Your Anxiety Toolkit - Anxiety & OCD Strategies for Everyday

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Now displaying: December, 2022
Dec 30, 2022

Welcome back, everybody. I am thrilled, thrilled, thrilled to have you here again, finishing out the year so strong. In this episode, we planned perfectly for this week because my guess is that you’re starting to make New Year’s resolutions or make New Year’s goals, and we wanted to talk, myself and the amazing guests that we have this week, about how you can change your habits in the most compassionate and effective way.. 

We have back this week with us Monica Packer. She’s been on the show before. To be honest, she’s like a warm hug to me. I just feel like it’s just sitting down and having a chat with a dear long friend, like an old friend. I love speaking with Monica. She’s just got such deep wisdom to her. And so, today, we got together and talked about how to change your habits compassionately and effectively. Because when people set resolutions or New Year’s goals, they’re just talking about creating new habits, like how can I create new habits in my life? How can I make a change in my life? And sometimes, we tend to do that in a very aggressive, critical way. And so, we wanted to sit down and talk about how we can do that in a compassionate, effective way.

317 How to change your habits (with Monica Packer)

Kimberley: Okay. Welcome, Monica. I’m so happy to have you here. 

Monica: Oh, it really is a joy. I just love everything you do and who you are, more importantly. So, I’m excited to be here again.


Kimberley: Thank you. Thank you. Okay, so you and I were chatting, and I love this idea of preparing for the hard day, but particularly emphasizing how to change your habits that prepare you for your dark day or your hard day. Tell me a little about why that is so important to you or even how you’ve implemented this in your life.

Monica: When I think back on my history with habit formation, it was clouded for a long time with these all-or-nothing models that taught me to have good habits, they needed to look this way, and it needed to be formed in this way. It needed to be consistent in this way. And a big part of that was not only were we supposed to have an ideal, we were supposed to start with the ideal. You just decide what the habit is and then you do it for 28 days, or whatever number we all have in our heads. You get to that magical number and it’s a habit. And that never worked for me. And so, for a really long time-- well, it worked for me when I was the type A, very overachieving perfectionist. But that came at a big cost in my life. And we talked about that I think in our past interview we did together. And that cost was not one I was willing to make for a long time. I wasn’t willing to sacrifice my mental and physical and spiritual health and my relationships anymore to be so performing. 

And so, because of that, I thought that was the only way to, one, progress in your life and have goals, but also trickle down to habits. I just thought I can do the habits that are required of me for my work and for my family, home management kind of things. But for myself, that was a different story because I thought, no, these are the habits I want, and they’re so beautiful and amazing and would be so helpful in my life. But in order to get there, I can’t do what that requires. I can’t, so I just didn’t. 

But then when I got back into habit formation a few years ago, which was not a plan of mine, but it just happened naturally as I was really working on identity and fulfillment in my life, I realized those two areas had to be supported with habits to just even give me the time and the energy to carve out what I needed to for those two areas of my life. And as part of that, I had to figure out habits in a new way. 

I know this is a really long answer to your question, but the nutshell version of this is that a lot of us, if not all of us, are set up to fail with habit formation in the way that we’ve been taught since we were little kids. I mean, even that number thing I said alone, like how many days does it take to form a habit – we all have a number because we’ve been taught a number. But that number is not realistic for most people, especially if you’re in a caretaking role or in any kind of position or season of life where you have to be more reactive in nature to your responsibilities. Every day is different. Every season is different too. There’s that kind of flexibility that makes it so you have to do habits differently. 

And so, what I’ve learned over the past few years is that, instead of starting with an ideal version of a habit, and that being “This is my habit,” those are only ideal. Those are only possible for those best of days kind of days. When you get really good sleep, your routine is really set. It’s more predictable. And that didn’t work for me, didn’t work for most of the women I work with. I work with primarily women. So, instead, what we want to do is both start with what I call a baseline habit and always have that be the foundational habit we come back to on our worst of days. 

The baseline habit to me is, the ideal is the highline. We definitely want to have the ideal in mind, like this is what I want ultimately. But the baseline is your foundational way to get there. It’s the form of the habit that you can do on your worst of day, when you’re really tired, when you’re going through a depressive episode, when a kid feels really sick during the night, whatever it is. And having that baseline version isn’t you lazying or-- what’s the word? It’s not you being lazy, it’s not yourself saying, “Oh, I’m just going to get my permission to not do the habit.” It’s no. This is my best-of-day version today on this worst-of-day. This is the best I can do on this day. And because I have this version of it, not only am I able to create a habit faster, like I don’t have to wait for a perfect 28 days, I also have something to always fall back onto on those days where I’m not having an ideal day. And that gives me the consistency I need to not only have that habit and what it’s going to provide for me, but also have the foundation to build on, so it gets higher and higher. And boy, I don’t even know how long I just talked


Kimberley: No, no, no, no. I have lots of questions. So, what does this look like? I love this idea – the baseline habit first. Let’s go way back. So, I think you’re referring to-- and let’s talk about what society tells us habits should look like. Now, I don’t actually have this correct, I think, but I think there’s a really famous book about habits that’s like one of the top Amazon selling that says, is it 60 days? What is the book actually saying?

Monica: Well, I’ve read every book and habit formation, so I’m trying to think of which one it is. They probably say 21, 28, or 100 days. Sometimes they say more than that. But yes.

Kimberley: Okay. So, listeners have probably read one or more of those as well, which is cool. So, let’s just acknowledge that that’s being said as the standard, but would you agree that that’s the standard for maybe people who don’t have a mental illness or people who have a kid who’s suffering? Would we agree that that’s for those incredibly lucky people or privileged people, or what would we say?

Monica: That was exactly the word I was going to use. It is a great standard and it’s a privileged standard. And it doesn’t even have to be about demographics. We can look at privileges that way in terms of gender, socioeconomic and race, and all of that. Those are all factors of course. But I would just even think about, if you’ve read those books and you learned so much like I did years ago, and then you tried to implement them and then you failed, whether it’s sooner or later, then you qualify. You qualify as, that doesn’t work for me

Now, consistency does still matter and we can talk about that, but it’s also not in the way we’ve been taught. So, there are seeds of truth that can apply to everyone in these methods that we’ve learned from and that have been so popular the past few years, but not so broadly prescribed to the general population. It’s not fair. It’s just, that’s the biggest place I actually start when I talk about habit formation, is helping people understand you’re not bad at habit formation, you’re not broken, these methods are broken for you.

Kimberley: Okay. So, that’s really helpful. And I’ll tell a story about that. I actually want to hear examples for you. I like this. I’m a pretty highly functioning person personally, but I think what’s-- but I also have a chronic illness. And by default, I think I’m actually doing what you’re talking about, but you can actually correct me maybe. I’m actually here to learn here. I’m definitely loving it. So, I have the things I want to get done on the days I don’t feel well and that looks a whole lot different to the things that I expect myself to get done on the days where I do feel well. The base, you called it a baseline habit. It’s more about expectations, I think maybe. My expectations on when the days I don’t feel well are like the basics. Is that what you talk about? Is that what you’re meaning when you say baseline?


Monica: So, let’s break this down just a little bit. One, starting with the idea that habits should be supportive. That’s their purpose. They’re not balls and chains to our lives. They shouldn’t be about the prescriptions.

Kimberley: It’s not a checklist.

Monica: The checklist, no. That’s the shift I can see you’ve already made, is these habits are there to support me. They’re to support me on my best of days and my worst of days. So, with that first breakdown, then baselines come in to any to-me supportive habit, personally supportive habit, whether that’s exercise, meditation, journaling, even getting up early, deep breathing, stretching, whatever those are to you. These grounding stabilizing habits, having those baseline versions is what helps you have the consistency you need to show up on those days where your expectations need to match your reality better.

Kimberley: Right. Well, that’s the point, isn’t it? Okay, so let’s talk about they have to be attached to the reality. So, what does that look like? Okay. We’ll call them-- well, how will we say it? “Hard days” and “easy days” or how will we--

Monica: I always say “best of days” and “worst of days,” but that’s really extreme language and I always preach against extremes, so maybe I shouldn’t be using that. But whatever you’re comfortable with.

Kimberley: Hard days and not hard days. Let’s do that. 

Monica: That sounds great. Because it doesn’t have to be like, you can only do the baseline if it’s the worst day ever. It’s just less-than-ideal day. 

Kimberley: Okay. So, what does that look like? 

Monica: Okay. So, let me give you a real-life example of a seasonal shift where my reality shifted, had to shift my expectations and the way I was showing up to the supportive habits. And this is more of a personal example. This summer, I was really sick with morning sickness, like really, really, really sick. And it went on for four months straight. And I’m still sick, but I’m better, way better. But during that time, I was still able to keep up my supportive habits, my most important ones, of exercise, of meditation, of journaling for my children, and of reading. But those supportive habits looked way different than my spring version of them before I got pregnant and my fall version now where I’m feeling better. I’ll take one of those examples. 

My exercise was I used to go for an hour-long walk and then do a strength training exercise video or something like that. It just turned into-- my baseline version of that was 20 minutes of slowly walking around my block. I didn’t even go far in case I needed to go home sooner. But that still was supportive enough for me to have the time alone that I needed to be able to show up to other things. 

Another example of this is, journaling for me typically looks like I have this journal for my kids that takes just a few minutes, and then I have a journal for myself that also just usually takes about five minutes. I decided journaling for myself could wait. So, I only had the two-minute version of journaling. And that still meant I would journal throughout all that time. And now what’s great about having those baselines is once the fall came around and I began to feel better, I was able to pick up my habits more in ways that match my reality. 

So, baselines, like I said, they are our less of ideal, less than ideal versions of the habits that can-- they give you the flexibility you need day to day, but season to season. So, as part of that, an important thing for women and men who are listening to know-- sorry, I’m used to talking to women, so I apologize for that. But an important thing to know is that your baselines can grow. 

Now my baselines even are different than the summer. They’re just a little bit more time intense or energy intensive than they were. Your highs get higher and your lows get higher too. Your baselines even grow. So, the less-than-ideal versions can grow too, and they have.

Kimberley: That’s awesome. And it’s funny as you’re talking about that I’m thinking of my patients. If we can keep the black-and-white view of it, like you either do it perfectly or you don’t do it, there’s often this shift. It’s like, “Oh no, Kimberley, I did really great. I did all my exposures this week,” or “I didn’t do any of my exposures this week. It’s been a ‘hard week.’” But then there can be a shift to, “Oh, I had such a hard day, so instead of doing all my exposures, I just did six minutes.” And I think that’s what you’re saying in terms of it being a baseline habit of like, they gave themselves permission for it to not be perfect so that even on their “worst day,” they were still able to get in that treatment that they know is going to help them for that supportive work. Is that what you would think of it as?

Monica: Mm-hmm. And I have a daughter who has generalized anxiety disorder. She’s on the spectrum as well. So, we have a lot of different things we need to keep up on in order for her to feel supported in her life. And even for her, we have baseline versions of these things. So, that way, in a day where she’s really struggling, we still have a way for her to feel supported without that all-or-nothing model, just taking off the table altogether.

Kimberley: Right. So, what kind of shifts would one have to make to create a baseline habit plan? Would we call it a “baseline habit plan”? 

Monica: Oh, yes.

Kimberley: Is this an intentional plan? Tell me.


Monica: So, first, you need to start with some small, internal habit changes, and that’s something we alluded to. Just pay attention to what your own habit story is. How did you grow up thinking habits should be formed? How do you currently think they should be formed? How do you view your capacity to form habits? And how are all of those things actually connected to you being taught habits in ways that actually are not right for you and that’s okay? Having that internal shift to one own, “Oh, I’ve been following the wrong model. So, I’m not broken and I’m capable of forming habits.” And also, the second shift there is just the supportive one. That’s the shift. It’s not about the shoulds and prescriptions. 

Now the external shifts is, I mean, that’s where we could break down. I could talk to you for an hour and a half about that, but you mentioned a plan, and that is what I help people do, is you do need a plan. And what that looks like is actually way simpler than maybe Pinterest would show you about a habit plan. You start with casting a vision of an ideal habit that matches a need you have. So, you can think more generally first like, what’s the supportive habit I need? I need to wind down at night, so what does that look like for me? And you cast a vision of what could that entail. And then what you do is you take that version and you make sure, one, it’s supportive. So, it’s not about a should. You make sure it’s really small. So, it needs to be-- well, we talked about the baseline version of that, but small is like broken down. So, not a full routine yet. We’re just starting with the first step. Simple is your baseline version. That’s like, what is the simplest version of even the small habit that I can start with? 


For an example, meditation habits, maybe you have a whole nighttime routine ideally that you would like and you know what that looks like. But you’re going to start small with just the habit of meditation at night. And then from there, you’re going to start by making it simple, and that means what’s the baseline version of that? The easiest version of this habit is one deep breath. That’s my baseline for meditation. And that actually was one of my habits during the summer. I still meditated all summer, but it was usually just a deep breath or 10 at night as I was falling asleep and just trying to clear my mind. 

So, we have supportive, small, simple. And the last thing here is specific, and specific means you don’t just say, “I’m going to have this new habit and I’m starting it tomorrow.” That’s not specific. You need to have it tied to an already existing habit and form what I call a when-then pairing. So, get clear about, okay, what already happens at nighttime that I can attach this new habit to? And they might be things-- actually, not even might. Most of the time, the existing habits are things you don’t know are habits because they are habits.

Kimberley: Like brushing your teeth. 

Monica: Yes. Dress in the bathroom, brushing your teeth, getting ready for bed. Or mine at night, honestly, a lot is just starting the dishwasher. Who knew? Oh, that’s a habit. I do that every night. So, it’s something like identifying what’s an existing habit around that time and attaching that supportive, small, simple habit to. That’s your habit plan.

Kimberley: Interesting. So, for those who-- let’s say, I’m going to offer the listeners. Let’s say, most of the people who listen, their goal is to face a fear. That’s my crowd. That’s my people. We face our fears. 

Monica: Love it. 

Kimberley: So, let’s say we’re trying to increase our ability to face a fear every day. So, what you’re saying is, find a habit you already do and attach it to the time in which you do that. So, let’s say if your goal is to do an exposure – that’s often the biggest form of facing fear – in order to get it to be a daily thing that you’re consistent with, you would find a time of the day that you would be already doing something. Often I’ll say, as you drive to work, you could do it while you’re driving to work. Is that what you’re saying?

Monica: Yeah. You’re nailing this. Exactly.

Kimberley: Okay. What if you don’t want to do the habit, but you know you should because it’s supportive?

Monica: So, this is going to-- you just did the biggest disclaimer there. If you truly love the result and the result is what you need in your life, shoulds can still be chosen. We don’t have to totally take shoulds off the table. And there’s a lot of that kind of talk, I think, out in the personal development world like, “No shoulds.” But honestly, I don’t feel like doing a lot of the things I need to do most days responsibility-wise. They are shoulds. But they are chosen because of the results or because of the benefit or what I know my responsibilities need me to do. 

Shoulds can be chosen. So, if you’ve deeply truly chosen the should, which is the first step, then you have to get clear about your baseline. And ask yourself, is this actually a baseline? Because it needs to be so small and simple that you can do it even when you don’t want to. That’s how small and simple it needs to be. And once you do that, you get the momentum, which is a whole other topic. And you might organically be like, “Oh, I can do another deep breath, or I can spend another minute on this exposure,” and ride that wave if you feel like it.

Kimberley: Right. And so, what I would offer to people if I’m going off of your example is, on your baseline day, on your hottest day, you could purposely have a thought you don’t want to have, and that’s it. That could be your baseline. Or another would be, let’s say there’s something you avoid. You could just do it for one minute, be around that thing you avoid for one minute. Is that what we’re looking for? Like one minute? 

Monica: Exactly. 

Kimberley: Good. Baby steps.

Monica: Yes. And don’t underestimate the power of these baselines. One of the biggest powers is momentum that I mentioned, but the other biggest one that honestly to me might even be more weighty than the momentum is the confidence. It’s the identity shift and how you view your capacity to form habits, and your capacity to follow through with the things you say you’re going to do for yourself.

Kimberley: Right. Isn’t that such a big piece of it? Like how many times have I-- let’s say a client has panic disorder and getting on the elevator is so painful because they’re so afraid of having a panic attack on an elevator, for example. And they’re standing at the doors and they’re saying, “I can’t. I just can’t do it.” That’s that confidence piece, right? Because we know we can. We could actually argue like, “No, you just take one foot and you put your foot on the elevator and then you put the other foot on the elevator and you’re in the elevator.” I think that that’s an interesting piece. And I talk a lot about motivation, but what you are bringing to the table, and correct me if I’m wrong, is there are many ways in which we could get motivation and momentum and confidence, but habits is another way.

Monica: Yes. And for me, these baseline versions are, go to a bigger picture concept that I teach in my community of creating momentum instead of waiting for motivation. And it’s just physics. It really is just using physics here. But like you said, it’s the confidence piece. It’s the identity piece of being someone who can face fears, of someone who can show up for themselves, even on the hard days, on all these levels that we’ve talked about. It really helps. The identity piece too is really important.


Kimberley: Right. Okay. So, you’re having a hard day. You originally, when we were chatting, were talking about the dark days. We call them a dark day, a hard day, the worst day and all the things. On the days where that’s the hardest of days, the darkest of days, we usually have a lot of thoughts about our capacity to do hard things on the dark day. I know we touched on this, but what is the mindset shift to allowing yourself to be in a baseline day? I’ll give you a personal example. When I have POTS, when I’ve massively relapsed, the day before I could walk three miles, no problem. And on my relapse days, I am lucky if I can get around the block. Lucky. That is lucky. And so, what needs to happen there to give ourselves permission to-- because I’ve actually been the person who goes, “Nope, I refuse this to be a bad day. I am going for that damn three-mile walk,” and then all hell gets broken. It’s horrible. There’s consequences to be paid for pushing myself. So, is there a piece here about the permission? That’s the main last piece I want to ask.

Monica: Oh yes. This alone takes a tremendous amount of courage. People, they think, “Oh, what? Habit probation takes courage?” Yeah, it does, especially if you’re doing it differently than the way that you’ve been taught. And this is where I would go back to something about proving yourself wrong. Doing something in a different way as a way to bolster your confidence and also your know-how, but to say like, “Maybe I can just try to see, I can just prove my old self wrong here. Does this still help? Is it still a way to show myself I care about myself?” on your really bad days where you’re recovering. Is this stretch still giving to your body? Is it still saying “I see you” and “I love you and I’m trying to help you and I know you’re trying to help me”? Maybe you can’t even do that block, but you can do a sense salutation or sorry, that’s the movement I keep doing over here, like what is she doing? That’s the movement I keep doing. 

What I would help people do who are stuck in that all-or-nothing mindset, it’s so hard to let go of. Believe me, I know. Adopt the mindset of curiosity of what would it look like to try this out? Can I prove myself wrong? And I would also get a little logical and look back on your past and say, “Overall, how has this all-or-nothing model served me? Has it helped me more or hurt me?” For the high majority of people, high majority, it hurts more than helps. 

Pay attention to the price you have paid in the past for the all and just acknowledge it takes real strength to do this. That’s one thing-- I had a client say this years ago. She said it takes the greatest of courage to do the smallest of things. And that’s where I would end. Just dare to have that courage to try the smallest of things and to try them again and again and again and see over time. You’ve got to give yourself that time to see how it can prove yourself wrong overall. And that these small ways we invest in ourselves, not only add up, but they count in the moment too.


Kimberley: Right. So beautiful. I have one more tactical question before I let you go. So, would you have people have a breakdown of all the steps to create a habit plan? Meaning, let’s say the goal is to get-- a lot of people here are working at developing a good exposure plan. Let’s say we’re goaling towards 30 minutes a day. Would you say, “Okay, on the dark hard days, we do two minutes. So, that’s reserved for the dark hard days. And then from there, we’re going to work at two minutes, three minutes, four minutes, five minutes, six minutes. And then by the end of the month, we want to be at nine minutes.”? Would you break it down like that or is that actually the opposite of the plan here that you’re trying to go for in terms of a supportive plan?

Monica: So, the bigger question I believe you’re asking is, how do we build, do it strategically or what does that look like? I would say that depends on what the habit is and the purpose of the habit. So, if this is more of like a therapy-based habit that you’ve been working on with clients, I would say it might be helpful to have that game plan. Perhaps not based on a certain time, but more about how consistently they’re able to perform the baseline version, and from there have the foundation they need to build. 

In general, though, for most habits, it goes two ways. You can either maximize or add. You can do longer amounts of the habit or more intensity, that’s maximizing, or you can add. That means you add another step to the bigger routine you want. And I find that can go two directions. One, strategically, you can think like, okay, this is my game plan. Maybe I don’t have an exact deadline, like in two weeks. It’s more organic feeling. It’s more intuitive. I feel strong enough. I feel like I’m in momentum. I feel like I have the structure I need to add or to maximize. But yeah, it still can be done strategically. But most of the time, it just happens organically. You just are able to-- that baseline rises, like we talked about. And as a baseline rises, that means you tend to have more like normal days in between days where you can do a step or two above naturally and organically. 

So, that depends. But ultimately, I think, have trust in yourself to know what you need for a specific habit. Do I need this to be strategic or am I okay to do this more intuitively and organically? But no matter what, starting with the ideal in mind is what gives you the target that you are headed towards.

Kimberley: Right. And that you can, any day, even if you’re on your way up to the strategic plan, you can rely on your base plan if needed. That’s your backup.

Monica: Always, always. And even over time, as your baselines rise, you still have that under baseline you can always fall back to. If seasons change, your life change, circumstances change, your health changes, those are always there for you.

Kimberley: Right. Love it. All right. Tell us where we can hear more about you.

Monica: Well, I am a podcaster on About Progress. We’re a personal development show. We don’t just talk about habits there. We talk about a lot of things. And I’d love for them to come and listen. And I do have a course on habit formation and it’s for women. I know there are men listening here, but it’s primarily for those who identify as women because of the bigger thing I have to teach about why habits spell in particular for women. So, it’s called the Sticky Habit Method, and they can go check that out at And it says sticky habit because you form habits that stick.

Kimberley: Nice. I love it. Oh my gosh, it’s so wonderful to have you. Like I said, your episode about perfectionism that we’ve done is a really high-rated episode. If you want to go back and listen to that, that would be cool too. Yeah, absolutely. 

Monica: That’s really the heart of all my work, including habit formation. Who knew I would even get into habits, but we’re here.

Kimberley: I love it. I love it. Thank you so much for coming on. I’ve loved listening. I’ve been the student today as well, so that was awesome. 

Monica: I love that. Thank you.

Kimberley: My pleasure. Thank you so much.



Dec 23, 2022

In this podcast:

  • Laura Ryan tells her story of overcoming superstitious Obsessions 
  • How to manage Whack-a-mole obsessions
  • How her family helped to support her as she overcame Superstitious OCD 
  • How to get through the hard OCD days
  • Perfectionism and Exposure & Response Prevention

Links To Things We Talk About:

Episode Sponsor:

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

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316 Overcoming Superstitious Obsessions (with Laura Ryan)


Kimberley Quinlan: Well, welcome, Laura. I am so excited to hear your story today about Overcoming Superstitious Obsessions. Thank you for coming on the show.

Laura Ryan: Thank you so much for having me. I'm so excited to be here.

Kimberley Quinlan:  Yeah, so it's wonderful. I love the stories when I accidentally meet people online, and then we have this cool story that's together, but we're not like not together at all. So I love hearing your story for the first time today, and I love that. I've been a small small part of that journey for you.  Tell me a little about you and your backstory in, you know, the area of recovery.

Laura Ryan:  Yeah. So I definitely would have had OCD my whole life, but it wasn't until I was about 17 or 18 years old that I just stumbled across something on the Internet where I was like Oh yeah, that sounds like me. I've got OCD, but it didn't. It wasn't stopping me from doing anything at that point. So I just ignored it and went on. I had three Uni degrees under my belt. I was working at a publisher and freelancing as a book editor, and then

Laura Ryan:  my family had some health issues, and my sister as well, had some relationship issues, and I don't think I knew what to do with the stress. Um, and OCD crept up. So gradually, it was undetectable, and then sudd,  I found myself at age 22 with crippling compulsions.


Laura Ryan:  It was nothing short of torture. It was horrific. I was so ill with OCD that I would come home from a day at work, and I wouldn't even remember the day because I'd spent the whole day in fight or flight. And I had mental sort of thought replacement and breath-holding compulsions. So it was completely invisible to people around me, but it was able to kind of have control over me for the whole day. Like from the second, I woke up to the second. I went to sleep. When I eventually saw a doctor, the psychiatrist was like, Oh, and how often are you affected by these thoughts? And I just didn't understand the question because I was like, Well, every few seconds, I guess.

Laura Ryan:  Yeah, so they were weird. Compulsions, like a lot of Shame around them as well because they were all kind of magical thinking superstitious. Like there was no logical link. They were all like, I'm holding my breath because I think I will magically give someone a disease if I breathe out while looking at them, or Yeah, just weird. We had rules that made absolutely no sense.

Laura Ryan:  which, Also. yeah, it impacted my self-esteem because I've always thought of myself as a Logical person, but these just made no sense.

Laura Ryan:  yeah, I also became stick thin because if I, and it wasn't even anything to do with the food, it was just if you eat this food, the intrusive thought will come true. And I, it just wasn't worth their Stress of eating. and then, there was a point where

Laura Ryan:  I would have conflicting compulsions, so OCD would kind of be like if you do this thing or if you don't do this thing, the intrusive thought will come true, and then I would just stand there paralyzed Like unable to do anything. I don't like to think how long I've spent just standing still, like the pervasive slowness, I think it's called was just Yes, stopped me from. Doing anything? Some nights it would have taken more than an hour to get to bed. It was just I had to touch wood or Rearrange things for so long before I was able to get to sleep. yeah, so I'd been a really


Laura Ryan:  Pleasant child and teenager big people pleaser perfectionist type person, and then all of a sudden I was this irritable, distracted young adult, and I didn't like who I was, and no one in my family knew what was going on with me. Um, and yeah, I was eventually unable to work, and I quit my job. And I was too anxious to Google things. So I looked up OCD on my podcast app, and that was when I found you were a guest on the mental illness happy hour, I think, and you played this game of one-up together, and it was like, It was incredible. It was like it was. Yeah, it was the first time I had

Laura Ryan:  heard of ERP and OCD.

Laura Ryan: Yeah. Sorry, it was the first time I'd heard of ERP and Anxiety treatment that wasn't just meditation or gratitude, which are helpful. But sometimes, when you're in that dark place, the only thing that can get to you. It is something dark itself but also brings that humor as well. I think it is just the most powerful tool you can have when you're there. Then I started looking up Absolutely everything Kimberley Quinlan. I was absolutely your number one fan. You say you had a small part in my story. You had a huge, huge part in my story. Because I was way too unwell to drive. There was no way I would go to my GP and get a mental health care referral. I was not going anywhere near Medical Center. And barely making it out of the house. So, when I found your ERP school to do online, it was nothing short of life-saving. I was able to get enough to go to the GP then and get a referral to see a psychologist.

Laura Ryan:  Yeah.

Kimberley Quinlan: It makes me want to cry, it does. And when can I ask a couple of questions about that when you said There's no way you would have gone to the GP because of the obsessions that held you back or just the shame of it? What was there? Another reason that that was such a huge step for you?


Laura Ryan:  It was mainly the superstitious obsessions. If I go there, I'll contract a disease or give someone a disease. Not even in a contaminated way. Just like a magical way. Yeah.

Kimberley Quinlan: Mmm, yeah, yeah, it's funny. I don't know when I'm helping people because you just don't know what you know. Just for those who are listening, the Mental illness happy hour is an amazing podcast, and then the host had no idea what OCD was. And so, we did play a game of one up, which is where we kind of, he said something scary. And then I went up. It was something even scarier and even more gruesome and horrible. Was that something that you started practicing on your own just from that episode? Or did you take up his school to follow the whole process?

Laura Ryan: A bit of both. I kind of took the one up and…

Kimberley Quinlan:  Inflecting.

Laura Ryan: I ran because I think it just helped me. so much immediately, and then ERP school was able to lead me through in a more systematic way. Yeah.

Kimberley Quinlan: Okay. Amazing. Oh, I'm so happy that I could be there. It's not so cool.

Laura Ryan: Yeah, absolutely.

Kimberley Quinlan: It's so cool.

Kimberley Quinlan: Especially you're my Aussie friend too. That just brings me so much joy. So as you and I emailed in preparation for this,  you beautifully and eloquently shared some of the pieces. I would love to hear from you if you spoke briefly about how your OCD evolved. Would you be willing to share a little bit about what that looked like for you?

Laura Ryan: Yeah. Yeah.

Laura Ryan: I had every kind of OCD, so as soon as I started doing ERP, OCD came back with a vengeance with some new topic and…


Laura Ryan: as I think a lot of OCD sufferers know, it can be especially difficult, when a new topic shows up because you don't know what's happening you are unfamiliar with. the sorts of thoughts it's going to throw you, and you don't know how to fight back yet. I remember when it initially switched from this sort of magical thinking superstition to moral OCD. 

Laura Ryan: Hit and run OCD, and I've heard stories about OCD sufferers turning themselves in for crimes they didn't commit, and that was absolutely the kind of thing I felt like doing at that point. I was like

Laura Ryan:   Although usually, I would panic when I was driving, I would constantly be checking in my rearview mirror, recycling, back driving around, again and again, to make sure I hadn't hidden anyone and then,

Laura Ryan:  Yeah, I think it just Really. OCD will fight back.

Laura Ryan:  Yeah, absolutely.


Kimberley Quinlan: that must have been pretty terrifying for you, though, or demoralizing for you for it to be sort of wack-a-moleing. Whack-a-mole obsessions are when your obsessions are changing from one obsession to another.  Your obsessions will be one up and one down. Switching between obsessions each day or even hour. How did you handle that?

Laura Ryan:  um,

Laura Ryan:  I think, just I think the main thing was staying in touch with the online community and because Every thought you've had, no matter how crazy it is. Someone else has had it, and someone else has probably done a compulsion. That's Like as, or more embarrassing, is something you've done.

Laura Ryan:  Yeah, I always think when I have a thought I met someone else's had this, and then I'll go on like OCD Reddit and find that they have.

Kimberley Quinlan:  Right. Absolutely. So so, that's how it evolved. Wait, you shared. Also, Where are you now? Like what does life look like for you now? Having gone through and know, you'd said You'd moved on to getting treatment. What's life like for you Now? What does recovery look like for you?

Laura Ryan: So, yeah, I spent the better part of two years just really taking the time to get better. I was doing bits of freelance work, but it shouldn't have been because it was taking me way too long. I wish I'd just given myself permission to rest properly. and I don't know whether this was a part of moral OCD or whether I like to think it's just part of who I am. Still, I didn't want to go back into publishing because I Um felt like I wanted to do a job helping other people, and I especially wanted to give back to the healthcare world.

Kimberley Quinlan: It.

Laura Ryan: That helped me so much. When I went, I went to the hospital to do an inpatient OCD program. And the people working in the program were obviously psychologists, psychiatrists, and occupational therapists. And so, I wanted to do a course in OT. But

Laura Ryan:  Then I saw speech-language, pathology, and I've been doing that course for the last two years, and I'm just about to graduate. So, Yeah.

Kimberley Quinlan:  Wow, that's so cool. Does OCD have something to say about you returning to school for that? Like, how did it How did your OCD handle that decision?

Laura Ryan: Oh my gosh, it was so. mad at me for picking something that I needed to do hospital placements to complete. Especially being speech-language. I think they called in America speech-language therapists, in hospitals, at least in Australia, there, they see the people with the Like worst neurodegenerative or the scariest diseases, or they've just had a stroke. Like, really, the most triggering things I could have thought of at the start of my journey. And yeah, and like, you have to like to touch them and would never ever have thought that I could have done this a couple of years ago.

Kimberley Quinlan: Yeah. In ERP school, we talk about your hierarchy, right? Like it would have been a 10 out of 10. I'm guessing you're like doing 10 out of 10…

Laura Ryan: Yeah.

Kimberley Quinlan: it's incredible of all the careers; you picked like your 10 out of 10. That's incredible. Right. Yeah. So was that like a decision? Like I'm doing it as an exposure, or is it just like your values led you there to get to that place?

Laura Ryan:  It was definitely my values and took me. And my therapist, a lot of coaching to get me through. Yeah.

Kimberley Quinlan:  Wow, it's so cool. It's so cool. It's like perfect, right? Because it's so often, I hear of people who have the career that they wanted, and their OCB gets in the way, right? You know, there he'll have health anxiety in there, and us or they have their teacher, but they have thoughts of, or pedophilia obsessions and impacts their work. Like you, you went the other direction where you moved into the career after your treatment which is just so cool. I love that you did that. So one thing you shared, Was what you find hard, and I love that you included that piece in what you find hard. So, would you be willing to share, What do you find hard? We talk about It's a beautiful day to do hard things, but What is it? It's okay that things are still hard. What do you find still hard?

Laura Ryan: Yeah, I find it now that I have so much functionality back compared to where I was not leaving the house to pretty much do everything that I want and need to, I find it hard to find the motivation to do ERP to kick those last mental compulsions, and those things that kind of still follow me around all day. Yeah, I think. I think now it's less about functionality and now more about doing it to get back that quality of life.

Laura Ryan:  which, yeah, I think I often find really hard to  it's much easier to. When you're doing ERP to reason with yourself, oh, I deserve to be able to leave the house and go to the shops. And so that's why I'm doing this thing that feels so awful. But when you're just saying, “Oh, I'm doing this now just because I want to be happy.” It's a lot harder to reason with myself

Kimberley Quinlan: Yeah, it's like you said at the beginning and I've heard that many times that if it's not impeding in your functioning, it is easier to sweep it under the rug and cope and not address the problem. And I've heard that many times. So I think that's a really valid point of, you know, a lot of people will say like there's a really strong. Why are they doing the exposures? There's not a strong why it's hard to do it. How are you learning or starting to practice tools to manage what's worked for you? And what hasn't

Laura Ryan:  'm getting a lot better at being less of a people pleaser and getting better at not putting everyone else before myself filling up my own cup so that I have some to give to everyone else. Yeah, I'm it is hard, but I'm definitely getting better at doing things because

Laura Ryan:  Yeah, if I give myself that, Quality of life. I can be. Even at least I can be if not for me, I can be there better for my family and friends.

Kimberley Quinlan: Yeah. Yeah. Is there you know, if you were to work? I mean, I'm assuming people listening are having similar struggles. Can you walk me through moment to moment how you muster up motivation? Or maybe it's a different experience to get yourself to do. Those exposures? Like, what do their steps involve? Or how do you get to that place?



Laura Ryan: Yeah, one of my favorite tools is just before I do anything. So if I'm if I've just driven in the car to go somewhere, I will take one minute before I get out of the car, I will take one minute. and just Kind of have a word with myself and OCD, and I'll be like, right, what's OCD? You're going to throw at me. It's going to say this, and then what will I do? I'm going to do this, and then how's OCD going to push back? And then what am I going to do? Like just having a game plan before you do.

Kimberley Quinlan: If?

Laura Ryan: Functional things for those mental compulsions.

Laura Ryan:  I find it's a really

Laura Ryan:  it's really helpful for me because I don't have to kind of set aside time and find that motivation to do it. I can just kind of plan and make ERP tasks out of, going to the shops or seeing a friend or  things like that.

Kimberley Quinlan: Yeah, that's cool. It's, I think of it, like Olympians or, you know, high-performance athletes as they, they do that same thing. They're high performing, you know, the high performers there, they're rehearsing. You know the strategy to get through that really hard moment. It sounds like you're doing something similar there, which is really cool. I'm fascinated by that, sports psychology piece of it, right? I think that's so cool. All right, you had mentioned, which I thought was fascinating, what OCD gave you. Now, this is sort of a controversial topic…

Kimberley Quinlan:  Okay. So one of the things that you wrote as we were emailing was what OCD gave you right, which I thought was so fascinating because usually, we hear stories are like, I hate OCD, and it's the worst thing ever. And I hate everything about it, and we even know there's some controversy of some people who have sort of misused OCD. I loved what you had to say. So, would you share it? What were your thoughts regarding what OCD gave you?

Laura Ryan:  Yeah, I definitely don't get me wrong. I think OCD is a very unique form of torture, I don't think it's. Yeah, it's horrible. It's absolutely. Yeah, I think. When you said it was one of their Top 10 Most debilitating disorders, you can have either physical or mental. Absolutely. I think it's just Awful. But I think going through treatment gave me this really, really,

Laura Ryan:  I was able to see these incredible sides to my family and friends. they were just so, Incredible at every turn and so accepting of something that's really hard to understand.

Laura Ryan:  and, Yeah, it's also just constant reminders to follow my values. Like if, if you're having a hard day with OCD, the only thing you can use is to get yourself out of that. is to be like, okay, well, What am I doing? What am I valuing? And the treatment is kind of mindfulness and coming back to

Laura Ryan:  What's important? So yeah, I think I'm I'm quite lucky to have those. those treatment principles kind of under my belt because, I think everyone can use them because they're just


Laura Ryan:  Yeah, that's how you have a better life. Yeah.

Kimberley Quinlan: Yeah, that's true. It's so true. And you, you talked about your you had sort of a shift in motivation to sort of take care of your health. Was there a shift in that for you? Once you started going through OCD treatment? That was when further beyond just your mental health,

Laura Ryan:  yeah, it was it kind of turned into adding in. Meditation moving my body a lot.

Laura Ryan:  Yeah, I I remember going down this because I had access to my uni like academic journal database, and I am early on. I went into a lot of obvious research about ERP and OCD. But also SSRIs and exercise.

Laura Ryan:  and I think people found Or some people. And at least for me, I find Like, I'm staying on the SSRIs, but exercise is. As effective for me as those. So if I Do them both. It's like supercharges it so good. Yeah.

Kimberley Quinlan: Yeah. Yeah, absolutely. The research backs that doesn't it? So that's so good.

Laura Ryan:  Yeah.


Kimberley Quinlan: That's so good. All right, the last thing I question I have for you it's just makes me giggle and smile and feel all good. Inside is tell me a little bit about what gets you through the hard things because that's what this is all about, right? That's what our whole message is. What are some of the things that get you through the hard things and the hard days?

Laura Ryan:  And definitely remembering my sense of humor. And Kind of encouraging the people around you. Because I'm not as. I'm not super comfortable yet telling my family and friends to You know, help me with exposure tasks, but if you can tell them, they help me laugh about these things. They'll They can people can do that, people know how to, and they want to, and it's really good.

Kimberley Quinlan:  Yeah.

Laura Ryan:  Yeah, also, if you go on the go on Reddit and look up Reddit OCD memes,  it's the best. It's so good. It's like and John Hershfield's means they're so good, and they

Laura Ryan: Again they like they get into these really dark awful themes but then we're laughing at them and I think that's just the fastest way to get power over OCD.

Kimberley Quinlan:  Yeah.

Laura Ryan: um, Yeah,…

Kimberley Quinlan: Yeah. Changes the game.

Laura Ryan: it's really cool. Definitely.

Kimberley Quinlan: Doesn't it right when you find? Yeah, it really really does. And you did talk about the game plan Already.

Laura Ryan:  Yeah.

Kimberley Quinlan: You mentioned something called a panic inventory. Do you want to share a little bit about what that is?

Laura Ryan:  Yeah, so I hope it's not a kind of reassurance knowing that I can go back and check it, but I never do. And so when I have an intrusive thought, I just write it down in the notes of my phone and it's stops me from doing things like, checking the police news or asking for reassurance, or like, if I have the thought written down, and it's there, and I can think Laura, you can come back to it like it's there. It's not going anywhere. You can come back to it tomorrow or next week, or even just if you can hold off on doing this compulsion for an hour, the thought will still be there. You can still

Laura Ryan:  Address it. If it still feels urgent, then and yeah, some of them only last a few minutes, some of them last a few days. But I've never come back to a thought a week later still panicking.

Kimberley Quinlan: Mmm, that's cool. It's funny, it makes me think about as With young children, when we're treating young children with OCD, we talk about their OCD box, and they imagine putting their thought up in the box and they leave the box there, not to kind of make the thoughts go away. But just like it's there, you can bring it with you. The box is always with you and…

Laura Ryan: Yeah.

Kimberley Quinlan: we're just not going to let it be there, and we're gonna go about our lives. Anyway, so does it sound like that for you? Is that kind of mindset there? yeah, so that I love that…


Laura Ryan:  Yeah, absolutely.

Kimberley Quinlan: because what you're really doing is you're saying I'm willing to let the thought come with me. And I'm gonna be uncertain about it and sort of staying very present. Like, we'll worry about it later, kind of like not that you're planning to worry about it later but she'll deal with it when it needs to be dealt with which is sounds like never Really okay.

Laura Ryan: Yeah.

Kimberley Quinlan: I love that. I love that. Yeah, okay, cool.

Kimberley Quinlan:  Anything else that you found to be helpful in getting you to where you are today in this really cool story?


Laura Ryan: Yeah, definitely. I think the Perfectionistic side of me thought that every ERP exposure had to be. 10 out of 10. Full-blown panic attack level, but it's At least for me it's only gonna work for insofar as I'm willing to actually feel what it brings up. So

Laura Ryan: I think they the best exposures for me are the ones that just feel mildly uncomfortable and even to the point where I'm sitting there and I'm like, Oh, am I, Even bothered by this. Like, it's sometimes I feel like I'm lying or…

Kimberley Quinlan:  Mmm.

Laura Ryan: Or I don't have OCD or yeah, I think those tiny. Yeah. Like a hundred. Many exposures are way way better than one, one giant one, at least for me.

Kimberley Quinlan: Wow. That's cool. I'm so glad you brought that up, and because that is actually, interestingly, I'll share with you when I'm supervising my staff. That's probably one of the biggest questions that my staff come with of like, my client seems to be wanting to do these crazy high hard explosions and it feels like it's sort of compulsive in that they're doing these exposures.

Laura Ryan:  Yeah.

Kimberley Quinlan: And I think you're speaking to this really important topic, which is the exposure should Simulate the fear and the uncertainty And so you're saying, I think. But correct me if I'm wrong Doing a small exposure actually simulates in brings on other obsessions and fears along the way. So that's how you're doing your exposures. That's so cool. Is that correct?

Laura Ryan: Yeah. Yeah, absolutely.

Kimberley Quinlan:  Yeah, wow. And we say Any happy school. We talk about doing a b minus effort, right? Like not doing it perfectly and sometimes perfect. You know, purposely making an exposure imperfect has, was that a trigger for you? As you went through this process of trying to make the exposures perfect? Yeah.

Laura Ryan: Yeah. Absolutely. I remember, I came to my first session with my psychologists, like, with a printed out, hierarchy of like this. Yeah. Everything was scored perfectly and I was ready to work from. Yeah. Number one, to number 10 in and cool. According to the research, we should be done in 12 weeks and then I'll say See you later. That was really…

Kimberley Quinlan: You like my schedule,…

Laura Ryan: no, it works.

Kimberley Quinlan: It says right here. This is how dispersed to go. Right, right. Okay. And it didn't work out that way. No, no that would have been hard to take.

Laura Ryan:  Yeah. Yeah.

Kimberley Quinlan: Yeah. Yeah, I have loved hearing your story. I'm so grateful that we got to meet in person and connect. You know, it's sort of a full circle moment for me and I hope you know that you should be so proud of the work you've done and how far you've come.

Laura Ryan: Thank you so much. Yeah, I can't believe I'm talking to you.

Kimberley Quinlan: Yeah. I know,…

Laura Ryan: Yeah, it's awesome.

Kimberley Quinlan: I'm so happy to have you on the show, I really? And that's again, I say it all the time, like it just to know that. That. People can make small but very mighty steps on their own. Is the whole mission here,…

Laura Ryan:  Yeah.

Kimberley Quinlan: right? Is that just even if it's the first step, I'm so happy if that's the step that people take. So I'm so grateful for you for sharing your story.Laura Ryan:  Thank you so much for having me.

Dec 16, 2022


  • How to include family members in ocd treatment
  • Supporting siblings during ocd treatment 
  • How to apply the “be seen” model
  • Ocd family therapy: including siblings as “assistant coaches” 
  • Developing empathy during ocd treatment

Links To Things I Talk About:

  • Instagram: @anxiouslybalanced

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315 How to effectively include family members in OCD treatment (with Krista Reed)Your anxiety toolkit


Kimberley Quinlan: Well, welcome Krista Reid. I am so excited to number one connect with you, but to talk about a topic that I don't talk a lot about which is something that I'm excited to really talk about with you today.

A Peaceful Balance Wichita: Yes, thank you so much for having me.

Kimberley Quinlan: So welcome.

A Peaceful Balance Wichita: I'm excited.

Kimberley Quinlan:  Yeah. Look at you. You're all the people who don't see, you're like everything's bright and it's so happy. It makes me so joyful just to see you.

A Peaceful Balance Wichita: Thank you, anybody. That has met me. Will get it. I'm a very colorful person. Thank you.

Kimberley Quinlan: I love that that we need more of you in the world.

Kimberley Quinlan: I really feel Yeah, good thing. I made children that sort of created more of me, right? That's the best I can do.

A Peaceful Balance Wichita: I we need more of you.

A Peaceful Balance Wichita:  You go. There you go.

Kimberley Quinlan: All right, let's talk about supportive siblings. Let's talk about…

A Peaceful Balance Wichita:  Yeah.


Kimberley Quinlan: how the family can play a role in recovery. I kind of want you to take the lead here and tell me everything, you know. So tell me a little bit about why this subject is important to you and how you used it in clinical and in the field of OCD.

A Peaceful Balance Wichita: Yeah, absolutely. And so I'll give you just a little bit of background. I always have been interested in sibling dynamics, and in fact, when I was in grad school completing my thesis, I even consulted the director of the program. I said, Are there any theories about siblings? And he's like, well, you know, there's the one by Alf or Alfred Adler on birth order. But really outside of that, no and that has just always been so entirely profound. Because when we think about family work, if you're looking at family theories, if you're looking at different types of family interventions and models, a lot of them really focus on parent child. And when you're dealing specifically with a child who has an, I'll go into the physical medical side as well, because I don't think this is exclusively just OCD or just mental illness.

Kimberley Quinlan: Mmm.

A Peaceful Balance Wichita: when we're seeing that a lot of times, the model is fixated on the child with the medical issue and the parent And what I was finding was that siblings. They kind of get othered In this. It's full process and the definition of other. It is essentially, you know, being excluded from meetings being excluded from family sessions being excluded in some way, shape or form. Now I could see how potential listeners will say, Well, isn't it that child with the OCD the child with the medical issues othered Yes, I'm not debating that at all, I'm saying, primarily within the family unit, that the sibling themselves can get very other and siblings struggle when their sibling has a disorder. You…

Kimberley Quinlan: Mmm.

A Peaceful Balance Wichita: they can struggle emotionally, they can struggle behaviorally. You know, just looking at the construct of OCD, they could struggle with the with the grief. Of their sibling having OCD, the moods that may come with the disorder. And oftentimes, this can lead to resentment within the sibling relationship, or even guilt or shame. And I I have siblings, and I think this potentially might be even where a lot of my work is very important because I am very close to my siblings. I am super close. Like I I feel like I'm very fortunate. I have, I have amazing relationships with my siblings and so it absolutely breaks my heart when you see a child.

A Peaceful Balance Wichita:  Who who has this? Some type of distance within their sibling relationship either because they themselves have the disorder or their sibling has the disorder. And so, I started finding different ways to incorporate siblings and to the therapeutic model. I'm really big into family work. I don't understand how special when you're working pediatrics pediatrics. And that's primarily what I'm going to focus on today is a pediatric work. I don't understand how when you're working with pediatrics? How you you can't have the family involved? To me, that doesn't make any sense because we're seeing, especially in the outpatient world, we're seeing these kids an hour a week, so tops four hours a month. Pretty sure there with their families, a lot more than just four hours a month. and then thinking about,

A Peaceful Balance Wichita:  The siblings. What can we do to make them feel like they're not being other? How can they also not be parentified? Because that's sometimes happens within the disorder. World is the siblings may feel that they have to have some type of responsibility for their siblings medical issues. And that is Absolutely. I don't want any sibling to have that. I want them to have a childhood. I want them to be kids, but how can we incorporate them without parentifying them and without othering them and also bringing in the family as a whole and tackling this beast together whether that's OCD or whatever? That beast might be.


Kimberley Quinlan: That's so interesting because as someone who treats OCD but also treats eating disorders, I have found that, you know, you'll treat the one child who has the primary disorder. We get them better. And then a year or two later, the other kid that didn't have the the diagnosis starts to suffer and all this emotion comes out and they start to really acknowledge how painful it was for them and and it all comes out later.

A Peaceful Balance Wichita: Okay.

Kimberley Quinlan: But I know that there are other cases where it comes out during and you've got multiple things happening at once. So, that is why I think this is so important is

Kimberley Quinlan: In my early days of treating you would be like, no, that the siblings. Fine. Look at how well they're doing. They're they're doing well in school and it's quite a miracle,…

A Peaceful Balance Wichita:  Yeah.


Kimberley Quinlan: isn't it? But then Yeah, it all comes out, right? It all comes out. So I love that you're talking about this, right? So you you And number number one, before we move on. Is this true of not just siblings, Would we say? This is true of partners of OCD or eating disorders or depression as well. Like Does this spread to that or…

A Peaceful Balance Wichita: Yeah. I I agree a hundred percent,…

Kimberley Quinlan: What are your thoughts?

A Peaceful Balance Wichita: you know, this, I hate to call it curriculum because that makes it sound so sterile.

A Peaceful Balance Wichita: Process I guess I'll call it and I feel that this process is and as as you know aforementioned it's not just about OCD. I can see this being across the board for any medical issue. Absolutely. It could be for Let's a roommate. Let's not even like let's let's take out the family part.

Kimberley Quinlan: um, And here.

A Peaceful Balance Wichita: You know what, working with a college. I college student, who has a roommate that, maybe they're pretty close with. Absolutely. I if they're willing to bring that person in, How can we incorporate them? Because doesn't that client win? That's what we're wanting…

Kimberley Quinlan:  Yeah.

A Peaceful Balance Wichita: because we know that no matter what your medical diagnosis might be relationships, struggle, and…

Kimberley Quinlan:  Mm-hmm.

A Peaceful Balance Wichita: that absolute last thing I would wish upon anybody.

Kimberley Quinlan: yeah, I'm even thinking of me as someone with a chronic illness On how I think it even like you said it stretches to medical to like that. You know, I know I look back until tell a quick story. I look back to when I was really sick and really sick. And I even remember seeing my children, Starting to play a parental role on me. Like, What do you need today? Mom, instead of like, No, I'm supposed to be asking you that Hun. Like, I think that it's,…

A Peaceful Balance Wichita: Yeah.

Kimberley Quinlan: it can spread. So I I think that this is that's again why? I think this is so important. So I'm gonna skip to my main sort of questions here. Now, it's like you talk about what is called a coach Like an OCD coach. I know I've watched one of your presentations like Do you want to share with us What this model may look like?


A Peaceful Balance Wichita: Yeah. Absolutely. So before I even talk about the OCD coach, because that's not like, I'm not reinventing the wheel, this isn't something that I think a lot of your listeners are going to say, Oh like that's that's a new thing. No, it's not a new thing especially when working pediatrics. That's a pretty common term because that's what we really want these parents, or caretakers to be of these kids. As we want them, to be able to learn how to do what we are doing with their kids. So they don't have to be in therapy forever. So, I developed this process and I call it BE SEEN  seen as an acronym, because why not us medical professionals. We love our acronyms. So let's make another acronym. And also it's really easy to just to remember

Kimberley Quinlan:  Right.

A Peaceful Balance Wichita:  And I chose this specific, acronym one. It fits the letters, really nicely of what I was hoping to explain throughout this process but also for a couple different reasons. One I have OCD and I struggled as a child and adolescent and one of the primary factors in my own recovery, that was so A profound was I realized I did not want to be seen. I did not want people to note because I felt I felt bad, You know that shame just smothers you like a blanket and it just it it was embarrassing. And then I was thinking about it from the other side of siblings.


A Peaceful Balance Wichita: When you have a child who has a chronic illness, you think about how often, are they going into doctors appointments? How often are they going into whatever type of treatment facility? They may they may be utilizing. The sibling is often and they can get hidden. They can get hidden. And if I in fact, I think it was Chris Baer who did unstuck who actually called the sibling, the forgotten child. and I,…

Kimberley Quinlan: Such a crisp, man.

A Peaceful Balance Wichita: I absolutely, I'm gonna, I'm gonna get to how that whole thing. Actually, kind of birthed this idea here in a bit.

A Peaceful Balance Wichita: But thinking about just how profound it could be for the sibling to be seen. And as I mentioned before,…

Kimberley Quinlan:  Hmm.


A Peaceful Balance Wichita: I don't want them to be responsible for their siblings treatment. That is so incredibly inappropriate. And I want them to have a childhood, but I also want them to participate and have a relationship with their sibling. So when I think of an OCD coach essentially, how I define an OCD coach, is going to be that's going to be the adult figure. So that is going to be the person that is going to take the the child to therapy to treatments. That's going to be the main one, utilizing, exposure and response prevention therapy. They're going to be kind of the one overhead and I like using the word coach.

A Peaceful Balance Wichita:  Because one, I really like sports and I just think that there's something kind of neat about a coach because a coach is going to be, they're gonna be tough. They're gonna be fair. And at the end of the day, all they want is for you to win. I just think that's such a cool concept and when you tell that to a parent, a parent, a lot of times can say, Okay, so I get that because I could say, I want you to be the parent to the kid but also think about a coach because when you have your child on a team,


A Peaceful Balance Wichita:  In OCD Family Therapy, that coach is going to be tough. And I'm not trying to take the emotions out at all because we know coaches can be incredibly empathetic. The coaches are probably going to push your child a little bit more than you would put child. And so putting yourself into that role and thinking about this is for a win, I know my child might be hurting, I know my child because they're doing the exposures because you're not allowing them to have the OCD accommodated, you're pushing them to grow. So, Putting yourself into the coaches role versus only solely. The parents' role can be such a powerful metaphor for parents and I just really, really love that. So when I'm looking at the siblings, I call those the assistant coaches, those are the ones that can assist and help out. The players.

A Peaceful Balance Wichita:  So the child that is in OCD  therapy or in treatment or whatever necessarily it might be and so be seen. So each letter of scene represents something s is supportive. How can you support the child? And I've actually created Worksheets, that are age appropriate for the sibling and the child with OCD, which again, it really could be any kind of medical thing because the acronym really doesn't exclusively cover OCD. They can do this together and so s is supportive finding different ways to support and

A Peaceful Balance Wichita:  With the worksheets that I've developed with ages five to 10. I just love this. It's it's an art activity and the kids together get to draw them slaying. I mean I'm using quotation marks slaying the OCD monster or making a can of like OCD away spray and so it's just a really, really cute. A activity to do and again because it's ages five to ten, that's such a level of mastery and explorative and, you know, they, they like to draw in color and play at that time. So, even if their sibling with OCD, it's a lot older. Think about what an amazing bonding experience that could be, you have a five year old sibling, and a 12 year old with OCD, that's a pretty cool, a situation able to put those two together to talk about it.

A Peaceful Balance Wichita: Because then that five year old. I mean, how empowering and beautiful that is is like, okay, so you know, sibling older sibling, I'm going to draw a can of a way spray, and this is what it's going to do, and it's gonna get it's gonna help get rid of this and this. And we know that children think so highly a metaphors. That, that could be such a really cool way for them to interpret that. And to be able to understand that because we also don't want little kids to well, it's not, we don't want to, it's they just simply don't have the cognitive abilities to understand OCD comprehensively So let's find age appropriate manners to be able to do that.


Kimberley Quinlan: Yeah.


A Peaceful Balance Wichita: And then the next one is developing empathy during OCD treatment. I'm not gonna lie doing an empathy exercise with kids can be a little bit challenging and I think I think that because the Emotions are so complex. In situations are so complex. And so I was trying to find a way to be able to put this in a manner that A five-year-old is going to comprehend and yet also like a 15 year old is not going to think is to babyish.

Kimberley Quinlan:  Yeah.

A Peaceful Balance Wichita: Per se. So it's a it's another worksheet because they're all worksheets it's another worksheet where the siblings can work alongside each other and it really can go either way. It usually works better if the child with OCD goes first. And so the child with OCD can share a so, for instance, I feel disgusted. When I'm around a bad food, I'm just gonna say something super blanketed and then the child the sibling with who does not have OCD could say, Okay? So let's talk about disgust. When do you feel disgusted? And they might say I feel disgusted when my parents make me eat broccoli. And so that's just a really cool and simple way for them to see that this is, you know, we can we can relate on emotions.

A Peaceful Balance Wichita: And we don't have to agree on your, on your emotional reaction, but we can all we can realize that we all have these emotions and this is how we can bond. And for a young young child,…

Kimberley Quinlan:  Hmm.

A Peaceful Balance Wichita: This could also be a really cool lesson in emotional intelligence, because they may not necessarily understand or comprehend. All these different kinds of emotions I'm not gonna lie. I think this might be my favorite one because I think this really encompasses a lot of different things. I love empathy exercises, I'm sure you like being big.

Kimberley Quinlan: Well, I think it builds on that common humanity, doesn't it?

A Peaceful Balance Wichita: But it really does. And that's the whole point is, you know, going back to what I mentioned about being seen, we're all humans and we're flawed and we don't want anybody to feel like they have to be perfect in this process and we don't want anybody to feel like they have to be all knowing, because there's such a beautiful way to which is actually Um, I was gonna go back to support. I've already talked about supportive, but it's a really cool way to support each other. and also not feel like you have to be an expert or Creating them per say,…

Kimberley Quinlan:  Yeah. Yeah. Yeah.

A Peaceful Balance Wichita: all right. So then the next one. The next E is encourage this one and the worksheets is make a sign. So like if you were at because again, these are assistant coaches and I'm kind of using the metaphor of sports or games or like, if you're running along a marathon, what sign would you hold for your sibling? And so, then they get to make a sign for older kids. It could be a Post-it notes, have Post-it notes, and then put it like in your siblings lunch or on the bathroom mirror, draw a picture of them, make a card for them, You know, finding different ways to encourage your sibling with out feeding and to the OCD. That could be a really big part of it. Because let's say, for instance, you have a sibling.

A Peaceful Balance Wichita: Who their OCD attaches on to the color? Black black is death. Black is some. Well, you know what, we're just not going to draw with the color black because it's not the siblings responsibility to do the exposures. Unless that is something that has been discussed actually in the therapy session, because, again, I can't say it enough that I do not want the sibling, to ever be in charge of treatment, or exposures or anything along the lines of that, of course, without actually working with a therapist beforehand.

Kimberley Quinlan: Right, right? Can I ask you a question really quite just to clarify Tim?

A Peaceful Balance Wichita: And yeah. Absolutely.

Kimberley Quinlan: So that parent is the coach. Right? And…

A Peaceful Balance Wichita:  Yes. Yes.

Kimberley Quinlan: then the child is the assistant coach, you mentioned. Do they get assigned that or…

A Peaceful Balance Wichita:  Correct.

Kimberley Quinlan: Do we just call them that? Do they know they're the coach? Do we use those words? Do we assign them? That? What are your thoughts?

A Peaceful Balance Wichita: I think that could really be up to a parent. Those are just terms that I've used you.


Kimberley Quinlan: They're like,…

Kimberley Quinlan: conceptualizations. Okay.

A Peaceful Balance Wichita: Exactly it…

A Peaceful Balance Wichita: because children work, so highly with metaphors and they can use whatever, I had a child. Once say, a lot of want to be a coach, I want to be a cheerleader. Cool. Then you could cheerlead we really kind of whatever it's like…

Kimberley Quinlan:  Okay.

Kimberley Quinlan:  Right.

A Peaceful Balance Wichita: if they want to be the waterboy, I mean I don't care as long as they whatever they can conceptualize it as and we can still kind of follow this supportive method fine.

Kimberley Quinlan: Yeah. Okay, thank…

Kimberley Quinlan: I just want to clarify that. So okay,…

A Peaceful Balance Wichita: Yep. Right.

Kimberley Quinlan: we're up to we're up to N.

A Peaceful Balance Wichita: That's just great. I say in is non-judgment. And this is the part that we really, really, really like to push that OCD is not your siblings fault. Absolutely did not ask to have OCD. They're not doing this on purpose to despise you or for whatever reason. And also realizing that as the sibling, the way the sibling with OCD behaves is not the siblings fault. This can be a part where you have some psycho education and learning more about what OCD is and what OCD is not. And finding different ways to be able to talk about that. Because that itself can be very difficult and…

Kimberley Quinlan: Mmm. Right.

A Peaceful Balance Wichita: I have, I do a lot of OCD psychoeducation when I work with families. And this is where I was going to bring unstuck back. I think that even before going through this process with families unstuck in my opinion I I'm sure other professionals you know, have their own ways of doing it but I find it to be one of the most profound psycho education methods to use for families. Because, and I'm, I do you work with kids as well. Okay, I'm sure you can, you can relate that when you're having that Psychoed session with a kid, it gets lost. They're done. They're bored. They're just like, well can I just do something else? When you have a which I love that, it's like 20 minutes, it was so made for kids the unstuck documentaries. It was beautiful. And kids talking about OCD to kids.

A Peaceful Balance Wichita: I mean I I don't know how it it is more impactful than that. Because a long treatment, it's funny enough, my clients will actually refer to the kids in the movie. Like oh, okay. Well, that one boy. Um, he was able to wear Hulk mask or that one, that one girl was able to hug a tree. Oh, that one. She ripped out pages of the Bible and they'll actually refer to that and they see that as being incredibly empowering. what that also does is it lets the parents know that here are some kids…

Kimberley Quinlan: You.

A Peaceful Balance Wichita: who I mean, you hear their stories, you know that those were pretty severe cases These are kids who came out the other side and are in recovery. and they're talking about these challenges, they're talking about How difficult it was for them. And so when parents are learning about ERP for the first time, it's it's very scary, it's very and so I think it's not only powerful for the children with OCD and their siblings but also their parents to be able to see this documentary, I can't speak highly enough about it, but that's not why we're here. Kim, we're not here to talk about this documentary.

Kimberley Quinlan: No, but I think I mean that's the beauty of the community, right? Is we all bring little pieces to what's so important. As you're talking, I'm thinking like

A Peaceful Balance Wichita: That.

Kimberley Quinlan: He sees that movie because that's the impact it's having. I mean I've seen it and I loved it it's so it's when we can't miss the siblings, right? Like that's some important piece. So I love that you're talking about that and I do think you're right. Question totally off topic.

A Peaceful Balance Wichita:  Yeah.

Kimberley Quinlan: But on topic is, when you're with a client, do you? Encourage them to watch on stock. Do you bring the family in and do this training with them? What kind how do you apply these concepts in session or Are you know, for someone who doesn't have therapy, what might they do?

A Peaceful Balance Wichita: Oh, okay, I'm gonna answer that. Someone who doesn't have therapy. Might what they do. I'll go. The therapeutic route to begin with, of course, after you solidify the diagnosis? Which again, for kids can be boy, that can be a challenge that can be such a challenge. So, this is after diagnosis, This is just part of the therapy. I do I, I will say, Okay, so bring in the family and I would say, I would love to have siblings here and they'll say, Well, the sibling is five or six, is that? Okay, absolutely, because you will be surprised at how aware the young sibling is going to be their older sibling.


A Peaceful Balance Wichita: And all time, you will also be surprised at how much accommodation the young child might be doing because they might see that as being. Well, that's just my older sibling. My only can't cut food.

Kimberley Quinlan: Yeah, right.

A Peaceful Balance Wichita: My older sibling doesn't walk down this one hallway. That's just how they are. Well, we also want to teach them that, you know, this is this, This has a name and here's some ways that you can be encouraging for your sibling. And so I have an entire session where I invite the entire family in and we watch the movie and then we process it together. and from there,…

Kimberley Quinlan:  Right.

A Peaceful Balance Wichita: We go on to.

A Peaceful Balance Wichita: Week, We go on to just write right away going on into the bc model and figuring out different ways how the sibling can be involved. Not other not excluded and then we'll go into more of kind of like, the clinical stuff, the Y box, exposure, higher and…

Kimberley Quinlan:  Yeah.

A Peaceful Balance Wichita: and so forth. But you ask, how can people that don't have therapy being able to utilize this. Honestly, it's on silly. I I'm probably the. Okay, there's two ways. I'm very competitive but I'm not competitive. When it comes to This this work, I post these worksheets for free on my website because this is something that I'm not here to make a profit off of it. I'm not here to, I'm not even gonna copyright it because at the end of the day, if we can help one sibling feel heard, Cool. That's it. That's that's amazing. No, no amount of money or…

Kimberley Quinlan:  Right. And

A Peaceful Balance Wichita: anything could ever be better than that?

Kimberley Quinlan: We can link the links to these worksheets in the show notes. You're comfortable with that. That would be amazing. Yeah. Okay,…

A Peaceful Balance Wichita:  Absolutely.

Kimberley Quinlan: that is so cool and so people can kind of work through them on their own. Okay.

A Peaceful Balance Wichita:  Mm-hmm. And in fact, there there was a family that I worked with whose younger sibling had had some special needs. And what I did with the parents, is I just kind of briefly explained this to them and because they know their kid better than, I know, their child and they know How how their child is going to be able to kind of understand process. This, they were able to take the information they did and that they needed to be able to help out the sibling who now helps out. That the sibling with OCD.

Kimberley Quinlan:  Yeah, yeah. Okay. So a couple of quick questions that I want to ask is so and it's a sort of going off of some past cases that I had. So what about the the sibling, Who's just really angry.

Kimberley Quinlan: the situation at how the, you know OCD has made their family, very For treatment before they were getting resources. Do, do they There's those children who have a lot of resistance to this idea of being a coach. You work with that. Is it through the empathy? Do you have any thoughts?

A Peaceful Balance Wichita: Door. And that's a fantastic question. Because we can't, we can't force. We can't force anybody to do anything. And I kind of view it like the child with OCD, If the child with OCD does not want to do the treatment. Well, then my job as a clinician is to meet that child while they're at and…

Kimberley Quinlan: Yeah.

A Peaceful Balance Wichita: that very much with the sibling, you know, of the child with Ocds, I'm gonna have to meet that sibling where they're at, if they don't want anything to do with this, if they want nothing to do with any of this process at all. I'll do one of a couple things one. I, I might refer the sibling on to a therapist who doesn't necessarily like they don't necessarily have to treat OCD but they can understand OCD comprehend OCD. Well enough to be able to have a conversation. And sometimes the sibling is like, Well, I'm not the one with the problem. I don't need to go into therapy, so I'll do my best. I can to coach the parents and help them to support that sibling as well.

Kimberley Quinlan: Right. Right, so. Okay and just conceptually. So the parents are using the parent. Coaches are using the bc model the children.

A Peaceful Balance Wichita:  Yeah.

Kimberley Quinlan: If they're ready and willing, they're using the bc model. And the person with the disorder or the medical condition is also using the bc model. Be seen model for the sibling and the family correct.

A Peaceful Balance Wichita:  Yeah, I mean this this doesn't have to just be with OCD, In fact, you know, as as I'm looking at just the the acronym of seeing, I don't know if you just has to just reach the medical stuff. Because at the end of the day, don't we generally want to be supportive and empathetic and encouraging and non-judgmental humans. I think just kind of a neat model just to teach our children in general.


Kimberley Quinlan: Mmm. Yeah.

Kimberley Quinlan:  That's what I was thinking. business sort of, like, 101 Training to be a nice. and like,

A Peaceful Balance Wichita: It really is it really? Like I said, I'm not reinventing the wheel, you know, I was able to use some different strategies that I've learned with. So originally as a therapist, I was on the way to becoming a play therapist. And a lot and also dealing with Dr. Bruce Perry's neurossequential model of. Oh My Gosh. Oh my gosh. Why can't I think what it is? It's his nurse sequential model for trauma. That's what it is. Oh wow. And then just just pulling different plate therapy, text me techniques. And I kind of just establish this thick this and…

Kimberley Quinlan: Yeah.

A Peaceful Balance Wichita: you're right. This is basically just Yeah, I like how you said 101. Be a nice person.

Kimberley Quinlan: Yeah, but the truth is and that's why I think it's so important is we all are nice people. We all want to be but when we get hit by a disorder, It's easy to go into reactivity as a parent. I know for myself or as I've seen, you know, siblings it's easy to go reactive. So these are sort of basic tools to come back to the basics and and recalibrate,…

A Peaceful Balance Wichita:  Exact.

Kimberley Quinlan: which is why I love it. Okay. So no,…

A Peaceful Balance Wichita:  Ly. Yeah.

Kimberley Quinlan: I love this so much is before we finish up. Is there anything that we haven't touched on that? You want to make sure we address here and we're talking about Supporting the siblings, but supporting the person with the disorder, any I've missed.

A Peaceful Balance Wichita: Um, can I list some resources? Oh, okay.

Kimberley Quinlan:  And please.

A Peaceful Balance Wichita: There's really not a ton of information out there about how can the sibling be involved with any medical treatment to be honest with you and I'll focus specifically on the OCD portion. Of course, John Hirschfield's amazing book in regards to family at the,…

Kimberley Quinlan: On a family,…

A Peaceful Balance Wichita: Yes at the very tail,…

Kimberley Quinlan: I see.

A Peaceful Balance Wichita: and he talks about different ways, family members can can be helpful. Natasha Daniels on her YouTube channel, she's so great. They're all great everybody. I'm listing is like All Stars. She specifically has a video about how to talk about OCD with young children and I think there's actually even more specific video about how to talk with siblings. Dr. Areeen Wagner on the Peace of Mind Foundation website. There is a whole slew of stuff about how to talk with siblings and I think the Bear Family is even involved in some of those presentations as well. And then this is gonna sound silly because I'm gonna shout out another podcast. Is that okay?

A Peaceful Balance Wichita: Okay, there's a couple on the OCD stories that they talk about siblings. Jessica, Surber rested.

Kimberley Quinlan:  Yes.

A Peaceful Balance Wichita: One about her own experiences being a sibling. And then, this is an older one. Maybe two, three years ago. Dr. Michelle Witkins. She does a lot of advocacy for siblings and so she has an amazing podcast on there where she talks about that work.

Kimberley Quinlan: Right? No, I will link to Eyes and you know I'm a massive stew fan so don't wait. Don't worry about it. No, I he's been on our show. I've been on his show a bunch of times. We are very much in Communic.

A Peaceful Balance Wichita:  I figured, I don't think there was a feud going on.

Kimberley Quinlan: Around food at all. No, that's that's so good that you have those and I will list those in the show notes for All as resources to use. I love. Thank you so much for sharing all those and we will have links to your sheets as well.

A Peaceful Balance Wichita: ah,

Kimberley Quinlan: You can An excellent resources.

A Peaceful Balance Wichita:  oh, you're sweet. Thank you.

Kimberley Quinlan:  Well, I am so grateful for you to come on and talk about this. I think it's really, really important that we talk about siblings, you know, address the whole family because it is a family condition, right? Thank you. I'm so just overjoyed to have you on the show.

A Peaceful Balance Wichita:  Well, thank you. I'm overjoyed to be here.

Kimberley Quinlan: Where can people hear from you or get information about you?

A Peaceful Balance Wichita: So my website, so my practice name is a peaceful balance, Wichita Kansas, and my website is a PB and really, to be honest with you, probably the easiest way to To contact me is on Instagram. I'm probably on their way more often than I'd like to admit and…

Kimberley Quinlan:  Yeah.


A Peaceful Balance Wichita: my handle is at anxiously balanced.

Kimberley Quinlan: Love it and you put some amazing exposure lists and movies. It's so good. You but no it's so it's such a huge resource.

A Peaceful Balance Wichita: I think I have way too much fun with those.

Kimberley Quinlan: If you're looking for specific movies, documentaries songs, I think you do a great job of listing exposures.

A Peaceful Balance Wichita:  Thank you.Kimberley Quinlan: Thank you so much.

Dec 9, 2022


In this podcast, Micah Howe addressed his expereince with intensive OCD treatment and the 6 most important turning points of OCD Recovery

  1. Compulsions keep OCD going, 
  2. I can control my reaction to OCD

  3. Worrying is a false sense of control and is not productive

  4. Anxiety does not mean something needs solving

  5. Find an OCD community

  6. Self-compassion helps manage uncertainty

Micah also addressed how to know you are ready for intensive ocd treatment and how he managed his OCD grief. 

Links To Things I Talk About:

ERP School:

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This is Your Anxiety Toolkit - Episode 314.

Welcome back, everybody. Today, we are talking about the major turning points of OCD recovery. This episode is literally how I want to end the year, although we do have more podcasts coming this year before we finish up 2022. But literally, this is like mic drop after mic drop after mic drop. I thoroughly enjoyed interviewing this week’s guest. I’m so honored to share with you this interview with Micah Howe. He’s an OCD advocate and is one of the most inspirational people I know. I just have so much respect and adoration for him. And this episode is literally a bomb. I just can’t, I can’t shout it from the rooftop loud enough.

I’m going to keep this intro very short because I really just want you to hear exactly what he’s saying. And really what we’re talking about here is some ideological shifts that he had, going through intensive treatment and treatment in general, specifically for OCD. But if you don’t have OCD, this is still going to be a powerful punch for your recovery because the tools that he shares that he realized on the end of his recovery are ones that anybody could apply to their recovery. So, let’s just do it. 

Before we move on, let’s quickly do the review of the week. This one is from Tristramshandy1378, and they said:

“I stumbled across your podcast recently. I have been through therapy with Anxiety and panic and I have a high-stress job that I love, but I needed to continue my journey to recovery and be reminded of all the skills that are available to help me along the way. Your online courses for OCD and your amazing podcast reminded me the most important part of the process is to love myself, before, during, and after my episodes of intense anxiety and that every day is a beautiful day to do hard things.”

Oh my gosh, Tristramshandy, this is just so exactly my mission and my model. And so, I’m so grateful for you for leaving a review. 

It sounds like actually Tristramshandy’s review of the week should actually be the “I did a hard thing,” but we have an “I did a hard thing” as well. This one is from Anonymous and they said:

“Hello, Kimberley. Very glad to have this resource. I did a hard thing. I started using public transportation much more often. It helps a lot with agoraphobia. I also significantly decreased media consumption, and that helped me learn to live with my thoughts and generally slowing down to process the information.”

So, thank you so much for Anonymous for sharing that. 

To be honest with you guys, the review of the week and the “I did a hard thing” and this entire episode is like three different “I did a hard thing” segment, so I’ve just so overjoyed that we’re all here doing the hard thing, bringing in the end of the year. This episode is going to be such an amazing resource for you. So, let’s get over to the interview.

314 The 6 most important turning points of OCD Recovery (with Micah Howe) Your anxiety toolkit

Introduction To Micah Howe

Kimberley: Thank you so much for being here, Micah. I am actually so excited to hear this story. So, welcome.

Micah: Yeah, thanks so much. Glad to be here.

Kimberley: Yeah. So, you and I had talked before we came on to record about how you are going, wanting to tell the story about your intensive OCD treatment specifically around OCD. And this is the topic that I find so interesting and something that I actually really am so excited to hear your story. So, would you be able to tell us just in brief what the backstory of your recovery looks like and get us up to date in terms of where you were, what you experienced, as much as you’re willing to share?

Intensive Treatment For Ocd 

Micah: Yeah. So, what had me in intensive treatment – I grew up in rural Iowa and so resources for OCD, particularly evidence-based treatments like ERP, particularly several years ago when I was first starting to show really debilitating symptoms, those sorts of resources were really hard to come by. And so, it took me a long time to find good help. And then once I did find good help, my OCD had gone on unrestrained for so long that I needed a really intensive setting. And so, my OCD started becoming quite debilitating around the age of 18 or 19. The college transition was really hard for me. But by the age of 25, even doing some outpatient therapy, it just wasn’t really putting much of a dent in what I was dealing with. And so, I ended up in a partial hospitalization setting where we were putting full-time job hours into exposures every week. And that’s what it took for me to begin to see breakthrough.

Kimberley: Right. So, what was it like? What were you experiencing? Because I’m sure there are people who are going through treatment who may be feeling similarly. You are doing outpatient once-a-week therapy, were you?

Micah: Yeah. 

How To Know You Are Ready For Intensive Ocd Treatment

Kimberley: And how did or was it you who knew you were ready for in treatment or was it the clinician who advised you to take that next step?

Micah: For the longest time, I had so much stigma about going to a “mental hospital.” Really, I didn’t know what to expect, and just naturally as people, we’re afraid of the unknown. And so, I was pretty resistant. But eventually, a clinician that I was working with really had said, “If you want to get to these goals you’re talking about in any reasonable amount of time, I really think I should recommend that you go to a higher level of care.” And so, that really opened me to this idea of seeking a higher level of care. It was the combination of a clinician recommending it and also my just experience of realizing, this once a week, I mean, we’re very well-intentioned here, but I’m just not getting very far.

Kimberley: And I think so many people are there and the stigma holds them back. There is a lot of stigma attached. Besides that conversation, was there any other shifts you had to make to get your foot in that door, or it was an easy decision once you explained it?

Micah: I hate to say it, but unfortunately, it’s all too common in the world of OCD recovery. But I was another one of those people that I went kicking and screaming. I had to hit rock bottom. It was helpful for a clinician to tell me, “I really think this would be beneficial to you.” It was eye-opening for me to realize, gosh, I’m coming back here every week and I’m just not getting very far. But I think what really pushed me the rest of the way was this very sobering realization that this OCD is going to continue to take as much of my life as I allow it to. If I continue to just do a level of therapy that, at least for me personally, is not getting me where I want to go – if I just continue doing that, hoping that something is going to change, experience was teaching me that OCD is not just going to back off if I don’t do anything different. So, I think that idea of hitting rock bottom, of being tired of chasing the same goals month after month that I wasn’t getting any closer to, that really pushed me to say, “Okay, I’m more afraid of losing my life and opportunities than I am of whatever stigma I might have to shoulder adding to my life’s resume that I spent time in a mental hospital.”

Micah’ Intensive Ocd Treatment Story

Kimberley: Yeah. You had to weigh the pros and the cons and all directions were leading you in that direction. That’s cool. That’s so cool that you were able to do that, make that shift in your mind and make that decision. So, okay, you’re in the door in intensive. Was it what you expected? Tell me about what you expected and how it was different.

Micah: Yeah. And it’s that question that I really appreciate because, for anybody listening that might be considering another level of care that is intimidated, I mean, that’s right where I was. I mean, I didn’t know what to expect. And when I got there, I’ll never forget the biggest thing that really was surprising to me is how calm and inviting and not scary it was. I met a lot of people there and I was like, “Wow, these people are just as genuine as I am. We’re all just trying to get better here.” And I also think, I thought there was going to be-- the other thing that really stuck out to me was I thought there was going to be this really significant talk therapy element. I thought we’re going to-- all these things that I couldn’t figure out in outpatient, these treatment teams at these intensive centers, they’re going to have the answers that my outpatient therapist didn’t have. And it’s actually like, no, they don’t have the answers. They’re actually more encouraging than my outpatient therapist that I live without the answers. 

And so, we’re not really talking through the things that concern me. We’re instead doing this evidence-based really rigorous exposure therapy where I’m not talking about my feelings and my past as much as I’m talking about how I reacted to something they asked me to challenge myself to do that day. And so, just the way they went about helping me get better was so different than the path I thought we were going to go down.

Kimberley: Yeah. Isn’t that interesting? Would you say-- and this is sometimes how I explain it to some clients, but you should actually give me feedback here. I’m as much learning from you as any. Sometimes we say intensive treatment isn’t different, it’s just more. It’s more frequent. It’s more of what you’re doing in session, and that’s a good thing. Was it that for you? Was it just more of what you were doing? Or was there some fundamental differences in the structure of the sessions? How was it different for you?

Micah: Again, yeah. I mean, obviously, I’m not a therapist or a medical doctor, anything. Everything I say on the episode is just from my limited personal experience as a sufferer. But I would say in my experience, when I was doing outpatient therapy, only meeting with a clinician once a week, only doing so many exposures a week, I guess this idea of tolerating uncertainty, I understood it, but I don’t think I bought in as deeply as I bought in when I was in intensive treatment because now, instead of we only have 50 minutes to talk through everything, now my treatment team is like, we’ve got two hours if you need it. And so, we’ve got two and a half hours if you need it. And so, if I was hung up on an exposure that I didn’t want to do, it wasn’t a situation of, “Ah, we’ll get to that next week.” It was like, “We can wait. What’s the issue? What’s getting in the way?” And so, I couldn’t just run out at the end of 50 minutes like I would in an outpatient context. We were there full-time to deal with fears and help me gradually be willing to engage in exposures, that in an outpatient context, I didn’t have to push myself that hard. And it was much harder than outpatient for me, but it also caused progress so much faster because when I ran into a bump, it was like, we’re either going to try to work through it now, or we will be right here tomorrow to keep working on it. And so, there was a consistency that created breakthrough that once a week just wasn’t doing. 

Kimberley: Right. See, that’s so interesting, the mindset shift for you that you had. So, okay, I’ve got lots of questions, but I also want to know, you have come with four main points that I want to make sure you’ve got plenty of time. So, I’ve probably got questions there as well because I always have too many questions.

Micah: Oh, no, that’s great.

The 6 Most Important Turning Points Of OCD Recovery

Kimberley: You had said there were four ideological shifts you had to make during intensive treatment, and I want to highlight those because they’re brilliant. So, would you be kind to share that with us?

Micah: Yeah. Do you want me to just start with the first one or did you want me to list--

Kimberley: Yeah, just lay them on.

  1. Anxiety Does Not Mean Something Needs Solving

Micah: There were so many, but for the sake of time, I think when I think about some of those paradigm shifts, some of those ideological shifts that really created a lot of breakthrough for me, the first thing that comes to mind is my treatment team challenging me to accept the notion that anxiety was tolerable and that it was an ordinary part of the human experience. When I started out in treatment, I saw anxiety as a signal that I was doing something wrong in my life, a signal that there was a problem that needed solving. And OCD didn’t exactly know what that problem was, but it had rituals to offer me in the meantime. And so, I just felt like anxiety, it is a catalyst, it is an impetus, it is a sign that something is awry and I’m supposed to be doing something. 

The last thing I thought was, like my treatment team encouraging me, “Micah, what if anxiety is just part of being a person? And what if it doesn’t necessarily mean that life is asking you to do anything to make it go away? And what if your life was actually better tolerating the distress that anxiety created rather than being a fugitive from it your whole life?” And I had never considered that in part because I again thought that it was extraordinary, but also, I had never considered the idea that anxiety could just be tolerated. It was so unique and novel to me because I just saw anxiety as anxiety is something I hate, anxiety is something I find unbearable, and either my life is miserable because it has anxiety in it, or I’m able to live the life I want because I’ve completely eliminated anxiety from my experience. And to be offered something in the middle, that that wasn’t black and white, that was so just revolutionary for me to say, “What if I can’t ever get away from this thing called anxiety? But also, what if I never come to love it either? What if I just live my life just lukewarm to this emotion? Just allowing it to be in my life?” And that was something that prior to my treatment team encouraging me to think that way. There was just nothing in my natural instinct that thought about just letting anxiety be around without reacting to it.

Kimberley: Yeah. So cool. Isn’t that so cool? Okay. So, what’s the next one?

  1. Compulsions Keep OCD

Micah: So, the next shift that was extremely meaningful to me – when I was in intensive treatment, we did a lot of ERP, we did some ACT principles, some behavioral activation because I also deal with comorbid depression and hoarding disorder, and we also did a fair amount of thought challenging. And the thought challenging was particularly insightful for me in that as I started to break down some of my rituals, I really had to come face to face with the fact that my rituals were creating very much the antithesis of what my OCD told me those rituals existed to accomplish. Compulsions keep OCD going.

So, for example, scrupulosity was a big issue for me. And my OCD was telling me all of these things you are doing, all of these repeating things you are doing, this is to make you feel closer to God. This is so that you will be more engaged with your faith. This is so that you will be a better Christian. And yet, as I started breaking these things down, I was like, I have never felt so disconnected from my faith as when these rituals have become such a significant part of my experience. And even with my hoarding, it had an effect. I was collecting all of these things to relieve anxiety. And the notion was you’re collecting these things so that when the day comes that you need them, you’ll have them. And yet, the effect was that I had so many things accumulated that when the day came that I thought, oh, that thing would be really great. I couldn’t even find the thing in my mess of things. And so, in reality, there wasn’t much of a difference between not having any of these things and having a basement so full of things that I couldn’t find the things I wanted anyway. 

And so, that thought challenging and really analyzing why am I doing this and what is the difference between how I feel about these rituals versus the reality they’re actually creating in my life? And I was able to see that I am giving up long-term progress towards the person I want to become in exchange for short-term relief of anxiety. And that took me a long time to acknowledge, but once I saw it, it helped me break away from the rituals a little bit easier. 

OCD Grief

Kimberley: I know, isn’t that so true? Is that we feel in the moment the ritual is helping. It’s like, this is a part of the solution. And that’s a big awakening when you’re like, it’s not a part of the solution. At least not the long-term one. That’s that. Was there any OCD grief? Was that a relief or was there some grieving you had to do about that?

Micah: Yeah, I think there was some grieving only in the sense that when you spend all this time doing these things and you’re believing your OCD that these are helping me, these are getting me closer to the person I want to be, there is some grieving in recognizing that there’s a lot of emotional reasoning involved in why I’m doing these things. They make me feel like I’m getting closer to the person that I want to be. But it’s really an illusion because people who are close to God, I don’t associate those people as being people who repeat their prayers so many times because they’re terrified. I associate those people as being people who enjoy the discipline of prayer, who enjoy being in religious services. And so, it was a very odd experience to have to come face to face with the reality that these rituals are making me feel a certain way, but when I look at the results I’m getting over the long term, I’m actually getting farther away from the person I’m wanting to be.

Kimberley: Right. It’s gold, isn’t it? And I’ve seen that recognition and realization in my clients and it’s a tough one, but it’s an important one. Did that come in pretty quick in your intensive treatment or did that take time?

Micah: I think in the first maybe week or two of intensive treatment, I just had my clinicians, because I was resistant to ERP at first. And so, there were a lot of nuggets being dropped that I was just like, “Whoa, I have not thought about that in my whole OCD journey.” So, I would say the real change happened several weeks into intensive treatment, but definitely that first week or two, I was encouraged to think about these rituals and uncertainty and all these different elements involved in recovery from OCD very differently than I ever had before. I mean, I remember one of my first conversations with a therapist at treatment just asking me to think about what do you think a committed Christian is like, what do you think their life looks like? And I had never thought about that before and I realized that doesn’t look anything like my life. And that was really eye-opening for me to be like, I don’t associate being close to God with doing all these things out of fear. I associate it with actually finding meaning in these things. And so, I just had to separate that, just because these things make me feel a certain way.

Another one was, I was so afraid of getting brain cancer and so I did all sorts of Google searching. And I was really challenged to think through, do you think about a healthy person as being someone that’s on Google all the time? Is that what health looks like to you? And of course, the obvious answer was no, but I just had never been encouraged to think that far previously.

Kimberley: Yeah. I’m loving everything you’re saying, so I’m just wondering like, keep going, keep going. What’s number three?

  1. I Can Control My Reaction To OCD

Micah: So, the third thing was, if there was anything that I underestimated when I came into intensive treatment, it was my own capacity for change. When I came into intensive treatment, there was a lot of hopelessness, and it was rooted in this idea. My thoughts trouble me deeply. My emotions bother me deeply. I can’t control either of those. And then on top of that, my life circumstances bother me. And although I might be able to change those, I can’t really change them quickly. And so, what hope is there for this getting better? 

The blind spot I had coming into treatment was this idea that even though it’s hard, and even though it doesn’t feel this way often, I do hold the keys to the behaviors that I choose. And my treatment team really worked hard to say, “Micah, it’s a losing battle to try to fight thoughts and emotions that you can’t direct. But what if we focus on the things that you do have some ability to influence, even if it’s hard to do?” 

And so, my life just really began to change, hope began to flood in when I began to buy into this idea that I’m not in control of many of the things I would like to be in control of, but I do have influence over my behavior. And because I’m so caught up in my rituals, I’m really not tapping into that potential at all when I’m coming into treatment. And so, once they started to say, “Micah, we’re not going to sit here and talk you out of your thoughts,” but they exposed me to ERP and concepts like neuroplasticity and this idea that what if we can’t change your life, but we can improve your brain’s ability to react to your life with more helpful behaviors? And I was just blown away because I had just never thought about it. I just thought, well, if we can’t change my thoughts, we can’t change my life. And they flipped that on its head and said, “Well, what if we just tolerate the distress of your thoughts and start living the way you want to live and see what happens?” And I didn’t even know that there was a relationship between cognition and behavior that allowed progress to be created that way. It was unbelievable.

Kimberley: There are all these light bulb moments. All I want to keep asking you, I keep feeling like myself going like, you were receptive to this? You were obviously eventually receptive to this, or did you fight them on this? I’m thinking about my clients and now the people listening, I know they may have been hearing these same things, whether it’s through this podcast or through their therapists, is like OCD has a strong opinion about these concepts too, I’m sure. Was OCD throwing a massive tantrum?

Micah: Yeah, no, for sure. I don’t want to make it sound like I just walked in and they said these things and I was hopping down the lane just like, “Oh, perfect.” It wasn’t that at all. There was a tremendous amount of resistance, but I think that that resistance was weakened faster, both because we were talking every single day for hours at a time and also because, by the time I reached intensive treatment, it was like, if I’m not willing to try these concepts, if I decide I don’t like this and I’m going to check myself out of this place, what am I going to go back to? Where am I going? If I’m not willing to try this, what’s the next thing? And I knew it was just going to be back to more rituals, not getting anywhere. And so, I was open. 

And there were also specific exposures that I’ll never forget. And I don’t think my behavioral specialists necessarily knew the depth of impact some of these exposures would have on me. They knew it would help, but some of them were like, “Wow, that was an unbelievable exposure.” One of them was, they had me watch YouTube videos of people who were explaining their experience of being diagnosed with terminal illnesses. And so, they’re dying and they’re on YouTube and they’re telling their story. And if I could find them of brain cancer, I did brain cancer. But if it was ALS, whatever, they just find a terminal disease, find someone who’s describing what it was like and watch those videos as an imaginative script. And I’ll never forget watching those videos and seeing even people dying of terminal illnesses had moments of laughter and smiles. And I thought to myself, they didn’t get there by sulking in their thoughts. I just realized, when these people know they’re dying, somehow, they decided: I’m going to do things that matter to me even when my brain is probably telling me, “Your life is over. What’s the point?” It just so inspired my confidence that, wow, I do not understand at an anatomical or at a metaphysical level what is involved in living life the way I thought I did. 

I had to be open to this idea that there is a way to choose behaviors, that my thoughts are not exactly supportive, and get places even when I don’t necessarily feel like getting to those places. And I didn’t realize I could just challenge my thoughts by choosing behaviors that mattered to me, even if it scared me to do it. And some of those exposures just really stuck with me in that sense.

Kimberley: I love that. And it is true, isn’t it? You’re doing an exposure to purposely simulate the fear and sometimes there’s a lesson in it. There’s a message-- not a message, but just a lesson. So, that is incredible. And thank you so much for sharing that exposure example because that’s some hard stuff you’re doing. That wasn’t easy.

  1. Worrying Is A False Sense Of Control And Is Not Productive

Micah: No, no. It wasn’t. And I think that was also part of the treatment that really was hard for me but has helped me grow so much, is just this idea that that worry doesn’t have any utility to it. My OCD convinced me for so long that by worrying about things, we’re doing something. And it was this magical thinking in a sense that something in the cosmos is happening because I’m here worrying. And really just being able to acknowledge, “Micah, your worrying is not doing anything productive. Your OCD can make you feel all day long, like the energy expenditure.” Well, there’s so much energy expenditure in my worrying. It has to be accomplishing something. Instead of just acknowledging it, it actually doesn’t have to be accomplishing anything and it isn’t. And as blunt and hard as that was to accept, it did help me when they started to offer me this acceptance piece of like, it sucks, but they really encourage me, my treatment team, that Micah, you do have to accept that you are a limited being and that there are answers that your OCD would love to have. And no amount of fretting about it is going to get you those answers. But it is going to chew up your life. It is going to take away opportunities. It is going to keep you out of the present moment. 

And I think-- sorry, I’ll just add two more things real quick, but I think the one thing was this idea. When I first came into treatment and they started offering mindfulness and we did a little bit of yoga, I really didn’t buy that when I got started. I just thought this is not me. But by the time I left treatment, I just found mindfulness for OCD to be the most helpful practice because the reason I didn’t like mindfulness at first is because I thought it was cheesy. But once I really started to buy into what my treatment team was saying, I really recognized at a very brutal level, mindfulness is just recognizing the world for what it actually is, even if I don’t like it. That what I really have as a guarantee is this moment, this breath, this blinking of my eyes. And that’s really all I know for sure. And as terrifying as that statement once was for me, I became much more pro-mindfulness as I became comfortable with accepting that reality about the world.

  1. Find An OCD Community

And then the last thing I would say as far as paradigm shifts that really was so impactful for me in intensive treatment was just this idea that uncertainty is a burden that is best shouldered authentically with other people. And what I mean by that is group therapy just meant the world to me when I was in intensive treatment. I grew up in rural Iowa where there’s a lot of stigma and talking about what I was dealing with was really hard. And so, to finally-- instead of just bury all this stuff and pretend that the world is not as uncertain as it really is and just try to get through, it was just so unbelievable to just finally be in a circle of people and we are all just admitting we are terrified of this thing called uncertainty. And I’m terrified of uncertainty related to my health. And you are terrified of uncertainty related to religion, and you are terrified of it related to whether or not you hit somebody on the way here to treatment today or whatever. And to just openly voice our fear of uncertainty. I can’t even explain it, but it just created a human bond to be able to be honest with each other in that way that I never experienced just trying to bury these things and pretend that uncertainty wasn’t as scary as it really was. 

  1. Self-Compassion Helps Manage Uncertainty

And I think the other thing it did is it introduced me to self-compassion in a way that I hadn’t really acknowledged before. There’s something unbelievable about, when I talk about how much uncertainty scares me, it’s so hard for me to feel empathy for myself. But as soon as I see another person across the room say it scares them, all of a sudden, it’s like, where’s all this empathy I have for them? When they say it affects them and, “oh, I had to drop out of college because I couldn’t deal with this and I’m scared of this and that,” when I have the same story, I don’t feel much compassion for myself, but when I see someone else have that story, here’s all this compassion. And I walked away from that thinking like, whatever it is that makes me so sympathetic to someone else’s struggles with these things, I need to find more of that for myself.

Kimberley: Is that something that was the switch that went on or is that something you go in and out of being able to do that self-compassion piece?

Micah: I think, if I’m being honest, it really is an in-and-out thing for me. And I think it is related to the camaraderie of other sufferers. Whenever I’m at the conference, gosh, I am like at my all-time annual self-compassion highest because it’s just like, “Ah, yeah.” I remember we’re all a community and it’s like high school musical all over again. We’re all in this together. But when I get back to Iowa and I’m not regularly rubbing shoulders with sufferers, I start comparing myself to non-sufferers a lot, and all of a sudden, this desire to be compassionate towards myself lessons. So, it’s something I have to work on continually to remember that I’m dealing with something that is not easy and a lot of people aren’t dealing with. And it’s just, I work very hard to try to remember the feelings that well up inside of me when I hear somebody that’s not me share their struggle and their recovery and do my best to be like, okay, whatever it is that wells up in me when it’s somebody else, I need to work hard to feel the same way about my own journey. But it’s definitely a process.

Kimberley: Oh my gosh, you’re on fire. These messages are so incredible. And I think it’s exactly like what people need to hear. It’s the pep talk they need. I want to be respectful of your time. Is there anything you want to say about your journey that you think would be helpful or that would be great for you to share?

Micah: Yeah. I think the only other thing I would say, and I say this quite often, but I just think in my journey, I think early on in my journey and especially when I was coming to intensive treatment, I wanted everything to happen fast. I wanted a quick fix. I was hurting so badly that I wanted things to get better so quickly. And I think one of the things that has become a mantra for me personally in my recovery is that my recovery was definitely not immediate, but it has been and continues to be substantial. And I think that’s a truth about my recovery that I’ve really tried to hang onto. Because I’m very much this person that I don’t want to just-- when people are looking for hope in my story, I don’t ever want to just say something that’s hopeful if it isn’t entirely true. And so, the thing I tried to say, at least I can’t say what will be appropriate for someone else’s recovery, but my recovery, it has not been as fast as I wanted it to be. I think it’s so important to be transparent with people and say, I have suffered with this disorder far longer than I ever would’ve wanted to, but my life has become and is continuing to become far more than I once thought it was going to become. And so, there is that bittersweet hope in that, I think, is the most honest and encouraging thing I can say about my experience.

Kimberley: You’re such a shining bright light. Thank you for sharing that. I feel it. I’ve got goosebumps. I love when I get to interview people, I get goosebumps the whole time. I’m so grateful for you sharing all of these wisdoms that you’ve shared, and that’s what they are. They’re just such deep wisdom. Can we hear where people can hear more about you, learn about you? How can people get your stuff?

Micah: Yeah. Right now, I don’t have a ton going. I hope to have more going in the near future. But if people want to reach out to me on Instagram, they can find me at @mentalhealthmhe.

Kimberley: Okay. So amazing. I’ll make sure to link that in the show notes. Micah, it has been such a pleasure. Thank you for sharing all these amazing things. Thank you. Thank you.

Micah: Thank you so much for having me on. This was a wonderful conversation.

Kimberley: Oh, it makes me so happy. Thank you.

Dec 2, 2022

In This Episode:

What causes anxiety?

Is Anxiety "normal"?

  • Genetic and environmental
  • It is NOT your fault.
  • You didn't ask for this
  • You are doing the best you can with what you have

Does that mean there is nothing you can do? No.

What causes anxiety disorders?

  • NIH - "Mood and anxiety disorders are characterized by a variety of neuroendocrine, neurotransmitter, and neuroanatomical disruptions.
  • Risk factors- These factors may increase your risk of developing an anxiety disorder:
  • Personality. People with certain personality types are more prone to anxiety disorders than others are.
  • Other mental health disorders. People with other mental health disorders, such as depression, often also have an anxiety disorder.
  • Having blood relatives with an anxiety disorder. Anxiety disorders can run in families.
  • Drugs or alcohol. Drug or alcohol use or misuse or withdrawal can cause or worsen anxiety.
  • Stress due to an illness. Having a health condition or serious illness can cause significant worry about issues such as your treatment and your future.
  • Stress buildup. A big event or a buildup of smaller stressful life situations may trigger excessive anxiety — for example, a death in the family, work stress or ongoing worry about finances.
  • Trauma. Children who endured abuse or trauma or witnessed traumatic events are at higher risk of developing an anxiety disorder at some point in life. Adults who experience a traumatic event also can develop anxiety disorders.

What causes anxiety in the brain?

  • a primary alteration in brain structure or function or in neurotransmitter signaling may result from environmental experiences and underlying genetic predisposition;
  • These alterations can increase the risk for developing anxiety disorders.
  • Abnormalities in a brain neurotransmitter called gamma-aminobutyric acid — which are often inherited — may make a person susceptible to GAD, according to NIH
  • Life events, both early life traumas, and current life experiences, are probably necessary to trigger episodes of anxiety.

What causes anxiety and panic attacks?

  • Same as above....but consider
  • avoidance
  • reassurance seeing
  • Mental rumination
  • other physical compulsions
  • Self-punishment

Links To Things I Talk About:

Episode Sponsor:

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

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This is Your Anxiety Toolkit - Episode 313. 

Hello friends. We are talking about what causes anxiety and why it is not your fault. So important. Okay, let’s say it again. Why it is not your fault. I know you’re probably beating yourself up for something related to your anxiety, that you should be handling it better, that there’s something wrong with your brain. I want to really knock this concern, this belief, this thought out if I can, and try to replace it with some information that you can use in the moment to reassure yourself, not in a compulsive way, but just to remind yourself it’s not your fault. Let’s stop beating you up for something that’s not your fault. If you saw something happen on the street and had nothing to do with you, you wouldn’t probably blame yourself or beat yourself up or shame yourself. And I would like you to do the same for your anxiety. Okay?

So, before we do that, let’s talk about the “I did a hard thing.” This is from anonymous. It’s pretty cool, I have to say. Anonymous says:

“I was diagnosed with relationship OCD this year after sharing my doubts and rumination patterns with a therapist. My parents have expressed concerns about a boyfriend I have been with for over a year, and I don’t think these concerns are valid and my therapist doesn’t think they’re concerning either. My parents’ comments still trigger my relationship OCD doubts big time. However, I have opened up to my parents about how I’m considering marrying my boyfriend and have responded to their criticism calmly without getting mad at them. It’s been really hard to establish boundaries, but also be kind. But I feel like I’m on track. I also am trying to see my parents’ criticism of him as a gift, at least I know that I can’t go to them for reassurance and it’s a great exposure opportunity.”

Anonymous, you are literally winning. The reason I am so thrilled, last week we did a whole episode on relationship OCD with Amy Mariaskin, and I really feel like you’re mastering all of those skills that we talked about last week. So, that is just amazing. Congratulations on that hard thing. It’s really, really cool work you’re doing. 

And quickly, before we move on, here’s the review of the week. This is from Susan in Plano. They said:

“It’s a life preserver! Kimberley, your podcast has been such a help to me as I pursue recovery from a particularly active and pesky flare-up of OCD. Diagnosed in 2007, I have just this year found an incredible therapist who specializes in anxiety and OCD. Your podcast encourages me to keep doing the hard things. It makes me laugh and assists me in realizing just how much company travels on this road (even when it feels lonely and isolating). I am profoundly grateful for your work, and I have personally recommended this podcast to at least ten people. Thank you so much.”

Susan, thank you so much. You guys, if you’re able to leave a review, of all the gifts you could give me, that would be the most beneficial to me. I love your reviews. Go to wherever you listen to this podcast and leave a review if you can. It does help me to reach more people and gain their trust. So, thank you so much. 


All right, let’s do it. What causes anxiety and why it is not your fault. Okay, so let’s first look at what causes anxiety. The first thing to remember here is, anxiety is actually not a problem. And what I mean by that is it is normal and healthy and an important part of our functioning and survival. What we’re talking about here is, normal anxiety has its roots in fear and what it really does is it helps us to respond to dangerous situations. So, if you were there facing some kind of dangerous, stressful situation, a bus was coming your way or your house was on fire, or your car broke down on the highway with tons of cars beating past you, you would naturally get anxiety. And that anxiety would show up to alert you that you must be careful and take care of this somewhat dangerous situation.

When that happens, you’ll notice your heart beating faster, your chest might get tired, you might need to pee, you might need to poop. You might feel like you need to throw up. You might feel an overall irritability or jitteriness. So many different symptoms. You might get dizzy, you might have a headache. So many symptoms of anxiety show up, not because there’s anything wrong with you, but because that is your brain’s way of preparing you for fight, flight, or freeze. It’s very, very important. And so, it is a normal function of the body. However, some of us experience extreme degrees of this and our brain sends this “normal anxiety” out when there’s not danger. Your brain is perceived there to be danger when in fact there isn’t any danger. And this becomes a problem and it becomes a cycle, particularly if we respond to it. 

So, what are we talking about when we’re talking about excessive degrees of anxiety, or in the case, we may be an anxiety disorder, which I’ll get to here in a minute, is we understand that problematic degrees of anxiety or high levels of anxiety are caused by genetics, which is your generations above you. It’s hereditary, but it’s also caused by environment. We don’t yet really understand what specifically causes it, but we know so far that it is a combination of genetics and environment. 

What that means is, you were probably genetically set up to have anxiety. It’s in your DNA the day you were born, which is why I’m going to emphasize to you that it is not your fault that you have anxiety. A lot of this could be passed down multiple generations. So, you might be thinking, “What? My parents aren’t anxious, my parents aren’t depressed, can’t be my family. Can’t be genetic for me. Must be just something wrong with me innately.” And I’m going to say, no, it could be paternal grandparents, maternal grandparents, or even further up the chain of genetics. Now we also know it could be environmental, it could be what you’ve been exposed to. We know that if you’ve been exposed to multiple stresses throughout your life, you may be more predisposed to anxiety. But we’ll get to that here in a little bit. 

The thing to remember as we move through is this going to keep reaffirming to you that it’s not your fault. You never asked for this. In fact, my guess is you’re asked to not have this many, many times. You’ve asked your brain, why are you this way? So, you really didn’t want this, you didn’t ask for it, and you’re doing the best you can with what you have. Meaning, even if it’s environmental, you would make-- some people might go, “Yeah, if I didn’t make this one decision, I wouldn’t have been exposed to this one thing.” We’re all doing the best we can with the information we have. It’s easier to look back with 20/20 vision, but in the moment, we’re all just doing the best we can.

Now, the thing to remember here as we go through is, please don’t get hopeless. Just because it’s environmental and genetic, it doesn’t mean that you are stuck with this problem now and that there’s nothing you can do. I’m going to outline here in a little bit close to the end exactly what you can do to have a toolkit to help you work through this situation that you’ve got this brain that’s responding. So, let’s really focus on that piece at the end. Okay? 


So, let’s move on now. What specifically causes anxiety disorders? Now, I’m going to leave you some links here in the show notes. If you want to do more in-depth, I am not going to go into great depth here because it’ll go over your head, most likely it goes over my head completely. They’re using some very scientific words. Unless you have some kind of really great science, you have great knowledge in this area, I’m not going to go into that because I don’t think it’s beneficial to fill your brain with all these words. That doesn’t mean anything. But basically, the National Institute of Health have said that mood and anxiety disorders – I’m actually reading directly from their website here – are characterized by a variety of neuroendocrine, neurotransmitter, and neuroanatomical disruptions. That is what they have said. And what they’re really talking about is a bunch of functions that happen in the brain that can get disrupted, causing us to have a brain that sets off the fire alarm or the danger alarm too often, too many times.

Now, what we also know, and this is actually coming from a Harvard Journal article, what we know is that they considered them to be risk factors for getting anxiety disorders. So, as we talked about above, anxiety is genetic and environmental, but what we do understand is that there are these particular risk factors that may make you more likely to develop an anxiety disorder. Again, not your fault, because we’re set up with this genetically or we’re exposed to these things environmentally. So, let’s go through them just briefly. 

Number one is personality. So, this is, again, a genetic thing. People with certain personality types are more likely to have anxiety such as anxiety disorder like OCD, PTSD, panic disorder, generalized anxiety, health anxiety, phobias, and so forth. There are certain personality types or personality factors. We know people who are more hyper-responsible are more likely to have anxiety. People who are perfectionistic are more likely to have anxiety. People who like to have more control tend to have more anxiety because we can’t control much in our lives like most of the people in our lives are. A lot of the times, we can’t control environmental factors. And so, that can create a lot of anxiety. 

Another risk factor is if you have another mental health disorder. So, if you have depression, you’re so much more likely to have generalized anxiety or panic disorder. If you have an eating disorder, you’re so much more likely to have OCD, generalized anxiety, phobias. These are really important factors to consider. And again, those disorders are more likely to be genetic as well. 

We know and we’ve already discussed, you are much more likely and you have a greater risk if you have a blood relative with an anxiety disorder. They do run in families. We also know that there are some risk factors related to drugs and alcohol. So, misuse or withdrawal of drugs and alcohol can cause anxiety. And this is not even just hardcore drugs. It could be caffeine, alcohol, marijuana, even some medical drugs. So, talk with your doctor about if any of these drugs you’re taking are causing anxiety. 

I have had clients report to me that they have several drinks or a couple of drinks every day, and they didn’t really see that to be a problem. Or maybe a little bit of marijuana every day, they didn’t see it to be a problem. But then once they took a break, they realized how much the alcohol and drugs were actually causing their anxiety. Same goes for caffeine. Again, I’m not giving you medical advice here. Please speak with your doctor about these things, but we do know that they are considered risk factors based on science.

Another one, and you know I’ve done episodes on this recently, is stress due to an illness can be a risk factor for having an anxiety disorder. Health conditions can cause significant stress on you and your family and can be something that can also impact your ability to succeed in treatment because you’re managing another illness, which I want to make sure, again, you recognize it is not your fault. You’re doing the best you can at juggling multiple things at the same time. 

Another one is stress buildup. A buildup of stress over time can increase your chances of having an anxiety and an anxiety disorder. This could be worry about work, school, finances, children, your medical health. It could be the pandemic. We have a massive increase in mental health issues right now because of the pandemic and the effects of the isolation of the pandemic. Again, please give yourself a break for what you’ve been going through. 

And then the last one, again, this is according to a Harvard research review, is trauma. Children who do endure abuse or trauma or witness, this is for adults too, have witnessed traumatic events are at higher risk of developing an anxiety throughout their life. This is true for adults. And I think it’s important that we acknowledge that. It doesn’t mean it’s always caused by trauma. Unfortunately, on social media, particularly Instagram, I feel like everything is caused by trauma these days. And I don’t want to discount that for people who have been through a traumatic event. But please don’t jump to that because then it confuses people who have anxiety and they didn’t have a trauma, and it makes everybody question everything. So, it can be trauma, but we don’t want to over-label that either. And I bring that up just because I do see everything being labeled as trauma these days, and that can be problematic and stigmatizing in and of itself. 

Okay. How are we doing, everybody? Are we hanging in? We’re getting through this. I know it’s a bigger, heftier session this time, but I think it’s so important. 


Alright, so let’s now talk about what causes anxiety in your brain. Again, we’re not going to go into too much depth here, but I’m going to throw some words at you, and we’re just going to do the best we can. 

Again, this is from the National Institute of Health, and they said a primary alteration in brain structure or function or in neurotransmitter signaling may result from environmental experiences or underlying genetic predisposition. Again, what they’re saying is environmental experiences and genetic predisposition can both create alterations in the brain structure or function of your brain. So, we are really getting clear on that. And these alterations increase the risk. 

Now, what they’re saying here is abnormalities in a brain neurotransmitter called gamma-aminobutyric acid are all often inherited. So, don’t worry about that big word. It’s just saying these abnormalities are often inherited and do make us more susceptible to, specifically here they were talking about generalized anxiety, but we do have information about that also being for OCD and panic disorder and so forth as well. Link is in the show notes if you want to read more about this. 

They’re also saying life events can trigger these. And what we know is our brain is what we call “neuroplastic.” Meaning, events can change our brain to having these alterations causing anxiety. But if we change our behaviors, we can actually reverse that in your brain. So, this is where we start talking about solutions to the problem. We can reverse the alterations made to our brain, particularly the neurotransmitters that were caused by genetics and environmental, when we change our behaviors. 


So, let’s talk about it. If we were to just overview what causes anxiety and panic attacks in general, we could say we’ve clearly outlined as genetics and environmental factors. That is completely out of our control. When we have these environmental factors or genetic predispositions, often, as I talked about, when our brain perceives anxiety, our natural instinct is to run away or do something or fight it. That’s your natural reaction. Anybody would do it. Anybody in your situation would do it. Again, I’m going to reinforce, this is not your fault. But what we do is when we have that faulty system in our brain that sets off an alarm that tells you there’s danger, what we end up doing is a bunch of what we call safety behaviors to try and reduce our discomfort and reduce our anxiety. Safety behaviors such as avoidance, reassurance-seeking, mental rumination, physical compulsions, or self-punishment. So, when we do that, our brain then goes, “Oh, they’re interpreting this as a danger. They’re responding to it as a danger. So, next time I have that thought or that situation, I’m going to send all the anxiety again.” And so, when it comes out again, if you respond with avoidance and reassurance-seeking and mental rumination and physical compulsions and self-punishment, you’re now stuck in a cycle where we reinforce the fear, the perceived danger. 

So, here is again where I’m going to offer to you, we have some options of intervening into this cycle. We talk about this in ERP School, the online course for OCD. We talk about it in overcoming anxiety and panic in our course for anxiety and panic on breaking the cycle by reducing our reaction to this stressful event or this brain danger alert. And when we do that, we can actually reverse that alteration in the brain. We have scientific proof of this, so I’m so excited that we get to do this together. It’s not like we end the episode by going, “Yeah, this is the problem and there’s no solution.” There’s multiple solutions. And it’s about really, again, intervening at the reaction we have to that anxiety. 

If you have a therapist, I want you to be talking with them about how you can intervene and break the cycle. If you don’t have a therapist, consider going to and looking at some of the courses that we have that may help you understand this process and help you intervene where and when you’re ready. Those courses are self-led. They’re not therapy, but they may help you look at the cycle and see where you’re getting stuck.

And so, that is where I’m going to leave you guys, which is with so much hope that, number one, we know what causes anxiety. We know very clearly, it’s not your fault. And then we can all come together and work at reducing the cycle that happens and changing our brain. It’s so cool. So, so cool. 

Thank you, guys, so much for being here with me. That was a hefty episode, but I hope you found it helpful. I’m so happy to get through that. Actually, I feel like that was super productive. And for me even, it’s like, oh, it’s so good to know that we can do so much about this.

So, as you guys know, I’m always going to say it’s a beautiful day to do hard things. Go and do some hard things today. They could be small hard things, big hard things, it doesn’t matter. Just baby steps lead to medium size steps, which lead to life-changing steps. 

Alright, my loves, have a wonderful day. I will see you next week. Please do go and leave a review. It should take you no more than a couple of minutes and it will help me so much. Thank you so much.