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Your Anxiety Toolkit - Anxiety & OCD Strategies for Everyday

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Now displaying: August, 2023
Aug 25, 2023

If you are interested in stopping compulsions using attention control, this is the episode for you.  I am really excited for this episode. This was a deep dive into really how to fine-tune your mindfulness practice for anxiety and OCD. Today we have the amazing Max Maisel, who is an OCD and anxiety specialist here in California. He came on to talk about these really nuanced differences of mindfulness, where we might go wrong with mindfulness, how we can get a deeper understanding of mindfulness, and this idea of attentional control. The real thing that I took away from this is how beneficial it can be at reducing mental compulsions, putting our attention on the things that we value, putting our attention on what we want to put attention on, not in a compulsive way at all. In fact, we addressed that throughout the episode, and it’s just so, so good. I’m so grateful to you, Max, for coming on, and I just know you guys are going to love this episode.

Now, we are talking about some pretty difficult things, like things that are hard to do. I even roleplayed and explained how hard it was for me to do it. I want, as you listen to this, for you to please practice an immense amount of self-compassion and recognition and acknowledgment of just how hard it is to do these practices and how we can always learn more. Hopefully, something in this episode clicks for you and feels very true for you and is hopefully very, very beneficial. 

I’m going to go take you straight to the show because that’s what you’re here for. Have a wonderful day everybody, and enjoy this interview with Max Maisel

351 Stopping Compulsions using Attention Control (with Max Maisel)

Kimberley: Welcome. I am so excited for this episode, mainly because I actually think I’m going to leave learning a ton. We have the amazing Max Maisel here today. Welcome.

Max: Thank you, Kim. It’s really good to be here. I’m super excited for our conversation.

MINDFULNESS FOR OCD 

Kimberley: Yeah. Okay. You know I use a lot of mindfulness. I am a huge diehard mindfulness fan, but I love that you have brought to us today, and hopefully will bring to us today, some ways in which we can drop deeper into that practice or zone in, or you might say a different word, like how to focus in on that. Tell me a little bit about how you conceptualize this practice of mindfulness and what you use to make it more effective for people with anxiety and OCD.

Max: Yes, for sure. So, I’m a major proponent of mindfulness practices. I use it myself in my personal life. I integrate it in the clinical work that I do with clients with OCD and anxiety. But one of the concerns that I’ve seen in my clinical work is that mindfulness is such a broad concept and it covers so many different types of psychological suffering. The research behind mindfulness is just like hundreds, maybe even thousands of studies. But when it comes to very specific and nuanced concerns like OCD and anxiety, it could be a little bit confusing for people sometimes to figure out, “Well, how do I apply this really healthy, beautiful, amazing tool to how my own brain is wired in terms of like sticky thoughts or just to engage in all sorts of compulsive behaviors.” I like to think about mindfulness from Jon Kabat-Zinn’s definition at the core—paying attention to the present moment in a way that’s non-judgmental and with this curious intentionality to it. But then within that, there’s some really nuanced details that we can talk more about how to make that really relevant to folks with OCD and anxiety.

THE DIFFERENCE BETWEEN ATTENTION & AWARENESS

Kimberley: Tell me a little bit. When we’re talking about mindfulness, we often talk about this idea of awareness. Can you differentiate first—and this is using some terminology just to set the scene—can you differentiate the difference between attention, awareness, and even a lot of people talk about distraction? Can you share a little bit about how they may be used and what they may look like?

Max: I love that question. I think in a good OCD treatment, people really need to have a good solid understanding of those differences. I’m actually going to borrow from a neuroscientist named Amishi Jha. She’s this incredible professor at the University of Miami. In her research lab, they look at the neurological underpinnings of mindfulness, and that very much includes attention and awareness. I highly encourage anybody to look up her work. Again, it’s Amishi Jha. She talks about attention or focused attention. If you imagine there’s a dark room, and if you turn on a flashlight and you shine that beam of light into that room and say that beam of light hits a vase on a table, again, what happens to that vase? What’s different compared to all the things in the background?

Kimberley: Is that a question for me?

Max: Yeah. If you imagine a beam of light, what goes on with that?

Kimberley: You would see the front of the vase, maybe it’s a bit shiny, or you would see the shadow of the vase. You would see the colors of the vase. The texture of the vase.

Max: That’s exactly right. From this vivid and detailed, you can see all the different descriptions of it and it becomes privileged above everything else in the room. That vase is that beam of light. And then somebody might take that flashlight and shine it to the right a little bit, and then it goes from the vase, let’s say, to a chair next to it. All of a sudden, that vase is still there, but it’s fallen into the background. We might call that our awareness, which we’ll talk about in a second. But then that table that we shine on or the chair is now privileged over the vase. That’s how you can think about focused attention, is this beam of light. Whereas awareness, instead of a focused beam, you can think about that more as a broad floodlight where it’s effortless, it’s receptive, and you’re noticing what is present in the moment without privileging one thing over the next. We’re not focusing or hooked on anything particular in that room, it’s just observing whatever comes up in the moment. Does that make sense?

WHAT IS DISTRACTION? 

Kimberley: It totally makes sense. Excellent. What about distraction? 

Max: Distraction, when we think about that broad floodlight of awareness, where again, where what’s privileges the present moment, distraction is trying to get things out of that. It’s trying to suppress or not think about or get something that is in your awareness, outside of your awareness. But unfortunately, the trap that people fall into is in order to get something out of your awareness, what you need to do first is shine your beam of attention onto it. Inadvertently, while it might seem like a good idea in the short term, especially if it’s something really scary, that pops up in your awareness like, “Oh, I don’t want this. I want to get this thing out of my awareness.” But in doing that, you’re literally shining your attention. That flashlight is right on the scary thing. The very act of trying to distract, trying to push it away actually keeps that thing going, which is why it can be so easy and so tricky to get stuck in these pretty severe OCD spirals by doing that.

Kimberley: Right. If we were talking about mindfulness, and let’s go back to that, are attention and awareness both parts of mindfulness? Give me how you would conceptualize that.

Max: That’s exactly right there, and that’s what I was talking about where mindfulness is such a beautiful, helpful practice and term. But oftentimes when we say just mindfulness, people don’t understand that there are really relevant parts of mindfulness that are actually applicable skills that we can practice getting really good and solid without shining that beam of light and focusing flexibly on aspects of our experience. We can get good at letting go of that focused attention and just being with what pops up in our awareness, which are very relevant practices when we have OCD or anxiety. But if we just say mindfulness as a whole, paying attention to the present moment, we could miss these really important nuances and actionable skills that are different parts of mindfulness.

Kimberley: Let’s go deeper into that. Let’s say you have OCD or you have panic disorder, or you have a phobia, and your brain-- I was talking with my son who has anxiety and he was saying, “I keep having the thought. No matter how many happy thoughts I have, it just keeps thinking of the scary thought.” That’s just a really simple example. How might you use attention versus awareness or attention and awareness for folks who are managing these really sticky thoughts, like you said, or these really repetitive, intrusive thoughts?

Max: It’s such a good question. OCD, I always talk about how clever and tricky it is. In order to get through OCD, we need to be even more clever, more tricky than OCD. One of the ways OCD gets people to fall into its trap is by confusing them. It gets people to try to control things that they cannot control, which is what pops up in their awareness, but it also blinds people and gets them that they can’t see that there are things that are in their control. That will be really helpful, powerful tools, and OCD gums up the works a little bit. 

MINDFULNESS & ATTENTION TRAINING

To be more specific, there’s an aspect of mindfulness that we can think of as attentional training or attentional flexibility. What that is, it’s strengthening up the brain’s muscles to be able to take control of that flashlight, of that beam of focused attention. OCD, what it’s going to do, it steals it from you and shines it on the really scary stuff, like with your son, “Oh, here’s a thought that you really don’t like,” or “Here’s a really uncomfortable sensation.” All of a sudden, that beam of light is shining there. What attention training does, it really teaches people to be able to first notice, “Oh, my beam of light is on something really scary. Okay, this is a thing. This is a moment to practice now.” But then more importantly, to be able to then take power back and be able to shine that flashlight in flexible ways that are in line with people’s values and goals versus are in line with OCD’s agenda.

But attention training, it’s not only getting really good and powerful at shining that beam of light on what you want to shine, but it’s also the practice of letting go of control over the stuff that’s in our awareness. We’re going to practice and allow those scary thoughts and feelings. I treat them like a car alarm going off where it might be annoying, might be uncomfortable, but I’m not going to focus on them. I’m not going to pay attention to it, because otherwise there’s going to be front and center. 

It’s both. It’s awareness, it’s being able to flexibly shift between different aspects of our experience, and it’s also allowing things to go, and you’re like that broader floodlight of awareness. I always find it really helpful to practice the skill of attention training on non-OCD, non-anxiety neutral stimuli. It’s not too triggering. And then we can start applying that to anxiety. If it’s okay with you, Kim, I would love to walk you through some quirky little easy exercises that just help you maybe understand what I’m talking about and hopefully your listeners as well.

Kimberley: I was just going to say, let’s do it. 

Max: Let’s do it. Let’s dive in. 

Kimberley: Let’s roleplay this. 

ATTENTION TRAINING EXERCISE

Max: Okay. I want you to roleplay with me and if your listeners would like to roleplay as well, more than happy to follow along too. Again, these exercises, I don’t see them as like coping skills. I see them as like creating an understanding of what we can control, what we can’t control, and being able to just feel what that’s like in our bodies and know that this is something that we can do. 

For the first one, what I want you to do is put your thumb and index finger together, like you’re making an okay sign. Put a little bit of pressure between your thumb and index finger, but not a whole lot of pressure. Just take a couple of seconds and see if you can put your brain into your thumb and your index finger and just notice what that feels like. Notice the sensations. Let me know when you feel like you’ve got a good sense of the feeling.

Kimberley: Yep, I got it. 

Max: What I want you to try to do is shine that beam of attention. Really focus in on the pressure only from your index finger and see if you cannot think about not engage in the pressure from your thumb, allowing that to be there. See if you can really find and identify what your index finger feels like. let me know when you’ve got that. Again, not thinking about your thumb, just focusing on your index finger.

Kimberley: Yeah, that was hard, but I got it.

Max: It is hard, right? Because what we’re doing is honing in that beam of light that we’re paying attention to. What I want you to do now is switch. Let your index finger, let that feeling go, and switch to your thumb. Again, only focusing on the pressure from your thumb and allowing your index finger, allowing that pressure to be there without thinking about it or controlling it. Just letting it exist, and then focusing on the pressure from your thumb.

Kimberley: Yeah, I got it. 

Max: We could do this for five, ten minutes. I won’t make you do it right now, but you can see there and there’s like a bump. There’s a shift where you go from one to the other. It’s great. It’s not about getting into details, it’s about noticing, “Oh, I can pay attention flexibly. I can focus on my index finger, allow the thumb feeling to be, and then I can switch to the opposite side.” That’s one way that people can start understanding what I’m talking about, where we can flexibly pay attention while allowing other stuff to exist in the background.

Kimberley: Let me bring up my own personal experience here because, like I said, I’m here to learn. As I was pushing, I actually had some pain in my thumb. As I was trying to imagine the top finger, that index finger, that was really hard because I have a little bit of ligament pain in my thumb. I had to work really hard to think about it. What was actually getting in the way was the thoughts of, “I won’t be able to do this because of the pain.” What are your thoughts on people who are fighting that?

Max: It’s such an important piece of this because oftentimes what prevents people from practicing are these thoughts and beliefs that pop up. The belief of, “I have no control over rumination,” or “I cannot pay attention.” I’m saying this, and where we’re stepping back and noticing these are thoughts, these are stories as well. Part of the practice is, can I see them as events of the mind? Can I see them as stories? Allow them to be in the background, just like we’re maybe allowing the sensation of your index finger to be in the background while maintaining focus on that one part of your experience, your thumb. Again, we want to treat pain, thoughts, feelings, sensations as best as we can, allowing them, seeing them as mental events versus as distinct parts of who you are as a person while maintaining as best as you can that focused beam of attention on what you choose to.

Kimberley: Right. This is really cool. Just so I understand this, but please don’t be afraid to tell me I’ve got it completely wrong. As I was doing it, I was noticing the top of my index finger, doing my best, and in my awareness was the thoughts I had and the pain that I had. My attention was on the top, but there was some background awareness of all the other noise. Is that what you’re saying?

Max: That’s exactly what I’m saying. The trick with OCD or anxiety is, can we allow the stuff in the background? Because a lot of people get annoyed or frustrated. And then as soon as you do that, that focus goes from your index finger to the stuff that you don’t want versus if we can let go of control. Another way to think about it too is if you’re looking out of a window. Focused attention would be, you are immensely engaging in this beautiful oak tree in your front yard. I don’t have an oak tree, but hopefully, somebody does. Imagine you’re really focusing on this oak tree, and that is what you’re paying attention to. 

Now, there might be other things that come and go. There might be birds flying and bushes in the background. There might be houses and a bunny rabbit running by. You could choose to then shift your beam of light from the tree to one of those things, but you don’t have to. You can keep paying attention to the tree and allowing all this other stuff to exist. That would be what we’re talking about and that’s the practice you could do with your fingers. And then with that same metaphor, broader just overall awareness would be looking out the window, but not intentionally focused on anything. Just letting your eyes wander to whatever is present. “Oh, I notice the tree and I notice a cloud and I notice a bird. Oh, I noticed a thought that I’ve been looking out this window for a very long time.” We’re not questioning, we’re not ruminating, we’re not judging, we’re just simply being there with what’s present. That’s that broader awareness piece to this. 

Kimberley: Okay. I love it. For those who have probably heard me talk about this, but not using this language, or are completely new and this is the first time I’ve ever logged in and listened to us, how may they apply this to specific intrusive thoughts that they’re having? Can you walk us through a real example of this? You could use my son if you want, or an actual case of yours or whatever.

Max: Yeah, for sure. If we think about it in this way, also, it’s like a little bit of a different approach than maybe how some people think about exposure and response prevention. Because in this way of doing things, there’s a really hard emphasis on the response prevention piece, which in this case would be not ruminating, not engaging in the mental compulsions. It’s doing the exposure, which is triggering the scary thoughts and the feelings, and then accessing awareness mode, like being with what’s present. 

An example of that, let’s just say somebody has an intrusive thought, a really scary fear that they might hurt somebody. They might be a serial killer or they might do something really bad. Let’s say we want to do an exposure with that thought and we choose a triggering thought of, “I am a murderer.” Normally, when they have that thought, they do all this stuff. Their focused attention is on that thought, and they’re trying to convince themselves they’re not a murderer. They’re trying to maybe look for evidence. “Did I kill somebody? I did not.” They’re engaging in this thought, doing all this sort of stuff that OCD wants them to. 

One way that we might use this difference in attention awareness, doing exposure would be to first evoke the scary thought. Maybe really telling themselves for a couple of seconds like, “I am a murderer. I am a murderer, sitting with the fear and the dread and all the stuff that comes up.” But then instead of focusing on it, then letting go of any engagement. We could just sit there and actually do nothing at all. We just watch and observe. Like you’re looking out that window and that thought “I’m a murderer” might pop up, it might go away. Another thought might pop up. But we want to take this stance of, “None of my business.” We’re going to sit here, we’re going to observe, and we’re not going to mentally engage in the thoughts. It’s really accessing this more of like awareness mode. We can actually do something like that. 

If you want to, Kim, we don’t have to use an intrusive thought, but we can, again, practice with a neutral thought together and then apply what I’m talking about. Usually, what people realize is that what happens to their intrusive thoughts is what happens to 99.9% of all the thoughts they get in a day where it comes and then it just goes away when it’s ready. If you think about it, we have thousands and thousands of thoughts per day. Mostly that’s what happens because we’re not focusing our beam of light on it, because we’re not doing all this work that inadvertently keeps it around. It’s exposure not only to sit with the feelings, but to practice the skill of letting go, of focusing on it, of letting go of any mental compulsive behaviors towards it.

ATTENTION TRAINING VS DISTRACTON

Kimberley: Right. I know this is going to be a question for people, so I’m going to ask it. How does attention training differ from distraction? Quite often, I will get really quite distressed messages from people saying, “But wait, if I’m being mindful on the tree, isn’t that me distracting against my thoughts?” Can you talk about, again, differentiating this practice with distraction or avoidance?

Max: Yep, absolutely. I like to think about it as an attitude that people take where we’re willing to have whatever our brain pops up at us. With distraction, we’re unwilling. We don’t want it, we don’t like it, we’re turning away from it. But that’s actually like, it’s okay too. We call it distraction, we can call it engagement. It’s okay to live your life to do stuff, but we have to first get really clear on, can I allow whatever my brain pops up to be there without then keeping that beam of attention on it? Because all mental rituals, all sorts of stuff that we do starts with focused attention. Summons, rituals are pure retention, but a lot of them like analyzing, reassurance, attention is a major part of them. If you can notice when our OCD took that beam of light and shined it, then we could practice taking the light off, allowing it to exist, allowing it to be there, but without engaging. If you want, Kim, I’m happy to maybe do another experiential exercise, not to throw too many at you today. 

Kimberley: No, bring it on.

Max: So maybe you and your listeners can understand that piece to it. 

Kimberley: Yes, please. 

ATTENTION TRAINING EXERCISE #2 

Max: Okay. Lets start with attention training exercise #2. What we’re going to do is we’re going to practice engaging in what we might think of as a rumination, analytical way of thinking. Again, rumination, mental compulsions, they are a behavior. They’re a mental action that we’re taking that we could turn on, but we can also turn off. We want to be able to turn off mental compulsions throughout the rumination, but allow any thoughts and feelings to exist without doing anything about them. I know it sounds heavy, so let me show you what I mean by that. 

Kimberley: Good. 

Max: What I want you to do is think about a vacation or a trip that you either have coming up, or it might be like a dream vacation that you really want to take, and just take a second and let me know when you got something in mind.

Kimberley: I got it.

Max: You got it. That was quick. That was a good thing. What I want you to do is start mentally planning out the itinerary for this vacation, thinking about what you’re going to do, all the steps you’re going to take, just like doing it in your mind. And then I’ll tell you when to stop.

Okay. Stop. Now what I want you to do is let go of that engaging analytic way of thinking and just sit here for a couple of seconds. We’re not going to do really anything. If the idea of the vacation pops up in your mind, I want you to allow it to pop up. But don’t think about it, don’t focus on it. Allow it to be there or not to be there. Just don’t do what you were just doing where you’re actually actively thinking about it. Are you ready? 

Kimberley: Mm-hmm.

Max: Okay. Again, we’re just going to sit and we’re going to observe. Whatever comes up, comes up. We’re going to let it hover and float in your overall awareness without focusing on it. 

Waves washing on the beach or just letting your thoughts and feelings come and go. We’re not engaging, we’re not thinking about them. We’re just observing. 

What I want you to do one last time, I want you to start thinking again, planning, going through the itinerary, thinking all the cool stuff you’re going to do. As you’re doing it, notice what that feels like psychologically to go from not doing to doing. And then start thinking about it, and I’ll let you know when to stop again.

All right. We can let go of the vacation. Again, just for five, ten seconds sitting. If the thought pops up, allow it to pop up, but don’t engage in it. Don’t manipulate it or actively walk through the itinerary again. Just notice what that’s like. 

Okay, Kim. I’d love to hear your experience walking through, turning it on the analytical way of thinking, and then turning it off and playing around with it a little bit.

Kimberley: Okay. Number one, I immediately was able to go into planning. I think because I do this, this is actually one of the things I do at bedtime. I’ve planned my 91st birthday, my 92nd birthday party. That’s what I love to do, so it was very easy for me to go into that. When I went back to more awareness of just what I noticed, I was actually able to do it really easily except of the thought like, “Oh, I hope I don’t have the thought. I hope I’m doing this right.”

Max: That’s such a beautiful way, and the mind is going to do stuff like that. We’re going to start thinking about thinking, and I’m curious how you respond to that thought. What you did next?

Kimberley: I was just like, “Maybe I will, maybe I won’t. What else?” And then I was like, “Well, there’s Max and there’s my microphone.” That was the work.

Max: Yes. That’s exactly what I’m talking about. We’re not like, “Don’t think about this vacation.” Because if we did that, what do you think that would do to you if you’re just sitting there in that moment of awareness and be like, “This is not a good thought to have, I can’t think about this upcoming vacation”?

Kimberley: Well, I had more of them and I had distress about them.

Max: Yeah, exactly. That’s what I mean by we’re not distracting, we’re allowing, but we’re also not analytically thinking about it. Now that we’re talking about this, I think this is a really important piece on where mindfulness can get maybe especially confusing or even contradictory for people. Again, to preface this, I’m a huge mindfulness advocate and fan, but one of the issues about mindfulness for OCD, in particular, is that mindfulness is really in a lot of ways teaching it, it’s about coming back to the present moment. I’m going to focus on my breath. I’m going to refocus to my body. I’m going to ground myself. Again, overall very healthy things to do, we should practice that. 

But the problem about that is if applied directly to OCD mental compulsions—and again, just to be really clear by mental compulsions, I’m talking about anything that people do to try to feel better, cope with, resolve a scary, intrusive thought. Kim, your six-part series, let’s say, on mental compulsions that you did is one of the best OCD contents I’ve ever seen. I think everybody should go back and listen to that, whether you have OCD or not. So, all this mental stuff that we do in response to a scary thought. Mindfulness can be really helpful in noticing when we get caught up and again, like flexibly shifting. But at the end of the day, sufferers of OCD really need to understand that you don’t need to focus onto the present moment to stop doing mental compulsions. Because it’s analytical, it’s a behavior, it’s a way of thinking. Just like you did, we can simply turn it on and then we can turn it off. 

Now, I don’t mean to say it’s as easy as just don’t do it. Obviously, it’s not the case. This is complex stuff. There’s so many psychological factors that lead people to ruminate and to do compulsions, but it’s a simple idea. People need a foundation to understand that mental compulsions are a behavior that we have a lot more agency over than your OCD wants you to think. I like to think about when you look at more traditional, like contamination OCD, people might wash their hands a lot. It’s the same thing where there’s the behavior of washing your hands that you could do or you cannot do. 

Now there’s entire treatment protocols helping people chip away at that to not wash their hands, so it’s not just like, “Don’t wash your hands.” But people understand that the goal of this treatment is to, “I’m washing my hands too much and now I’m not washing my hands.” If you apply the same mindful logic to rumination, it would be like, “Oh, we’re going to wash your hands, but you cannot wash your hands. You’re just going to have to use wet wipes forever.” It’s like, oh, I’ll get maybe a step in the right direction. But people need to know that the goal here is to not wash your hands. Just like with more Pure O rumination type of OCD, the goal is to learn how to not ruminate. Learn how to step out of that.

Kimberley: Yeah. I think you had said somewhere along the way that it’s a training. It’s a training that we do. What’s interesting for me, I’ll use this as solely example, is I am in the process of training myself to do what I call deep work, because I have two businesses, things are chaotic, and I can get messages all the time. When I sit down to do something, I’m being pinged on my phone and called on my computer and email bells, so I’m training myself to focus on doing the thing I’m doing and not give my attention to the dinging of the phone and so forth as a training. I’m trying to train myself to be able to go longer, longer, longer periods and hold my attention, which at the beginning, my attention, I could really only do like 15 minutes of that and it felt like my brain was going to explode. Would you say that this is a similar practice in that we’re slowly training our brain to be able to hold attention and awareness at the same time and increase it over time? 

Max: Yeah, absolutely. I think everything with OCD and anxiety is a process. First, it takes awareness, and that’s where mindfulness can be so helpful, where the practice of mindfulness is about being more aware. “I’m aware, I’m ruminating. I’m aware of that. I’m doing some sort of compulsion.” That itself could take a very long time. I think it’s all about baby steps. 

Now, I will say though, Kim, some people, when I explain them these differences and they’re able to really feel what it’s like to be ruminating, what it’s like not—some people click and they can do it really fast. They’re like, “Oh my gosh. I had no idea that this is something I was doing.” Some people, it takes a very long time and there’s a spectrum. I think everybody always needs to go at their own pace and some people are just going to need to work at it harder. Some people, it’s going to come really easy and natural. There’s no right or wrong way to do it. These are principles that live in the ERP lifestyle. We want to start taking little baby steps as much as we can.

Kimberley: Right. For those listening and for me too, where it clicked for them, what was the shift for them specifically?

Max: The shift was understanding that while it felt like rumination—again, a lot of this is like, think about OCD, there’s this big unsolvable problem and they’re trying to solve it. They’re analyzing it, they’re paying attention to it, they’re focusing on it, they’re thinking about it, for them to really feel that, “This is something that I am doing. I know there’s reasons why I’m doing it, there’s beliefs I have about the utility of ruminating, including beliefs that I can’t control this, when really, we can’t control it. Beliefs about how helpful it is.” There’s a lot of reasons why people do that, but to recognize, “Oh my gosh, this is a thing that’s a lot more in my control than I thought.” When they experience that stepping back and allowing their brain to throw out whatever it does without having to engage with it, game changer. 

Also, in terms of classic mindfulness, think about mindfulness of breath. The instructions generally are, we’re going to focus on, say the breath, the rise and fall of my belly. My attention goes, I’m going to come back to it. I think if we do that with a very specific intention, it could be so relevant and so helpful for OCD. That intention is seeing your brain as a little puppy dog. When you have OCD, that puppy dog is full of energy. OCD is like this mean bully that’s thrown a tennis ball and getting that puppy dog to go. 

What mindfulness of breath can teach you, if we’re aware of this, we go into it like, “This is what I’m going to work on. This is how my OCD is getting me—it’s getting me to follow these lines of thought.” When you’re there sitting on your breath to be able to notice where your thought goes, be able to look at it, “None of my business. Come back to my breath.” To me, Kim, that is actually exposure and response prevention. You expose yourself to discomfort of not following the thought, which is really hard. For people with OCD, without OCD, that’s hard to do, but like you said, that is absolutely a skill that people can get better at.

STOPPING COMPULSIONS WITH ATTENTION TRAINING 

Kimberley: Yeah, and it’s response prevention. It’s the core of that. Okay, I love this. I love this. Now, as we wrap up, is there anything that you feel we haven’t covered here that will bring us home and dial this in for those who are hearing this for the first time or have struggled with this in the past? 

Max: I think we did a pretty good job. I mean, it’s very nuanced stuff. I like to see this for people that feel like their OCD is well enough managed, but there’s still work to go. This is like icing on the cake. Let’s really look at the nitty-gritty of how this works. Or if people are feeling really stuck and they’re not knowing why, hopefully, this can shine a light on some of these less talked about principles that are really important. 

But I guess the one final thing, going all the way back to Amishi Jha and her neurological research on mindfulness, really fascinating studies out of her lab show that 50% of the time, 50% of her waking day, people are not aware. They’re not aware of what’s going on, which means 50% of this podcast, people aren’t going to be paying attention to. We can’t take offense to that because it’s 50% of any podcast. When you have that coupled with OCD’s tendency to steal that beam of focused attention on scary stuff, it can be so devastating and so stuck for people. Hopefully, some of the stuff can give a sense of what we do about that and how we can start making moves against anxiety and OCD.

Kimberley: Yeah, and compassion every step of the way.

Max: Oh my gosh. I think everything needs to be done, peppered with compassion. Or maybe peppered is too level like in the context of full radical compassion. That’s such an important part of all of this work.

Kimberley: Yeah, because it’s true. I mean, even myself who has a pretty good mindfulness practice, I was even surprised how much of mine was like, “Am I doing this right? What if I don’t do it right? Will this work? How will it help me?” All of the things. I think that everyone’s background noise, like you said, is very normal. I so appreciate you bringing this to the conversation, because again, I talk about mindfulness a lot. One other thing is, I will say when, let’s say, someone has a somatic obsession or they have panic, and so they’re having a lot of physical sensations. When you say “Come to the present,” they’re like, “But the present sucks. I don’t want to be here in the present.” What are your thoughts on that? 

Max: Somatic OCD and panic, I think out of any themes or content when it comes to awareness and attention, those are the most relevant. If you think about somatic OCD, where people come obsessed about different parts of their perceptual experience, it’s all about people trying to not be aware of things that they can’t control, and then therefore they’re aware of it all the time. I think this is especially spot on for those. It’s helpful for all forms of anxiety, but that in particular, that’s going to be-- we tend to not do exposures by hyper-focusing on what they’re afraid of because that’s compulsive. That’s we’re focusing on controlling more. This process should be effortless. When we’re ruminating, when we’re compulsing or paying attention, that’s like you’re on the treadmill. You’re doing work, and just hopefully, people experience some of these exercises, all we’re doing is getting off the treadmill. We want to be doing less, if anything. OCD is making you work for it. It’s making you do stuff. We want to identify that and do a whole lot less. And then you’ll forget about it usually until you don’t. It’s like, “Oh crap, here it is again.” And then, “Okay, cool. I just practiced. Let me do it again,” until it loses power more fully.

Kimberley: Yeah. I so appreciate you. Tell us what people can hear about you.

Max: I run a practice in Redondo Beach. We’re called Beachfront Anxiety Specialists. We have our website. Again, my name’s Max Maisel, and people can feel free to Google us and reach out at any time.

Kimberley: Amazing. Thank you. We’ll have all of your links in the show notes. I’m really, truly grateful. Thank you for coming on and talking about this. It is so nuanced, but so important. As I say to my patients, I could say it 10 times and sometimes you need to hear a similar thing in a different way for it to click. I’m so grateful. Hopefully, this has been really revolutionary for other people to hear it from a different perspective. I’m so grateful for your time. 

Max: Thank you. It’s such a privilege to be here with you and your listeners and I really appreciate you having me on today.

Kimberley: Thank you.

Aug 18, 2023

Welcome back, everybody. This is a last-minute episode. I usually am really on schedule with my plan for the podcast and what I want to do, but I have recently got back from vacation and I have been summoned to jury duty.  For my own self-care, the idea of going to this master plan that I created for all of the other episodes that I do a lot of planning and a lot of prep and really think it through today, I was like, “I deeply need this episode to land on my own heart.” This is as much for me as it is for you, and it is a community effort, which also was very helpful for me. 



As you may know, I’m a huge proponent of self-compassion, which isn’t just having bubble baths and lighting a candle. It’s actually stopping and asking, “What do you need in this moment?” And I really dropped in and I was like, “I need this to be really simple, really easy, and I need this to be also something that will land.” Let’s do it. 

Today, we’re talking about the 14 things you should say to a loved one with anxiety. I asked everyone on Instagram to weigh in on what they need to hear, and the response was so beautiful, it actually brought me to tears. 

Ep 350 14 Things You Should Say to a Loved One with Anxiety

I am going to share with you the 14 things that you should say to a loved one with anxiety, and I’m also going to talk about, it’s not just what we say. I was thinking about this the other day. When we’re anxious, the advice we get can make us feel very soothed and validated, or it can feel really condescending. Saying “stop worrying” can be really condescending. It can make us enraged. But if someone so gently says, “Listen, don’t worry, I got you.” You know what I mean? The tone makes a huge difference. 

For those of you who are family members or loved ones who are listening to this, to really get some nuggets on what they can do to support their loved one, remember that the tone and the intent are really 80% of the work. That is so, so important. Here we go. Let’s go through them. 

I AM HERE FOR YOU.

The first thing you should say to a loved one with anxiety is, “I am here for you.” The beauty of this is it’s not saying, “How can I make your discomfort go away?” It’s not saying, “What should we do to fix this and make you stop talking about it and stop having pain about it?” It’s just saying, “I’m here, I’m staying in my lane and I’m going to be there to support you.” It’s beautiful. 

HOW CAN I SUPPORT YOU?

The second thing you could say to a loved one with anxiety is, and this is actually my all-time favorite, this is probably the thing I say the most to my loved ones when they’re anxious or going through a difficult time, “How can I support you?” It’s not saying, “What can I do?” It’s not saying, again, “How can I fix you?” or “Let’s get rid of it.” It’s just saying, “What is it that you need? Because the truth is, I don’t know what you need and I’m not going to pretend I do because what may have worked for you last week mightn’t work this week.” That’s really important to remember. How can I support you?

YOU ARE NOT BAD FOR EXPERIENCING THIS.

The third thing you could say to a loved one with anxiety is, “You are not bad for experiencing this.” So often when we are going through a hard time, we’re having strong emotions. We then have secondary shame and blame and guilt for having it. We feel guilty, we feel weak, we feel silly, we feel selfish, we feel juvenile for struggling—often based on what we were told in childhood or in our early days about having emotions. We can really start to feel bad for having it. Or for you folks with OCD or intrusive thoughts, you might feel bad because of the content of your obsessions. 

Now let’s pause here for a second and be very clear. We also have to recognize that we don’t want to be providing reassurance for our loved ones with OCD and intrusive thoughts because, while giving them reassurance might make them feel better for the short term and might make you feel like you’re really a great support person, it probably is reinforcing and feeding the disorder and making it worse. 

So in no way here am I telling you to tell your loved ones like, “You’re not bad. You’re not going to do the thing that you think you’re going to do,” or “That fear is not going to come true.” We don’t want to go down that road because that’s going to become compulsive and high in accommodation. Those two things can really, really make your OCD and intrusive thoughts much, much, much worse. But we can validate them that having a single emotion like anxiety, shame, anger, sadness does not make them a bad person. So, so important.

THINGS WILL GET BETTER... THIS WILL NOT LAST FOREVER.

The fourth thing you should say to a loved one with anxiety is, “Things will get better,” and another thing that the folks on Instagram said is, “This will not last forever.” This was something that was said many, many times. I pulled together the main common themes here.

But what I loved about this is they were bringing in the temporary nature of anxiety, which is a mindfulness concept, which is, this is a temporary experience that this anxiety will not last forever. Again, pay attention to the tone here. Telling them “This won’t last long” or “This won’t last forever” in a way that devalues their experience or disqualifies their experience, or invalidates their experience isn’t what we’re saying here. What they’re saying is, they’re really leading them towards a skill of recognizing that yes, this is hard, we’re not denying it. Yes, this is hard, but things will get better or that this won’t last forever. 

The thing I love about “Things will get better” is, so often when we have anxiety, and we recently did an episode about this—when you have invasive anxiety all the time, you can start to feel depressed about the future. You can start to feel helpless and hopeless about the future. Offering to them “This will get better with steps and together we’ll do this and we’ll support you and we’ll take baby steps,” that can really help reduce that depressive piece of what they’re experiencing. 

 YOU HAVE GOTTEN THROUGH THIS BEFORE.

The fifth thing you should say to a loved one with anxiety is, “You have gotten through this before.” Now, that reminds them of their strength and courage. Even if they’ve never done this scary thing before, chances are, they’ve done other scary things before or other really difficult things in their life. Often I’ll say to patients when they’re new to treatment, “Tell me about a time where you did something you actually didn’t think you could do.” It’s usually things like, “I ran a marathon,” or “I rode a bike up this really steep hill and I couldn’t do it forever. And then one weekend I built up and I could,” or “I never thought I would pass this one exam and I’d failed it multiple times and I finally did.” It helps us to really see that you are a courageous, resilient person, that you’ve gotten through hard things before. 

Again, we’re not saying it in a sense of urgency like, “Get up and do the hard things because you’ve done them before.” We are really dropping into their experience. We’re really honoring their experience. We’re not rushing them too much. 

I have learned as a parent of a kid who hates needles, this is the biggest lesson for me because I’m an exposure therapist. I’m like, “Let’s go, let’s face our fear.” I’ve learned to trust my child. When we go in to get vaccinations or immunizations, my child says, “Mama, I’m going to do it, but you have to let me do this at my pace.” I was like, “Wow, you’re quite the little wise one.” It was so profound to me that I was pushing them too fast, going, “Let’s just get it over with. Once you’re done, you’ll feel so much better.” They really needed to slow it down and be like, “I’m going to do it. It’s just going to be at my own pace.” I digress. 

I AM PROUD OF HOW HARD YOU ARE TRYING.

The sixth thing you should say to a loved one with anxiety, and you don’t have to say all of these by the way, but number six is, “I am proud of how hard you are trying.” I loved this because it, number one, validates that they’re going through a hard thing. It also encourages and recognizes that they are trying their best. 

Often we make the mistake of saying, “You could be doing a little better.” The truth is, yeah, you will be doing better in the future, but you’re doing the best you can right now with what you have, so do really say, “I’m proud of how hard you are trying.”

One thing I’ve also learned, and I learned this from another clinician once, is this clinician taught me. She says, “I never tell my patients how proud I am of them.” She says, “I always say, you must be so proud of how hard you are trying.” She said that because that gives them ownership of being proud. It gives them permission to be proud. I have learned in many clinical settings with patients to say that. Not all the time, sometimes I just straight up say, “I’m so proud of you.” I don’t think there’s anything wrong with that. But you might even want to play around with this nuanced change in this sentence of, “I’m so proud of how hard you are trying and you must be so proud of how hard you are trying.” So powerful the use of words here. 

LET’S LISTEN TO STORIES OF OTHER PEOPLE WHO HAVE GOTTEN THROUGH THIS.

The seventh thing you need to say to a loved one who has anxiety is, “Let’s listen to stories of other people who have gotten through this.” The person who wrote this in, I loved it because they actually gave some context of them saying, “In a moment where I don’t think I can do the scary thing, sometimes hearing other stories of people who have done this work is exactly what I need to remind myself that I can do this hard thing.” This is how they did it, and I have the same skills that they do. I’m the same human that they are. They’re no better or worse than me. 

If you go back, there’s tons of stories and OCD stories that you can look at on Your Anxiety Toolkit podcast or OCD stories or other podcasts, or even IOCDF live streams of other people’s stories that can be inspiring to you.

I WILL DO THE DISHES TONIGHT.

The eighth thing you should say to a loved one with anxiety is, I loved this one, “I will do the dishes tonight.” I loved this one. They actually put a smiley face emoji after it because really what they’re saying is, “You need a break and I’m going to be the break you need.” It’s not to say, again, that we’re going to accommodate you and we’re going to do all your jobs and chores for you. All they’re saying is, “I can see anxiety’s taking a lot of space for you. As you work through that—not to do compulsions, but as you work through that and navigate that using your mindfulness and your ERP and your willingness and your act and all of the skills you have—as you do that, I’m going to take a little bit of the slack and I’m going to do the dishes tonight.” I just loved this. I would never have thought to include that. I thought that was really, really cute. 

YOU ARE ALLOWED TO TAKE THIS TIME AND THIS SPACE.

The ninth thing you should say to a loved one with anxiety is, “You are allowed to take this time and this space.” I thought that was really a beautiful way. Quite a few people said something similar like, “You’re allowed to struggle at this time. It’s okay that you’re having this discomfort. I’m going to give you some space to just feel your feelings. Be uncomfortable if that’s what you’re doing. Bring on the loving kindness and the compassion, and I’m actually going to give you space to do that. You’re allowed to take this time. You’re allowed to take up this space with these emotions.”

As somebody who, myself, struggles with that, I feel like I should tie my emotions up and put them in a pretty bow. I really felt this one really landed on me. It was exactly what I needed to hear as well. Thank you, guys. 

YOU DO NOT NEED TO SOLVE EVERYTHING RIGHT NOW. YOU CAN PACE YOURSELF THROUGH THIS.

The tenth thing you should say to a loved one with anxiety is, “You do not need to solve everything right now. You can pace yourself through this.” There’s two amazing things I love about this, which is number one, reminding us that we can be uncertain, that we can be patient, that we can let this one sort of lay it down, sit down. We don’t have to tend to it right now, we can just let it be there. We’re going to go about our time. Absolutely. And that you can pace yourself in that. 

Often I get asked questions like, “I just want to get it all done right now. I just want to get all my exposures done and I want to face all my fears and I want to have all the emotions and get them over and done with.” You can pace yourself through this. I think that’s so important to remember. 

WHAT’S IMPORTANT TO YOU RIGHT NOW?

The eleventh thing that you should say to a loved one with anxiety is—this is actually not something you’d say, it’s actually something you would ask. They’d say, “I need them to ask me, what’s important to you right now.” I think this is beautiful because instead of supporting them, you’re really just directing them towards their north star of their values. “If you’re anxious, let me just be a prompt for you of, what’s important to you right now.” So cool. It’s really helping them, especially you guys know when we’re anxious, we can’t think straight. It’s so hard to concentrate, it’s all blurry and things are confusing. Sometimes being given a prompt to help direct us back to those values is so, so important.

I BELIEVE YOU.

The twelfth thing that you should say to a loved one with anxiety is, “I believe you.” Really what we’re saying here is, “I believe that this is really hard for you. You’re not trying to attention seek. I believe that you’re struggling.” This was a big one, especially for those people who have a chronic illness. As someone with a chronic illness, so many people kept saying, “Are you sure it’s not in your head? Are you sure it’s not anxiety? Maybe you’re seeking attention.” For people to say, “I believe you, I believe what you’re experiencing. I believe that this is really hard for you,” I think that that is so powerful and probably the deepest level of seeing someone authentically and vulnerably.

All right, we’re getting close to the end here guys. You have held in strong. 

YOU ARE STRONGER THAN YOU THINK AND YOU HAVE GOT THIS.

The thirteenth thing you should say to a loved one with anxiety is, “You are stronger than you think and you have got this.” So good. Again, similar to what we’ve talked about in the past, but it’s reminding them of their strengths, reminding them of their courage, reminding them of their resilience. 

Sometimes when we’re anxious, we doubt ourselves, we doubt our ability to do the hard thing. They’re saying, “You’ve got this. Let’s go. Come on, you’ve got this.” But again, not in a way that’s demeaning or condescending, or invalidating. It’s a cheerleading voice. 

I KNOW YOU CAN RESIST THESE COMPULSIONS.

The fourteenth thing you should say to a loved one with anxiety, but I do have a bonus one of course, is,” I know you can resist these compulsions.” This is for the folks who have OCD and who do struggle with doing these compulsions. Or if you have an eating disorder, it might be, “I know you can resist restriction or binging or purging,” or whatever the behavior is. Maybe if you have an addiction, “I know you can resist these urges.” Same with hair pulling and skin picking. It’s really reinforcing to them that, “I know you can do this. I know you can resist this urge or compulsion, whatever it may be.” 

Again, it gives us a north star to remind ourselves what are we actually here to do. Because when we’re anxious, our default is like, “How can I get away from this as fast as possible?” Sometimes we do need a direction change of like, “No, the goal is to reduce these safety behaviors.”

BONUS: IT’S A BEAUTIFUL DAY TO DO HARD THINGS.

These are so beautiful. I’m going to add mine in at the end and you guys know what I’m going to say. We almost need a drum roll, but we don’t need a drum roll because I’m going to say that the 15th thing that I always say to any loved one, including myself with anxiety, is, “It’s a beautiful day to do hard things. It’s a beautiful day to do freaking hard things. It’s a beautiful day to do the hardest thing.” I say that because it reminds me to look at the beauty of it, to look at the reward of it, and to remind myself that yes, we can do hard things. 

My friends, thank you for allowing this to be a nice, soft landing for me today. I know I have to rearrange all the schedule and my podcast editor and my executive assistant is going to have to help me with all of the mix-up and mess around. But I’m grateful for the opportunity just to slow down with you this week. 

Take a deep breath. 

Drop into what do I need. I hope you’re doing that for yourself. I will see you next week back on schedule and I cannot wait to talk with you there. 

Have a wonderful day everybody, and talk to you soon.

Aug 11, 2023

Today, we’re talking about when anxiety causes depression and vice versa. This is a topic that I get asked about all the time. It can be really confusing and a lot of time, it’s one of those things that we talk about in terms of like, is it the chicken or the egg? I want to get to the bottom of that today. 

When anxiety causes depression, it can feel like your world is spinning and racing from one thought to another. You may feel a complete loss of interest in the things that you’re doing. You may have racing thoughts, depressive thoughts, or thoughts of doom. This can be really, really overwhelming. Today, I want to talk about when anxiety causes depression and how you might target that, and also when depression causes anxiety.

Let’s get into it. We’re going to go through a couple of things today. Number one is we’re going to go through why does anxiety cause depression, how does depression cause anxiety, how common is depression and anxiety, particularly when they’re together, and what to do when depression and anxiety mix. Now, stick around till the end because I’m also going to address how OCD causes depression and how social anxiety causes depression, and what to do when anxiety and depression impact your sleep, and in this case, cause insomnia. I’m so excited to do this. Let’s get started. 

349 When Anxiety Causes Depression (and vice versa)

WHAT CAUSES ANXIETY AND DEPRESSION

What causes anxiety and depression? Let’s look at that first. 

What we understand is that anxiety and depression—we don’t entirely know just yet to be exact, but what we know so far is that there is a combination between genetics, biology, environment, and also psychological factors. That’s a big piece of what we’re going to be talking about today. 

Now, if you want to know specifically the causes of anxiety, and that’s really what you’re wanting, you can actually go over to Episode 225 of Your Anxiety Toolkit. We have a whole episode there on what causes anxiety and what you can do to overcome anxiety. That might be a more in-depth understanding of that. 

But just in general, we do know that genetics play a huge component. However, we do know, talking about the psychological factors, that often people who do have depression, that depression does cause an increase in anxiety. A lot of people who have an anxiety disorder do notice that they feel themes of depression like hopelessness, helplessness, and worthlessness. 

WHY DOES ANXIETY CAUSE DEPRESSION?

Now, let’s first look at, why does anxiety cause depression? The thing to remember here is, anxiety alone doesn’t cause depression in all cases. There are lots of people who do have an anxiety disorder who don’t experience depression. However, we do know that for those who have a lot of anxiety, maybe untreated anxiety or anxiety that is very complex and they’re in the early stages of recovery or learning the tools and mastering those tools, it is common for people with anxiety or uncertainty to start to feel doom and gloom about their life. Often it comes in the form of feeling like, “Is this going to be here forever?” A lot of people will say, “What’s the point really of life if I’m going to be experiencing this level of suffering with my anxiety every single day?” And that’s very, very valid. 

When you’re suffering to the degree that some of you are with very chronic anxiety disorders, very severe degrees of anxiety disorders, it makes complete sense that you would start to feel like, “What is the point? How do I get through this? No one can help me. Am I someone who can be helped?” These are very common concerns. I myself have struggled with this as well, particularly when your anxiety feels so out of control and you don’t feel like you have mastery over it yet. I think that that is a very, very normal experience for people who have that degree of anxiety. 

This also includes other anxiety disorders like phobias, panic disorder, PTSD, and eating disorders. I know when I had my eating disorder, I felt so stuck, “How am I ever going to climb out of this deep hole that I’m in?” And that in and of itself made me feel depressed. I had what we call secondary depression. My primary condition was an eating disorder, and then I had a secondary depression because of how heavy and how overwhelming my primary condition was. 

If that’s something that you resonate with, I first want to acknowledge and recognize that this is very normal, very common, but also very treatable, particularly if you have a mental health professional who can help you. But again, I want to go back and say, just because you have anxiety or intrusive thoughts, doesn’t mean that you will be anxious and depressed for the rest of your life. With mastery and tools and recovery and practice and patience and compassion, you can actually slowly peel those layers of depression and anxiety away. 

WHY DOES DEPRESSION CAUSE ANXIETY?

So then we move over now and look at, why does depression cause anxiety? If your primary diagnosis or your primary disorder is depression, meaning that’s the first disorder you had and you didn’t have an anxiety disorder before that, or that’s the disorder that is the largest and the one that takes up the most space in your life. When we are depressed, often people will have anxiety about how much that depression is going to impact them in their life. Similar to the last points we made about anxiety. A lot of my patients and a lot of you folks have written in or messaged me or in my comments on Instagram talking about the overwhelming fear of relapse and the overwhelming fear of going back to those dark days when depression was so strong and you couldn’t get out of bed, and it was almost traumatizing how painful and how much suffering you are experiencing. It is, again, very normal to have a large degree of anticipatory anxiety about how that may impact you. 

Now, in addition, depression in and of itself will say some pretty mean things. Actually, let me rephrase that—will always lie to you about who you are, your worth, your future, your place in the world. When you hear those things on repeat, of course, you’re going to have anxiety about, will that come true? Is that possible? Oh my goodness, that’s not what I want for my life. This is not how my life was supposed to go. The messages and the narrative of depression in and of itself can create an immense degree of anxiety. 

HOW COMMON IS DEPRESSION AND ANXIETY?

Now, let’s take a look now, as promised, to look at how common anxiety and depression are. I’m actually going to read you some statistics here that I got from some really reputable journal articles, and I will link them in the show notes. 

One research said that generalized anxiety disorder affects 6.8 million adults in the United States. That’s 3.1% of the population, and that’s just in the United States. That’s not talking about the world. Yet, only 43.2% of them are receiving treatment. That’s from the National Institute of Mental Health. Now, what’s interesting about that, as I remember sharing before, is being untreated increases your chances of having both. Because as you can imagine, if you’re having a disorder and it’s not improving, you’re going to feel more depressed about it and you’re going to feel more anxious about that. 

Statistics also show that women are twice as likely to be affected as men with generalized anxiety. Generalized anxiety disorder often co-occurs with major depression. They are almost always going to go together. Now, we also know that depression is a very common illness worldwide, with an estimated 3.8% of the population affected. That’s 5% for adults and 5.7% for adults older than 60 years. That’s very interesting as well to see how our age can impact these disorders, and that comes directly from the Institute of Health Metrics and Evaluation.

We have some really important information here to show that there is a huge overlap between the two. And then it gets murky because then, again, as I mentioned in the intro, is it the chicken or the egg? Which one do we treat? Which one do we look at? Which one came first? Which is the primary? Which is the secondary? 

WHAT TO DO WHEN DEPRESSION AND ANXIETY MIX?

Let’s talk first about what to do when depression and anxiety mix, because that’s why you’re here. It’s important and what’s cool is to recognize that we have a treatment that can target both. As you all know, I’m a Cognitive Behavioral Therapist and we have a lot of research to show that cognitive behavioral therapy or CBT can help with both. Thank goodness, it’s not that you have to go to one particular treatment for one, and then you have to learn a whole other treatment for another. We actually have this one treatment that you can use to address both in different ways. 

Now, CBT is going to be looking at your cognition, your thoughts, which we know with anxiety and depression, there are a lot of irrational, faulty thoughts. It also looks at your behaviors and how those behaviors may actually be contributing to your anxiety and your depression. Not to say that it’s your fault. I want to be really clear here. We are not saying that this is all your fault and you’ve got bad thoughts and you’ve got bad behaviors. That’s why you have both and you’re going to be stuck in both until you change that. Absolutely not. We’re not here to blame. What we’re here to do is be curious about our thoughts and about our behaviors, and then look and do experiments on what helps and what doesn’t.

I’ll give you an example of a really basic CBT skill that I used recently, and that was that somebody I knew was talking about how difficult it is to go to bed. They get really depressed going to bed. It makes them have a lot of thoughts about how they didn’t get done what they wanted to do. They would procrastinate going to bed, but before they know it, it would be 3:00 AM in the morning or even later. They still haven’t yet journeyed through their night routine to go to bed. 

We talked about what would be effective for you, what behavior change would be effective for you to move into the direction that you want. With CBT, we are not looking at 17 different changes at once. We might make one simple change at a time and then look at your thoughts about that. This is a really important way for us to be curious and do experiments and look at what’s effective and what’s not effective and make small little tweaks to your behaviors. 

Now, some examples of this, we go through this extensively in our online course called Overcoming Depression. We also go through this extensively in our online course called Overcoming Anxiety and Panic, where we thoroughly go through your thoughts and then do an inventory of your behaviors. I give tons of examples of little ways that you can change behaviors, moving in ways that will reduce the repetition of these disorders. Let’s talk a little bit about that. 

One really important piece for depression when we’re talking about behavioral therapy is activity scheduling. The less routine you have, the more likely you are to be depressed. Often people with depression tend to lose their routine or they have lost their routine, which can actually contribute to depression. What we might do is we might look at our day and implement or add just one or two things to create some routine. Once you’ve got those things down, maybe you have a morning routine in the morning where you take a walk at eight o’clock, and that’s it for now. Let’s just try on that. And then by lunchtime, we might add in some kind of pleasurable activity. Because we know with depression, as I mentioned at the beginning, depression can take away our pleasure or interest in hobbies. We might introduce those back, even though I know that you’re not going to experience as much pleasure as maybe you used to. But we’re going to experiment and be curious about bringing back things into your life like paint-by-number, crochet, or whatever it might be. 

I personally just took up crocheting when I was in Australia. My mom insisted that I learn how to crochet and it’s quite impressive to me how something so simple can be such a mindful activity. Even though I only do it for 5, 10, 15 minutes a day, that in and of itself can be an incredible shift to our mental health. Again, I want to make clear, none of these alone will snap you out of depression. It’s a series of small baby changes in a direction that is right for you and is in line with your values.

Now, another thing you can do when depression and anxiety mix is to consult with your doctor about antidepressant medications for anxiety & depression or what we call SSRIs. We know that research shows that a combination of CBT and medication is a really effective way to come out of that hole of depression and anxiety. If that’s something you are interested in or willing to consider, please do go to a medical professional or a psychiatrist and talk with them about your particular needs. It can be incredibly helpful. I know for me, during different stages of my life, SSRIs have been so, so helpful. That’s something that you could also consider.

The next thing you can do when depression and anxiety mix is to consider exercise. We actually have research to show that exercise is as effective as medications or SSRIs, which blows my mind. Actually, I think it’s so wonderful that we have this research. In my opinion, add it slowly to your calendar. I’m not here to say this means you have to go out and do an hour class at the gym. It could be as simple as taking a walk around the block. 

Actually, recently, as many of you follow me on Instagram, I am trying to get back to exercising more as I still continue to recover from my chronic illness, POTS. I don’t go and do huge workouts. For me, it’s first starting in baby steps, 5, 10 minutes. Or can I do a plank for 30 seconds? And that’s it to start. I want to again encourage you to take baby steps here and implement just little things at a time. And then ask yourself, how does this feel? Did this help? Did this hinder? How does it feel in my body? And then if you need to, talk to a mental health professional about what would be the best step for you next. Now we also know that exercise aids relaxation, it aids over well-being. It’s incredibly helpful, again, for your mental health. That’s something you can consider and consult with a doctor as well. 

Now another thing you can consider is relaxation techniques. Now here, we’re not talking about doing breathing just to get rid of anxiety. We know that that doesn’t typically work, but there are ways in which you can learn to breathe as an act of self-compassion, of slowing down and acknowledging where you are and slowing down your behaviors, and checking in with yourself. This does include some mindfulness or you can even consider taking up one or two minutes of meditation a day. These techniques can be very helpful for both depression and anxiety. 

Again, I keep teasing this, but I keep having technical issues. We will eventually have a meditation vault for you guys that will have meditations for anxiety and depression specifically and anxiety with intrusive thoughts. I’ve tried my best to continue to add. We’ve got probably over 30 meditations already. That will be available to you soon as well, so do keep an eye out for that.

HOW OCD CAUSES DEPRESSION? 

Now, let’s talk as promised about how OCD causes depression, because I know a lot of you out there have OCD. If you don’t have OCD, stick with this because I’m also going to go through here about insomnia. We do know that statistically, OCD affects 2.5 million adults. That’s 1.2% of the population. That’s just what we know of. That’s not actually the real stats because there are so many people who haven’t reported it because of stigma and shame and so forth. We know here that women are three times more likely to be affected than men. That’s actually not my experience. I think I have a 50/50 in my clientele. But that’s what the statistics show. 

Again, as you can imagine, if you have OCD and you’re completely flooded with intrusive thoughts, you’re doing compulsions for hours, you’re stuck in a mental loop, I think the research shows 80% of people also have depression, up to 85%. Now, that is significant in the overlap and it just shows how much OCD can take you down and really target your worth and your sense of identity and your self-esteem and how much shame and guilt and blame goes along with those. When you’re experiencing that, of course, you’re going to experience some depression or themes of depression, as I said before, hopelessness, helplessness, and worthlessness. 

If this is the case for you, what we often recommend, again, especially if the primary condition is OCD and then you have depression because of that, we really want to target getting you better from OCD as soon as we can. A lot of the time, when depression is caused by the anxiety disorder, the major treatment goal needs to be getting that primary condition under control. Often once we get that primary condition under control, the depression does lift.

Now, again, it’s different if you’re someone who’s always had depression or had it throughout your life. We still want to go back and look at cognitive behavioral therapy or mindfulness-based cognitive behavioral therapy. We also want to look at maybe including a massive self-compassion practice because that is absolutely key for all of these conditions, no matter what, whether they’re coexisting or not. But you can also include other modalities like acceptance and commitment therapy. You could also do other modalities such as dialectical behavioral therapy. That’s particularly helpful if you’re engaging in impulsive behavior or self-harm. You’re having a tremendous degree of suicidal ideation, or sometimes in some cases, suicide attempts. These are other options you can add to your cognitive behavioral therapy if you require it. Because remember, we have to look at you as a person, not just you as a diagnosis. We have to really be certain that we look at all the symptoms, you have a thorough assessment, we’re clear on what’s the primary and secondary condition, and then we can create a treatment plan for you that targets those specific symptoms. 

If you have OCD and you don’t have access to a mental health professional, we do have ERP School, which is an online class for OCD, it’s on demand. You can watch it as many times as you want. You can go to CBTSchool.com to get any of these courses. But that is there for you. I made it specifically for people who either don’t have access to mental health services, can’t afford them, or have had it in the past and they just want to hear it be said in a different way. Maybe you really like my way of training and teaching and you want to hear it and how I apply it with my patients. All of the courses that I have recorded are exactly how I would treat my clients and how I would walk them through the process. They’re there for you if you would like.  

HOW SOCIAL ANXIETY CAUSES DEPRESSION?

Now let’s move on to how social anxiety causes depression. Now, this is true for everything, and forgive me because I should have mentioned this before. One of the most common safety behaviors that come out with social anxiety is avoidance, isolation. But I should have mentioned before, that is very true of any anxiety disorder. It’s very true of OCD, it’s very true of post-traumatic stress disorder. When we isolate and we avoid, we do tend to feel more depressed because we have less connection in our life, we have less interaction, which can be a really great way for us to stay present. When we’re in a room by ourselves with our thoughts, that can always create more anxiety and more depression. That’s very common for social anxiety. 

The other thing to remember about social anxiety too is the voice of social anxiety is also very, very mean, just like OCD and generalized anxiety and depression. Thoughts we have when we have social anxiety are often like, “You look like an idiot. You look awkward. What’s wrong with you? Why did you say that? You shouldn’t have said that. They’re going to think you’re stupid.” As you can imagine, those thoughts in and of themselves will create more anxiety, and that secondary depression, that layer of like, “I give up. I can’t do this. This is too hard. What’s even the point of trying?” 

WHAT TO DO WHEN ANXIETY AND DEPRESSION CAUSE INSOMNIA

Last of all, we want to talk about what to do when anxiety and depression, or one or the other, cause insomnia. Now, it’s important to recognize here that one of the core symptoms of depression is insomnia or getting too much sleep. It can go either way, but there are some people who have depression and one of their symptoms is they cannot fall asleep. They lay in bed for hours just round and round and round ruminating. That is true for any of the anxiety disorders as well. 

When you have anxiety and you have depression, you go to bed, you turn the lights off, and you are left with your thoughts. If your thoughts are mean, if your thoughts are catastrophic, if your thoughts are very much in the theme of hyper-responsibility or perfectionism, it’s a very high chance that you’re going to get stuck being completely overwhelmed with those thoughts and then have a hard time falling asleep. What happens there, as this is the theme of today, is it becomes a cycle. The less sleep you get, the more anxious you might feel. Or the more that you have anxiety, the more you might be afraid you won’t fall asleep, and that anxiety in and of itself keeps you up and you’re caught in a cycle. 

What I want to offer to you here, as we look at all of these conditions, let’s wrap this up for you, is number one, if you have anxiety and/or depression, you are so not alone. I would say the majority of my patients have both. No matter what anxiety disorder, they have little inklings or massive degrees of depression. That does not mean there’s anything wrong with you and it doesn’t mean you cannot move into recovery. It also doesn’t mean that this is your fault. 

I really want to emphasize here that with compassion and baby steps and PATIENCE, we can slowly come out of this place and get you back out. I strongly encourage you to reach out and have a team around you who can support you, even if you haven’t got access to a mental health professional, your medical doctor, or any friends you may have, family. Maybe it’s using resources like online courses or workbooks. We have, for people with OCD, The Self-Compassion Workbook for OCD. They’re amazing workbooks for depression. One I strongly encourage you to consider is a book by David Burns called Feeling Good. It’s an amazing resource using cognitive therapy for depression. These are things that you can bring in and gather as a part of your resources so that you can slowly find your way out. Hopefully, the clouds will separate and you can see the sky again. 

I truly want to recognize here that this is really hard. We’re talking about two very influential conditions that bully us and can make us feel hopeless. I want to recognize that and validate you and send you a large degree of love because this is hard work. 

As I always say, it is a beautiful day to do hard things. I say that because if we can look for the beauty, that in and of itself is a small step to moving out of these conditions. Look for the beauty in your day, and see doing the hard things as a beautiful thing because, with each hard thing you do, you’re taking one step closer to your recovery. You just focus on one hard thing at a time, and then you focus on the next hard thing and you celebrate your wins, and you of course act as kindly and as compassionately as you can.

Thank you so much for being here. I hope that was helpful. We went all the way through what to do when anxiety causes depression and vice versa. I hope you took so much from today’s video and podcasts. For those of you who are listening on podcast, do know that we will be introducing a lot of these on video on YouTube as well. If you want to see my face, I will be over on YouTube as well. 

I’m so honored that you have spent your time with me. I know how valuable your time is. I do hope that you have a wonderful day. Please do remember it is a beautiful day to do hard things and I am here cheering you on every step of the way.

Aug 4, 2023

Welcome back, everybody. It is so good to have you here talking about hyper-responsibility & hyperresponsibility OCD. A lot of you may not even know what that means and maybe have never heard it, or maybe you’ve heard the term but aren’t quite sure what it entails. And some of you are very well acquainted with the term hyper-responsibility. I thought, given that it’s a theme that’s laced through so many anxiety disorders through depression that we should address it. I think that’s a really great starting point.

WHAT IS HYPER-RESPONSIBILITY OCD?

Let’s talk about first what is hyper-responsibility. Hyper-responsibility is an inflated sense of responsibility. It is feeling responsible for things that are entirely out of your control, such as accidents, how other people feel about you, how other people behave, events happening in your life. It’s ultimately this overwhelming feeling that the world rests on your shoulders, that it’s up to you and it’s your job to keep yourself and everybody else safe. Even as we look at this definition of what hyper-responsibility is, I’m actually feeling and noticing in my body this heaviness, this weight that you’re carrying, and it is an incredible weight to carry. It is an incredibly stressful role to play. If you’re someone who experiences hyper-responsibility, you often will have additional exhaustion because of this. 

348 Hyper Responsibility When you feel responsible for everyone and everything

WHAT IS THE DIFFERENCE BETWEEN HYPER-RESPONSIBILITY AND RESPONSIBILITY OCD?

One thing I want to clear up as we move forward is first really differentiating the difference between hyper-responsibility and responsibility OCD. When we say “hyper-responsibility,” we’re talking about a heightened sense of responsibility. Actually, let me back up a little bit. We do have responsibility. I am an adult. I’m responsible for my body, I’m responsible for two young children, a dog. Responsibility is one thing. You need to keep them safe, you need to take care of them, you need to show up in respectful ways. But hyper-responsibility is so much more than that. It’s taking an incredible leap of responsibility and feeling responsible for all the teeny tiny things, like I said before, that are out of your control. 

Now, once we’ve determined what responsibility is, then we can also look at responsibility OCD. Now specifically for those who have responsibility OCD is where this sense of hyper-responsibility has crossed over into meeting criteria for having the obsession of hyper-responsibility that’s repetitive, intrusive, unwanted, and you’re also engaging in a significant degree of compulsions that, again, meet criteria for OCD. They could be mental compulsions, physical compulsions, avoidant compulsions, reassurance-seeking compulsions, and so forth. 

The way I like to think of it is on a spectrum. We have responsibility on one side, then in the middle, we have hyper-responsibility, and then it goes all the way over to responsibility OCD. Some people will differentiate them differently in terms of they will say, hyper-responsibility is the same thing as responsibility OCD. But I’m not here to really diagnose people, and I’m not here to tell people that they have OCD if they don’t quite resonate with that. I’ll use me as an example. I 100% struggle with hyper-responsibility in certain areas of my life. But the presentation of that hyper-responsibility, I don’t feel, and I’m sure my therapist doesn’t feel, meets criteria for me to get the diagnosis of OCD. That’s why I want to make sure this is very loose so that you can decide for yourself where you fit on that spectrum. 

HYPER RESPONSIBILITY SYMPTOMS OR RESPONSIBILITY OCD SYMPTOMS

A little bit more about hyper-responsibility symptoms or even responsibility OCD symptoms. Examples will include: when something goes wrong, you’re probably likely to blame yourself and feel guilty for the fact that something went wrong. Even disregarding whether it was your fault or not, you’ll feel a sense that this was your mistake, that you should have prevented it. 

Another hyper-responsibility symptom is you might believe that it is up to you to control the outcomes of your life. It is up to you to control the outcomes of other people’s lives—your dependence, your partner, your family members, and so forth, the people at your work, the projects at your work, or at school. 

Another symptom of hyper-responsibility and responsibility OCD is this act of always trying to “fix” the problem. Even when you’ve recognized that there is no solution, you feel this need to just keep chipping away and finding the solution to prevent the bad thing from happening or being responsible for the bad thing. You may spend hours trying to prevent accidents or bad things from happening. What I mean by spending hours is it takes up a significant degree of your time, and it’s usually quite distressing. It’s a heavy feeling. 

There is a difference between responsibility and hyper-responsibility. An example might be my husband found that one of our decks was rickety and shaking, and he felt it was his responsibility to fix that. He did it in a very measured way, in a very rational way, and it was coming from a place of his genuine value and his genuine view that it’s his responsibility to fix that. However, hyper-responsibility would be fixing it, but then also checking every part of it to make sure that it was safe, spending a lot of time going over all the possible scenarios on how it may not be safe, how it could have been safer, what it would mean if something bad happened, replaying. I actually shouldn’t use the word “replay.” It’s almost like future forecasting what would happen and who would be at fault if something bad did happen. 

Again, if we even went further into more responsibility OCD, it might involve repetitively doing these over and over again to get a sense of relief from this hyper-responsibility or to absolutely get security and certainty that nothing bad will ever happen. Often in this case, if I was using this example, maybe they would do the avoidant compulsion of saying, no one’s allowed on the deck, even though it might be a safe, secure deck. That’s just one example. It’s probably not the best example, but I’m trying to use it in contrast to the many ways in which this can play out, especially for those who don’t have hyper-responsibility. 

A thing to remember is, people who don’t have hyper-responsibility may look at the person with hyper-responsibility with a quite perplexed look on their face because to them, they can’t understand why the person feels so heavy loaded with responsibility. And that can be very frustrating, particularly as it shows up in relationships. 

Now, an inflated responsibility may also present as people-pleasing, which is really an attempt to control how people feel about you. It may also present as giving a lot of money or time to charities or groups of people who are less privileged and so forth. Again, let’s get really nuanced. It doesn’t mean if you donate money that you have hyper-responsibility. A lot of these actions people may do from a place of value. But again, we always want to look at the intention of why they’re doing it, and are they doing it to reduce or remove this feeling that they’re having? 

Another symptom of an inflated responsibility is over-researching unlikely threats or possible scenarios. You’re really doing it to try and prevent something bad from happening. Is it possible that someone could fall off a deck? Sometimes I’ll explain it to you, for me personally, often it’s related to the law. For me, it will show up in, “Oh, I’m a boss. I’m someone who has employees. What are all the possible scenarios that legally could impact me? Let me do a lot of research around that.” Until I catch it, and I’m like, “Kimberley, you’re engaging in a ton of reassurance here. Let’s not try to solve problems until they’re actually here and actually a problem.”

Another example of an inflated responsibility is keeping physical or mental lists like, did you do this? Did you do that? Did you do this? That’s really an attempt to make sure nothing bad has happened. 

One other thing is—I remember doing this a lot when I had a baby—checking the baby over and over. I felt that it was my responsibility to keep this baby alive, and yes, it was my responsibility to keep my baby alive. But I had somehow taken it upon myself that if something happened, I would be fully at fault. That it wouldn’t have been my husband’s fault, who’s laying right next to me, who is a fully engaged and loving dad. I had taken it on myself that 100% of the responsibility of her wellness and his wellness, my children are mine, and if something happened, 100% of the fault would be on me. 

I have such compassion for the moms out there who experience this responsibility weight on their shoulders. I think number one, it’s societal. Number two, I think it’s normal, again. But number three, it’s so terrifying because often, not just for moms, for everybody here, the thing that we are worried about are often people we deeply love too. The things that we hold in high value. That’s again why it can be so incredibly painful. 

Now, while these behaviors don’t necessarily, again, mean you have hyper-responsibility or OCD. Again, I want you to think of it like it’s on a spectrum. It is important to know that lots of people with OCD experience hyper-responsibility in many areas of their lives, and that hyper-responsibility shows up in many different subtypes of OCD, many themes of OCD. If you have OCD, you can really put that in your back pocket and keep an eye out and really increase your awareness of how hyper-responsibility is showing up and making it harder for you to overcome your obsessions and compulsions. 

We can all agree as we move forward that hyper-responsibility deeply, deeply impacts somebody’s mental health and their overall well-being. My hope is now to give you some tools, some things that I’ve found helpful for me to manage that—things that I’ve had to practice over and over again. 

WHAT CAUSES RESPONSIBILITY OCD & HYPER RESPONSIBILITY?

Now, before I do that, let’s quickly check in on, often people will ask what causes responsibility OCD or hyper-responsibility. There are a couple of things to think about here. When I’m talking with patients who have OCD, I don’t spend a lot of time digging deep into childhood stuff and bringing up old events and so forth. For some people, that can be incredibly helpful. I tend to find it often does become compulsive and we spend a lot of time there instead of actually targeting the behaviors that are problematic. But for the sake of today, of just giving you some education, we do know that hyper-responsibility CAN, not always, but CAN come from childhood experiences and family dynamics. Often a child may feel it’s their job to take care of other people. Maybe they’ve been taught that. Maybe they’re the eldest sibling and they were given a lot of responsibility. Maybe their parents were very, very strict, and that for them, they felt that they had to maintain that perfect demeanor and perfect school report and so forth. We do know that childhood experiences, that environment that we were raised in can impact someone’s experience of hyper-responsibility. 

We also know that brain disorders like OCD, other anxiety disorders, or even depression, or trauma—trauma is not a brain disorder—these mental health disorders can also exacerbate the theme of hyper-responsibility in people. 

We also know that external pressures, societal expectations, the way our culture raises us can also add to a sense of hyper-responsibility. I know for me, as I’ve thought about this a lot recently, which was a part of the reason why I wanted to do this episode, I am a therapist; it’s an incredible weight of responsibility to be a therapist. I’m surrounded by laws and ethics and licensing boards and all of these rules. I find that the environment of my work can very much nurture my already inclination to have hyper-responsibility. I do think too the environment we are even in as an adult can keep this going. 

And then the last thing I want to look at, which we’ll talk about here in a second, is simply irrational beliefs and rules we keep for ourselves can very much “cause” (I don’t like to use that word) and exacerbate hyper-responsibility. 

STRATEGIES FOR MANAGING HYPER-RESPONSIBILITY

Now that we have this and we can get a feel for why someone may experience this, now let’s talk about some strategies for managing hyper-responsibility. Because that’s why you’re here and that’s what I really love to do the most. Let’s talk about it.

First, when I’m managing my own hyper-responsibility or I’m talking with patients about it, the first thing I do is get really clear on what is your responsibility and what is not. I often will do an exercise with my patients and say, “Okay, you are a human being. I want you to write me a job description of what you need to do to be a human being, to exist as a human being.” Let’s say I owned a supermarket and I hired someone to work at the register, the job description would say exactly what is your responsibility. It would say, “You need to turn up at this time, you need to leave at this time. When you come, you need to log in, you need to clock in, you need to put your uniform on. Here’s the things that you need to do that are your responsibility.” And then that employee has a very clear understanding of what their role entails. 

Now, for you as a human, and everybody’s job description looks a little different, I want to first get clear on what is your responsibility. For me, I’ll use an example, I’m a mom, so I do have to be responsible for the well-being of my two children. But let’s get a little clearer on what that means. Does that mean I have to just keep them fed and dressed? Or does that mean for me and my values that I keep them fed and dressed and have a degree of emotional support, but to what degree? This is why I want you to get really clear on what it is for you and your values. 

And then once we do that, you can actually sit with a trusted person—either a family member, a therapist, a mental health provider, or a loved one—and start to question how much responsibility you’re taking on. Of the things on your list, what are the things that are actually not in your control? Not in your control. Because if you have an anxious brain, remember your brain is going to tell you all of the worst-case scenarios. That’s your brain’s job. If you have an anxiety disorder, you’re probably got a hyperactive brain that lists them off like a Rolodex, da da, da, really, really fast. All the worst-case scenarios. 

People with hyper-responsibility often use that Rolodex of information and just start adding that to their job description. “Oh, well, if there’s a possible chance that they could run out and whatever it may be, well then I have to protect for that,” even though it hasn’t happened and it’s highly unlikely. You can start to see, once you are looking at this list of rules you have for yourself, where you’ve pushed from just having a responsibility to having hyper-responsibility. 

Another example might be in relationships. I’ll use again me as an example. My husband and I are going to be 20 years married this year. For years, I took on as my responsibility that I was supposed to keep him happy. Over and over again, I found that I was unable to do this because I’m a human being and I’m faulty and I’m going to make him mad and annoyed sometimes. But I’d taken this responsibility that it was my job to maintain his happiness. And that’s not actually the job description of being a human being. Once I started to go through this with my therapist at the time, I’m starting to see, I’m trying to control things that are out of my control. 

The second thing I want you to think about is once you are clear on what is your responsibility, you have this great roadmap now. Now you have to think about staying in your lane. I may have talked about this on the podcast before, but I talk about this a lot with my patients. Once you’ve determined what is in your control, what is in line with your values, not just what anxiety’s telling you, but what you believe is a healthy limit for you, then you can work at keeping yourself within those parameters and practicing not engaging in picking up responsibility outside of your lane again. 

We always use the metaphor of like, I’m in my car, I can control what kind of car I drive, what speed I go, that’s my responsibility. But let’s say my child is in the lane, metaphorical lane next to me, and they’re speeding like crazy, and they’re driving all over. My kids haven’t got a driver’s license, just stay with me for the metaphor. But let’s say my kid or my partner is in their car and they’re smoking and they’re checking their phone and they’re swaying all over and they’re doing all these things. I have to then determine, if I’m going to respond to that, what is my capacity in my lane. Let’s say it was my husband. I have to basically accept that he’s a full-grown adult who is responsible for himself, which sucks. Believe me, I know. This drove me crazy that I had to let him be in his own lane and I had to stay in my lane. 

I remember having fights with my therapist, not actual fights, but conversations. I’m like, “If we were using this metaphor, he could die. He could get himself into trouble.” She would say, “Yes, and you’re going to have to decide what’s best for you. There’s no right for every one person. We’re not going to treat everyone the same, but you have to take responsibility for how much you engage in trying to control the people around you, and you also have to be willing to allow this to be out of your control sometimes.” You can imagine me sitting in the chair. This was way before COVID. I’m sitting back on the couch and my arms are crossed and I’m all mad because I’m just coming to terms with this idea that I can’t be responsible for everything, that I’m exhausted from trying, that I’m creating a lot of relationship drama because of my attempt to take control and be hyper responsible. I had to give it up. But the giving up of it, the staying in my lane required that I had to feel some really uncomfortable feelings.

Let’s just take a breath for that because it was tough and it is tough. I’m sure if you are experiencing hyper-responsibility, you too are riding strong waves of guilt, regret, shame, anger, resent because of this hyper-responsibility. 

If this is you, what you can also do is really double down with your mindfulness practice. The biggest, most important piece of this is increasing your awareness of where it shows up in your life, in what corner, and how it creeps into little parts of your life, and noticing when it does and why it is. In that moment, maybe the question might be, what is it that I’m unwilling to feel? What am I unwilling to tolerate in this moment, and how might I increase my willingness to feel these feelings of guilt or regret or shame, or anxiety, massive degrees of uncertainty? Can I allow them without engaging in these behaviors that just keep this hyper-responsibility going? It’s a huge test of awareness. And then we double down with kindness, and I’ll tell you why. Because when you have hyper-responsibility, you’re probably going to be plagued with guilt. You feel guilty for all the things happening with someone. We feel anxious because we didn’t get it right. We couldn’t keep the things straight and perfect and it’s really, really heavy. 

In order for us to negotiate with ourselves through those emotions in a non-compulsive way, we have to have a self-compassion practice where we give ourselves permission to get it wrong sometimes. We give ourselves permission to make mistakes sometimes. We allow things to fall apart. That’s the hard part, I think. It feels so wrong to not be fixing things all the time. It can feel so irresponsible to not be preventing things and we have to be willing to navigate and ride through that compassionately.

Now, if you’re someone who really struggles with guilt, I’ve got two podcast episodes that you really need to go and listen to. Number one was Episode 161, which is all about this idea that feeling guilty does not mean you have done something wrong. A lot of people with anxiety, hyper-responsibility, and OCD think and feel that if they feel guilt, it must be evidence that they did something wrong. We have a whole episode, Episode 161 again, where you can go and listen and learn about how our brains make mistakes on this one. 

In addition, if you are someone who has OCD and you really struggle with regret and guilt, we also have another Episode 310. It wasn’t that far gone, that I talked about how regret and guilt are also obsessions. Meaning we have intrusive thoughts, we have intrusive feelings, and sometimes the intrusive feeling is guilt and regret. Please do use that resource as well. 

And then the last thing I would want you to think about here is, for those of you who are in the background listening, but secretly thinking, “But I have screwed up. I have made mistakes. I’ve made so many mistakes and I need to make sure that never happens again,” number one, let me slow down for a sec—I want to first acknowledge that you are a human and you will make mistakes just like I am a human and we will continue to mess up over and over again. Let’s just get that out in the open. Let’s just come to a place where we can acknowledge and humble ourselves with the fact that yes, we are going to make mistakes. A part of you in this moment when you’re saying, “But I’ve made mistakes, I’ve really screwed up,” is that you will not accept that that is a part of being a human. That is the tax on being a human, my friend. You’re going to have to come to a place of acceptance of that. 

Often people say, “That sucks. I don’t want that,” and I’m going to keep saying, “But you will.” They’ll say, “But I don’t want to,” and I’ll say, “But you will.” We could go all day on that one. But if you are someone who actually did screw up, it then again becomes a concept or a practice of when you screw up, how do you handle it? Do you screw up and beat yourself up for days and days and months and months and years or years? Or do you screw up and learn from it and acknowledge your humanness and learn what the mistakes are, and then do your best to pivot within the rules in which you set in what we said was your lane? Because often what happens is we do all this work, we address our job description as being a human and what’s just within your line of values and what’s your regular human responsibility. And then when something goes wrong, they hypercorrect and they go back to these rules that include a lot of control, a lot of preventing, a lot of ruminating, a lot of making sure, and you’ve gone back to being in all of everybody’s lanes. If you’re struggling with this, you can go to Episode 293. I did an episode called “I Screwed Up, Now What?” I really think that that was an episode where I had made a massive mistake and I was navigating through it in real-time and sharing what I thought was helpful. 

RESPONSIBILITY OCD TREATMENT

If you’re wanting to learn more about responsibility OCD treatment, I’m going to strongly encourage you to look for an exposure and response prevention therapist who will be able to identify your specific subtypes and help apply an ERP plan for you. Now, if you cannot access professional help, you can also go to CBTSchool.com. We have ERP School, which is our online course teaching you how you can practice ERP. The course is not specifically about hyper-responsibility, but it will allow you to do an inventory of your specific set of obsessions, your specific set of compulsions, and put a plan together so that you can start to target these behaviors on your own. You can very much get up and running on your own if you do not have access to professional mental health. The whole point of me having those courses isn’t to replace therapy. It’s there to help you get started if you haven’t got any way to get started. Often people go there because they want to know more and they want to understand the cycle of OCD, and that’s why we made it.

My lovely friends, that is hyper-responsibility. We’re talking about when you feel responsible for anything and everything and everyone. If that is you, let me leave you with this parting message: Please slow down and first recognize the weight that you’re carrying. Sometimes we have to do an inventory of the costs of this hyper-responsibility because it’s so easy just to keep going and keep carrying the load and pushing harder and solving more and preventing more. But I want you to slow down for you as an act of compassion and take stock of how heavy this is on you, how exhausting this is on you, and then start to move towards acknowledging that you don’t have to live this way, you don’t deserve to live this way. That there is another way to exist in the world compassionately and effectively without taking on that responsibility. If you need support, of course, reach out and get support because you don’t have to do it alone. There are ways to crawl out of this hyper-responsibility and get you back into that lane that’s healthy for you. 

I’m sending you so much love. I hope you’re having a wonderful summer for those of you who are in the northern hemisphere. I have just gotten back from the southern hemisphere and I loved getting some sun. I’m so happy just to be here with you and keep working through this stuff with you and addressing these really cool, important topics. 

Have a wonderful day. Do not forget, it is a beautiful day to do hard things. Take care.

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