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

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Your Anxiety Toolkit - It's a Beautiful Day to Do Hard Things
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May 20, 2022

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

Covered in This Episode:

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

Links To Things I Talk About:

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

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

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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 13, 2022

SUMMARY: 

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

In This Episode:

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

Links To Things I Talk About:

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

Episode Sponsor:

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

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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

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

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

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 6, 2022

SUMMARY:

Covered in This Episode:

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

Links To Things I Talk About:

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

Episode Sponsor:

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

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

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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.

Apr 29, 2022

SUMMARY:

Welcome to the first week of this 6-part series on Mental Compulsions.  This week is an introduction to mental compulsions.   Ove the next 6 weeks, we will hear from many of the leaders in our feild on how to manage mental compulsions using many different strategies and CBT techniques.  Next week, we will have Jon Hershfield to talk about how he using mindfulness to help with mental compulsions and mental rituals.

In This Episode:

  • What is a mental compulsion?
  • Is there a different between a mental compulsion and mental rumination and mental rituals?
  • What is a compulsion?
  • Types of Mental Compulsions

Links To Things I Talk About:

How to reach Jon https://www.sheppardpratt.org/care-finder/ocd-anxiety-center/
ERP School: https://www.cbtschool.com/erp-school-lp

Episode Sponsor:

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

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EPISODE TRANSCRIPTION

This is Your Anxiety Toolkit - Episode 282 and the first part of a six-part series that I am overwhelmed and honored to share with you – all on mental compulsions.

I have wanted to provide a free resource on mental compulsions for years, and I don’t know why, but I finally got enough energy under my wings and I pulled it off and I could not be more excited. Let me tell you why.

This is a six-part series. The next six episodes will be dedicated to managing mental compulsions, mental rituals, mental rumination. I will be presenting today the first part of the training, which is what we call Mental Compulsions 101. It will talk to you about all the different types of mental compulsions, give you a little bit of starter training. And then from there, it gets exciting. We have the most incredible experts in the field, all bringing their own approach to the same topic, which is how do we manage mental compulsions?

We don’t talk about mental compulsions enough. Often, it’s not addressed enough in treatment. It’s usually very, very difficult to reduce or stop mental compulsion. I thought I would bring all of the leaders, not all of them, the ones I could get and the ones that I had the time to squeeze into this six-part series, the ones that I have found the most beneficial for my training and my education for me and my stuff. I asked very similar questions, all with the main goal of getting their specific way of managing it, their little take, their little nuance, fairy tale magic because they do work magic. These people are volunteering their time to provide this amazing resource.

Welcome to number one of a six-part series on mental compulsions. I hope you get every amazing tool from it. I hope it changes your life. I hope you get out your journal and you write down everything that you think will help you and you put it together and you try it and you experiment with it and you practice and you practice because these amazing humans are so good and they bring such wisdom.

I’m going to stop there because I don’t want to go on too much. Of course, I will be starting. And then from there, every week for the next five weeks after this one, you will get a new take, a new set of tools, a new way of approaching it. Hopefully, it’s enough to really get you moving in managing your mental compulsion so you can go and live the life that you deserve, so that you can go and do the things you want without fear and anxiety and mental compulsions taking over your time.

Let’s do this. I have not once been more excited, so let’s do this together. It is a beautiful day to do hard things and so let’s do it together.

Welcome, everybody. Welcome to Mental Compulsions 101. This is where I set the scene and teach you everything you need to know to get you started on understanding mental compulsions, understanding what they are, different kinds, what to do, and then we’re going to move over and let the experts talk about how they personally manage mental compulsions. But before they shared their amazing knowledge and wisdom, I wanted to make sure you all had a good understanding of what a mental compulsion is and really get to know your own mental compulsions so you can catch little, maybe nuanced ways that maybe you’re doing mental compulsions.

I’m going to do this in a slideshow format. If you’re listening to this audio, there will be a video format that you can access as well here very soon. I will let you know about that. But for right now, let’s go straight into the content.

Who is Kimberley Quinlan?

First of all, who am I? My name is Kimberley Quinlan. A lot of you know who I am already. If you don’t, I am a marriage and family therapist in the State of California. I am an Australian, but I live in America and I am honored to say that I am an OCD and Anxiety Specialist. I treat all of the anxiety disorders. I also treat body-focused repetitive behaviors, and we specialize in eating disorders as well. The reason I tell you all that is you probably will find that many different disorders use mental compulsions as a part of their disorder. My hope is that you all feel equally as included in this series.

Now, as well as a therapist, I’m also a mental health educator. I am the owner, the very proud owner of CBTSchool.com. It is an online platform where we offer free and paid resources, educational resources for people who have anxiety disorder orders or want to just improve their mental health. I am also the host of Your Anxiety Toolkit Podcast. You may be watching this in a video format, or you may actually be listening to this because it will also be released. All of this will be offered for free on Your Anxiety Toolkit Podcast as well. I wanted to just give you all of that information before we get started so that you know that you can trust me as we move forward. Here we go.

What is a Mental Compulsion?

First of all, what is a mental compulsion? Well, a mental compulsion is something that we do mentally. The word “compulsion” is something we do, but in this case, we’re talking about not a physical behavior, but a mental behavior. We do it in effort to reduce or remove anxiety, uncertainty, some other form of discomfort, or maybe even disgust. It’s a behavior, it’s a response to a discomfort and you do that response in a way to remove or resist the discomfort that you’re feeling.

Now, we know that in obsessive-compulsive disorder, there are a lot of physical compulsions. A lot of us know these physical compulsions because they’ve been shown in Hollywood movies. Jumping over cracks, washing our hands, moving objects – these are very common physical compulsions – checking stoves, checking doors. Most people are very understanding and acknowledge that as being a part of OCD. But what’s important to know is that a lot of people with OCD don’t do those physical compulsions at all. In fact, 100% of their compulsions are done in their head mentally. Now, this is also very true for people with generalized anxiety. It’s also very true for some people with health anxiety or an eating disorder, many disorders engage in mental compulsions.

Mental Compulsion Vs Mental Ritual?

For the sake of this series, we use the word “mental compulsion,” but you will hear me, as we have guests, you will hear me ask them, do you call them “mental compulsions”? Some people use the word “mental ritual.” Some people use the word “mental rumination.” There are different ways, but ultimately throughout this series, we’re going to mostly consider them one and the same. But again, just briefly, a mental compulsion is something you do inside of your mind to reduce, remove, or resist anxiety, uncertainty, or some form of discomfort that you experience. Let’s keep moving from here.

What is a Compulsion

Now, who does mental compulsions? I’ve probably answered that for you already. Lots of people do mental compulsions. Again, it ranges over a course of many different anxiety disorders and other disorders, including eating disorders. But again, generalized anxiety, social anxiety, phobias, health anxiety, post-traumatic stress disorder. Some of the people with that mental disorder also engage in mental compulsions.

Predominantly, we talk a lot about the practice of mental compulsions for people with obsessive-compulsive disorder. The thing to remember is it’s more common than you think, and you’re probably doing more of them than you guessed. I’m hoping that this 101 training will help you to be able to identify the compulsions you’re doing so that when we go through this series, you have a really good grasp of where you could practice those skills.

Now, often when people find out they’re doing mental compulsions, they can be very hard on themselves and berate and criticize themselves for doing them. I really want to make this a judgment-free and punish-free zone where you’re really gentle with yourself as you go through this series. It’s very important that you don’t use this information as a reason to beat yourself up even more. So let’s make a deal. We’re going to be as kind and non-judgmental as we can, as we move through this process. Compassion is always number one. Do we have a deal? Good.

Types of Mental Compulsions

Here is the big question: Are there different types of mental compulsions? Now, I’m going to proceed with caution here because there is no clear differentiation between the different compulsions. I did a bunch of research. I also wrote a book called The Self-Compassion Workbook For OCD. There is no specific way in which all of the psychological fields agree on what is different types of mental compulsions. There are some guidelines, but there’s no one list.

I want to proceed with caution first by letting you know this list that we use with our patients. Now, as you listen, you may have different names for them. Your therapist may use different terminology. That’s all fine. It doesn’t mean what you have done is wrong or what we are doing is wrong. To be honest with you, this would be a 17-hour training if I were to be as thorough as listing out every single one. For the sake of clarity and simplicity, I’ve put them into 10 different types of mental compulsions. If you have ones that aren’t listed, that doesn’t mean it’s not a mental compulsion. I encourage you to just check in. If you have additional or you have a different name, that’s totally okay. Totally okay. We’re just using this again for the sake of clarity and simplicity. Here we go.

1. Mental Repeating

The first mental compulsion that we want to look at is mental repeating. This is where you repeat or you make a list of individual items or categories. It can also involve words, numbers, or phrases. Often people will do this for two reasons or more, like I said, is they may repeat them for reassurance. They may be repeating to see whether they have relief. They may be repeating them to see if they feel okay. They may be repeating them to see if any additional obsessions arise, or they may be repeating them to unjinx something. Now, that’s not a clinical term, so let’s just put that out there.

What I mean by this is some people will repeat things because they feel like the first time something happened, it was jinx. Like it will mean something bad will happen. It’s been associated with something bad, so they repeat it to unjinx it. We’ll talk more about neutralizing compulsions here in a second, but that’s in regards to mental repeating. You may do it for a completely different reason. Don’t worry too much as we go through this on why you do it. Just get your notepad out and your pencil out and just take note. Do I do any mental repeating compulsions? Not physical. Remember, we’re just talking about mental in this series.

2. Mental Counting

This is where you either count words, count letters, count numbers, or count objects. Again, you will not do this out loud. Well, sometimes you may do it out loud in addition to mental, but we’re mostly talking about things you would do silently in your head. Again, you may do this for a multitude of reasons, but again, we want to just keep tabs. Am I doing any mental counting or mental counting rituals?

3. Neutralization Compulsions or Neutralizing Compulsions

What we’re talking about here is you’re replacing an obsession with a different image or word. Let’s say you are opening your computer. As you opened the computer, you had an intrusive thought that you didn’t like. And so in effort to neutralize that thought, you would have the opposite thought. Let’s say you had a thought, a number. Let’s say you’ve had the number that you feel is a bad number. You may neutralize it by then repeating a positive number, a number that you like, or a safe number. Or you may do a behavior, you may see something being done and you have a negative thought. So then, you recall a different thought or a prayer, it could be also a prayer, to undo that bad feeling or thought or sensation.

Now, when it comes to compulsive prayer, that could be done as a neutralization. In fact, I almost wanted to make prayer its own category, because a lot of people do engage in compulsive prayer, particularly those who have moral and scrupulous obsessions. Again, not to say that all prayer is a compulsion at all, but if you are finding that you’re doing prayer to undo a bad thought or a bad feeling or a bad sensation or a bad urge – when I say bad, I mean unwanted – we would consider that a neutralization or a neutralizing compulsion.

4. Hypervigilance Compulsions

Now again, this is the term we use in my practice. Remember here before we proceed that hypervigilance is an obsession, meaning it can be automatic, unwanted, intrusive, but it can also be a compulsive behavior. It could be both or it could be one. But when I talk about the term “hypervigilance compulsions,” this is also true for people with post-traumatic stress disorder, is it’s a scanning of the environment. It’s a scanning, like looking around. I always say with my clients, it’s like this little set of eyes that go doot, doot, doot, doot really quick, and they’re scanning for danger, scanning for potential fear or potential problems. They also do that when we’re in a hypervigilance compulsion. We may do that with our thoughts. We’re scanning thoughts or we’re scanning sensations like, is this coming? What’s happening? Where am I feeling things?

You may be scanning and doing hypervigilance in regards to feeling like, am I having a good thought or a bad thought or a good feeling or a bad feeling? And then making meaning about that. You may actually also be hypervigilant about your reaction. If let’s say you saw something that usually you would consider concerning and this time you didn’t, you might become very hypervigilant. What does that mean? I need to make sure I always have this feeling because this feeling would mean I’m a good person or only good things will happen.

The last one again is emotions, which emotions and feelings can sometimes go in together. Hypervigilant compulsion is something to keep an eye out. It could be simple as you just being hypervigilant, looking king around. Often this is true for people with driving obsessions or panic disorder. They’re constantly looking for when the next anxiety attack is coming.

5. Mental Reassurance

We can do physical reassurance, which is looking at Google, asking a friend like, are you sure nothing bad will happen? We can do physical, but we can also do mental reassurance, which is mentally checking to confirm an obsession is not or will not become a threat. This is true for basic like we already talked about and some checking and repeating behaviors. You may mentally stare at the doorknob to make sure it is locked. You may mentally check and check for reassurance once, twice, five times, ten times, or more. If the stove is off or that you are not having arousal is another one, or that you are not going to panic. You may be checking to get reassurance mentally that your fear is not going to happen.

Again, some people’s fear is fear itself. The fear of having a panic attack is very common as well. Again, we’re looking for different ways that mentally we are on alert for potential danger or perceived danger.

6. Mental Review

We’ve talked a lot about behaviors that we’re doing in alert of anxiety. Mental review is reviewing and replaying past situations, figuring out the meaning of internal experiences, such as, what is the meaning of the thought I had? What is the meaning of the feeling I had? What is the meaning of that sensation? What does that mean? What is the meaning of an image that just showed up intrusively and repetitively in my mind? What is the meaning of an urge I have?

This is very true for people with harm obsessions or sexual obsessions. When they feel an urge, they may review for hours, what did that mean? What does that mean about me? Why am I having those? And so the review piece can be very painful. All of these are very painful and take many, many hours, because not only are you reviewing the past, which can be hard because it’s hard to get mental clarity of the past, but then you’re also trying to figure out what does that mean about me or the world or the future. So, just things to think about.

To be honest, mental review could cover all of the categories that we’ve covered, because it’s all review in some way. But again, for the sake of clarity and simplicity, I’ve tried to break them up. You may want to break them up in different ways yourself. That is entirely okay. I just wanted to give you a little category here on its own.

7. Mental Catastrophization

This is where you dissect and scrutinize past situations with potential catastrophic scenarios. Now, I made an error here because a lot of people do this about the future as well. But we’ll talk about that here in a little bit.

Mental catastrophization, if you have reviewed the past and you’re going over all of the potential terrible situations. This is very true for people who review like, what did I say? Was that a silly thing to say? Was that a good thing to say? What would they think about me?

Mental catastrophization is reviewing the past, but is also the future and reviewing every possible catastrophic scenario or opportunity that happened. Whether it happened or not, it doesn’t really matter when it comes to mental compulsions. Usually, when someone does a mental compulsion, they’re reviewing maybe’s, the just in case it does happen, I better review it.

8. Mental Solving

Very similar, again, which is anticipating future situations with or without potential what-if scenarios. Very similar to catastrophization compulsions. This is where you’re looking into the future and going, “What if this happens? What if that happens? What if this happens? Well, what if that happens?” and going through multiple, sometimes dozens of scenarios of the worst-case scenarios on what may or may not happen. Again, it usually involves a lot of catastrophizing. But again, these are all safety behaviors. None of this means there’s anything wrong with you or that you’re bad or that you’re not strong.

Remember, our brain is just trying to survive. In the moment when we are doing these, our brain actually thinks it’s coming up with solutions, but what we have to do, and all of the guests will talk about this, is recognize. Most of the time, the problem isn’t actually happening. We’re just having thoughts that it’s happening. Again, this is reviewing thoughts of potential what-if scenarios.

9. Mental Self-Punishment

I talk a lot about this in my book, The Self-Compassion Workbook For OCD. Mental self-punishment is a compulsion, a mental compulsion that is not talked about enough. One is criticizing, withholding pleasure, harshly disciplining yourself for your obsessions or even the compulsions that you’ve done. Often, we do this as a compulsion, meaning we think that if we punish ourselves, that will prevent us from having the obsession or the compulsion in the future. The fact here is beating yourself up actually doesn’t reduce your chances of having thoughts and feelings and sensations and behaviors or urges. But that is why we do them. It’s to catch when you are engaging in criticizing or withholding or punishing compulsions.

10. Mental Comparison

Again, not a very common use of compulsions, but this is one I like to talk about a lot. Most of my patients with OCD and with anxiety will say that they know for certain that they compare more than their friends and family members who do not have anxiety disorders. I’ve put it here just so that you can catch when you are engaging in mental comparison, which is comparing your own life with other people’s life, or comparing your own life with the idea that you thought you should have had for your life. So, an idea of how your life was supposed to be.

This is a compulsive behavior because it’s done again to reduce or remove a feeling or a sensation or a discomfort of anxiety or uncertainty you have around your current situation. It’s really important to catch that as well because there’s a lot of damage that can be done from comparing a lot with other people or from a fantasy that you had about the way your life should or shouldn’t look. Again, we will talk about this in episodes, particularly with Jonathan Grayson. He talks a lot about this one. I just wanted to add that one in as well.

They’re the main top 10 mental compulsions. Again, I want to stress, these are not a conclusive list that is the be-all and end-all. A lot of clinicians may not agree and they may have different ways of conceptualizing them. That is entirely okay. I’m never going to pretend to be the knower of all things. That is just one way that we conceptualize it here at our center with our staff and our clients to help patients identify ways in which they’re behaving mentally.

Something to think about here, though, is you may find some of your compulsions are in more than one category. You might say, “Well, I do mental comparison, but it’s also a self-punishment,” or “I do mental checking, but it’s also a form of reassurance.” That’s okay too. Don’t worry too much about what section it should be under. Again, it’s very fluid. We want you just to be able to document. It doesn’t matter what category it is particularly. I really just wanted this 101 for you to do an inventory and see, “Oh, wow, maybe I’m doing more compulsions than I thought.” Because sometimes they’re very habitual and we are doing them before we even know we’re doing them. I just want to keep reminding you guys it’s okay if it looks a little messy and it’s okay if your list is a little different.

The main question here as we conclude is: How do I stop? Well, the beauty is I have the honor of introducing to you some of the absolute, most amazing therapists and specialists in the planet. I fully wholeheartedly agree with that. While I wish I could have done 20 people, I picked six people who I felt would bring a different perspective, who have such amazing wisdom to share with you on how to manage mental compulsions.

Now, why did I invite more than one person? Because I have learned as a clinician and as a human being, there is not one way to treat something. When I first started CBT School, I was under the assumption that there is only one way to do it and it’s the right way or the wrong way. From there, I have really grown and matured into recognizing that what works for one person may not work for the next person.

As we go through this series, I may be asking very, very similar questions to each person. You will be so amazed and in awe of the responses and how they bring about a small degree of nuance and a little flare of passion and some creativity of each person and bring in a different theme. I’m so honored to have these amazing human beings who are so kind to offer their time, to offer this series, and help you find what works for you.

As you go through, I will continue reminding you, please keep asking yourself, would this work for me? Am I willing to try this? The truth is, all of them are doable for everybody, but you might find for your particular set of compulsions specific tools work better. So trial them, see what works, be gentle, experiment. Don’t give up. It may require multiple tries to really find some little win. Please, just listen, enjoy, take as many notes as you can, because literally, the wisdom that is dropped here is mind-blowing.

I’ve been treating OCD for over a decade and I actually stopped a few things after I learned this and went straight to my staff and said, “We have to make a new plan. Let’s implement this. This is an amazing skill for our clients. Let’s make sure we do it.” Even I, I’m a student of some of these amazing, amazing people.

How do I stop? Stay tuned, listen, learn, take notes, and most importantly, put it into practice. Apply. That’s where the real change happens.

Now, before we finish, please do note this series should not replace professional healthcare. This or any product provided by CBT School should be used for education purposes only, so please take as much as you can. If you feel that you need more support, please reach out to a therapist in your area who can help you use these tools and maybe pick a part. Maybe there’s a few things that you need additional help with, and that is okay.

Thank you, guys. I am so excited to share this with you.

Have a wonderful day.

Apr 22, 2022

SUMMARY: 

This episode addresses some common questions people have about anxiety and arousal. Oftentimes, we are too afraid to talk about anxiety and arousal, so I thought I would take this opportunity to address some of the questions you may have and take some of the stigma and shame out of discussing anxiety and how it impacts arousal, orgasm, intimacy, and sexual interactions.

In This Episode:

  • How anxiety and arousal impact each other (its a cycle)
  • Arousal Non-Concordance and how it impacts people with anxiety and OCD
  • How to take the shame out of arousal struggles
  • Understanding why anxiety impacts orgasms and general intimacy

Links To Things I Talk About:

Article I wrote about OCD and Arousal Non-Concordance
https://www.madeofmillions.com/articles/whats-going-ocd-arousal

Come as You are By Emily Nagoski, PhD
Come as You Are Workbook By Emily Nagoski, PhD
ERP School: https://www.cbtschool.com/erp-school-lp

Episode Sponsor:

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

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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

SUMMARY: 

This episode addresses some common questions people have about anxiety and arousal. Oftentimes, we are too afraid to talk about anxiety and arousal, so I thought I would take this opportunity to address some of the questions you may have and take some of the stigma and shame out of discussing anxiety and how it impacts arousal, orgasm, intimacy, and sexual interactions.

In This Episode:

  • How anxiety and arousal impact each other (its a cycle)
  • Arousal Non-Concordance and how it impacts people with anxiety and OCD
  • How to take the shame out of arousal struggles
  • Understanding why anxiety impacts orgasms and general intimacy

Links To Things I Talk About:

Article I wrote about OCD and Arousal Non-Concordance
https://www.madeofmillions.com/articles/whats-going-ocd-arousal

Come as You are By Emily Nagoski, PhD
Come as You Are Workbook By Emily Nagoski, PhD
ERP School: https://www.cbtschool.com/erp-school-lp

Episode Sponsor:

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

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

EPISODE TRANSCRIPTION

This is Your Anxiety Toolkit - Episode 281.

Welcome back, everybody. How are you? It is a beautiful sunny day here in California. We’re actually in the middle of a heatwave. It is April when I’m recording this and it is crazy how hard it is, but I’m totally here for it. I’m liking it because I love summer.

Talking about heat, let’s talk about anxiety and arousal today. Shall we? Did you get that little pun? I’m just kidding really.

Today, we’re talking about anxiety and arousal. I don’t know why, but lately, I’m in the mood to talk about things that no one really wants to talk about or that we all want to talk about and we’re too afraid to talk about. I’m just going to go there. For some reason, I’m having this strong urge with the podcast to just talk about the things that I feel we’re not talking about enough. And several of my clients actually were asking like, “What resources do you have?” And I have a lot of books and things that I can give people. I was like, “All right, I’m going to talk about it more.” So, let’s do it together.

Before we do that, let’s quickly do the review of the week. This one is from, let’s see, Jessrabon621. They said:

“Amazing podcast. I absolutely love everything about this podcast. I could listen to Kimberley talk all day and her advice is absolutely amazing. I highly recommend this podcast to anyone struggling with anxiety or any other mental health professional that wants to learn more.”

Thank you so much, Jess.

This week’s “I did a hard thing” is from Anonymous and they say:

“I learned it’s okay to fulfill my emotions and just allow my thoughts and it gave me a sense of peace. Learning self-compassion is my hard thing and I’m learning to face OCD and realize that it’s not my fault. I’m learning to manage and live my life for me like I deserve, and I refuse to let this take away my happiness.”

This is just so good. I talk about heat. This is seriously on fire right here. I love it so much. The truth is self-compassion practice is probably my hard thing too. I think that me really learning how to stand up for myself, be there for myself, be tender with myself was just as hard as my eating disorder recovery and my anxiety recovery. I really appreciate Anonymous and how they’ve used self-compassion as their hard thing.

Let’s get into the episode. Let me preface the episode by we’re talking about anxiety and arousal. If I could have one person on the podcast, it would be Emily Nagoski. I have been trying to get her on the podcast for a while. We will get her on eventually. However, she’s off doing amazing things. Amazing things. Netflix specials, podcasts, documentaries. She’s doing amazing things. So, hopefully, one day. But until then, I want to really highlight her as the genius behind a lot of these concepts.

Emily Nagoski is a doctor, a psychology doctor. She is a sex educator. She has written two amazing books. Well, actually, three or four. But the one I’m referring to today is Come as You Are. It’s an amazing book. But I’m actually in my hand holding the Come as You Are Workbook. I strongly encourage you after you listen to this podcast episode to go and order that book. It is amazing. It’s got tons of activities. It might feel weird to have the book. You can get it on Kindle if you want to have it be hidden, but it’s so filled with amazing information. I’m going to try and give you the pieces that I really want you to take away. If you want more, by all means, go and get the workbook. The workbook is called The Come as You Are Workbook: A Practical Guide to the Science of Sex. The reason I love it is because it’s so helpful for those who have anxiety. It’s like she’s speaking directly to us. She’s like, it’s so helpful to have this context.

Here’s the thing I want you to consider starting off. A lot of people who have anxiety report struggles with arousal. We’re going to talk about two different struggles that are the highlight of today. Either you have no arousal because of your anxiety, or you’re having arousal at particular times that concern you and confuse you and alarm you. You could be one or both of those camps.

So let’s first talk about those who are struggling with arousal in terms of getting aroused. So the thing I want you to think about is commonly-- and this is true for any mental health issue too, it’s true for depression, anxiety disorders, eating disorders, dissociative disorders, all of them really. But the thing I want you to remember, no matter who you are and what your experience is, even if you have a really healthy experience of your own sexual arousal and you’re feeling fine about it, we all have what’s called inhibitors and exciters. Here is an example.

An inhibitor is something that inhibits your arousal. An exciter is something that excites your arousal. Now you’re probably already feeling a ton of judgment here like, “I shouldn’t be aroused by this and I should be aroused by this. What if I’m aroused by this? And I shouldn’t be,” and so forth. I want us to take all the judgment out of this and just look at the content of what inhibits our arousal or excites our arousal. Because sometimes, and I’ll talk about this more, sometimes it’s for reasons that don’t make a lot of sense and that’s okay.

Let’s talk about an inhibitor, something that pumps the brakes on arousal or pleasure. It could be either. There’s exciters, which are the things that really like the gas pedal. They just really bring on arousal, bring on pleasure, and so forth.

We have the content. The content may be first mental or physical, and this includes your health, your physical health. For me, I know when I am struggling with POTS, arousal is just barely a thing. You’re just so wiped out and you’re so exhausted and your brain is foggy. It’s just like nothing. That would be, in my case, an inhibitor. I’m not going to talk about myself a lot here, but I was just using that as an example. You might say your anxiety or your obsession is an inhibitor. It pumps the brakes on arousal. It makes it go away. Worry is one.

It could also be other physical health, like headaches or tummy aches, or as we said before, depression. It could be hormone imbalances, things like that. It’s all as important. Go and speak with your doctor. That’s super important. Make sure medically everything checks out if you’re noticing a dip or change in arousal that’s concerning you.

The next one in terms of content that may either excite you or inhibit you is your relationship. If your relationship is going well, you may or may not have an increase in arousal depending on what turns you on. If your partner smells of a certain smell or stench that you don’t like, that may pump the brakes. But if they smell a certain way that you do really like and really is arousing to you, that may excite your arousal.

It could also be the vibe of the relationship. A lot of people said at the beginning of COVID, there was a lot of fear. That was really, really strong on the brakes. But then all of a sudden, no one had anything to do and there was all this spare time. All of a sudden, the vibe is like, that’s what’s happening. Now, this could be true for people who are in any partnership or it could be just you on your own too. There are things that will excite you and inhibit your arousal if you’re not in a relationship as well, and that’s totally fine. This is for all relationships. There’s no specific kind.

Setting is another thing that may pump the brakes or hit the gas for arousal, meaning certain places, certain rooms, certain events. Did your partner do something that turned you on? Going back to physical, it could also depend on your menstrual cycle. People have different levels of arousal depending on different stages of their menstrual cycle. I think the same is true for men, but I don’t actually have a lot of research on that, but I’m sure there are some hormonal impacts on men as well.

There’s also ludic factors which are like fantasy. Whether you have a really strong imagination, that either pumps the brakes or puts the gas pedal in terms of arousal. It could be like where you’re being touched. Sometimes there’s certain areas of your body that will set off either the gas pedal or the brakes. It could be certain foreplay.

Really what I’m trying to get at here isn’t breaking it down according to the workbook, but there’s so many factors that may influence your arousal.

Another one is environmental and cultural and shame. If arousal and the whole concept of sex is shamed or is looked down on, or people have a certain opinion about your sexual orientation, that too can impact your gas pedal and your brakes pedal. So, I want you to explore this, not from a place of pulling it apart really aggressively and critically, but really curiously and check in for yourself, what arouses me? What presses my brakes? What presses my gas? And just start to get to know that. Again, in the workbook, there’s tons of worksheets for this, but you could also just consider this on your own. Write it down on your own, be aware over the next several days or weeks, just jot down in a journal what you’re noticing.

Now, before we move on, we’ve talked about a lot of people who are struggling with arousal, and they’ve got a lot of inhibitors and brake pushing. There are the other camp who have a lot of gas pedal pushing. I speak here directly to the folks who have sexual obsessions because often if you have sexual obsessions, the fact that your sexual obsession is sexual in nature may be what sets the gas pedal off, and all of a sudden, you have arousal for reasons that you don’t understand, that don’t make sense to you, or maybe go against your values.

I’ve got a quote that I took from the book and from the workbook of Emily Nagoski. Again, none of this is my personal stuff. I’m quoting her and citing her throughout this whole podcast. She says, “Bodies do not say yes or no. They say sex-related or not sex-related.” Let me say it again. “Bodies do not say yes or no. They say sex-related or not sex-related.”

This is where I want you to consider, and I’ve experienced this myself, is just because something arouses you doesn’t mean it brings you pleasure. Main point. We’ve got to pull that apart. Culture has led us to believe that if you feel some groinal response to something, you must love it and want more of it.

An example of this is for people with sexual obsessions, maybe they have OCD or some other anxiety disorder, and they have an intrusive thought about a baby or an animal. Bestiality is another very common obsession with OCD or could be just about a person. It could be just about a person that you see in the grocery store. When you have a thought that is sex-related, sometimes because the context of it is that it’s sex-related, your body may get aroused. Our job, particularly if you have OCD, is not to try and figure out what that means. It’s not to try and resolve like, does that mean I like it? Does that mean I’m a terrible person? What does that mean?

I want you to understand the science here to help you understand your arousal, to help you understand how you can now shift your perspective towards your body and your mind and the pleasure that you experience in the area of sexuality. Again, the body doesn’t say yes or no, they say it’s either sex-related or not sex-related.

Here’s the funny thing, and I’ve done this experiment with my patients before, is if you look at a lamp post or it could be anything, you could look at the pencil you’re holding and then you bring to mind a sexual experience, you may notice arousal. Again, it doesn’t mean that you’re now aroused by pencils or pens. It’s that it was labeled as sex-related, so often your brain will naturally press the accelerator.

That’s often how I educate people, particularly who are having arousal that concerns it. It’s the same for a lot of people who have sexual trauma. They maybe are really concerned about the fact that they do have arousal around a memory or something. And then that concerns them, what does that mean about me? And the thing to remember too is it’s not your body saying yes or no, it’s your body saying sex-related or not sex-related. It’s important to just help remind yourself of that so that you’re not responding to the content so much and getting caught up in the compulsive behaviors.

A lot of my patients in the past have reported, particularly during times when they’re stressed, their anxiety is really high, life is difficult, any of this content we went through, is they may actually have a hard time being aroused at all. Some people have reported not getting an erection and then it completely going for reasons they don’t understand. I think here we want to practice again non-Judgment. Instead, move to curiosity. There’s probably some content that impacted that, which is again, very, very, normal.

this is why when I’m talking with patients – I’ve done episodes on this in the past, and we’ve in fact had sex therapists on the podcast in the past – is they’ve said, if you’ve lost arousal, it doesn’t mean you give up. It doesn’t mean you say, “Oh, well, that’s that.” What you do is you move your attention to the content that pumps the gas. When I mean content, it’s like touch, smell, the relationship, the vibe, being in touch with your body, bringing your attention to the dance that you’re doing, whether it’s with a partner or by yourself, or in whatever means that works for you. You can bring that back. There’s another amazing book called Better Sex Through Mindfulness, and it talks a lot about bringing your attention to one or two sensations. Touch, smell being two really, really great ones.

Again, if your goal is to be aroused, you might find it’s very hard to be aroused because the context of that is pressure. I don’t know about you, but I don’t really find pressure arousing. Some may, and again, this is where I want this to be completely judgment-free. There’s literally no right and wrong. But pressure is usually not that arousing. Pressure is not that pleasurable in many cases, particularly when it’s forceful and it feels like you have to perform a certain way. Again, some people are at their best in performance mode, but I want to just remind you, the more pressure you put on yourself on this idea of ending it well is probably going to make some anxiety. Same with test anxiety. The more pressure you put on yourself to get an A, the more you’re likely to spin out with anxiety. It’s really no different.

So, here is where I want you to catch and ask yourself, is the pressure I put on myself or is the agenda I put on myself actually pumping the brakes for me when it comes to arousal? Is me trying not to have a thought actually in the context of that, does that actually pump the brakes? Because I know you’re trying not to have the thought so that you can be intimate in that moment and engaged in pleasure. But the act of trying not to have the thought can actually pump the brakes. I hope that makes sense. I want you to get really close to understanding what’s going on for you.

Everyone is different. Some things will pump the brakes, some things will pump the accelerator. A lot of the times, thought suppression pumps the brakes. A lot of the times, beating yourself up pumps the brakes. A lot of the time, the more goal, like I have to do it this way, that often pumps the brakes. So, keep an eye out for that. Engage in the exciters and get really mindful and present.

A couple of things here. We’ve talked about erections, that’s for people who struggle with that. It’s also true for women or men with lubrication. Some people get really upset about the fact that there may or may not be a ton of lubrication. Again, we’ve been misled to believe that if you’re not lubricated, you mustn’t be aroused or that you mustn’t want this thing, or that there must be something wrong with you, and that is entirely true. A lot of women, when we study them, they may be really engaged and their gas pedal is going for it, but there may be no lubrication. And it doesn’t mean something is wrong. In those cases, often a sex therapist or a sex educator will encourage you to use lubrication, a lubricant.

Again, some people, I’ve talked to clients and they’re so ashamed of that. But I think it’s important to recognize that that’s just because somebody taught us that, and sadly, it’s a lot to do with patriarchy and that it was pushed on women in particular that that meant they’re like a good woman if they’re really lubricated. And that’s not true. That’s just fake, false. No science. It has no basis in reality.

Now we’ve talked about lubrication. We’ve talked about erection. Same for orgasm. Some people get really frustrated and disheartened that they can’t reach orgasm. If for any reason you are struggling with this, please, I urge you, go and see a sex therapist. They are the most highly trained therapists. They are so sensitive and compassionate. They can talk with you about this and you can target the specific things you want to work on. But orgasm is another one. If you put pressure on yourself to get there, that pumps the brakes often.

What I want you to do, and this is your homework, is don’t focus on arousal. Focus on pleasure. Focus on the thing that-- again, it’s really about being in connection with your partner or yourself. As soon as you put a list of to-dos with it is often when things go wrong. Just focus on being present as much as you can, and in the moment being aware of, ooh, move towards the exciters, the gas pedal things. Move away from the inhibitors. Be careful there. Again, for those of you who have anxiety, that doesn’t mean thought suppress. That doesn’t mean judge your thoughts because that in and of itself is an inhibitor often.

I want to leave you with that. I’m going to in the future do a whole nother episode about talking more about this idea of arousal non-concordance, which is that quote I use like “The bodies don’t say yes or no, they say sex-related or not sex-related.” I’ll do more of that in the future. But for right now, I want it to be around you exploring your relationship with arousal, understanding it, but then putting your attention on pleasure. Being aware of both, being mindful of both.

Most people I know that I’ve talked to about this-- and I’m not a sex therapist. Again, I’m getting all of this directly from the workbook, but most of the clients I’ve talked to about this and we’ve used some worksheets and so forth, they’ve said, when I put all the expectations away and I just focus on this touch and this body part and this smell and this kiss or this fantasy, or being really in touch with your own body, when I just make it as simple as that and I bring it down to just engaging in what feels good – sort of use it as like a north star. You just keep following. That feels good. Okay, that feels good. That doesn’t feel so great. I’ll move towards what feels good – is moving in that direction non-judgmentally and curiously that they’ve had the time of their lives. I really just want to give you that gift. Focus on pleasure. Focus on non-judgmentally and curiously, being aware of what’s current and present in your senses.

That’s all I got for you for today. I think it’s enough. Do we agree? I think it’s enough. I could talk about this all day. To be honest, and I’ve said this so many times, if I had enough time, I would go back and I would become a sex therapist. It is a huge training. Sex therapists have the most intensive, extensive training and requirements. I would love to do it. But one day, I’ll probably do it when I’m 70. And that will be awesome. I’ll be down for that, for sure. I just love this content.

Now, again, I want to be really clear. I’m not a sex therapist. I still have ones to learn. I still have. Even what we’ve covered today, there’s probably nuanced things that I could probably explain better. Again, which is why I’m going to stress to you, go and check out the book. I’m just here to try and get you-- I was thinking about this. Remember, I just recently did the episode on the three-day silent retreat and I was sitting in a meditation. I remember this so clearly. I’m just going to tell you this quick story.

I was thinking. For some reason, my mind was a little scattered this day and something came over with me where I was like, “Wouldn’t it be wonderful if I didn’t just treat anxiety disorders, but I treated the person and the many problems that are associated with the anxiety disorder? Isn’t that a beautiful goal? Isn’t that so? Because it’s not just the anxiety, it’s the little tiny areas in our lives that it impacts.” That’s when I, out of me, as soon as I finished the meditation, I went on to my-- I have this organization board that I use online and it was arousal, let’s talk about pee and poop, which is one episode we recently did. Let’s talk about all the things because anxiety affects it all. We can make little changes in all these areas and little changes. Slowly, you get your life back. I hope this gives you a little bit of your sexual expression back, if I could put it into words. Maybe not expression, but just your relationship with your body and pleasure.

I love you. Thank you for staying with me for this. This was brave work you’re doing. You probably had cringy moments. Hopefully not. Again, none of this is weird, wrong, bad. This is all human stuff.

Finish up, again, do check out the book. Her name is Emily Nagoski. I’ll leave a link in the show notes. One day we’ll get her on. But in the meantime, I’ll hopefully just give you the science that she’s so beautifully given us.

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

Please do leave a review. It helps me so much. If you have a few moments, I would love a review, an honest review from you.

Have a good day.

Apr 22, 2022

SUMMARY: 

This episode addresses some common questions people have about anxiety and arousal. Oftentimes, we are too afraid to talk about anxiety and arousal, so I thought I would take this opportunity to address some of the questions you may have and take some of the stigma and shame out of discussing anxiety and how it impacts arousal, orgasm, intimacy, and sexual interactions.

In This Episode:

  • How anxiety and arousal impact each other (its a cycle)
  • Arousal Non-Concordance and how it impacts people with anxiety and OCD
  • How to take the shame out of arousal struggles
  • Understanding why anxiety impacts orgasms and general intimacy

Links To Things I Talk About:

Article I wrote about OCD and Arousal Non-Concordance
https://www.madeofmillions.com/articles/whats-going-ocd-arousal

Come as You are By Emily Nagoski, PhD
Come as You Are Workbook By Emily Nagoski, PhD
ERP School: https://www.cbtschool.com/erp-school-lp

Episode Sponsor:

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

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

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

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 15, 2022

In this week’s podcast episode, we are reflecting on the question, “Does anxiety make you need to pee or poop? Yes, you read that right! Today, we are talking ALL about how anxiety can cause frequent urination and the fear of peeing your pants.

Have you found yourself getting anxious you might need to pee or poop in public which, in turn, makes you need to pee or poop in public?

Bathroom emergencies are way more common than you think. I even share a story of how I, myself, had to handle the urgency to 🏃🏼‍♀️🏃🏿‍♂️ to the restroom.

In This Episode:

Why do we need to pee and poop when we are anxious?
What causes the psychological need to urinate or defecate when anxious?
How to stop anxiety Urination
How to manage a fear of peeing your pants or pooping your pants
How to use mindfulness and self-compassion when experiencing nervous pee syndrome

Links To Things I Talk About:

Overcoming Anxiety and Panic 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.

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EPISODE TRANSCRIPTION

This is Your Anxiety Toolkit - Episode 280.

Welcome back, everybody. I am so thrilled to have you here with me again today. Today’s format is going to be a little different. I have fused the “I did the hard thing” with the question that we’re going to address today.

Usually, I sit down to the microphone and I look at my screen and I think about what I want to talk about, and I just start talking about it. To be honest, that is how this show goes. It has always been how this show has gone. But a follower on Instagram reached out to me this week and posed a really great question. So, with her permission, I will anonymously invite you to listen to the question, and then we’re going to talk about some solutions.

The reason I wanted to go word for word is I think you’re probably going to get what she’s saying, because I’ve been in this position. I know most of my clients have been in this position. It’s not the funniest thing to talk about. I mean, I love talking about it, but it’s not the funniest thing for you to talk about, or often people have a lot of shame and embarrassment around this topic. So, I wanted to just, let’s just talk about it.

Now, the reason I say I love to talk about it is, you know probably from previous episodes, I commonly ask my clients pretty personal questions. And often questions are like, are you prioritizing time to pee and poop? Are you holding your pee and poop? My job is to ask the questions that people are often too afraid to bring up. I often ask some personal questions about sexual arousal and things like that, again, because I have been trained to understand there’s a lot of stigma and shame, and embarrassment around these topics. And so I try to de-stigmatize them and take the shame out of them by just addressing them because they’re normal human struggles that we have.

As you may imagine, today, we’re talking about anxiety and pee and poop, and how anxiety can often make us feel like we urgently need to pee or/and poop. That’s the topic of today. I’m going to read you this. It’s a two-part question. I’m going to address them separately, but all from the same situation. It said: “Kim, I hope you are well. I was reading your post yesterday about the hardest part of facing your fear.”

To give you some backstory, I did a post on what the hardest things about facing fears are. I posed this question to Instagram and everyone wrote in. And using the results of what everyone wrote in, I created a post. And number seven was physical symptoms, especially bowel issues, and it really resonated with me.

Why do we need to pee and poop when we are anxious?

“You have said before that when you get feelings of discomfort, to just sit with it and do nothing.” That’s a common theme I talk about, is if you have discomfort, do nothing at all. You just sit with it. “But when it comes to bowel issues or needing to urinate due to anxiety, I get confused at what to do. Should I be sitting with it or going to the loo because that’s what my body needs? There are sort of two parts to my anxiety. With this, I’ll give you an example.” She said, “This weekend, I’m going to a christening and I get anxious for these types of events, like christenings, weddings, theater, anywhere where there is lots of people and they sit together in a certain way. I feel anxious about needing to go to the bathroom. It’s almost like I’m anxious of the symptom of anxiety.”

Yes. Now this is exactly what it is like for so many people, and it’s a really great question. Here is my response. Naturally, it’s a normal part of the human instinct to need to pee and poop when you’re anxious. Hundreds of thousands of years ago, when we were faced with danger or some kind of threat, in order to get away from that threat, usually you needed to be able to run many, many, many miles in a very short period of time. Now, we have cars and planes to get away from danger, or we have technology to help us to get away from danger. But back we needed to run that long-distance and exert a lot of energy. And so naturally, our bodies get rid of weight and waste so that you can be prepared to run a long distance away from the threat. Often the easiest way to get rid of that waste and weight is to defecate (to go poop) and to urinate, which is to go pee, or in some cases, throw up. Some people when they’re anxious, because their brain has detected danger, whether there’s danger or not, you may do one of those three things. That’s a very, very normal approach to the fight, flight, and freeze.

So, in this case, let’s say your brain has set off a false alarm and is saying there’s going to be lots of people there, and what if you need to pee and poop? So now you’re afraid of the symptom of anxiety like they’ve asked. What do you do? So here is my answer to that.

When we have any symptoms of anxiety – increase in heart rate, sweating, lots of racing, thoughts, it could be tummy ache, it could be the need to urinate – yeah, we do want to practice the art of sitting with it, meaning tolerating it without reacting to it in an aversive way, meaning trying to resist it, make it go away, how can we remove this discomfort from our life? When we do that, we get into a cycle where you’re constantly trying to get rid of discomfort and that keeps you stuck.

In this situation, yeah. If you have a slight urge to urinate or to go to the bathroom, if you’re able to, do try to tolerate that discomfort. However, if there’s a strong urge to go to the bathroom, there is absolutely nothing wrong with going to the bathroom. What I would say to you is it depends. The answer is it depends, and it’s a very personal one.

I will tell you a story personally. I know it was probably TMI, but I remember when I was becoming an American citizen, I was overwhelmingly anxious about this situation. I was afraid of everything. I was afraid of the test. I was really emotional about becoming an American. I felt like I was denouncing my country. I was so anxious about the security process. I was so afraid that I was going to mess up and get into some legal trouble, even though I’d done everything by the book. It was really, really overwhelming. The minute I got in line, which were these thousands of people in line, I needed to go to the bathroom, like right now, it had to happen. So, in that instance, yes, I’m going to ask somebody where the bathroom is and I’m going to go to the bathroom. So, I did okay. TMI, but we’re talking about it. Everybody pees and poops, so I’m not embarrassed.

Now, as soon as I got back in line, I lost my spot. I was at the back of the line again. My husband was with me. “Uh-oh, I need to go to the bathroom again.” I already know, I’ve probably dropped a lot of that weight. My brain thinks that there’s a major danger when there’s not. So, my job then is I could have easily gotten out of line again to try and get rid of that discomfort and that fear and that uncomfortableness in my stomach. But because I knew I’d already gone, my job was, I really need to get into this security building as a government building. I can’t keep getting out of line. My work then was to practice seeing if I could just hold that feeling.

Now I’m not here at all saying or suggesting that you should hold for long periods of time or even to be where you’re tolerating an experience of pain. Again, it depends. The answer is, it depends. If you’ve already gone, can you hold on? If let’s say you’re holding on and you’re like, “Oh no, it’s definitely coming, I need to go,” by all means, go. That’s not a compulsion. It’s just you listening to your body. It’s you giving yourself permission to just go with the flow and again, it’s a wonderful exposure of giving your body’s permission to run the show.

How to stop Anxiety Urination?

I think the answer is, listen to your body, see what you can do. Again, we always want to be experimenting with tolerating discomfort for long periods or as long as you can. Bit for no reason should you hold for long periods of time and put yourself in additional pain.

Now that being said, if you’re going to the bathroom, just to remove your anxiety about going to the bathroom, or you’re going to the bathroom to remove your anxiety of whether or not you will pee or poop your pants, that’s a different story. If you’re going to the bathroom to relieve anxiety, not physical, like actual urgency to go to the bathroom, well then yes, you’re giving into fear. We don’t want to let fear win, particularly when your brain is telling us there’s danger when there’s not.

A perfect example, I’m becoming a citizen. I have to take a test. There’s no real danger. The worst thing that could happen is I fail the test or I don’t bring a paper or something. In this case for the ceremony, the worst thing that could happen is you would need to go to the bathroom, right? Or even if you maybe-- again, the worst thing that could happen is you would have to go. But if fear is saying, “Oh no, no, there is really bad possible, maybe possible maybes,” because fear does that, it always gives you the possible maybes – then no, we would not go to the bathroom just to relieve anxiety.

If a lot of people, specifically those with panic disorder, they are very, very afraid of the sensations of anxiety. So, your job is actually, if that’s the case, to practice leaning in and having those sensations, tolerating those sensations. Or if you’re going to do exposure and response prevention, even better, you would purposely try to create the scenario so that you could simulate the anxiety and practice tolerating it that way.

So, my answer, I know, isn’t direct. It is, it depends. But when it does come to fear, it’s always going to be the same – do not let fear make your choices. Do no.

The next part of the question, I think, is another part of this, which I think is really important. So, they said, the second part is, “If I do need it and I have to leave the room during the ceremony, I wonder what people will think of me. I feel like I’m being a disruption. Also, if I have to move past anyone, I sit down, I feel like a nuisance. And then too, so often at the end of the seat--” so they sit at the end of the seat, excuse me, just in case. “Some of my compulsions, safety behaviors around this are needing to know where the nearest toilet is, going multiple times beforehand. Or I may do a certain number of pelvic floor squeezes whilst in the toilet.” They said, “Sorry if this is a long message, I just wanted to explain fully. I think the main thing I’m asking you is, should I be sitting with the feeling or not? If you do not see this up, the rest is just saying about the message.”

There we go. I think there’s so much great opportunity here for exposure and really willingness to be uncomfortable. The first thing is, everyone pees and poops. There is no shame in needing to go to the bathroom. I have a lot of clients who, when they’re anxious, they got to go. They got to go. It’s not anxiety. They’ve got to go to the bathroom or there’s going to be an accident. Not the fear. It’s like, “No, it’s actually coming.” If that’s the case, your job is to give yourself permission to be a human with anxiety and to be gentle and compassionate toward yourself that yes, sometimes people need to leave ceremonies.

If someone behind you is judging you for needing to leave, that is a full reflection on them. It means nothing about you. Human beings are allowed to come and go as they please. If they need to pee and poop, that is their right. What I would encourage you to do is, this is like a social anxiety sort of talk, and we’ve got some podcasts on social anxiety, but your job is to give other people permission to judge us and do nothing about it. Do nothing. Do nothing about their judgment, because their judgment is a full reflection of them and their beliefs, not of us.

The next part is they’ve gone over a ton of safety behaviors – checking the toilet, going multiple times. I would strongly-- if it were my client and you guys do what’s right for you always, take what you need, leave the rest. But if it were my client or if it were myself, I would strongly suggest other than otherwise not doing these behaviors. We don’t want to be doing behaviors. This goes for every topic. We don’t want to be doing behaviors just in case, that just in case behaviors keep us stuck in a cycle of anxiety, that just in case behaviors validate your fear as if your fear is true and important and a fact. We don’t want to do that. We can’t do that because when we do that, we keep the fear cycling.

So, I would actually encourage you to not check for bathrooms, not go to the bathroom before, unless of course you genuinely need to, not just because of fear. If for some reason you have the need, practice saying “I can have it.” If the feeling is the pressure is down in that bowel and that pelvic area, that won’t kill you either.

I always think of when I’m on an airplane to Australia, you know what happens? You get on the plane, you put your bags away. You’re getting ready. And then they say, preparing for takeoff, the seatbelt light comes on, and then immediately you need to go pee. And you can’t get up. They won’t you, so you hold it. People hold it all the time. Again, we don’t want you to push you through pain, but you can hold it. Be really honest with yourself. Nothing terrible is going to happen. If it’s really urgent, of course, I mean, even on a plane, if you’re really going to pee or poop your pants, they’re going to let you stand up. They’re not going to make you sit in the chair. Try not to be doing these behaviors. Practice tolerating the discomfort of other people possibly judging you.

One thing to keep in mind here too is when-- let’s say you go back to my story, I had to leave the line. I could have done a lot of mind reading, which is a cognitive distortion, which is going, “Oh, they think this and he thinks that, and she thinks that about me.” That’s all mind reading. You don’t actually know what they’re thinking. They might be thinking, what a beautiful dress you’re wearing, or they might be thinking, man, I can’t wait for this ceremony to be over. You have no idea, they might be thinking about something so different. So, it’s important that we also practice not mind reading what people think about us.

There you have it. These urgencies to go are normal. Everyone pees and poops. That’s just the facts. It doesn’t matter whether you do it once a day or 20 times a day, depending on if you’re anxious. Give yourself to not be perfect.

A lot of times, we also talk about when people are doing exposures or they’re having a panic attack, they’re like, “Ah, it’s not just the panic attack. I don’t want people to see me having a panic attack,” or “It’s not just the anxiety. I don’t want to have to cry in public.” The work here is you’re a human being. If you’re a human being, you won’t be perfect. If you’re holding yourself to a standard where you, number one, aren’t allowed to cry, you’re not allowed to pee, you’re not allowed to poop, you’re not allowed to disrupt other people, Well, that’s a lot of expectations you’re putting on yourself. That’s a lot of pressure that you just created in your head. No one else is expecting perfection from you. So, maybe adjust the expectations there as well.

Now the last thing I will address, which isn’t specifically to the pee and the poop, is some people get a lot of gas when they’re anxious. They have a strong urgency to pass gas. This is very common for people who have irritable bowel syndrome, same with getting diarrhea or needing to pee or poo. This is very common. If you have IBS, please do speak with a doctor. Let them know that you’re struggling with this. There’s nothing to be ashamed of. They can, of course, diagnose you, make sure they maybe get you some help in those areas. Again, if you need to pass gas, no different. Humans pass gas. It’s not something to be completely ashamed of. Is it embarrassing? Yes, it is. But you do what you have to do. You just have to get through.

I’ve heard so many people tell me stories of their most anxious moment being made more difficult because they had no choice, but to pass gas during that. And if that’s the case for you as well, again, I think any human who ridicules someone for needing to pass gas, which is such a human thing, I think we pass gas 17 times on average a day. Everyone, not select people, everyone, anyone who passed judgment on you for that is probably may want to step up their ability to be compassionate and empathic. Again, it’s not about you, it’s about them. So, be super, super gentle with yourself.

I think I hit my limit of how many times I said pee and poop, and now we’ve added in pass gas and we’ve even used the “diarrhea” word, which I think is epic. I think I’ve checked all the boxes for today’s episode. So, I hope that it was helpful for you. I genuinely hope that it just dropped some of the anxiety and judgment you have about yourself in regards to the urgency to need to go and pee and poop.

If I were to summarize it, I would say it’s very common to need to urinate, go to the bathroom or even pass gas. Lots of people have even diarrhea, very, very strong diarrhea. If that is the case for you, do what you need to do as best as you can. It’s okay if you need to go to the restroom. No problem. If you’re only going to reduce your anxiety about needing to go, I encourage you to try and challenge that some. Again, we do not want to give all of our power to fear. We actually want to ignore fear and give it none of our attention. If you can do that, you’re doing amazing hard work.

I love you all so much. Thank you for holding space for me as we talk about all things, bowel-related and urination-related. Even though it’s uncomfortable, it is so important for us to be having these conversations. I hope again, it was helpful for you, and thank you for holding space for me as we talk about these things together.

All right. I love you all. I hope you’re having an amazing, amazing week. I hope you’re being kind to yourself and really opening your heart to your own suffering instead of shutting it down because you’re suffering matters. It deserves to be held tenderly.

It is a beautiful day to do hard things. I cannot finish an episode without saying it. I encourage you, if you’ve gotten this far in the episode, to practice the hard things as much as you can every single day.

Have a wonderful day, everyone.

Apr 8, 2022

In todays podcast episode, together we do a self-compassion check in.  First, we address what is self-compassion and then, we check in on our needs.  Mindful Self-Compassion involves first, being aware of what we need and what needs tending to.  In this episode, we also walk through a self-compassion meditation together.

In This Episode:

  • What is Self-Compassion?
  • What do I need?
  • How can I give myself self-compassion right now?
  • Self-compassion meditation.

Links To Things I Talk About: https://read.amazon.com/kp/embed?asin=B08WGW9XCZ&preview=newtab&linkCode=kpe&ref_=cm_sw_r_kb_dp_XSDYJ2MCRJBYEFCPS5NF&tag=cbtschool-20 ERP School: https://www.cbtschool.com/erp-school-lp

Episode Sponsor:

This episode of Your Anxiety Toolkit is brought to you by CBTschool.com. CBTschool.com is a psychoeducation platform that provides courses and other online resources for people with anxiety, OCD, and Body-Focused Repetitive Behaviors. Go to cbtschool.com to learn more. Spread the love! Everyone needs tools for anxiety... If you like Your Anxiety Toolkit Podcast, visit YOUR ANXIETY TOOLKIT 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 1, 2022

In this week’s episode of Your Anxiety Toolkit Podcast, I share what I learned from my 3-day silent meditation retreat. This 3-day silent meditation retreat was rough, I won’t lie.  I had to ride many highs and lows, so I wanted to share them with you.

Links To Things I Talk About:

Tara Brach Silent Meditation Retreat home schedule
https://www.tarabrach.com/create-home-retreat/

Mindfulness Book
https://www.amazon.com/

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

Episode Sponsor:

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

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

EPISODE TRANSCRIPTION

This is Your Anxiety Toolkit - Episode 178.

Welcome back, everybody. I am so thrilled to be here with you today. I recently got back from a three-day silent retreat. I was by myself for the entire three days. It was a three-day silent retreat. I have done silent retreats in the past at Buddhist monasteries and Buddhist retreat centers. This is the first time I’ve done it on my own, and I followed the Tara Brach self-retreat website. I will leave the notes in the show notes so that you can check that out. It was amazing. I can’t lie. I had so many mind-blowing moments and I want to share with you each and every single one. I’m going to give you the cliff notes version. Otherwise, I would have you here for days on end. But I am so excited to share that with you.

Before we do that, of course, you know we always do the “I did a hard thing.” This is a segment where someone can write in, submit the hard thing they’ve done. This one is by Mgwolfie1992, and they’ve said:

“I have OCD and ASD. Certain shirts do not feel right. Before starting ERP, when I put on a shirt that’s uncomfortable, I immediately take it off, which was making me late for work. After starting ERP, I have slowly worked my way up to wearing and keeping that uncomfortable shirt on for 12 minutes.”

Mgwolfie1992, this is just you doing the work. I’m so, so impressed. This is exactly what it’s like for everybody listening or watching today, is it is about just small baby increments and getting yourself higher and higher and a little more difficult, a little more difficult. I’m so impressed with the work that you’re doing. This is just so incredibly powerful and rewarding, and I hope that you keep going.

Let’s talk about what I learned from my three-day silent retreat. Just to give you a setup, I rented through Airbnb a small little cabin in the depths of Topanga, which is very close to where I live in Los Angeles. I was following the Tara Brach home retreat that she created at the beginning of COVID. Now, when COVID hit, I so desperately wanted to do this, but I was in the middle of writing The Self-Compassion Workbook For OCD, and so I did not have time or the bandwidth to really go and really be with myself. I just had so much going on. As you probably remember, the world just felt so scary and no one knew what was happening. So I definitely wasn’t ready to do something at that time.

After several years or even months at this point where I feel like I’ve really, really prioritized my mental health and my medical health, I was finally in a place where I just felt like I needed some time to really go and let go of some things. I could be doing this at home. I could do this every day and I have since I returned, but I really felt that I needed these three days to do a deep dive into really some things that I had been working through having a medical illness, a chronic illness. I have postural orthostatic tachycardia syndrome, really coming down out of the pandemic and so forth. So, I really felt like I just needed this time to really not have the kids around and just drop down in and do that really hard work.

I took with me a journal. I took with me a book called Mindfulness by Joseph Goldstein. I strongly recommend that you try it. It is very heavy on Buddhist philosophy, but it is such an important book about mindfulness.

And so to start off, the thing that I learned the most was I needed so desperately to go back to basics. Everything felt so complex – everything I was teaching, everything I was doing in therapy, the practices of my own. It just felt like there were so many spinning parts. When I got there, I just dropped down to like, “Kimberley, let’s go back to the basics.” So I wanted to share with you what those basics were.

Number one, I went right back to the core of mindfulness, which was mostly me. The main agenda was to observe what showed up instead of being in reaction to it. Here, when life is so busy and chaotic and so many things happening at once, it’s really hard to be an observer. I think I have lost my ability to do that.

And so once I got there, I promised myself and my friends that I would not be contacting them, that I would have just one part of the day where I would text people back. I would check my phone, make sure everybody was okay and my clients were okay and my staff were okay. I would respond back, but very limited. And that throughout the day, if I felt the need to pick up my phone, or I felt the need to call, or I felt the need that I needed to talk to someone, that I had to stay in that feeling. And that’s why I really chose the silent retreat. I wanted to create an environment where I couldn’t rely on anybody except myself, and that no matter what I felt I had to hang on and I had to ride it out and I wanted to really drop down a little deeper and really explore what was going on for me.

Now, the thing that was most profound is the first day was excruciating. I mean, painful. I had every emotion under the sun. At one point at the evening, when I told my husband I would call after me waiting through these emotions all day, I did text and he asked how I was doing, and I said, “This is so hard. I don’t even want to be here.” I didn’t ask for his advice, but he did say via text, “Just keep going.” So, I did. Of course, I did.

But what was so fascinating to me, and one thing I really learned about myself, and I’m wondering if you do the same thing, is I had gone into this silent retreat not exhausted. Usually, by the time I take a break, I am so wiped out that I’m completely like starfish on the bed, completely out of it. This was really interesting because, for the first time, I wasn’t exhausted, and on the first day, I kept having the thought, “You don’t deserve this.” I kept thinking, this is ridiculous. People are at war. There is floods in my home country. So many people have it worse than me. “You don’t deserve this, Kimberley. This is unnecessary. This is actually very silly of you to have asked to do this three-day silent retreat.” I was so shocked at those thoughts.

Now, here is where the observing skill was so helpful for me. Instead of having that thought and then going, “Yeah, you’re right,” and then beating myself up or maybe even going home or feeling guilty or punishing myself, I just observed it and went, “Huh, that’s interesting. I’m having thoughts that this is selfish,” or “I’m having thoughts that this was silly.” Instead of fusing with those thoughts, I just observed them.

And I also observed the feeling and going, “Uh-huh, I feel guilty,” or “I feel selfish.” But instead of saying, “I am guilty and I am selfish,” I didn’t over-identify with those emotions, which is another mindfulness skill that I wanted to go back to the basics, is how much we over-identify with the thoughts we have. If something is uncomfortable, we go, “Oh, that means it must have to go away, and this is wrong. I’m wrong and I shouldn’t be feeling this way.” Instead, I just sat in it and I had this-- I want you to just imagine me. If you’re listening to the podcast, you won’t be able to see me. But if you’re watching me on video right now, I just had my head and kept nodding and smiling, like I was almost dancing with my head and just going, “Uh-hmm, yes, brain, I hear you. Yes, mind, I can hear what you’re saying, but I’m not going to connect with that. I’m going to allow it. I’m not going to push it away, but I’m just going to observe it.” Oh my gosh, I had so many breakthroughs, one after or the other, of just catching these rules and beliefs I have and how invasive they are and how reactive I am to them. Even though I’ve practiced this for years, I just knew I needed this time to let go of all of this.

Now the second thing I learned besides really dropping down into the basics and observing everything and not identifying was, in the Mindfulness book that I was reading, and I had it as my agenda to read it, is I had to practice going back to accepting impermanence. Now impermanence is a Buddhist concept that they talk about a lot. Basically, what it means is that this is temporary.

As I sat and I meditated so much on this three-day retreat, not so much the second day, but the first and the third day were really good meditation days. I sat on my meditation seat and all I would do is just try to stay in the moment and notice the impermanence. So, as a satisfying feeling showed up, I would just notice that this is temporary, that it will go, and I’m not going to cling to it. As an uncomfortable thought showed up, I said to myself, “This is temporary. I’m not going to cling to it. I’m not going to push it away.” Everything that showed up, I just kept going, “This is temporary. This is temporary.” Some people would probably argue that that’s a problem. Like, why would you push away good thoughts? But I had to keep reminding myself that my attachment to good is what creates a lot of my suffering.

A lot about impermanence is also looking at the fact that everything is temporary. In this beautiful rental that I had was these beautiful windows. I would sit right at the edge of the window and I would overlook this beautiful creek, all these trees, and leaves. A part of the meditation that I had practiced and I have practiced for many years is to meditate on impermanence, which is to sit and look. This time my eyes were open, and everything I see, I contemplated how temporary it is.

If it was a leaf that is just newly budded, I would imagine it fully coming into bloom, falling off the tree, and then completely breaking down into the ground where it was mud muddy and sludgy and yucky. And then looking at, let’s say the wood and going, “Yes, that too will break down over time.” Looking at my hand and my face and my body and imagining me too once was very youthful and now looking slightly older and acknowledging that that too is impermanence and that I too will die.

From that meditation, I cried. I sobbed actually, and I let go of a lot of beliefs and values I was hanging onto that really aren’t my values in terms of me having to stay young, that me having to stay liked by people, that I had to hold onto this idea. Instead, I was actually moving towards saying, “It’s okay. You can like me or hate me, because you liking me may actually be temporary. You may only need me for a period in your life. And then you may not need me.” And then again, observing what showed up for me and letting go of that too. It was just this massive cycle and it kept going and going. I would keep hitting these same things that I needed to let go of and learn and practice like observing and recognizing that things are temporary and that it doesn’t mean anything about me.

I know this may actually be a lot, but I can’t tell you how powerful it was. It was such a beautiful experience of letting go, of catching where I’m attached to things, and then letting go of that as well. I’m not saying that because I let them go they don’t bother me anymore. I am now in a cycle and it got me going and now allowing that letting go to be more automatic. Whereas before, I used to joke with my husband and my best friend. When they’d make a suggestion to me, like maybe they would offer me some advice, I would respond a little defensively. And that’s one of the reasons I really wanted this three-day retreat, is I could feel the tension in me on how inflexible I was and how I was being stubborn and holding tight on things. I knew that’s not what my core nature is.

I’m going to keep this short and I’ll give you one more thing that I learned. And this thing has probably been the most beautiful lesson I’ve ever learned. It’s been so synchronistic because so many things have really reinforced things since I’ve returned. This is the idea of independence versus interdependence.

I think since I recovered from my eating disorder, I have made it my goal to be independent. I don’t want to rely on people. I don’t want to ask them for help. I want to be a strong woman. I want to be a powerful human. I want to be peaceful in myself. I want to be self-sustaining, if that makes sense. This has been such amazing growth for me. I have learned so much and really learned my own strength because I made a deal with myself that I would always be my first person. Through that, I have learned to trust myself, to rely on myself, that I’m stronger than I thought. It’s a big reason why I say it’s a beautiful day to do hard things, is because I’ve practiced that my whole life.

But I was reading something from one of these, in the Tara Brach retreat, she has a lot of retreat talks and I was listening to some of these Dharma talks. One of them was that we’re interdependent. Even though we’re independent, we also need other people. And that actually through being interdependent is where we build community. It made me realize that I think I’ve swung too far in the independence. If there was a pendulum swinging, I’d swung too far in the independence and I needed to recognize how much I need other people. I need my friends, I need my husband more, I need my children more in different areas, that I need to ask for help more. It doesn’t mean I have to pay people. It doesn’t mean they owe me. It doesn’t mean I now fully swung the other direction into always being dependent. It’s that I’ve acknowledged that change happens more on the local level.

Since I created this podcast and I have an Instagram profile, I think my mind had very much gone to a large scale. Like, I have to make a huge difference, that I could make a huge difference. Something came through me, a sense of knowing in terms of, yes, I can make a large difference, but I can’t forget the local difference that I can make, the connection with my neighbors, the connection with my school. Particularly since COVID, we’ve become so technological. How can I actually connect with people more on a one-to-one basis instead of a one-to-thousand?

For some reason, that really spoke to me and I’ve never been more empowered and excited to serve you all because I think I needed to come out of the big crowd, thousands of people and really just start to go back to thinking one-to-one and thinking about the person instead of the crowd. I think that that will help me a lot in terms of being more connected, feeling more connected, feeling not lonely in things. They have that whole thing about you can be surrounded by people, but still feel lonely. I think that’s probably why I felt lonely in the past.

They’re the main things I learn. There are so many more, but really, I just want to emphasize, if you can create a one day or even a half-day silent retreat where you sit and really be with your emotions and commit to seeing what comes up, you will be shocked at the explosion of experiences that you have inside you. It doesn’t have to be three days. You don’t have to rent someplace. You could do it in your own home, even in one room if you need it, and really drop down. When those really painful emotions come up, really sit with them and be with them and practice letting them wax and wane as much as you can.

That’s what I learned. I hope that that has been inspiring to you in some way or another. For me, I’m more committed to my meditation practice than I’ve ever been. I’m more committed to my mindfulness than I’ve ever been, and I’m more connected to my business than I’ve ever been, which is really, really beautiful.

All right, thank you so much. I am so grateful for you being here with me today. I just love this work I’m doing with you and I hope that it is beneficial to you.

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

“This podcast is a gift. I just found this podcast and I’m binging on the episodes. I learn something through each episode, and I love her practical advice and tools. I feel like part of a community-what a gift!”

Thank you, kdeemo. Please, please do go and leave a review. I know you are very busy. I very much respect your time, but the best gift you can give me is just a view and honest review. It helps me to reach more people and that makes me feel so fulfilled and happy.

Have a wonderful day, everybody.

Mar 25, 2022

Common treatment of derealization and depersonalization Kimberley Quinlan

SUMMARY:

Derealization & depersonalization are common experiences of anxiety. In this episode, we take a look at the definition of derealization and depersonalization. We also explore the common symptoms of derealization and depersonalization and the treatment of derealization and depersonalization. I also explore mindfulness and CBT skills to help you manage your discomfort and anxiety.

In This Episode:

  • The definition of derealization
  • The definition of depersonalization
  • Explore the symptoms of derealization
  • Explore the symptoms of depersonalization
  • Comparing derealization vs depersonalization
  • Common treatment of derealization and depersonalization

Links To Things I Talk About:

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

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

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

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

EPISODE TRANSCRIPTION

This is Your Anxiety Toolkit - Episode 227.

Welcome back, everybody. I am so grateful to have this time with you. As you know, I promised this year would be the year I doubled down and get really into the nitty-gritty of some of the topics that people don’t talk enough about regarding anxiety. Today is so in line with that value

Today, we are talking about what is derealization and depersonalization. These are two what I would consider symptoms of anxiety. I see it all the time in my practice. I see it reported and commented all the time on Instagram. If you follow me on Instagram, we put out tons of free information there as well. This is such an important topic. And for some reason, we aren’t talking about these two topics enough.

My goal today is actually to give you a 101 on derealization and a 101 on depersonalization. We can touch upon derealization disorder and depersonalization disorder as well, but at the end, I want to give you as many tools as I can to point you in the right direction.

Before we do that, let’s do the “I did a hard thing,” because we love that, right? The “I did a hard thing” is a segment where people submit the hard things they’re doing. The main reason I do this is because, number one, you’re my family. We’re all in this together. But number two, often people, many years ago when I started the podcast, people were like, when I started saying it’s a beautiful day to do hard things, which I say all the time, a lot of people were saying, “But how hard does it have to be? And how do I handle the hard things? Can you give me an example?” And so, these have been just such a wonderful way to share how other people are doing hard things.

This one was submitted anonymously, and they said:

“I’ve struggled with suicidal ideation for a very long time. And after years of therapy, self-discovery, and lots of hard work, I’m finally accepting that I am better off in the world than out of it.”

Now I just have to take a deep breath and nearly cry because this is seriously the hard work. Sometimes when we’re talking about “I did a hard thing,” we’re talking about facing one small thing or one large thing, but I really want to honor Anonymous here and all of you who are doing this really long-term work and deep, deep work around really acknowledging how important you are and how much the world needs you in it and on it.

So anonymous, I love you. You are amazing. I have such respect for the work that you’ve done and are doing, and thank you. Again. I think we don’t talk about suicidal ideation enough either. In fact, I should really do an episode on that as well. I respect you and I’m so grateful you submitted this week.

Okay, here we go. I have some notes, which I rarely use notes for episodes, but I didn’t want to miss anything. I’ve got so much I want to share. I will do my best to break this down into, like I said, a 101, small bite-size helpful tools.

You will hear me, as I talk, taking little deep breaths and that’s because I have to practice slowing down. Just a little off-topic, when I’m doing podcasts, I get so geeked out that my brain races, and I’m all over the place and I’m talking fast and I have to slow down, “Kimberley, pump the breaks, lady.”

Let’s together take a breath... and let’s just be together.

First let’s talk about derealization. The definition of derealization is that derealization is a mental state or a psychological experience, it could also be a physiological experience, where things feel unreal. Not like, “Oh, that’s totally unreal, man. Amazing.” I’m talking where they don’t feel real. When you have derealization, you might feel detached from your surroundings. You don’t feel connected to what’s going on around you, and people and objects may also seem unreal.

Often people, when they have derealization or derealization disorder, feel like they’re going crazy. Actually, they feel like they’re going crazy. Not just the term that people use on the street. They actually feel like they’re losing touch with reality.

When we talk about derealization disorder, we’ll talk about that here in a little bit, but we could use them interchangeably. Lots of people have derealization without having the disorder, but to have derealization disorder, you have to experience derealization. So I’m including them both there.

Now the prevalence of derealization, I wanted to just give you this information because I felt it was very validating. I myself struggle with derealization and depersonalization. It was really validating for me to hear that more than half, more than 50% of people may have this disconnection from reality at least once in their lifetime. 2% of people experience it enough for it to become some kind of disorder, just like derealization disorder or even a dissociative disorder like amnesia.

If you’re concerned, you can go speak with your doctor or your therapist, or a licensed therapist for an assessment if you’re concerned about it. A lot of people who I have seen have already been to the doctor, gotten cleared. Schizophrenic is often a very big concern. People often feel that they’ve been misdiagnosed.

Now derealization is similar, but distinctly different from depersonalization, which we would talk about here soon. Some symptoms of derealization include feelings of being unfamiliar with your surroundings. You feel like you’ve never been there before, or you may feel like you’re living in a movie or a dream. You may feel emotionally disconnected from your loved ones or colleagues or friends. You just feel very numb. Like I said, you’re just very out of order. Things feel very strange. Your surroundings and the environment also may appear distorted, blurry, colorless, two-dimensional, or artificial.

I remember the first time I ever had derealization. I was sitting across from a client and I was an intern. I was very anxious. I’ve talked about this on the podcast before. I was sitting across from them and all of a sudden, their body looked like a caricature of themselves. The caricature is where their body is really small and their head is huge. I was looking at my client, trying to be a therapist, and I’m thinking what happened. All of a sudden, their neck was very, very small and short and their head looked gigantic. It looked like a drawing, not three-dimensional, but two-dimensional. And that was so concerning to me. I freaked out. I got through the session. Thankfully, again, I had tools to use. But it was really scary. It actually brought on some panic later in that evening because it didn’t go away for a little bit of time.

Now, depersonalization, the definition of depersonalization involves feeling a detachment, not from your environment like in derealization, but from your own body and your thoughts and your feelings. Think of it like it’s like you’re watching yourself from an outsider. I always say it’s like you’re flying on the wall, looking at yourself, or it’s like looking at a movie of yourself.

Now, symptoms of depersonalization include feelings that you’re an outsider observer, like I just said. You’re disconnected to your body again. Others report that it feels like they’re a robot and that they don’t have control of their movements. Again, you feel like you’re watching yourself and you don’t have control of what’s going to happen next.

Another symptom of depersonalization may include the sense that your body and legs and arm appear distorted. They may feel enlarged or shrunken. Some people report that their head is wrapped in cotton. That’s a different symptom.

Another example I always use with my patients is often when I have depersonalization, which isn’t very often anymore, is I’d look at my hand and I couldn’t tell if it was my hand or not. I didn’t feel like it was my hand. Again, really scary, can feel really concerning in the moment.

Now you may also experience some numbness, whether that’s emotional or physical. Some people say all of these symptoms are similar for derealization as well. You may feel like your memories lack emotion. Again, you’re disconnected from your own experience. So, that can be an additional symptom of depersonalization.

Now for both, I’m going to talk about them together now. For both, the duration of these symptoms may last just a few minutes, they can last a few hours. Some people, particularly if you have derealization disorder or depersonalization disorder, it can be days, weeks, and months. In that severity, I would encourage you to go and speak with a mental health provider who is trained and can assess you properly.

Now, to be diagnosed with derealization or to be diagnosed with depersonalization, there is no lab test. There’s no scan you can have. It requires a trained professional to review your symptoms and give you the diagnosis. You could probably, by listening to this, define for yourself whether you have the criteria to meet this classification. But if you’re wanting to be sure, I strongly encourage you to seek professional help to get that diagnosis.

Now, the prevalence of the struggles almost always start in late childhood or early adulthood. The statistics, this is why I have my notes today, the average age starts around 16. 95% of cases are diagnosed before the age of 25. Not always, but that has been the common statistics that they’re showing. I think that’s really helpful to know.

Now, that being said, what do you do from here? The treatment of depersonalization and derealization is often CBT (Cognitive Behavioral Therapy). Basically, what we do, and this is a lot of the work that you probably already have skills if you’ve listened to a lot of the podcast episodes – a lot of it is around practicing your mindfulness tool. The first thing I want to let you know is it doesn’t mean you’re going crazy. I totally get that. It feels like you are, but it doesn’t. The good news is, when you can’t stop appraising it as “I am going crazy,” you’ll actually start to notice it’s just a really strange feeling, but it doesn’t mean anything is wrong.

I once had a teen client who told me, he said he was laughing and we were giggling together. He said, “The crazy thing is some of my friends pay a lot of money to feel this way by using drugs,” and he says, “I have it for free. I have this strange feeling, this out-of-body experience. And I don’t even have to be under the control of a drug or a substance.” He said, “When I looked at it from that perspective, I stopped appraising it as if it’s dangerous.” And that was a game-changer for him to stop appraising it as if it is a dangerous problem.

For me now, when I have derealization, it usually occurs when I’m driving. I used to panic that that meant I was going to crash. But then when I just said, “Okay, I’m just having a feeling and I’m going to let it be there.” I’m not going to do anything about it. I’m not going to judge it negatively. I’m going to allow it to rise and fall on its own. And I’m going to put all of my attention on just staying present.

Now your brain is going to say, “Yeah, but present is bad. Present is terrible. Bad things are going to happen. What if you’re going crazy?” And your job is actually to practice just letting those be thoughts, because that’s what they are. They’re thoughts. Just because you have them doesn’t mean they’re facts. Lots of people have derealization. The clients I’ve had who’ve had severe derealization and derealization and depersonalization disorder, they now say, “Yeah, it happens. No big deal. They just go about my day.”

Now in the early stages of treatment, you’re going to hate this idea, but it works, is we actually used to purposely induce this sensation so that they could practice tolerating the discomfort without responding in unhealthy ways or in compulsive ways. We would sit them down and spin them around in a chair. We would have them stare at the wall. We would have them look at really psychedelic YouTube videos where the colors and the patterns are all wavy like seventies, like psychedelic. And we would practice inducing the feeling. From there, they would practice willingly allowing the discomfort and going about their day, being gentle with themselves, engaging in the things they value. Of course, they might feel great, and that’s okay. You can slow down a little and do what you need to do.

But ultimately, when you have depersonalization and derealization, the goal is simply to do nothing at all. Crazy. When I tell my patients that, they’re like, “Oh my goodness, you’re either crazy or you’re brilliant.” By the end, usually, they say that this treatment, not me, but the treatment is brilliant, because it teaches them not to be afraid of it and not to try and live their life avoiding it.

I’ve had patients report that they’ve avoided things at great length just to avoid the experience of depersonalization and derealization. And when they avoid it, it just keeps them stuck and keeps them scared and keeps it happening more.

The other thing I will add is, do not check to see if you’re derealized or depersonalized, because just the act of checking for it, like a mental check, can actually bring on the symptoms. Now, that’s easier said than done. Am I right? Yes, it’s very hard. I know it’s easy to say, “Just stop doing that.” But if you’re engaging in a lot of checking behavior, sometimes it’s helpful to catch when you are and bring yourself back to the present, do whatever disengagement skills you can use to get you back into the present moment. Again, we don’t want to push the discomfort away, but we also don’t want to give too much hyper attention to these sensations and symptoms.

If you’re struggling with these symptoms, go and see a mental health professional. You can quiz them, ask them if they have skills in this. Look on their website, see if they’ve got any information about it that will help you to get the help that you need.

This is great. Like I said, this is what I call derealization and depersonalization 101. But there are many, many other tools that you can use to help manage this. One day I will do my best to create an online course about this that goes into detail so you have that, but for right now, I hope that this is helpful.

Now, before we finish up, I’m going to do the review of the week. We have an amazing review here from Jessrabon621 and they said:

“Amazing podcast. I absolutely love everything about this podcast. I could listen to Kimberley talk all day and her advice is absolutely amazing. I highly recommend this podcast to anyone struggling with anxiety or any other mental health professional that wants to learn more.”

Thank you, Jessrabon621. I am so grateful that I’ve helped and I’m so happy that you’ve left a review. Thank you. I love your reviews. They help me so much.

2022 is the year that I want to get a thousand reviews. If you can help, I would be so grateful. Go in wherever you’re listening, click on the reviews, leave a review. You don’t have to write something. You can just rate it. Leave an honest review. I am so, so grateful. We will be giving a pair of Beats headphones to one lucky winner by the time we hit 1,000 reviews. So I am so grateful.

Have a wonderful day, and I’ll see you next week.

Mar 18, 2022

SUMMARY:
Overcoming Health Anxiety is possible! Today, we interview Ken Goodman and his client Maria on overcoming hpyochondria using Cognitive Behavioral Therapy. In this episode of Your Anxiety Toolkit Podcast, you will learn key concepts of health anxiety and how to overcome their health anxiety.

In This Episode:

  • What it is like to have health anxiety
  • The key concepts of treating Hypochondria
  • Tips for managing fears of death and cancer.
  • A step-by-step approach to overcoming health anxiety.

Links To Things I Talk About:

https://www.kengoodmantherapy.com/
Quiet Mind Solutions
ERP School: https://www.cbtschool.com/erp-school-lp

Episode Sponsor:

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

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

EPISODE TRANSCRIPTION

This is Your Anxiety Toolkit - Episode 226.

Welcome back, everybody. If you have health anxiety, hypochondria, health anxiety disorder, or you know of somebody who has health anxiety, you are going to love this episode. I mean, love, love, love this episode.

Today, we have Ken Goodman, who’s on the show. He’s a clinician who’s here with his patient and they’re sharing a success story, a recovery story of health anxiety, and it is so good. I am so honored to have both of them on. It was so fun to actually interview other people and the way they’re doing it, and look at the steps that were taken in order to overcome health anxiety. And this is the overcoming health anxiety story of all stories. It is so, so good. I’m not going to waste your time going and telling you how good it is. I’m just going to let you listen to it because I know you’re here to get the good stuff.

Before we do that, I wanted to do the “I did a hard thing” and this one is from Dave. It says:

“I’ve been trying to get back into meditating regularly. I was sitting at a desk this morning, reviewing my work emails. And I told myself, before I get even further in my day, I need to meditate. I did a guided meditation, even though I felt a strong pull inside to go back to work. I kept getting caught up in my thoughts, but I just kept telling myself it doesn’t need to be a perfect meditation. I said the goal today is just to be able to sit without being busy for three minutes. Nothing more. It was hard, but I did it.”

Dave, thank you so much for the submission of the “I did a hard thing” segment, because I think that meditation is so important. In fact, I keep promising myself I’m going to implement it more into this podcast. And Dave has really looked at some of the struggles people have with meditation. And look at him, go, it’s so amazing. Totally did it. So amazing. Dave, thank you so, so, so much. I love it. If you want to submit, you may submit your “I did a hard thing” by going to KimberleyQuinlan-lmft.com. If you go to the podcast page, there is a submission page right on the website. And from there, let’s just go straight to the show. I hope you enjoy it.

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 11, 2022

SUMMARY: 

Many people ask me, “Why do I have anxiety?” and the truth is, there is no clear-cut answer. However, in this week's episode, I give you nine possible causes of anxiety and what you can do to manage anxiety in your daily life. Some causes are in your control, and some are not.  Either way, it is important that you are super gentle with yourself as you explore some of the reasons for anxiety in your life. 

In This Episode:

  • NINE possible causes of anxiety for you in your life
  • What you can do to manage your anxiety
  • How to overcome anxiety by changing small behaviors
  • Reasons you experience anxiety may include
    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.
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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 4, 2022

SUMMARY: 

In today's podcast episode, we have Dean Stott from DLC Anxiety talking about his experience with Panic Disorder and Overcoming Panic Disorder.  In his upcoming book, Greater Than Panic, Dean talks about what it was like for him to experience agoraphobia, panic disorder, and other struggles after the death of his father.  Dean spread an inspiring story about overcoming panic and how he is Greater than Panic.

In This Episode:

  • What it was like for Dean Stott to have Panic Disorder
  • How he overcame panic disorder using CBT and Mindfulness
  • How Dean created DLC Anxiety, an online platform that helps millions with panic, anxiety and other mental illnesses.
  • Tools that he found helpful to manage his Panic Disorder while also grieving the loss of his father.

Links To Things I Talk About:

DEANS BOOK GREATER THAN PANIC 

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.

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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.

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Kimberley: Welcome, Dean. I am so happy to have more-- actually, as much as I’m happy to have you on the podcast, I’m just happy to have chats with you. Welcome.

Dean: Thank you so much. Thank you for inviting me, Kim.

Kimberley: Yeah. So, I feel like I know you and your story pretty well. But I would love for you to share your story with my listeners because I think you have some really great stuff to share. So, can you share whatever you’re comfortable about your recovery?

Dean: Yeah, sure. So, basically, once upon a time, I was going through a panic disorder. So, dealing with four panic attacks, maybe four or five panic attacks every single day, where I get the worst period. And yeah, I went through a panic disorder, did my own research, a lot of science research, CBT research, mindfulness meditation, and curated my own plan out of recovery with the guidance of a really good support network, friends, and mentors, who’d been through an anxiety disorder and come out the other side and fully recovered from the panic disorder. I then wanted to take that feeling of the support that I was given from my older mentor, the friend that had been through it. I wanted to share that with as many people as I possibly could. So, I came up with DLC Anxiety.

So, at first, I remember sitting down and I was like, “How can I get this message out to as many people as possible?” And I was thinking of local support community groups, like the Alcoholic Anonymous groups where people go and it’s a supportive network between each other. But then I was just so eager to try and get it even more on a global stage. And I saw what Instagram does and I just thought it would fit nicely in there, because I did see that there wasn’t many mental health communities when I first started. So, I thought there was definitely a nice place for it to fit there. So, yeah, I started to tell my story on Instagram. People started to relate, and it was a snowball effect from there. And now we’re over a million followers in the community, which is fantastic.

Kimberley: So cool. So, I think that the whole concept here is really to look at what-- let me backtrack a little bit. So, in your recovery, did you do it all on your own? Did you have a therapist? What was that process like for you?

Dean: Yeah. So, my father passed away. Like any people, any male in that situation, I bottled up the feelings that I was going through and tried to carry on with going to work and trying to get back into my daily routine. Almost putting it to the back of my mind because I wasn’t-- well, I didn’t have the techniques to cope with that and I’d never cope with loss before. So, it was from that bottling up of the grief that the panic attacks started and occurred. 

So, when I first started having panic attacks, the first thing I did was go to the doctors who then referred me onto a grief counselor, but just specifically to address the grief side of things and not the anxiety, not the panic attacks. Regarding the anxiety and panic attacks, that was me curating, delving into a lot of psychoeducation, which I found very useful, learning about the system and the symptoms of anxiety. Now I’d done Psychology at university and done CBT before. So, it is like not I’d never--I knew the basic concepts of anxiety, but learning more about it and learning about the scary symptoms where you think-- firstly, when you have a panic attack, you really think that you’re going to die. It’s a really, really scary thing to go through. And yeah, to start learning about that was super important for my recovery.

 

Kimberley: Right. And so, let’s talk about community, why do you feel the community aspect was so important for you? Tell me about the idea of creating a mental health community for someone, let’s say, who’s suffering with panic disorder or grief or OCD or anxiety. What’s your thoughts on that?

 

Dean: Yeah. So, when I was going through panic disorder, I felt isolated, I felt alone, and really, I didn’t really want to bring it up to people around me because I just didn’t think they’d be able to relate to me. I thought these symptoms was just something that I was going through and something that I’d have to stick with for the rest of my life. I thought that was me, that I was going to be Dean who has these panic attacks. And I was going to have to navigate my way through my daily routine. And I think when I opened up to my mentor, a close friend of mine, who was working with me at the time – when I opened up and he shared his experience, it was the biggest weight off my shoulders, knowing that someone else had been through not the exact same story, but it experienced all these scary symptoms that felt isolated, felt alone, but more importantly overcome an anxiety disorder. And I think it was that inspiration and motivation that really helped me in my recovery. 

So, yeah, having an important-- so, DLC is Dean’s Like-Minded Community. So, it’s a community full of like-minded people on anxiety recovery journeys. Some people are at the end, like myself, I don’t deal with panic attacks anymore, but some people are at the start, some people are in the middle. And they can all relate to each other no matter where they are on that journey. And then what’s beautiful about the community is where you see them sharing tips and experiences that work for them. And I know you speak about it highly as well, having an anxiety toolkit, because some tools might work for one person, but then might not work for another. But I think it’s very important to get as much information out there about all the different range of tools, so then each person can individualize their own recovery.

Kimberley: Yeah. So important more now than ever, I think, given that the degree of mental illness is so high given COVID and isolation and everything. Okay. So, you have this platform. I love it. Very much, I loved being a part of your community. Why do you think that that is the most important piece, the community aspect? Can you share a little bit about what you see and hear from your community and why that’s so important?

Dean: Yeah. So, again, so many DMs from people saying that they just feel connected. They feel hope, they feel inspiration, they feel motivation. Not only for me, who’s at the head or the founder of the community, but of all these people that are going through it, jumping over a million people worldwide. We know mental health. It doesn’t have a face, it doesn’t have a color, doesn’t have a social structure, it doesn’t matter what you’re working as it can affect anyone. And I think that’s why it’s really important and became an integral part of the community, was the interview series that I started doing with firstly mental health professionals from around the world. So, CBT professionals like yourself, Kim. Then we’ve had psychiatrists, psychologists, doctors. And having just as much information about anxiety and anxiety recovery, I think has been a super important part.

 

So, again, it’s not only having this community, it’s having the psychoeducation and real good-- I’m in a real good place now where I can guest on who I’ve joined a world-renowned within the space of anxiety. And also, we’ve had so many celebrities, musicians, actors, actresses come on and tell their own mental health stories where they struggled or where they’ve been vulnerable. And that’s really related to the community as well. Because obviously, people work at celebrities, people work at musicians and they might not know that just too, they’re going through a mental health disorder. So, yeah, having people like that come on and tell their own stories has been super, super beneficial for everyone as well. 

Kimberley: Yeah. See, the cool thing is that the science, this is why I’m really fascinated in, is the science of self-compassion says that there are three components of self-compassion. One being mindfulness, the second being common humanity in that reminding yourself that you’re not alone in your struggles is the second most important part of self-compassion. The third being self-kindness. Now the reason I love this is I know for myself in the areas that I struggle, if I look at an account and I can see that a million people follow a mental health account, it gives me a sense of common humanity that there are a million people struggling with something. If you see an OCD account and it’s got 60,000 followers, you’re like, oh my God, that’s a lot of people. I must not be alone in my struggle or an eating disorder account. Or I love some of the autism accounts. I think it shows that it gives you permission to see that you’re not alone. And I love that. It’s such a beautiful piece of the work.

Dean: Yeah. And especially where you just mentioned self-kindness as well. I think that’s an important subject just to speak about, is that when you’re going through an anxiety disorder, you have this inner critic that’s telling you that you’re never going to come out of it, that you’re not good enough, that maybe this is happening to you for a reason. When you come across these communities of people who are on their own journey of recovery might be a little a few more steps ahead than you, and you see that they have a positive outlook, some of them, on recovery and they are making steps. I think knowing to change that in a narrative and have that self-love and compassion is super important when it comes to anxiety disorders.

Kimberley: Yeah. And that’s the benefit of social media right there. I think social media gets a really bad rep, but we have to weigh the pros and cons because there are lots of pros, right?

Dean: Yeah, no, 100%. What I’d say is this is how I define it, is that if we just take Instagram and our mental health community so all the mental health accounts that are doing great, I see just like a safe haven corner of Instagram where people can go to and feel supported and connected and learn more about mental health in general. An app, like you say, can have a negative effect on people. And I think people speak about the algorithm and obviously, it’s all guessing what the algorithm’s going to do next, but I think we can actually use the algorithm in our favor. 

And if you just bear with me on this, if you think about all the accounts that you’re following, so if you’re following all positive mental health accounts or self-compassion or self-care, self-love, then the algorithms are going to spew that out to you in your own feed. So, what are you doing? You’re starting to change that in a narrative like in your digital world, because you open up your app and you start to see all this self-love and positivity. So, you can definitely use the algorithm. So, I think it’s super important in taking a look at who you’re following and seeing, does that benefit your mental health? And if it doesn’t, then I don’t think you should be following them.

 

Kimberley: Yeah, I agree. Actually, I just was saying yesterday that I was just scrolling my-- I’m rarely on social media just to scroll. I’m usually there to do the work I do. My son was sick. I was sitting there wasting time. But the cool thing is the suggested was all cool stuff. It was really cool. I was like, “Oh, I love all these new ideas and these new looks.” And I was really appreciating what was being suggested to me, even though I know there’s some controversy around that. It was very cool.

Dean: And you can imagine if somebody’s just starting or at the beginning of anxiety disorder and they’ve got this negative outlook and they’re isolated and they haven’t connected, then the algorithm may be spewing them not the right information. So, I think it’s important to really highlight the best we can our corner of Instagram, this mental health community that’s doing so great. And it’s a new wave of mental health support really and much needed, like you say, with COVID and everything that everyone’s still going through. I think over the next five, 10 years, it’s going to be more needed than ever.

Kimberley: Right. Absolutely. I can’t agree more. I don’t even think we have the stats yet on what mental illness is like from COVID, mostly the isolation of COVID. So, I 100% agree. So, let’s step outside of the online world and let’s talk generally, how did you find this community? Not the online community, but as you were going through recovery, did you tell them about your struggles? Did they come to you? How would you suggest people tell somebody about their struggles? Do you have any thoughts on that? 

 

Dean: Yeah. So, my body and my mind and everything was telling me not to open up about anxiety and not to speak to anyone and to keep it as an inner struggle, because everything with anxiety, we know it’s all internal, it’s all inwards. We’re ruminating on our thoughts, feelings, and sensations. So, it doesn’t make sense to then speak to other people. It’s not natural to do that. So, I had to go against that and I just started to open up and not feel ashamed to tell people what I was going through. I think I got to a point where it felt like I was struggling too much for me to be going through it, so I felt like I had to.

So, my advice to people would be, speak to the people around you, have a support network. You may come across people who dismiss your anxiety [00:15:20 inaudible]. And it’s super important to know that just because they dismiss it doesn’t mean anything. It’s just, they may be their views. They might not have the education on mental health. So, yeah, if you get dismissed, that shouldn’t stop you from opening up, because I know that people often, especially in my community, say, “Well, I feel like I can’t tell people because if I tell my parents, for example, they just tell me to continue to get on with it that I don’t have these issues.” 

So, I think that when that happens and you have parents and it’s important to put mental health boundaries in place, obviously, especially if we’re living with our parents, we can’t just move out or whatever or if we’re young. So, we have to put these boundaries in place and have a support network around us. So, if you are younger, it could be someone in your education system, it could be a support worker, or it could be the online communities like we mentioned.

 

Kimberley: Yeah. That’s interesting because what’s been on my mind lately, particularly in the online space, is what to do when you have been dismissed. Now that happens from parents and loved ones. But I think it does happen on social media as well, right? You will have-- the message I’ve been trying to give is, if it’s helpful, take it. And if it’s not helpful, leave it. Because a lot of people will come to my platform and say, “I’m freaking out because I just read this, which goes against what you’re saying. And I don’t know who to believe.” And they’re doing the best they can with what they’ve got. So, I think that it’s important for people, even on the online, to also dismiss bad advice online, right?

Dean: Yeah, definitely. So many people get dismissed online, don’t they? But I think you gave some great advice, Kim. And that was, anybody can write anything on social media doesn’t mean that it’s true, does it? So, we need to take in what someone’s saying to us, but if it doesn’t fit our way of thinking or it doesn’t benefit us, then it’s okay to reject it. Just like if we think of anxiety and thoughts and you get these irrational thoughts. We get this irrational thought and we don’t believe it. What do we do? We don’t accept it. We can reject and replace it. And that’s what we should do with the information around us. So, if we see a negative comment towards us, it’s so easy, isn’t it? It is so natural for us to react in a negative way because that’s the way we’re built. You know what I mean? It’s our protective system there to try and protect us. But yeah, if it’s not benefiting you, then it’s okay to step away and move away from it.

Kimberley: Okay. So, let’s talk about the dreaded trolls because that’s the perfect segue. So, what I would love for you and I to talk about, and if it’s okay, be as open as you can, but let’s talk about the mental impact of having a troll, because I think you could have a bully at school and you could have a bully for a boss or you could have a bully online. And I think it’s similar in how we can internalize it. So, I have had a troll for over a year now who’s pretty aggressive. And most of my people know aggressive and awful. And in the beginning, I took it completely personally, right? Completely personally. I thought everyone was just going to hate me. And it was the most-- you know the whole thing about you have to break something to put it back together the right way?

Dean: Uh-hmm.

Kimberley: That’s how it felt for me, because obviously, I had built my platform and what I do, my businesses on this idea that if I just do good and I’m kind all the time, no one will ever hate me. It’s impossible to hate me if I’m kind. I think it was this belief system that I had. And that got shattered into millions of pieces because there were people who really didn’t like me. And so, I think that I’m glad it broke and it got shattered because I got to put it back properly of I had to restructure that belief. But that was really, really hard. And having someone online say things, such horrible things, I really, really had a difficult time of not taking it personally. So, can you share what your experience of online trolls and that kind of thing has been?

Dean: Yeah, sure. So, with the DLC Anxiety community, especially when the first lockdown happened and we had the celebrities and musicians, they all started to gain control back of their own social media accounts. So, we saw a lot of celebrities sharing mental health stuff, which is amazing because it’s shining a big light on everything to do with mental health. So, I saw an exponential growth within that period of the community. And yeah, I remembered it was on either speaking on interviews with people or just on lives. Again, your mind zones in. Doesn’t matter how many positive messages you see on your Instagram lives, for example. It’s only natural if you see one negative comment for your mind to then just zone in on that.

And I remember the first time that happened to me. I was really taken back because I was putting 23, out of 24 hours into being in this community and helping the best I can, sharing a very vulnerable story to do with my father passing and then an anxiety disorder. And I thought I was being vulnerable and open and honest, and like you say, just trying to give as much love and support for people as I could. And then to see that someone else, some people were being negative towards this, it was dismay. I couldn’t believe it. It didn’t feel real. It was like, “Why are they saying negative things towards me?” 

So, it was definitely a learning curve. I always remember the first time that happened. Over time, it has got better. Like you say, you managed to structure and rearrange things and you managed to not take these things personally and look from the outside, that the people that are spreading hate or being negative, they may be hurting themselves. 

My take on it now, Kim, is that even if these people are spreading hate and being horrible on my community, especially towards me, is that hopefully, they may get some good out of one of the other interviews with someone else, because I know that these people, they’re in need of mental health support themselves. And for whatever reason, they haven’t been able to get it. And I always think that if they’re giving me hate, I can now take it. And hopefully, they might see something that benefits them. But it has been very hard to change my perspective on that. It was not an easy road.

Kimberley: Yeah. That’s hard for me. I think on my end, I just had to keep reminding myself that, well, all the words are about me, it’s really not about me. It’s a lot about them and their struggle. The way I work through it-- and maybe you could tell me what you think as you see the troll, like how do you think about it. For me, when I see really awful, hurtful, hard comments, I first remind myself, this person had to suffer a great, great deal to be spreading this much hate. To understand that they had to-- no one who’s had a really easy life is jumping onto the internet and spending hours spreading hate on people. It’s usually that they’ve been through an immense. And that was really helpful for me, compassion-wise, of just to be like, “I actually have compassion for you. You’ve obviously been through the wringer.”

And then the second piece for me, and this was the hard part and I’m curious, I really want to know your thought, was to start to trust that people will trust me, that people will see the real me, not me that that person is saying I am by me being consistent and showing up as me. And that was a hard piece because, at the beginning, I was like, “But what if they don’t trust me?” The consistency has been really helpful for me. But I think the truth is, that has also been really helpful for me to translate it into the real world. 

 

Dean: I was just going to say, yeah, because if your inner critic, like you say, is wanting for everyone to relate to everything that you’re putting out there, all the amazing stuff that you’re putting out there, the last thing you want is somebody trying to discredit that because, you know what I mean? All we’re trying to do is help the people around us. So, yeah, it’s that inner critic and working on our inner ourselves. 

When I see a troll online now, I just tend to leave them be. I think just leave them to do what they want. I think we know that our communities know what we’re about. They know how much we give to our communities, they know how much support and wealth that we give everyone on a continuous day. And like you said, you can’t stop these people, but also, just because they’re writing something, it doesn’t mean that it’s true, which I thought was beautiful for you to say. 

Kimberley: Yeah. It’s tough. I mean, I think that that is a huge part of our mental wellness, is how we relate to people, right? And we’re in relationships. So, even if we’ve got a panic disorder, I was thinking about this the other day, is we’ve had a really, really rough house here in the Quinlan house this week. It’s been pretty chaotic, lots of sickness, lots of scary COVID scares, and so forth. And there was a time where I would’ve lashed out because of my own anxiety. I would’ve been really snarky to my husband because he goes to work and he doesn’t have to handle it. And I would often displace my anxiety and anger, just snotty. And that happens a lot. I hear a lot of people talking about just in daily life like, “I’m really struggling because my partner and I aren’t getting along because everyone’s anxious and so forth.” So, I think it is helpful to be in relationship with people who do have their own struggles. Like I said, it happens online, but it’s also happening at home. 

Dean: Yeah. It can just happen on a day-to-day basis. A lot of people say that they can’t deal with people when they’re being negative towards them in real life. But it’s about taking a step back and knowing that the person who’s spreading that negativity towards you, that maybe they’re having a really rough time at home with their partner, that maybe they’ve got troubles with their job, money. It could be anything. Maybe they were traveling to work and they got caught up. And we’re all a product of our emotions at that time. And emotions, as we know, they come and go and it doesn’t curate who we are as a person. 

 

So, if someone’s being angry towards you and negative towards you, it’s about taking a step back and knowing that it’s more on them again and it’s more on what their experience and the feelings and emotions and putting the correct boundaries in place. But it is really hard to do. I’m not saying that it’s easy to do. It is super, super hard, especially when someone’s coming at you with negativity. Your first line of defense is, you know what I mean, to attack normally, isn’t it? Or to take a massive step back. So, yeah, it takes a lot of practice, but it can be done.

Kimberley: So, talk to me about, you’re probably the one person who would know the answer to this, can you share with us about managing mental illness with social media? How might someone have a healthy relationship with social media and the use of social media?

Dean: Yeah. I have to put boundaries in myself because I say everything that I do is on Instagram, 99% of it. And if I’m not working on Instagram, I’m working on my website, which again is online. So, yeah, putting boundaries in place is super important, having rest away from social media, what we mentioned earlier about following accounts that really benefit you and have a positive impact on you and just getting rid of the negative accounts that are not making you feel good. You don’t want to go onto social media and not feel good because we all know we spend way too much time on social media. And if we’re spending that time looking at negativity, then that’s what it’s going to do. It’s going to put our mood in that sense. And we could really spiral into a state of being in a negative state just by what we consume. It’s like when people speak about the news and say, “Oh, well, I can’t watch that because it affects my mental health.” Social media is exactly the same, but probably more so, because we’re spending more time on it and it’s literally part of who we are now.

Kimberley: Right. What would you say to someone who uses social media to cope with their anxiety, meaning to distract against it or to get them through their panic? Do you have any thoughts on managing it for anxiety?

Dean: Yeah. It’s a very good question. So, I always go back to thinking, at the start of my panic disorder, if there were communities like ours out there, would it have been beneficial for me? And the number one answer is yes, 100%. It would’ve been an eye-opener. I would’ve felt I wasn’t alone. I would’ve felt motivated and encouraged that I can continue. But if you’re using anxiety communities as a way to not do the hard work, then I think it can be detrimental. I think anxiety recovery is about doing the hard work. 

Now, a lot of people, and I’ve just done a post on this, unfortunately can’t have the access towards therapy, which we know has a massive benefit on mental health. We speak about anxiety, the latest sciences, the medication and a combination with CBT therapy has the best results. Now, that doesn’t mean for everyone, but some people may do better with medication, some people may do better with therapy. So, I think that having a community to help you and understand the psychoeducation behind it is great. But if you’re using it as a distraction to try and distract you from feeling anxious and dealing with the anxiety head-on, that’s when it can become detrimental. 

I often say that there’s so much information-- and you can obviously maybe shine away on this, Kim, but what would you say to people who say that they can’t access therapy? Maybe it’s a money thing. Maybe it could be anything, couldn’t it? Do you believe that these people can still recover? Because there seems to be a narrative online that therapy is the only way forward. I think that’s an unhealthy way of looking at it because we know that anxiety recovery, there’s so many different routes out of it, and it all leads to the same angle, doesn’t it? Which is anxiety recovery. So, what would you say to the people that can’t access therapy? Would you be still giving them hope?

Kimberley: Well, to be honest with you, 1000% I would give hope. I myself have had therapy for some things, but I really didn’t feel like therapy for other issues were helpful. And I felt it was better for me to actually work through a workbook, listen to a ton of podcasts. I’m a real mix. I’ve been blessed and privileged to have some amazing therapy, but some of my mental illness, I really needed to do on my own. But I did them through, like I said, a workbook, a support group, some were online courses. I mean, that’s why I created ERP School, was because people didn’t have-- that we’re turning them away to nothing. But what was really interesting about ERP School and CBT School is just recently, out of the blue, a bunch of people have reached out to me and said, “I wanted just to let you know that that got me right back on my feet.” It’s so wonderful to hear those stories, because otherwise, you’d don’t know them and you didn’t realize what an impact. So, no, I absolutely believe, I’m a real big believer in workbooks. I struggled with workaholism and that workbook for workaholism was huge for me and perfectionism. These are two really, really important things that I use that did not require therapy at all.

Dean: Yeah. So, like you, Kim, I like to be guided by the science. So, I know obviously how important therapy and how life-changing it can be for some people with anxiety. But also, I think there’s still a lot of stigma around medication when it comes to anxiety, especially online. And yeah, I think we need to do a little bit more work on that because I think anxiety medication is being dismissed more so. Maybe that’s another conversation that we can have in the future. But I didn’t go through therapy with my own anxiety disorder, with the panic attacks. Mine was going online. I think you have to go to a trusted site. So, over here, you have the National Health Service, which has a ton of resources, all scientific, proven, all credible from the correct sources. And I think if you’re researching and looking at all the correct things, I think that can be really powerful for you. So, if you can’t access therapy, of course, there’s still hope. Of course, you can still recover. And that my message to everyone is I did it. So, if I can, I’m just a regular guy, you can do it too. 

Kimberley: I love that. Just because I know, and thinking of the person listening here, like how did you do it? I know we haven’t got a ton of time, but could you just say, how did you muster up the courage on your own to face your fears?

 

Dean: That’s a great question. And I do have my book coming out, which is--

Kimberley: All right.

Dean: Yeah. So, the book is called Greater Than Panic. It’s the number one question that I’ve been asked since day one of starting out the anxiety community, and that was, what is your story and how did you get from four panic attacks a day to be in the head of DLC Anxiety and be in the face of the interviews and not having panic attacks? Obviously, I’m still having anxiety. That’s a message that I think isn’t hammered home enough, whereas the goal of anxiety recovery is not never to feel anxious again. I think people often are misguided and have misinformation, especially at the start of an anxiety disorder, thinking that the goal is to never feel anxious again. The goal is to change your behavior to when you’re feeling anxious and make sure that it doesn’t have a detrimental impact on your day-to-day.

I go right back to the basics. I go back to speaking about my father’s death, which was obviously a really terrible time, and it brought out a lot of emotions but also, I think it was important for me to go back and just explore it again. And I speak about my relationship with the doctor. It’s again another message that I like to hit home, is that if you’re dealing with any physical symptoms to do with emotional symptoms, to do with anxiety, your first port of call has to be the doctor, because we know that anxiety disorders can mimic other things. And so, it’s super important for a medical professional, a GP, a doctor, to run diagnostic tests to make sure that everything else is okay. And then when they tell you that it is okay, you can sit down with the doctor and you can start to plan your journey of recovery, which may be therapy, maybe self-help, maybe meditation, mindfulness, exercise, medication, so many different routes. 

But yeah, my number one message is, if you’re dealing with physical symptoms and you haven’t had them checked out, you have to go to the doctor. So, I speak about my relationship with the doctor. I speak about curating my own anxiety toolkits. So, what worked for me and the research and the science behind each thing that I was trying and how it had a benefit impact for me. And I speak about exposure therapy and how that was really beneficial for me, but doing it not guided by your therapist. 

Now, if you look at the science, you would say that the best effects of exposure therapy is guided with a therapist, but I didn’t personally have a therapist in my journey. But if you can have a therapist, I definitely recommend that that’s the best route to go down. But I speak about how exposure therapy worked for me and I speak about the hiccups on that road to recovery and what recovery looked like, what it meant to me. And then I speak about the anxiety community and how I wanted to spread the message and get that message across to as many people as I possibly can. And yeah, it takes me to the present day. 

 

Kimberley: I can’t wait. That’s so exciting. So, tell me about the name of the book.

 

Dean: Greater Than Panic. So, that’s the message that you are greater than panic. Just because you have feelings of panic, if you’re up in panic attacks or panic disorders, it doesn’t mean that you’re broken, it doesn’t mean that you can’t be fixed. There’s nothing to fix because you’re not broken. So, you are greater than panic at all life, things, all the dreams, aspirations, careers, travel, love, money, whatever it is that you want, you can get. Doesn’t matter that you’re going through panic or have panic attacks. O if you’ve been through panic disorder, the other message is that you’re greater than panic.

Kimberley: Amazing. Okay. So, I’m going to leave you. I feel like that’s the perfect way for us to end out. Is there anything else you want to share with us, any links, or how people can hear about you?

Dean: Just DLC Anxiety over on Instagram and the website, www.dlcanxiety.com. I’d just like to thank you, Kim, for obviously inviting me on here. And I’d like to thank you for everything that you’re doing in the mental health space. CBT is super important to me. It’s an integral part to my recovery. And yeah, I’m just super grateful for our connection on Instagram and just everything that you’re doing.

Kimberley: Thank you. I feel so blessed that we randomly got to meet. You know what, it’s such a blessing. So, thank you. I’m so grateful.

Dean: Thank you.

-----

Thank you so much for listening. I’m sure you got so much from that. Before we finish up, let’s do the review of the week. This is from Disc Golf Nate. They gave five stars and they said:

“As Kimberly would say, this is not necessarily a substitute for in-person therapy. But it is still a very powerful tool. I’ve used this podcast in conjunction with my therapist and some books, but this podcast brings me the most peace.”

Thank you so much, Disc Golf Nate. I am so honored for that amazing review. And yes, this should not substitute therapy, but my hope is it gives you some tools, some skills, some hope, some support, some joy, and compassion into your recovery. So, I’m so honored to have this time with you. I will see you all next week.

 

Feb 25, 2022

SUMMARY:

We all know that self-compassion is am important tool for anxiety recovery.  In this weeks episode of Your Anxiety Toolkit podcast, I address a common concern; “What if I dont deserve self-compassion?”  This is such a common reason people do not provide themselves with compassion.  In this episode, review the reasons YOU DO DESERVE SELF-COMPASSION and some key concepts and self-compassion mediations to help you practice self-compassion.

In This Episode, we cover:

  • Self-Compassion Definition
  • Reasons people feel they do not deserve self-compassion
  • Ways to manage feeling unworthy of self-compassion
  • How to practice Mindful Self-Compassion

Links To Things I Talk About:

Self-compassion Mediation: Here is a link to several self-compassion meditations from previous episodes.
https://kimberleyquinlan-lmft.com/episode-2-lovingkindness-meditation/
https://kimberleyquinlan-lmft.com/ep-134-giving-and-receiving-meditation/
https://kimberleyquinlan-lmft.com/ep-110-this-compassion-practice-tonglen-meditation-for-anxiety-will-change-your-life/

Episode Sponsor:

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

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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 18, 2022

SUMMARY:

This week’s episode is incredibly inspiring, with Lora Dudek talking all about getting real about OCD recovery.  Lora shares her experience of having harm obsessions and harm OCD and how she managed being a mom during ERP. Lora also shared some wonderful ERP activities she did to help her keep track of her exposures.

In This Episode:

  • What OCD Recovery looks like for Lora
  • Her experience with Harm OCD
  • What kind of Exposure and Response Prevention (ERP) Lora used for harm OCD
  • How she used ERP and recovery to decide what her values were (starting a career in ERP)

Links To Things I Talk About:

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 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 11, 2022

SUMMARY:

Today, we are going to talk with you about the 7 common struggle you have with time management.  Do you find yourself constantly looking at the clock? Or, wishing time would go faster?  Do you feel like your to-do list is so long that you will never get them done? Or, do you feel like you never have time to prioritize yourself?  In today's, podcast, we talk all about your relationship with time and why it is a HUGE part of managing anxiety, depression, and stress.

In This Episode, we address the 7 common struggles you have with time management.

  • “I don't have enough time”
  • “I have so much to do”
  • “I have so much I want to do”
  • “I struggle to start and stop activities”
  • “I don't a good understanding of how long things take”
  • “I don't like structure”
  • “I hate being told what to do with my time”

Links To Things I Talk About:

ONLINE COURSE Time Management for Optimum Mental Health
https://www.cbtschool.com/timemanagement


Episode Sponsor:

This episode of Your Anxiety Toolkit is brought to you by CBTschool.com.  CBTschool.com is a psychoeducation platform that provides courses and other online resources for people with anxiety, OCD, and Body-Focused Repetitive Behaviors.  Go to cbtschool.com to learn more.
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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 4, 2022

SUMMARY: In this episode, we review how important it is to address procrastination, as it impacts so many people in so many ways.   We also will review how procrastination is the same thing as avoidance and how people can work towards implementing time management skills to help them build a routine that helps them get the things they want to get done.

In This Episode:

  • We outline procrastination definition and procrastination pros and cons.
  • How procrastination is simply an avoidance safety behavior.
  • How to manage procrastination in , Anxiety, OCD and OCD recovery
  • Our new course called Time Management for Optimum Mental Health

Links To Things I Talk About:

  • ONLINE COURSE Time Management for Optimum Mental Health

https://www.cbtschool.com/timemanagement

Episode Sponsor:

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

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

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

EPISODE TRANSCRIPTION

This is Your Anxiety Toolkit - Episode 220.

Welcome back, everybody. How are you? Really, really, how are you? How is your heart? How is your mind? What’s showing up for you? How are you? I really want you to check in, in case you haven’t checked in for a while. How are you doing? It’s important. Let’s make sure we check in.

Today, we’re talking about procrastination. It’s one of the most common questions I get when I’m doing live calls on Instagram and Facebook, like how do I manage procrastination? A lot of you are also managing perfectionism and it’s getting in the way of you doing the things you want to do or doing the things you have to do.

Because I get asked this so much, I actually wanted to show people how I do it. So what I did is I created a whole mini-course, it’s called Time Management For Optimum Mental Health. You can get it if you go to CBTSchool.com/TimeManagement, or you can click the link in the show notes below. It’s a full course of showing you how I manage time and why I manage my time to help manage my mental health and my medical health. A lot of you know I have struggled with a chronic illness. Time management has been huge in me staying functioning and managing mental overwhelm and a lot of procrastination. In the course, it’s only $27, it’s a mini-course and it shows you exactly-- I have recorded the screen as I’m showing you exactly how I do it. If you’re interested, go over and check it out. I’d love to have you take the course and put it into practice.

Now, one of the things about this episode is this is actually me giving you a sneak peek into the course because it’s one of the bonuses of the course to talk about procrastination. So I wanted to share it with you here on the podcast as well. You will hear me refer to the other parts of the course as you listen. That doesn’t matter. You’ll still get everything you need to know about procrastination and how to manage it today. But yes, if you’ve already taken the course, you probably have already listened to this bonus. But for today, let’s talk about procrastination.

Before we head over into the episode, I wanted to do the review of the week. This is a review from Sadbing, and they’ve said:

“Desperately needed. I am an LICSW that has searched high & low for a podcast that delivers quality content. I felt relieved to finally find one! This podcast provides an honest depiction of how anxiety shows up in people’s lives & gives you effective feedback on how to live with it. Thank you!”

Thank you, Sadbing. Thank you so much for that amazing review. I do ask that anyone who’s listening, please, the one thing you can do, this is what I offer freely to you all. If you get a second, just click below, in whatever app you’re listening to, and leave a review. It helps me so much reach all the people. The more reviews we have, the more people will trust the podcast and continue listening to this free resource. So, yay.

All right. Let’s get over to this episode about managing procrastination. I hope you find it helpful. If you want to learn more about time management, head on over to CBTSchool.com/TimeManagement, and you can get a mini-course for 27 bucks. It’s amazing value for a short period of time and a short amount of money. So, yeah. All right. So happy to have you here with me today. Thank you for giving your time to me and trusting me with your precious time. I will see you after the show.

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 avoidance. We avoid the thing that will create discomfort for us, and simply put, that is what procrastination is.

Now, why do we call it a safety behavior? We could call it a compulsion. But we call it a safety behavior because not everybody does it compulsively, but they may do it to create a false sense of security, a false sense of safety. As human beings, we want safety. It feels good to feel safe. It feels good to feel like, “Oh, I don’t have to face that hard thing.” So, yes, we consider it a safety behavior.

Now, does that mean that you’re bad and lazy or not good? Absolutely not. Everybody engages in safety behaviors. It’s a human part of life. But what we want to look at here is, is it creating trends in your life? Is it creating impact or consequences to your life that create more discomfort and more distress later? Most of the time people say, “Yeah, I avoid,” and it’s getting to be a problem. If that’s for you and that’s happening to you, you’re definitely not alone.

Now, how do we manage procrastination? The first thing is identify what it is you are avoiding specifically. Don’t just say, “I’m avoiding the email.” Don’t just say, “I’m avoiding exercise,” or “I procrastinate.” Don’t say those things. I mean, you can, but ideally, you will stop and go, “Okay, what is it about the email that I don’t want to tolerate? Ah, writing an email brings up social anxiety for me,” or “Ah, writing the email reminds me that I’m really behind on that project. Writing that email brings up shame because last time I spoke to them, I said something silly or something like that,” or “I don’t want to exercise because, ah, every time I exercise, it creates discomfort in my chest and it makes me feel like I’m panicking.”

So you’ll identify the specific thing that is causing you to avoid specific. You might even get a specific like I did. It’s the physical sensations I don’t want to feel. Or it’s the thought that this was my fault that I don’t want to think. You may get to the bottom of that. Now, of course, if you guys know anything about me, I’m always going to say, it’s a beautiful day to do hard things.

The only way we can overcome these strong emotions, particularly fear and guilt and shame, is to stare them in the face. Our job, and this is what I’m going to encourage you to think about, is to really look at, yes, avoiding. What is the pros of avoiding this? And then on the right-hand side, you could write this on a piece of paper, what are the cons? What are the consequences of me continuing to avoid this thing?

Now often when you write that down, that in and of itself is a motivator because you’re going, “Oh my goodness, writing the email is uncomfortable for the duration that I write the email, not writing it is uncomfortable, even when I’m not working on it, because I’m constantly nagged by the fact that I have to write it, or it’s constantly sitting on my list or I constantly see it in the schedule.” A lot of you in, and we’re in the Time Management course – a lot of you have avoided managing time because putting this in the calendar makes you face the fact that you’ve got something scary to do.

Now, you will see me, I’m holding my hand on my chest right now and I’m sending you much compassion because these are really difficult things. These may seem easy for other people, but they’re hard for you and me. And so we must be compassionate with the fact that they’re hard. Here is what I’m going to say: Being compassionate can actually take some of that pain away. It won’t take it all. You still have to do it. You have to ride the wave of discomfort. It will rise in full as you go. But you can also be gentle with yourself and reduce your suffering instead of criticizing yourself or how hard it is for you. Don’t compare how it is for you compared to your friend or your seatmate or your neighbor.

This is what you do. You practice compassion before you do the activity first. I’m sorry. You commit to doing the activity. You put it in your schedule. You write down when you’re going to do it and how long you think it’s going to take. And then you practice compassion. “Wow, I’m going to be really gentle with myself as I ride out the emotions and the experience of doing that thing.” You may want to get a partner, an accountability partner, who can help remind you and support you as you do the thing. A lot of my patients have an accountability partner. They’re like, “It’s three o’clock.” They’re texting, “It’s three o’clock. I know you’re about to do a scary thing. Good job. Keep going. Don’t stop. Don’t back out. I’ll be right here. You text me as soon as you’re done.” See if you can do that. If you don’t have someone to do that, be that for yourself. So it’s in your calendar. You’re going, you’re gentle. You’re going to do the thing.

What I personally like to do is keep a notepad down next to me as I’m writing an email or recording a podcast or doing something that creates anxiety for me. I jot down the thoughts and feelings I’m having. Not a lot, bullet points. Like, “Oh, I’m having the thought that this is not helpful. I’m having the thought that this is not good enough. I’m having the thought that this should be better. I’m having the thought that I made a mistake. I’m having the thought that this should be going fast or better.”

Like I said, and you may start to notice – and this is true, I’ve seen a lot of patients say – as you write it down, it’s the same five thoughts over and over and over. When you’re not aware of that, it feels like 55 thoughts or 55,000 thoughts. But once you have it on paper, you will see, often our brain is just repeating the same thing. When you can see that, you can go, “Oh, brain, I’m sorry that you’re sending those messages. Thank you for showing up. Thank you for trying to alert me to the possible dangers, but I have avoided this for so long, and it avoiding it and it procrastinating only delays and continues my suffering.” And you feel your emotions. You ride them out. You tender with yourself as you do the thing. And that’s how you get through it. Once you’re done, you must celebrate and say kind things and congratulate yourself. Don’t forget that stage because that’s so, so important.

But the main point to remember here is that avoidance keeps you stuck. Avoiding the thing you’re afraid of is actually what then creates some depressive thinking, some hopeless thinking, or helpless thinking. “I’ll never be able to... I won’t be able to... I can’t...” We really want to be careful of that type of thinking, because that is the thinking where depression lives. Again, the more you face the things that are uncomfortable, you will build a sense of mastery of that.

It won’t go well the first time, I promise you. Most of life is trial and error. I have found the only way to move forward is to practice failing. Here is what I’m going to ask of you. As you practice this activity or practice of not procrastinating, of facing the thing you’re afraid of, of doing the thing you’ve been avoiding, I want you to practice or remind yourself that you are really not growing if you’re not failing. I’m going to say that again. You’re really not growing if you’re not failing, because if you’re only doing things that go well, chances are, you’re avoiding a lot of things. If you’re only doing things that are going well, the chances are, you’re not building mastery with the hard things in life, and life is 50/50. We know this, that life comes with 50% good and 50% hard. We have to practice failing so we can learn how to be better.

This whole course is about that. You’re going to practice not procrastinating. You may or may not succeed. That’s not really the important part. The important part is that you look at the data, the data being, how did it go, like that reassess stage, which we have as one of the steps in the course. Look at the data, what worked, what didn’t and what do I need to change? This is not a perfect practice. It’s going to be changing as you change. And so having the ability to adapt and having the humility to say, “All right, it’s not working. What do I need to do?”

This has been probably my biggest struggle in my entire life, is I avoid looking at the data of what’s not going well. If someone tells me what’s not going well, I get offended instead of going, “Okay, this is not personal. It’s just data. How can I use this data to help me not make the same mistake over and over again?”  Often what I’m doing, I’m churning out a lot of content and I’m not looking at the data when the data could help me to say, what is the most effective? What is the most helpful to other people? How can this be as jam-packed helpful as possible? I have to look at the data, and in order to do that, I have to be willing to fail. It’s okay to fail. This is a practice. It’s not perfection.

But when it comes to procrastination, you have to be willing to be uncomfortable. You have to be willing to do hard things. This is why we keep saying, it’s a beautiful day to do hard things. Now, of course, go back, follow the steps of the whole course. You’ve gotta get it in the schedule before you can really do that. But then I want you to even get very microscopic and look at when you’re scheduling. Let’s say there’s something you’re avoiding and procrastinating on. Schedule small activities so that you don’t procrastinate.

One of the best lessons I’ve learned when it came to me, recovering from my medical struggles, is I have to get a lot of exercise. Not running exercise, a lot of personal training, physical therapy type of exercises, and I hate them. They’re the most boring, annoying, monotonous things on the planet. However, I have found that if I schedule, “Kimberley, at this time, you’re going to put your shoes on. Kimberley, at this time, you’re going to fill up your drink bottle,” I am more likely to do it. I get very microscopic in my planning.

Now, again, you won’t want to do this with all the things in your life. Pick one thing if that’s what you want to work on, and work at creating a system that gets you to do the thing that you continue to procrastinate on. I would not probably do my physical therapy and my training, these annoying, repetitive activities, if I hadn’t created a system that makes it doable. I have a Bluetooth speaker, I put very loud music on. It’s usually reggae or something very hippy, so I feel like at least I’m chilling out as I do it. I marry the thing that’s uncomfortable with something that’s tolerable.

Now, you won’t always be able to do this, and that is fine. Sometimes you just got to ride the wave and face your fear. That’s okay. But that is an idea if it’s for things like daily activities and routines in your life. If it’s facing fears and exposure work, well, no, we don’t want to marry it with these things because that can work as a neutralizing compulsion. If you’re someone who is in treatment for an anxiety disorder and you’ve been given an exposure, well, no, you’re just going to have to practice riding the wave of discomfort, but do not forget that self-compassion piece. It is crucial. Do not forget using your mindfulness skills where you allow your discomfort. You’re non-judgmental about your discomfort. You’re willing to allow it to be there. These are all crucial practices.

I would even consider writing down all the things where you struggle with procrastination and work through them, practice them, just like you would be lifting a weight, just like you would practice if you were learning French or piano. Pick up the basic things and practice the basics first and go through all of them. Try to get yourself through as many as you can so that you build a sense of mastery like, “I can do that. Even if I don’t want to, I can. I could if I had to,” which I think is a really great way of thinking about things that are uncomfortable in your life. “I don’t want to do them, but I could if I had to.” It’s better than “I can’t” and “I don’t want to.”

All right. That is procrastination. I hope that has been helpful. I really want to stress to you that procrastination is a thing that everybody does. Again, it’s not personal, but I really, really encourage you to master doing the things that you avoid. Avoidance keeps anxiety strong. Avoidance keeps you in the cycle of anxiety, and we want to break that cycle.

I hope that is helpful. I am really excited to see you go out and do those things. If you want to, you can share them with me on social media or things that you’re doing. It’s a beautiful day to do hard things. I love when people tag me with that.

Have a wonderful day, everybody, and I will see you in the next module.

Jan 28, 2022

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

In This Episode:

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

Links To Things I Talk About:

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

Episode Sponsor:

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

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

Episode Transcription

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

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

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

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

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

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

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

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

Do you have a healthy relationship with alcohol Your anxiety toolkit

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

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

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

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

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

Amanda: Yeah. I was going to say.

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

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

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

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

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

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

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

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

Kimberley: Yeah.

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

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

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

Kimberley: Don’t tell them.

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

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

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

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

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

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

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

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

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

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

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

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

Kimberley: Social anxiety is a big one.

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

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

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

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

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

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

Amanda: Yeah.

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

Amanda: It’s true.

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

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

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

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

Kimberley: Yeah.

Amanda: Sorry if I messed up.

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

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

Kimberley: 100%.

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

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

Amanda: Thank you. This was so great.

-----

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

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

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

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

Have a wonderful day, everybody.

Jan 21, 2022

In today’s episode, Kimberley Quinlan talks about the importance of identifying catastrophic thinking. The reason this is so important is that this type of cognitive distortion or cognitive error can increase one’s experience of anxiety and panic, making it harder to manage it at the moment. Kimberley talks about the importance of mindfulness and self-compassion when responding to catastrophization also. 

In This Episode:

  • What is Catastrophization?
  • Why is it important that we catch how we catastrophize?
  • How to manage Catastrophization?
  • How correcting our thoughts can help, sometimes..but not always.

Links To Things I Talk About:

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

Episode Sponsor:

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

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EPISODE TRANSCRIPTION

This is Your Anxiety Toolkit - Episode 218.

Welcome back, everybody. How are you doing? How are you really? Just wanted to check in with you first, see how you’re doing. We’re friends, so it’s my job to check in on you and see how you are. Thank you for being here with me again. I do know how important your time is, and I am so grateful that you spend it with me. Thank you. That is such a joy and it’s such a wonderful experience to know that I am spending time with you each week.

This week, we are talking about the danger of catastrophization. Now, I’ll talk with you a little bit more about what that means here in a second, but basically what I want to do in this episode is really to take off from the very first episode of this year, which was the things I’d learned in 2021. One of the points that I made there was to really take responsibility for your thought errors, right? And I wanted to pick one of the thought errors that I see the most in my clients. In fact, in the last couple of weeks, it’s been an ongoing piece of the work we do. It’s not all of the work, but it’s a piece of the work, is for me just to be, I’m still doing teletherapy. So, we’re sitting across from the screen and just reflecting and modeling back to them some of the ways in which they speak to themselves and really looking at how helpful that is and how that impacts them.

So, before we get into that episode, I want to offer to you guys to submit your “I did a hard thing.” Today, as I went to prepare for this episode, I checked the link and we’d actually used up all of the ones that were submitted probably in August of 2021. And so I’m going to encourage you guys to submit your “I did a hard thing” so I can feature you on the podcast. When we first submitted, we had like 70 submissions, and I’ve used all of them up. And I would love to get new ones to share with you and have you be featured on the show. So, if you want to go over, you can click on the show notes for the link, or if you want, you can go to kimberleyquinlan-lmft.com. So, that’s Kimberley Quinlan - L for License, M for Marriage, F for Family, T for Therapy.com. Click on the podcast link, which is where we hold all of our podcasts, and you could submit your “I did a hard thing.” And I’d love to have you on the show. It actually is probably my favorite part. I could easily just have a whole show called “I did a hard thing” and it could be just that.

All right. So, let’s get into the episode. Today, I want to talk with you about the danger of catastrophization, and let me share with you how this shows up. So, I want to be clear that you cannot control your thoughts, your intrusive thoughts that repetitively show up, and you can’t show your fear up. You cannot change your feelings. So, you can’t tell yourself not to be sad if you’re sad and you can’t tell yourself not to be anxious if you’re anxious and you can’t not panic if you’re panicking. But you can change how you react and how you behave. That is a common CBT rule.

The Danger of Catastrophization Your anxiety toolkitNow often, when you have an intrusive thought, a lot of my patients or clients will report having anxiety or having a thought or having a feeling or having an urge or having an image that shows up in your head – because that’s what I do, right? People come to me with a problem. The problem is usually a thought, feeling, sensation, urge, or image. That’s what I do. And what I try to do is change the way they respond. That is my job, right?

Now, what often happens is, there is a thought or a feeling or a sensation or urge, impulse, whatever it may be that shows up, and they often will respond to that by framing it in a way that is catastrophic. I’ll give you some examples.

So, when they have the presence of anxiety in their body, they may frame it as: “I’m freaking out.” That’s a catastrophic thought. When they had a lot of anxiety or maybe they had a panic attack, they frame it or they assess it by saying, “Kimberley, I almost died. I had the biggest panic attack of my life. I almost died.” Or “It nearly killed me. The anxiety nearly killed me,” or “The pain nearly killed me.” They may have tried to do an exposure or they may have tried to reach a goal that they had set, and they’ll say, “I failed miserably. It was a total disaster.” They are trying to recover from a mental illness or a medical illness, and they’ll say, “I’ll never amount to anything. I’ll never get better.” Or they’re suffering.

We have different seasons in our lives. We have seasons where things go really, really well and we’re like winning at life. And then we have seasons where things are hard and we just have hurdle after hurdle, after hurdle, and they’ll say, “There’s no point, my life is not worth living,” or “I’m never going to be able to solve this.”

Now, first of all, if you’ve thought any of these things, I am sending you so much love. Your thinking is not your fault. I’m not here to place blame on you like, “Oh, you’re bad at this,” because our brains naturally catastrophize, because our brain wants to make sense of things and put them in little categories because that is the easiest, quickest way to understand our world. So naturally, we do this to make sense of the world. If I said to my daughter, “How are you doing with math?” She’d go, “Oh, it totally sucks,” because it’s easier to say, “It totally sucks,” than to say, “There are some things that I’m doing well with and some things that I am not. I am struggling with this thing, but I’m finding this part really enjoyable.” That takes a lot of energy to say that, and it takes a lot of energy to hold opposing truths. We’ve talked about this in the past. It’s not the fastest, efficient way to live when you’re living in those types of ways.

So, what we often will do, particularly if we are having a lot of strong emotions, is we catastrophize. Now often a client will say some of these or many others. There’s many ways we can catastrophize, which is to make a catastrophe out of something. When they say it, I don’t say, “That’s wrong. You’re bad for thinking that.” I’ll just say, “I’m wondering what percent of that is correct. Like I almost died. Okay, I’m interested to know a little bit about that. Did you almost die?” And they’ll be like, “No.” I’m like, “Okay.” And I’m not there to, “I really want to model to you.”

I’m never across the screen or across the office with my patient, trying to tell them how wrong they are. Never. That’s never my goal. But I want them to start to acknowledge that the way in which they think and they frame an experience can create more problems. Now if they said to me, “Kimberley, I want to think this way. I like it. It makes me happy. It brings me joy. I’m fulfilled this way,” I have nothing to fix.

But often, once we reflect, and I often will then ask my patients, “So when you say ‘I totally freaked out.’ You had anxiety and you said, ‘I totally freaked out,’ how does that feel?” And often they’ll say, “Not good.” They’ll say, “It actually makes me feel more anxious.” Or if they had an intrusive thought, let’s say they had OCD and they had an intrusive thought and we can’t control intrusive thoughts, and then their response was, “I’m a horrible human being who doesn’t deserve to be a mom for having that thought,” I’ll say, “How does it feel to respond to your intrusive thought that way? How does that have you act?” And they’re like, “Well, it makes me feel terrible and not worthy. And then I don’t want to do anything, or then I just want to hide, or then I have so many emotions. I start freaking out even more. And now it’s a big snowball effect.”

So then we start to gently and curiosity-- sorry guys. Then we begin to gently and curiously take a look at what are the facts or what actually lands to be true and helpful. I want to be clear. We do not replace catastrophization with positive thinking. I would never encourage a client to replace “I am freaking out” with “I am feeling wonderful” because that’s not true. They’re actually experiencing discomfort. They are experiencing panic. They had an intrusive thought. They’re having an urge to pick or pull. They’re having an urge to binge. They’re having depression. They’re having self-harm thoughts.

So I’m not here to, again, change those particularly. But I really encourage them to look at how you frame that experience, how you respond to that experience. What would bring you closer to the goal that you have for yourself? Because usually, when people come to me, they’ll say, “I want to feel less anxious,” or “I want to do less compulsions,” or “I want to pick my skin less,” or “I want to binge less,” or “I want to love my life. I want to feel some self-esteem and worth. I want to take my depression away.”

So, we want to really look at catastrophization and look at the danger of continuing to use that pattern. Now, let me get you in on a little trick here. I titled this podcast “The Danger of Catastrophization” because the title in and of itself is a catastrophization. Did you pick that up? That’s a lot of what happens in social media, is they use catastrophic words to peak your interest. It sells a lot of things. In fact, some businesses sell on the principle of catastrophization. They tell you what catastrophe will happen if you don’t buy their product. They might say, “You’ll have wrinkles. Terrible, old wrinkles if you don’t buy our product.” And that may feel like a catastrophe because they’re trying to sell you their product. They may say, “If you don’t buy this special extra filter for your car, it could explode on the highway.” That’s a catastrophe. “Okay, I’ll buy it.”

So, even my naming of it, I want you to be aware of how it piques your interest, the catastrophes, and how it draws you in because nobody wants a catastrophe. But for some reason, we think in this way. So I made a little trick there. I tricked you into listening. I try not to use it as a tool, but I thought today it would be really relevant to bring it up and see whether you caught that catastrophization that I did to get you onto this episode. I’m a naughty girl, I know.

There it is. I want you to catch how you frame things and how you tell stories about things that you’ve been through or about the future and catch the catastrophization that you do. If you have a supportive partner or friend or somebody in your life, a loved one, and you trust them, you may even ask them to just give you a little wink every time they catch you using a catastrophization. Sometimes you don’t catch it until someone brings it to your attention. Because again, our brain works on habit. Our brain works on what it knows, and it doesn’t really like to change because that means you have to use more energy. But I promise you. I promise, promise, promise you, this is the energy you want to use. This little extra piece of energy is totally worth it, because think about it. If I said to you, “I had a panic attack, it was really uncomfortable. I rode it out. There were some moments where I felt really confident and some moments where I was struggling, but it did go away eventually,” ask yourself how that feels. And then I’m going to tell you a different version: “I was totally freaking out. I totally thought I was going to die. It was so bad. I really think it was the most painful thing I’ve ever been through in my whole entire life.” How does that feel? It feels terrible.

A lot of panic comes from people catastrophizing, using language that feels really dangerous. The danger of catastrophization – remember, it feels dangerous when we use catastrophization. So, just be aware of it. Catch it if you can. Okay?

All right. Before we finish up, I want to do the review of the week. This is by Dr. Peggy DeLong and she said, “Wonderful practices!” She gave it a five-star review and said, “I appreciate that you highlight these skills as practices. Coping with anxiety is not a one-and-done deal. Practicing these skills, even on good days, especially on good days, helps to promote long-term well-being. Thanks for providing this service!”

Thank you so much, Dr. Peggy DeLong. I am so grateful for your reviews. Please, go and leave a review if you have some time. I would be so grateful. It really helps me reach people who, let’s say, look at the podcast and think to themselves, would this be helpful to me? And if there’s lots of reviews, it helps build trust for them that they would then click, and then hopefully I can help them. Okay?

All right. Sending you all my love.

One quick thing to remember is if you go over to cbtschool.com, we actually have a full training on this, on correcting the way that you think. Again, the goal is not to change your intrusive thoughts, but the goal is to work on how you reframe things. So you can go there for that training.

All right. All my love to you guys. Have a wonderful day. It is a beautiful day to do hard things.

Jan 14, 2022

SUMMARY: 

Today we have Windsor Flynn talking about how she realized the benefits of meditation for anxiety and OCD in her recovery. Winsdor brought her lived experience and training to the conversation and addressed how meditation has helped her in many ways, not just with her OCD and mental health.

In This Episode:

The benefits of meditation for general anxiety
The benefits of meditation for OCD
The roadblocks to practicing meditation
How Mindfulness and mediation help with daily stress (especially through COVID-19)

Links To Things I Talk About:

Instagram: @windsormeditates
Instagram: @Windsor.Flynn
Website: www.windsorflynn.com (Windsor is certified to teach the 1 Giant Mind 3 Day Learn Meditation course).
ERP School: https://www.cbtschool.com/erp-school-lp

Episode Sponsor:

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

This is Your Anxiety Toolkit - Episode 217.

You guys, 217. That’s a lot of episodes. I’m very excited about that.

Today, we have with us the amazing Windsor Flynn. I cannot tell you how incredibly by inspired I am with Windsor. She is very cool and has so much wisdom and so much kindness to share.

Today, we have her on to talk about having anxiety and learning the importance of meditation. Now, Windsor speaks specifically about having OCD and how much it has helped her to take up a meditation practice. She goes over the couple of main key points, which is number one, anyone can meditate. And that meditation can be user-friendly for people, even with OCD. And she said, “Especially for people with OCD.” And she actually gives us the amazing gift of a guided meditation at the end, that just helps you bring your attention to the present and learn to drop down into your compassion and your body. And then the third point she makes is that meditation can be integrated into your life, even if you feel like you don’t have time, or even if it’s really uncomfortable. And she shares some amazing experiences and examples of where she really struggled and how she got through those difficulties. So, I’m going to quickly first do the “I did a hard thing” and then I’m going to let you guys get right into the amazing conversation with Windsor Flynn.

So, today’s “I did a hard thing” is from Anonymous, and they said:

“I wear a dress that has been sitting in my closet for months. I was always scared to show my skin since breaking out in hives over my social anxiety. I felt proud for the first time in a long time.”

This is so cool. You guys, I love this so much. They’re really talking about showing up imperfect and all, or letting people judge them and going and doing what you want to do anyway. And that is what this podcast is about. It’s about living the life that you want, not the life that anxiety wants you to have. And often, anxiety will keep your life very small if you only listen to it and only follow its rules. And so, anonymous is doing this work, walking the walk, not just talking the talk. So, yes, I’m so, so in love with this.

Now you guys, you can go over to my private practice website, which is where the podcast lives. It’s Kimberley Quinlan - L for License, M for Marriage, F for Family, and T for Therapist – I had to think there – .com. So, KimberleyQuinlan-lmft.com. And then you can click on the podcast and right there is a link for you to submit your “I did a hard thing” and you can be featured on the show. So, go do that, but not right away. First, I want you to listen to this amazing, amazing episode.

Benefits of Meditation for Anxiety and OCD Your anxiety toolkit

Kimberley: Welcome. I am so excited for this episode. I have a reason for being so excited, which I’ll share with you in a second, but first, I want to introduce to you Windsor Flynn. She is incredible. I have watched you grow over the last what? A year or two years since I’ve known you. It is so wonderful to have you on, so thank you for coming.

Windsor: Yeah. Thank you for inviting me. This is so cool because I’ve spent a lot of time listening to your podcast and, I don’t know, just hoping to be on Monday, but I didn’t know for what. So, this is really cool for me.

Kimberley: Yeah, this is so cool. So, you’re coming on to talk about meditation. And the reason that this is so exciting for me is that is actually what this podcast was originally for – was to bring mindfulness and meditation practice to people who have anxiety. And I did a lot of meditations at the beginning and then I lost my way. So, I feel like you coming here is full circle. We’re going back to the roots of the show to talk about mindfulness and meditation. Do you want to share a little bit about your story with mental health and why you landed on this as being your passion project?

Windsor: Yeah, sure. So, I started-- I guess my mental health story goes way back, but I’ll just start at the beginning when I first came to my OCD diagnosis. I had been experiencing anxiety. Looking back, I will say it was pretty debilitating, but I was sort of just powering through it. I was a new mom. I didn’t have a lot of mom friends, the first in my group to have kids. My parents are across the ocean in Hawaii. I’m in California, in San Francisco with my boyfriend who is shocked at being a dad.

So, I’m very anxious, but I’m doing all the things. And I had started experiencing intrusive thoughts, which I didn’t know were intrusive thoughts. I was just really worried that I was going to become a headline for like moms that murder. I hate moms that kill because I had heard of this story. I’m sure so many people who grew up at the same time as me were really familiar with the Andrea Yates story. I don’t need to go full into detail, but she had some mental health issues and she ended up killing her kids. It’s a very, very sad story, but I had attached to that because I was just so, so scared that that would happen to me. And I don’t know why I was nervous that this would happen to me. But ever since I was little, I just always thought that anything drastic, it would happen to me. I would be there for the end of the world. I would be there to witness a mass murder, or I would be a victim of a serial killer. All these things, I just thought it had to be me. I don’t know why.

So, of course when I have a baby, I’m thinking, “Oh no, this horrible thing, it’s bound to happen to me. I need to pay attention.” So, that’s when the hypervigilance started, all of these things that I now have language for, but I wasn’t quite sure how to explain, and I also didn’t want to explain it to anyone because it sounds unhinged. So, I was doing this alone. I was trying to keep myself very busy. I was doing all the classic compulsory activities that happen when you’re trying to avoid intrusive thoughts and avoid this massive discomfort in fear. And eventually, we moved out of the city. So, not only was I mothering by myself-- not really by myself. I had a partner, but he was working a lot just with his schedule. So, he was sleeping most of the day and gone all night.

So then we moved across the bay to Alameda and then I just didn’t even have friends anymore. So, I was all alone. So, I was thinking, “Wow, if there’s ever going to be a time that I’m going to just completely go off, it’ll be now.” And then it just snowballed. It spiraled into this thing where I couldn’t not be scared and I didn’t know what was going to happen. I was convinced that I was going to kill my son for no other reason. Then I just had a feeling that something bad was going to happen.

So, I looked up postpartum mood disorders because somehow, I knew those existed. And I was hoping that this had something to do with it. I still had hope that there was an explanation. And I found something that said Postpartum OCD, and anxiety. And of course, I hit every single track mark. It wasn’t mild symptoms. I was just, yup. Check, check, check, check, check. And so, I felt a little okay. Not really, right?

And I finally saw someone who ended up being-- she said she was a postpartum specialist, which was great. I signed up with her. We talked. She told me I had OCD. It was cool. But she didn’t give me any tools. She was doing the root cause stuff, which is probably really helpful in other circumstances, not necessarily for OCD. But she reassured me enough that I was cool with my OCD. I was like, “Well, I’m not going to kill anyone. That’s fine. I can go home. I can continue being a mom as long as you’re telling me I’m not a murderer.” Just like, “No, you’re not a murderer.” I was like, “Great, well, we’re done here, I guess.” And I got pregnant again. And of course, I was so scared. I was like, “That’s going to happen again. I’m going to have postpartum OCD.”

So, I couldn’t pause my whole pregnancy, but it was in the name of preparedness. So, I didn’t know that I was making my symptoms worse and worse and worse until I had the baby. This time I’m not scared I’m going to kill anyone. I’m just scared that now I think she’s the devil, which I did not know how to recognize it.

So, finally, I’m experiencing a whole different subset of OCD symptoms. I didn’t know, but I just thought, well, it was OCD the first time. I’m just going to check. And luckily, I landed on my therapist. I still see-- even though this was four years ago, I still see her every two weeks. I love her. She’s the best. She’s given me all the tools I needed to manage my mental health, got me to a place where not only was I totally understanding the disorder, but I felt really comfortable sharing and sharing in a way that I thought would be helpful to other people.

So, that’s when I started advocating for maternal mental health and OCD, and that’s how we know each other, through the internet, social media space. And I guess that was a mouthful, but that was how I landed onto the advocacy part. And eventually, I switched to meditation because I felt like this was a tangible way that I could offer a service that I know to be helpful for the management of mental health. And I know how much resistance there is towards starting this meditation practice because I too went through a number of years where I absolutely said no to this idea of meditation. But once I started, I realized, wow, I don’t know why I didn’t do this sooner. There’s really something to it. And it’s very teachable. And I know from firsthand experience how beneficial it is.

Kimberley: I love that. I actually don’t think I’ve heard your entire story. So, thank you for sharing that with me and everybody. I didn’t realize there were two waves of OCD for you and two different subtypes, which I think is common, for a lot of people.

Windsor: Yeah.

Kimberley: I love that. So, I think what you’re saying, and can you correct me if I’m wrong? So, the first wave was reassurance, what you used to get you through. And then the second you used ERP?

Windsor: Yes.

Kimberley: Okay, great. And then from there, the third layer of recovery or however you want to say it, was it meditation, or were there other things you did to get to the meditation place?

Windsor: Well, I was doing ERP and that really helped with my OCD management. I was able to recognize whenever I had a new obsession, and I feel like I could recognize anyone’s new obsession. At this point, I was like, ‘Oh, that’s this, that’s this. It’s tied into this.” So, I had a really great understanding, and that was cool. But I still have two kids, we’re still in a pandemic, I still have communication issues with my partner – all these normal things that ERP doesn’t necessarily help with. So, it was really just about finding that balance between working on myself and stress management and really getting to be that calm, chill person that I’ve always wanted to be. Even when I was doing the best with my OCD, I was still not so relaxed because I had a lot of attachments to how I wanted people to perceive me, how my children were behaving, not necessarily in a controlling way, but just really feeling a lot of responsibility over everything.

And so, the meditation was just this next step that I was hoping would get me there, because I was feeling a lot of stress, not even related to my OCD, just in general. And I wanted to be able to find something that would help me get through that stress so that I could start really figuring out what it is I wanted to do, just even for fun again, instead of just only feeling this overwhelmed.

Kimberley: Yeah. No, I really resonate with that. All I can say for me is, while I had a different story, I had an eating disorder, I was trying to do meditation during that, but the thoughts and everything was just too big for it. And it was hard for me to access actual meditation without it just being an opportunity to ruminate, sitting there, just cycling. So, the main thing I really want to ask you, if you’re willing to share, is let’s say specifically someone with OCD, what were some of the struggles that you had with meditation? Because I know so many people with OCD are really resistant to it because the thoughts get louder when you sit still and so forth. So, what were some of the things that you had to work through to be able to sit on a cushion?

Windsor: Yeah. That’s such a great question because I feel like, had I not figured out that I had OCD and then done all this work with ERP to really learn how to acclimate myself to the presence of intrusive thoughts, I don’t know that I would’ve been successful in meditation. Actually, I know that I wasn’t because I had tried it before, and it was too hard. So, I really-- even with ERP, once I started the meditation journey, the first few weeks were pretty challenging for me because as someone with OCD, every time I close my eyes and I’m not occupied, or my brain is not occupied, it’s like prime time. This is OCD’s favorite. It’s like the time to shine. It’s like, “Okay, here I am. What can we throw out to you today?”

And so, knowing that this was a possibility, even when I signed up to learn meditation, I was like, “Okay, I’m going to do this. I’m going to try, I’m going to give college a try.” Then my OCD was like, “No.” You close your eyes, something could happen, like you could have a breakdown or you could make all these realizations that you are a psycho killer. And then you’ll just definitely kill everyone. Thank God you tried meditation. Now your true self can come out. And I was like, “Okay, I’m going to just do it anyways. I’m just going to meditate because I have to see, not even in a compulsory way, I have to see if this is true. But I can’t-- knowing now what OCD does, I couldn’t-- it was almost I took it as a personal challenge.

Kimberley: Like an exposure, right? It was like an exposure, like, “Okay, fine. I’m going to-- let’s see.”

Windsor: I signed up to learn meditation as a true exposure because now I had this fear that if I come to all these realizations, it won’t be cool. It will be devastating for everyone around me. So, I was like, “Well, I’m going to try. I’m going to try to meditate.” And do you know what? I cried and panicked the first time. I had to turn off my camera because I did not want the teacher to see.

Kimberley: So you did it live.

Windsor: I did it live. It was so hard. It was like a total exposure because this was in front of-- I think there were 25 people in the course and everyone was closing their eyes, I’m assuming. But 20 minutes is a long time to meditate. So, I know people were going to be opening their eyes. So, I was live having this fear that I was going to turn into a psycho killer on the camera. So, I was crying because it was hard. But you know what? I’m so glad I did because also ERP showed me that crying is fine. We can cry when we do hard things. I was doing the hard thing and I was proud of myself. I even shared afterwards. We were like, “Who wants to share?” And I was like, “Me.” I cried and I had a panic attack.

Kimberley: See. That is so badass in my mind. That is so cool that you did that. You rode that wave.

Windsor: Yeah. And it was great because if I didn’t do that or purposely put myself into the situation to cry and do this hard thing, I wouldn’t have been able to get to the good part of meditation, which I love. I like to talk about the good part of meditation. But having OCD makes starting the hardest part.

Kimberley: Yeah. What is the good part of meditation for you? Because I think that no one wants to do hard things unless they know there’s some kind of reward at the end. Everyone’s going to be different, but for you, what is the why? Why would you do such a thing?

Windsor: Well, because I learned this thing, right? That was so valuable. Someone told me, we don’t gauge the benefits of meditation for how we feel when our eyes are closed. We’re more interested in what happens while our eyes are open. How is it impacting? And I noticed almost right away that when tensions were high, when I usually would be the first to participate-- because I’m really affected by the way other people’s moods are. I feel responsible or I have to change it. I became dysregulated really easily. I noticed almost right away that when other people were feeling their feelings around me, I was able to observe them instead of participate in that, which was really cool. And it was just so much nicer to be able to be supportive instead of become one of those people who also needed support in that moment.

And I also noticed right away that I had a higher tolerance for loud noises and just disruptions, because I’m pretty sensitive to lots of different noises at once. It gets me pretty anxious and agitated. So, having kids at home all day isn’t ideal for that. And so, the meditation really helped me a lot with that. I was able to recover more quickly from periods of dysregulation. Maybe I would become dysregulated, but I could calm down quicker. And so, I really loved that.

And I noticed that as before where I would be like, I need wine at 4:30 or whatever time it was. Once I started meditating for a few weeks, then wine just became something that tasted good that I liked in the afternoons. I didn’t need it. Sometimes I would be like, “Wow, we’re having dinner. Oh my God, kids, I didn’t even have wine.” And they were like, “Wow, you’re right.” And so, I would pour myself a glass just because I like it.

Kimberley: Right. Not because you needed it to get through the afternoon.

Windsor: Yeah. And so, I really liked all those changes. And it just is really restful, which I wasn’t expecting. The practice itself, the one that I practice, it’s twice a day. And I find that doing those two meditations really gives me more energy because I’m not a coffee person. So, yeah, I just feel like what started as a thing that I wanted to feel more rested and less stress, it has actually become a tool that I can use to help maintain a busier lifestyle, which as much as I don’t love for everyone, I can’t avoid it. Anyway.

Kimberley: That is so cool. I mean, how amazing that this practice came to you. So, you are talking about this specific meditation practice that you use and the benefits. Do you want to share a little about what specifically you use? I’m sure some people here have heard from me of self-compassion meditations and mindfulness meditations, but do you want to share specifically what practices you are interested in practicing?

Windsor: Yeah. So, the practice that I find the most success and enjoyment out of is a silent meditation, which actually was the most intimidating for me, but I love it. It’s the one giant mind being technique. It’s called a being technique because, I guess the focus of the meditation is to connect with your being, which I guess if you say it without sounding too woo-hoo or anything like that, we’re just connecting to your true self apart from all the thoughts and the ideas and all the conditioning we have. Just getting back to you, which is something that I really wanted, especially after having two kids and being confused in the state of life that’s not really developed yet. So, I love that part. And since I didn’t have to focus on anything like someone else’s voice, or trying to follow a guided meditation, sometimes I feel that takes more energy because I still have to pay attention to something. A silent meditation allowed me to really find that rest and allowed my brain to just slow down.

Kimberley: Yeah. I too. I mean, I love guided meditations for people who are starting off and need some instructions. But I find the silent meditation once I got the hang of it, I could practice it in a minute between clients. I could just sit for-- I could quickly go into that and then come out. Or if I’m presenting and I’m listening to someone, I could just drop down into that. So, I really love the idea of this as well because it’s something you can practice in small pieces.  Not so formally, but drop into just connecting down out of your head into your body kind of thing. Okay, so the biggest question I’m guessing people have is, are you “successful” with your meditations daily? What does it look like day-to-day? Are there ups and downs? How is it for you?

Windsor: Yeah. This is something that comes up a lot when people ask, because we know that, yes, all meditation is helpful. But we also know that to get the most benefit out of meditation, it’s best to have a regular practice. And this could mean meditating once a day, or with this particular technique, meditating twice a day. And it sounds a lot. And I would love to say I meditate twice a day every day, no matter what. But I have OCD, so I allow myself to be a little bit more flexible. I don’t really love rigidity when it comes to things like that because I have a tendency to really grab onto them. So, I do allow myself to skip it sometimes, either for reasons like I forget, or the day just gets ahead of me. As important as meditation is, there’s a lot of things that trumpet, like do my kids need something? Do I have to pick someone up? Is everyone being fed? There’s all these things that are also really important. So, I do try to meditate twice a day. Most days I do. Sometimes I don’t. But that’s okay because I did what I had to do to keep everything going.

Kimberley: What about during your meditation?

Windsor: What, excuse me?

Kimberley: What about during your meditation? Is that an up and a down process? Do you have “good days” and “bad days” with it or is it pretty consistent for you now?

Windsor: Well, I don’t like to talk about the meditations as being good or bad. Some are really gratifying and some are less gratifying, because even the less gratifying meditations are really good for you. You’re still going to benefit from them, even though it wasn’t necessarily easy or didn’t feel good. But that’s just like a lot of things. Meditation can be categorized as something like that, like maybe brushing your teeth or exercising. Maybe you don’t love it all the time, but you do it because it’s good for your body and it helps you reach certain goals. And sometimes it’s really hard for me to get to a good juicy place, and that’s okay. I’ve just started to not expect a certain experience when I go into the meditation. And that makes everything a lot easier because then I’m not letting myself down or I’m not feeling disappointed or I’m not crushing a goal. I don’t go into the meditation feeling like I’m going to feel so relaxed and cool. I just say, “Oh, I’m going to close my eyes and we’ll just see what happens during this session.”

Kimberley: And that’s why I love what you’re saying because it’s so in line with recovery, like dropping the expectations, dropping just the good feelings, dropping goals, having these big goals all the time. I think that’s-- sometimes I have found, what happens in your meditation is like a metaphor for life, right? Like, okay, today is a busy brain day. There’s going to be days like that. And I think that it’s a great way to just practice the tools in a small setting that you would be practicing in the day anyway.

Windsor: Exactly. That’s why I love it for people with OCD too because let’s say you commit to doing it 20 minutes a day or 20 minutes twice a day. During that 20 minutes, you know that any thoughts can come up, any feelings can come up, and you’re just going to let them be there. And this is excellent practice for when you’re going about your daily life and you have no control ever over what comes into your mind or what happens. But since you’ve been practicing this in your meditations, those responses to accept and let go become more automatic. So, not only are you having great meditation experiences or anything, but in your life, you can use those same tools. It’s not just adding another thing. It all works together. The meditation is so helpful in every aspect.

Kimberley: Right. It’s like we go to the gym to strengthen our muscles and we meditate to strengthen our brain muscles, right?

Windsor: Yeah.

Kimberley: Yeah. I love that. So, one thing I didn’t ask you ahead of time, but I’m wondering, would you be interested in leading us through a couple of minute meditation to get us experiencing that?

Windsor: Yeah. And you know what? I was thinking of like, maybe I should think of something to say in case she asks it, but I don’t think she will. So, yeah, we can just do a short-- what I do sometimes when I don’t do the whole 20 minutes is I just do a short mini one, like a minute or two.

Kimberley: Would you lead us?

Windsor: Yeah. Okay. So, for everyone listening and for Kimberley, I just want to show you a little bit about what it looks like to connect to your being and to practice a silent meditation, just for a short little grounding experience in the middle of a busy day or before a meeting, anytime you need to.

So, what I like to do before I meditate is to just get into a comfortable spot. You don’t necessarily have to be on a fancy cushion. You just have to have your lower back supported. And go ahead and close your eyes. And what I like to do before I start any meditation is take a few deep belly breaths. So, we’ll just breathe into our noses right now. Feel your belly. Feel your chest... And release through the mouth.

One more deep breath into the nose... into your belly... and release.

And one more deep breath into the nose. Feel your belly... and release.

So, now you just want to let your breath settle into its own natural rhythm. This isn’t a breathing meditation. We’re not going to focus on our breath. And you can scan your body for any tension that you might be holding. A commonplace is in your neck and your shoulders. Make sure you drop your shoulders, can wiggle your jaw a little bit, and just let all of that tension go.

So, when we’re meditating, we don’t want to put a focus on any thoughts that might come into our mind. But when they do come in, we just want to acknowledge them and recognize that this is a normal part of meditation. We never want to resist any thoughts or feelings that we might have. These are all important.

And just continue following your natural breath. And has any thoughts come into your mind, just remember that we don’t have to engage with them. It’s okay to just witness them and let them pass through you.

Maybe you might notice a sound outside or a body sensation. That’s okay. Just be a witness to that too.

Now you can take another deep breath into the nose... Into your belly... and breathe out.

And you can start to bring your awareness back to your body and see how it feels to be where you are.

You can start to bring your awareness back into the space. And slowly, when you’re ready, you can open your eyes.

Kimberley: Oh, what a treat.

Windsor: And that’s a little meditation, but I was really feeling it for a second.

Kimberley: Yeah. I just kept smiling because it was such a treat. What a treat that I get to have my own little meditation instructor in the middle of a podcast. It’s my favorite. What a gift. Thank you so much.

Windsor: You’re welcome.

Kimberley: Yeah. Thank you. I think I love-- I just want to highlight a couple of things you said, which is, for those who have anxiety, meditation is not the absence of thoughts and feelings, right? You highlighted that and that was so helpful, just to acknowledge that thoughts and feelings will happen, sensations will happen, but we just become an observer to them, which I think again, not only helps us with meditation, but it helps us with response prevention, during our exposures. It helps us during panic. Such a great tool. So, I’m so grateful for you sharing that.

Windsor: Cool. Well, thanks for letting me. I love to talk about it when I have the chance.

Kimberley: Yeah. Okay. So, I want to ask one final question, which is, what do you really want people to know? If there’s something we’ve missed today or if you want to drive home the main point, what is your main message that you’re wanting people to take away from today’s podcast?

Windsor: I guess what I really want people to know about meditation is that you don’t have to be a certain type of person to do this. You don’t need to be a specific personality type or have certain interests to make meditation work for you. You can just be yourself and come as you are and treat this practice as a gift that you’re giving yourself, that you deserve to take part in because it offers such deep rest and relaxation. That meditation can be a part of a modern, busy lifestyle. You don’t have to be common Zen all the time to do it. I think that meditation is for everybody.

Kimberley: I love that. I always remember, I think I could be killing this here, but the Dalai Lama says, and this always gets me laughing because he always says, if you don’t have time for meditation, you are the one who needs to meditate the most.

Windsor: Yeah. I love that one.

Kimberley: I killed the way that he said it, but for me, so often I’m like, “Oh, I don’t have time. Oh, I didn’t get time today.” And he really keeps nagging me in my mind in terms of knowing the more busy you are, the more you may want to prioritize this. Of course, like you said, that happens and priorities happen. But for me, that was the main message I had to keep reminding myself when it came to meditation. So, I loved that.

Windsor: Yeah.

Kimberley: Well, thank you so much. This is just delightful. Really it is. It has brought such joy to me today because like I said, it feels full circle to be coming back and talking more about meditation and doing more of that here. Where can people get a hold of you and hear about your work?

Windsor: So, I have my Instagram, @windsor.flynn, and that’s my OCD one. I talk a little bit about meditation on there, but I know that not everyone is necessarily ready for that. So, I do have my other Instagram, @windsormeditates. And that’s when I focus a little bit more on the meditation. And if you’re interested in taking any of my group courses or private meditation sessions, you can just go to my website, windsorflynn.com. All very easy, just search my name on the internet, and then you’ll find some links for those.

Kimberley: And we’ll have all the links in the show notes as well. So, if people are listening on, they should be able to connect to that. So, amazing. I’m so-- pardon?

Windsor: I was just going to say thank you so much for having me. I’m a big fan of yours and I love the work that you’re doing and I feel so honored that I get to be on your podcast.

Kimberley: No, I feel likewise. I love what you’re doing. There’s so many things I wish I could focus on. And I love when somebody like you will come along and they focus on that one thing. It just makes me really happy because I just love when people are finding little areas, particularly in the OCD and mental health space where it’s like, we need these sources. So, I’m so happy that you’re doing that work. Thank you.

Windsor: Cool. Thank you so much.

Kimberley: My pleasure. And like I said, go follow Windsor. She’s amazing, and I’m just honored to have you here.

Windsor: Thank you.

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Okay. So, before we finish up, thank you so much for being here and staying till the end. Before we finish, I want to share a review of the week. This one is from Cynthia Saffel and she said:

“I’m so excited to share these podcasts with my clients.” She gave it a five-star review and said, “I first was introduced to Kimberley’s clear and compassionate teaching style when I took the ERP school course for therapists.” For those of you who don’t know, we have a CEU approved course called ERP School, where you can learn how to treat OCD using ERP. And she went on to say, “In the past 3 weeks since taking the course I recommended both the course and podcasts to my clients.”

Thank you so much, Cynthia, for your review. And for everyone who leaves a review, it is the best gift you can give me in return for these free resources. So, if you have the time, please do go over and leave a review and have a wonderful day. It is a beautiful day to do hard things. Have a wonderful day, everybody.

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