natural and healthy to have needs. We all have them. Have a wonderful day, everybody. I hope you are doing well. Before we finish up, we are going to do the review of the week. This one is from Jessrabon621, and it says: “Amazing podcast! I absolutely love everything about this podcast! I could listen to Kimberley talk all day and her advice is absolutely amazing. I highly recommend this podcast for anyone struggling with anxiety or any mental health professional that wants to learn more.” Thank you so much, Jessrabon621. I love, love, love, love your reviews. Please do leave a review. I am trying to get to a thousand reviews and I will be giving away a free pair of Beats headphones to one lucky winner who leaves a review. Have a wonderful day, everybody. And I will see you all next week.

Apr 08, 2022
Ep. 278 What I learned From My Three Day Silent Retreat
21:44

In this week’s episode of Your Anxiety Toolkit Podcast, I share what I learned from my 3-day silent meditation retreat. This 3-day silent meditation retreat was rough, I won’t lie.  I had to ride many highs and lows, so I wanted to share them with you.

Links To Things I Talk About:

Tara Brach Silent Meditation Retreat home schedule
https://www.tarabrach.com/create-home-retreat/

Mindfulness Book
https://www.amazon.com/

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

Episode Sponsor:

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

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

EPISODE TRANSCRIPTION

This is Your Anxiety Toolkit - Episode 178.

Welcome back, everybody. I am so thrilled to be here with you today. I recently got back from a three-day silent retreat. I was by myself for the entire three days. It was a three-day silent retreat. I have done silent retreats in the past at Buddhist monasteries and Buddhist retreat centers. This is the first time I’ve done it on my own, and I followed the Tara Brach self-retreat website. I will leave the notes in the show notes so that you can check that out. It was amazing. I can’t lie. I had so many mind-blowing moments and I want to share with you each and every single one. I’m going to give you the cliff notes version. Otherwise, I would have you here for days on end. But I am so excited to share that with you.

Before we do that, of course, you know we always do the “I did a hard thing.” This is a segment where someone can write in, submit the hard thing they’ve done. This one is by Mgwolfie1992, and they’ve said:

“I have OCD and ASD. Certain shirts do not feel right. Before starting ERP, when I put on a shirt that’s uncomfortable, I immediately take it off, which was making me late for work. After starting ERP, I have slowly worked my way up to wearing and keeping that uncomfortable shirt on for 12 minutes.”

Mgwolfie1992, this is just you doing the work. I’m so, so impressed. This is exactly what it’s like for everybody listening or watching today, is it is about just small baby increments and getting yourself higher and higher and a little more difficult, a little more difficult. I’m so impressed with the work that you’re doing. This is just so incredibly powerful and rewarding, and I hope that you keep going.

Let’s talk about what I learned from my three-day silent retreat. Just to give you a setup, I rented through Airbnb a small little cabin in the depths of Topanga, which is very close to where I live in Los Angeles. I was following the Tara Brach home retreat that she created at the beginning of COVID. Now, when COVID hit, I so desperately wanted to do this, but I was in the middle of writing The Self-Compassion Workbook For OCD, and so I did not have time or the bandwidth to really go and really be with myself. I just had so much going on. As you probably remember, the world just felt so scary and no one knew what was happening. So I definitely wasn’t ready to do something at that time.

After several years or even months at this point where I feel like I’ve really, really prioritized my mental health and my medical health, I was finally in a place where I just felt like I needed some time to really go and let go of some things. I could be doing this at home. I could do this every day and I have since I returned, but I really felt that I needed these three days to do a deep dive into really some things that I had been working through having a medical illness, a chronic illness. I have postural orthostatic tachycardia syndrome, really coming down out of the pandemic and so forth. So, I really felt like I just needed this time to really not have the kids around and just drop down in and do that really hard work.

I took with me a journal. I took with me a book called Mindfulness by Joseph Goldstein. I strongly recommend that you try it. It is very heavy on Buddhist philosophy, but it is such an important book about mindfulness.

And so to start off, the thing that I learned the most was I needed so desperately to go back to basics. Everything felt so complex – everything I was teaching, everything I was doing in therapy, the practices of my own. It just felt like there were so many spinning parts. When I got there, I just dropped down to like, “Kimberley, let’s go back to the basics.” So I wanted to share with you what those basics were.

Number one, I went right back to the core of mindfulness, which was mostly me. The main agenda was to observe what showed up instead of being in reaction to it. Here, when life is so busy and chaotic and so many things happening at once, it’s really hard to be an observer. I think I have lost my ability to do that.

And so once I got there, I promised myself and my friends that I would not be contacting them, that I would have just one part of the day where I would text people back. I would check my phone, make sure everybody was okay and my clients were okay and my staff were okay. I would respond back, but very limited. And that throughout the day, if I felt the need to pick up my phone, or I felt the need to call, or I felt the need that I needed to talk to someone, that I had to stay in that feeling. And that’s why I really chose the silent retreat. I wanted to create an environment where I couldn’t rely on anybody except myself, and that no matter what I felt I had to hang on and I had to ride it out and I wanted to really drop down a little deeper and really explore what was going on for me.

Now, the thing that was most profound is the first day was excruciating. I mean, painful. I had every emotion under the sun. At one point at the evening, when I told my husband I would call after me waiting through these emotions all day, I did text and he asked how I was doing, and I said, “This is so hard. I don’t even want to be here.” I didn’t ask for his advice, but he did say via text, “Just keep going.” So, I did. Of course, I did.

But what was so fascinating to me, and one thing I really learned about myself, and I’m wondering if you do the same thing, is I had gone into this silent retreat not exhausted. Usually, by the time I take a break, I am so wiped out that I’m completely like starfish on the bed, completely out of it. This was really interesting because, for the first time, I wasn’t exhausted, and on the first day, I kept having the thought, “You don’t deserve this.” I kept thinking, this is ridiculous. People are at war. There is floods in my home country. So many people have it worse than me. “You don’t deserve this, Kimberley. This is unnecessary. This is actually very silly of you to have asked to do this three-day silent retreat.” I was so shocked at those thoughts.

Now, here is where the observing skill was so helpful for me. Instead of having that thought and then going, “Yeah, you’re right,” and then beating myself up or maybe even going home or feeling guilty or punishing myself, I just observed it and went, “Huh, that’s interesting. I’m having thoughts that this is selfish,” or “I’m having thoughts that this was silly.” Instead of fusing with those thoughts, I just observed them.

And I also observed the feeling and going, “Uh-huh, I feel guilty,” or “I feel selfish.” But instead of saying, “I am guilty and I am selfish,” I didn’t over-identify with those emotions, which is another mindfulness skill that I wanted to go back to the basics, is how much we over-identify with the thoughts we have. If something is uncomfortable, we go, “Oh, that means it must have to go away, and this is wrong. I’m wrong and I shouldn’t be feeling this way.” Instead, I just sat in it and I had this-- I want you to just imagine me. If you’re listening to the podcast, you won’t be able to see me. But if you’re watching me on video right now, I just had my head and kept nodding and smiling, like I was almost dancing with my head and just going, “Uh-hmm, yes, brain, I hear you. Yes, mind, I can hear what you’re saying, but I’m not going to connect with that. I’m going to allow it. I’m not going to push it away, but I’m just going to observe it.” Oh my gosh, I had so many breakthroughs, one after or the other, of just catching these rules and beliefs I have and how invasive they are and how reactive I am to them. Even though I’ve practiced this for years, I just knew I needed this time to let go of all of this.

Now the second thing I learned besides really dropping down into the basics and observing everything and not identifying was, in the Mindfulness book that I was reading, and I had it as my agenda to read it, is I had to practice going back to accepting impermanence. Now impermanence is a Buddhist concept that they talk about a lot. Basically, what it means is that this is temporary.

As I sat and I meditated so much on this three-day retreat, not so much the second day, but the first and the third day were really good meditation days. I sat on my meditation seat and all I would do is just try to stay in the moment and notice the impermanence. So, as a satisfying feeling showed up, I would just notice that this is temporary, that it will go, and I’m not going to cling to it. As an uncomfortable thought showed up, I said to myself, “This is temporary. I’m not going to cling to it. I’m not going to push it away.” Everything that showed up, I just kept going, “This is temporary. This is temporary.” Some people would probably argue that that’s a problem. Like, why would you push away good thoughts? But I had to keep reminding myself that my attachment to good is what creates a lot of my suffering.

A lot about impermanence is also looking at the fact that everything is temporary. In this beautiful rental that I had was these beautiful windows. I would sit right at the edge of the window and I would overlook this beautiful creek, all these trees, and leaves. A part of the meditation that I had practiced and I have practiced for many years is to meditate on impermanence, which is to sit and look. This time my eyes were open, and everything I see, I contemplated how temporary it is.

If it was a leaf that is just newly budded, I would imagine it fully coming into bloom, falling off the tree, and then completely breaking down into the ground where it was mud muddy and sludgy and yucky. And then looking at, let’s say the wood and going, “Yes, that too will break down over time.” Looking at my hand and my face and my body and imagining me too once was very youthful and now looking slightly older and acknowledging that that too is impermanence and that I too will die.

From that meditation, I cried. I sobbed actually, and I let go of a lot of beliefs and values I was hanging onto that really aren’t my values in terms of me having to stay young, that me having to stay liked by people, that I had to hold onto this idea. Instead, I was actually moving towards saying, “It’s okay. You can like me or hate me, because you liking me may actually be temporary. You may only need me for a period in your life. And then you may not need me.” And then again, observing what showed up for me and letting go of that too. It was just this massive cycle and it kept going and going. I would keep hitting these same things that I needed to let go of and learn and practice like observing and recognizing that things are temporary and that it doesn’t mean anything about me.

I know this may actually be a lot, but I can’t tell you how powerful it was. It was such a beautiful experience of letting go, of catching where I’m attached to things, and then letting go of that as well. I’m not saying that because I let them go they don’t bother me anymore. I am now in a cycle and it got me going and now allowing that letting go to be more automatic. Whereas before, I used to joke with my husband and my best friend. When they’d make a suggestion to me, like maybe they would offer me some advice, I would respond a little defensively. And that’s one of the reasons I really wanted this three-day retreat, is I could feel the tension in me on how inflexible I was and how I was being stubborn and holding tight on things. I knew that’s not what my core nature is.

I’m going to keep this short and I’ll give you one more thing that I learned. And this thing has probably been the most beautiful lesson I’ve ever learned. It’s been so synchronistic because so many things have really reinforced things since I’ve returned. This is the idea of independence versus interdependence.

I think since I recovered from my eating disorder, I have made it my goal to be independent. I don’t want to rely on people. I don’t want to ask them for help. I want to be a strong woman. I want to be a powerful human. I want to be peaceful in myself. I want to be self-sustaining, if that makes sense. This has been such amazing growth for me. I have learned so much and really learned my own strength because I made a deal with myself that I would always be my first person. Through that, I have learned to trust myself, to rely on myself, that I’m stronger than I thought. It’s a big reason why I say it’s a beautiful day to do hard things, is because I’ve practiced that my whole life.

But I was reading something from one of these, in the Tara Brach retreat, she has a lot of retreat talks and I was listening to some of these Dharma talks. One of them was that we’re interdependent. Even though we’re independent, we also need other people. And that actually through being interdependent is where we build community. It made me realize that I think I’ve swung too far in the independence. If there was a pendulum swinging, I’d swung too far in the independence and I needed to recognize how much I need other people. I need my friends, I need my husband more, I need my children more in different areas, that I need to ask for help more. It doesn’t mean I have to pay people. It doesn’t mean they owe me. It doesn’t mean I now fully swung the other direction into always being dependent. It’s that I’ve acknowledged that change happens more on the local level.

Since I created this podcast and I have an Instagram profile, I think my mind had very much gone to a large scale. Like, I have to make a huge difference, that I could make a huge difference. Something came through me, a sense of knowing in terms of, yes, I can make a large difference, but I can’t forget the local difference that I can make, the connection with my neighbors, the connection with my school. Particularly since COVID, we’ve become so technological. How can I actually connect with people more on a one-to-one basis instead of a one-to-thousand?

For some reason, that really spoke to me and I’ve never been more empowered and excited to serve you all because I think I needed to come out of the big crowd, thousands of people and really just start to go back to thinking one-to-one and thinking about the person instead of the crowd. I think that that will help me a lot in terms of being more connected, feeling more connected, feeling not lonely in things. They have that whole thing about you can be surrounded by people, but still feel lonely. I think that’s probably why I felt lonely in the past.

They’re the main things I learn. There are so many more, but really, I just want to emphasize, if you can create a one day or even a half-day silent retreat where you sit and really be with your emotions and commit to seeing what comes up, you will be shocked at the explosion of experiences that you have inside you. It doesn’t have to be three days. You don’t have to rent someplace. You could do it in your own home, even in one room if you need it, and really drop down. When those really painful emotions come up, really sit with them and be with them and practice letting them wax and wane as much as you can.

That’s what I learned. I hope that that has been inspiring to you in some way or another. For me, I’m more committed to my meditation practice than I’ve ever been. I’m more committed to my mindfulness than I’ve ever been, and I’m more connected to my business than I’ve ever been, which is really, really beautiful.

All right, thank you so much. I am so grateful for you being here with me today. I just love this work I’m doing with you and I hope that it is beneficial to you.

Before we finish up, let’s do the review of the week. This is from kdeemo and they said:

“This podcast is a gift. I just found this podcast and I’m binging on the episodes. I learn something through each episode, and I love her practical advice and tools. I feel like part of a community-what a gift!”

Thank you, kdeemo. Please, please do go and leave a review. I know you are very busy. I very much respect your time, but the best gift you can give me is just a view and honest review. It helps me to reach more people and that makes me feel so fulfilled and happy.

Have a wonderful day, everybody.

Apr 01, 2022
Ep. 227 Derealization Depersonalization
19:51

Common treatment of derealization and depersonalization Kimberley Quinlan

SUMMARY:

Derealization & depersonalization are common experiences of anxiety. In this episode, we take a look at the definition of derealization and depersonalization. We also explore the common symptoms of derealization and depersonalization and the treatment of derealization and depersonalization. I also explore mindfulness and CBT skills to help you manage your discomfort and anxiety.

In This Episode:

  • The definition of derealization
  • The definition of depersonalization
  • Explore the symptoms of derealization
  • Explore the symptoms of depersonalization
  • Comparing derealization vs depersonalization
  • Common treatment of derealization and depersonalization

Links To Things I Talk About:

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

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

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

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

EPISODE TRANSCRIPTION

This is Your Anxiety Toolkit - Episode 227.

Welcome back, everybody. I am so grateful to have this time with you. As you know, I promised this year would be the year I doubled down and get really into the nitty-gritty of some of the topics that people don’t talk enough about regarding anxiety. Today is so in line with that value

Today, we are talking about what is derealization and depersonalization. These are two what I would consider symptoms of anxiety. I see it all the time in my practice. I see it reported and commented all the time on Instagram. If you follow me on Instagram, we put out tons of free information there as well. This is such an important topic. And for some reason, we aren’t talking about these two topics enough.

My goal today is actually to give you a 101 on derealization and a 101 on depersonalization. We can touch upon derealization disorder and depersonalization disorder as well, but at the end, I want to give you as many tools as I can to point you in the right direction.

Before we do that, let’s do the “I did a hard thing,” because we love that, right? The “I did a hard thing” is a segment where people submit the hard things they’re doing. The main reason I do this is because, number one, you’re my family. We’re all in this together. But number two, often people, many years ago when I started the podcast, people were like, when I started saying it’s a beautiful day to do hard things, which I say all the time, a lot of people were saying, “But how hard does it have to be? And how do I handle the hard things? Can you give me an example?” And so, these have been just such a wonderful way to share how other people are doing hard things.

This one was submitted anonymously, and they said:

“I’ve struggled with suicidal ideation for a very long time. And after years of therapy, self-discovery, and lots of hard work, I’m finally accepting that I am better off in the world than out of it.”

Now I just have to take a deep breath and nearly cry because this is seriously the hard work. Sometimes when we’re talking about “I did a hard thing,” we’re talking about facing one small thing or one large thing, but I really want to honor Anonymous here and all of you who are doing this really long-term work and deep, deep work around really acknowledging how important you are and how much the world needs you in it and on it.

So anonymous, I love you. You are amazing. I have such respect for the work that you’ve done and are doing, and thank you. Again. I think we don’t talk about suicidal ideation enough either. In fact, I should really do an episode on that as well. I respect you and I’m so grateful you submitted this week.

Okay, here we go. I have some notes, which I rarely use notes for episodes, but I didn’t want to miss anything. I’ve got so much I want to share. I will do my best to break this down into, like I said, a 101, small bite-size helpful tools.

You will hear me, as I talk, taking little deep breaths and that’s because I have to practice slowing down. Just a little off-topic, when I’m doing podcasts, I get so geeked out that my brain races, and I’m all over the place and I’m talking fast and I have to slow down, “Kimberley, pump the breaks, lady.”

Let’s together take a breath... and let’s just be together.

First let’s talk about derealization. The definition of derealization is that derealization is a mental state or a psychological experience, it could also be a physiological experience, where things feel unreal. Not like, “Oh, that’s totally unreal, man. Amazing.” I’m talking where they don’t feel real. When you have derealization, you might feel detached from your surroundings. You don’t feel connected to what’s going on around you, and people and objects may also seem unreal.

Often people, when they have derealization or derealization disorder, feel like they’re going crazy. Actually, they feel like they’re going crazy. Not just the term that people use on the street. They actually feel like they’re losing touch with reality.

When we talk about derealization disorder, we’ll talk about that here in a little bit, but we could use them interchangeably. Lots of people have derealization without having the disorder, but to have derealization disorder, you have to experience derealization. So I’m including them both there.

Now the prevalence of derealization, I wanted to just give you this information because I felt it was very validating. I myself struggle with derealization and depersonalization. It was really validating for me to hear that more than half, more than 50% of people may have this disconnection from reality at least once in their lifetime. 2% of people experience it enough for it to become some kind of disorder, just like derealization disorder or even a dissociative disorder like amnesia.

If you’re concerned, you can go speak with your doctor or your therapist, or a licensed therapist for an assessment if you’re concerned about it. A lot of people who I have seen have already been to the doctor, gotten cleared. Schizophrenic is often a very big concern. People often feel that they’ve been misdiagnosed.

Now derealization is similar, but distinctly different from depersonalization, which we would talk about here soon. Some symptoms of derealization include feelings of being unfamiliar with your surroundings. You feel like you’ve never been there before, or you may feel like you’re living in a movie or a dream. You may feel emotionally disconnected from your loved ones or colleagues or friends. You just feel very numb. Like I said, you’re just very out of order. Things feel very strange. Your surroundings and the environment also may appear distorted, blurry, colorless, two-dimensional, or artificial.

I remember the first time I ever had derealization. I was sitting across from a client and I was an intern. I was very anxious. I’ve talked about this on the podcast before. I was sitting across from them and all of a sudden, their body looked like a caricature of themselves. The caricature is where their body is really small and their head is huge. I was looking at my client, trying to be a therapist, and I’m thinking what happened. All of a sudden, their neck was very, very small and short and their head looked gigantic. It looked like a drawing, not three-dimensional, but two-dimensional. And that was so concerning to me. I freaked out. I got through the session. Thankfully, again, I had tools to use. But it was really scary. It actually brought on some panic later in that evening because it didn’t go away for a little bit of time.

Now, depersonalization, the definition of depersonalization involves feeling a detachment, not from your environment like in derealization, but from your own body and your thoughts and your feelings. Think of it like it’s like you’re watching yourself from an outsider. I always say it’s like you’re flying on the wall, looking at yourself, or it’s like looking at a movie of yourself.

Now, symptoms of depersonalization include feelings that you’re an outsider observer, like I just said. You’re disconnected to your body again. Others report that it feels like they’re a robot and that they don’t have control of their movements. Again, you feel like you’re watching yourself and you don’t have control of what’s going to happen next.

Another symptom of depersonalization may include the sense that your body and legs and arm appear distorted. They may feel enlarged or shrunken. Some people report that their head is wrapped in cotton. That’s a different symptom.

Another example I always use with my patients is often when I have depersonalization, which isn’t very often anymore, is I’d look at my hand and I couldn’t tell if it was my hand or not. I didn’t feel like it was my hand. Again, really scary, can feel really concerning in the moment.

Now you may also experience some numbness, whether that’s emotional or physical. Some people say all of these symptoms are similar for derealization as well. You may feel like your memories lack emotion. Again, you’re disconnected from your own experience. So, that can be an additional symptom of depersonalization.

Now for both, I’m going to talk about them together now. For both, the duration of these symptoms may last just a few minutes, they can last a few hours. Some people, particularly if you have derealization disorder or depersonalization disorder, it can be days, weeks, and months. In that severity, I would encourage you to go and speak with a mental health provider who is trained and can assess you properly.

Now, to be diagnosed with derealization or to be diagnosed with depersonalization, there is no lab test. There’s no scan you can have. It requires a trained professional to review your symptoms and give you the diagnosis. You could probably, by listening to this, define for yourself whether you have the criteria to meet this classification. But if you’re wanting to be sure, I strongly encourage you to seek professional help to get that diagnosis.

Now, the prevalence of the struggles almost always start in late childhood or early adulthood. The statistics, this is why I have my notes today, the average age starts around 16. 95% of cases are diagnosed before the age of 25. Not always, but that has been the common statistics that they’re showing. I think that’s really helpful to know.

Now, that being said, what do you do from here? The treatment of depersonalization and derealization is often CBT (Cognitive Behavioral Therapy). Basically, what we do, and this is a lot of the work that you probably already have skills if you’ve listened to a lot of the podcast episodes – a lot of it is around practicing your mindfulness tool. The first thing I want to let you know is it doesn’t mean you’re going crazy. I totally get that. It feels like you are, but it doesn’t. The good news is, when you can’t stop appraising it as “I am going crazy,” you’ll actually start to notice it’s just a really strange feeling, but it doesn’t mean anything is wrong.

I once had a teen client who told me, he said he was laughing and we were giggling together. He said, “The crazy thing is some of my friends pay a lot of money to feel this way by using drugs,” and he says, “I have it for free. I have this strange feeling, this out-of-body experience. And I don’t even have to be under the control of a drug or a substance.” He said, “When I looked at it from that perspective, I stopped appraising it as if it’s dangerous.” And that was a game-changer for him to stop appraising it as if it is a dangerous problem.

For me now, when I have derealization, it usually occurs when I’m driving. I used to panic that that meant I was going to crash. But then when I just said, “Okay, I’m just having a feeling and I’m going to let it be there.” I’m not going to do anything about it. I’m not going to judge it negatively. I’m going to allow it to rise and fall on its own. And I’m going to put all of my attention on just staying present.

Now your brain is going to say, “Yeah, but present is bad. Present is terrible. Bad things are going to happen. What if you’re going crazy?” And your job is actually to practice just letting those be thoughts, because that’s what they are. They’re thoughts. Just because you have them doesn’t mean they’re facts. Lots of people have derealization. The clients I’ve had who’ve had severe derealization and derealization and depersonalization disorder, they now say, “Yeah, it happens. No big deal. They just go about my day.”

Now in the early stages of treatment, you’re going to hate this idea, but it works, is we actually used to purposely induce this sensation so that they could practice tolerating the discomfort without responding in unhealthy ways or in compulsive ways. We would sit them down and spin them around in a chair. We would have them stare at the wall. We would have them look at really psychedelic YouTube videos where the colors and the patterns are all wavy like seventies, like psychedelic. And we would practice inducing the feeling. From there, they would practice willingly allowing the discomfort and going about their day, being gentle with themselves, engaging in the things they value. Of course, they might feel great, and that’s okay. You can slow down a little and do what you need to do.

But ultimately, when you have depersonalization and derealization, the goal is simply to do nothing at all. Crazy. When I tell my patients that, they’re like, “Oh my goodness, you’re either crazy or you’re brilliant.” By the end, usually, they say that this treatment, not me, but the treatment is brilliant, because it teaches them not to be afraid of it and not to try and live their life avoiding it.

I’ve had patients report that they’ve avoided things at great length just to avoid the experience of depersonalization and derealization. And when they avoid it, it just keeps them stuck and keeps them scared and keeps it happening more.

The other thing I will add is, do not check to see if you’re derealized or depersonalized, because just the act of checking for it, like a mental check, can actually bring on the symptoms. Now, that’s easier said than done. Am I right? Yes, it’s very hard. I know it’s easy to say, “Just stop doing that.” But if you’re engaging in a lot of checking behavior, sometimes it’s helpful to catch when you are and bring yourself back to the present, do whatever disengagement skills you can use to get you back into the present moment. Again, we don’t want to push the discomfort away, but we also don’t want to give too much hyper attention to these sensations and symptoms.

If you’re struggling with these symptoms, go and see a mental health professional. You can quiz them, ask them if they have skills in this. Look on their website, see if they’ve got any information about it that will help you to get the help that you need.

This is great. Like I said, this is what I call derealization and depersonalization 101. But there are many, many other tools that you can use to help manage this. One day I will do my best to create an online course about this that goes into detail so you have that, but for right now, I hope that this is helpful.

Now, before we finish up, I’m going to do the review of the week. We have an amazing review here from Jessrabon621 and they said:

“Amazing podcast. I absolutely love everything about this podcast. I could listen to Kimberley talk all day and her advice is absolutely amazing. I highly recommend this podcast to anyone struggling with anxiety or any other mental health professional that wants to learn more.”

Thank you, Jessrabon621. I am so grateful that I’ve helped and I’m so happy that you’ve left a review. Thank you. I love your reviews. They help me so much.

2022 is the year that I want to get a thousand reviews. If you can help, I would be so grateful. Go in wherever you’re listening, click on the reviews, leave a review. You don’t have to write something. You can just rate it. Leave an honest review. I am so, so grateful. We will be giving a pair of Beats headphones to one lucky winner by the time we hit 1,000 reviews. So I am so grateful.

Have a wonderful day, and I’ll see you next week.

Mar 25, 2022
Ep. 226 Overcoming Health Anxiety with Ken and Maria
43:10

SUMMARY:
Overcoming Health Anxiety is possible! Today, we interview Ken Goodman and his client Maria on overcoming hpyochondria using Cognitive Behavioral Therapy. In this episode of Your Anxiety Toolkit Podcast, you will learn key concepts of health anxiety and how to overcome their health anxiety.

In This Episode:

  • What it is like to have health anxiety
  • The key concepts of treating Hypochondria
  • Tips for managing fears of death and cancer.
  • A step-by-step approach to overcoming health anxiety.

Links To Things I Talk About:

https://www.kengoodmantherapy.com/
Quiet Mind Solutions
ERP School: https://www.cbtschool.com/erp-school-lp

Episode Sponsor:

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

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EPISODE TRANSCRIPTION

This is Your Anxiety Toolkit - Episode 226.

Welcome back, everybody. If you have health anxiety, hypochondria, health anxiety disorder, or you know of somebody who has health anxiety, you are going to love this episode. I mean, love, love, love this episode.

Today, we have Ken Goodman, who’s on the show. He’s a clinician who’s here with his patient and they’re sharing a success story, a recovery story of health anxiety, and it is so good. I am so honored to have both of them on. It was so fun to actually interview other people and the way they’re doing it, and look at the steps that were taken in order to overcome health anxiety. And this is the overcoming health anxiety story of all stories. It is so, so good. I’m not going to waste your time going and telling you how good it is. I’m just going to let you listen to it because I know you’re here to get the good stuff.

Before we do that, I wanted to do the “I did a hard thing” and this one is from Dave. It says:

“I’ve been trying to get back into meditating regularly. I was sitting at a desk this morning, reviewing my work emails. And I told myself, before I get even further in my day, I need to meditate. I did a guided meditation, even though I felt a strong pull inside to go back to work. I kept getting caught up in my thoughts, but I just kept telling myself it doesn’t need to be a perfect meditation. I said the goal today is just to be able to sit without being busy for three minutes. Nothing more. It was hard, but I did it.”

Dave, thank you so much for the submission of the “I did a hard thing” segment, because I think that meditation is so important. In fact, I keep promising myself I’m going to implement it more into this podcast. And Dave has really looked at some of the struggles people have with meditation. And look at him, go, it’s so amazing. Totally did it. So amazing. Dave, thank you so, so, so much. I love it. If you want to submit, you may submit your “I did a hard thing” by going to KimberleyQuinlan-lmft.com. If you go to the podcast page, there is a submission page right on the website. And from there, let’s just go straight to the show. I hope you enjoy it.

Overcoming Health Anxiety with Ken Goodman and Maria Your anxiety toolkit

Kimberley: Welcome. I am so excited for this episode. Welcome, Ken and welcome, Maria.

Ken: Thank you for having me.

Maria: Hi, Kimberley.

Kimberley: So, as you guys, we’ve already chatted, but I really want to hear. This is really quite unique and we get to see the perspective of a client and the therapist. If I could do one of these every single week, I would. I think it’s so cool. So, thank you so much for coming on and sharing. We’re going to talk about health anxiety. And so, Maria, we’re going to go back and forth here, but do you want to share a little bit about your experience with health anxiety?

Maria: Yes. I think I’ve had health anxiety probably for like 15, 20 years and not known about it. Looking back now, everything comes clear when you see the multiple pictures that you’ve taken of certain lumps and whatever five years ago. I’m like, “Oh my gosh, I have so many pictures that I’ve taken and so many different things.” But yeah, I’ve been struggling for a while I think, and had multiple doctor’s appointments. Until I realized that I had health anxiety, it was an everyday struggle, I think.

Ken: Well, you came to me and you were mostly worried at the time about ticks and Lyme disease and skin cancer, but you told me that for the previous 15 years or so, you were worried about other things. What are those things?

Maria: Well, I was mostly completely obsessed with moles on my skin and them being cancerous. And I was scared of ticks. I would not be able to walk through any grass or go hiking. I was scared that I would have to check my whole body to make sure that there were no ticks on me. I was completely scared of Lyme disease, and it just completely consumed my life really. And they were the main things. But looking back before that, I think that I always had a doctor’s appointment on the go. I would book one, and as soon as they said, “You can book online,” That was it for me. I would have one booked, and then I’d go, “Oh, what if there’s something else next week? You know what, I’m just going to book one for next week, just in case something comes up.” I am a terrible person when it comes to that because I’m taking up multiple doctor’s appointments. And I knew that. But it was trying to reassure myself, trying to control the situation, trying to control next week already before it even happened. So, yeah.

MARIA’S SYMPTOMS OF HEALTH ANXIETY

Kimberley: Right. What did it look like for you? What did a day look like for you pre-treatment and pre-recovery?

Maria: Some days it could be fine. I remember days where nothing was bothering me. It was such a nice feeling. And then I was scared because I never knew what was going to trigger me and it could be anything at any time. And I think that was the not knowing. And then as soon as I would latch onto something, I would come to the phone, I’d start Googling over and over again, hours of Googling and then checking. And then it was just ongoing. And then my whole day, I was in my head my whole day, just what if, what if, asking questions, going back to Google, trying to find that reassurance that of course never happened.

Ken: Yeah. You tell me that you would take pictures of your moles and then compare them with the cancerous moles online and do those things.

Maria: Yeah. And I would book-- and interestingly enough, looking back now, I went through a phase of always having a doctor’s appointment. And then I also went through a phase of completely avoiding the doctor as well, not wanting to go because I didn’t want them to say something that I knew was going to trigger a whole host of anxiety. So, I’ve gone through multiple doctors. And then once you start the doctor’s appointments, then you’re on a roller coaster. Because you walk away from that appointment, never feeling, or for me, never feeling reassured. Or feeling reassured for maybe a few minutes, and then you leave, and then the anxiety kicks in. “Oh, I never asked them this,” or “Oh my gosh, well, what did that mean?” And then the what-ifs start again and you’re back to square one. So then, you go, “Oh, no, I didn’t try just what they said. I’m going to book another appointment and this doctor is going to be the doctor that reassures me.”

MANAGING DOCTOR VISITS WITH HYPOCHONDRIA

Kimberley: Right. Or sometimes a lot of clients will say to me like, “The doctor made a face. What did that face mean? They made a look and it was just for a second, but were they questioning their own diagnosis and so forth?” And I think that is really common as well.

Ken: Well, the doctor will say anything and it could be something very simple like, “Okay, you’re all good. I’ll see you in six months.” And the person will leave thinking, “Why would he want me to come back in six months if nothing was wrong?”

Maria: Well, that’s interesting that you would say that because I think probably at my lowest point, I was keeping notes about my thought process and what I was feeling when I was actually going to the doctors or waiting for the results. And actually, I thought it might-- if I have a few minutes to read what I actually was going through in real-time, I know it’s probably very relatable.

Kimberley: I would love that.

Maria: I had gone to basically a doctor’s appointment, an annual one where I knew I was going to have to have blood tests. And they’re the worst for me because the anticipation of getting the results is just almost worse than getting the results, even though--

Ken: Did you write this before we met?

Maria: No. While I was seeing you, Ken.

Ken: In the beginning?

Maria: Yeah. When you’d asked me to write down everything and write down what I was feeling, what I was thinking, and then read it back to myself. And this is what I had written down, actually, when I was going through the doctor’s appointment and waiting or had just gotten the results.

Kimberley: If you would share, that’d be so grateful.

Maria: So, my blood results came back today. I felt very nervous about opening them. The doctor wrote a note at the top. “Your blood results are mostly normal. Your cholesterol is slightly high, but no need for medication. Carry on with exercise and healthy eating.” “Mostly,” what does that mean? “Mostly”? I need to look at all the numbers and make sure that everything is in the normal range. “Okay, they’re all in the normal range except for my cholesterol. But why does she write mostly? Is there something else that she’s not telling me? I need reassurance. I’m driving down to the doctor’s right now. I can’t wait the whole weekend.” I go into the doctor’s office and ask them, “Is there a doctor who’s able to explain to me my results?” The receptionist said, “No, you have to make another appointment.” I explained to her, “You don’t understand. I just need somebody to tell me that everything is normal.”

Finally, this nice lady saw the anxiety on my face. She calls the doctor over to look at the labs. The receptionist shows the doctor the one lab panel, and he says, “Everything is completely normal. Nothing was flagged. Everything is completely fine.” I thank him so much for looking and walk away. As soon as I get outside, I realize I didn’t ask him to look at all the lab panels. What if she meant mostly normal on the other lab panels that I didn’t show him? When I get home, I look over each one multiple times and make sure that each one is in the exact number range. After looking over them four or five times and seeing that each one is in the number range except for my cholesterol, I still feel like I need to have her explain to me why she wrote the word “mostly.” The crazy thing is I’m not concerned about the high cholesterol. I can control that. I don’t know what she meant by the word “mostly.” I’m going to send her a message. And I’m going to ask her to clarify. I have to believe that she would tell me if something was wrong. I wish there was an off button in my head to stop me worrying about this.

Ken: I remember this now. I remember. And this was in the middle. Maria was really avoiding going to the doctor and she had overdue with some physical exams. And so, we really worked hard for her to stop avoiding that. She got to the point where she felt good enough about going to the doctor. And she really, I think I remember her not having any anticipatory anxiety, handling the doctor very well, host the doctor very well, until she got the email and focused on the word “mostly.” And that sent her spiraling out of control. But the interesting thing about that whole experience was that we processed it afterwards, and that whole experience motivated her to try even harder. And then she took even bigger strides forward. And within a couple of months, she was really doing so much better. And I think it’s been over a year now since that and continues to do really well.

Kimberley: Yeah. Thank you so much for sharing that. I actually was tearing up. Tears were starting to come because I was thinking, I totally get that experience. I’m so grateful you shared it because I think so many people do, right?

Maria: Yeah. And there’s always and/or. You go into the doctor’s appointment, they tell you everything. And because your adrenaline is absolutely pumping, you forget everything. And then you come out and you go, “Oh my gosh, I can’t remember anything.” Then the anxiety kicks in and tells you what the anxiety is like, “Oh no, that must have been bad. That must have been--” yeah.

Ken: And that boost in adrenaline that just takes over is so powerful. You can forget any common sense or any therapeutic strategies or tools that you might have learned because now you just get preoccupied with one word, the uncertainty of that word.

Maria: Yeah. I would have to have a family member come in, my husband to come in and sit in the-- it got to that point where he would have to come in and sit in the appointment, so then after the appointment, I could have him retell me what was said, because I knew as soon as the adrenaline kicked in, I would not be able to remember anything.

ROADBLOCKS TO HEALTH ANXIETY TREATMENT

Kimberley: Right. Ken, this brings me straight to the next question, which would be like, what roadblocks do you commonly see patients hit specifically if they have health anxiety during recovery or treatment?

Ken: Well, unlike other fears and phobias, the triggers for health anxiety are very unpredictable. So, if you have a fear of elevators, flying or public speaking, you know when your flight is going to be, you know when you have to speak or you know when you have to drive if you have a fear of driving. For health anxiety, you never know when you’re going to be triggered. And those triggers can be internal, like a physical sensation, because the body is very noisy. And everyone experiences physical sensations periodically and you never know when that’s going to happen. And then you never know external triggers. You never know when the doctor is going to say something that might trigger you, or you see a social media post about a GoFundMe account about someone that you know who knows someone who’s been diagnosed with ALS. So, you never know when these things are going to happen. And so, you might be doing well for a couple of weeks or even a month, and suddenly there’s a trigger and you’re right back to where you started from. And so, in that way, it feels very frustrating because you can do well and then you can start becoming extremely anxious again.

Another roadblock I think might be if you need medicine, there’s a fear of trying medicine because of potential for side effects and becomes overblown and what are the long-term side effects, and even if I take it, I’m going to become very anxious. And so, people then are not taking the very thing, the medicine that could actually help them reduce their anxiety. So, that’s another roadblock.

Kimberley: Yeah. I love those. And I think that they’re by far the most hurdles. And Maria, you could maybe even chime in, what did you feel your biggest roadblock to recovery was?

Maria: Being okay with the unknown. Trying to be in control all the time is exhausting and trying to constantly have that reassurance and coming to terms with, “It’s okay if I can’t control everything. It’s okay if I don’t get the 100% reassurance that I need. It’s good enough,” that was hard for me. And also, not picking up the phone and Googling was the biggest. I think once I stopped that and I was okay with not looking constantly, that was a huge step forward.

Ken: You really learn to live with uncertainty. And I think you start to understand that if you had to demand 100% certainty, you had to keep your anxiety disorder. In order to be 100% certain, that meant keep staying anxious.

Kimberley: Yeah. Being stuck in that cycle forever.

Ken: You didn’t want that anymore. You wanted to focus on living your life rather than being preoccupied with preventing death.

SKILLS AND TOOLS TO OVERCOME HEALTH ANXIETY

Kimberley: Right. So, Maria, I mean, that’s probably, from my experience as a clinician, one of the most important skills, the ability to tolerate and be uncertain. Were there other specific tools that you felt were really important for your recovery at the beginning and middle and end, and as you continue to live your life?

Maria: Yes. I think the biggest one was me separating my anxiety from myself, if that makes sense. Seeing it as a separate-- I don’t even know, like a separate entity, not feeling like it was me. I had to look at it as something that was trying to control me, but I was fine. I needed to fight the anxiety. And separating it was hard in the beginning. But then I think once I really can help me to understand how to do that, at that point, I think I started to move forward a bit more.

Kimberley: So, you externalized it. For me, I give it a name like Linda. “Hi, Linda,” or whatever name you want to give your anxiety. A lot of kids do that as well like Mr. Candyman or whatever.

Maria: Yeah. It sat on my shoulder and try to get in my head. In the beginning, I would be brushing off my shoulder constantly. Literally, I must have looked crazy because I was brushing this anxiety off my shoulder every 10 minutes with another what-if. What if this? What if that? And I think I had to retrain my brain. I had to just start not believing and being distracted constantly by the “What if you do this” or “What if that?” and I’d say, “No, no.”

Ken: Yeah. I’d treat a lot of health anxiety. I have a lot of health anxiety groups. And I do notice that the patients that can externalize their anxiety and personify it do way better than the people who have trouble with it. And so, whether it’s a child or a teenager or an adult, I am having them externalize their anxiety. And I go into that, not only in my groups, but in the audio program I created called the Anxiety Solution Series. It is all about how to do that. And it makes things so much easier. If now you’re not fighting with yourself, there’s no internal struggle anymore because now you’re just competing against an opponent who’s outside of you. It makes things easier.

Kimberley: Right. Yeah. And sometimes when that voice is there and you believe it to be you, it can make you feel a little crazy. But when you can externalize it, it separates you from that feeling of going crazy as well.

Maria: I felt so much better as soon as I did that because I felt, “Okay, I think I can fight this. This isn’t me. I’m not going crazy. This is something that I--” and I started to not believe. And it was long, but it was retraining my brain. And I would question the what-ifs and it didn’t make sense to me anymore. Or I would write it down and then I would read it back to me, myself, and I’d be like, “That’s ridiculous, what I just thought.” And the other tool which was hugely helpful was breathing, learning how to breathe properly and calm myself down. I mean--

Ken: Yeah. There’s lots of different types of breathing out there. And so, I teach a specific type of breathing, which is, I call it Three by Three Relaxation Breathing, which is also in the Anxiety Solution Series. And it really goes over into detail, a very simple way to breathe that you can do it anywhere. You can do it in a waiting room full of people, because it’s very subtle. It’s not something where you’re taking a big breath and people are looking at you. It’s very, very subtle. You can do it anywhere.

MEDITATION FOR HEALTH ANXIETY

Kimberley: Ken, just so that I understand, and also Maria, how does that help someone? For someone who has struggled with breathing or is afraid of meditation hor health anxiety and they’ve had a bad experience, how does the breathing specifically help, even, like you were saying, in a doctor’s appointment office?

Maria: I’ve done it actually in multiple doctor’s appointments where I’ve had that feeling of, “I’ve got to get out of here now.” It’s that feeling of, “Uh, no. Right now, I need to leave.” Before, before I started, I would leave. And now I realized, no, I’m not. I’m going to sit and I’m going to breathe. And no one notices. No one can see it. You can breathe and it really does calm me down, especially in the past, I’ve had panic attacks and feeling like I can’t breathe myself. When you start to realized that you can control it and it does relax you, it really helps me a lot. I do it all the time.

Kimberley: It’s like a distress tolerance tool then, would you say?

Maria: It’s something that I can carry around with me all the time, because everyone needs to breathe.

Kimberley: Yeah. I always say that your breath is free. It’s a free tool. You could take it anywhere. It’s perfect.

Maria: Yeah. So, it’s something that I can do for myself. I can rely on my breathing. And now knowing after Ken teaching me really how to do it properly, it’s just invaluable. It really is, and empowering in a way. Now, when I feel like I can’t be somewhere, and in fact just not so long ago, I was in a doctor’s appointment, not for myself, but I sat there and it was really high up and there was lots of windows around. Of course, I don’t like being [00:22:34 inaudible]. And I felt I have to get out. “Nope, I’m not going to do it. I’m not going to do it.” I sat there, I did my breathing. I actually put my earphones in and started listening to Ken’s anxiety solutions and listened and took my mind off of it, and I was fine. I didn’t leave. And actually, I walked away feeling empowered afterwards. So, it’s huge. It’s really helpful.

Ken: Yeah. You just said a couple of very important things. You made a decision not to flee, so you decided right there, “I’m not going anywhere. So, I’m going to stay here. I’m going to tolerate that discomfort, but I’m going to focus on something else. I’m going to focus on my breathing. I’m going to listen to the Anxiety Solution Series.” And then by doing that, I’m assuming your anxiety either was contained, it stayed the same, or maybe it was reduced. Yeah?

Maria: Yeah, it was reduced. It stayed the same. And then it started to reduce. And naturally, by the end, I was like, “I’m fine. Nothing is going to happen.” So, it was great. And the other-- I want to say actually one more thing that really, really helped me. And it was actually a turning point, was that I was in another appointment. The doctor came in and told me I was fine. And it was actually like an appointment where they had called me back medically. So, it was a different scenario. It wasn’t me creating something in my head. But anyway, there was a lot of anticipation beforehand and he came in and he said, “You are fine. Go live your life.” And I walked away and I went home. And within maybe about 40 minutes, I said, “Maybe he was lying to me. Maybe he was just trying to make me feel good because he saw how anxious I was.” And at that point I realized, this is never going to stop, never. Unless I fight back, I will never-- I felt robbed of the relief that I should have felt. When he told me that, I wasn’t getting that relief and I was never going to have that relief unless I used-- and at that point, I actually got angry. And I remember telling Ken, I was like, “I’m so angry because I felt robbed of the relief.” And at that point, I think I then kicked up my practicing of everything tenfold. And that was a turning point for me.

Ken: Yeah. That anger really helped you. And anxiety is a very, very powerful emotion, but if you can access or manufacture a different emotion, a competing emotion, and anger is just one of them, you can often mitigate the anxiety. You can push through it. And for you, it was an invaluable resource, because it was natural. You actually felt angry. For other people, they have to manufacture it and get really tough with their anxiety. But for you, you at that moment naturally felt it.

And you’re right. You said it is never going to stop. And physical sensations, the body is noisy. People will have the rest of their life. You’re going to have a noisy body. So, that will never stop. It’s your reaction and your response to those physical sensations that is key. And you learn how to respond in a much more healthy way to whenever you got any sort of trigger external or internal.

TREATMENT FOR HEALTH ANXIETY/HYPOCHONDRIA

Kimberley: It’s really accepting that you don’t have control over anxiety. So, taking control where you have it, which is over your reactions. And I agree, I’ve had many clients who needed to hit rock bottom for a certain amount of time and see it play out and see that the compulsions didn’t work to be like, “All right, I have to do something different. This is never going to end.” And I think that that insight too can be a real motivator for treatment of like, “I can’t get the relief. It doesn’t end up lasting and I deserve that like everybody else.” So, Ken, how do you see as a clinician the differences in recovery and treatment for different people? Do you feel like it’s the same for everybody, or do you see that there are some differences depending on the person?

Ken: Well, when I treat people with health anxiety, although the content of their specific fears might be different – some might worry more about their heart, some might worry more about shaking that they experience and worry about ALS – the treatment is basically the same, which is why I can treat them in classes or groups because it’s basically the same. There are some variations. Some people are more worried about things, where other people feel more physical sensations. And I may have to tailor that a bit. So, some people have to-- their problems are more the physical sensations that they feel and they can’t tolerate those physical sensations. And other people it’s more mental. They’re just constantly worried about things. But in general, they can be treated very similarly. It’s learning how to tolerate both the uncertainty and the discomfort and the stress that they feel.

Kimberley: Right. And I’ll add, I think the only thing that I notice as a difference is some people have a lot of insight about their disorder and some don’t. Some are really able to identify like, “Ah, this is totally Linda, my anxiety,” or whatever you want to name your anxiety. “This is my anxiety doing this.” Whereas some people I’ve experienced as a clinician, every single time it is cancer in their mind and they have a really hard time believing anything else. Like you said, they feel it to be true. Do you agree with that?

Ken: Completely. Yeah. Some people will come to me and they know it’s probably anxiety, but they’re not sure. And some people, they are thoroughly convinced that they have that disease or that disorder. And even after months and months and months of-- and oftentimes the content changes. So, I have patients who, when I first start seeing them, they might be afraid of cancer. And then two months later, it’s their heart. And then a couple of months later after that, it’s something else. There’s always something that can come up and they’re always believing it’s something medical. And of course, they go back to, “Well, what if this time it is? What if this time it is cancer?” And that’s where they get caught in the trap. So, for them, it’s answering that question. For Maria, it’s the word “mostly” that she became fixated on to get lured in and take the bait. It’s like, what happens to a fish that takes the bait? Now they’re struggling. So, now once you take the bait, you’re struggling.

Kimberley: Right. And I would say, I mean, I’ll personally explain. A lot of my listeners know this, but I’ll share it with you guys. I have a lesion on the back of my brain that I know is there. And I have an MRI every six months. And I have a lot of clients who have a medical illness and they have health anxiety, and it’s really managing, following the doctor’s protocol, but not doing anything above and beyond that because it’s so easy to be like, “Well, maybe I’ll just schedule it a little earlier because it is there and I really should be keeping an eye on it.” And that has been an interesting process for me with the medical illness to tweak the treatment there as well.

Ken: Yes, absolutely. I have a patient right now and she has a legitimate heart issue that is not dangerous. They’ve had many, many tests, but all of a sudden, her heart will just start racing really fast, just out of the blue. And it happens randomly and seems like stress exacerbates the frequency of it. But it’s not just irritating for her, it was scary because every time she would experience it, she thought, “Maybe this is it. I’m having a heart attack.” But she really had to learn to tolerate that discomfort, that it was going to happen sometimes and that was okay. It happens and you just have to learn to live with it.

Kimberley: Right. So, Maria, this is the question I’m most excited about asking you. Tell me now what a doctor’s appointment looks like for you.

Maria: It looks a lot better. You can actually pick up the phone and book an appointment now without avoiding it. I practice everything that I’ve learned. I’m not going to lie. The anticipation, maybe a couple of days before, is still there. However, it’s really not as bad as it was before. I mean, before, I would be a complete mess before I even walked into the doctor’s office. Now, I can walk in and I’m doing my breathing and I’m not asking multiple questions. I’m now okay with trusting what the doctor has to say. Whereas before, if I didn’t like what he had to say or he didn’t say exactly the way I wanted to hear it, I’d go to another doctor. But now, I’m okay with it. And it’s still something I don’t necessarily want to do. But leaps and bounds better. Leaps and bounds really. I can go in by myself, have a doctor’s appointment, ask the regular questions and say, “Give me the answers,” and leave and be okay with it.

GETTING TEST RESULTS WITH HEALTH ANXIETY

Kimberley: How do you tolerate the times between the test and the test results? How do you work through that? Because sometimes it can take a week. You know what I mean? Sometimes it’s a long time.

Maria: Yeah. I mean, I haven’t-- so, obviously, it’s yearly. So, I’m at that point next year where I will have to go and have all my tests again and get the results and anticipate. But I think for me, the biggest thing is distraction and trying not to focus too much beforehand and staying calm and relaxed. And that’s really it. I mean, there’s always going to be anxiety there for me, I think, going to the doctors. It’s not ever going to go away. I’m okay with that. But it’s learning how to keep it at a point where I can understand what they’re telling me and not make it into something completely different.

Ken: I think you said the keywords – where you’re putting your focus. So, before, your focus was on answering those what-if questions and the catastrophic possible results. And now I think your focus is on just living your life, just going about living your life and not worrying or thinking about what the catastrophic possibilities could be. Is that accurate? Would you say it’s accurate?

Maria: Yeah. Because if you start going down that road of what-if, you’re already entering that zone, which it is just, you’re never going to get the answer that you want. And it’s hard because sometimes I would sit and say to myself, “I’m going to logically think this out.” And I would pretend. I mean, I even mentioned to Ken, “No, no, I’m logically thinking this out. This is what anyone would do. I’m sat there and I’m working out in my head.” And he said, “You’ve already engaged. You’ve already engaged with the anxiety.” “Have I?” And he said, “Yeah. By working it out in your head, you’re engaging with the anxiety.” And that was a breakthrough as well because I thought to myself after, “I am.” I’m already wrapped up in my head logically thinking that I’m not engaging, but I’m completely engaging. So, that was an interesting turning point as well, I think.

Kimberley: Amazing. You’ve come a long, long, long way. I’m so happy to hear that. Ken, before we wrap up, is there anything that you feel people need to know or some major points that you want to give or one key thing that they should know if they have health anxiety?

Ken: Oh my gosh, there are so many. There is a tendency for people with all types of anxiety to really focus their attention on the catastrophic possibilities instead of the odds of those catastrophic possibilities happening. The odds are incredibly low. And so, if you’re focusing on the fact that it’s probably not likely that this is going to happen, then you’ll probably go through your life and be okay if you can focus your attention on living your life. But if you focus on those catastrophic possibilities that are possible, they are, then you’re going to go through life feeling very, very anxious. And if you focus on trying to prevent death, prevent suffering, then you’re not really living your life.

Kimberley: That’s it right there. That’s the phrase of the episode, I think, because I think that’s the most important key part. I cannot thank you both enough for coming on.

Ken: This is fun. This is great.

Maria: It was fun.

Kimberley: Maria, your story is so inspiring and you’re so eloquent in how you shared it. I teared up twice during this episode just because I know that feeling and I just love that you’ve done that work. So, thank you so much for sharing.

Ken: Yeah. She’s really proof that someone who’s suffered for 15, 20, some odd years with anxiety can get better. They just have to be really determined and really apply the strategies and be consistent. She did a great job.

Kimberley: Yeah. Massive respect for you, Maria.

Maria: Oh, thank you.

Kimberley: Amazing. Ken, before we finish up, do you have any-- you want to share with us where people can hear from you or get access to your good stuff?

Ken: Yeah. So, quietmindsolutions.com, I have a whole bunch of information on health anxiety. I have two webinars in health anxiety on that website, as well as other webinars in other specialties I have. Also, I have the Anxiety Solution Series, which is a 12-hour audio program, which focuses on all types of anxiety, including health anxiety, as well as others. And you can listen to a few chapters for free just to see if you would like it, if you could relate to it. And there’s other programs, other articles, and videos that I produced. I have a coloring self-help book, which is basically a self-help for people with anxiety, but every chapter has a coloring illustration where you color. And the coloring illustration actually-- what’s the word I’m looking for? It’s basically a representation of what you learn in that chapter. It strengthens what you learn in that chapter.

Kimberley: Cool.

Ken: Yeah. And then a book called The Emetophobia Manual, which is a book for people who have fear of vomiting.

Kimberley: Amazing. And we’ll have all those links in the show notes for people as well. So, go to the show notes if you’re interested in getting those links.

Ken: Ken Goodman Therapy is the other website. It has similar information.

Maria: I wanted to mention as well that I actually watched one of Ken’s webinars quite by accident in the beginning before I realized I had health anxiety. And after watching it, I thought, “Oh my gosh, I’ve got that.” And so, it was hugely, hugely helpful because I think that having this for so many years and not realizing, there’s a lot of people that still don’t realize that they suffer from health anxiety. For me, as soon as I could label it as something, it was a relief because now I could find the tools and the help to work on it and get that relief.

Kimberley: Amazing. Okay. Well, my heart is so full. Thank you both for coming on. It’s really a pleasure to hear this story. So inspiring. So, thank you.

Ken: Yeah. Thank you for doing this, Kimberley.

Maria: Thank you.

Ken: And thanks, Maria.

-----

Thank you so much for listening. Before we finish up, we’re going to do the review of the week. This is from kdeemo, and they said:

“This podcast is a gift. I just found this podcast and I’m binging on the episodes. I learn something through each episode, and love her practical advice and tools. I feel like part of a community-what a gift!”

Oh, I’m so, so grateful to have you kdeemo in our community. This is a beautiful, beautiful space. My hope is that it’s different to every other podcast you listen to in that we give you a little bit of tools, a little bit of tips, but a huge degree of love and support and compassion and encouragement. So, thank you so much for your review. I love getting your reviews. It helps me to really double down in my mission here to give as many practical free tools as I can. It is true, it is a gift to be able to do that. So, if you could please leave a review, I would be so, so grateful. You can click wherever you’re listening and leave a review there. Have a wonderful day.

Mar 18, 2022
Ep. 226 Overcoming Health Anxiety with Ken and Maria
Mar 18, 2022
Ep. 225 What Are the Causes Of Anxiety (And What You Can Do To Overcome It)
20:50

SUMMARY: 

Many people ask me, “Why do I have anxiety?” and the truth is, there is no clear-cut answer. However, in this week's episode, I give you nine possible causes of anxiety and what you can do to manage anxiety in your daily life. Some causes are in your control, and some are not.  Either way, it is important that you are super gentle with yourself as you explore some of the reasons for anxiety in your life. 

In This Episode:

  • NINE possible causes of anxiety for you in your life
  • What you can do to manage your anxiety
  • How to overcome anxiety by changing small behaviors
  • Reasons you experience anxiety may include
    1. Genetics
    2. Caffeine
    3. Distorted Thoughts
    4. Behaviors
    5. Trauma
    6. Environment
    7. Stress Management
    8. Lack of Tools
    9. Isolation (lack of community)

Links To Things I Talk About:

Time Management for Optimum Mental Health https://www.cbtschool.com/timemanagement
ERP School: https://www.cbtschool.com/erp-school-lp

Episode Sponsor:

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

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

Causes of anxiety Your anxiety toolkit

EPISODE TRANSCRIPTION

This is Your Anxiety Toolkit - Episode 225.

Welcome back, everybody. Today, we are talking about the causes of anxiety, why you are anxious and what you can do about it. This is a topic I feel like keeps coming up with my clients like, “But why? Why is this happening?” And I totally get it. Now, a lot of the times, I encourage my patients the end goal, jump straight to the end goal is we don’t want to spend too much time trying to solve why we’re anxious. That in and of itself can become a compulsive problematic behavior. But I wanted to just address it because I don’t think I have addressed it yet in the podcast. I thought now is a good time to really just look at some of the reasons we humans are anxious. I’m an anxious person, my guess that the fact that you’re listening to Your Anxiety Toolkit means you or someone you love is an anxious person. So, let’s talk about why we’re anxious. What are the causes of anxiety and what are some of the reasons we are anxious.

Now before we do that, we want to, of course, do our “I did our hard thing” segment, and this one is for Bradley. Bradley wrote:

“I was at a family event and had to see a family member I haven’t seen in four years. I said a firm, no contact boundary with her since she was so toxic. And as much as I tried, I knew I could not control whether she came or not. Seeing her was very hard, but I gave myself loads of self-compassion and allowed that moment to be very difficult.” Oh, Bradley, this is so good. “I was pleasant to her, but I did not engage beyond what was necessary. I took multiple moments throughout the event to check in with myself and see what my body needed.”

This is so good and this is such great modeling of how we can regulate and monitor ourselves, giving ourselves kindness as we do hard things. I love this. Thank you so much for sharing it. This is really super inspiring. I think we all need to practice this one a little better, myself included. I hope that that brings you some inspiration before we move on into the episode. Thank you again, Bradley, for submitting that. I love hearing the “I did a hard thing.”

Let’s talk about why you and I, and we might be anxious.

1. Genetics

Reason number one is genetics. I think that if I’m with a client and they ask me, this is usually the spiel I would give them, which is, genetically, a lot of us are set up to have anxiety. What that means is somewhere in our lineage, our parent, our grandparent, someone had anxiety and it is quite a genetic trait to have. As we go through these, I’m really wanting you, just as a side note, to think about these things, but we don’t want to use these as an opportunity to blame other people. We don’t want to blame, of course, our parents or our grandparents. It wasn’t their fault. Obviously, they probably had it passed down from somebody else as well. But as we move through some of these, I also don’t want you to displace blame onto yourself, and we can talk about that as we go. But genetics is a reason that some of us are anxious.

I’ll give you a little bit of a piece of my personal experience here, is I often-- I mean, I know every anxiety tool in the book and there’s been many times where I’ve visited doctors or psychiatrists and they ask me about anxiety and I’ll say, “Yes, I have anxiety.” They’ll say, “Well have you had therapy? Have you tried medicine?” “Yeah, I’ve tried all of those things and I’m highly functioning and I have a wonderful life.” But I also have to accept that some degrees of anxiety are just genetic. I’m not going to get rid of them all. In fact, I don’t want to get rid of all anxiety.

I want to use this as an opportunity to remind you that this is not meaning that it’s a list of things you now have to go and fix. Not at all. This is about just being aware of what’s going on. Hopefully, at the end, we’ll talk more about this, is you can then acknowledge what might be bringing the anxiety on, but then go straight to your toolkit. The tools are the most important part here –acceptance, not judgment, willingness, compassion, being mindful. Go straight back to your tools once you’ve listened to this podcast because that’s going to be the most important piece.

2. Caffeine

The second reason you might have anxiety is because of caffeine. A lot of people report that if they have too much caffeine, they get jittery and it sets off a nervous response in the body where the brain then sends out a whole bunch of anxiety hormones and chemicals in the body. Caffeine mimics anxiety, which then means that now you have more anxiety, because when you have anxiety and you experience something like it, usually, if you go, “Oh my gosh, yeah, something must be wrong,” your body proceeds to send out more and more and more and more anxiety.

Caffeine can be one, but I will also tag on additional one here, which is alcohol. A lot of my patients have reported that if they’re drinking too much alcohol, they do feel that same jitteriness the next day, which then causes their brain to think something is wrong. Therefore, again, send out more anxiety, chemicals and hormones, something to think about.

3. Distorted Thoughts

Now, the third is really important. I’ve done podcast episodes on this before, and it’s distorted thoughts, catching your distorted thoughts. If you are at the supermarket and the man or woman next to you drops the cereal box all over the floor or they drop a can or a glass bottle, and it shatters everywhere, you are naturally going to have anxiety. Normal. Anyone would have anxiety. It’s a big shock to the system. But if you then have distorted thoughts about that, like that means it’s bad luck, I did something wrong, I’ve humiliated myself, they’re going to be judging me – there are so many different distorted thoughts. I’m just using this as an example. Or another example would be you are interacting with someone at the bank and you have then following the distorted thought of like, “They are judging me. They think I’m stupid. I I didn’t handle that well.” Maybe you have the thought bad things are going to happen and you’re catastrophizing. Those thoughts will create anxiety.

Now again, if you go back and listen to those episodes back a few weeks ago, you will remember me saying, we cannot control our intrusive thoughts. I want to make that really clear. There are a lot of thoughts you are having right now that you have no control over. What I’m talking about at distorted thoughts are the thoughts on how you appraise a situation. Let’s say you have a thought, let’s say you have harm obsessions, and you have a thought like, “What if I wanted to hurt somebody or so forth?” That you can’t control. But if then you appraise it going, “I’m a terrible person for having that thought,” that’s the distorted thought that you can actually work on. Those distorted thoughts can cause anxiety as well.

4. Behaviors

Sometimes our behaviors can create anxiety. Avoidance is one of them. You would think that avoiding your fear makes anxiety go away. Makes sense, right? But actually, it’s not true. The more you avoid things, the more you actually increase your anxiety about that thing.

If you’ve avoided something for a very long time, let’s say you avoided flying. Now, even the thought of flying is going to give you anxiety. So, behaviors can cause anxiety as well. Now, this also includes compulsive behaviors. It includes reassurance-seeking behaviors. It includes rumination in your mind, mental compulsions. Behaviors can increase the degree in how your brain responds.

People pleasing, this is a big one for me. If I’m people pleasing, trying to make everybody happy, no one upset, you would think, oh, that’s a good thing. You’re being a kind human being. Well, yeah, except it then creates a lot of anxiety at the idea that someone doesn’t like something you did or that they’re upset with you about something that you did. Now, you haven’t built up a tolerance to just the fact that we can’t please everybody. These are ideas on how behaviors can actually cause anxiety.

5. Trauma

In the mental health field today, everybody is saying everything is trauma. It’s like, “You’ve traumatized me. I was traumatized by this.” It’s important that we-- and this is for another conversation, but I’m going to slide it in here. When we talk about trauma, where I’m actually talking about life-threatening trauma. Not to say that we call it little “t” trauma. There’s big “T” trauma, which are life-threatening events, war, assault, witnessing a death, and so forth. There’s some examples. It doesn’t include all of them, but that’s what we call capital “T” trauma. There are little “t” traumas. We all have little “T” traumas and they can cause anxiety.

I’ll give you an example. When I was a kid, we went through, in 1992 I think it was, this devastating drought. I grew up on a farm. We really needed water and the whole environment was just desperate for water and we didn’t have enough water. We had to pay to have a truck bring water just so that we could have baths. It was really scary as a very young child to be afraid of not having enough water to drink. It was scary. We could call that a little “t” trauma. Still to this day, when my kids, my son just spends forever in the shower, I start to notice I get anxious when he’s in there for a long time because my brain is telling me we’re going to run out of water. That’s an example of why you may notice some anxiety show up.

Now I can correct that and remind myself that I live in times where there’s no drought or that we have excess water and so forth. And that’s where I check those cognitive thoughts and errors of my thinking. But the trauma itself can cause the anxiety. Again, I want us to be really careful around the word “trauma” because I don’t want us to be using “trauma” about all the things, because that actually isn’t good for our brains either to keep telling ourselves we were traumatized. That actually can create anxiety in and of itself.

6. Environment

You all have experienced this. Even though I don’t know you and your beautiful face, this you would have experienced in the last few years – the environment of COVID creates anxiety. Seeing people with the mask at the beginning of COVID, I’m guessing you would’ve had a bout of anxiety. Being around loud noises can create anxiety. Being in countries or regions where there are discord, conflict, war, they can create anxiety. Being in an abusive household, the environment of abusive household can create, of course, anxiety. Having someone around you who yells a lot and screams and throws things can create anxiety. There we’re going into the line again of trauma, but we want to consider environment.

7. Stress Management

A big one for right now as well. If you have an incredible amount of stress on your plate, you will naturally have anxiety. If this is you, I’m going to encourage you to consider taking some of the stress off your plate, if possible. I know it’s hard. Some of you have double jobs and family and chronic illnesses and medical, mental illnesses. It’s hard. But anywhere you can, ask yourself, is there a way I can make this easier or simpler so that I can reduce my stress?

8. Lack of Tools

Now this is a big one for me because I get really grumpy and cross. That’s an Australian term for everyone who is an Australian. When you say you’re cross, it means you’re angry or very grumpy about something. I get really cross when people who claim to be anxiety specialists give these strategies that actually make anxiety worse. Sometimes people do have generalized anxiety, but the tools they’ve been given can actually make it worse.

Telling people just to use oils – oils are fine. I have nothing wrong with oils. I actually, PS, love oil. But if that’s your only skill and only tool that you have and your only agenda for recovery, that’s not going to help. It’s actually going to create more anxiety because you’re going to keep getting frustrated on why it’s not working. If your only tool is to, again, another gripe I have that makes me very cross – ah, so funny that I get so upset about it – is people who talk about thought-stopping, like just think about a big red stop sign. That is not a helpful tool. Sometimes it works for some people. But if you have a repetitive intrusive thought, that is not going to work. It’s actually going to make your anxiety worse.

Lack of tools is an important one. I’m even going to say be critical, even of me when I’m giving tools. Really stop and ask yourself, does this work for me? Because I don’t know each and every one of you and all the intricacies of what’s going on for you psychologically. Always stop and ask yourself, is this helpful? I like to give you as many science-based tools as I can. I try not to just decide of a strategy that I use and just use it. But I want you to be really critical of everybody. Be very wise in your selection of who you choose to get advice from. That’s just a little piece to think about. Like I said, I always say this, take what you need and leave the rest if it’s not helpful.

9. Isolation

The last one is important. It’s not last for any specific reason, but it’s isolation. If you are in isolation for too long, meaning that you’re alone, you don’t have community, you don’t have connection, your brain will naturally get anxious. Sometimes people love isolation. I myself love isolation and quiet and to be by myself. Oh, it’s so good. I just love it. I just can sit and be still.

It’s good for some people, but too much isolation, prolonged periods of isolation often can cause anxiety, because we are community humans. Humans are built on community and tribe and needing each other. That goes back thousands, millions of years. For those who are struggling, they’re like, “Everything’s fine. I don’t know why, I’m in my safe house.” It’s like, “Well, when’s the last time you saw somebody?” “Oh, it was months ago.” “Okay, well, that makes sense. You haven’t had any of that.” There is some science to showing that your parasympathetic nervous system slows down when you’re in connection and even physical touch with somebody. That’s just something to think about as well.

There you have it. Those are the nine reasons, 10 if we include alcohol. They’re the reasons that you might feel anxiety in your life or in your lifetime. I hope that this brings you some insight and you had a few aha moments about maybe why your anxiety is showing up again. I promised I would say at the end, this is not to say that now you have to go and fix all of those nine things. Actually, quite the opposite. We don’t fix anxiety. In fact, the more ideal option would be to practice befriending and allowing and not judging anxiety. But if this is helpful for you to maybe make some tweaks in your life, change your distorted thoughts, reduce your caffeine, manage your stress, change your environment, get some connection, get some helpful tools, that would make me so, so happy.

Before we finish up, we are going to do the review of the week. This one is from Tennessee Lana. She said:

“Game changer. I found this podcast four years ago and it has been monumental in my anxiety and OCD recovery. Many podcasts led to new content that I could follow and learn. I could write about this and never stop but instead I’ll leave a few adjectives that I think adequately describe this podcast. Kind, insightful, intelligent, easy, interesting, practical, helpful, uplifting, and LOVING.”

Oh my goodness, Tennessee Lana, do you know the word I love the most? Practical. If I can be practical in helping you, I feel like I am winning in my career. All of those adjectives make me so overjoyed, but I love these. Actually, Tennessee Lana, I’m going to steal them from you. Copy and paste them. Maybe put them on my desktop just to remind me of the goals of the podcast. Love it.

I hope you found this helpful. Have a wonderful day. Please go to leave a review if you can. Those reviews allow me to reach more people from people who trust the show, which is key. If someone can see that other people are enjoying it, that means they can trust us quickly, which is the goal. And then from there, I hope that this episode was helpful and gave you some insights.

All right. I will see you next week. Have a wonderful day.

Mar 11, 2022
Ep. 224 Greater Than Panic (with DLCAnxiety)
44:18

SUMMARY: 

In today's podcast episode, we have Dean Stott from DLC Anxiety talking about his experience with Panic Disorder and Overcoming Panic Disorder.  In his upcoming book, Greater Than Panic, Dean talks about what it was like for him to experience agoraphobia, panic disorder, and other struggles after the death of his father.  Dean spread an inspiring story about overcoming panic and how he is Greater than Panic.

In This Episode:

  • What it was like for Dean Stott to have Panic Disorder
  • How he overcame panic disorder using CBT and Mindfulness
  • How Dean created DLC Anxiety, an online platform that helps millions with panic, anxiety and other mental illnesses.
  • Tools that he found helpful to manage his Panic Disorder while also grieving the loss of his father.

Links To Things I Talk About:

DEANS BOOK GREATER THAN PANIC 

Greater Than Panic Book

Amazon link

Episode Sponsor:

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

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

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

EPISODE TRANSCRIPTION

This is Your Anxiety Toolkit - Episode 224. 

 

Welcome back, everybody. We have an amazing guest, a very, very sweet friend of mine. I am so excited to have on with us Dean Stott from DLC Anxiety. He is a true legend. Dean is on the episode today to tell his story about going from having a fairly severe panic disorder to then creating a mental health platform with over 1 million followers. He’s now all about creating mental health awareness sharing with people. He’s such a cool human being. And I’m so honored to have him on today. 

 

We talk about his recovery, which you will get a lot of hope from because, like everyone who comes on the podcast, he really did the work, which is so cool. But then we also talk about the role that social media can play in mental health recovery, things to look out for, how to handle trolls, the benefits of being online, especially social media. If you have a mental illness, we go through it all. And it’s such a great episode. So, I’m so excited to have Dean on today. 

 

Before we get into the episode, I want to give you the “I did a hard thing” for the week. This is from Nicole, from the Netherlands, and she said:

 

“I did a hard thing and I get very anxious when I have to call my doctor. My heart rate goes up and I get all trembly. So, I tend to avoid calling the doctor. But because I had been feeling dizzy, I had to get my blood checked. Afterwards I would have to call the doctors for the results, except I didn’t. I told myself if there was anything serious, surely they would call me. I kept this up for almost two weeks and then I suddenly thought I really should call for the result. So I pushed in the numbers to the doctor’s office, feeling all kinds of nervous. I was very tempted to just hang up. While I was waiting, I thought, why did I do this? What if I get bad news? But then I had another thought, if it’s bad news, all the more reason to hear it. So I hung on and I faced my fears. Turns out I have a vitamin D deficiency. It’s not very worrisome, but important to fix. I’m so glad I phoned the doctor, even though I REALLY DIDN’T WANT TO. Nicole from the Netherlands.”

Nichole, I love this story. And the thing I love the most, and for those of you who want to submit for this, please do go. I’ll leave a link in the show notes. But Nicole, I love that you detailed what got you to do it, how you did it, what thoughts you had to shift up to get yourself to do the hard thing. You walked us through step by step and it makes my heart want to explode with joy. Thank you so much for sharing it. Amazing, amazing, amazing, amazing, amazing work. I am so, so impressed. So, thank you, Nicole. I love it. 

Let’s get over to the show where we can hear all about Dean’s recovery.

-----

Kimberley: Welcome, Dean. I am so happy to have more-- actually, as much as I’m happy to have you on the podcast, I’m just happy to have chats with you. Welcome.

Dean: Thank you so much. Thank you for inviting me, Kim.

Kimberley: Yeah. So, I feel like I know you and your story pretty well. But I would love for you to share your story with my listeners because I think you have some really great stuff to share. So, can you share whatever you’re comfortable about your recovery?

Dean: Yeah, sure. So, basically, once upon a time, I was going through a panic disorder. So, dealing with four panic attacks, maybe four or five panic attacks every single day, where I get the worst period. And yeah, I went through a panic disorder, did my own research, a lot of science research, CBT research, mindfulness meditation, and curated my own plan out of recovery with the guidance of a really good support network, friends, and mentors, who’d been through an anxiety disorder and come out the other side and fully recovered from the panic disorder. I then wanted to take that feeling of the support that I was given from my older mentor, the friend that had been through it. I wanted to share that with as many people as I possibly could. So, I came up with DLC Anxiety.

So, at first, I remember sitting down and I was like, “How can I get this message out to as many people as possible?” And I was thinking of local support community groups, like the Alcoholic Anonymous groups where people go and it’s a supportive network between each other. But then I was just so eager to try and get it even more on a global stage. And I saw what Instagram does and I just thought it would fit nicely in there, because I did see that there wasn’t many mental health communities when I first started. So, I thought there was definitely a nice place for it to fit there. So, yeah, I started to tell my story on Instagram. People started to relate, and it was a snowball effect from there. And now we’re over a million followers in the community, which is fantastic.

Kimberley: So cool. So, I think that the whole concept here is really to look at what-- let me backtrack a little bit. So, in your recovery, did you do it all on your own? Did you have a therapist? What was that process like for you?

Dean: Yeah. So, my father passed away. Like any people, any male in that situation, I bottled up the feelings that I was going through and tried to carry on with going to work and trying to get back into my daily routine. Almost putting it to the back of my mind because I wasn’t-- well, I didn’t have the techniques to cope with that and I’d never cope with loss before. So, it was from that bottling up of the grief that the panic attacks started and occurred. 

So, when I first started having panic attacks, the first thing I did was go to the doctors who then referred me onto a grief counselor, but just specifically to address the grief side of things and not the anxiety, not the panic attacks. Regarding the anxiety and panic attacks, that was me curating, delving into a lot of psychoeducation, which I found very useful, learning about the system and the symptoms of anxiety. Now I’d done Psychology at university and done CBT before. So, it is like not I’d never--I knew the basic concepts of anxiety, but learning more about it and learning about the scary symptoms where you think-- firstly, when you have a panic attack, you really think that you’re going to die. It’s a really, really scary thing to go through. And yeah, to start learning about that was super important for my recovery.

 

Kimberley: Right. And so, let’s talk about community, why do you feel the community aspect was so important for you? Tell me about the idea of creating a mental health community for someone, let’s say, who’s suffering with panic disorder or grief or OCD or anxiety. What’s your thoughts on that?

 

Dean: Yeah. So, when I was going through panic disorder, I felt isolated, I felt alone, and really, I didn’t really want to bring it up to people around me because I just didn’t think they’d be able to relate to me. I thought these symptoms was just something that I was going through and something that I’d have to stick with for the rest of my life. I thought that was me, that I was going to be Dean who has these panic attacks. And I was going to have to navigate my way through my daily routine. And I think when I opened up to my mentor, a close friend of mine, who was working with me at the time – when I opened up and he shared his experience, it was the biggest weight off my shoulders, knowing that someone else had been through not the exact same story, but it experienced all these scary symptoms that felt isolated, felt alone, but more importantly overcome an anxiety disorder. And I think it was that inspiration and motivation that really helped me in my recovery. 

So, yeah, having an important-- so, DLC is Dean’s Like-Minded Community. So, it’s a community full of like-minded people on anxiety recovery journeys. Some people are at the end, like myself, I don’t deal with panic attacks anymore, but some people are at the start, some people are in the middle. And they can all relate to each other no matter where they are on that journey. And then what’s beautiful about the community is where you see them sharing tips and experiences that work for them. And I know you speak about it highly as well, having an anxiety toolkit, because some tools might work for one person, but then might not work for another. But I think it’s very important to get as much information out there about all the different range of tools, so then each person can individualize their own recovery.

Kimberley: Yeah. So important more now than ever, I think, given that the degree of mental illness is so high given COVID and isolation and everything. Okay. So, you have this platform. I love it. Very much, I loved being a part of your community. Why do you think that that is the most important piece, the community aspect? Can you share a little bit about what you see and hear from your community and why that’s so important?

Dean: Yeah. So, again, so many DMs from people saying that they just feel connected. They feel hope, they feel inspiration, they feel motivation. Not only for me, who’s at the head or the founder of the community, but of all these people that are going through it, jumping over a million people worldwide. We know mental health. It doesn’t have a face, it doesn’t have a color, doesn’t have a social structure, it doesn’t matter what you’re working as it can affect anyone. And I think that’s why it’s really important and became an integral part of the community, was the interview series that I started doing with firstly mental health professionals from around the world. So, CBT professionals like yourself, Kim. Then we’ve had psychiatrists, psychologists, doctors. And having just as much information about anxiety and anxiety recovery, I think has been a super important part.

 

So, again, it’s not only having this community, it’s having the psychoeducation and real good-- I’m in a real good place now where I can guest on who I’ve joined a world-renowned within the space of anxiety. And also, we’ve had so many celebrities, musicians, actors, actresses come on and tell their own mental health stories where they struggled or where they’ve been vulnerable. And that’s really related to the community as well. Because obviously, people work at celebrities, people work at musicians and they might not know that just too, they’re going through a mental health disorder. So, yeah, having people like that come on and tell their own stories has been super, super beneficial for everyone as well. 

Kimberley: Yeah. See, the cool thing is that the science, this is why I’m really fascinated in, is the science of self-compassion says that there are three components of self-compassion. One being mindfulness, the second being common humanity in that reminding yourself that you’re not alone in your struggles is the second most important part of self-compassion. The third being self-kindness. Now the reason I love this is I know for myself in the areas that I struggle, if I look at an account and I can see that a million people follow a mental health account, it gives me a sense of common humanity that there are a million people struggling with something. If you see an OCD account and it’s got 60,000 followers, you’re like, oh my God, that’s a lot of people. I must not be alone in my struggle or an eating disorder account. Or I love some of the autism accounts. I think it shows that it gives you permission to see that you’re not alone. And I love that. It’s such a beautiful piece of the work.

Dean: Yeah. And especially where you just mentioned self-kindness as well. I think that’s an important subject just to speak about, is that when you’re going through an anxiety disorder, you have this inner critic that’s telling you that you’re never going to come out of it, that you’re not good enough, that maybe this is happening to you for a reason. When you come across these communities of people who are on their own journey of recovery might be a little a few more steps ahead than you, and you see that they have a positive outlook, some of them, on recovery and they are making steps. I think knowing to change that in a narrative and have that self-love and compassion is super important when it comes to anxiety disorders.

Kimberley: Yeah. And that’s the benefit of social media right there. I think social media gets a really bad rep, but we have to weigh the pros and cons because there are lots of pros, right?

Dean: Yeah, no, 100%. What I’d say is this is how I define it, is that if we just take Instagram and our mental health community so all the mental health accounts that are doing great, I see just like a safe haven corner of Instagram where people can go to and feel supported and connected and learn more about mental health in general. An app, like you say, can have a negative effect on people. And I think people speak about the algorithm and obviously, it’s all guessing what the algorithm’s going to do next, but I think we can actually use the algorithm in our favor. 

And if you just bear with me on this, if you think about all the accounts that you’re following, so if you’re following all positive mental health accounts or self-compassion or self-care, self-love, then the algorithms are going to spew that out to you in your own feed. So, what are you doing? You’re starting to change that in a narrative like in your digital world, because you open up your app and you start to see all this self-love and positivity. So, you can definitely use the algorithm. So, I think it’s super important in taking a look at who you’re following and seeing, does that benefit your mental health? And if it doesn’t, then I don’t think you should be following them.

 

Kimberley: Yeah, I agree. Actually, I just was saying yesterday that I was just scrolling my-- I’m rarely on social media just to scroll. I’m usually there to do the work I do. My son was sick. I was sitting there wasting time. But the cool thing is the suggested was all cool stuff. It was really cool. I was like, “Oh, I love all these new ideas and these new looks.” And I was really appreciating what was being suggested to me, even though I know there’s some controversy around that. It was very cool.

Dean: And you can imagine if somebody’s just starting or at the beginning of anxiety disorder and they’ve got this negative outlook and they’re isolated and they haven’t connected, then the algorithm may be spewing them not the right information. So, I think it’s important to really highlight the best we can our corner of Instagram, this mental health community that’s doing so great. And it’s a new wave of mental health support really and much needed, like you say, with COVID and everything that everyone’s still going through. I think over the next five, 10 years, it’s going to be more needed than ever.

Kimberley: Right. Absolutely. I can’t agree more. I don’t even think we have the stats yet on what mental illness is like from COVID, mostly the isolation of COVID. So, I 100% agree. So, let’s step outside of the online world and let’s talk generally, how did you find this community? Not the online community, but as you were going through recovery, did you tell them about your struggles? Did they come to you? How would you suggest people tell somebody about their struggles? Do you have any thoughts on that? 

 

Dean: Yeah. So, my body and my mind and everything was telling me not to open up about anxiety and not to speak to anyone and to keep it as an inner struggle, because everything with anxiety, we know it’s all internal, it’s all inwards. We’re ruminating on our thoughts, feelings, and sensations. So, it doesn’t make sense to then speak to other people. It’s not natural to do that. So, I had to go against that and I just started to open up and not feel ashamed to tell people what I was going through. I think I got to a point where it felt like I was struggling too much for me to be going through it, so I felt like I had to.

So, my advice to people would be, speak to the people around you, have a support network. You may come across people who dismiss your anxiety [00:15:20 inaudible]. And it’s super important to know that just because they dismiss it doesn’t mean anything. It’s just, they may be their views. They might not have the education on mental health. So, yeah, if you get dismissed, that shouldn’t stop you from opening up, because I know that people often, especially in my community, say, “Well, I feel like I can’t tell people because if I tell my parents, for example, they just tell me to continue to get on with it that I don’t have these issues.” 

So, I think that when that happens and you have parents and it’s important to put mental health boundaries in place, obviously, especially if we’re living with our parents, we can’t just move out or whatever or if we’re young. So, we have to put these boundaries in place and have a support network around us. So, if you are younger, it could be someone in your education system, it could be a support worker, or it could be the online communities like we mentioned.

 

Kimberley: Yeah. That’s interesting because what’s been on my mind lately, particularly in the online space, is what to do when you have been dismissed. Now that happens from parents and loved ones. But I think it does happen on social media as well, right? You will have-- the message I’ve been trying to give is, if it’s helpful, take it. And if it’s not helpful, leave it. Because a lot of people will come to my platform and say, “I’m freaking out because I just read this, which goes against what you’re saying. And I don’t know who to believe.” And they’re doing the best they can with what they’ve got. So, I think that it’s important for people, even on the online, to also dismiss bad advice online, right?

Dean: Yeah, definitely. So many people get dismissed online, don’t they? But I think you gave some great advice, Kim. And that was, anybody can write anything on social media doesn’t mean that it’s true, does it? So, we need to take in what someone’s saying to us, but if it doesn’t fit our way of thinking or it doesn’t benefit us, then it’s okay to reject it. Just like if we think of anxiety and thoughts and you get these irrational thoughts. We get this irrational thought and we don’t believe it. What do we do? We don’t accept it. We can reject and replace it. And that’s what we should do with the information around us. So, if we see a negative comment towards us, it’s so easy, isn’t it? It is so natural for us to react in a negative way because that’s the way we’re built. You know what I mean? It’s our protective system there to try and protect us. But yeah, if it’s not benefiting you, then it’s okay to step away and move away from it.

Kimberley: Okay. So, let’s talk about the dreaded trolls because that’s the perfect segue. So, what I would love for you and I to talk about, and if it’s okay, be as open as you can, but let’s talk about the mental impact of having a troll, because I think you could have a bully at school and you could have a bully for a boss or you could have a bully online. And I think it’s similar in how we can internalize it. So, I have had a troll for over a year now who’s pretty aggressive. And most of my people know aggressive and awful. And in the beginning, I took it completely personally, right? Completely personally. I thought everyone was just going to hate me. And it was the most-- you know the whole thing about you have to break something to put it back together the right way?

Dean: Uh-hmm.

Kimberley: That’s how it felt for me, because obviously, I had built my platform and what I do, my businesses on this idea that if I just do good and I’m kind all the time, no one will ever hate me. It’s impossible to hate me if I’m kind. I think it was this belief system that I had. And that got shattered into millions of pieces because there were people who really didn’t like me. And so, I think that I’m glad it broke and it got shattered because I got to put it back properly of I had to restructure that belief. But that was really, really hard. And having someone online say things, such horrible things, I really, really had a difficult time of not taking it personally. So, can you share what your experience of online trolls and that kind of thing has been?

Dean: Yeah, sure. So, with the DLC Anxiety community, especially when the first lockdown happened and we had the celebrities and musicians, they all started to gain control back of their own social media accounts. So, we saw a lot of celebrities sharing mental health stuff, which is amazing because it’s shining a big light on everything to do with mental health. So, I saw an exponential growth within that period of the community. And yeah, I remembered it was on either speaking on interviews with people or just on lives. Again, your mind zones in. Doesn’t matter how many positive messages you see on your Instagram lives, for example. It’s only natural if you see one negative comment for your mind to then just zone in on that.

And I remember the first time that happened to me. I was really taken back because I was putting 23, out of 24 hours into being in this community and helping the best I can, sharing a very vulnerable story to do with my father passing and then an anxiety disorder. And I thought I was being vulnerable and open and honest, and like you say, just trying to give as much love and support for people as I could. And then to see that someone else, some people were being negative towards this, it was dismay. I couldn’t believe it. It didn’t feel real. It was like, “Why are they saying negative things towards me?” 

So, it was definitely a learning curve. I always remember the first time that happened. Over time, it has got better. Like you say, you managed to structure and rearrange things and you managed to not take these things personally and look from the outside, that the people that are spreading hate or being negative, they may be hurting themselves. 

My take on it now, Kim, is that even if these people are spreading hate and being horrible on my community, especially towards me, is that hopefully, they may get some good out of one of the other interviews with someone else, because I know that these people, they’re in need of mental health support themselves. And for whatever reason, they haven’t been able to get it. And I always think that if they’re giving me hate, I can now take it. And hopefully, they might see something that benefits them. But it has been very hard to change my perspective on that. It was not an easy road.

Kimberley: Yeah. That’s hard for me. I think on my end, I just had to keep reminding myself that, well, all the words are about me, it’s really not about me. It’s a lot about them and their struggle. The way I work through it-- and maybe you could tell me what you think as you see the troll, like how do you think about it. For me, when I see really awful, hurtful, hard comments, I first remind myself, this person had to suffer a great, great deal to be spreading this much hate. To understand that they had to-- no one who’s had a really easy life is jumping onto the internet and spending hours spreading hate on people. It’s usually that they’ve been through an immense. And that was really helpful for me, compassion-wise, of just to be like, “I actually have compassion for you. You’ve obviously been through the wringer.”

And then the second piece for me, and this was the hard part and I’m curious, I really want to know your thought, was to start to trust that people will trust me, that people will see the real me, not me that that person is saying I am by me being consistent and showing up as me. And that was a hard piece because, at the beginning, I was like, “But what if they don’t trust me?” The consistency has been really helpful for me. But I think the truth is, that has also been really helpful for me to translate it into the real world. 

 

Dean: I was just going to say, yeah, because if your inner critic, like you say, is wanting for everyone to relate to everything that you’re putting out there, all the amazing stuff that you’re putting out there, the last thing you want is somebody trying to discredit that because, you know what I mean? All we’re trying to do is help the people around us. So, yeah, it’s that inner critic and working on our inner ourselves. 

When I see a troll online now, I just tend to leave them be. I think just leave them to do what they want. I think we know that our communities know what we’re about. They know how much we give to our communities, they know how much support and wealth that we give everyone on a continuous day. And like you said, you can’t stop these people, but also, just because they’re writing something, it doesn’t mean that it’s true, which I thought was beautiful for you to say. 

Kimberley: Yeah. It’s tough. I mean, I think that that is a huge part of our mental wellness, is how we relate to people, right? And we’re in relationships. So, even if we’ve got a panic disorder, I was thinking about this the other day, is we’ve had a really, really rough house here in the Quinlan house this week. It’s been pretty chaotic, lots of sickness, lots of scary COVID scares, and so forth. And there was a time where I would’ve lashed out because of my own anxiety. I would’ve been really snarky to my husband because he goes to work and he doesn’t have to handle it. And I would often displace my anxiety and anger, just snotty. And that happens a lot. I hear a lot of people talking about just in daily life like, “I’m really struggling because my partner and I aren’t getting along because everyone’s anxious and so forth.” So, I think it is helpful to be in relationship with people who do have their own struggles. Like I said, it happens online, but it’s also happening at home. 

Dean: Yeah. It can just happen on a day-to-day basis. A lot of people say that they can’t deal with people when they’re being negative towards them in real life. But it’s about taking a step back and knowing that the person who’s spreading that negativity towards you, that maybe they’re having a really rough time at home with their partner, that maybe they’ve got troubles with their job, money. It could be anything. Maybe they were traveling to work and they got caught up. And we’re all a product of our emotions at that time. And emotions, as we know, they come and go and it doesn’t curate who we are as a person. 

 

So, if someone’s being angry towards you and negative towards you, it’s about taking a step back and knowing that it’s more on them again and it’s more on what their experience and the feelings and emotions and putting the correct boundaries in place. But it is really hard to do. I’m not saying that it’s easy to do. It is super, super hard, especially when someone’s coming at you with negativity. Your first line of defense is, you know what I mean, to attack normally, isn’t it? Or to take a massive step back. So, yeah, it takes a lot of practice, but it can be done.

Kimberley: So, talk to me about, you’re probably the one person who would know the answer to this, can you share with us about managing mental illness with social media? How might someone have a healthy relationship with social media and the use of social media?

Dean: Yeah. I have to put boundaries in myself because I say everything that I do is on Instagram, 99% of it. And if I’m not working on Instagram, I’m working on my website, which again is online. So, yeah, putting boundaries in place is super important, having rest away from social media, what we mentioned earlier about following accounts that really benefit you and have a positive impact on you and just getting rid of the negative accounts that are not making you feel good. You don’t want to go onto social media and not feel good because we all know we spend way too much time on social media. And if we’re spending that time looking at negativity, then that’s what it’s going to do. It’s going to put our mood in that sense. And we could really spiral into a state of being in a negative state just by what we consume. It’s like when people speak about the news and say, “Oh, well, I can’t watch that because it affects my mental health.” Social media is exactly the same, but probably more so, because we’re spending more time on it and it’s literally part of who we are now.

Kimberley: Right. What would you say to someone who uses social media to cope with their anxiety, meaning to distract against it or to get them through their panic? Do you have any thoughts on managing it for anxiety?

Dean: Yeah. It’s a very good question. So, I always go back to thinking, at the start of my panic disorder, if there were communities like ours out there, would it have been beneficial for me? And the number one answer is yes, 100%. It would’ve been an eye-opener. I would’ve felt I wasn’t alone. I would’ve felt motivated and encouraged that I can continue. But if you’re using anxiety communities as a way to not do the hard work, then I think it can be detrimental. I think anxiety recovery is about doing the hard work. 

Now, a lot of people, and I’ve just done a post on this, unfortunately can’t have the access towards therapy, which we know has a massive benefit on mental health. We speak about anxiety, the latest sciences, the medication and a combination with CBT therapy has the best results. Now, that doesn’t mean for everyone, but some people may do better with medication, some people may do better with therapy. So, I think that having a community to help you and understand the psychoeducation behind it is great. But if you’re using it as a distraction to try and distract you from feeling anxious and dealing with the anxiety head-on, that’s when it can become detrimental. 

I often say that there’s so much information-- and you can obviously maybe shine away on this, Kim, but what would you say to people who say that they can’t access therapy? Maybe it’s a money thing. Maybe it could be anything, couldn’t it? Do you believe that these people can still recover? Because there seems to be a narrative online that therapy is the only way forward. I think that’s an unhealthy way of looking at it because we know that anxiety recovery, there’s so many different routes out of it, and it all leads to the same angle, doesn’t it? Which is anxiety recovery. So, what would you say to the people that can’t access therapy? Would you be still giving them hope?

Kimberley: Well, to be honest with you, 1000% I would give hope. I myself have had therapy for some things, but I really didn’t feel like therapy for other issues were helpful. And I felt it was better for me to actually work through a workbook, listen to a ton of podcasts. I’m a real mix. I’ve been blessed and privileged to have some amazing therapy, but some of my mental illness, I really needed to do on my own. But I did them through, like I said, a workbook, a support group, some were online courses. I mean, that’s why I created ERP School, was because people didn’t have-- that we’re turning them away to nothing. But what was really interesting about ERP School and CBT School is just recently, out of the blue, a bunch of people have reached out to me and said, “I wanted just to let you know that that got me right back on my feet.” It’s so wonderful to hear those stories, because otherwise, you’d don’t know them and you didn’t realize what an impact. So, no, I absolutely believe, I’m a real big believer in workbooks. I struggled with workaholism and that workbook for workaholism was huge for me and perfectionism. These are two really, really important things that I use that did not require therapy at all.

Dean: Yeah. So, like you, Kim, I like to be guided by the science. So, I know obviously how important therapy and how life-changing it can be for some people with anxiety. But also, I think there’s still a lot of stigma around medication when it comes to anxiety, especially online. And yeah, I think we need to do a little bit more work on that because I think anxiety medication is being dismissed more so. Maybe that’s another conversation that we can have in the future. But I didn’t go through therapy with my own anxiety disorder, with the panic attacks. Mine was going online. I think you have to go to a trusted site. So, over here, you have the National Health Service, which has a ton of resources, all scientific, proven, all credible from the correct sources. And I think if you’re researching and looking at all the correct things, I think that can be really powerful for you. So, if you can’t access therapy, of course, there’s still hope. Of course, you can still recover. And that my message to everyone is I did it. So, if I can, I’m just a regular guy, you can do it too. 

Kimberley: I love that. Just because I know, and thinking of the person listening here, like how did you do it? I know we haven’t got a ton of time, but could you just say, how did you muster up the courage on your own to face your fears?

 

Dean: That’s a great question. And I do have my book coming out, which is--

Kimberley: All right.

Dean: Yeah. So, the book is called Greater Than Panic. It’s the number one question that I’ve been asked since day one of starting out the anxiety community, and that was, what is your story and how did you get from four panic attacks a day to be in the head of DLC Anxiety and be in the face of the interviews and not having panic attacks? Obviously, I’m still having anxiety. That’s a message that I think isn’t hammered home enough, whereas the goal of anxiety recovery is not never to feel anxious again. I think people often are misguided and have misinformation, especially at the start of an anxiety disorder, thinking that the goal is to never feel anxious again. The goal is to change your behavior to when you’re feeling anxious and make sure that it doesn’t have a detrimental impact on your day-to-day.

I go right back to the basics. I go back to speaking about my father’s death, which was obviously a really terrible time, and it brought out a lot of emotions but also, I think it was important for me to go back and just explore it again. And I speak about my relationship with the doctor. It’s again another message that I like to hit home, is that if you’re dealing with any physical symptoms to do with emotional symptoms, to do with anxiety, your first port of call has to be the doctor, because we know that anxiety disorders can mimic other things. And so, it’s super important for a medical professional, a GP, a doctor, to run diagnostic tests to make sure that everything else is okay. And then when they tell you that it is okay, you can sit down with the doctor and you can start to plan your journey of recovery, which may be therapy, maybe self-help, maybe meditation, mindfulness, exercise, medication, so many different routes. 

But yeah, my number one message is, if you’re dealing with physical symptoms and you haven’t had them checked out, you have to go to the doctor. So, I speak about my relationship with the doctor. I speak about curating my own anxiety toolkits. So, what worked for me and the research and the science behind each thing that I was trying and how it had a benefit impact for me. And I speak about exposure therapy and how that was really beneficial for me, but doing it not guided by your therapist. 

Now, if you look at the science, you would say that the best effects of exposure therapy is guided with a therapist, but I didn’t personally have a therapist in my journey. But if you can have a therapist, I definitely recommend that that’s the best route to go down. But I speak about how exposure therapy worked for me and I speak about the hiccups on that road to recovery and what recovery looked like, what it meant to me. And then I speak about the anxiety community and how I wanted to spread the message and get that message across to as many people as I possibly can. And yeah, it takes me to the present day. 

 

Kimberley: I can’t wait. That’s so exciting. So, tell me about the name of the book.

 

Dean: Greater Than Panic. So, that’s the message that you are greater than panic. Just because you have feelings of panic, if you’re up in panic attacks or panic disorders, it doesn’t mean that you’re broken, it doesn’t mean that you can’t be fixed. There’s nothing to fix because you’re not broken. So, you are greater than panic at all life, things, all the dreams, aspirations, careers, travel, love, money, whatever it is that you want, you can get. Doesn’t matter that you’re going through panic or have panic attacks. O if you’ve been through panic disorder, the other message is that you’re greater than panic.

Kimberley: Amazing. Okay. So, I’m going to leave you. I feel like that’s the perfect way for us to end out. Is there anything else you want to share with us, any links, or how people can hear about you?

Dean: Just DLC Anxiety over on Instagram and the website, www.dlcanxiety.com. I’d just like to thank you, Kim, for obviously inviting me on here. And I’d like to thank you for everything that you’re doing in the mental health space. CBT is super important to me. It’s an integral part to my recovery. And yeah, I’m just super grateful for our connection on Instagram and just everything that you’re doing.

Kimberley: Thank you. I feel so blessed that we randomly got to meet. You know what, it’s such a blessing. So, thank you. I’m so grateful.

Dean: Thank you.

-----

Thank you so much for listening. I’m sure you got so much from that. Before we finish up, let’s do the review of the week. This is from Disc Golf Nate. They gave five stars and they said:

“As Kimberly would say, this is not necessarily a substitute for in-person therapy. But it is still a very powerful tool. I’ve used this podcast in conjunction with my therapist and some books, but this podcast brings me the most peace.”

Thank you so much, Disc Golf Nate. I am so honored for that amazing review. And yes, this should not substitute therapy, but my hope is it gives you some tools, some skills, some hope, some support, some joy, and compassion into your recovery. So, I’m so honored to have this time with you. I will see you all next week.

 

Mar 04, 2022
Ep. 223 What if I Don't Deserve Self-Compassion
20:22

SUMMARY:

We all know that self-compassion is am important tool for anxiety recovery.  In this weeks episode of Your Anxiety Toolkit podcast, I address a common concern; “What if I dont deserve self-compassion?”  This is such a common reason people do not provide themselves with compassion.  In this episode, review the reasons YOU DO DESERVE SELF-COMPASSION and some key concepts and self-compassion mediations to help you practice self-compassion.

In This Episode, we cover:

  • Self-Compassion Definition
  • Reasons people feel they do not deserve self-compassion
  • Ways to manage feeling unworthy of self-compassion
  • How to practice Mindful Self-Compassion

Links To Things I Talk About:

Self-compassion Mediation: Here is a link to several self-compassion meditations from previous episodes.
https://kimberleyquinlan-lmft.com/episode-2-lovingkindness-meditation/
https://kimberleyquinlan-lmft.com/ep-134-giving-and-receiving-meditation/
https://kimberleyquinlan-lmft.com/ep-110-this-compassion-practice-tonglen-meditation-for-anxiety-will-change-your-life/

Episode Sponsor:

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

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

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

What if I don't deserve Self-Compassion Your anxiety toolkit

EPISODE TRANSCRIPTION

This is Your Anxiety Toolkit - Episode 223.

Welcome back, everybody. It is a joy to be with you again. Thank you so much for being here with me. Thank you so much for putting aside your valuable time to spend it with me. I feel so honored.

Today, we are talking about a question. And in effort for us to respond to this question, we’re actually going to ask ourselves some questions and I’m going to have some questions for you, and you’re going to think about them, hopefully, and then make some changes if you think that is what you need.

The big question of the week is: What if I do not deserve self-compassion? Now, one of the most common questions I get is this question, particularly when I’m with patients and we’re discussing the idea of practicing self-compassion or kindness towards themselves. Often, that is a question they ask, what if I don’t deserve it, or they may even make a statement like, “I don’t deserve self-compassion.”

Now, this is particularly true for those who are very self-critical and blame themselves for certain things that have happened either to them or that they have done. Like I’m saying, it’s like things that were accidental, things that they didn’t have control over, or maybe some things and mistakes that they did make. This is a really important question for us to explore. I’m going to hopefully get to explore it with you.

Before we do that, I would like to do the “I did a hard thing” for the week. This one is from Sophia. Thank you, Sophia, for writing in and telling us your hard thing. Sophia said:

“I suffered from OCD starting when I was 19. My hard thing I did was I reported my stepfather in for sexual abuse that occurred when I was nine when I found out I wasn’t the last victim. It took me 28 years to get to this place. And let me tell you, OCD really played into my intrusive thoughts. It made the process so much harder. But I did it and I feel like I’m out of the web of manipulation from my stepdad. This podcast helps so much and the book for self-compassion and fear workbook my OCD therapist recommended to me. I saw your podcast listed in the first few pages. Thank you for being a part of my support system without even knowing.”

Wow, that was an amazing “I did a hard thing.” Thank you so much, Sophia, for sharing that amazing hard thing. You are showing up and facing fear and pulling your shoulders back and living your life according to your values. That is impressive. I’m so honored to have you share that with us and really do wish you the best. You are doing amazing things.

Okay. So, let’s move into the bulk of the podcast in terms of let’s talk about what if I don’t deserve self-compassion. This is so important. I’m going to first pose to you the first question I have for you, which is, who actually deserves self-compassion?

If someone says to me, “Well, I don’t deserve it.” I’ll say, “Well, who does? What do you have to do to be warranted of compassion? Who does deserve it?” I really pose this question. I really hope you answer it. I would like actually you to sit down and ask yourself, “Well, then who does?” And you will begin to see very quickly, I’m guessing, the rules in which you have for yourself that keep you stuck.

Oh, the people who don’t have these thoughts, the people who don’t make mistakes, the people who are perfect, the people who look like they’re happy and are doing well. Or often people will say, “Everybody else is off the hook. It’s just, I’m not off the hook. Everyone else can be imperfect, mistake makers, but not me.” You’ll quickly learn the rules of your life.

I want to ask you, do you want to live by those rules anymore? Because this is not playing games. This is your life. Do you want to keep holding yourself to those rules that you just listed off? How does it benefit you to continue to hold yourself to that high, high standard? Often, we say, “I shouldn’t have these feelings. I don’t deserve it because I’m weak. I don’t deserve self-compassion because I’m not valuable. I don’t deserve self-compassion because of the content of my thoughts. The content of my thoughts is too heinous.” Okay. So, there you might want to look at, again, what are the rules and do you want to live by those rules? Because the truth is, you can’t control your thoughts and you can’t control your feelings and you can’t control life a lot of the time, almost all of the time. And so, again, do you want to live by those rules?

Next question: Are you beating yourself up for something that’s not your fault? Meaning can you control your thoughts? Because my thoughts aren’t my fault. I know my feelings aren’t my fault. I know how I interpret things aren’t my fault. That’s usually coming from years and years of being trained to think that way. I know my beliefs aren’t even my fault. I actually think we’re just creatures of habit and we were raised to believe certain things and we are going to make mistakes. I’m going to say this again: What would you have to do to warrant deserving self-compassion?

Often when we actually explore this, I really, really hope you start and actually write your answers down to these questions because when we stop and we look at like, okay, so if you don’t deserve self-compassion, we really know the benefit of you practicing self-compassion so much so that I am in the process of creating a course that will teach you. I’ve already written a book for people with OCD, but I’m creating a minicourse on how to practice self-compassion. It’s that important. I want everybody to have access to it, not just those who have OCD. That is a big part of my mission, is to get everybody to be practicing self-compassion.

Let’s say we really understand the benefits of it. We know it’s important. We know it can increase motivation, make you more successful, decrease procrastination, make you feel like a better sense of self. It can help you achieve your goals. So many benefits. It actually reduces inflammation. It gives you better wellness and health. It increases life satisfaction. So many benefits. Let’s say we want you to do it because it’s healthy, just like you would exercise because it’s healthy, or you would go get it to the dentist because it’s healthy. What would you have to do then to be warranted and deserving? And often then, again, you’re going to be very clear in terms of this list of things.

I’m going to ask you, are the list of things even realistic? Really, if you said, “Okay, I’d need to no longer have these thoughts and I would have to have changed the past and done something different. I’d have to regulate my emotions all the time. Never snap at my children and never say something silly at a party.” Is that even possible for any human? Really for any human, is that realistic? Do you actually think you can actually achieve that really honestly? This is a question. This is not rhetorical. This is an actual question.

The chances are, when you really answer it, the truth is, you’re not giving yourself self-compassion because you don’t feel like you deserve it. But the truth is, you will never be able to meet these rules that you’ve created for yourself. I don’t want to say that as if I’m blaming you. We’ve all done this. But I want you to be really honest with yourself in regards to, you’re never going to get to the place where you practice self-compassion if you keep those high level of rules, those perfectionistic rules. And then you miss out on this wonderful opportunity for your mental health and for your physical health, and for your wellbeing.

Here is another question: What would you have to feel in order to offer yourself self-compassion? Meaning how would you need to feel about yourself? What emotion would you need to feel in order to feel like you deserve it? What would you have to experience about yourself? Not the rules, but like would you have to. Some people say, “I don’t feel like I deserve it.” It’s a feeling.

The reason I ask this question is because often people will say, “It’s just a feeling I get. Sometimes I feel like I do and sometimes I feel like I don’t, usually depending on whether I’ve checked off all of these boxes.” But it’s still a feeling that you’re going off because it’s different. It’s not like you get your notepad out and you check the boxes. It’s a feeling.

I might pose to them, could you actually offer yourself self-compassion without the feeling and just do it anyway? It’s a very, very radical thought. What a radical idea that you might offer it to yourself even though you don’t feel like you deserve it. Could you offer it because of what you’ve been through or because of the checkboxes that you haven’t checked? Meaning I believe, and I’ve said this on the podcast before, and I’m going to say it very, very clearly here for you, I believe the more that you suffer, the more you are deserving of self-compassion. It’s not the more mistakes you’ve made and the more you’ve suffered, the less you deserve it. It’s actually the more you deserve it. “Oh, I’ve made a lot of mistakes today.” Oh, you’re even more deserving of self-compassion. We want to offer more to you. Oh, you are having a really hard day with some really hard emotions and some strong emotions. Oh, even more of a reason to offer compassion.

Now, usually when we talk about this, clients will say, “No, that’s just letting yourself off. That’s just getting out of jail free card.” I’m going to offer to you, like let’s trick this belief and check made it a little bit if we were talking chess, is self-compassion is not a get-out-of-jail-free card. It doesn’t mean you stop holding yourself accountable. It’s actually what helps you towards change. You are saying, “I don’t deserve self-compassion. I need to suffer and be criticized and punished because of something that happened.” Does that actually move you towards perfection? No, it doesn’t. It doesn’t create any change. In fact, it keeps you now doing behaviors, like I said, self-criticism, self-punishment, which keeps you stuck in a cycle of feeling bad and negative thoughts and feeling depressed and feeling hate towards yourself. Very little good comes from that. That is not getting you out of any problem. It doesn’t lead you towards being the best version of yourself. In fact, it leads you towards more and more suffering.

Mindful Self-Compassion

Offering mindful self-compassion doesn’t absolve you from what happened in the past. Ideally one day you will forgive yourself, but that’s a different topic. Forgiveness is not self-compassion. You can do both. You could forgive yourself as a form of self-compassion and you could be self-compassionate, which could lead you towards forgiveness. But here, what I don’t want you to think of is that people who are self-compassionate are just like, “Oh no big deal. I just totally did a terrible thing, and it’s not a big deal. I don’t have to beat myself up because that would be unkind.” No, that’s not what we’re talking about. And no one does that. If that’s the case, you’re not practicing self-compassion at all.

Self-compassion is just simply offering kindness towards suffering. That’s it. It’s not ranking you higher or lower and the good or bad person. It doesn’t mean that you don’t matter. It doesn’t mean that your pain doesn’t matter. It doesn’t mean that you can’t hold yourself accountable and take responsibility. It just means the absence of beating yourself up and meeting your pain with kindness and compassion instead of criticism and punishment.

The thing you’ve got to run mind yourself, and this is a huge thing I’m doing this year, is really trying to identify what’s working and what’s not. I do a lot of therapy. I think a lot. It’s one of my best skills and one of my biggest flaws, is I think a lot, I feel a lot. And it’s not a bad thing, but I’m really trying to be more efficient and effective. Meaning, okay, what’s the right amount of being responsible and taking responsibility? Because you could do a little bit, which is really responsible and very helpful. But then if you do too much of that, that doesn’t make you a super responsible person. It means now you’re moving into self-punishment. So, too much of one thing can be good and too much of one thing can also be bad. It gets you into trouble.

So, how can you be effective with the behaviors that you engage in, is the amount of criticism or self-punishment or deprivation of compassion, which is what we’re doing here and talking about, does that bring you benefits to your life? It’s an important concept for you to think about. Whether you think you deserve it or not, or whether you feel you deserve it or not, is it effective? We’ll come right back to one of the first concepts, which is, just because you think it, still doesn’t make it true. So, just because you think you don’t deserve it doesn’t mean you don’t deserve it. It just means you’re having thoughts that you don’t deserve it and thoughts aren’t always right.

We recently did a whole episode on guilt, quite a few months ago, but the whole concept was just because you feel guilty doesn’t mean you’ve done something wrong. Our brains make mistakes all the time. So, just because you think you don’t deserve it doesn’t mean you don’t deserve it. We think messed up, scary, wrong things all the time, and the truth is, anxiety lies. Depression lies. OCD lies. Panic lies. Chances are, a lot of these beliefs you have around self-compassion are also just lies. We want to move you towards recognizing that everyone deserves compassion. So, that’s the final where we land here, which is everyone deserves it. Everyone.

Really to be honest, even when I say the more you suffer, the more you deserve it, that’s actually not completely correct too, because that would still be buying into this idea that certain people deserve it more than others. Everyone deserves it equally every day, 24 hours. It’s just a done deal. You don’t have to give yourself self-compassion. But what are the negative impacts of your life, if you don’t, and what are the positive impacts in your life if you do? Think about how much good you can do in the world if you did. That’s the point I want to make.

Keep an eye out. We have a whole course on self-compassion coming. It will be for everyone. It will be $27. I’m in the process of making it. It will probably be available when this comes out, but just in case it’s not, keep an eye out in future podcasts. I will have a link on CBT School. You can go there and check it out. I cannot wait to share that with you. It’ll be a lot of these concepts, but actually more applicable skills for you to practice. Head on over to CBTSchool/self-compassion. I’m sure it’ll be there by the time we get to this episode and I am so excited to share it with you.

Before we finish up, let’s do the review of the week. This one is from Kanji96 and it says:

“This podcast is very helpful for me, especially when I’m going through hard times. Right now happens to be one of those hard times and here I am back listening to Kimberley. Thank you.”

Thank you so much, Kanji. Your reviews mean the world to me. Please, please, please go and leave a review. I mean it. If you get any benefit from the podcast, this is one way that if you feel at all so inspired to leave a review, it really helps me. It helps me to reach more people. It helps people to feel like they can trust the information here. I would love your honest review. So, go over to podcast app or wherever you listen and leave a review there. I am so grateful.

Have a wonderful day, everybody, and I will see you next week.

Feb 25, 2022
Ep. 222 Getting Real about OCD Recovery (with Lora Dudek)
39:38

SUMMARY:

This week’s episode is incredibly inspiring, with Lora Dudek talking all about getting real about OCD recovery.  Lora shares her experience of having harm obsessions and harm OCD and how she managed being a mom during ERP. Lora also shared some wonderful ERP activities she did to help her keep track of her exposures.

In This Episode:

  • What OCD Recovery looks like for Lora
  • Her experience with Harm OCD
  • What kind of Exposure and Response Prevention (ERP) Lora used for harm OCD
  • How she used ERP and recovery to decide what her values were (starting a career in ERP)

Links To Things I Talk About:

Episode Sponsor:

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

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

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

EPISODE TRANSCRIPTION

This is Your Anxiety Toolkit - Episode 222. 

Welcome back, everybody. I am so happy to be with you today. Oh my goodness, I’m going to tell you a story, totally off-topic. But today’s episode is number 222, and coincidentally, it’s coming out just by coincidence the week of February 22, 2022. The reason that that is special for me isn’t because I have any kind of affiliation with numbers, it’s that I have this amazing memory of when I was very young. It was the 9th of the 9th, 1999. My mom, who is the most amazing human being in the whole world, had a 9/9/99 party, and everyone had to bring nine of something, nine flowers, nine chocolates. You could bring whatever you wanted. Nine of... We had nine of everything – nine shrimp on the plate, nine prawns. In Australia, we call them prawns. It was such an amazing memory. 

I told my children that we were going to do something similar because I just feel like that was such a beautiful memory. And so, I feel like I’m beginning that whole celebration with you because coincidentally, it’s episode 222 on the week of 2/22/2022. Oh my goodness. I’m sorry. I know that has nothing to do with the episode, but it is a story that is so near and dear to my heart and I just wanted to share it. It isn’t actually an off-talk topic because I really do want to bring some more joy to this episode and I really do want to slow down and enjoy with you all. It is a huge part of my goal for this year. So, thank you for sitting in that joyful story with me.

If you would like, I hope you do something with twos, if you can, on that day, something fun. Buy yourself 22 flowers, say 22 nice things to yourself, whatever it may be, because these are very much once in a lifetime experiences and memories. 

Today, we have Lora Dudek with us on the podcast. Now, to say that I am a Lora Dudek fan is an understatement. I love this human being. She is such a shining light, especially for people who have OCD and want to feel like there is hope. She has such a beautiful story, such a hard, but beautiful story, and a real authentic, genuine story to share. I am honored to have her on the show like I am to have so many people come on who have a recovery story to tell. I particularly love when I can be a part of it and I was a part of their story, or CBT School was a part of their story or ERP School was a part of their story. And so, it is just such an honor to have Lora on here. She’s talking about what recovery looks like for her. The reason I love this idea is, recovery is different for everybody. I really wanted you to get an experience of what it looks like for someone who has really done the work. Like I said, so many of our podcast guests have done the work and Lora is no exception. So, I’m going to head over and let you guys listen to that. 

Before we do that, I first want to do the “I did a hard thing.” This week’s “I did a hard thing” is from Fabian, and they said:

“Hi, Kimberley. First of all, thanks for creating the room to write about my anxiety. I am recovering from OCD, and today I was at the dentist for a tooth filling. I don’t like it because my mouth is blocked and I’m scared of getting enough air. And moreover, I do not like to get injections.” Oh my goodness, Fabian, I feel you on this one. “I was able to face both and stay very present with the body sensations like cold hands, many, many thoughts, high heartbeats. It was a hard thing to finish the week and I’m happy that I did it. I will have to face it again in February 🙂. All the best to you and your team.”

Amazing, Fabian. I feel you on so many levels. The dentist is so hard for me. No matter how many tools I use, it’s always going to be hard, but you did the hard thing. And that is what I love. So, thank you so much for contributing your “I did a hard thing.” I am honored and major props to you. 

Okay. Let’s get over to the show.

Getting Real about OCD Recovery (with Lora Dudek) Your anxiety toolkit

Kimberley: Welcome, everybody. I am so excited about this episode today. We have Lora Dudek. She is now a Licensed Professional Counselor, but when I first met her, she was going through her own journey, and I wanted her to share her journey with you today. Welcome, Lora.

Lora: Thank you so much. I’m so excited to be here. 

Kimberley: Oh my gosh. Okay. So, we’ve already pretty much cried before we even got on today together, which is beautiful. And so, I can’t wait to get into this whole conversation together. You and I met online many years ago, and now you’re a therapist, which just blows my mind, helping people. Can’t believe that. So, that’s amazing. Do you want to share with us your full-circle story?

Lora: Yeah, absolutely. So, one of the things that we were just talking about was that I started listening to Kimberley’s podcast back in 2017, somewhere around then, when I had been newly diagnosed with OCD. This is a total full-circle moment for me because she was such a-- I just called her a ‘lighthouse’ back in the day. 

My own story really started when I was just a kid. I mean, I was a little girl and was having intrusive thoughts. My intrusive thoughts have always been harm-related. As a kid, I didn’t obviously really didn’t know what that meant. I had a big obsession with death. I was very, very scared to die and other people around me dying or me somehow hurting them. But when I was little, it always just manifested as telling someone I was scared that they were going to die, and then them reassuring me that they weren’t going to die, which is such an interesting thing to look back on. No one ever knew that. But that’s where the reassurance started. 

I was looking back. I can see these areas of my life that were impacted from the get-go really. And then when I had my daughter in 2014, the anxiety just became absolutely overwhelming. From the moment that I knew that I was pregnant, there were just basically constant thoughts about something bad happening. I felt the entire time that I was pregnant like, I don’t know how to describe it really. Maybe nine months of almost getting ready to attend a funeral truly is how I felt, because it just seemed so heavy, already knowing I was going to be really responsible for this life. 

While I was pregnant, I even got one of those sonogram machines or the fetal heartbeat machines. I would be sitting at the office and have an intrusive thought that something had happened to her, and I would rush home and I’d make sure that her heart was still beating. My doctor knew me very well because I was basically calling every other week with something that might be wrong, that never was. And then once she was born, it really manifested as just constantly checking on her. These intrusive thoughts that something really bad was going to happen to her, that I wasn’t going to be able to take care of her, and constantly asking my husband at the time that I’m an okay mom. I can do this. I’m able to do this. 

Those went on really. These thoughts and that heightened anxiety went on for-- she was 16 months old at her first Christmas or her second Christmas, sorry. We traveled with family to go see family, and I was putting her down for her nap and ended up laying down beside her. She fell asleep and I fell asleep next to her. It was in a bed. When I woke up, my first thought was, oh my God, is she breathing? I thought I had smothered her. And so, I put my hand on her chest and I could feel that she was breathing and I went to get up and walk away. I had the thought, what if she’s not? I was like, “Okay, let me check one more time.”

That is where I say the walls came down, because from that moment on, it was like, there wasn’t any-- the checking just got out of control and it flipped. It got into this area where I was scared that something bad was going to happen to her, but now, I was going to do something bad to her. It just changed flavors really quickly. 

We got home from that trip and I told my husband. He had to go on a business trip for two days. I basically didn’t sleep for two days. “I thought I’m going to hurt her. Something awful is going to happen to her. I can’t take care of her.” Just going out of my mind. I used to get up and check on her, probably 10 times a night, to make sure she was still breathing. At this point, I became so scared of myself that I would block my bedroom door at night with my dresser to make sure that I wasn’t going to get up and do something to her. I was like, “Whoa, something’s really wrong here.”

So, I looked up an Anxiety Specialist and went and saw her. It took me about a couple of months seeing her and building rapport with her to actually let her in on some of the thoughts that I was having. I remember very vividly. It was an early morning appointment. It was a 7:00 AM appointment. The night before I barely slept, because I really did think like, this is it. I’m going to get hauled away tomorrow. I’m going to tell her these thoughts I’m having, and this is going to be the end of me. And so, that morning, I kissed my daughter, I kissed my husband. I walked out the door and got in my car and I was like, “All right, that’s the last time I see him for a while.” 

But I got into my therapist’s office and I broke down. I’m like, “I have these thoughts that I’m going to hurt my daughter. It’s the worst thing in the world.” She was like, “Do you want to?” I was like, “Oh my God, how could you even ask me that? She’s the most important thing in my life.” She asked me a couple of other questions. But then she said, “Do you know anything about OCD?” Through my tears, I was like, “Yeah, I do. I know OCD. I’m not clean. In fact, I’m really messy. I don’t even know why you’re asking that.” I was frustrated. 

And then she told me about intrusive thoughts and compulsions, and it was the biggest light bulb moment of my life. Everything just started making sense really from some of my earliest thoughts. I do have to say it was a bit of a relief at the beginning. So, that’s the story. That’s how I got diagnosed, and it started a whole new part of my journey.

Kimberley: Yeah. So you had relief. 

Lora: Yeah. 

Kimberley: And then what was your emotion?

Lora: Yeah, I mean, the relief was like, I’m not crazy, that it was so like something has got to be really wrong with me. And then it was just like, whoa, I checked the box for everything she just talked about with this disorder. And then the emotion, after a little bit, the emotion became like, this is going to take a lot of work. This is going to be a level of acceptance that was like, I started getting acclimated to what exposure therapy was. She didn’t practice exposure therapy, but she was amazing in the sense that she was like, “I have the person for you.” She knew enough, which is so important--

Kimberley: Yeah. Thanks for that.

Lora: Yes. To send me to an OCD Specialist. That therapist was amazing. She laid out for me how this was going to work, what we are going to do. It was a relief at first. And then there was a lot of grief. There was a lot of heartache, realizing how much this disorder had taken from my life. Ignorance can be bliss sometimes. I think that I dismantled that notion through doing ERP and exposures, and it became a very interesting part of the journey.

Kimberley: I know, I was thinking about you. You were saying you got in your car, you said goodbye. And then you had to walk back to your car and drive back to your house, right? How is that?

Lora: It’s like, I mean, I have some health anxiety too, so I always liken it too. I walk into a doctor’s office thinking this is going to be cancer. And then I walk back like, “Okay, now I just go back to life.” 

Kimberley: Right. I can just have this image of you, walking back to your car, going, “I guess I’m going home now.”

Lora: Yes. And I got back. My husband was like, “Hey, you doing okay?” I was like, “I got to tell you what just happened. This is what they said. Did you know that obsessive-compulsive disorder is like this?” And he is like, “No, but I mean, makes a lot of sense.”

Kimberley: Yeah. How crazy. It’s so amazing that you had that opportunity. Again, we know that that’s not a lot of people’s stories, so I’m so happy that you had that experience.

Lora: The thing, Kimberley, is that I do want to point out that I had been seeing someone for anxiety almost my entire adult, different therapists. This is the first time. Like, I said, I would have these harm thoughts, but I was just like, push them away, get rid of them. This was the first time I’d ever come head to head with being actually like, “I’m responsible for a little life. This is all on me.” It felt like I wasn’t going to be able to live the life I truly wanted to live. Other times, it was just like, okay, I can walk away from it. I can find some way to not be around it. Now I’m talking about my daughter who means more to me than anything in the world. Something has got to give.

Kimberley: Yeah. That’s really helpful to know that you have been in therapy. 

Lora: Yeah.

Kimberley: When I had previously done a presentation with you through the International OCD Foundation, and you shared about your exposure board, this whole idea blew my mind. The reason I really want the listeners to understand, when I teach ERP, I’m literally just teaching my way of doing it and I love hearing other people’s way of doing it. It’s the same, but it’s different. And so, I’d love for you to share about that as an idea for people. 

Lora: Yeah. Well, what started as one of the biggest, I felt like, almost hindrances of my pregnancy was that at the time I was pregnant, there were seven other women at my work that were also pregnant. I remember seeing them all being so happy. And then they had their babies and they were so happy, and they were-- obviously, it wasn’t like, we’re not going to blow this up like some kind of blissful totally time. They were new moms too, but they were going out and doing stuff. And that’s all I wanted. That’s what I wanted so badly, was to have those experiences with my daughter. 

So, my therapist and I started with imaginals and started with some really small things. I mean, I laugh about it now, small. Back then, it was like, no way. I did one where I was going crazy, where this wasn’t really OCD, the timeless tale of it’s not OCD. Such a classic. So, we started with imaginals and then even imaginals into sleepwalking at night, hurting my daughter, things like that. So, we worked our way up then to one day I was sitting in her office and she said, “What do you want to do?” I was like, “I just want to do normal stuff. I want to go to the zoo.” And she’s like, “All right, we’re going to the zoo.” And I was like, “What?”

Kimberley: You’re like, “Take it back.”

Lora: “I don’t say zoo.”

Kimberley: “I meant Zoom.”

Lora: “I want to have a video conference in the safety of my own home.” So, we started putting together this hierarchy based off things that I wanted to do with my daughter. And then she said, “I think a really good idea would be to take some pictures while you’re doing these and we’ll see what happens.” And I was like, “I’m absolutely not doing that.” There’s no way I’m taking pictures, because as I’m sitting there and having this conversation with this OCD on my shoulder, telling me, “You’re going to bring pictures back in here of you dumping your daughter into a tiger cage. Great. Let’s do that.” But we talked about it and I was like, “Okay, I’m going to do it.” So, that was the first real exposure I did when I went out on my own.

We start actually-- I should back up, we did start with driving, because I had this thing with my daughter not actually being in the car. I had left her somewhere. So, we drive and I wouldn’t look in the rear view. That was a whole exposure. When we got past that, then we went to the zoo. We went to the mall to have lunch. We went to the swimming pool, which was just like the death pool as far as I was concerned. Let’s see, I have the whole exposure board still on the side of my wall. I mean, we went and got pedicures and manicures. We did things that I wanted to do with my daughter. We got flu shots. That I wanted to do with my daughter that OCD told me was absolutely not possible, without having someone to tell me the whole time what I was doing. 

My reassurance came in the form of calling my husband, texting my sister pictures because then everything’s okay. They can see what I’m doing. And so, doing these exposures without engaging in calling anybody the entire time, without texting anybody the entire time. Just me and OCD and my daughter and here with the three Amigos. Here we go.

Kimberley: Mom and daughter and the third wheel, right?

Lora: Yeah. So, that’s how they looked. It was like, I really, really hit it hard over a summer, the summer of 2018. I called it my summer of ERP. Once I got going, I just wanted to keep going. It was terrible at the beginning, terrible because I would complete an exposure and I’d get home and then the rumination would want to start. It was difficult not to engage in that. It was difficult to just watch it. But through the exposures, I said at one point that the butterflies were my yellow brick road. Whenever I’d think about something and I got that feeling like, oh, it was OCD being like, “Really, are we?” And then I was like, “Ah, okay, here we go. Follow, follow, follow, follow.”

Kimberley: Isn’t it that in and of itself is beautiful? I always say with my staff, is you follow the smell. Meaning wherever it’s smelly and you don’t want to go, you go there. And that’s what you were doing, is just wherever you felt butterflies, if I’m right, you would go and do that thing. 

Lora: Yeah, absolutely. Because it became that-- my therapist phrased it in a way where she was like, “We’re going to play scientist.” That’s what she’d tell me. “We’re going to go try this out. Let’s just bring back what we find.” It was such a compassionate way to do that. It wasn’t like, “Here’s your exposure, do it. Go. Boom,” which sometimes I think can be a little helpful. But for me, it worked to be like, “Let’s go see about this.”

Kimberley: Yeah. “Let’s be curious.” I love it. Now I’ve seen this exposure board and it is so beautiful. You would have no idea you’re doing exposures. You look delighted most of the time. I wonder if you could even send me a photo and maybe we could show that in the show note, that would be wonderful.

Lora: I would love to. 

Kimberley: Yeah. I’d love to be able for people to click and actually see what it looks like. Maybe we could even say-- I try to give homework during the podcast. We could even say, “If you have anxiety, you could create your own.”

Lora: Yes. That would be awesome, because I’m telling you, whoever’s listening to this right now, you’re going to see that I look back on this board and it’s us smiling. There is one picture where my daughter is screaming, but that was the flu shot picture, and we did a hard thing. It was a beautiful day to do a hard thing, and I put it on that board, man.

Kimberley: Good for you. She deserved to cry. I think that you’re making a good point here, and I’ve had this conversation with some of my clients, is exposure is even if you don’t smile for the photos, still put it up because you did it, right?

Lora: Right. You did it. And that’s a thing. Along the way, those victories, I really don’t believe that there’s such thing as small victories. I know we say it a lot. A victory is a victory is a victory. Take it, hold onto it, and know that’s the fuel that you’re putting in this device right now that is getting you through this.

Kimberley: Yeah. I love it. Are there any other exposures that you did that you want to share that people may find different or creative? I love the creative ones.

Lora: Well, I just think that the exposures started to become organic. When I was first diagnosed with OCD, I did not know OCD’s voice at all. I was like, “No, no, no, that’s the voice that’s kept me safe my whole life.” And so, along the way, the more I started to do some of the work, I started to realize that that what-if voice, that’s when I’m like, “Ah, if I’m going along and doing something, what-if pops up.” That’s my voice of OCD. I’ve learned that. And so, for me, a lot of my exposures, even to this day, have to do with when the what-if pops up. How can I look the what-if in the eye? I left out obviously in a place where my daughter couldn’t get them, but I’ve left out kitchen utensils before. Just last night, I mean, I mentioned how I’m doing some OCD work again right now because it continues. The what-if popped up and my daughter hadn’t drained the bathtub. I was going to drain it right away. Now it’s not even like what-if. It’s OCD being like, “Whew, way to think of that one.” That was it really. And then I stopped myself from draining the bathtub and it’s like, “No, no, no.” And so then, I left the bathroom and I’m like, “We’re just going to leave that tonight.” 

Kimberley: That’s so cool. 

Lora: Really anywhere that I can poke the bear, I guess me and my daughter doing things out in public, then that just confronting that fear of me that I’m going to lose control, not be able to help her if she needs it. All those things, wherever the what-if pops up, that’s where I knew my work was. And it still is to this day.

Kimberley: Yeah. I love that you share that too. So, it sounds like some people, when we’re hearing this amazing story, they think it’s just, you’re done. Your exposure is done. Is that the case for you?

Lora: Yeah. I was one of those people, I’m going to get through this summer of ERP, which is why I still call it summer of ERP. It was the one summer. I had these high hopes that then once I get into grad school and once I really start working with people with OCD and helping people that the OCD just fizzles. I have recently just come into this space of understanding and ultimately, some acceptance of like, this is kind of a way that I live right now. I don’t know what five or 10 years down the road looks like. And I’m really, as far as OCD is concerned, not too focused on it. I’m focused right now on, how’s it showing up and are the things that I’m doing helpful? Are they getting me to where I want to be or am I staying in the same spot? That’s my litmus test, is am I living the life according to my values that I want to live?

So, recovery for me right now looks like I do exposures still, and I have even after the 20 months of COVID. I thought, man, I bet it could be really helpful to speak with an OCD Specialist again to get a little bit of guidance, get some creativity because that can help sometimes. So, I’m doing that right now even, and it’s been amazing. I think it’s just a process of building the muscle, of keeping the muscle and I think I’m gaining more acceptance by the year. 

Kimberley: Yeah. I mean, that’s a piece of it. You had said before, as we talked like mindfulness and self-compassion and act was such an important piece of your work and acceptance is such a core part of all of that, because there is so much grief. We don’t talk about it enough, right?

Lora: Yeah. There is though.

Kimberley: What was it like for you-- let me rephrase that. Was mindfulness and self-compassion a part of this process for you? 

Lora: Yeah, absolutely. So, my amazing therapist knew about Mindfulness-Based Stress Reduction and she had mentioned it to me. There was a program that was going on. I lived in Dallas at the time, at the Dallas Yoga Center. It was an eight-week MBSR program and I signed up for it. We did a body scan, a 40-minute body scan, the first class, and everybody woke up and they were like, “That was so relaxing. That was so awesome.” I raised my hand, I literally raised my hand and I was like, “I don’t think I did that right. I just had a 40-minute panic attack.” It was awful. 

But I should say too, that shortly after I got diagnosed with OCD, I realized I had become incredibly dependent on alcohol, especially being a new mom. So, I had completely quit drinking. I was like, “All right, if I’m going to do this, I’m going to do this. Let’s go.” I quit drinking. I didn’t want to have that crutch. I was in the MBSR program. I talked to the teacher. She convinced me to come back the next week. And then the next week, we did another meditation. Towards the end of it, she read a Mary Oliver poem that ends with “Tell me what you plan to do with your one wild and precious life.” It felt like a dam burst open in me at that moment. I was like, it is so precious and it is so amazing, and like, “Lora, you can do this. Let’s give this everything we’ve got, the exposures.” Learning to sit with myself through mindfulness was huge because OCD and anxiety do not like that. We need to be moving. 

So, mindfulness was so huge for me to be able to just breathe and be in a moment and watch my thoughts instead of engage with them. Mindfulness then I say was the gateway to self-compassion because I’m not sure-- maybe I would’ve gotten there, but it wouldn’t be as soon to be able to be with myself and to hold myself and that loving-kindness. When you don’t even want to sit with yourself, it’s really hard to be able to look at yourself and be like, “I’m here.” You want to be like, “Let’s go.” So, yeah, self-compassion then was huge, because that voice of OCD is so nasty. I worked on a self-compassion journal for about six months straight, every day, really journaling.

Kimberley: What would you write? What would that look like? 

Lora: Yeah. So, I read and worked through with my therapist the Kristin Neff’s first book. And so, each day I would pick something that had happened, that was a little difficult and I would break it down into the three components of self-compassion. I would be mindful about what happened. Didn’t need any of my judgment in there. Let’s just lay it out there, what happened. Then the common humanity of it. Who else do you think in the world might have experienced this, or that feeling of not being alone. Man, probably a lot of people ran into something like this today. And then self-kindness. A lot of times, my self-kindness sounded like, “I’m really proud of you. That was really hard.” I don’t know how many entries I had over those months of being in a grocery store. Like a toddler going nuts in a grocery store and then just the flare-up of like, “Ah!” At the end of the day, that’s what I choose. 

I remember a couple of months, maybe three or four months in, where I was sitting down to write and I couldn’t think of something really hard that had happened that day. And I was like, “What?” It was such a weird feeling. After months and months and months of really intense therapy and some difficult things I was working with, I was like, “Today, I’m just going to be compassionate then about how much work I’ve been doing.”

Kimberley: Wow. I love that you’re sharing that because I’ve found even since-- I mean, I wrote a book on self-compassion, but since I wrote the book, I’m even pushing my clients to do it even more. The journaling and the writing to themselves seem to be the most powerful part of the work, the writing to themselves.

Lora: Yes. And I think that the writing to myself and the speaking to myself was the most powerful part of it. In the beginning, it was absolutely the hardest, especially with the voice of OCD. When I would look in the mirror and I would say, “You’re doing the best you can, Lora. You’re really doing this,” OCD would be right there to be like, “Are you?” It’s so egotistical. It just wants all the attention. “Maybe you’re not.” I sat down with my therapist a couple months into really keeping that journaling and I was just exhausted, just so tired from some of the work. I don’t know if you can see it. Can you see on my back wall “As long as it takes”?

Kimberley: Yeah.

Lora: I sat down and I just started crying one day and telling her this has just been so hard that sometimes I feel like I haven’t made any progress. I feel like I take two steps forward and five steps back, and was just really down about stuff. She sat there, just really holding some amazing space for me, but I said, “How long is this going to take?” She just looked at me and she just put her head to the side. Really, she’s such a sweet person, and she said, “As long as it takes.” She said it just like that, “As long as it takes.” And I was like, “Okay. As long as it takes. Throw out the timeline then. Let’s just keep going.”

Kimberley: Yeah. I love that I got goosebumps hearing you say it. All the hairs in my arms are standing up. And I love that you have it on the wall, because I read it as we were starting. I was like, “You know what? We’re good.” It shakes off all the rules and stories we tell ourselves.

Lora: Yes. My mom actually, she made that for me, for my graduation from grad school. She made that and framed it for me. 

Kimberley: I love it. Yeah. You are so inspiring really.

Lora: Thank you so much.

Kimberley: Yeah. Number one, I’m so grateful that you’re here and you’re sharing this, and number two, I’m so excited that you’re going to change lives for people, being a therapist and so forth. I’m just so grateful that I got to see some of it.

Lora: Yes. Because before we even started recording, we were talking about how on the Mondays-- what were they? Magic Mondays?

Kimberley: Magic Mondays.

Lora: Magic Monday. I’d be like, “All right, it’s magic Monday.” I’d log on and I’d ask questions and I was really inquisitive and you were so sweet. You answered all the questions and you were just so-- it was like this feeling of it’s going to be alright. It is. I think when we can cultivate that and know the sky sometimes can feel like it’s falling, we do really have the power to look around and say like, “Here I am.” Here I am, put our hand on our heart and say, “This is what I can do in this moment. I can at least show up for me at the very least.” And that’s not the least thing at all.

Kimberley: No, no. Like I said, you’re so inspiring. I’ve written so many notes, which is so fun. I don’t usually get that many notes down. So, I’m just so grateful for you for coming on and sharing your story. I loved presenting with you. That’s where I felt like I got to know you, so I’m so grateful. Where can people find you?

Lora: I am on Instagram and the account that I share a lot of my OCD journey with and things that I have learned along the way is Judgment-Free Anxiety, but it’s judgment_free_anxiety.

Kimberley: I love that. What’s for you in the future? Tell us about what’s popping out for you.

Lora: Oh man. Well, right now, I hope to be employed somewhat soon. It’s a new life now after grad school and after becoming licensed, and just hopefully a lot more adventures with my daughter, going to do that. And man, that’s it. I did actually recently become certified to teach mindfulness, so I’m also looking at doing something with that as well, but I’m not sure exactly what.

Kimberley: Yeah. Such good skills to have in your toolbelt.

Lora: Yes, absolutely.

Kimberley: Well, thank you so much. You filled my heart up today. Thank you. 

Lora: Thank you so much, Kim. Thank you.

-----

Thank you so much for coming and listening to our podcast. Before we finish up, let’s do the review of the week. This is from nmduncan827, and they said:

“Compassion, comfort, and wisdom. I’ve been following Kimberley Quinlan for years now and I can’t say enough wonderful things about her and her work. As someone who has had OCD their entire life, I feel like finally at the age of 33 I’m beginning to find helpful resources to really push me along in my road to recovery. Between Kim’s Instagram page and her podcast and her new book— there’s little nuggets of compassion, comfort, and wisdom. I found this no matter where I am on my journey. I couldn’t recommend this more for my fellow OCD and anxiety-disorder community! So grateful for Kim.”

Thank you, nmduncan827. Thank you so, so, so much. I am so honored. And of course, you can find me at Your Anxiety Toolkit on Instagram. You can get my book anywhere where you buy books, specifically on Amazon and barnesandnoble.com called The Self-Compassion Workbook for OCD. And of course, the podcast is here. Any time you like, go back, listen to old episodes. Sometimes they’re the best ones. I will see you guys next week.

Feb 18, 2022
Ep. 221 7 Common Struggles you have with Time Management
27:11

SUMMARY:

Today, we are going to talk with you about the 7 common struggle you have with time management.  Do you find yourself constantly looking at the clock? Or, wishing time would go faster?  Do you feel like your to-do list is so long that you will never get them done? Or, do you feel like you never have time to prioritize yourself?  In today's, podcast, we talk all about your relationship with time and why it is a HUGE part of managing anxiety, depression, and stress.

In This Episode, we address the 7 common struggles you have with time management.

  • “I don't have enough time”
  • “I have so much to do”
  • “I have so much I want to do”
  • “I struggle to start and stop activities”
  • “I don't a good understanding of how long things take”
  • “I don't like structure”
  • “I hate being told what to do with my time”

Links To Things I Talk About:

ONLINE COURSE Time Management for Optimum Mental Health
https://www.cbtschool.com/timemanagement


Episode Sponsor:

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

This is Your Anxiety Toolkit - Episode 221.

Welcome back, everybody. I am so thrilled to have you here with me today for Episode 221. Oh my, how is that possible?

We are getting so much feedback, such amazing feedback from last week’s episode. I wanted to additionally offer you one more bonus piece of content from our new course, which is called Time Management for Optimum Mental Health. You can check it out at CBTSchool.com/TimeManagement. It is a course. We have it for $27. It’s a mini-course, so it shouldn’t take up a ton of your time, and it’s me showing you exactly how I manage time.

Now, the reason I created that course was because so many people were reporting to me – clients, followers, listeners – that COVID has destroyed the rhythm and the routines that they had, and that they really want to find a way to implement during their day time to do their therapy homework, do get exercise, maybe have more pleasure in your life, maybe reduce overwhelm, a lot of overwhelm because the to-do list is always so long. Am I right? The to-do lists are always so long. There seems to be a never-ending list of things to do. So, I added all that in, showed you exactly how I did that. Again, you can go and check that, or you can click the link below in the show notes.

But as a bonus to that course, I did a Q and A where people submitted their questions. I have addressed that in that bonus, and I’m today giving it to you free in today’s podcast episode. If you want to get a feel for what we’re covering, you will have some reference to the course throughout, but you don’t need to purchase the course to get benefit out of this episode today. However, together they would be really beneficial, I’m sure.

Today, we’re going to cover a couple of main topics. Here I’m going to give you some overview. Some of the questions people or the concerns or roadblocks they had around time management were things like, “I don’t have enough time. I have so much to do on my to-do list.” Another question we will cover in today’s episode is, “I have so much I want to do. I just can’t, again, find time.”

Someone brought up-- multiple people, forgive me, brought up that they struggle to start and stop activities. They struggle to get the motivation to get going. And then once they’re going, they have a hard time transitioning into other activities. We address that as well.

Someone posted in that they struggle with having a good understanding of how long things take. This is one of the reasons I have myself had to use a lot of time management, is I was underestimating how long things were taking and I was leading to a lot of anxiety and overwhelm.

We also address people who don’t like a lot of structure in their life and we also address people who don’t like scheduling and don’t like time management because they don’t like being told what to do with their time. We’re going to address all of that today, but we also go much deeper into that in the time management course. You can run over there if you want to take a look at that.

Before we get into the show, let’s do today’s review of the week. This one is from Sheffie, and they said:

“Wonderful resource! You can’t help but love Kimberley.” Oh, that’s so kind. Thank you, Sheffie. “She has such warmth and sincerity, is positive and funny, and spreads so much good into the world. On top of all that, she’s a gifted clinician who does a great job sharing her knowledge with others. And she does all this with a lovely Australian accent.” Oh my goodness, this is so kind. “All of her content is fantastic, but I especially love the podcast because each episode is packed with so many nuggets of wisdom that are applicable to so many situations. They’re thought provoking and I find myself pondering them for a long while after. They’re also a good length - great content without going on for hours, very digestible.”

Thank you so much, Sheffie. That is so kind. Actually, one thing, as I’m really listening and reading that off, sometimes I know I’ve mentioned this before, but creating a podcast can feel really lonely because I’m talking into a microphone. Sometimes I don’t know if things land for everybody. I’m talking about what resonates for me and what I know has resonated from my clients, but it’s never really sure, like how is anyone feeling about this? So, just getting your reviews actually is very heartwarming to me. So, thank you. It actually helps me to feel like I’m on the right track and I’m helping and I’m bringing value to your life. Thank you so much, Sheffie. Please do go and leave a review. It does help me so much in my heart, but so helps me just to get more followers and listeners.

All right, let’s get over to it. Let’s talk today about your relationship with time. Let’s address some of these common roadblocks to time management, and I hope you find it incredibly helpful. Have a wonderful day, everybody.

Do you have a good relationship with time Your anxiety toolkit

Welcome, everybody. I am so excited to be here with you to talk about your relationship with time. Now, this is an interesting topic, I think, and one that very much relates to our mental health. I personally find a lot of my thoughts are around time and about my belief that I don’t have enough of it. This has probably been a very big part of my own experience of suffering because I keep telling myself, “I don’t have enough of it.” I really want to see whether this is true for you.

Now, I did a poll on Instagram and asked my friends there to give me their biggest struggles with time management. As you may know, I have a full course on time management specifically related to managing mental health, how you can make time for your recovery, how you can make time for things that really benefit your mental health. A lot of the times we end up getting our to-do list done instead of scheduling in pleasure and downtime and rest, and we don’t rest and have pleasure until we’ve got our list of to-dos done. But the problem is, the to-do list is always longer than the day. Am I right?

We cut all of these submissions of things that people struggle with, a lot of the topics we discuss directly in the course, but a lot of them I wanted to discuss today specifically related to these struggles and the relationship people have with time. The first one here is, “I don’t have enough time.” Now I have two answers to this concern. number one, chances are, you are right. You don’t have enough time to do the things that you are pressuring yourself to do.

Now, I understand that many of you have jobs and you’re going to school and you have children or you have loved ones and you have your own chronic illnesses or mental illness. So I agree. The list of things to do is very, very long. But I’ve wanted to first just ask you, is all the things on your to-do list being demanded of you, or are you demanding them of you? It could be one or the other. I just wanted to ask you, because I know for me, there are lots of things that I get demanded to do. I have to work. I have to make money. I have to be a mom. These are things that I really value and I want to take care of. But in addition to that, there’s a lot of things on my to-do list that I actually don’t have to do. I place those stresses on myself right.

Now we’re not here to blame. I never want this to be about blaming ourselves, but it’s helpful to inquire. What things on your list do you have that actually create more stress? Is it helpful to add those things on your list? Is there a way you could maybe give yourself a break from the long things of all the things you have to do? Assess for yourself what’s important. Is it important to me to get this done?

But here is the thing. As we talk about in time management, the online course, is I have so many things that I value. I have so many things I want to do. I have so many ways I want to show up for people and friends and family. At the end of the day, it’s unrealistic. Even though I want to do it, I don’t have the time. To reflect, I don’t have the time. Yeah, that’s true. Sometimes the most compassionate thing I can do is to acknowledge that and be more realistic with the projects I put on my to-do list.

Often I’ll speak with clients about, are you taking too many courses? And they’ll say, “No, I have to. Everybody is taking this many.” And I’ll go, “But is it working for you?” If you’re really honest with yourself, does taking that many courses benefit you and give you time to recover from your mental illness? Does saying yes to volunteer, while volunteering is an incredibly valuable and helpful thing, are you in a place in your life right now or a season in your life where you can do that in a healthy way that still prioritizes your mental health? Just questions to think about. You may have some strong reactions to these, and I would inquire if you do. I’m not suggesting anything here, except I want you to inquire what is best for you.

Now on the flip side of this, I can also say, even on the days when I’ve managed my time and my to-do list, I still just have the thought. “I don’t have enough time. I don’t have enough time. I don’t have enough time.” And that’s my relationship with time. It’s not great. My personal relationship with time, I have a long way to go. My relationship with time, as if it’s a thing, is when I look at it, I say to it, “There’s not enough of you.” But I only have 24 hours. You only have 24 hours and we have to negotiate with what we want to cram into that 24 hours. It can be whatever you like really. You can sleep for as long as you think you need to sleep. You can work, you can go to school, you can take up whatever hobbies. Your job is to decide what’s best for you based on your values and your family and your needs.

The next one is, “I have so much to do.” Again, we have a relationship with time. When it’s not about time, it’s about our to-do list. I really want this time management course that I’ve created. You can go to https://www.cbtschool.com/timemanagement. If you haven’t already, if you’re listening to the course right now, I want you to really, really think about the to-do list and reassess the to-do list. If it doesn’t need to be done, I would encourage you to consider taking it off.

Now, I understand, a lot of things on the list have to be done and I want them to be done, which is why you should, if you need, take a look at the procrastination episode and module, and you can maybe look at that as well. But like I said always, a lot of the thoughts we have about time are either facts or the mindsets that we have. So, we may need to think about how much pressure we’re putting on ourselves.

Another very small shift to that thought is, “There’s so much I want to do.” Now, here is another, this is very important. I personally, as a human being, there is so much I want to do. I have such passion to do this project and write that book and to create that podcast. I have all these things and hobbies I want to do. It’s a wonderful thing. Some of you may not have that experience right now and that’s okay. Sometimes depression and anxiety can take the passion out of things. But a lot of you, I hear because you want to get things done and you can’t find a way to put it into your schedule. I really want to encourage you to start to do these things you want to do, but you have to be realistic about time.

A part of the reason I made this course and not other courses is that this course could be a very quick make. Meaning it didn’t take me six months to make some of my courses. The Time Management course is-- what is it? Almost 100 minutes or 120 minutes. It’s easier for me to do this than to create a six-month-long course. I did it in small 20-minute increments. I want to encourage you that if your relationship with time is saying, “I have so much I want to do, I don’t have enough time,” find in your schedule 10 minutes to start, because 10 minutes today and 10 minutes next week and 10 minutes the week after that, before you know it, you will start to have some momentum, even if it’s 10 minutes a week. A lot of times we don’t do things because we tell ourselves that there’s not enough time and there’s too much to do. Instead of just giving yourself permission to just do little baby steps, create what you can in small amounts of time.

Somebody had written, “I struggle to start and stop activities.” This is very, very important. A lot of people struggle with time because getting going needs a lot of created momentum. The thing to remember is that motivation, and I will create a full mini-course on this very soon as well, is motivation is not something you just get. It’s not inherent. You don’t wake up with it. Motivation is something that you have to really create of your own. You have to cultivate motivation. You have to harvest motivation. It’s something that you generate on your own.

So to start an activity, usually, you will need to look at first what’s getting in the way. We talked about procrastination in last week’s episode and in other modules of this course. That’s a big one. Starting usually means you have to generate motivation based on willingness to be uncomfortable, cleaning up any negative thoughts you have or critical thoughts you have about doing the activity. Setting time and reminders to remind you, because sometimes really honestly, you’re busy. You’re a busy person or you’re an overwhelmed person. So, you will need timers and reminders and calendars, but it’s really generating that activity.

One of the best things to do is to keep in mind or to draw on a piece of paper or write it down, how you will feel when it’s done, what it will look like when it’s done, like a vision board almost, but it’s okay. Put some time into it, like what emotions will I feel when I’ve completed this email? Or what will be the result if I create this course 20 minutes at a time? Little baby steps.

When it comes to stopping, it’s probably going to be much of the same tools. Schedule your time to do things, set an alarm or a reminder if you’re someone who gets stuck in it. So set a time or a reminder, put up sticky notes, and then also be willing to be uncomfortable. When I let my kids have tech time, we schedule tech time every day. When I say, “Turn it off,” they don’t like it. They’re in this mode of playing their game. They’re watching the thing they want to watch. Moving out of that can feel very jarring and uncomfortable.

And so, we have planned ahead for that. We know that when tech time is over, my husband and I, we may want to implement some family time or snack time, something that can help move us onto the next activity. Something motivating and pleasurable is often very helpful when moving from some kind of either uncomfortable experience to a different experience or you’re in a pleasurable experience. You’ve got to move into something uncomfortable. There are some tips that may help that you may want to experiment with.

The next one is, “I don’t have a good understanding of how long things take.” Now, this is huge. Again, if you’re listening to this on the podcast, this is another reason where I stress the importance of you. If you want to take the course, I stress how helpful it can be.

I write down how long things take often. Probably once a month, I do an inventory of my day. How long does it take to get my emails done? How long does it take to get the kids to school? How long? While this may seem like a lot of work, it pays off because I will then realize I only scheduled 30 minutes for emails, but to be honest, emails are taking me 45 minutes. Helpful data. Important data to help me then renegotiate my schedule so that it is kind, or to really work at not spending as much time on emails, or to be less perfectionistic about emails, or to delegate emails or whatever project it is that you’re doing to somebody else.

It may be that there are multiple solutions to this problem of not understanding how long things take. But I think the first thing is, you’ve got to have data. You can’t assume a solution if you don’t know what the problem is. Please, I encourage you. It doesn’t take long. Just have a little notepad, scratchpad, how long things take, particularly the things you’re having trouble in the day. It doesn’t have to be the whole day.

The next one is, this was very cool, “I don’t like structure.” Now, if this is you, I am so with you. I was and have been in my life someone who doesn’t like structure. It stresses me out, makes me anxious. The pressure is overwhelming. I don’t like structure. However, as someone who was forced to practice these skills, because life was so chaotic and unmanageable, I have found now I have a much better life with structure. I have found I’m more creative and spontaneous now that I have structure in my life because I know the things I need to get done are done. So then I feel free to go and do spontaneous things, take a drive, go on a vacation, and so forth, because I know. Or in this case, during COVID, because everything is so uncertain, I know how long things take, the structure of days. If there were, let’s say someone in my family gets COVID – my children, myself, my husband – I know how to renegotiate the day really quickly because I have a really good understanding of the structure. It helps me to recalibrate if there is a major change in the day, because I’m used to that structure. I know how long things take. I know the practice of things. It’s been overwhelmingly beneficial in my life.

If you don’t like too much structure, it doesn’t matter. You can actually just block schedule. I like to really be specific, but I know a lot of my colleagues and clients that I’ve taught this to, they just like blocks, like bigger blocks, like four-hour blocks. From 10:00 to 2:00 is work, from 2:00 to 5:00 is this. And those blocks can actually just create a little bit of structure for them. And then they can slice in new projects if they have them. Homework for therapy, if they need it.

A lot of my patients, I see they’re professional successful people who are now I’m giving them additional 45 to 90 minutes of homework a day, and they say, “How am I ever going to fit this in? I’m already overwhelmed.” We go through this process and we look at where they could slide in, 10 minutes here and 15 minutes here. Can you do some of your homework on your way to work and so forth? That can be really beneficial. That way, even though they don’t like structure, they’ve found a way to prioritize what they need to get done so that they can get the benefits that they wanted.

Last one, this is a big one, “I hate being told what to do with my time.” This is actually, I think, sponsored by my husband, but this was actually given to me from many social media people who have submitted their questions about time management. But I agree. I think my husband would very much agree with this – I hate being told what to do with my time.

There is, when it comes to time management, a-- I wouldn’t say it’s a humbling, but it’s a letting go, a letting go of control, because when you don’t want to be told what to do with your time, it feels like you’re being controlled. Again, I don’t think you have to do any of this if you don’t want to. I wouldn’t encourage you to make any of these changes if you really, really disagree with them. However, I would encourage you to consider at least giving it 30 days, because what you will find is, when you schedule things, it might feel like you’re being told to do something with your time. You’re doing it.

I don’t want you to have anybody else telling you what to do, but if you’re putting down on your schedule what you want to do, I want you to remind yourself why. Why are you doing this? Often it’s because the chaotic and unplanned day only creates more suffering. Chances are, you already have a lot of suffering. I’m guessing because you know about me, you have some kind of anxiety or depression or medical or mental struggle. So, even though this scheduling and this time management practices can feel like you’re using your freedom, I personally think it’s gaining freedom. It’s taking back control over the chaos in your mind – the running list, the mental rumination, the anxiety of all the things, and having it to be where it’s all there and it’s done.

Now, it doesn’t have to be for you. I want you to find specifically, and you will see, remember we talk about in the course, we have a whole module on considering your specific set of circumstances. I want you to consider what’s good for you and make plans and adjustments, but keep my voice in your mind. Sometimes the more you plan it, the more freedom and free space you have in your mind to do the things you want, because you’re not constantly carrying around the to-do list. It’s there anyway, you might as well handle it efficiently.

So, that’s my real encouragement. Again, I’m really for it. You may not be for it. I’m not going to harass you and make you agree with my view on it. But I know the science here and I have seen it benefit so many people, and I really hope that you can give it a go and let your guard down and let go of your need to have that control and honor what’s important to you and follow through with what’s important to you so that you get the things that you want and you get the mastery of the things in your life that are important to you.

I hope that’s helpful. I’m so grateful to have you here with me today to talk about your relationship with time. There may be many other things I haven’t addressed. If I haven’t addressed your specific struggle with relationship with time, I encourage you to journal down and explore how you might manage that because we do only have 24 hours and I want you to really find some peace in some of those parts of your day instead of carrying around the to-do list.

Have a wonderful day and I will talk to you very, very soon.

Feb 11, 2022
Ep. 220 Time Management Procrastination
22:30

SUMMARY: In this episode, we review how important it is to address procrastination, as it impacts so many people in so many ways.   We also will review how procrastination is the same thing as avoidance and how people can work towards implementing time management skills to help them build a routine that helps them get the things they want to get done.

In This Episode:

  • We outline procrastination definition and procrastination pros and cons.
  • How procrastination is simply an avoidance safety behavior.
  • How to manage procrastination in , Anxiety, OCD and OCD recovery
  • Our new course called Time Management for Optimum Mental Health

Links To Things I Talk About:

  • ONLINE COURSE Time Management for Optimum Mental Health

https://www.cbtschool.com/timemanagement

Episode Sponsor:

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

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EPISODE TRANSCRIPTION

This is Your Anxiety Toolkit - Episode 220.

Welcome back, everybody. How are you? Really, really, how are you? How is your heart? How is your mind? What’s showing up for you? How are you? I really want you to check in, in case you haven’t checked in for a while. How are you doing? It’s important. Let’s make sure we check in.

Today, we’re talking about procrastination. It’s one of the most common questions I get when I’m doing live calls on Instagram and Facebook, like how do I manage procrastination? A lot of you are also managing perfectionism and it’s getting in the way of you doing the things you want to do or doing the things you have to do.

Because I get asked this so much, I actually wanted to show people how I do it. So what I did is I created a whole mini-course, it’s called Time Management For Optimum Mental Health. You can get it if you go to CBTSchool.com/TimeManagement, or you can click the link in the show notes below. It’s a full course of showing you how I manage time and why I manage my time to help manage my mental health and my medical health. A lot of you know I have struggled with a chronic illness. Time management has been huge in me staying functioning and managing mental overwhelm and a lot of procrastination. In the course, it’s only $27, it’s a mini-course and it shows you exactly-- I have recorded the screen as I’m showing you exactly how I do it. If you’re interested, go over and check it out. I’d love to have you take the course and put it into practice.

Now, one of the things about this episode is this is actually me giving you a sneak peek into the course because it’s one of the bonuses of the course to talk about procrastination. So I wanted to share it with you here on the podcast as well. You will hear me refer to the other parts of the course as you listen. That doesn’t matter. You’ll still get everything you need to know about procrastination and how to manage it today. But yes, if you’ve already taken the course, you probably have already listened to this bonus. But for today, let’s talk about procrastination.

Before we head over into the episode, I wanted to do the review of the week. This is a review from Sadbing, and they’ve said:

“Desperately needed. I am an LICSW that has searched high & low for a podcast that delivers quality content. I felt relieved to finally find one! This podcast provides an honest depiction of how anxiety shows up in people’s lives & gives you effective feedback on how to live with it. Thank you!”

Thank you, Sadbing. Thank you so much for that amazing review. I do ask that anyone who’s listening, please, the one thing you can do, this is what I offer freely to you all. If you get a second, just click below, in whatever app you’re listening to, and leave a review. It helps me so much reach all the people. The more reviews we have, the more people will trust the podcast and continue listening to this free resource. So, yay.

All right. Let’s get over to this episode about managing procrastination. I hope you find it helpful. If you want to learn more about time management, head on over to CBTSchool.com/TimeManagement, and you can get a mini-course for 27 bucks. It’s amazing value for a short period of time and a short amount of money. So, yeah. All right. So happy to have you here with me today. Thank you for giving your time to me and trusting me with your precious time. I will see you after the show.

Managing Procrastination Your anxiety toolkit

Welcome. You wouldn’t have a time management course without really addressing procrastination. Procrastination is, number one, the biggest question I get, which is another reason why I wanted to make this course, is because it’s so common. It’s such an easy trap to fall into. It’s such a human trap to fall into to procrastinate. But I wanted to take a deep dive into procrastination today and talk about some skills that you can practice to manage procrastination.

Let me really just dive into, first, what is procrastination? Now simply put, procrastination is an avoidant safety behavior. What does that mean? When human beings assume or see or assign things as a threat, our mind does that. So our mind will assign something as threatening, whether it be, “I have to write this email.” It could be as simple as writing an email. It could be, “I have to present something. I have to get a project done. I have to go and exercise.” Our brain will present that as some kind of danger or challenge or threat.

Now you might be thinking to yourself, there’s nothing dangerous about exercise or writing an email, but there may be for you because doing that means you have to have some uncomfortable feelings. Maybe shame, maybe anxiety, maybe irritability. Anger might show up. Guilt might show up. Because those emotions are uncomfortable and maybe if we haven’t developed skills on mastering those emotions, events like writing an email or exercising or doing a project may be experienced as dangerous or a threat.

When our brain interprets things as a threat, naturally, it is going to set off the alarm and try to either get you to run away from it, to fight it, or to freeze. That’s how fight, flight, and freeze response. And the most common as humans is avo