Navigating the intricate landscape of mental health can often feel like deciphering a complex puzzle, especially when differentiating between conditions ADHD vs.anxiety. This challenge is further compounded by the similarities in symptoms and the potential for misdiagnosis. However, understanding the nuances and interconnections between these conditions can empower individuals to seek appropriate treatment and improve their quality of life.

ADHD, or Attention Deficit Hyperactivity Disorder, is a neurodevelopmental condition characterized by symptoms of inattention, hyperactivity, and impulsivity. While commonly diagnosed in childhood, ADHD persists into adulthood for many individuals, affecting various aspects of their daily lives, from academic performance to personal relationships. On the other hand, anxiety disorders encompass a range of conditions marked by excessive fear, worry, and physical symptoms such as heart palpitations and dizziness.

The intersection of ADHD and anxiety is a topic of significant interest within the mental health community. Individuals with ADHD often experience anxiety, partly due to the challenges and frustrations stemming from ADHD symptoms. Similarly, the constant struggle with focus and organization can exacerbate feelings of anxiety, creating a cyclical relationship between the two conditions.

A critical aspect of differentiating ADHD from anxiety involves examining the onset and progression of symptoms. ADHD is present from an early age, with symptoms often becoming noticeable during childhood. In contrast, anxiety can develop at any point in life, triggered by stressors or traumatic events. Therefore, a thorough evaluation of an individual's history is vital in distinguishing between the two.

Moreover, the manifestation of symptoms can offer clues. For example, while both ADHD and anxiety can lead to concentration difficulties, the underlying reasons differ. In ADHD, the inability to focus is often due to intrinsic attention regulation issues. In anxiety, however, the concentration problems may arise from excessive worry or fear that consumes cognitive resources.

Understanding the unique and overlapping aspects of ADHD and anxiety is crucial for effective treatment. For ADHD, interventions typically include medication, such as stimulants, alongside behavioral strategies to enhance executive functioning skills. Anxiety disorders, meanwhile, may be treated with a combination of psychotherapy, such as cognitive-behavioral therapy (CBT), and, in some cases, medication to manage symptoms.

The integration of treatment modalities is paramount, particularly for individuals experiencing both ADHD and anxiety. Addressing the ADHD symptoms can often alleviate anxiety by improving self-esteem and coping mechanisms. Similarly, managing anxiety can reduce the overall stress load, making ADHD symptoms more manageable.

In conclusion, ADHD and anxiety represent two distinct yet interrelated conditions within the spectrum of mental health. The complexity of their relationship underscores the importance of personalized, comprehensive treatment plans. By fostering a deeper understanding of these conditions, individuals can navigate the path to wellness with greater clarity and confidence. This journey, though challenging, is a testament to the resilience and strength inherent in the human spirit, as we seek to understand and overcome the obstacles that lie within our minds.

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TRANSCRIPT

Kimberley: Welcome, everybody. We are talking about ADHD vs anxiety, how to tell the difference, kind of get you in the know of what is what. 

Today, we have Dr. Ryan Sultan. He is an Assistant Professor of Clinical Psychiatry at Columbia University. He knows all the things about ADHD and cannabis use, does a lot of research in this area, and I want to get the tea on all things ADHD and anxiety so that we can work it out. So many of you listening have either been misdiagnosed or totally feel like they don’t really understand the difference. And so, let’s talk about it. Welcome, Dr. Sultan.

ADHD vs. ANXIETY

 Ryan: Thank you. I really like doing these things. I think it’s fun. I think psychiatrists, which is what I am, I think one of the ways that we really fail, and medical doctors in general don’t do well at this, which is like, let’s spend some time educating the public. And before my current position, I did epidemiology and public health. And so, I learned a lot about that, and I was like, “You know how you can help people? We have a crisis here. Let’s just teach people things about how to find resources and what they can do on their own.” And so, I really enjoy these opportunities. 

WHAT IS ADHD vs. WHAT IS ANXIETY? 

 I was thinking about your question, and I was thinking how we might want to talk about this idea of ADHD versus anxiety, which is a common thing. People come in, and they see me very commonly wanting an evaluation, and they think they have ADHD. And I understand why they think they have ADHD, but their main thing is basically reporting a concentration or focus issue, which is a not specific symptom. Just like if I’m moody today, that doesn’t mean I have a mood disorder. If I’m anxious today, it doesn’t mean I have an anxiety disorder. I might even feel depressed today; it doesn’t mean I have a depression disorder. I could even have a psychotic symptom in your voice, and it does not mean that I have a psychotic disorder. It’s more complicated than that. 

 I think one of the things that the DSM that we love here in the United States—but it’s the best thing we have; it’s like capitalism and democracy; it’s like the best things that we have; we don’t have better solutions yet—is that it describes these things in a way that uses plain language to try to standardize it. But it’s confusing to the general public and I think it’s also confusing to clinicians when you’re trying to learn some of these conditions. 

WHEN IS ADHD vs. ANXIETY DIAGNOSED?

 And certainly, one of the things that have happened in my field that people used to talk a lot about is the idea that, is pediatric, meaning kid diagnosis of ADHD, which often in my area here in the United States will be done by pediatrician, are they adequately able to do that? Because poor pediatricians have to know a lot. And ADHD, psychiatric disorders are complicated. Mental health conditions are super complicated. They’re so complicated that there are seven different types of degree programs that end up helping you with them. PsyD, PhD, MD, clinical social worker, mental health counselor, and then there’s nurse practitioner. So, like super complicated counseling. So, how do we think about this? 

The first thing I try to remind everyone is, if you’re not sure what’s going on with you, please filter your self-diagnosis. You can think about it, that’s great. Write your notes down, da-da-da, but I would avoid acting purely on that. You really want to do your best to get some help from the outside. And I know that mental health treatment is not accessible to everyone. This is an enormous problem that existed before the pandemic and still exists now. I say that because I say that all the time, and I wish I had a solution for you. But if you have access to someone that you think can help you tease this throughout, you want to do that. 

SYMPTOMS OF ADHD vs. ANXIETY

 But what I would like us to do, instead of listing criteria, which you can all Google on WebMD, let’s think about them in a larger context. So, mental health symptoms fall into these very broad categories. And so, some of them are anxiety, which OCD used to be under, but it’s now in its own area. Another one, would be mood. You can have moods that are really high, moods that are really low. Another one you could take ADHD, you could lump it in neurodevelopmental, which would mix it with autism and learning disorders. You could lump it with attention, but the problem with that is it would also get lumped with dementia, which are processes that overlap, but they’re occurring at different ends of the spectrum. 

 So, let’s think about ADHD and why someone might have ADHD or why you might think someone has ADHD, because this should be easier for people to tease out, I think. ADHD is not a condition that appears in adulthood. That’s like hands down. Adult ADHD is people that had ADHD and still have ADHD as adults. And most people with ADHD will go on to still have at least an attenuated version, meaning their symptoms are a little less severe, maybe, but over 60% will still meet criteria. It’s not a disorder of children. Up until the ‘90s, we thought it was a disorder of kids only. So, you turned 18, and magically, you couldn’t have ADHD anymore, which didn’t make any sense anyway. 

 So, to really get a good ADHD diagnosis, you got to go backwards. If you’re not currently an eight-year-old, you have to think a little bit about or talk to your family, or look at your school records. And ideally, that’s what you want to do, is you want to see, is there evidence that you have, things that look like ADHD then? So, you were having trouble maintaining your attention for periods of time. Your attention was scattered in different ways. Things that are mentally challenging that require you to force yourself to do it, that particularly if you don’t like them, this was really hard for you. You were disorganized. People thought that things went in one year and out the other. 

 Now this exists on a spectrum. And depending on the difficulty of your scholastic experience and how far you pushed yourself in school, these symptoms could show up at different times. For example, it’s not uncommon for people to show up in college or in graduate school. Less so now, but historically, people were getting diagnosed as late as that, because now they have to write a dissertation. For those of you guys who don’t know, a dissertation is being asked to write a book, okay? You’re being asked to write a book. And what did you do? You went to college. Okay, you went to college, and then you had some master’s classes, and then you get assigned an advisor, and you just get told to figure out what your project is. It is completely unstructured. It is completely self-sufficient. It is absurd. I’m talking about a real academic classic PhD. That is going to bring it. If somebody has ADHD, that’s going to bring it out because of the executive functioning involved in that, the organization, the planning. I got to make an outline, I got to meet with my mentor regularly, I got to check in with them, I got to revise it, I got to plan a study or a literature review. There’s so many steps involved. So, that would be something that some people doesn’t come up with then. 

 Other kids, as an eight-year-old boy that I’m treating right now, who has a wonderful family that is super supportive, and they have created this beautiful environment for him that accommodates him so much that he has not needed any medication despite the fact that there’s lots of evidence that he is struggling and now starting to feel bad about himself, and he has self-esteem issues because he just doesn’t understand why he has to try so hard and why he can’t maintain his attention in this scenario, which is challenging for him. 

 So, ADHD kids and adults, you want to think of them as their brains as being three to five years behind everyone else in their development, okay? And they are catching up, but they’re more immature, and they’re immature in certain ways. And so, this kid’s ability to maintain his attention, manage his own behaviors, stay organized, it’s like mom is sitting with this kid doing his homework with him continuously, and if she stops at all, he can’t hold it together on his own. So, when we think about that with him, like, okay, well, that’s maybe when it’s showing up with him. That’s when it’s starting to have a struggle with him. 

 But let’s relate it to anxiety. One problem would be, do you have ADHD or do you have anxiety? Well, there’s another problem. Another problem is having ADHD is a major risk factor for developing an anxiety disorder, okay? So now I’m the eight-year-old boy, and this eight-year-old boy does not have the financial resources to get this evaluation, or the parents that are knowledgeable enough to know that, it might even have been years ago where there was less knowledge about this. And he’s just struggling all the time, and he feels bad about himself, and he’s constantly getting into trouble because he is losing things because he can’t keep track of things because he’s overwhelmed. And now he feels bad about himself. Okay. He has anxiety associated with that. So now we’re building this anxiety. So he might even get mood symptoms, and now we have a risk for depression. 

 So, this is just one of the reasons why these things are like these tangled messes. You ever like have a bunch of cords that you have one of the dealies, you keep throwing them in a box, and now you’re like, “What do I do? Do I just throw the cords out or entangle them?” It’s a very tangled mess. Of course, it takes time to sort through it. The reason I started with ADHD is that it has a clear trajectory of it when it happens. And in general, it’s a general rule, symptomatology, meaning like how severe it is and the number of symptoms you have and how impairing it is. They’re going to be decreasing as you get older. At least until main adulthood, there’s new evidence that shows there might be a higher risk for dementia in that population. 

 But let’s put geriatric aside. There’s a different developmental trajectory. Whereas anxiety, oh God, I wish I could simplify anxiety that much. Anxiety can happen in different ways. So, let’s start with the easy thing. Why would you confuse them in this current moment? If I am always worried about things, if I’m always ruminating about things, I’m thinking about it over and over again, I’m trying to figure out where I should live or what I should do about this, and I just keep thinking about it over and over again, and I’m in like a cycle. Like, pop-pa-pa pop-pa pop-pa-pa-pa. And then you’re asking me to do other things. I promise you, I will have difficulty concentrating. I promise you, I can’t concentrate because it’s like you’re using your computer and how many windows do you have open? How many things are you running? I mean, it doesn’t happen as much anymore, but I think most of us, I meant to remember times where you’re like, “Oh, my computer is not able to handle this anymore.” You’re using up some of your mind, and you can call that being present. 

 So, when people talk about mindfulness and improving attention, one of the things that they’re probably improving is this: they’re trying to get the person to stop running that 15, 20% program all the time. And it’s like your brain got upgraded because you can now devote yourself to the task in front of you. And the anxiety is not slowing you down or intruding upon you, either as an intrusive thought in an OCD way or just a sort of intrusive worry that’s probably hampering your ability to do something concentration-intensive. And then if you have anxiety problems and you’re not sleeping right, well, now your memory is impaired because of that. So, there’s this cycle that ends up happening over and over again. 

IS HYPERACTIVITY ANXIETY OR ADHD?

Kimberley: Yeah, I think a lot of people as well that I’ve talked to clients and listeners, also with anxiety, there’s this general physiological irritability. Like a little jitteriness, can’t sit in their chair, which I think is another maybe way that misdiagnosis can -- it’s like, “Oh, they’re hyperactive. They’re struggling to sit in their chair. That might be what’s going on for them.” Is that similar to what you’re saying?

 Ryan: Yeah. So, really good example, and this one we can do a little simpler. I mean, the statement I’m going to say is not 100% true, but it’s mostly true. If you are an adult, like over 25 for sure, and you are physically jittery, it is very unlikely that that is ADHD. Because ADHD, the whole mechanism as we understand it, or one of the mechanisms causing the thing we call ADHD, which of course is like a made-up thing that we’re using to classify it, is that your prefrontal cortex is not done developing. So, it needs to get myelinated, which is essentially like -- think about it like upgrading from dial up to some great, not even a cable modem. You’re going right to Verizon Fios. Like amazing, okay. It’s much faster, and it’s growing. And that’s the part of you that makes you most human. That’s the most sophisticated part of your brain. It’s not the part that helps you breathe or some sort of physiological thing, which, by the way, is causing some of those anxiety symptoms. They’re ramped up in a sympathetic nervous system way, fight or fight way. It’s the part that’s actually slowing you down. That’s like, “Whoa, whoa, whoa, whoa, whoa, calm down, calm down, calm down.” This is why, and everyone’s is not as developed. So, we’re all developing this thing through 25, at least ADHD is through 28. 

 Car insurance goes down to 25 because your driving gets better, because your judgment gets better, because you can plan better, because you are less risk-taking. So, your insurance has now gone down. So, the insurance company knows this about us. And our FMRI scans, you scan people’s brains, it supports that change. These correlate to some extent with symptomology, not enough to be a diagnosis to answer the person’s question that they’re going to have that. I wish it was. It’s not a diagnosis. We haven’t been able to figure out how to do that yet. 

 So, by the time you’re 25, that’s developed. And the symptoms that go away first with ADHD are usually hyperactivity, because that’s the inability to manage all the impulses of your body, not in an anxious, stressed-out way, but in an excited way. You think of the happy, well-supported, running around ADHD kid is kind of silly and fun. It’s a totally different mood experience than the anxiety experience. Anxiety experience is unpleasant for the most part. Unless your anxiety is targeting you to hyper-focus to get something done, which is bumping up some of your dopamine, which is again the opposite experience of probably having ADHD, it’s a hyper-focus experience, certainly, the deficit part of ADHD, you’re going to be feeling a different physiological, the irritability you talked about 100%. You’re irritable because you are trying so hard to manage this awful feeling you have in your body. You physically feel so uncomfortable. It is intolerable. 

 I have this poor, anxious young man that has to do a very socially awkward thing today. Actually, not that socially awkward. He created the situation, which is one of the ways we’re working on it with him in treatment. And I’m letting him go through and do this as an exposure because it’ll be fine. And he’s literally interacting with another one of our staff members. But he finds these things intolerable. He talks about it like we are lighting him on fire. So, he’s trying to hold it together, or whatever your physiological experience is. It may not have been as dramatic as I described. You’re irritable when people are asking things of you because you don’t have much left. You’re not in some carefree mood where you’re like, “Whatever, I’m super easygoing. I don’t care.” No, you’re not feeling easygoing right now. You’re very, very stressed out. 

 Stress and anxiety are very linked. Just like sadness and depression are very linked, and like loneliness and depression are linked, but they’re not the same thing. Stress and anxiety are very, very linked, and they’re similar feelings, and they’re often occurring at the same time and interacting with each other.

ADD vs. ADHD

 Kimberley: Right. One question really quick. Just to be clear, what about ADD vs. ADHD?

 Ryan: We love to change diagnostic criteria. People sit around. There’s a committee, there’s a whole bunch of studies. And we’re always trying to epidemiologically and characterologically differentiate what these different conditions are. That’s what the field is trying to do as an academic whole. And so, there’s disagreements about what should be where. So, the OCD thing moving is one of them. 

 The ADD thing, it’s like a nomenclature thing. So, the diagnosis got described that the new current version of the diagnosis is attention deficit hyperactivity disorder, and then you have three specifiers, okay? So, that’s the condition you have. And then you can have combined, which is hyperactive and inattentive. Just inattentive, just hyperactive. And impulsive is built in there. So, it’s really not that interesting. People love to be like, “No, no, I have ADD. No, I don’t have the hyperactive.” And I’m like, “I know, but from a billing point of view, the insurance company will not accept that code anymore. It doesn’t exist.”

DOES ADHD OR ANXIETY IMPACT CONCENTRATION? 

Kimberley: Yeah. So, just so that I know I have this right, and you can please correct me, is if you have this more neurological, like you said, condition of ADHD, you’ll have that first, and then you’ll get maybe some anxiety and some depression as a result of that condition. Whereas for those folks, if their primary was anxiety, it wouldn’t be so much that anxiety would cause the ADHD. It would be more the symptoms of concentration are a symptom of the anxiety. Is that what you’re saying?

Ryan: Yes, and every permutation that you can imagine based on what you just said is also an option. Like almost every permutation. Like how are they interacting with each other? How are they making each other worse? How are they confusing each other? Because you can have anxiety disorders in elementary school. I mean, that is when most anxiety disorders, the first win, like the wave of them going up is then. And you think about all the anxiety you have. 

 I got a friend of mine who’s got infants. And it’s fun to see like as they’re developing, when they go through normal anxiety, that that is a thing that they’re going to pass. And then there’s other things where, at some point, we’re like, actually, now we’re saying this is developmentally inappropriate, which means, nope, we were supposed to have graduated from this and it’s still around. 

 And so, one of the earlier ways that psychiatric conditions were conceptualized, and it’s still a useful way to conceptualize them, is the normal behavior version of it versus the non-normal behavior version of it. And again, I hate non-normal, I don’t want to pathologize people, but non-normal being like, this is causing problems for you. And if you think about it from an evolutionary point of view, all of these conditions have pretty clear evolutionary bases of how they would be beneficial. Anxiety is going to save your ass, okay? Properly applied anxiety, it’ll save your tribe. You want someone who’s anxious, who’s going to be like, “We do not have enough from this winter.” An ADHD person was like, “It’ll be fine. I’m just going to go find something else.” And you’re like, “No.” And then when that winter’s really bad and you save that little bit of extra food, that 30% that the anxious person pushed for, maybe you didn’t eat all 30% of it, but you know what, it probably benefited you and it might’ve actually made the whole tribe survive or more people survive or better health condition. So, it’s approving everyone’s outcomes. 

 The ADHD individual, you get them excited about something—gone. They’re going to destroy it. They’re going to find all the berries. They’re going to find all the new places. They’re going to find all the new deer. They’re going to run around and explore. It’s great. Great, great, great. 

 Depression is like hibernation. And if you look at hibernation in a mammal, like what happens, there’s a lot of overlaps. Lower energy, maybe you store up some food for the winter. It’s related to the seasons. You’re in California, right? This is not a problem you have, but for those of us in New York, where we have seasonality, seasonal depression is a thing. It’s very much a thing. It’s very noticeable, and it’s packed on top of these conditions everyone else is having.

 But the idea is that the hibernation or the pullback is like something happens to you that upsets you, which is the psychosocial event that’s kicking you in the face that might set off your depression. That’s why people always say, “Oh, depressions just don’t come out of nowhere. This biochemical thing isn’t true.” What they’re saying is something has to happen to start to kick off the depression, but that’s not enough. It’s that you then can’t recover from it. 

 And so, a normal version of it is that you get knocked out and you spend a week or two, you think about it. Rumination is a part of depression for many people. You reevaluate, and you say, “You know, I got kicked in the face when I did that. That was not a good plan for me. I need a new plan. I either need to do something different or I need to tackle that problem differently.” And so, that would be the adaptive version of a depressive experience. Whereas the non-adaptive version is like, you get stuck in that and you can’t get out.

 Kimberley: Or you avoid.

 Ryan: The avoiding doing anything about it, and then that makes it worse. So, you started withdrawing. I mean, that’s the worst thing you can do. This is a message to everyone out there. The worst thing that you can do is withdraw from society for any period of time. Look, I’m not saying you can’t have a mental health day, but systematic withdrawal, which most of us don’t even realize is happening, is going to make you worse because the best treatment for every mental health condition is community. It is really. All of them. All of them, including schizophrenia. 

 I used to work in Atlanta. I did my residency. There’d be these poor guys that have a psychotic disorder. They hear voices. The kinds of people that, here in New York City, are homeless, they’re not homeless there. Everyone just knows that Johnny’s just a little weird and his mom lives down the street. And if we find Johnny just in the trash can or doing something strange, or just roving, we know he’s fine, and someone just takes him back to his mom’s house and checks on him. Because there’s a community that takes care of him, even though he’s actually quite ill from our point of view. But when you put him in an environment where that community is not as strong, like a city, it does worse, which is why mental health conditions are much higher rates in urban areas. Probably why psychiatry and mental health in general is such a central thing in New York City.

TREATMENT FOR ADHD vs. ANXIETY

 Kimberley: Yeah. Okay, let’s talk quickly about treatment for ADHD. We’re here always talking about the treatment for anxiety, but what would the research and what’s evidence-based for ADHD if someone were to get that clinical diagnosis?

 Ryan: So, you want to think about ADHD as a thing that we’re going to try to frame for that person as much as how is it an asset, because it historically has made people feel bad about themselves. And so, there are positive aspects to it, like the hyper focus and excitability, and interest in things. And so, trying to channel into that and then thinking about what their deficits are. So, they’re functional deficits. If you’re talking adult population, functional deficits are going to be usually around executive functioning and organization planning. Imagine if you’re like a parent of small children and you have untreated ADHD, you’re going to be in crazy fight-or-flight mode all the time because there’s so many things to keep track of. You have to keep track of your wife and their life.

Kimberley: I see these moms. My heart goes out to them.

Ryan: And they’re probably anxious. And the anxiety is probably protecting them a little bit. Because what is the anxiety doing? You think about things over and over and over again, and you double check them. You know what that’s not a bad idea for? Someone who’s not detail-oriented, who’s an ADHD person, who forgets things, and he gets disorganized. So, there’s this thing where you’re like, “Okay, there may actually be a balance going on. Can we make the balance a little bit better?” So, how do you organize yourself? 

MEDICATIONS FOR ADHD

Right now, there’s a stimulant shortage. Stimulants are the most effective medication for reducing ADHD symptoms. They are the most effective biological intervention we have to reduce the impact of probably any psychiatric condition, period. They are incredibly effective, like 80, 90% resolution of symptoms, which is great. I mean, that’s great. That’s great news. But you also want to be integrating some lifestyle changes and skills alongside of that. So, how do you organize yourself better? I mean, that’s like a whole talk, but like lists, prioritizing lists, taking tasks, breaking them down into smaller and smaller pieces. Where do you start? What’s the first step? Chipping away. You know what? If you only go one mile a day for 30 days, you go 30 miles. That’s still really far. I know you would have gone 30 miles that day, especially if you have ADHD, but you’re still getting somewhere. 

And so, that kind of prioritization is really, really important. And so, you can create that on your own. There are CBT-based resources and things to try to help with that. There are ADHD coaches that try to help with that. It’s consistency and commitment around that. So, how do you structure your life for yourself? That poor PhD candidate really needs to structure their life because there is no structure to their life. 

The other things we want to think about with that, I mean, really good sleep, physical exercise. People with ADHD, we see on FMRI scans when you scan someone’s brain, there’s less density of dopamine receptors, less dopamine activity. You want to get that dopamine up. That’s what the medications are doing, is predominantly raising the dopamine. So, physical activity, aerobic exercise, in particular, is going to do that. Get that in every day, and look, it’s good for you. It’s good for you. There is no better treatment for every condition in the world other than exercise, particularly aerobic. It basically is good for everything. If you just had surgery, we still want you to get out and walk around. Really quickly, that actually improves your outcome as fast as possible.

So, those are the things I like people to start with if they can do that, depending on the severity of what’s going on, the impact, what other things have already been tried. Stimulant medications or non-stimulant medications like Wellbutrin, Strattera, Clonidine are also pretty effective. Methylphenidate products, which is what Ritalin is. Adderall products mixed in amphetamine salts, Vyvanse, these are very effective medications for it. There’s a massive shortage of these medications that people are constantly talking about, and is really problematic and does not appear to have an endpoint because the DEA doesn’t seem ready to raise the amount that they allow to be made because they are still recovering from the opioid crisis, which is ongoing. And so, they’re worried about that. Really, they want to be very thoughtful about this. These medications have a very low-risk potential for misuse. In fact, people with ADHD, they appear to reduce the risk of developing a substance use disorder. It’s the most common thing that people worry about. So, treatment actually reduces that. 

That said, the worst -- I mean, I don’t want to say the worst thing. I mean, people hate me. The really not great way to get psychiatric treatment is to show up to someone once and then intermittently meet with them where they write a prescription for a medication for you that’s supposed to help you, and stimulant medications are included on that. So, that’s probably why I didn’t lead with that, even though there’s actually more science to support them, is that by themselves, it’s really going to limit how much help you’re going to get.

Kimberley: Can you share why?

Ryan: Because you need to understand your condition, because you need to spend time with your clinician learning about your condition and understanding how it’s affecting your life, and understanding how the medication is actually meant to be a tool. It should be like wearing glasses. It doesn’t do the work for you. It doesn’t solve all your problems, but it’s easier to read when you put your glasses on than without it. It supports you. You still need to figure out how to get these things done. It lowers the activation energy associated with it. But you also want to monitor it. You can’t take these medications 24 hours a day and just be ready to go and work, which is things that people have tried. It doesn’t work because you need to sleep, because you will die. They’ve tried this. We know that you will literally die, like not sleeping. And in the interim, you are damaging yourself significantly. So, taking it and timing it in an appropriate way, still getting sufficient sleep, prioritizing other things—they are like a piece of a puzzle, and they are a really powerful piece. But you really don’t want that to be the only thing driving your decision-making, or that be what the interaction is really about. And by the way, the same thing is true for all psychiatric medications.

Kimberley: I was going to say that’s what we know about OCD and anxiety disorders too. Medication alone is not going to cut you across the line.

 Ryan: And for most people, therapy alone is also not going to cut the line. You have to have a mild case for therapy alone to be okay. And I can trouble for that statement. But the other thing is lifestyle. What lifestyle changes can I make? And those together, all three, are going to mean that you get better faster, you get more better than you would have, you’re more likely to stay better. And they start to interact with each other in a good way, where you get this synergistic effect of ripples of good things happening to you and personal growth. You look back, and you’re like, “Geez, I’m on version 3.0 of me. I didn’t know that there was a new, refined personal growth version of me that could actually function much better. I didn’t actually believe that.”

DOES ADHD IMPACT SELF-ESTEEM?

 Kimberley: Well, especially you talked about this impact to self-esteem too. So, if you’re getting the correct treatment and now you’re improving, as you go, you’re like, “Okay, I’m actually smart,” or “I’m actually competent,” or “I’m actually creative. I had no idea.” 

 Ryan: Yes. “I’m not stupid.” Lots of people with ADHD think they’re stupid. 

 Kimberley: Yeah. So, that’s really cool. One question I have that’s just in my mind is, does --

 Ryan: And that should be part of your treatment, is the working through. That was essentially a complex trauma. It’s the complex trauma of having this condition that may not have been treated that made you think that you were an idiot because you were being shoved into a situation that you did not know how to deal with because your ADHD evolved to be an advantage for you as a hunter-gatherer for the hundreds of thousands of years that we had that, and that modern world is not very compliant for. It doesn’t experience you as fitting into it well. And then you feel bad about yourself.

ADHD IN MALES vs. FEMALES

 Kimberley: Right. You’re the class clown, or you’re the class fool, or the dumb girl, or whatever. Now, my last question, just for my sake of curiosity, is: does ADHD look different between genders?

 Ryan: This is an area of significant research. So, historically, the party line has been that ADHD is significantly more common in boys and girls. And the epidemiology, the numbers, the prevalence have always supported that. Like 3 to 1, 2 to 1, like a much more, much more common. Refining of that idea has come up with a couple of thoughts. One, for whatever reason, I don’t know how much of this is genetic. I have no idea how much of this is environmental, sociological. All other things being equal, after a certain young age, girls just always seem to be ahead of boys in their development. I mean, talk to any parent that’s had a lot of kids, and they’ll tell you that they’re like, “I don’t know why the girls are always maturing faster.” So, that’s a bias that is going to always make at any given point. The boys look worse because their brains are not developed. So, they’re going to be -- remember that immature younger thing? They’re going to be immature and younger. And so at any given marker is that.

 The other thing that’s come up is that the hyperactivity seems to be something we see a lot more in males than in females. That’s another thing. And versus inattentiveness, which you see in both and is usually the predominant symptom. And the kid who gets noticed is the little boy who’s like -- I mean, not that you could do this in today’s world, but has scissors and is about to cut a kid’s cord. I’m trying to make a silly imagery. That kid’s getting a phone call. No one didn’t notice that. The whole class called that. Whereas like daydreaming, I’m not really listening—this is a more passive experience of ADHD. And they’re not disrupting the room. Forget about the gender thing. Just that presentation is also less noticed. 

 So, I think the answer is the symptomology presentation is a little different. It tends to be predominantly hyperactive. Are the rates different? Yes, they’re probably not as wide of a difference as we think they are, because we’re probably missing a good number of girls. Are we missing enough girls to make it 50/50? I don’t know. That would be a lot of -- it’s a big gap. It’s not close. It’s a pretty big gap. Maybe we’re certainly missing some. 

 And then the other aspect of it is particularly post-puberty. Even before puberty, there’s hormonal changes going on. And these hormones, particularly testosterone, which is present in everyone, we think about it as a male thing, but it’s really just like a balance thing. You have significant amounts of both. It affects a number of things, and attention is one of them. So, there’s so many complexing factors to it. That’s why I said, it’s something we’re still trying to sort out. 

 One of the things that’s really interesting that goes back to the hormone thing is that if you talk to young women— so postmenstrual, they’ve gone through puberty—they will tell you over and over again that their symptomology, just like we have mood symptoms tend to be worse during that time period of when you’re ovulating, the ADHD symptoms will be worse as well. And so, there’s increasing evidence that if you’re on ADHD medication and you have ADHD, which again, we’re making lots of presumptions here, go get that confirmed, guys. But if you’re on that time period just leading up to ovulation a little bit after, you may actually need a higher dose of your medication to get the same effect. That there’s something about the way progesterone and whatever is changing that it affects functionally your attention and your experience of your symptomatology. 

 Kimberley: Interesting. Yeah, thank you for sharing that. Is there anything you feel like we’ve missed or a point you really want to make for the folks who are listening who are trying to really untangle, like you said, that imagery of untangle, anxiety, ADHD, all of the depression, self-esteem?

 Ryan: This is like a sidebar that’s related. So, one of my other areas of interest is cannabis. And here in New York, we’ve had a lot going on with cannabis. And there’s a lot of science going on around, can cannabis be used to treat things, particularly psychiatric disorders? And I know that a lot of people are interested in that.

 One of the things that I’ve been really trying to caution people around with it is that the original thing that I was probably taught in the ‘90s about cannabis, marijuana being like this incredibly unsafe thing, is not true. But the narrative that it’s totally fine and benign is also not true. And that it is probably going to be effective in reducing anxiety acutely, and it will probably be effective in maybe even improving your mood. And some people with ADHD even think it improves their attention by calming their mind. I am very cautious about people starting to use that as part of their treatment plan. And I can tell you why.

 Kimberley: Because you did say there’s an increase in substance use.

 Ryan: The problem is that it’s not rolled out in a way that reflects an appropriate medical treatment. So, if you do it recreationally, obviously, it’s basically like alcohol. You just get what you want, and you decide what you want. If you do it medically, depending on the state, as a general rule, you just get a medical card and then you decide what you’re going to do, which just seems crazy to me. I mean, you don’t do that. You don’t send people home with an unlimited amount of something that is mind-altering and tell them to use as much as they need. And the potencies, the strength of it has gotten stronger and stronger. 

 And so, I really caution people around this because when you use it regularly, what ends up happening is you get this downregulation, particularly daily use. You get this downregulation of your receptors, your cannabinoid receptors. We all have cannabinoid receptors. And you have fewer and fewer of them. And because you have so much cannabinoid in your system because you’re getting high that your body says, “I don’t need these receptors.” So then when you don’t get high, those cannabinoid receptors that modulate serotonin, dopamine—so functionally, your attention, your mood, your anxiety level—there’s none of them left because they’ve been getting bound like crazy to this super strong thing. And you’re making almost none yourself, so you’re going to feel awful. You’re going to feel awful. And it’s not dosed in any kind of appropriate way. We’re not giving people guidance on this. 

 So, I really caution people when they’re utilizing this, which the reality is that a lot of people are, that they be thoughtful about that and thoughtful about the frequency that they’re using and the amounts that they’re using, and if they’re at a point where they’re really trying to self-medicate themselves, because that can really get out of control for people. They can get really out of control. And I think it’s unfortunate that we don’t have a better system to help people with that. That is more like the evaluation of an FDA-approved medication or something like that has a system through it. 

 So, I just wanted to add that because I know this is something that a lot of people are thinking about. And I think it can be hard to get really good science information on since there’s a big movement around making this change. When we’re doing a big movement around pushing for a change, we don’t want to talk about the reasons that the change might be a little problematic, and therefore slow the change down. So, we forget about that. And I think for the general public, it’s important to remember that.

 Kimberley: Yeah, I’m so grateful that you did bring that up. Thank you. Where can our listeners learn more about you or be in touch with you?

 Ryan: So, if they want to learn more about my practice, my clinical practice, integrativepsych -- no, integrative-psych.org. We changed. We wrote .nyc. There we go. And then if you want to learn about my science and my lab and our research, which we also love, if you just go to Sultan (my last name) lab.org, it redirects to my Columbia page, and then you can see all about that and send some positive vibes to my poor research assistants that work so hard. 

 Kimberley: Wonderful. I’m so grateful for you to be here. Really, I am. And just so happy that you’re here. So much more knowledgeable about something that I am not. And so, I’m so grateful that you’re here to bring some clarity to this conversation, and hopefully for people to really now go and get a correct assessment to define what’s going on for them.

 Ryan: Yeah, I hope everyone is able to digest all this. I said a lot. And can hopefully make better decisions for themselves for that. Thank you so much.

 Kimberley: Thank you.

Exploring the relationship between faith and recovery, especially when it comes to managing Obsessive-Compulsive Disorder (OCD), reveals a complex but fascinating landscape. It's like looking at two sides of the same coin, where faith can either be a source of immense support or a challenging factor in one’s healing journey.

On one hand, faith can act like a sturdy anchor or a comforting presence, offering hope and a sense of purpose that's invaluable for many people working through OCD. This aspect of faith is not just about religious practices; it's deeply personal, providing a framework that can help individuals make sense of their struggles and find a pathway towards recovery. The sense of community and belonging that often comes with faith can also play a crucial role in supporting someone through their healing process.

However, it's not always straightforward. Faith can get tangled up with the symptoms of OCD, leading to situations where religious beliefs and practices become intertwined with the compulsions and obsessions that characterize the disorder. This is where faith can start to feel like a double-edged sword, especially in cases of scrupulosity, where religious or moral obligations become sources of intense anxiety and compulsion.

The conversation around integrating faith into recovery is a delicate one. It emphasizes the need for a personalized approach, recognizing the unique ways in which faith intersects with an individual's experience of OCD. This might involve collaborating with religious leaders, incorporating spiritual practices into therapy, or navigating the complex ways in which faith influences both the symptoms of OCD and the recovery process.

Moreover, this discussion sheds light on a broader conversation about the intersection of psychology and spirituality. It acknowledges the historical tensions between these areas, while also pointing towards a growing interest in understanding how they can complement each other in the context of mental health treatment.

In essence, the relationship between faith and recovery from OCD highlights the importance of a compassionate and holistic approach. It's about finding ways to respect and integrate an individual's spiritual beliefs into their treatment, ensuring that the journey towards healing is as supportive and effective as possible. This balance is key to harnessing the positive aspects of faith, while also navigating its challenges with care and understanding.

Justin K. Hughes, MA, LPC, owner of Dallas Counseling, PLLC, is a clinician and writer, passionate about helping those impacted by OCD and Anxiety Disorders. He serves on the IOCDF's OCD & Faith Task Force and is the Dallas Ambassador for OCD Texas. Working with a diversity of clients, he also is dual-trained in psychology and theology, regularly helping anyone to understand the interaction between faith and mental health. A sought-after writer and speaker, he is currently mid-way through writing his first workbook on evidence-based care of OCD for Christians. He is seeking a collaborative agent who will help secure the best publishing house to help those most in need. Check out www.justinkhughes.com to stay in the loop and get free guides & handouts!

Kimberley: Welcome, everybody. Today, we’re talking about faith and its place in recovery. Does faith help your recovery? Does it hinder your recovery? And all the things in between. 

Today, we have Justin Hughes. Justin is the owner of Dallas Counseling and is a clinician and writer. He’s passionate about helping those who are impacted by OCD. He is the Dallas ambassador for OCD Texas and serves on the IOCDF’s OCD and Faith Task Force, working with a diversity of clients. He’s also dual-trained in psychology and theology, regularly helping anyone to understand the interaction between faith and OCD, most commonly Christians. But today, we’re here to talk about faith in general. Welcome, Justin.

Justin: Kimberley Jayne Quinlan, howdy.

Kimberley: You said howdy just perfectly from your Texas state. 

Justin: Absolutely.

Kimberley: Okay. This is a huge topic. And just for those who are listening, we tried to record this once before, we were just saying, but we had tech issues. And I’m so glad we did because I have thought about this so much since, and I feel like evolved a little since then too. 

So, we’re here to talk about how to use faith in recovery and/or is it helpful for some people, and talk about the way that it is helpful and for some not. Can you share a little bit about your background on why this is an important topic for you?

Justin: Absolutely. So, first of all, as a man of faith, I’m a Christian. I went to a Christian college, got my degree in Psychology, and very much desired to interweave studies between psychology and theology. So, I went to a seminary. A lot of people hear that, and they’re like, “Did you become a priest?” No, it was a counseling program at a seminary, Dallas Theological Seminary. I came here and then found my wife, and I stayed in Dallas. 

And it’s been important to me from a personal faith standpoint. And I love the faith integration in treatment and exploring that with clients. And of course -- or maybe I shouldn’t say of course, but it’s going to be a lot of Christians, but I work with a lot of different faith backgrounds. And there are some really important conversations happening in the broader world of treatment about faith integration and its place. And we’re going to get into all those things and hopefully some of the history and psychology’s relationship to faith, which has not been the greatest at different points.

For me personally, faith isn’t just an exercise. It’s not something that I just add on to make my day better. In fact, a lot of times, faith requires me to do way more difficult things than I want to do, but it’s a belief in the ultimate object of my faith in God and Christ as a Christian. I naturally come across a lot of people who not only identify that as important but find it as very essential to their treatment. And let’s get into that, the folks that find it essential, the people who find it very much not, and the people who don’t. But that’s just a little bit about me and why I find this so important.

Kimberley: Yeah. It’s interesting because I was raised Episcopalian. I don’t really practice a lot of that anymore for no reason except, I don’t know, if I’m going to be really honest. 

Justin: So honest. I love that. 

Kimberley: Yeah, I’ve been thinking about it a lot because I had a positive experience. Sometimes I long for it, but for reasons I don’t know. Again, I’m just still on that journey, figuring that piece out and exploring that. 

Where I see clients is usually on the end of their coming to me as a client, saying, “I’m a believer, but it’s all gotten messed up and mushed up and intertwined.” And I’m my job. I think of my job as helping them untangle it.

Justin: Yeah.

Kimberley: Not by me giving my own personal opinion either, but just letting them untangle it. How might you see that? Are you seeing that also? And what is the process of that untangling, if we were to use that word?

Justin: It’s so broad and varied. So, I would imagine that just like with clients that I work with and folks that come to conferences and that I talk with, the listeners in your audience, hi listeners, are going to have a broad experience of views, and it’s so functional. So, I want people to hear right away that I don’t think that there’s just a cookie-cutter approach. There can’t be with this. And whether we’re treating OCD, anxiety disorders, or depression, or eating disorders, or BFRVs, fill in the blank, there are obviously evidence-based treatments which are effective for most, but even those can’t be a cookie cutter when it comes down to exactly what a person needs to do or what is required of them in recovery. 

So, yes, let me just state this upfront for the folks that might be unduly nervous at this point. First of all, the faith piece, religious piece, does not have to enter into treatments for a lot of people to get the job done. In fact, actually, for a lot of people, it was much more healing for them, including many of my clients. I have friends and family members that sometimes look at me as scant. So like, “Wait, you went to seminary, and sometimes you don’t talk about God at all.” And it’s like, “Yeah, sometimes we’re just doing evidence-based treatment, and that is that.” And as an evidence-based practitioner, that’s important to me. 

So, when people come in, I want to work with what their goals are, their values. And a lot of people have found themselves, for any number of reasons, stuck, maybe compulsions or obsessive thoughts or whatever, are stuck in all things belief, religion, or faith or whatever else. And sometimes actually, the most healing thing for them to do is sometimes get in, get out, do the job clinically, walk away, experience freedom, and then grow and develop personally. 

But then I’ve also discovered that there’s this other side that some people do not find a breakthrough. Some people stay stuck. And maybe these are the people that hit the stats that we see in research of 20% or so just turn down things like ERP, (exposure and response prevention) with OCD when they’re offered. And then another 20 to 30% drop out. And we have great studies that tell us that most people who stick with it get a lot of benefits, but there’s all the other folks that didn’t. And sometimes it’s because people -- no offense, you all, but sometimes people just don’t want to put in the work and discipline. 

However, we can’t minimize it to that. Sometimes it’s truly people that are willing to show up, and there’s a complex layer of things. And the cookie-cutter approach is not going to work for them. Maybe they have the intersection of complex health issues, intersection of trauma, intersection of even just family of origin things where life is really difficult, or even just right now, a loneliness epidemic that’s happening in the world. 

And by the way, I’m a huge believer in the evidence base. There’s a lot in the evidence base that guides us. And as I’m talking today, I want to be really clear that when I work with folks, even when we get into the spiritual, I’m working with the evidence base. Yeah, there’s things that there’s no specific protocol for, but a lot of folks, I think, can hopefully be encouraged that there’s a strong research base to the benefits and the use and the application and also the care of practicing various spiritual practices through treatments. 

So, to come back to the original question, it depends so much. It’s like if somebody asked me a question like, “Hey, Justin. Okay, so as a therapist, do you think that --” and I get these questions all the time, “Is it okay for me to...? Like, I am afraid of this.” I got this question at one point. Somebody was curious if I thought it was okay for them to travel to another city. And it’s like, it depends. It’s almost always an “it depends.” 

So, that’s where I’m going to leave it, that nice, squeaky place that we all just want a dang answer, but the reality is, it is going to massively depend on the person and where they are, and what their needs are.

Kimberley: Yeah, I mean, and I’ll speak to it too, sometimes I’ve seen a client. Let’s give a few examples of a client with OCD. The OCD has attacked their faith and made it very superstitious or very fear-based instead of faith-based. And I think they come in with that, “Everything’s so messy and it used to make so much sense, and now it doesn’t.” 

For eating disorders, I’ve had a lot of clients who will have a faith component where there are certain religions that have ways in which you prepare foods and things, and then that has become very sticky and hard for them. The eating disorder gets involved with that as well. 

And let me think more just from a general standpoint, and I’ll use me as an example, as just like a generally anxious person. I remember this really wonderful time, I’ll tell you a funny story, when my daughter was like five, out of nowhere, she insisted that we go to every church. Like she wanted to go to a Christian and a Catholic and Jewish temple and Muslim and Buddhist. She wanted to try all of them, and we were like, “Great, let’s go and do it.” And I could see how my anxious brain would go black and white on everything they said. So, if they said something really beautiful, my brain would get very perfectionistic about that and have a little tantrum. I think it would be like, “But I can’t do it that perfect,” and I would get freaked out, but also be able to catch myself. So, I think that it’s important to recognize how the disorder can get mixed up in that.

Justin: Yeah, absolutely.

Kimberley: Right? Let’s now flip, unless you have something you want to add, to how has faith helped people in their recovery, and what does that look like for you as a clinician, for the client, for their journey?

Justin: Yeah, absolutely. Well, on the clinical side of things, the starting place is always going to be the assessments and diagnosis and treatment plan. And then the ethics of it too is going to be working with the person where they are and their beliefs and not forcing anything, of course. And so folks are naturally -- I get it, I respect it. I would be nervous of somebody of a different belief background that’s overt about things. Some people come in, they look at the wall, they see Dallas Theological Seminary, they’ve studied a few things in advance. So, yeah, the starting places, sitting down, honest, building rapport, trust, assessing, diagnosing.

So, for the folks where the faith piece is significant, I’ll put it into two categories. So, one is sometimes we have to talk about aspects of faith just from a pure assessment sample. So, a common example of that is scrupulosity in OCD. So, I have worked with even a person on the, believe it or not, Faith and OCD Task Force who is atheist. And so, why in the world do we need to talk about faith? Why is that person even on the Faith and OCD Task Force? Well, they’re representing a diversity of views and opinions on the role of faith and OCD. 

Kimberley: Love it.

Justin: And it’s so interesting to look at it at a base level with something like OCD. But frankly, a lot of mental disorders or even just challenges in life, if clinicians, one, aren’t asking questions about, hey, do you have any religious views, background, even just in your background? Do you have spiritual practices that are important to you? We’re missing a massive component. And here’s the research piece. We know from the research that, actually, a majority of people find things of faith or spirituality important, and secondarily, that a majority of people would like to be able to talk about those things in therapy. Straight-up research. So, a couple of articles that I wrote for the IOCDF on this reference this research. So, it is evidence-based to talk about this. 

And then when we get into these sticky areas of obsessions and anxiety disorders, of course, it’s going to poke on philosophy, worldview, spirituality. And so, it could be even outside of scrupulosity, beliefs that at first it just looks like we need some good shame reduction exercises, self-compassion, and so forth, but we discover that, oh, the person struggling with contamination OCD has a lot of deeper beliefs that they think that somehow, they are flawed because they’re struggling. They’re not a good enough, fill in the blank, Christian. They’re not good enough. Because if so, surely God would break through in a bigger way. If so... Wouldn’t these promises that I’m told in scriptures actually become true? 

And the cool thing is, there’s a richness in the theology that helps us understand the nuance there, and it’s not that simple. But if we miss that component, and it’s essential for treatment, it’s not just like, “Oh, I feel bad about myself. And yeah, sometimes I’m critical with myself.” And if we don’t go at that level of core fear, or core distress, or core belief, oftentimes we’re missing really a central part of the treatment, which we talk about in any other domain. People just get nervous sometimes, thinking about spirituality. It’s like politics and religion, right? Nobody talks about those things. Well, if we’re having deeper conversations, we usually are. And as clinicians, those of you that are listening to the podcast as clinicians, you know that you have to work with people of different political leanings, people of different faith leanings, people who actually live in California versus [inaudible]. I love California. 

So, the first category is, if we’re doing good clinical work, we’re going to be asking questions because it matters to most people. If we don’t, we’re missing a huge piece. It doesn’t mean you’re a bad therapist, but hey, start asking some questions if you’re not, at a minimum. 

But then there’s the second piece that most people actually want to know, and most people have some aspects of practice or integration, or even the most religion church-averse type of person will have any number of things come up such as, “Yeah, I pray occasionally,” or “Yeah, I do this grounding exercise that puts me in touch with the universe or creation or whatever it is.” 

So, there’s the second category of when it is important to a person because it’s part of the bigger picture of growth, it’s part of the bigger picture of breaking free from challenges that they have, and, frankly, finding meaning. And I’ll just make one philosophical comment here, because I’m a total nerd. Psychology can never be a worldview. Psychology tells us what. Psychology is a subset of science. And by worldview, I mean a collective set of beliefs, guidance, direction about how life should be lived. We can only say, “Hey, when you do this, you tend to feel this way, or you tend to do these behaviors more or do these behaviors less.” At the end of the day, we have to make interpretations and judgments about right and wrong, how to live life, the best way to live life. These are in the realm of interpretation. 

So, surprise, surprise, we’re in the realm of at least philosophy, but we very quickly get into theology. And so back to the piece that most people care about it, most people have some sort of spiritual practice that they’ll resonate with and connect with. And then most people actually want to integrate a little bit into therapy. And then some people find that it is essential. They haven’t been able to find any lasting freedom outside of going deeper into a bigger purpose, `bigger meaning.

Kimberley: You said a couple of things that really rang true for me because I really want to highlight here, I’m on the walk here as well as a client. And I love having these conversations with clients, not about me, about them, but them when they don’t have a spiritual practice, longing for one. I’ve had countless clients say, “I just wish I believed.” And I think what sometimes they’re looking for is a motivator. I have some clients who have a deep faith, and their North Star is that religion. Their North Star is following the word of that religion or the outcome of it, whether it be to go to heaven or whatever, afterlife or whatever. They believe like that’s the North Star. That’s what determines every part of their treatment. Like, “Why are we doing this exposure today?” “Because this is my North Star. I know where I’m heading. I know what the goal is.” And then I have those clients who are like, “I need a North Star. I don’t have one. I don’t get the point.” And I think that is where faith is so beautiful in recovery. 

When I witness my clients who are going to do the scary thing, they don’t want to do it, but they’re so committed to this North Star, whatever it might be. And maybe there’s a better language than a North Star, again, whatever that is for that person. Like, “I’m walking towards the light of whatever that religion is.” I feel, if I’m going to be honest, envious of that. And I totally get that some people do too. 

What would you say to a client who is longing for something like that? Maybe they have spiritual trauma in some respects or they’ve had bad experiences, or they’re just unsure. What would you say to them?

Justin: Yeah, that’s really great. And first of all, I just want to really say that it takes a lot of vulnerability and strength to talk as you do. And one of the ways that I admire you, KQ, is through your ability to have these vulnerable conversations. So not just like the platform of expert, because at the end of the day, we’re all just people and on a journey for sure. And so thanks for being honest with that. 

And I’m on a journey as well. And certainly, I realized jumping on podcasts, these things put us in the expert role and we speak at conferences and things like that. But I think that’s a bit of the answer right there, is that being where we are to start with is so huge. And I mean, you’re so good with the steps to take around acceptance and compassion. That’s it. It’s like fear presses towards a thousand different possibilities, and none of them come true exactly that way. And it can lead towards people missing a lot of personal growth stuff, spiritual growth stuff. And one of those things, I think, that we do is we sit with that.

Clinically, I’m going to assess, ask a lot of questions, Socratic questions as a subset of the cognitive therapy side of doing that. Let me just come back to the simplicity. I think we get there. We sit in it for a second. And otherwise, we miss it. We’re rushing to preconceived solutions or answers, but we’re saying that we don’t necessarily have an answer for that. So, what if we take some time to actually notice it and to be with that and to actually label it and be like, “I’m not sure. I’m yearning. I’m envious. I’m wanting something, but I don’t know. So, put me in, coach.” I’ll sit with people. That’s really the first thing. 

Kimberley: Yeah. What I have practiced, and I’ve encouraged clients is also being curious, like trying things out if that lines up with their values, going to a service, reading a book, listening to a podcast, and just trying it on. For me, it’s also interesting with clients, is if they’re yearning for it, try it on and observe what shows up. Is it that black-and-white thinking or perfectionism? Is it your obsessions getting involved? Is it that it just doesn’t feel good in your body? And so forth. Again, just be where you are and take it slow, I think. 

I have a few other areas I want you to look at in terms of giving me your professional thoughts. If somebody wants to incorporate faith into their treatment, what can that look like? Can it look like praying together? What does that look like?

Justin: You’re asking all the good questions. Yeah, absolutely. And also, one other thing to reference, I know you’re friends with Shala Nicely and Jeff Bell. And so they wrote a book. And for those that are on that, I would say, more “I’m seeking journey,” it’s When in Doubt, Make Belief: An OCD-Inspired Approach to Living with Uncertainty. And I love Shala and Jeff. They’re so great, and they’ve been really pivotal people in my own life, not just as friends, but just as personal growth too. And so, that’s an example specifically where Shala talks about the throes of her suffering. Is Fred in the Refrigerator? is her basically autobiography that goes into the clinical piece too, where at the end of the day, there was a bit of a pragmatic experience that she couldn’t -- the universe being against her, she basically always had that view and she needed something that was different. And so she got there, I think. I hope I’m reflecting her sentence as well, but got there pragmatically. “The universe is friendly” is something that she said. 

Now, I just know that my Christian brothers and sisters, if they’re listening to this, they’re probably like, “What the heck is Justin talking about? The universe is friendly?” Because that’s very, very different from the language that we’ve used, but it’s just such a great example to me of just one step at a time, a person on the journey. They’re looking at those things and assessing, okay, what is obsessive, what is compulsive, what is this thing that I can believe in and I ultimately do, but maybe I’m not. I don’t want to or I’m not ready, or it doesn’t make sense to me to make a jump into an organized religious plea for whatever else. And so, how does it look for clients? 

So in short, do I pray with clients? Yeah, absolutely. Do I open up the Bible? Yes, absolutely. Actually, it is a minority of sessions, which again, on my more conservative friends and family side of things are almost shocked and scratching their heads. Like, “You’re a Christian, you do counseling, and you’re not doing that.” We’re a bunch of weirdos. We’re in that realm of the inter-Christian circle in a good sense. We believe so deeply that God loves us and God has interceded and does intercede, and interacts with our present, not just a historical event here and there, and we’re left on our own, the deistic watchmaker, to use a philosophical reference there. That because we believe that so strongly, we’re not going to take no for an answer in the sense of the deeper growth and deeper faith. 

So, sometimes that backfires though, especially getting into the superstitious, like, “Well, God’s got to be in everything, and I’m not feeling it,” as opposed to like, “Okay. Is it possible that I could just have a brain that gives me some pretty nasty thoughts sometimes and it doesn’t necessarily reflect that I’m in a bad state, that I can be curious about what a person getting mangled by a car might look like mentally and then be terrified by that?” And then like, “Thanks, brain, for giving me the imagination. Glad I can think through accidents so I can maybe be a safer driver.” Yeah, absolutely. But I will say that’s one of those sticky points a lot of times for Christians because we believe that thoughts matter and beliefs matter. And so there can be this overinterpretation of everything is always something really big and serious about my status and my heart, and something that’s really big and serious about spiritual things or demonic stuff, or fill in the blank. 

So, the faith integration piece, I do carefully, but I’m not scared of it. I’ve done it so often. It’s through a lot of assessments. It has to be from the standpoint of the client’s wanting that. Usually, the client is asking me specifically, like, “Hey, would you pray at the end of the session?” Sure, absolutely, in most cases. 

And this, such a deep topic. I’m fully aware that there are those in the camp that view faith integration as completely antithetical to what needs to happen in treatments. And they argue their case, they’re going to argue it really strongly, but the same exists on the other side as well. And I try and work in that realm of, okay, what’s good for the clients? And are there some things that I don’t do? Yeah, but I’m not really asked to do them. 

I’ve had a number of Muslim clients throughout the year. I don’t join in with Ramadan with clients in various practices or fasting with a client, for example. That’s not my faith practice there. But can I walk with the client who is trying to differentiate between the lines of fasting and I had water at this point, and the sun was going down and I thought. And other people were having water, but I’m getting stuck on assessing, like, was it too early, and did I actually violate my commitment, my vow? Did I violate what I was supposed to be doing? 

I can absolutely work with that person, and I need to. I can’t really work with OCD or anxiety disorders if I wanted to turn that person away at the door and be like, “Oh, well, I’m not Muslim, so I’m sorry.” No, we’re going to jump into it and be like, “Okay, so tell me about this thought and then this behavior that came up at this time, and you’re noticing that that’s a little different from your community, that other people are starting to drink water, eat food. And so, you mentioned that it was right at sunset, but what time was that?” “Well, actually, it was like 10:30 p.m. It’s two hours dark.” It’s like, “But I think I saw a glow in the distance.” And it’s like, “Okay, now we’re into a pretty classic OCD realm.” And so the simplest way that I can say that faith integration can be done in therapy is carefully, respectfully, with good assessments.

Kimberley: Do you have them consult with their spiritual leader if you’re stuck on that? And does that involve you speaking with them, them speaking with them, all three of you? What have you done?

Justin: Yeah, absolutely. So, there is a collaboration that goes in a number of different ways. Most of the time, people can speak with their clergy member or faith leader pretty directly, pretty separately, and that is going to work just fine. I would say in most cases, people don’t need to, especially if I’m working with OCD. A lot of folks usually have a pretty good general sense of, “Okay, I know what my faith community is going to say about this is X, but I’m scared because it feels like it’s on shaky ground, I’m obsessing,” et cetera. 

So, the clarification with the clergy, for instance, or a leader is more from the standpoint of if there’s not a defined value definition practice, and that does come up for sure. So, helping that person to even find who that might be, especially if they’re not a part of that, and/or maybe a good article to read with some limits, like, okay, three articles max. Check out a more conservative view, a more liberal view, a more fill in the blank. 

And then my friend and colleague Alec Pollard up at St. Louis Behavioral Medicine Institute, he’s been on scrupulosity panels with me. He uses this excellent form called the PISA, (Possibly Immoral or Sinful Act). And it’s just a great several-question guide. That or any number of things can be taken to clergyperson, leader in Christian circles a lot of times, like a Bible study or community group. Maybe flesh those things out just a little bit, maybe once, maybe twice max. 

And so, back to how much others are integrated, yeah, it’s a mix and match, anything, everything. For me, with direct conversations with clergy, it’s actually because I’m pretty deep into this realm, I have pretty easy access to a lot of folks, so I don’t really need to so much talk directly or get that person on a release. But a lot of people do, especially if they don’t know that religious belief or faith traditions approach on certain topics. 

Kimberley: Yeah. It’s so wonderful to talk about this with you. 

Justin: Thanks, Kimberley. Same here.

Kimberley: Because I really do feel, I think post-COVID, there’s more conversations with my clients about this. This could be totally just my clients, but I’ve noticed an increased longing, like you said, for that connection, the loneliness pandemic.

Justin: Yeah, that’s statistical. 

Kimberley: Such a need for connection, such a need for community, such a need for that, like what is your North Star? And it can be, even if we haven’t really talked about depression, it can be a really big motivator when you’re severely depressed, right?

Justin: Absolutely. 

Kimberley: And this is where I’m very much like so curious and loving this conversation with my clients right now in terms of, where is it helpful? Where isn’t it helpful? As you said, do you want to use this as a part of your practice here in treatment, in recovery? And what role does it play? I know I had mentioned to you, I’d even asked on Instagram and did a poll, and there were a lot of people saying, “It gave me a community. It immensely helps. It does keep me focused on the goal,” especially if it’s done intentionally without letting fear take over. Is there anything you wanted to add to this conversation before we finish up? 

Justin: Yeah, I guess two things. So, one is you talked about that, and we talked about a couple of those responses before we jumped on to recording. So, in summary, the responses were all across the board, like, “Ooh.” Let me know if I’m summarizing this well, but, “I have to be really careful. That can be really compulsive or not so much. I don’t like to do that. I don’t think it’s necessary.” And then like, yeah, absolutely. This is really integral and really important. Is that a fair summary?

Kimberley: Very much. Yep. 

Justin: Okay. And so, I’m building this talk, Katie O'Dunne and Rabbi Noah Tile, ERP As a Spiritual Practice. We’re giving here at the Faith and OCD Conference in April, if this is out by then. And in my section that I have, I’m covering the best practices of treatments, specifically ERP (exposure and response prevention) for OCD, and clinically, but then also from a faith standpoint, what do we consider with that? And there’s this three-prong separation that I’m making. I’m not claiming a hold on the market with this, but I’m just observing. There’s one category of a person who comes into therapy, and it’s like, yeah, face stuff, whatever. It doesn’t matter, or even almost antagonistic against it. Maybe they’ve been burnt, maybe they’ve been traumatized or abused with faith. Yeah, I get it. So, that first camp is there.

But then there’s also a second camp that people like to add on spiritual practices. They might mix and match, or they might follow a specific system, belief system. And whether it gets into mindfulness or meditation practices or fasting or any number of things, they find that there’s a lot of benefit, but it’s maybe not at the heart of it. 

And then there’s this third prong of folks that it is part and parcel of everything they do. And I work with all three. They come up in different ways. And sometimes people cycle between those different ones as well in treatments in the process.  

Kimberley: I’m glad you said that.

Justin: Yeah. And so, I just thought that was interesting when you pulled folks

that had come up. Really, the second thing, and maybe this is at least my ending points unless we have anything else, you had mentioned to the audience that graciously, we had some tech issues. You all, it wasn’t Kimberley’s tech issues. It was Justin’s tech issues. I spilled coffee on my computer like a week or two prior. It zapped. It’s almost like you’d see in a movie, except it wasn’t sparking. And I’m like, “Oh my goodness.” And it was in a client session. That was a whole funny story in of itself. And I’m like, “Oh my goodness.” It wasted my nice computer that I use for live streaming and all of that. And so I’m using my little budget computer at home. It’s like, “Oh, hopefully it works.” And it just couldn’t. It couldn’t keep up with all the awesomeness that KQ’s spitting out.

And I shared with you, Kimberley, a little bit on the email, something deep really hit me after that. I felt a lot of shame when we tried back and forth for 30 minutes to do it, and my computer kept crashing, basically because it couldn’t stand the bandwidth and whatever else was needed. And one might think it’s just a technical thing, but I’d had some stuff happen earlier that week. I started to play in my church worship band, lead guitar, and there was something that I just wasn’t able to break through, and I was just feeling ashamed of that. And it just really hit me. 

And one of my key domains that I am growing in is my own perfectionism, as a subset of my own anxiety, and perfectionism is all about shame. And I love performance, I love to perform well. I like to say, “Oh, it’s seeking excellence, and it’s seeking the best for other people’s good.” But deep down inside, perfectionism is this shame piece that anything shy of perfect is not good enough, and it just hit me. I felt like trash after that happened. I felt embarrassed. And you were so gracious, “It’s okay, we’ll reschedule.” 

And so, I went for a walk, which I do. Clear my mind, get exercise. And I was just stuck on that. And one of the ways where my Christian walk really came in at that moment was, I started to do some cognitive restructuring. I started to -- for you all who don’t know, it’s looking at the bigger picture and being more realistic with negative thoughts. Like, “Ah, I can’t believe this happened. I failed this,” as opposed to like, “Okay, we’re rescheduling. It’s all right. It actually gave us more time to think about it.” And I didn’t know that then, but I could have said similar things. 

I was doing a bunch of clinical tools that are helpful, but frankly, it wasn’t until I just tapped into the bigger purpose of, one, not controlling the universe. I don’t keep this globe spinning. I barely keep my own life spinning. Two, God loves me. And three, it’s okay. It’s going to work that out. Four, maybe there’s something bigger, deeper going on that I don’t know. And I can’t guarantee that it was for this reason. I’m not going to put that in God’s mouth and say that, “Oh yeah, okay, well, He gave us a couple more weeks to prepare.” I don’t know. I really don’t know. But it helped me to tap into like, “Okay, it’s all right. It’s really all right.” 

And it took me about half a day, frankly. I’m slightly embarrassed to say, “No, I’m not embarrassed to say that as a clinician who works with this stuff. I have full days, I have full weeks. I have longer periods of time where I’m wrestling with this stuff.” And yeah, areas have grown. I’ve improved in my life for sure, but I’m just a hot mess some days. 

Kimberley: But that’s nice to hear too, because I think, again, clients have said it looks so nice to be loved by God all the time. That must be so nice. But it’s not nice. I hate that you went through that. But I think people also need to know that people of faith also have to walk through really tough days and that it isn’t the cure-all, that faith isn’t the cure-all for struggles either. I think that’s helpful for people to know.

Justin: Yeah, that’s right. So, thank you for letting me share a little bit of that. And yeah, the personalized example of why, at least for me, faith is important. If folks come into my office and they say, “Nah, no thanks,” okay, I’m going to try lightly, carefully, or just avoid it altogether if that’s what they want. But oftentimes it’s really at the center of, okay, purpose, meaning, direction, guidance, and okay, you want to do that? I’ll roll up my sleeves, and let’s go. 

Kimberley: Yeah. See, I’m glad that it happened because you got to tell that beautiful story. And without that beautiful story, I would be less happy. So, thank you for sharing that and being so vulnerable. I think I shared with you in an email like I’ve had to get so good at letting people down that I get it. And I love that you have that statement, like God loves me. That is beautiful. That’s like sun on your face right there. I love that you had that moment. 

Justin: Yeah, it comes up so much, so many times. In the Bible and even to -- like I wrote this article on Fear Not. So, the most common exhortation in all of the Christian Bible is fear not. So, one might think like, “Oh yeah, don’t commit adultery,” or “Don’t kill, don’t murder,” or fill in the blank. Not even close. The most common exhortation in all of scriptures is actually fear not, and then love, various manifestations all throughout. I could go on, but I know we’re out of time. 

Kimberley: Well, what I will say is tell people where they can hear about you and even access that if they’re interested. I love to read that article. So, where will people hear about you and learn more about the work you do? Please tell us everything.

Justin: Yeah, sure. And I’ll include some stuff for your show notes that you can send to the things referenced. And then JustinKHughes (J-U-S-T-I-N-K-H-U-G-H-E-S) .com is my base of operations where the contact, my email practice information, my blog is on there. And you can subscribe to my newsletter totally free. Totally, totally free. And I do a bunch of eBooks as well on there that are free. JustinKHughes.com/GetUnstuck to join one of four of the newsletters. 

Other than that, that’s where those announcements come out for different conferences. So, Faith and OCD, if this is out in time in April, but April every year, it’s getting to be pretty big. We’re getting hundreds of people attending. We’re now in our fourth annual IOCDF (International OCD Foundation Conference), local conferences, various live streams. So, anyway, the website is that base, that hub, where you’ll actually see any number of those different announcements. Thanks for asking. 

Kimberley: I’m going to make sure this is out before the conference. Can you tell people where they can go to hear about the conference?

Justin: Yeah. So, IOCDF.org. And then I think it’s /conferences, but you can also type into Google conferences and there’s a series of all sorts of different conferences going on. And this is the one that’s dedicated to OCD and faith concerns. And just when you think that it’s just one specific belief system, then prepare to be surprised because we’ve done a lot of work to have a diverse group of folks, sharing and speaking and covering a lot of things, ranging from having faith-specific or non-faith nuns, support groups. So, there are literally support groups if you’re an atheist and you have OCD, and that’s actually an important part of where you are in your journey. But for Christians, for Muslims, for Jewish, et cetera, et cetera, we’re trying to really have any number of backgrounds supported along with talks and in broad general things, but then we get more specific into, “Hey, here’s for clinicians. Hey, here’s for the tips on making for effective practices.” 

Kimberley: Yeah, amazing. And I’ll actually be speaking on self-compassion there as well. So, I’m honored to be there. Thank you for being here, Justin. This was so wonderful. 

Justin: Yeah, this really was. Thank you.

Exploring the relationship between faith and recovery, especially when it comes to managing Obsessive-Compulsive Disorder (OCD), reveals a complex but fascinating landscape. It's like looking at two sides of the same coin, where faith can either be a source of immense support or a challenging factor in one’s healing journey.

On one hand, faith can act like a sturdy anchor or a comforting presence, offering hope and a sense of purpose that's invaluable for many people working through OCD. This aspect of faith is not just about religious practices; it's deeply personal, providing a framework that can help individuals make sense of their struggles and find a pathway towards recovery. The sense of community and belonging that often comes with faith can also play a crucial role in supporting someone through their healing process.

However, it's not always straightforward. Faith can get tangled up with the symptoms of OCD, leading to situations where religious beliefs and practices become intertwined with the compulsions and obsessions that characterize the disorder. This is where faith can start to feel like a double-edged sword, especially in cases of scrupulosity, where religious or moral obligations become sources of intense anxiety and compulsion.

The conversation around integrating faith into recovery is a delicate one. It emphasizes the need for a personalized approach, recognizing the unique ways in which faith intersects with an individual's experience of OCD. This might involve collaborating with religious leaders, incorporating spiritual practices into therapy, or navigating the complex ways in which faith influences both the symptoms of OCD and the recovery process.

Moreover, this discussion sheds light on a broader conversation about the intersection of psychology and spirituality. It acknowledges the historical tensions between these areas, while also pointing towards a growing interest in understanding how they can complement each other in the context of mental health treatment.

In essence, the relationship between faith and recovery from OCD highlights the importance of a compassionate and holistic approach. It's about finding ways to respect and integrate an individual's spiritual beliefs into their treatment, ensuring that the journey towards healing is as supportive and effective as possible. This balance is key to harnessing the positive aspects of faith, while also navigating its challenges with care and understanding.

Justin K. Hughes, MA, LPC, owner of Dallas Counseling, PLLC, is a clinician and writer, passionate about helping those impacted by OCD and Anxiety Disorders. He serves on the IOCDF's OCD & Faith Task Force and is the Dallas Ambassador for OCD Texas. Working with a diversity of clients, he also is dual-trained in psychology and theology, regularly helping anyone to understand the interaction between faith and mental health. A sought-after writer and speaker, he is currently mid-way through writing his first workbook on evidence-based care of OCD for Christians. He is seeking a collaborative agent who will help secure the best publishing house to help those most in need. Check out www.justinkhughes.com to stay in the loop and get free guides & handouts!

Kimberley: Welcome, everybody. Today, we’re talking about faith and its place in recovery. Does faith help your recovery? Does it hinder your recovery? And all the things in between. 

Today, we have Justin Hughes. Justin is the owner of Dallas Counseling and is a clinician and writer. He’s passionate about helping those who are impacted by OCD. He is the Dallas ambassador for OCD Texas and serves on the IOCDF’s OCD and Faith Task Force, working with a diversity of clients. He’s also dual-trained in psychology and theology, regularly helping anyone to understand the interaction between faith and OCD, most commonly Christians. But today, we’re here to talk about faith in general. Welcome, Justin.

Justin: Kimberley Jayne Quinlan, howdy.

Kimberley: You said howdy just perfectly from your Texas state. 

Justin: Absolutely.

Kimberley: Okay. This is a huge topic. And just for those who are listening, we tried to record this once before, we were just saying, but we had tech issues. And I’m so glad we did because I have thought about this so much since, and I feel like evolved a little since then too. 

So, we’re here to talk about how to use faith in recovery and/or is it helpful for some people, and talk about the way that it is helpful and for some not. Can you share a little bit about your background on why this is an important topic for you?

Justin: Absolutely. So, first of all, as a man of faith, I’m a Christian. I went to a Christian college, got my degree in Psychology, and very much desired to interweave studies between psychology and theology. So, I went to a seminary. A lot of people hear that, and they’re like, “Did you become a priest?” No, it was a counseling program at a seminary, Dallas Theological Seminary. I came here and then found my wife, and I stayed in Dallas. 

And it’s been important to me from a personal faith standpoint. And I love the faith integration in treatment and exploring that with clients. And of course -- or maybe I shouldn’t say of course, but it’s going to be a lot of Christians, but I work with a lot of different faith backgrounds. And there are some really important conversations happening in the broader world of treatment about faith integration and its place. And we’re going to get into all those things and hopefully some of the history and psychology’s relationship to faith, which has not been the greatest at different points.

For me personally, faith isn’t just an exercise. It’s not something that I just add on to make my day better. In fact, a lot of times, faith requires me to do way more difficult things than I want to do, but it’s a belief in the ultimate object of my faith in God and Christ as a Christian. I naturally come across a lot of people who not only identify that as important but find it as very essential to their treatment. And let’s get into that, the folks that find it essential, the people who find it very much not, and the people who don’t. But that’s just a little bit about me and why I find this so important.

Kimberley: Yeah. It’s interesting because I was raised Episcopalian. I don’t really practice a lot of that anymore for no reason except, I don’t know, if I’m going to be really honest. 

Justin: So honest. I love that. 

Kimberley: Yeah, I’ve been thinking about it a lot because I had a positive experience. Sometimes I long for it, but for reasons I don’t know. Again, I’m just still on that journey, figuring that piece out and exploring that. 

Where I see clients is usually on the end of their coming to me as a client, saying, “I’m a believer, but it’s all gotten messed up and mushed up and intertwined.” And I’m my job. I think of my job as helping them untangle it.

Justin: Yeah.

Kimberley: Not by me giving my own personal opinion either, but just letting them untangle it. How might you see that? Are you seeing that also? And what is the process of that untangling, if we were to use that word?

Justin: It’s so broad and varied. So, I would imagine that just like with clients that I work with and folks that come to conferences and that I talk with, the listeners in your audience, hi listeners, are going to have a broad experience of views, and it’s so functional. So, I want people to hear right away that I don’t think that there’s just a cookie-cutter approach. There can’t be with this. And whether we’re treating OCD, anxiety disorders, or depression, or eating disorders, or BFRVs, fill in the blank, there are obviously evidence-based treatments which are effective for most, but even those can’t be a cookie cutter when it comes down to exactly what a person needs to do or what is required of them in recovery. 

So, yes, let me just state this upfront for the folks that might be unduly nervous at this point. First of all, the faith piece, religious piece, does not have to enter into treatments for a lot of people to get the job done. In fact, actually, for a lot of people, it was much more healing for them, including many of my clients. I have friends and family members that sometimes look at me as scant. So like, “Wait, you went to seminary, and sometimes you don’t talk about God at all.” And it’s like, “Yeah, sometimes we’re just doing evidence-based treatment, and that is that.” And as an evidence-based practitioner, that’s important to me. 

So, when people come in, I want to work with what their goals are, their values. And a lot of people have found themselves, for any number of reasons, stuck, maybe compulsions or obsessive thoughts or whatever, are stuck in all things belief, religion, or faith or whatever else. And sometimes actually, the most healing thing for them to do is sometimes get in, get out, do the job clinically, walk away, experience freedom, and then grow and develop personally. 

But then I’ve also discovered that there’s this other side that some people do not find a breakthrough. Some people stay stuck. And maybe these are the people that hit the stats that we see in research of 20% or so just turn down things like ERP, (exposure and response prevention) with OCD when they’re offered. And then another 20 to 30% drop out. And we have great studies that tell us that most people who stick with it get a lot of benefits, but there’s all the other folks that didn’t. And sometimes it’s because people -- no offense, you all, but sometimes people just don’t want to put in the work and discipline. 

However, we can’t minimize it to that. Sometimes it’s truly people that are willing to show up, and there’s a complex layer of things. And the cookie-cutter approach is not going to work for them. Maybe they have the intersection of complex health issues, intersection of trauma, intersection of even just family of origin things where life is really difficult, or even just right now, a loneliness epidemic that’s happening in the world. 

And by the way, I’m a huge believer in the evidence base. There’s a lot in the evidence base that guides us. And as I’m talking today, I want to be really clear that when I work with folks, even when we get into the spiritual, I’m working with the evidence base. Yeah, there’s things that there’s no specific protocol for, but a lot of folks, I think, can hopefully be encouraged that there’s a strong research base to the benefits and the use and the application and also the care of practicing various spiritual practices through treatments. 

So, to come back to the original question, it depends so much. It’s like if somebody asked me a question like, “Hey, Justin. Okay, so as a therapist, do you think that --” and I get these questions all the time, “Is it okay for me to...? Like, I am afraid of this.” I got this question at one point. Somebody was curious if I thought it was okay for them to travel to another city. And it’s like, it depends. It’s almost always an “it depends.” 

So, that’s where I’m going to leave it, that nice, squeaky place that we all just want a dang answer, but the reality is, it is going to massively depend on the person and where they are, and what their needs are.

Kimberley: Yeah, I mean, and I’ll speak to it too, sometimes I’ve seen a client. Let’s give a few examples of a client with OCD. The OCD has attacked their faith and made it very superstitious or very fear-based instead of faith-based. And I think they come in with that, “Everything’s so messy and it used to make so much sense, and now it doesn’t.” 

For eating disorders, I’ve had a lot of clients who will have a faith component where there are certain religions that have ways in which you prepare foods and things, and then that has become very sticky and hard for them. The eating disorder gets involved with that as well. 

And let me think more just from a general standpoint, and I’ll use me as an example, as just like a generally anxious person. I remember this really wonderful time, I’ll tell you a funny story, when my daughter was like five, out of nowhere, she insisted that we go to every church. Like she wanted to go to a Christian and a Catholic and Jewish temple and Muslim and Buddhist. She wanted to try all of them, and we were like, “Great, let’s go and do it.” And I could see how my anxious brain would go black and white on everything they said. So, if they said something really beautiful, my brain would get very perfectionistic about that and have a little tantrum. I think it would be like, “But I can’t do it that perfect,” and I would get freaked out, but also be able to catch myself. So, I think that it’s important to recognize how the disorder can get mixed up in that.

Justin: Yeah, absolutely.

Kimberley: Right? Let’s now flip, unless you have something you want to add, to how has faith helped people in their recovery, and what does that look like for you as a clinician, for the client, for their journey?

Justin: Yeah, absolutely. Well, on the clinical side of things, the starting place is always going to be the assessments and diagnosis and treatment plan. And then the ethics of it too is going to be working with the person where they are and their beliefs and not forcing anything, of course. And so folks are naturally -- I get it, I respect it. I would be nervous of somebody of a different belief background that’s overt about things. Some people come in, they look at the wall, they see Dallas Theological Seminary, they’ve studied a few things in advance. So, yeah, the starting places, sitting down, honest, building rapport, trust, assessing, diagnosing.

So, for the folks where the faith piece is significant, I’ll put it into two categories. So, one is sometimes we have to talk about aspects of faith just from a pure assessment sample. So, a common example of that is scrupulosity in OCD. So, I have worked with even a person on the, believe it or not, Faith and OCD Task Force who is atheist. And so, why in the world do we need to talk about faith? Why is that person even on the Faith and OCD Task Force? Well, they’re representing a diversity of views and opinions on the role of faith and OCD. 

Kimberley: Love it.

Justin: And it’s so interesting to look at it at a base level with something like OCD. But frankly, a lot of mental disorders or even just challenges in life, if clinicians, one, aren’t asking questions about, hey, do you have any religious views, background, even just in your background? Do you have spiritual practices that are important to you? We’re missing a massive component. And here’s the research piece. We know from the research that, actually, a majority of people find things of faith or spirituality important, and secondarily, that a majority of people would like to be able to talk about those things in therapy. Straight-up research. So, a couple of articles that I wrote for the IOCDF on this reference this research. So, it is evidence-based to talk about this. 

And then when we get into these sticky areas of obsessions and anxiety disorders, of course, it’s going to poke on philosophy, worldview, spirituality. And so, it could be even outside of scrupulosity, beliefs that at first it just looks like we need some good shame reduction exercises, self-compassion, and so forth, but we discover that, oh, the person struggling with contamination OCD has a lot of deeper beliefs that they think that somehow, they are flawed because they’re struggling. They’re not a good enough, fill in the blank, Christian. They’re not good enough. Because if so, surely God would break through in a bigger way. If so... Wouldn’t these promises that I’m told in scriptures actually become true? 

And the cool thing is, there’s a richness in the theology that helps us understand the nuance there, and it’s not that simple. But if we miss that component, and it’s essential for treatment, it’s not just like, “Oh, I feel bad about myself. And yeah, sometimes I’m critical with myself.” And if we don’t go at that level of core fear, or core distress, or core belief, oftentimes we’re missing really a central part of the treatment, which we talk about in any other domain. People just get nervous sometimes, thinking about spirituality. It’s like politics and religion, right? Nobody talks about those things. Well, if we’re having deeper conversations, we usually are. And as clinicians, those of you that are listening to the podcast as clinicians, you know that you have to work with people of different political leanings, people of different faith leanings, people who actually live in California versus [inaudible]. I love California. 

So, the first category is, if we’re doing good clinical work, we’re going to be asking questions because it matters to most people. If we don’t, we’re missing a huge piece. It doesn’t mean you’re a bad therapist, but hey, start asking some questions if you’re not, at a minimum. 

But then there’s the second piece that most people actually want to know, and most people have some aspects of practice or integration, or even the most religion church-averse type of person will have any number of things come up such as, “Yeah, I pray occasionally,” or “Yeah, I do this grounding exercise that puts me in touch with the universe or creation or whatever it is.” 

So, there’s the second category of when it is important to a person because it’s part of the bigger picture of growth, it’s part of the bigger picture of breaking free from challenges that they have, and, frankly, finding meaning. And I’ll just make one philosophical comment here, because I’m a total nerd. Psychology can never be a worldview. Psychology tells us what. Psychology is a subset of science. And by worldview, I mean a collective set of beliefs, guidance, direction about how life should be lived. We can only say, “Hey, when you do this, you tend to feel this way, or you tend to do these behaviors more or do these behaviors less.” At the end of the day, we have to make interpretations and judgments about right and wrong, how to live life, the best way to live life. These are in the realm of interpretation. 

So, surprise, surprise, we’re in the realm of at least philosophy, but we very quickly get into theology. And so back to the piece that most people care about it, most people have some sort of spiritual practice that they’ll resonate with and connect with. And then most people actually want to integrate a little bit into therapy. And then some people find that it is essential. They haven’t been able to find any lasting freedom outside of going deeper into a bigger purpose, `bigger meaning.

Kimberley: You said a couple of things that really rang true for me because I really want to highlight here, I’m on the walk here as well as a client. And I love having these conversations with clients, not about me, about them, but them when they don’t have a spiritual practice, longing for one. I’ve had countless clients say, “I just wish I believed.” And I think what sometimes they’re looking for is a motivator. I have some clients who have a deep faith, and their North Star is that religion. Their North Star is following the word of that religion or the outcome of it, whether it be to go to heaven or whatever, afterlife or whatever. They believe like that’s the North Star. That’s what determines every part of their treatment. Like, “Why are we doing this exposure today?” “Because this is my North Star. I know where I’m heading. I know what the goal is.” And then I have those clients who are like, “I need a North Star. I don’t have one. I don’t get the point.” And I think that is where faith is so beautiful in recovery. 

When I witness my clients who are going to do the scary thing, they don’t want to do it, but they’re so committed to this North Star, whatever it might be. And maybe there’s a better language than a North Star, again, whatever that is for that person. Like, “I’m walking towards the light of whatever that religion is.” I feel, if I’m going to be honest, envious of that. And I totally get that some people do too. 

What would you say to a client who is longing for something like that? Maybe they have spiritual trauma in some respects or they’ve had bad experiences, or they’re just unsure. What would you say to them?

Justin: Yeah, that’s really great. And first of all, I just want to really say that it takes a lot of vulnerability and strength to talk as you do. And one of the ways that I admire you, KQ, is through your ability to have these vulnerable conversations. So not just like the platform of expert, because at the end of the day, we’re all just people and on a journey for sure. And so thanks for being honest with that. 

And I’m on a journey as well. And certainly, I realized jumping on podcasts, these things put us in the expert role and we speak at conferences and things like that. But I think that’s a bit of the answer right there, is that being where we are to start with is so huge. And I mean, you’re so good with the steps to take around acceptance and compassion. That’s it. It’s like fear presses towards a thousand different possibilities, and none of them come true exactly that way. And it can lead towards people missing a lot of personal growth stuff, spiritual growth stuff. And one of those things, I think, that we do is we sit with that.

Clinically, I’m going to assess, ask a lot of questions, Socratic questions as a subset of the cognitive therapy side of doing that. Let me just come back to the simplicity. I think we get there. We sit in it for a second. And otherwise, we miss it. We’re rushing to preconceived solutions or answers, but we’re saying that we don’t necessarily have an answer for that. So, what if we take some time to actually notice it and to be with that and to actually label it and be like, “I’m not sure. I’m yearning. I’m envious. I’m wanting something, but I don’t know. So, put me in, coach.” I’ll sit with people. That’s really the first thing. 

Kimberley: Yeah. What I have practiced, and I’ve encouraged clients is also being curious, like trying things out if that lines up with their values, going to a service, reading a book, listening to a podcast, and just trying it on. For me, it’s also interesting with clients, is if they’re yearning for it, try it on and observe what shows up. Is it that black-and-white thinking or perfectionism? Is it your obsessions getting involved? Is it that it just doesn’t feel good in your body? And so forth. Again, just be where you are and take it slow, I think. 

I have a few other areas I want you to look at in terms of giving me your professional thoughts. If somebody wants to incorporate faith into their treatment, what can that look like? Can it look like praying together? What does that look like?

Justin: You’re asking all the good questions. Yeah, absolutely. And also, one other thing to reference, I know you’re friends with Shala Nicely and Jeff Bell. And so they wrote a book. And for those that are on that, I would say, more “I’m seeking journey,” it’s When in Doubt, Make Belief: An OCD-Inspired Approach to Living with Uncertainty. And I love Shala and Jeff. They’re so great, and they’ve been really pivotal people in my own life, not just as friends, but just as personal growth too. And so, that’s an example specifically where Shala talks about the throes of her suffering. Is Fred in the Refrigerator? is her basically autobiography that goes into the clinical piece too, where at the end of the day, there was a bit of a pragmatic experience that she couldn’t -- the universe being against her, she basically always had that view and she needed something that was different. And so she got there, I think. I hope I’m reflecting her sentence as well, but got there pragmatically. “The universe is friendly” is something that she said. 

Now, I just know that my Christian brothers and sisters, if they’re listening to this, they’re probably like, “What the heck is Justin talking about? The universe is friendly?” Because that’s very, very different from the language that we’ve used, but it’s just such a great example to me of just one step at a time, a person on the journey. They’re looking at those things and assessing, okay, what is obsessive, what is compulsive, what is this thing that I can believe in and I ultimately do, but maybe I’m not. I don’t want to or I’m not ready, or it doesn’t make sense to me to make a jump into an organized religious plea for whatever else. And so, how does it look for clients? 

So in short, do I pray with clients? Yeah, absolutely. Do I open up the Bible? Yes, absolutely. Actually, it is a minority of sessions, which again, on my more conservative friends and family side of things are almost shocked and scratching their heads. Like, “You’re a Christian, you do counseling, and you’re not doing that.” We’re a bunch of weirdos. We’re in that realm of the inter-Christian circle in a good sense. We believe so deeply that God loves us and God has interceded and does intercede, and interacts with our present, not just a historical event here and there, and we’re left on our own, the deistic watchmaker, to use a philosophical reference there. That because we believe that so strongly, we’re not going to take no for an answer in the sense of the deeper growth and deeper faith. 

So, sometimes that backfires though, especially getting into the superstitious, like, “Well, God’s got to be in everything, and I’m not feeling it,” as opposed to like, “Okay. Is it possible that I could just have a brain that gives me some pretty nasty thoughts sometimes and it doesn’t necessarily reflect that I’m in a bad state, that I can be curious about what a person getting mangled by a car might look like mentally and then be terrified by that?” And then like, “Thanks, brain, for giving me the imagination. Glad I can think through accidents so I can maybe be a safer driver.” Yeah, absolutely. But I will say that’s one of those sticky points a lot of times for Christians because we believe that thoughts matter and beliefs matter. And so there can be this overinterpretation of everything is always something really big and serious about my status and my heart, and something that’s really big and serious about spiritual things or demonic stuff, or fill in the blank. 

So, the faith integration piece, I do carefully, but I’m not scared of it. I’ve done it so often. It’s through a lot of assessments. It has to be from the standpoint of the client’s wanting that. Usually, the client is asking me specifically, like, “Hey, would you pray at the end of the session?” Sure, absolutely, in most cases. 

And this, such a deep topic. I’m fully aware that there are those in the camp that view faith integration as completely antithetical to what needs to happen in treatments. And they argue their case, they’re going to argue it really strongly, but the same exists on the other side as well. And I try and work in that realm of, okay, what’s good for the clients? And are there some things that I don’t do? Yeah, but I’m not really asked to do them. 

I’ve had a number of Muslim clients throughout the year. I don’t join in with Ramadan with clients in various practices or fasting with a client, for example. That’s not my faith practice there. But can I walk with the client who is trying to differentiate between the lines of fasting and I had water at this point, and the sun was going down and I thought. And other people were having water, but I’m getting stuck on assessing, like, was it too early, and did I actually violate my commitment, my vow? Did I violate what I was supposed to be doing? 

I can absolutely work with that person, and I need to. I can’t really work with OCD or anxiety disorders if I wanted to turn that person away at the door and be like, “Oh, well, I’m not Muslim, so I’m sorry.” No, we’re going to jump into it and be like, “Okay, so tell me about this thought and then this behavior that came up at this time, and you’re noticing that that’s a little different from your community, that other people are starting to drink water, eat food. And so, you mentioned that it was right at sunset, but what time was that?” “Well, actually, it was like 10:30 p.m. It’s two hours dark.” It’s like, “But I think I saw a glow in the distance.” And it’s like, “Okay, now we’re into a pretty classic OCD realm.” And so the simplest way that I can say that faith integration can be done in therapy is carefully, respectfully, with good assessments.

Kimberley: Do you have them consult with their spiritual leader if you’re stuck on that? And does that involve you speaking with them, them speaking with them, all three of you? What have you done?

Justin: Yeah, absolutely. So, there is a collaboration that goes in a number of different ways. Most of the time, people can speak with their clergy member or faith leader pretty directly, pretty separately, and that is going to work just fine. I would say in most cases, people don’t need to, especially if I’m working with OCD. A lot of folks usually have a pretty good general sense of, “Okay, I know what my faith community is going to say about this is X, but I’m scared because it feels like it’s on shaky ground, I’m obsessing,” et cetera. 

So, the clarification with the clergy, for instance, or a leader is more from the standpoint of if there’s not a defined value definition practice, and that does come up for sure. So, helping that person to even find who that might be, especially if they’re not a part of that, and/or maybe a good article to read with some limits, like, okay, three articles max. Check out a more conservative view, a more liberal view, a more fill in the blank. 

And then my friend and colleague Alec Pollard up at St. Louis Behavioral Medicine Institute, he’s been on scrupulosity panels with me. He uses this excellent form called the PISA, (Possibly Immoral or Sinful Act). And it’s just a great several-question guide. That or any number of things can be taken to clergyperson, leader in Christian circles a lot of times, like a Bible study or community group. Maybe flesh those things out just a little bit, maybe once, maybe twice max. 

And so, back to how much others are integrated, yeah, it’s a mix and match, anything, everything. For me, with direct conversations with clergy, it’s actually because I’m pretty deep into this realm, I have pretty easy access to a lot of folks, so I don’t really need to so much talk directly or get that person on a release. But a lot of people do, especially if they don’t know that religious belief or faith traditions approach on certain topics. 

Kimberley: Yeah. It’s so wonderful to talk about this with you. 

Justin: Thanks, Kimberley. Same here.

Kimberley: Because I really do feel, I think post-COVID, there’s more conversations with my clients about this. This could be totally just my clients, but I’ve noticed an increased longing, like you said, for that connection, the loneliness pandemic.

Justin: Yeah, that’s statistical. 

Kimberley: Such a need for connection, such a need for community, such a need for that, like what is your North Star? And it can be, even if we haven’t really talked about depression, it can be a really big motivator when you’re severely depressed, right?

Justin: Absolutely. 

Kimberley: And this is where I’m very much like so curious and loving this conversation with my clients right now in terms of, where is it helpful? Where isn’t it helpful? As you said, do you want to use this as a part of your practice here in treatment, in recovery? And what role does it play? I know I had mentioned to you, I’d even asked on Instagram and did a poll, and there were a lot of people saying, “It gave me a community. It immensely helps. It does keep me focused on the goal,” especially if it’s done intentionally without letting fear take over. Is there anything you wanted to add to this conversation before we finish up? 

Justin: Yeah, I guess two things. So, one is you talked about that, and we talked about a couple of those responses before we jumped on to recording. So, in summary, the responses were all across the board, like, “Ooh.” Let me know if I’m summarizing this well, but, “I have to be really careful. That can be really compulsive or not so much. I don’t like to do that. I don’t think it’s necessary.” And then like, yeah, absolutely. This is really integral and really important. Is that a fair summary?

Kimberley: Very much. Yep. 

Justin: Okay. And so, I’m building this talk, Katie O'Dunne and Rabbi Noah Tile, ERP As a Spiritual Practice. We’re giving here at the Faith and OCD Conference in April, if this is out by then. And in my section that I have, I’m covering the best practices of treatments, specifically ERP (exposure and response prevention) for OCD, and clinically, but then also from a faith standpoint, what do we consider with that? And there’s this three-prong separation that I’m making. I’m not claiming a hold on the market with this, but I’m just observing. There’s one category of a person who comes into therapy, and it’s like, yeah, face stuff, whatever. It doesn’t matter, or even almost antagonistic against it. Maybe they’ve been burnt, maybe they’ve been traumatized or abused with faith. Yeah, I get it. So, that first camp is there.

But then there’s also a second camp that people like to add on spiritual practices. They might mix and match, or they might follow a specific system, belief system. And whether it gets into mindfulness or meditation practices or fasting or any number of things, they find that there’s a lot of benefit, but it’s maybe not at the heart of it. 

And then there’s this third prong of folks that it is part and parcel of everything they do. And I work with all three. They come up in different ways. And sometimes people cycle between those different ones as well in treatments in the process.  

Kimberley: I’m glad you said that.

Justin: Yeah. And so, I just thought that was interesting when you pulled folks

that had come up. Really, the second thing, and maybe this is at least my ending points unless we have anything else, you had mentioned to the audience that graciously, we had some tech issues. You all, it wasn’t Kimberley’s tech issues. It was Justin’s tech issues. I spilled coffee on my computer like a week or two prior. It zapped. It’s almost like you’d see in a movie, except it wasn’t sparking. And I’m like, “Oh my goodness.” And it was in a client session. That was a whole funny story in of itself. And I’m like, “Oh my goodness.” It wasted my nice computer that I use for live streaming and all of that. And so I’m using my little budget computer at home. It’s like, “Oh, hopefully it works.” And it just couldn’t. It couldn’t keep up with all the awesomeness that KQ’s spitting out.

And I shared with you, Kimberley, a little bit on the email, something deep really hit me after that. I felt a lot of shame when we tried back and forth for 30 minutes to do it, and my computer kept crashing, basically because it couldn’t stand the bandwidth and whatever else was needed. And one might think it’s just a technical thing, but I’d had some stuff happen earlier that week. I started to play in my church worship band, lead guitar, and there was something that I just wasn’t able to break through, and I was just feeling ashamed of that. And it just really hit me. 

And one of my key domains that I am growing in is my own perfectionism, as a subset of my own anxiety, and perfectionism is all about shame. And I love performance, I love to perform well. I like to say, “Oh, it’s seeking excellence, and it’s seeking the best for other people’s good.” But deep down inside, perfectionism is this shame piece that anything shy of perfect is not good enough, and it just hit me. I felt like trash after that happened. I felt embarrassed. And you were so gracious, “It’s okay, we’ll reschedule.” 

And so, I went for a walk, which I do. Clear my mind, get exercise. And I was just stuck on that. And one of the ways where my Christian walk really came in at that moment was, I started to do some cognitive restructuring. I started to -- for you all who don’t know, it’s looking at the bigger picture and being more realistic with negative thoughts. Like, “Ah, I can’t believe this happened. I failed this,” as opposed to like, “Okay, we’re rescheduling. It’s all right. It actually gave us more time to think about it.” And I didn’t know that then, but I could have said similar things. 

I was doing a bunch of clinical tools that are helpful, but frankly, it wasn’t until I just tapped into the bigger purpose of, one, not controlling the universe. I don’t keep this globe spinning. I barely keep my own life spinning. Two, God loves me. And three, it’s okay. It’s going to work that out. Four, maybe there’s something bigger, deeper going on that I don’t know. And I can’t guarantee that it was for this reason. I’m not going to put that in God’s mouth and say that, “Oh yeah, okay, well, He gave us a couple more weeks to prepare.” I don’t know. I really don’t know. But it helped me to tap into like, “Okay, it’s all right. It’s really all right.” 

And it took me about half a day, frankly. I’m slightly embarrassed to say, “No, I’m not embarrassed to say that as a clinician who works with this stuff. I have full days, I have full weeks. I have longer periods of time where I’m wrestling with this stuff.” And yeah, areas have grown. I’ve improved in my life for sure, but I’m just a hot mess some days. 

Kimberley: But that’s nice to hear too, because I think, again, clients have said it looks so nice to be loved by God all the time. That must be so nice. But it’s not nice. I hate that you went through that. But I think people also need to know that people of faith also have to walk through really tough days and that it isn’t the cure-all, that faith isn’t the cure-all for struggles either. I think that’s helpful for people to know.

Justin: Yeah, that’s right. So, thank you for letting me share a little bit of that. And yeah, the personalized example of why, at least for me, faith is important. If folks come into my office and they say, “Nah, no thanks,” okay, I’m going to try lightly, carefully, or just avoid it altogether if that’s what they want. But oftentimes it’s really at the center of, okay, purpose, meaning, direction, guidance, and okay, you want to do that? I’ll roll up my sleeves, and let’s go. 

Kimberley: Yeah. See, I’m glad that it happened because you got to tell that beautiful story. And without that beautiful story, I would be less happy. So, thank you for sharing that and being so vulnerable. I think I shared with you in an email like I’ve had to get so good at letting people down that I get it. And I love that you have that statement, like God loves me. That is beautiful. That’s like sun on your face right there. I love that you had that moment. 

Justin: Yeah, it comes up so much, so many times. In the Bible and even to -- like I wrote this article on Fear Not. So, the most common exhortation in all of the Christian Bible is fear not. So, one might think like, “Oh yeah, don’t commit adultery,” or “Don’t kill, don’t murder,” or fill in the blank. Not even close. The most common exhortation in all of scriptures is actually fear not, and then love, various manifestations all throughout. I could go on, but I know we’re out of time. 

Kimberley: Well, what I will say is tell people where they can hear about you and even access that if they’re interested. I love to read that article. So, where will people hear about you and learn more about the work you do? Please tell us everything.

Justin: Yeah, sure. And I’ll include some stuff for your show notes that you can send to the things referenced. And then JustinKHughes (J-U-S-T-I-N-K-H-U-G-H-E-S) .com is my base of operations where the contact, my email practice information, my blog is on there. And you can subscribe to my newsletter totally free. Totally, totally free. And I do a bunch of eBooks as well on there that are free. JustinKHughes.com/GetUnstuck to join one of four of the newsletters. 

Other than that, that’s where those announcements come out for different conferences. So, Faith and OCD, if this is out in time in April, but April every year, it’s getting to be pretty big. We’re getting hundreds of people attending. We’re now in our fourth annual IOCDF (International OCD Foundation Conference), local conferences, various live streams. So, anyway, the website is that base, that hub, where you’ll actually see any number of those different announcements. Thanks for asking. 

Kimberley: I’m going to make sure this is out before the conference. Can you tell people where they can go to hear about the conference?

Justin: Yeah. So, IOCDF.org. And then I think it’s /conferences, but you can also type into Google conferences and there’s a series of all sorts of different conferences going on. And this is the one that’s dedicated to OCD and faith concerns. And just when you think that it’s just one specific belief system, then prepare to be surprised because we’ve done a lot of work to have a diverse group of folks, sharing and speaking and covering a lot of things, ranging from having faith-specific or non-faith nuns, support groups. So, there are literally support groups if you’re an atheist and you have OCD, and that’s actually an important part of where you are in your journey. But for Christians, for Muslims, for Jewish, et cetera, et cetera, we’re trying to really have any number of backgrounds supported along with talks and in broad general things, but then we get more specific into, “Hey, here’s for clinicians. Hey, here’s for the tips on making for effective practices.” 

Kimberley: Yeah, amazing. And I’ll actually be speaking on self-compassion there as well. So, I’m honored to be there. Thank you for being here, Justin. This was so wonderful. 

Justin: Yeah, this really was. Thank you.

Now fix this one error in thinking if you want to be less anxious or depressed, either one. Today, we are going to talk about why it is so important to be able to identify and challenge this one error in your thinking. It might be the difference between you suffering hard or actually being able to navigate some sticky thoughts with a little more ease. Let’s do it together.

Welcome back, everybody. My name is Kimberley Quinlan. I’m an anxiety and OCD specialist, and I am so excited to talk with you about this very important cognitive error or error in thinking that you might be engaging in and that might be making your life a lot harder. This is something I catch in myself quite regularly, so I don’t want you to feel like you’re wrong or bad for doing this behavior, but I also catch it a lot in my patients and my students. So, let’s talk about it. 

The one error you make is black-and-white thinking. This is a specific error in thinking, or we call it a cognitive distortion, where you think in absolutes. And I know, before you think, “Okay, I got the meat of the episode,” stay with me because it is so important that you identify the areas in your life in which you do this. You mightn’t even know you’re doing it. 

Again, often we’ve been thinking this way for so long, we start to believe our thoughts. Now, one thing to know, and let’s do a quick 101: we have thoughts all day. Everybody has them. We might have all types of thoughts, some helpful, some unhelpful. But if you have a thought that’s unhelpful or untrue and you think it over and over and over and over again, you will start to believe it. It will become a belief. Just like if you have a lovely, helpful thought and you think that thought over and over and over again, you will start to believe that too. 

And what I want you to know is often, for those with mental health struggles, whether that be generalized anxiety, panic disorder, depression, eating disorders, OCD, PTSD, social anxiety, the list goes on and on, one thing a lot of these disorders have in common is they all have a pretty significant level of errors in thinking that fuel the disorder, make the disorder worse, prevent them from recovering. My hope today is to help you identify where you are thinking in black and white so we can get to it and apply some tools, and hopefully get you out of that behavior as soon as possible. 

Here are some examples of black-and-white thinking that you’re probably engaging in in some area of your life. 

The first one is, things are all good or they’re all bad. An example might be, “My body is bad.” That there are good bodies and bad bodies. There are good people and bad people. There are good thoughts and bad thoughts. That’s very true for those folks with OCD. There are good body sizes and bad body sizes, very common in BDD and eating disorders. There are people who are good at social interaction and bad at social interaction. That often shows up with people with social anxiety. That certain sensations might be good, and certain sensations might be bad. So if you have panic disorder and you have a tight chest or a racing heart rate, you might label them as all bad. And this labeling, while it might seem harmless, is training your brain to be on high alert, is training your brain to think of things as absolutes, which does again create either anxiety or a sense of hopelessness, helplessness, and worthlessness specifically related to depression. So we’ve got to keep an eye out for the all good and the all bad. 

The next one we want to keep an eye out for is always and never. “I always make this mistake. I never do things right. I will always suffer. I will never get better.” These absolutes keep us stuck in this hole of dread. “It’ll always be this way. You’re always this way.” And the thing to know here is very, very rarely is something always or never true. We can go on to talk about this here in a little bit, but I want you just to sit with that for a second. It’s almost never true that almost never is the truth. How does that sound for a little bit of a tongue twister? 

Next thing is perfect versus failure. If you’re someone who is aiming for that is either perfect or “I’m a failure,” we are probably going to have a lot of anxiety and negative feelings about yourself. This idea that something is a failure. I have done episodes on failure before, and I’ll talk about that here in a second. But the truth is, there is no such thing as failure; it’s just a thought. And all of these are just thoughts. They’re just thoughts that we have. And if we think that our thoughts are facts, we can often again get into a situation where we have really high anxiety or things feel really icky. 

Another absolute black-and-white thinking that we do is that this is either easy or it’s impossible. There’s only those two choices. It should be either really easy or it’s not possible at all. Again, it’s going to get us into some trouble when we go to face our fears because facing fears is hard. We’ve talked about, it’s a beautiful day to do hard things. And the reason I say that is to really challenge this idea that things should be easy. And just because they’re hard doesn’t mean they’re impossible. Often people will say, “I can’t.” Again, just because they’re hard doesn’t mean that you can’t do it. It just might take some practice. 

So, these are common ways that black-and-white thinking shows up. And by now, if you’re listening, you’re probably thinking, “Oh yeah, I’ve been called out.” And that’s okay. We all do this type of thinking. But let’s talk about now tools and what you can do to target this. 

Let me tell you a story. Recently, I found myself managing what I would consider a crisis, a family crisis. It took several months for us to navigate this very, very difficult time. And I often leave voice recordings to my best friend. We communicate that way quite regularly. And every now and then, I listen back to what I’ve said to her just to hear myself and what I’m saying and where my head is. And I was shocked to hear me saying, “It’s always going to be this way. It’ll never get better. This is so bad. I failed. This is impossible. I can’t do this anymore.” I was doing all of the things. And for me, that awareness is what clicked me into like, “Oh, no wonder I’m panicking. No wonder I feel dread the minute I wake up in the morning because my story about this is exacerbating and making this harder on me. It’s creating more suffering.”

So the first thing I did is what I would tell my patients as well—to start with just a simple awareness training. Just being aware of when you do it. We don’t have to change anything. We’re not going to judge ourselves, but we’re just going to write down on a sticky note or an app on your phone every time you get caught in a black-and-white thinking, and we’re going to jot it down. “I always will feel this way. I will never get better. This will forever be a failure.” We want to just jot it down. And that is, in and of itself, a huge part of the work—just being aware when you catch it. We’re not here to come down hard on you for doing it. Sometimes it’s just a matter of going, “Oh, okay, Kimberley, I see that I’m doing black-and-white thinking.” And that might be all that we do. 

Often, with my patients, I will have them log this for homework because, in CBT, we do a lot of homework. And so I will say, “I want you to write it down and come back to me next week because next week, we’re going to work on the next tool.” 

Now this may be a little different depending on the condition, and I want to make sure I’m really thorough here. If you have GAD (generalized anxiety disorder) or panic, we do a lot of cognitive restructuring. We do a lot of cognitive restructuring about how you cope with your discomfort. And in some cases, we might even restructure the content of your thought. 

However, if you have OCD, it’s a little tiny bit different. We would still correct your thoughts about your ability to tolerate discomfort or your thoughts about yourself. But we want to be careful because sometimes when we start looking too close at the thought and trying to make sense of it and trying to correct it too much, we can actually start to be doing a little nuanced, subtle compulsion where we’re getting reassurance, we’re confessing, we are reinforcing the whole importance of this by going over it and correcting it, correcting it and correcting it. So just keep an eye out for that. If you’re in therapy, bring it up with your therapist just to make sure that you’re not using this skill today in a way that could become compulsive. Sometimes it does, sometimes it doesn’t, depends on the person. 

 For eating disorders, I know as my recovery from eating disorder, I did a lot of this, really examining, is my body all good or all bad? Is there such a thing as a perfect body or a failed body? This food or this body size, how do we determine its goodness or its badness? And looking at how extreme it can be. 

Now, another really important piece here is with depression. In depression, we use a lot of black-and-white thinking. “I’m all that. They’re all good. I’m a failure. I’ll never get better. It’ll never get better. Things will never look up. It’ll always be this way.” Depression loves to use black-and-white thinking. 

And so when we talk about cognitive restructuring, what we’re not talking about is just making it all positive. So here are a couple of examples. If you have depression, and for those of you, if you have depression and you don’t have access to a therapist, we have a whole online course called Overcoming Depression, where we go through this in depth of the common errors, not just black and white thinking, but the common errors in depression. And we work at coming up with helpful ways to respond. But one of the tools and skills that we use is, we don’t want to just come up with positive thoughts. It’s going to feel crappy to you. It’s going to feel fake. It’s not going to land. But what we want to do is find corrections or rebuttals to that thought that are more evidence-based, more rational, more logical, more helpful—things that might feel truer to you, even if it’s still somewhat distorted. It’s better than thinking in these absolutes because, like I said before, if you’re thinking in absolutes, you can guarantee you’re going to feel crummy. 

Another example is with GAD (generalized anxiety disorder) or with panic disorder. A lot of it is catching our appraisal of sensations and feelings in our body. Now, again, we actually have a whole course on this as well called Overcoming Anxiety and Panic. Again, we go through a whole module of cognitive restructuring where we identify the specific thoughts that people with generalized anxiety and panic have. And it will be looking for where you make these black-and-white, all-or-nothing statements that “It would be bad if that happened. I will always again feel this way. I’ll never amount to anything. This panic attack will never end. I’m not handling it well. I’m handling it all bad,” or that “This sensation is impossible, and I can’t tolerate it.” So we go through it and really look at what are the things that you’re worrying about, and how are you really bringing in black and white thinking? 

There are other distortions. In fact, there are 10 other distortions which we’re not covering today. Those are all in those courses as well. But again, for today, I wanted to really double down on this one. This one is particularly pesky and problematic. 

The other thing to remember as we’re looking at black-and-white thinking is to remember that usually, 99.999 % of the time, things happen in the middle, in the gray. I often will hear me say to clients, “Can you be a little more gray about that?” Not to say a little more dark and depressive. I’m saying gray in that, “Is there somewhere in the middle that is more true and factual? Is it all good or all bad or is it a little of both? Or is it none of either? Where in the middle does it land? Oh, you’re having the thought that you’re either successful or a failure? Where is everybody else in this continuum?” Most likely, they’re in the gray. Can you learn to be more comfortable accepting the gray of the world and not going to these absolute black-and-whites? 

The beauty is in the gray. We know this. The beauty is being kind to yourself in the gray, which brings me to the last point here, which is to practice self-compassion. We are in the gray. This podcast episode in and of itself is neither all bad nor all good. It’s going to be a variation, and a lot of that’s going to be dependent on people’s opinion, where they are, what they’re thinking, their mood, that things are really black and white. And can we be gentle with ourselves and humble enough to allow ourselves to see that this is neither good, bad, success, failure, always, never? These skills and the awareness of when we’re thinking this way can reduce a significant amount of our suffering, especially when you catch them, label them, and redirect in a kind, compassionate way. 

One thing I don’t want you to do is identify how you’re thinking in this black-and-white way and respond to that with black-and-white thinking by saying, “You’ll always think this way. You’ll never ever stop doing this.” Ironic, but we do it all the time. Almost always, when people criticize themselves, they’re using one of the two areas in thinking black and white thinking and labeling, which is like name calling. And again, we want to identify these areas in thinking. 

Again, if you want to go back and take a look at those courses, we go through this immensely in depth because there’s such an important part of Overcoming Anxiety and Panic and Overcoming Depression. And again, that’s the names of the courses. You can head over and look into that in the show notes, or go to CBTSchool.com. We have all of our courses listed there. 

All right, folks, that’s it. Please fix this error in thinking if you want to be less anxious. Black-and-white thinking will create so much suffering in your life. And my hope is that these episodes and the work we do here at Your Anxiety Toolkit make you suffer a little bit less each week. 

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

Obsessive-Compulsive Disorder (OCD) is a challenging condition, but the good news is that it's highly treatable. The key to effective management and recovery lies in understanding the condition, embracing the right treatment approaches, and adopting a supportive mindset. This article distills essential guidance and expert insights, aiming to empower those affected by OCD with knowledge and strategies for their treatment journey.

• YOU ARE BRAVE FOR STARTING OCD TREATMENT

Taking the first step towards seeking help for OCD is a significant and brave decision. Acknowledging the courage it takes to confront one’s fears and commit to treatment is crucial. Remember, showing up for therapy or seeking help is a commendable act of bravery.

• YOU CAN GET BETTER WITH OCD TREATMENT

OCD treatment, particularly through methods like Exposure and Response Prevention (ERP) and Cognitive Behavioral Therapy (CBT), has shown considerable success. These evidence-based approaches are supported by extensive research, indicating significant potential for individuals to reclaim their lives from OCD’s grasp. The path may not lead to a complete eradication of symptoms, but substantial improvement and regained control over one’s life are highly achievable.

• OCD TREATMENT IS NOT TALK THERAPY

OCD therapy extends beyond the realms of conventional talk therapy, involving specific exercises, homework, and practical worksheets designed to confront and manage OCD symptoms directly. These tools are integral to the treatment process, allowing individuals to actively engage with their treatment both within and outside therapy sessions.

• THERE IS NO SUCH THING AS “BAD” THOUGHTS

A pivotal aspect of OCD treatment involves changing how individuals perceive their thoughts and their control over them. It's essential to recognize that thoughts, regardless of their nature, do not define a person. Attempting to control or suppress thoughts often exacerbates them, which is why therapy focuses on techniques that allow individuals to accept their thoughts without judgment and reduce their impact.

• YOU CAN NOT CONTROL YOUR THOUGHTS, BUT YOU CAN CONTROL YOUR BEHAVIORS

You will have intrusive thoughts and feelings. This is a part of being human, and it is not in your control. However, you can learn to pivot and change your reactions to these intrusive thoughts, feelings, sensations, urges, and images. 

• YOU HAVE MANY OCD TREATMENT OPTIONS

While medication can be a valuable part of OCD treatment, particularly when combined with therapy, it's not mandatory. Decisions regarding medication should be made based on personal circumstances, preferences, and professional advice, acknowledging that progress is still possible without it.

In addition to ERP and CBT, other therapies such as Acceptance and Commitment Therapy (ACT), mindfulness, and self-compassion practices have emerged as beneficial complements to OCD treatment. These approaches can offer additional strategies to cope with symptoms and improve overall well-being.

The accessibility of OCD treatment has expanded significantly with the advent of online therapy and self-led courses. These digital resources provide valuable support, particularly for those unable to access traditional therapy, enabling individuals to engage with treatment tools and strategies remotely.

For those without access to a therapist, self-led OCD courses and resources can offer guidance and structure. Engaging with these materials can empower individuals to take active steps towards managing their OCD, underscoring the importance of self-directed learning in the recovery process.

• TREATMENT WILL NEVER INVOLVE YOU DOING THINGS YOU DO NOT WANT TO DO

I am usually very clear with my patients. Here are some key points I share

• • I will never ask you to do something I do not want you to do
  • I will never ask you to do something that I myself would not do 
  • I will never ask you to do something that goes against your values.

• RECOVERY IS NOT LINEAR

Recovery from OCD is not a linear process; it involves ups and downs, successes and setbacks. Embracing discomfort and challenges as part of the journey is essential. Adopting a mindset that views discomfort as an opportunity for growth can greatly enhance one’s resilience and progress in treatment.

There will be good days and hard days. This is normal for OCD recovery.  There will be days when you feel like you are making no progress, but you are. Keep going at it and be as gentle as you can

• SETTING CLEAR TREATMENT GOALS

Clarifying treatment goals is crucial for a focused and effective therapy experience. Whether it's reducing compulsions, living according to one’s values, or tackling specific fears, clear goals provide direction and motivation throughout the treatment process.

• BE HONEST WITH YOUR THERAPIST

The success of OCD treatment is significantly influenced by the honesty and openness of the individual undergoing therapy. Without reservation, sharing one’s thoughts, fears, and experiences allows for more tailored and effective therapeutic interventions.

• IT IS A BEAUTIFUL DAY TO DO HARD THINGS. 

No question. You can do hard things! 

OCD is a complex but treatable condition. By understanding the essentials of effective treatment, including the importance of evidence-based therapies, the role of mindset, and the value of self-directed learning, individuals can embark on a journey towards recovery with confidence. Remember, every step taken towards confronting OCD is a step towards reclaiming control over one’s life and living according to one's values and aspirations.

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TRANSCRIPT

There is so much bad advice out there about OCD treatment. So today, I wanted to share with you the 11 things I specifically tell my patients on their first day of OCD therapy. 

Hello, my name is Kimberley Quinlan. I’m an OCD specialist. I specialize in cognitive behavioral therapy, and I have helped hundreds of people with OCD over the course of the 10, 15 years I have been in practice. 

Now, whether you have an OCD therapist or not, my goal is to help you feel confident and feel prepared when addressing your OCD treatment and symptoms, whether you have an OCD therapist or not. That is the big goal here at CBTSchool.com and Your Anxiety Toolkit podcast. 

Make sure you stick around until the end because I will also be sharing specific things that you can remember if you don’t have a therapist, because I know a lot of you don’t. And I’ll be sharing what you need to know so that you don’t feel like you’re doing it alone. 

Now, if you’re watching this here on YouTube, or you follow me on social media at Your Anxiety Toolkit, let me know if there’s anything I’ve missed or anything that you were told on your first session that was particularly helpful, because I’m sure your knowledge can help someone else or another person with OCD who is in need of support and care and advice. So let’s go.

Here are the 11 things that I tell my patients on their first day of OCD therapy. Number one, I congratulate them for showing up, because showing up for OCD treatment is probably one of the most brave things you can do. I really make sure I validate them that this is scary, and I’m really glad they’re here. And I’m pretty impressed with the fact that they showed up, even though it’s scary. 

The second thing I tell them is that OCD treatment is successful. You can come a long way and make massive changes in your life by going through the steps of OCD treatment, showing up, being willing to take a look at what’s going on in your life, and making appropriate changes so that you can get your life back, do things you want to do, spend more time with your family, your friends, the things you love to do, like hobbies, and that OCD treatment can be very effective. We’re very lucky that OCD is a very treatable condition. It doesn’t mean it’ll go away completely, but you can have absolute success in getting your life back. 

Now, one thing to know here is, how do we know this? Well, OCD treatment research and OCD treatment articles. If you go onto Google Scholar, you will find a lot of articles that show a meta-analysis of the OCD treatments available, where it shows that ERP and cognitive behavioral therapy are the gold standard of treatment. And using a meta-analysis, that basically means that they’ve surveyed all of the large, well-done research articles and found which one shows the most results and shows that they have the most repeated results over periods of time. And that’s why it is so important that you do follow the research because there is a lot of bad information out there, absolutely. 

Now, the third thing I tell my patients on their first day of therapy is that OCD treatment is not talk therapy. It’s not just talking, that it requires OCD therapy exercises and homework and lots of worksheets. I have a packet that we give our patients at the center that I own in Calabasas, California. Everyone gets a welcome manual. And in the welcome manual, it’s got worksheets on identifying obsessions and compulsions. It’s got mindfulness worksheets. It’s got logging worksheets. And I will send you home with those to do for homework. You’ll come back. Let me know what worked, what didn’t work, what was helpful, what wasn’t. And you will be doing a lot of this work on your own. 

Now, again, as I mentioned at the beginning, if you do not have access to OCD therapy or you don’t have the resources to get that, we have an online course called ERP School. It is a course specifically for people with OCD, where I walk you through the specific steps that I take my patients through. And all of those worksheets are there. They have worksheets on identifying your obsessions, identifying your compulsions, mindfulness, self-compassion worksheets, things that can remind you and prompt you in the direction of setting up a plan so that you can get moving and make the steps on your own.

The fourth thing that you need to know on the first day of your therapy is that there is no such thing as bad thoughts. Let’s just sit with that for a second. There is no such thing as bad thoughts. Your thoughts do not define you, nor do your behaviors, that you might have these thoughts that you think are going to really freak you out. You might have this idea, these thoughts, these intrusive, repetitive, scary thoughts, and you might think, “Well, I can’t even tell Kimberley about them yet.”

I will often tell my patients like there is nothing these walls haven’t heard, and you probably won’t shock me because I haven’t been shocked in many, many, many years working as an OCD therapist. I’ve heard it all. I’ve heard the most, what people perceive as the grossest thoughts. It’s a normal part of the work that we do. And your thoughts are neither good nor bad and they do not define you. And I really make that point made because, as we move forward, I want you to know that I’ve seen a lot of cases and that “your thoughts aren’t special” in that they’re not something that I would be alarmed by. 

The fifth thing that I would tell my patients is that you cannot control your thoughts. And I bet you believe it because you’ve probably tried over and over again, and all you found is the more you try and control it, the more thoughts you have. The more you try to suppress your thoughts, the more thoughts you have.

There are, as we’ve already discussed, OCD treatment options that will really solidify this concept. Now, the most important one is exposure and response prevention, which is the type of treatment that we use for OCD and is the type of treatment that all of those research articles I discussed before show and direct to as a really successful treatment for OCD. 

Now, in addition, there are other OCD treatment options. One of those treatment options is OCD treatment with medication. Now, again, when you do that meta-analysis, we have found that a combination of CBT and ERP with medication is the most successful. Now, that doesn’t mean you have to take medication, though. I’m never going to tell my patients that they have to take medication. 

So we can have OCD treatment with medication. We can have OCD treatment without medication. In fact, some of my most difficult cases, the clients, for medical reasons or for personal values reasons, chose not to go on medication. You can still get better. It might make it a little more difficult. You may want to speak with your therapist, or if you’re doing this alone, you might need to put in a little extra homework, have a team of support, and people who are really there holding you accountable. Absolutely. But medication is another treatment option that you may want to consider as you move through this process.

Now there are also new treatments for OCD recovery. They might include acceptance and commitment therapy, mindfulness practices, self-compassion. We even have some research around dialectical behavioral therapy as other OCD treatment interventions. I will be implementing those as we go, depending on what roadblocks show up. And again, if you’re doing this on your own, there are amazing resources that can also help you, and I’ll share about those here in a bit.

Again, as we’ve talked about, there is also OCD treatment online. Since COVID-19, we’ve done a lot of growing in terms of being able to utilize CBT via the internet, via our computers, via our smartphones. A lot of people come to us because they’ve looked for OCD treatment in Los Angeles, which is where we are. And even though they only live a few miles down the street, they’re still doing sessions online because it’s so convenient. They can do it at home between sessions with their work or between getting their kids to school. So, OCD treatment online has become a very popular way to also access treatment. And I give these to my clients as we go, because sometimes they’re going to need a little extra help. 

Now, as I’ve mentioned to you earlier in there, if you don’t have access to OCD treatment, there are tons of self-led OCD courses. Again, one of the ones that we offer is ERP School. Now you can go to CBTSchool.com, or you can click the link below in the show notes, where we have all of these courses for OCD and other anxiety disorders. But there are others as well—other amazing therapists who have created similar products. 

When we’re really looking at treatment depending on your age, the treatment does look very similar for OCD treatment for adults and OCD treatment for children. They are very, very similar. With children, we might play more games, have more rewards, use those strategies, but to be honest with you, adults are just big kids in adult bodies. So I really believe that we want to make this as fun as we can. Have rewards. Have there be something that you’re working towards. Make it fun. Make it a part of a game. I use a lot of games in treatment and a lot of ERP games because why do we want to make everything boring all the time? Why not make it a little bit fun if we can?

Number seven, the main thing I’m going to tell you here, and this is really, really important, is I will not ask you to do something that you don’t want to do. I have this in our welcome manual. We don’t ask people to do things that go against their values, and we don’t ask people to do things that I myself would not do. There are a lot of TV shows that sort of use ERP and exposure work as sort of like doing your worst, worst, worst, worst, worst case. And that’s fine. But often we’re not doing that. We’re doing exposures, we’re facing your fears so that you can get back to functioning, so you can get back to doing the things you want to do.

So again, I’m not going to have you do anything you don’t want to do. You’re in charge. If you’re taking ERP School, we do the same thing. You create your own plan. You create a hierarchy of what you want to start with, and we work our way up. And we do the same thing in therapy as well. 

Now the eighth thing that I will tell you, and by then you’re probably getting a little tired and overwhelmed. We might take a little tea break really quick, but I would tell you that recovery is not linear. While we do have effective treatment for OCD, it will be an up-and-down process. You’ll have really good days, and you’ll have some hard days. And those hard days don’t mean that you’re doing anything wrong. It doesn’t mean that your treatment’s not successful. It just means we have to take a look here and see what’s going well, what’s not going well, what do we need to tweak, do we need to make a pivot here. Or do we need to reassess something and maybe apply some additional tools—mindfulness tools again, self-compassion skills, some distress tolerance skills, maybe? But just remember, your recovery will not be linear, and that is okay. 

Now the ninth thing I’m going to tell you is that your OCD treatment goals must be clear. You are going to get really clear on why you’re here, what you want to do, why you’re doing this treatment because it is hard work. Again, there’s homework. I’m going to be giving you some things to do at home, and they’re going to be a little bit difficult. They’re going to cause you to feel some feelings that maybe you don’t want to feel, some sensations you don’t want to feel. 

And so, really again, I will ask them, like, what are your goals for treatment? Now, some common OCD goals for OCD therapy is to reduce compulsions. “I want to be able to not be doing these compulsions for hours and hours.” Other people say, “I want to live my life according to my values. I don’t want to let fear constantly be telling me what to do.” Other people will say, “I want to learn how to tolerate this discomfort and this uncertainty because every time I try and run away from it, it just gets worse. It makes it worse. And now I’m stuck in this cycle.” So it’s important that you get really clear. 

Sometimes people will come in and they’ll say, “I’ve never been to Paris. I want to be able to go to Paris with my family. And so, that’s the goal.” That’s fine too. You could have a large goal like that, or you could have a really simple goal like, “I just want to have more space in my life to paint,” or “I don’t want to feel like I’m on edge all the time, like the scariest thing is going to happen all the time.” And that’s fine too. 

Now, the 10th thing that you’re going to need to know and need to remember is, our recovery is really dependent on how open and honest you are. As I said at the beginning, some people don’t feel yet like they can trust to tell me the depth of their intrusive thoughts, and that’s okay. But throughout therapy, I’m going to need you to be really honest with me and really honest with yourself, because if you’re not disclosing what’s going on and the thoughts you’re having, we can’t actually apply the skills to it. And then it puts a wrench in the success of your treatment. 

So we want you to be as open, honest as you can. And I often will say to them, there is nothing I haven’t heard. In fact, if you have taken ERP School already—a lot of you have—we actually play a couple of games where we play a game called One Up, which is where no matter what thought you have, you make it a little worse or little more scary. And I give some demonstrations and show like I’m not afraid to go there. I will go to the scary, yucky place just to show you that that’s what I want you to do as well. Again, it doesn’t have to be all serious. We’re allowed to play games, and we do that in therapy as well. 

Often people will ask like, how do I tell my therapist about these horrible thoughts I’m having? Like, how do I share? If you’re having a specific type of thought that you feel is particularly taboo or very scary to share, or you’re afraid of the consequences of sharing, what I would encourage you to do is do a very quick Google search. There are some amazing websites and articles online of your obsession. Print it out and bring it to your therapist, and say, “Hey, this is what I’m dealing with. I’m too scared or I’m too vulnerable to share. It’s so horrendous in my mind, but this is what I’m going through.” And chances are, again, the therapist, if they’re a trained OCD specialist, will go, “Ah, thank you for letting me know. I’ve treated that before. I’m good to go.” Again, if they’re a newer therapist, it’s still okay because they’re getting the education about really common obsessions that happen a lot in our practice. 

Okay. Here we go—drum roll to the last one. And I know you guys are probably already guessing what it is. It’s something I say to my patients and to you guys all the time, and it’s this: It’s a beautiful day to do hard things. 

We have been taught that life should be easy, shouldn’t be scary, shouldn’t be hard, and that you should be Instagram-ready all the time. But the truth is, life is hard. And today is a beautiful day to do those hard things. I have found that those who recover the fastest and the most successful over time are the ones who see discomfort as a challenge, something that they’re willing to have. They’ll say, “Bring it on, let’s go. Bring my shoulders back. I know it’s going to be here.” And they’re really gentle with themselves when they have this discomfort. And I want you to really walk away feeling empowered that you too can handle some pretty uncomfortable things because you already are. So again, it’s a beautiful day to do hard things. 

All right, let’s round it out because I know I promised you some extra things here. Now, what have we covered? We’ve covered the mindset shifts that you need for OCD therapy, behavioral changes that you’re going to need to make. We’ve talked about complementary tools, the most important being self-compassion. And also, guys, you can also follow Your Anxiety Toolkit because we have over 380 episodes of tools and core concepts, and everything like that. 

Now, for treatment, just so that you get an idea of what this would look like, I share with my patients what treatment looks like. So usually, once I’ve told them all of this, I send them home with their welcome manual, and I’ll say, “The next two to three sessions, I’m going to be training you for this treatment. And a lot of that is going to involve psychoeducation, me giving you tools, giving you strategies, putting a plan together.” And again, for those of you who don’t have therapy, we do exactly that in ERP School. So if you feel like you need some structure, you can go to CBTSchool.com and access ERP School. We can go through that. 

Now, for those of you, again, who don’t have an OCD therapist, does OCD therapy and treatment work for you too? Yes. We actually have some early research to show that self-led programs can be very successful for people with OCD and with other anxiety disorders. So, if you don’t have access to therapy, you could take ERP School. You could buy some workbooks that you buy from Amazon or your local bookstore. There are a ton of workbooks out there. Shameless plug, I also wrote one called The Self-Compassion Workbook for OCD. You can get it wherever you buy books. There are also online groups. I’m a huge, huge proponent of online groups. So if there are support groups in your area, by all means, use those because just knowing other people who are struggling, what you’re struggling with can be so validating and inspiring because you’re seeing them do the hard thing as well. 

But either way, treatment requires a lot of homework. So, as I say to patients, showing up here once a week isn’t going to get you better. You’re going to have to practice the skills. And if you don’t have a therapist, you’re going to be doing that anyway. So I want to really hope that you leave here with a sense of inspiration and hope that you can get better even if you don’t have OCD therapy at this time.

So there you go, guys. There are the 11 things I tell my patients on the very first session. I will usually end the session by encouraging them and, again, congratulating them for coming in and doing this work with me. Let them know I’m so excited for them. 

I hope that this was helpful for you, and my hope is that you too will then go on to learn all the tools that you need in your tool belt and go on to live the life that you want to live because that’s the whole mission here at Your Anxiety Toolkit. 

Have a wonderful day, everybody, and I’ll talk to you next week.

In the realm of managing anxiety and panic attacks, we often find ourselves inundated with advice on what to do. However, the path to understanding and controlling these overwhelming experiences also involves recognizing what not to do. Today, we shed light on this aspect, offering invaluable insights for those grappling with panic attacks. 

Stop doing these things if you are having panic attacks, and do not forget to be kind to yourself every step of the way. 

1. DON'T TREAT PANIC ATTACKS AS DANGER

It's a common reaction to perceive the intense symptoms of a panic attack—rapid heartbeat, dizziness, or a surge of fear—as signals of immediate danger. However, it's crucial to remind ourselves that while these sensations are incredibly uncomfortable, they are not inherently dangerous. Viewing them as mere sensations or thoughts rather than threats can create a helpful distance, allowing for more effective response strategies.

2. DON'T FLEE THE SCENE

The urge to escape a situation where you're experiencing a panic attack is strong. Whether you're in a grocery store, on an airplane, or in a social setting, the instinct to run away can be overwhelming. However, leaving can reinforce the idea that relief only comes from escaping, which isn't a helpful long-term strategy. Staying put, albeit challenging, helps break this association and builds resilience.

3. DON'T ACCELERATE YOUR ACTIONS

During a panic attack, there might be a tendency to speed up your actions or become hyper-vigilant in an attempt to alleviate the discomfort quickly. This response, however, can signal to your brain that there is a danger, perpetuating the cycle of panic. Slowing down your breath and movements can alter your brain's interpretation of the situation, helping to calm the storm of panic.

4. AVOID RELIANCE ON SUBSTANCES

Turning to alcohol or recreational drugs as a quick fix to dampen the intensity of a panic attack can be tempting. Nonetheless, this can lead to a dependency that ultimately exacerbates the problem. It's important to let panic's intensity ebb and flow naturally, without leaning on substances that offer only a temporary and potentially harmful reprieve.

5. STOP BEATING YOURSELF UP

Self-criticism and judgment can add fuel to the fire of anxiety and panic. It's vital to adopt a compassionate stance towards yourself, recognizing that experiencing panic attacks doesn't reflect personal failure or weakness. Embracing self-kindness can significantly mitigate the added stress of self-judgment, creating a more supportive environment for recovery.

SEEKING SUPPORT

Remember, you're not alone in this struggle. Whether through therapy, online courses, or community support, reaching out for help is a sign of strength. Resources like "Your Anxiety Toolkit" are there to remind you that it's possible to lead a fulfilling life, despite the challenges panic attacks may present.

Lastly, embrace the notion that it's a beautiful day to do hard things. Facing panic with acceptance rather than resistance diminishes its hold over you, opening the door to healing and growth.

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TRANSCRIPT: 

Stop doing these things if you have panic attacks. I often, here on Your Anxiety Toolkit, talk about all the things you need to do—you need to do more of, you need to practice skills that you can get better at. But today, we’re talking about the things you shouldn’t do if you are someone who experiences panic attacks, panic disorder, or any other disorder that you also experience panic attacks in. Let’s get to it. Let’s talk about the things not to deal.

Welcome back. Stop doing these things if you have panic attacks. When I say that, in no way do I mean that the things we’re going to discuss you should beat yourself up for. If you’re doing any of the things that we talk about today, please be gentle. It is a normal human reaction to do these things. I don’t want you to beat yourself up. Please feel absolutely zero judgment from me because even I am someone who needs to keep an eye out for this, keep myself on check with these things when I am experiencing panic attacks as well. Let’s go through them. 

The number one thing to stop doing if you’re having a panic attack is to stop treating them like they are dangerous. If you experience symptoms of panic or you experience panic disorder, you know that feeling. You feel like you’re going to die. You feel like your heart is going to explode or implode, or your brain will explode or implode. You’ll know that feeling of adrenaline and cortisol rushing around your body. You get it; I get it. It feels so scary. But we must remind ourselves that it’s not dangerous, and we can’t treat them like they’re dangerous. We can’t respond to these symptoms as if they’re dangerous. We want to instead treat them like they are, which is sensations in the body or thoughts that appear in your brain. Once we can do that, then we have a little bit of distance from them and we can respond effectively. 

Now, the second thing I want you to stop doing if you have panic attacks is to never leave. If you are at the grocery store and you’re having a panic attack, do not leave the grocery store. If you’re on an airplane, boarding an airplane, and you’re having a panic attack, do not leave the airplane. If you’re in a room and you’re experiencing panic, don’t leave. 

Now, I know in that moment, it can feel so dangerous, as we just discussed, and so scary, but when we leave, we will associate relief with running away, and we actually don’t want that. Instead, with panic, we want the relief to be that we wrote it out and we were able to tolerate that feeling and navigate that feeling effectively and compassionately and not from the place of running away and escaping. If you can do one thing, the most important thing to do is to not leave where you’re at. 

Now, does that mean that you can’t take a minute to step away for a second? That’s fine. Does it mean that you can’t, if you’re in a conversation, just say, “Can I have a few minutes? I just need to run to the restroom,” or whatever it be, take some time to get yourself back together? That’s okay. We’re not here to win any races or anything, but do your best not to leave the actual environment or place that you are having the panic attack. 

Now, the third thing you can not do if you’re having a panic attack is don’t speed up your actions. We talk a lot about this in our online course called Overcoming Anxiety and Panic. How you respond to a panic attack can really determine how your brain interprets the event. If you’re having a panic attack and you really speed up and you start to act frantic or in an urgent way, and you’re sort of like hypervigilant looking around or trying to urgently frantically change something, your brain will interpret that high-paced activity or that speeding up of your actions as if it is a danger, and it will keep sending out hormones like cortisol and adrenaline, which will keep the panic attack and the anxiety going.

What we want to do instead is slow it down, slow your breath down, slow your actions down, really get in tune. If you can just slow it down a little and change how you respond. And what we want to do here—and we do this in Overcoming Anxiety and Panic, if you’re interested in taking this course and you don’t have access to therapy or you’re wanting a step-by-step way of working through generalized anxiety and panic, go ahead and take a look. It’s at CBTSchool.com. You can go and check it out there, but if not, you can also do this with your clinician or by yourself—is do an inventory of how you respond when you are panicking. What safety behaviors do you engage in to try and get it to go away? What do you do to respond to it as if it is dangerous? Do you leave? Do you speed up? Do you become hypervigilant? Do you seek reassurance? Do you do mental compulsions? 

We can go through and do an audit of those behaviors and see what you’re doing to sort of control and manage that anxiety. And we want to really work hard at reducing those behaviors. Do an inventory and get very clear so that next time you are having a panic attack, you can instead change those behaviors or replace them with more effective behaviors. If you’re interested again in that course, you can go to CBTSchool.com/overcominganxiety. 

Now, the fourth thing you need to stop doing if you have panic is to not rely on substances. And when I say substances, I mean alcohol or recreational drugs. There is a massive overlap between people with panic attacks and panic disorder and substance use, and I get it. Having a quick drink of alcohol can sometimes take the edge off a panic attack. However, once again, if that is your way of coping, you will build a reliance and a dependence on that behavior. And we want to work instead at allowing that discomfort to rise and fall on its own without intervening with ineffective behavior. And recreational substances are a really big no-no if you’re someone who is experiencing a panic attack. 

Now, that is different from prescribed medications. If you have been prescribed a psychiatric medication and you’re following the doctor’s orders, that is a different story. And please do go and speak to your doctor about those specific directions. What I’m speaking about right here is substances like recreational drugs or alcohol to help manage that panic attack. 

Now, the last thing you need to stop doing if you have panic disorder or panic attacks is you have to stop beating yourself up. Beating yourself up will only make it worse. In fact, we have research to show that the more you criticize yourself, beat yourself up, judge yourself, the more likely you are for your brain to release more anxiety hormones and increase the experience of anxiety and panic. And so, that goes against everything that we want and need. We don’t need to add more anxiety to the mix if you’re already experiencing a panic attack. 

And so, what we want to do here is work at not beating yourself up, not criticizing yourself for having this because it’s not your fault. It doesn’t mean there’s anything wrong with you. It’s a normal human reaction to want to run away and do everything you can to make it go away, including drinking substances and doing recreational drugs. We don’t want to beat ourselves up, whether you’ve done those in the past or if you’re currently doing them.

If you’re struggling, reach out for help. There are clinicians around the world who can help. We have, again, online courses, if you haven’t got access or you can’t afford those services. There are books, there are podcasts like this one that are free. Do what you can to get support and get help so that you’re not doing this alone. 

You aren’t alone. Thousands and millions of people around the world struggle with panic attacks. Again, they do not mean that there’s anything wrong with you. And there are important, very effective skills you can use to manage them, and go on and live a very, very, very, very wonderful, successful, fulfilling life. 

Of course, I’m always going to end with this because I always do, but do also remind yourself it is a beautiful day to do hard things. The more you can willingly have panic and allow it to rise and fall on its own, the less power it has over you. So, do remember today is a beautiful day to do hard things. 

Thank you so much for being here with me. I look forward to seeing you next week on Your Anxiety Toolkit, and I’ll see you there.

Anxiety can often feel like a relentless storm, clouding your thoughts and overwhelming your sense of calm. It's during these turbulent times that finding the right words can be akin to discovering a lifeline amidst the chaos. 

To aid you in navigating these stormy waters, we've curated a list of 20 empowering phrases based on expert advice. These phrases are designed to validate your feelings, soothe your inner critic, fill you with encouragement, and help you respond proactively to anxiety. Here's how you can incorporate them into your life to foster resilience, kindness, and self-compassion.

VALIDATE THE DIFFICULTY

• "This is hard, and it's okay that it's hard for me." Acknowledge the challenge without judgment.
• "I'm doing the best I can in this moment." Remind yourself of your effort and resilience.
• "My feelings are valid and understandable." Affirm the legitimacy of your emotions.
• "I am human, and having a difficult day is okay." Normalize the ups and downs of human experience.
• "I give myself permission to feel this while being kind to myself." Embrace your feelings with compassion.

SOOTHE THE CRITICAL VOICE

• "This is not my fault." Release unwarranted guilt and blame.
• "It’s okay that I’m not perfect." Celebrate your humanity and imperfections.
• "It's okay to make mistakes." View errors as opportunities for growth.
• "My challenges do not define my worth." Separate your worth from your struggles.
• "May I be gentle with myself as I navigate this difficult season?" Practice self-compassion and kindness.

FILL YOURSELF WITH ENCOURAGEMENT

• "It's a beautiful day to do hard things." Empower yourself to face challenges.
• "I can tolerate this discomfort." Recognize your strength and resilience.
• "This anxiety or discomfort will not hurt me." Acknowledge your capacity to withstand anxiety.
• "Humans are innately resilient." Remind yourself of your inherent ability to overcome adversity.
• "I am more than my worst days." Focus on the breadth of your life’s narrative.

GET CLEAR ON YOUR RESPONSE TO ANXIETY

• "I REFUSE to lead a life based on fear." Commit to acting on your values.
• "I choose to speak to myself with understanding and patience." Cultivate a compassionate inner dialogue.
• "I have already chosen how I'm going to respond, and now I'm going to honor that decision." Preemptively decide on positive actions.
• "I will treat myself with the same kindness that I offer others." Extend your empathy inward.
• "I’m going to honor my journey and respect my own pace." Accept your unique path and timing.

BONUS PHRASE FOR CONTINUOUS SUPPORT

• "We are just going to take one step at a time." Focus on the present moment to manage overwhelm.

These phrases, thoughtfully designed to address different facets of anxiety, are tools at your disposal. Use them to navigate through moments of anxiety, to remind yourself of your strength, and to cultivate a kinder relationship with yourself. Remember, it's not about employing all of them at once but finding the ones that resonate most with you. Anxiety is a complex and deeply personal experience, and thus, your approach to managing it should be equally personalized. Let these phrases be your guide as you continue on your journey toward a more peaceful and empowered state of being.

TRANSCRIPTION: 

Here are 20 phrases to use when you are anxious. Now I get it, when you’re anxious, sometimes it’s so hard to concentrate. It’s so hard to know where you’re going, what you want to do, and it’s so easy just to focus on anxiety and get totally stuck in the tunnel vision of anxiety or feel completely overwhelmed by it. 

Today, I want to offer you 20 phrases that you can use when you’re feeling anxious or experiencing OCD. These are yours to try on and see if you like them. You don’t have to use all of them. They’re here for you to use as you wish, and hopefully, they’re incredibly helpful.

All right, my loves, let’s talk about the 20 phrases you can use when you’re feeling anxious. Now, I have prepared these in four different steps. You can actually go through and pick one or several of these and go through these, write them down, and have them in your pocket or in your wallet, or whatever you want, a sticky note on your fridge to use as you need. These are to help guide you towards a life where you lean into your fear. You treat yourself kindly. You encourage yourself. You champion the direction you want to go in. And my hope is that you can use these in many different scenarios, and they can help you get to the life that you want. Let’s go and do it. 

The first category is validate the difficulty. Most people, when they’re anxious, they get caught up in this wrestle of, “I shouldn’t have this. Why do I have it? It’s not fair,” and I totally get it. But what we want to do is first validate the difficulty. If you can say that, and you can do that by using one of these five phrases:

Number one, “This is hard, and it’s okay that it’s hard for me.” Again, let’s say it together. “This is hard, and it’s okay that it’s hard for me.”

The second phrase that I’m going to offer to you is, “I’m doing the best I can in this moment.” The truth is, you are doing the best you can with what you have and given the circumstances. I want you to remember that as best as you can as well. 

Number three, “My feelings are valid and understandable.” If anybody else was in this exact situation, they’d probably be thinking, feeling, and acting in the same way.

The fourth one is, “I am human, and having a difficult day is okay.” Not only is it okay, it’s normal. Humans have difficult days. This is a total normal part about being human. You might be having an immense amount of anxiety, but please do remember the millions of other human beings around the globe who are having a very similar experience to you. It doesn’t mean there’s anything wrong with you. 

And then the fifth way I want you to validate the difficulty is to say, “I give myself permission to feel this while being kind to myself.” Remember I said “while.” I give myself permission to feel this way while being still kind to myself. 

Let’s move on to the second category, which is soothing the critical voice. I know when we have anxiety, we can be really, really hard on ourselves. The phrase I want you to practice or trial is, number one, “This is not my fault.” And it’s not your fault. You did not ask for this. You can’t stop the fact that your brain sometimes gets hijacked and throws a bunch of anxiety or thoughts, or feelings towards your urges. It is not your fault. 

The second one is, “It’s okay that I’m not perfect.” Nobody is. We want to remember that this is our first time being a human and we’re not going to get it right the first time. It’s okay that you’re not perfect, nobody is. 

You might also want to try the phrase, “It’s okay to make mistakes.” That is how I learn and grow. Remember here of all the people who have succeeded in their recovery, or all the people who are succeeding in other areas of their life, they didn’t get there because of easy, breezy times. They got there by making mistakes, and they’d keep going and they keep trying, and they’d go again and they go again and they learn and they grow.

The next thing you may want to try on, and another phrase you can use is, “My challenges do not define my worth.” You’re not either better or worse for having this anxiety. You’re not less than or more than depending on whether you have a mental illness or not. Your worth is not something that’s up for discussion, and it’s not up for measurement. We all have equal worth. And this challenge that you’re experiencing or this anxiety you’re experiencing does not define your worth. 

Now, the last one I want you to practice here, you can actually practice more from a meditation or a meditation practice, which is a practice of loving kindness. We could call it a metta meditation or a loving-kindness meditation. And the goal from this is to actually meditate on sending yourself loving kindness. 

Now, if you’re someone who wants to learn how to do this, we have an entire meditation vault called the Meditation Vault, where I have created over 30 different meditations for people, specifically with anxiety, to help you practice meditation and learn how to practice loving kindness. You can go to CBTSchool.com to learn more about that. I would, again, need to spend a whole other episode talking to you about that. But if you want to practice the art of sending yourself loving kindness, you can go there to learn more. 

But for right now, to finish out this category, what we want to do is practice one of those meditations, which is to offer yourself the phrase, “May I be gentle with myself as I navigate this difficult season?” What we are doing here is we’re offering ourselves a promise per se of saying, “May I be gentle with myself?” In a true loving-kindness meditation, often what we do say is, “May I be happy? May I be well? May I live with ease?” And if you particularly like my voice and it feels very soothing to you, all of those meditations are there in the meditation vaul, and we go through that extensively. 

The next section is to fill yourself up with encouragement. Now, when we are anxious, it’s easy to feel very discouraged and just want to run away and change every part of our plans for the day. But what we want to do is we want to fill yourself up with encouragement. Here are some phrases that you can use to help with that goal. 

Number one, you know I’m always going to say this, “It’s a beautiful day to do hard things.” We can do hard things. We have to keep repeating this to ourselves. You may even want to add some sass to it and add a little swear word. A lot of my patients have said, “It’s a beautiful day to blank hard things.” Now that’s okay too. You can sass it up, whatever feels most empowering to you. 

Another way you can fill yourself up with encouragement is to offer yourself the phrase, “I can tolerate this discomfort,” because you can, and you have, and you will. “I can tolerate this discomfort.”

Another thing you can offer is, “This anxiety or this discomfort will not hurt me. I am stronger than I could ever know.” And the truth is, anxiety does not hurt you. It’s uncomfortable, and it’s painful. I understand that. But it won’t hurt you. It won’t damage you. It won’t destroy you, that we’re stronger than we could ever, ever believe we could be. 

The next thing you may offer to yourself, and this is one that I particularly love, is that humans are innately resilient. They do most of their growing through hard things. And I’ve already mentioned this to you before. Most of the really successful people got there, not because it was easy and breezy; it’s because we are resilient, and that’s how we grow, and that’s how we learn, that we can get through very, very difficult things.

And then the last thing is, “I am more than my worst days.” That this might be a difficult day, but I am more than this difficult day. There’s a bigger story here for me. This uncomfortable moment or this uncomfortable day is just a part of that story. But the bigger picture is that I am much more than these hard, difficult days. 

And then the last category, which you have to also include, is to get very clear on how you are going to respond. This is where we get a little more firm with ourselves in the phrases. You will hear, I get a little sassy myself in this, and we get a little more decisive or confident. Even if you don’t feel confident, we want to speak in this confident, assured way. 

Number one is, “I REFUSE,” and I’ve written refuse in capital letters. “I REFUSE.” And I say this to myself, I want you to say this to yourself. “I REFUSE to lead a life based on fear.” I will move forward, acting on my values and my beliefs, and who I want to be. That’s the first phrase. And we want to emphasize, “I refuse to act out on this fear.”

The second is, “I choose to speak to myself with understanding and patience.” I’m choosing that because it’s so easy to fall back into criticism and blame and humiliation and critical self-punishing words. I choose to speak to myself with understanding and patience. 

Now, the third one involves you being very proactive. Now, I’ll give you the phrase first, and then I’ll explain it to you. The phrase is, “I have already chosen how I’m going to respond, and now I’m going to honor that decision.” What I want you to do, if you are someone with anxiety, is to create a plan ahead of time—to have a plan on how you are going to respond to anxiety. 

Now, if this is difficult for you, we have two courses that I want you to rely on. Number one is Overcoming Anxiety and Panic, and the other one is ERP School. And that’s for people with OCD and health anxiety. If you’re someone who struggles with generalized anxiety or panic or OCD, you are going to need a plan ahead practice. You’re going to need to know what fear and obsessions and thoughts and fear and all the things get you to do normally. And then you’re going to have to be able to break that cycle with a specific plan on attack on how you’re going to handle that. And we go through those steps in those two courses or any of our courses. We break it down so that you have a specific plan on how you’re going to handle this, what you’re going to do, what you’re not going to do, how you’re going to treat yourself, and so forth. 

If you haven’t got a therapist and you want to learn how to do that, head over to CBTSchool.com. Those courses, there is low cost as we could make them, and they’re there for you to help you have a plan so that you can say to your anxiety when you’re struggling, “I’ve already chosen how I wish to respond, and now I’m going to honor that decision. “

Now, the reason that I say that phrase that way is when you have a plan up ahead head, that’s one part of it, but then you have to honor your plan. And what often happens is, when we have a plan and we don’t honor that plan, that’s often when we start to feel like we distrust ourselves. We feel like we’ve let ourselves down. 

And so what we want to do is we want to make a plan, and then we want to choose to honor that plan. And by honoring the plan that you set out -- and I’m not going to tell you what that plan should be. The cost isn’t going to tell you what you have to do. You get to decide that for yourself based on your own core values. But once you do that, and when you follow through by honoring that decision that you made ahead of time, that’s when you start to trust yourself. That’s when you start to really feel empowered. That’s when you start to break that cycle of anxiety because you’ve stood firm on the ground on what your plan was and how you’re going to show up.  

I’ll repeat it again. “I have already chosen how I want to respond, and now I’m going to honor that decision because I matter, and this is my life, and I want to follow through in the way I said I would.”

Now, the fourth one is, “I will treat myself with the same kindness that I offer others in this situation.” Again, we’re speaking firmly and kindly with conviction to ourselves. “I will treat myself with the same kindness that I would offer to others.” 

And then the last one is, “I’m going to honor my journey and respect my own pace.” This doesn’t have to be a straightforward, linear process. In fact, it won’t be. And we have to honor our own journey and our own pace, because sometimes it takes longer for us than it does for others. And that’s okay. We’re going to honor our journey. We’re going to respect our own pace. 

And I will offer you a bonus phrase, which is, “We are just going to take one step at a time.” Just focus on one step at a time. Because if you’re looking too far ahead, it will get overwhelming. You are handling a huge, huge discomfort. And so we want to be as gentle as we can. We want to honor our values. We want to lead with our values, not lead with fear. And my hope is one or many of these phrases will help you get there. I hope this has been helpful. 

Again, I want to remind you, some of these won’t land for you, and that’s entirely okay. Just practice and try the ones that you feel will be helpful, and leave the rest. This is your journey. You get to choose it. I just hope that some of these skills and tools that we talk about on Your Anxiety Toolkit are helpful. And I hope you have a wonderful, wonderful day.

THE RISING TIDE OF TEEN DEPRESSION: UNDERSTANDING AND ADDRESSING A MODERN CRISIS

In recent times, the specter of teen depression has loomed larger than ever before, casting a long shadow over the lives of young individuals across the globe. With reports indicating a significant upsurge in cases of depression among adolescents, the need to unravel the complexity of this issue and explore effective strategies for intervention has never been more urgent.

At the heart of the matter is the alarming statistic that suicide rates among teenagers aged 15 to 19 have surged by 76% since 2007, with a particularly distressing increase observed in teen girls. The rates of suicide have doubled among female teens compared to their male counterparts, underscoring a gendered dimension to the crisis. Moreover, the youngest demographic, children between the ages of 10 and 14, has witnessed the highest rate of increase in suicide across all age groups, a fact that underscores the severity and early onset of mental health challenges in today's youth.

This escalation in teen depression and suicidal ideation can be attributed to a myriad of factors, ranging from societal pressures and the rapid pace of cultural shifts to the unique challenges posed by the digital age. The omnipresence of social media and technology, while offering new avenues for connection, has paradoxically fostered a sense of isolation and disconnection among adolescents. The digital landscape, with its relentless comparison and instant feedback loops, has exacerbated feelings of inadequacy, anxiety, and despair among young people.

Furthermore, the impact of depression is not confined to any single demographic. Contrary to previous beliefs that African-American families were less likely to experience suicidal ideation, recent research has unveiled an elevated risk among African-American boys aged five to 11. This revelation challenges preconceived notions about the protective factors supposedly inherent in certain communities and underscores the indiscriminate nature of mental health challenges.

The narrative surrounding teen depression and despair is further complicated by the conflation of despair with clinical depression. While depression is a diagnosable condition characterized by a specific set of symptoms persisting over time, despair can embody similar feelings of hopelessness and sadness without necessarily meeting the criteria for a clinical diagnosis. This distinction is crucial for understanding the breadth and depth of the emotional turmoil experienced by adolescents, which may not always fit neatly into diagnostic categories.

Addressing this burgeoning crisis requires a multifaceted approach, centered around the power of connection and the cultivation of resilience. Building resilience in young people involves fostering internal coping mechanisms as well as providing robust external support systems. Parents, educators, and mental health professionals play a pivotal role in modeling healthy coping strategies and offering unwavering support to adolescents navigating the tumultuous waters of mental health challenges.

One of the key strategies for combatting teen depression involves nurturing meaningful connections between young people and their caregivers. The act of showing up for adolescents in both significant moments and the mundane details of daily life can have a profound impact on their sense of belonging and self-worth. Consistency in presence and support, coupled with genuine engagement in activities that resonate with the interests of young people, can fortify their emotional resilience and counteract feelings of isolation and despair.

In the digital realm, it is imperative to strike a balance between leveraging technology for connectivity and mitigating its potential negative impacts on mental health. Encouraging responsible and mindful use of social media, fostering face-to-face interactions, and emphasizing the importance of digital detoxes can help alleviate the pressure and anxiety associated with online environments.

As society grapples with the escalating crisis of teen depression, it becomes increasingly clear that a collective effort is required to address the underlying causes and provide a supportive framework for adolescents. By prioritizing mental health education, advocating for comprehensive support services, and fostering an environment of openness and understanding, we can begin to turn the tide against teen depression. In doing so, we not only alleviate the immediate suffering of young individuals but also lay the groundwork for a healthier, more resilient generation.

TRANSCRIPTION

Kimberley: Welcome, everybody. I am so delighted to have our guest on today, Dr. Chinwé Williams. Welcome, Dr. Chinwé Williams. I’m so happy to have you here.

Chinwé: Oh, I’m so excited to be here. Thanks so much for having me.

Kimberley: As I said to you, several months ago, I was having a massive influx of cases of teens, my teen clients and my staff’s teen clients reporting really strong waves of depression, including not just my clients, but also my pre-teen, also reporting that that’s what some of our friends are reporting. I think it’s everywhere. And I really feel that, even though we always talk about anxiety here, I really wanted to make sure we’re addressing the really high rates of depression and despair in teens. So, thank you for writing the most wonderful book. As I went to research that, I found your book, it’s called, Seen: Despair and Anxiety in Kids and Teenagers and the Power of Connection. So, thank you for writing that book. 

Chinwé: Thank you so much for reading it. Yes.  

Kimberley: Yes, I actually listened to it. So, I actually got to hear your voice, which I thought was really beautiful because you and Will Hutcherson, who wrote it, it was lovely. You bounced back and forward between the two of you.

Chinwé: Yes, we did. We did. 

Kimberley: What made you decide to write this book?

Chinwé: I started my career as a high school counselor, my goodness, probably now 18 years ago, which is so weird for me to admit that, or even wrap my mind around that. And I loved working with adolescents. And in the particular high school that I was working at, we were really, really able to do the work of promoting and supporting the mental and emotional well-being of students, not just the academic well-being. And a lot of my school counselor friends at other schools, they were really focused on the schedule and post-secondary options, and SATs. So, I was really fortunate to be at a school where I saw students almost like how I’m seeing clients clinically, 10 o’clock, 11 o’clock, 11:15, 11:30. And so, that was such a great experience for me, especially early in my career. 

The reason we wrote the book is because, back then, 18 years ago, I saw a little bit of self-harm. I saw anxiety. I saw depression. I certainly saw despair. I saw kids, students struggling with relationships, struggling with, what is my future going to look like? However, what we are seeing today, what I am seeing in my clinical practice, I still work with adolescents, but I do work with a great deal of adults. I work with parents and families, and I have conversations with just my friends and people that I’m doing life with. The episodes or experiences of anxiety and depression has really just increased significantly. Kimberley, I am sure that you are so aware of just the stats that are out there that really point to the shift that’s occurred in our culture, specifically as it relates to youth mental health. 

Just for example, and this seems like such a long time ago, but I think it really gives us an idea of how much has changed, a good bit has changed in a relatively short period of time. But the stats are pointing to the fact that since 2007, suicide rates have increased a whopping 76% for teenagers between the ages of 15 and 19. So 76%. So the bulk of that number really is pointing to how our teen girls are struggling. Suicide rates are double in teen girls versus our boys. The highest rate of increase in suicide among all age groups—and this is where I always have to take a deep breath still—is in kids. These are kids between the ages of 10 and 14 is what the research is showing. 

The alarming part of this whole thing is that we’re seeing younger and younger kids impacted by what we sometimes think of as, yes, adolescence is tough. There are hormones. There’s social pressures. There are academic pressures. Kids are worried about the future. Well, younger and younger kids are also being impacted by feelings of hopelessness and discouragement. 

And the other thing—you and I talked about this before we started recording. The other thing that’s been really shocking for a lot of people to learn is when I started my career, way back in the day, we were told that families of color, specifically African-American families, were really the least likely to take their own lives. But what we have learned recently, and this is a stat that has really shocked, but also confused and confounded a lot of clinicians, as well as mental health researchers, is that there’s an elevated risk of suicidal thoughts for African-American boys between the ages of five and 11. So once again, just younger and younger kids are experiencing really hopeless feelings, but we are seeing the most anxiety, the most despair, and depression among adolescents and young adults. So that’s why we wrote the book.

 Kimberley: I get teary just hearing about it. My heart aches, and I feel like it’s a crisis. It’s a crisis that they’re experiencing and parents. I think what was really also very beautiful that you talked in the book about how, I think, even as clinicians, we perceive kids who are struggling with, “Oh, they must have gone through a trauma.” But also, it’s just kids who haven’t been through a trauma. I mean, I think the COVID in and of itself and all of the unrest of our world is traumatic for everybody. But it was also very validating to see that this is also for reasons that we yet don’t really understand. Do you want to speak to that at all?

 Chinwé: Yes, absolutely. So in the book, I wrote about clients that I’ve experienced throughout the years. I’ve changed factors and variables that would easily identify them. But many people will point to some of the illustrations in the book that are of kids who come from really supportive families. Many of them are high achieving. Many of them have a lot of resources that they just have access to, and yet they still experience levels of anxiety, sadness, even are self-harming, even espouse suicidal thoughts, or we call it suicidal ideation. 

What that tells us, again, I think just sort of zooming out, is the bigger picture of just so many things that have shifted in our culture, so many things that have shifted from a societal perspective where young people are feeling disconnected, they’re feeling more anxious, they are more resourced. The research tells us that Gen Alpha and Gen Z are the most diverse, more resourced, tech-savvy. They’re so connected to the technological and global world, but they feel so disconnected oftentimes from themselves, from their family members, and also their friends. And so, I think it really is so interesting that it really speaks to, regardless of the walk of life or where you or your family falls from an income perspective, none of us are immune. 

I try to be pretty transparent. My daughter has given me permission to share. She is 20 years old. She’s in college. She is brilliant and kind and thoughtful and highly sensitive and gifted and has a mother who’s a mental health professional. And at 13, she experienced high, high anxiety and high levels of despair. And again, she’s given me permission to share, and I do share this when I talk to parents and educators across the country, and I’m so grateful that she’s given me that permission. But just to show that she had resources. She was in private school. She’s my bonus daughter. She had support from me, her dad, and also her biological mom, and her grandparents, and she still experienced what a lot of kids across the country are experiencing.

 Kimberley: I’m so grateful you share that. I think that that’s it too. We would assume that if your bonus mom is a therapist and you have all the resources, it just wouldn’t happen to you. But it doesn’t discriminate, does it? It can affect any family. As a clinician, I don’t think I was really trained to really understand that either. I was trained to think like, okay, there must be something wrong with the family, they must be fighting at home, or there must be discord at home, or so forth. So I’m so grateful that you share that. And thank you to her. How brave and wonderful that she struggled and obviously came through on the other side, absolutely. 

In the book, this blew my mind, really, honestly. I’m almost embarrassed to say, but it blew my mind that you described that there is a difference between despair and depression. Can you share what that is all about?

 Chinwé: Yes. As you know, depression is a clinical term. It’s a diagnosis that has a set of symptomology that’s connected to it. So, we as clinicians are looking for certain symptoms that exist more days than not over a two-week period of time, right? At that two-week mark, I’m starting to pay a lot of attention when parents are sharing what’s happening with their kids. Because when you’re an adolescent, we know that hormones will shift your mood, you’ll be high on something that you’re watching on TV. Not high literally, because we got to make that distinction. You’re not vaping or using marijuana, but you’re feeling euphoric and you’re elated about something maybe you’re seeing on television. And then you look down at your phone, or your mom asks you to clean your room or do your work. And then you can look like you have a level of despair. But that may not be the case, right? We know with adolescents, there are just normal ups and downs that are just a part of that stage of development. 

So it’s important to really share that in order to get a diagnosis of depression. You want to see a number of symptoms for a period of time that really impact your child’s level of functioning in a persistent and pervasive way. Maybe they’re not functioning as well as they normally would at school or if they have an after-school job or an extracurricular activity or you’re noticing that some things at home. So those are some things that we look at from a clinical perspective. 

Now, despair is something different, but not by a whole lot. There’s a whole lot of overlap, and we do go into it with pretty great in-depth in the book, but essentially, despair really has a lot of those same symptoms of depression where you’re feeling lethargic, perhaps low energy. You struggle with thoughts that tell you maybe that you’re not enough, you’re inadequate, or inferior. Sometimes you don’t feel like doing those things that you normally love to do. In clinical terms, we call it anhedonia, right? Those things that you typically enjoy that make you happy—playing with your pet, going for a walk, hanging out with your friends. If you’re not doing those things, we do start to wonder about some mood issues, some internalizing disorders. So, anxiety, mood issues such as depression, but with despair, and we make this distinction on purpose with intentionality, and here’s why. 

Despair does share a lot of the symptoms as depression, but it doesn’t need to meet the criteria for major depression for us to really know that is a tough place to be. And many of us, especially young people, we may not be able to just relate or connect to having major depression or bipolar, but many of us on this earth can relate to having an experience of loss or grief or deep disappointment, or pain that we just continue to stuff and we rally and we show up for the next thing and we show up for the next thing. But that pain is still there, and it doesn’t really have a place to go because we haven’t really shared with people that we were going through this pain. We just kept going with our routine. 

Despair can make you feel the exact same way, but it doesn’t necessarily rise to the level of a mental health diagnosis. And it’s important to point out because young people right now are going to social media outlets like TikTok, and they’re hearing from social media influencers—I put that in quotation marks—that are saying, “If you have this symptom, then you have this diagnosis.” And so, young people are attaching to those labels, and we did not want that in this book. This book is for anyone who has a child, a student, someone that you’re coaching, leading, guiding, that is struggling with a mental health issue, or just struggling emotionally, but it doesn’t necessarily lead to a criteria that indicates that there’s some sort of diagnosis.

 Kimberley: Thank you for differentiating that, because that was really cool for me to hear from a clinician diagnostically. That was really cool to know. Let’s talk about solutions. So we know this is happening. You talk about, and I am too is going to say, like we’re sending all the love to the parents who are navigating this. We’re sending all the love to the clinicians and the teachers and the school counselors and the guidance counselors who are navigating this with their teens. What can we do for our teens, or how can we help them?

 Chinwé: Excellent question. As a mental health practitioner and a parent of three kids, I know how difficult it can be to sort of see the big picture when your child is struggling. We all can relate to feeling overwhelmed, again, even as a professional. I’ve talked to my pediatrician friends and my medical doctor friends. It’s the same thing when it’s your kid. You have all the head knowledge, but sometimes it can still be difficult. 

I think for all of the families that are listening right now, I want you to remember a really important word that’s actually overused. That word is resilience. We’re hearing a whole lot about resilience. We’re hearing a whole lot about emotional resilience, mental resilience. In the book Seen, we call it grit. We acknowledge because I’m talking to educators across the country that are seeing this and parents and even employers that are feeling this. We acknowledge that in a lot of ways, the younger generation, they have lost their grit. They don’t appear to be as resilient as the older generations. 

But where I want to step in is by saying that we don’t shame them or blame them. And how many times have we turned on the news and we heard, “Oh, these kids are snowflakes,” or “These kids are weak,” or “They’re not tough, and they just need to pull their pants up,” and whatever the saying is.

Kimberley: Pull them up by the bootstraps.

Chinwé: Thank you. And your big girl panties—I’ve heard that too. And I was traveling the other day, someone said, “Yeah, my dad always said, ‘Just put some mud on it, put some dirt on it, and keep it going.’” And the older generation, we have a tendency to blame the younger generation for experiencing this mental health crisis, and that just isn’t fair. 

We do want to help them to develop grit and build grit, but the way that we help them with resilience is remembering that a key element of resilience is internal coping resources with external support. That external support is key. When young people are facing any sort of mental health challenge, again, it doesn’t have to be depression; it could just be a period of high anxiety or sadness that’s just gone on for too long. They need to know that they have what it takes, but they need people to remind them and people to walk alongside them because life will be full of difficulty, of course. But we want to teach our young people that they can face this, anything that overwhelms them. They can experience that overwhelm, but also know that they have the ability to pull on those internal coping resources, assuming that they’ve been taught those resources, and also access the support of families. 

The first thing that I want to tell parents is to model exactly what you want to see. And this is big, and this could be its own episode, and maybe you’ve already done an episode. But the way that we help young people when they’re having a tough time is to model good mental health even—and this is important—even when you’re struggling. Because I struggle sometimes, and I have the coping resources. Life can feel really overwhelming and can test us. But do we pretend like we don’t struggle just because we’re parents or adults or because I’m a licensed professional? Well, how’s that going to help my child? 

So, it’s important for parents to know that the very first lesson around mental and emotional wellness has to come from you. When your kids are able to see how you, first of all, identify that you’re having a challenge and then respond to the challenge, that helps them. That helps them know that, okay, I can go through a tough situation or feel a level of distress, but I don’t have to sit with it and rally, or I don’t have to pretend like it hasn’t happened or whatever’s happening hasn’t affected me. 

So, what a parent can do is when you get home from work or your day or a meeting with a friend that just was hard and heavy, acknowledge that. We don’t want to weigh kids down, and I get that. We don’t want to put our problems onto them, but it’s okay to say in a very general or conversational way it has been a really long day. Or, “I met with mommy’s friend, Cindy. Oh, she’s had a lot going on in her family. Oh, I just need a moment. I think what I’m going to do is before I get dinner started, I’m going to go for a walk, or I’m going to just take a couple of deep breaths, or I’m just going to have a seat. I’m going to rest.”

How many of us—Kimberley, I’m guilty of this—come home, we’ve had a hard day, we heard something heavy, and we go straight to cooking and cleaning and checking homework and all the things. So, what happens to that energy? So, I feel like this is just a really good opportunity to show kids the value of acknowledging that every day isn’t going to be great and it’s not supposed to be, but what can you do about it?

 Kimberley: Yeah. That is so important, I think. And I think it’s easier said than done. I think that parents are exhausted too, right? They’re struggling at high rates too, I’m assuming. I don’t know the research on that. So, I think we also need to wrap everyone in compassion in that we’re doing the best we can. 

You also talked about social media before and about how much connecting to social media disconnects them from the family. And I think that as parents, sometimes we let them be on tech because parents need a break, you know what I mean? I know I’ve caught myself with that with my nine-year-old of, “I’m just going to let him have some tech time because I need a break,” but then that’s disconnecting them. Can you speak to the impact of social media for teens?

 Chinwé: Yeah. I think the first thing that would really highlight this topic is to mention that just so recently, I want to say probably a couple of months ago, we learned that the federal government, along with at that time 13 separate states—I’m sure it’s more at this point—sued the social media giant, Meta, which many of your listeners will recognize Meta as the parent organization for Facebook and Instagram. Now, we use Facebook and Instagram to promote mental health. And so, there are benefits to social media 100%, and I think it’s important to highlight that for parents because some kids really are getting information about causes that they want to support. They are getting information about mental health. Sometimes it’s in the bite-size way where we want them to dig in a little bit more, right? But they’re good aspects to mental health. 

But the reason for the lawsuit was because the social media giant was being accused of creating intentionality features that are causing addiction to social media, which is one of the things that has been identified as fueling this mental health crisis among youth. So, there are real stats that are -- we probably have always had a sense that being connected or over-connected to technology wasn’t good. During COVID, what the heck else were we supposed to do as parents? We were doing Zoom school. I’m sure you had your own podcasts at that point. I was doing podcasts. I was doing telehealth. So I appreciated technology, but like you said, a lot of parents really leaned on technology during that time because we didn’t have a whole lot else going on and kids still needed to stay connected, and so did we. But I think that balance is so key.  

I’m going to tell you, when I travel and people ask me, what’s the thing that worries you the most about young people as a former high school counselor, someone who works with adolescent mental health? And I say very quickly, without hesitation, that I am really concerned about the fast-paced nature of our culture. We are moving, I think, at lightning speed as a culture. We’re becoming increasingly more digitally connected, which means that we’re becoming more and more less physically connected. So how does that impact our young people? And we’re so quick to point to these things (I’m holding my phone right now) and ask young people, especially teenagers, to do less of this. But if we’re honest, aren’t we just as guilty as parents? 

I have a colleague, and I don’t know if you would agree with this at all. I’m still kind of wrapping my mind around it because I like to see hard stats. But I had a colleague that said that he believes that most adults have some level of digital addiction. I don’t know. I don’t know that for a fact, but I know again that we are very much so attached to our phones. And so, the younger generation sees that. And if they’re going through despair, if they’re having thoughts of self-harming, if they’re having anxious thoughts, and they see that we are super duper connected to our phones, where then do they go? Are we essentially modeling the same thing? 

So again, I’m not here to say that technology doesn’t have its utility. It’s not all bad. But when our world is moving so fast that our nervous systems can’t keep up, what do we need to do? The answer is to slow down and have more face-to-face connections.

Kimberley: Yeah. I think that without the research, I can say for myself, it’s interesting. I actually had a colleague of mine, we both agreed we would track how many times we picked up our phone. And when I tracked it, it was always like, “Oh, I’m overwhelmed. I’ll just watch Instagram for a minute,” or “I’m feeling sad. I’ll just watch Instagram for a second.” And it was like, that’s my first coping skill. This is not good. That’s not good. So I totally agree with what you’re saying. 

I have one more question for you. So, the real word that felt so yummy to my whole body when I read your book was the word connection and how important that is for our teens but also for, I think, all humans. How might we connect better with our teens?

Chinwé: Oh gosh, can I throw a stat that’s sticking in my head? Can I throw that out right now? 

Kimberley: Please.

Chinwé: From birth to graduation, I still get goosebumps, and I’ve been saying this for about a year now. From birth to graduation, we have 936 weeks with our kids. 936 weeks and roughly 3,000 hours in one year. So, just depending on where you are in your parenting phase, depending on just who you are and the makeup of your nervous system, that’s going to land differently for you. But I know the first time, and even today when I hear that, I’m like, “There’s not enough time. Am I doing enough? Should I not be on this podcast? Should I be with her in school?” So it’s fine. 

But I think that, like, am I spending enough time? Am I connecting? And I don’t know one parent that I’ve counseled or that I do life with that doesn’t want to be a good parent. And I always remind parents that it’s not this whole connection piece that we’re seeing in the attachment research and the neuroscientific research. It’s not about being a perfect parent. It really is about being an intentional parent and showing up undistracted. So that whole conversation about before we check our kids, let’s see if we’re modeling the behavior we want them to see as it relates to technology. And again, tons of compassion. I’m a huge proponent on giving yourself the kindness that you would give someone else who might be struggling. So, that’s really important. But showing up undistracted, but also showing up when it’s not convenient. 

We know through brain research that connection can help bring down all of that energy that happens on the right side of the brain when an individual is highly activated, high anxiety for far too long, a state of despair for far too long, which can actually end up feeling like just numbness, like I feel nothing. 

So, what helps individuals to begin to heal, promote that healing is connection with another human being that they feel loved and cared for, that they feel respected, someone that respects them, someone that values who they are, not just what they do. “I love you just for who you are.” That’s something that I say. 

I’m actually being reminded of a Valentine’s Day card that my third grader made for me. And he wrote the sweetest thing, and I’m not going to read all of it, but at the very end, he said, “Thank you for loving me even when I’m unlovable.” And I sort of chuckled, and he read it to me and we laughed at the same time because that’s something I say to him all the time. Regardless of the behavior, regardless of what we are facing right now, the correction or the challenge, or you’re not getting along with your brother, I love you no matter what. 

So, even just hearing that, even just hearing that as adults that someone is going to be by our side and going to help us through a tough time, even when maybe we’re not acting lovable or “acceptable” from society’s perspective, what’s better than that? 

One of the very first tools that we talk about in our book Seen, we have five connection tools. The very first tool is showing up and showing up when it’s not convenient. As mama bears and papa bears, we have that instinct to swoop in and protect our kids when they’re struggling. And we also show up during those huge milestone moments—the concerts, the graduations, the big sporting events. And by the way, kids want to look up and see us and see grandparents in the stands. That’s important.

But the kids that I’ve been counseling throughout the years, they want their parents to show up in the seemingly insignificant and mundane moments of life, just to do basic things. Not to check the homework, not to talk about the boy that texted last night, but go for a coffee to just connect. Go in the front yard and play basketball. Go fishing. 

The key is whatever is meaningful and valuable to your child, those are the things that we want parents to engage in. And consistency really matters. And we’re talking about teenagers. This is what I’ve learned throughout the years, especially when I was a school counselor—the tendency is to think that as our kids get older, they need us less and less. And this is what my teenagers in therapy are telling me—I find that when they hit 13, 14, and 15, ooh, they are making huge life decisions. And even though there’s sometimes that conflict that happens between parents and teenagers or parents and preteens that can cause parents to sometimes disconnect because we get our feelings hurt sometimes and disengage, that’s when our kids are making really tough life decisions, so that’s when they need us the most. 

Consistency matters. So, it’s not showing up here and there. No knock on people who have busy lives and busy jobs, but the research shows that consistency builds trust. So, we show up, we show up undistracted, and we show up before they ask us to.

Kimberley: So beautiful. For me, it’s been a constant reminder of like, look them in the eyes. It’s so easy to be talking while chopping vegetables or checking email. It’s like, “Kimberley, stop and look at them in the eyes. That’s what they need to be seen.” So, I love that so much. 

I understand that you have a new book out. Please tell us all about where people can find you and learn about you. And you have a new book out. Tell us all the things.

Chinwé: Oh, thank you so much. Yes, our first book was Seen, which is really a book for connecting with a young person, if you’re a parent, educator, coach, regardless of mental health diagnosis. However, as we were traveling and sharing about the contents of Seen, everywhere we would go, parents would say, “Oh, this is awesome. I’m going to give this to my teenager.” And Will and I would be like, “No, this is not for your teenager; this is actually for you and another caring adult.” And then they would say, “Well, where’s the book for teenagers or is there a workbook?” 

And so, we wrestled with this for about a year, and we decided, looking at the stats, that’s really pointing to anxiety being super high, very rampant among all of us, including adults, 28% of adults have an anxiety disorder. We also are seeing that young people, adolescents, and young adults are struggling with anxiety. So we wrote a book that’s specifically for strategies to help with anxiety, and it’s called Beyond the Spiral: Why You Shouldn’t Believe Everything Anxiety Tells You. And it’s really going over six different lies that anxiety tells you. And here’s a sneak peek: Anxiety tells you that you have no control. Anxiety tells you that you’re going to miss out. Anxiety tells you that you should just ignore it, and anxiety tells you that you’re not safe. And there are two more. But then every single chapter, we talk about the lie, we talk about what’s happening in the brain that’s really highlighting that lie. And then we talk about psychological strategies that are tried and true, probably many of the ones that you’ve written about in your books and resources, many of the ones that I use with my clients today. And then there’s a spiritual piece for those who really have a strong faith. We bring in spiritual elements and practices that we believe are also really important to ease in anxiety.

Kimberley: Amazing. Thank you so much for being here. Is there any social media handles or websites that people can find your information?

Chinwé: Thank you for asking. So I am also pretty active on Instagram, and my Instagram handle is dr.chinwewilliams. So dr.chinwewilliams. And if you want to just learn a little bit more about me and my practice, I have a website, and it’s drchinwewilliams.com.

Kimberley: Amazing. And we’ll link all that in the show notes. I am so grateful for this book. I’m so grateful for you. I love the work that you’re doing. So thank you for coming on.

Chinwé: Thank you for your kindness. Thank you for your -- I’ll be honest with you, when I’m preparing for podcasts, I don’t have a lot of time, but I really do think it’s important to just get a flavor of the host, the content that they produce, the guests that they have on. But I don’t have a lot of time, right? So, I usually have time to listen to maybe 15 or 20 minutes of maybe one or two podcast episodes.

When I tell you, I was like, “Where am I going to start?” I was looking through your title list, and I was blown away. I listened to two and a half episodes, two entire episodes, and a half of one. And I was thinking, where has she been all my life? She’s going to be an amazing resource for my clients who -- I’m a trauma therapist, and as you know, that was formerly considered an anxiety disorder. So this is something that I’m really excited to present to my clients. So thank you for the work that you do.

Kimberley: Oh, thank you so much. I’m so grateful.

In the realm of mental health, the role of an anxiety therapist is often shrouded in mystery and misconceptions. To shed light on this crucial profession, Joshua Fletcher, also known as AnxietyJosh, shares insights from his latest book, "And How Does That Make You Feel?: Everything You (N)ever Wanted to Know About Therapy," in a candid conversation with Kimberley Quinlan on her podcast.

Joshua's book aims to demystify the therapeutic process, offering readers an intimate look behind the therapy door. It's not just a guide for those struggling with anxiety but an engaging narrative that invites the general public into the world of therapy. The book's unique angle stems from a simple yet intriguing question: Have you ever wondered what your therapist is thinking?

One of the book's key revelations is the humanity of therapists. Joshua emphasizes that therapists, like their clients, are complex individuals with their own vices, flaws, and inner dialogues. The book begins with a scene where Joshua, amidst a breakthrough session with a client, battles an array of internal voices—from the biological urge to use the restroom to the critical voice questioning his decision to drink an Americano right before the session.

This honest portrayal extends to the array of voices that therapists and all humans contend with, including anxiety, criticism, and analytical thinking. Joshua's narrative skillfully normalizes the internal chatter that professionals experience, even as they maintain a composed exterior.

The conversation also touches upon the diverse modalities of therapy, highlighting the importance of finding the right approach for each individual's needs. Joshua jests about "The Yunger Games," a fictional annual event where therapists from various modalities compete, underscoring the passionate debates within the therapeutic community regarding the most effective treatment methods.

A significant portion of the book delves into the personal growth and challenges therapists face, including dealing with their triggers and the balance between professional detachment and personal empathy. Joshua shares an anecdote about experiencing a trigger related to grief during a session, illustrating how therapists navigate their emotional landscapes while maintaining focus on their clients' needs.

The awkwardness of encountering clients outside the therapy room is another aspect Joshua candidly discusses. He humorously describes the internal turmoil therapists experience when meeting clients in public, highlighting the delicate balance of maintaining confidentiality and acknowledging the shared human experience.

Joshua's book, and his conversation with Kimberley, paint a vivid picture of the life of an anxiety therapist. It's a role filled with challenges, personal growth, and the profound satisfaction of facilitating others' journeys toward mental wellness. By pulling back the curtain on the therapeutic process, Joshua hopes to demystify therapy, making it more accessible and less intimidating for those considering it.

In essence, being an anxiety therapist is about embracing one's humanity, continuously learning, and engaging in the most human conversations without judgment. It's a profession that requires not only a deep understanding of mental health but also a willingness to confront one's vulnerabilities and grow alongside their clients. Through his book and the insights shared in this conversation, Joshua Fletcher invites us all to appreciate the intricate dance of therapy—a dance that, at its best, can be life-changing for both the therapist and the client.

Transcript: 

Kimberley: I’m very happy to have back on the show Joshua Fletcher, a dear friend of mine and quite a rock star. He has written a new book called And How Does That Make You Feel?: Everything You (N)ever Wanted to Know About Therapy. Welcome back, Josh.

Joshua: It’s good to be back. Thanks, Kim. When was the last time we spoke together on a podcast? I think you were on The Disordered podcast not so long ago. That was lovely. But I remember my guest appearance on Your Anxiety Toolkit was lovely.

HOW DOES THAT MAKE YOU FEEL? 

Kimberley: I know. I’m so happy to actually spend some time chatting with you together. I’m very excited about your new book. It’s all about therapy and anxiety and what it’s really like to be an anxiety therapist and the process of therapy and all the things. How did this book come about?

Joshua: I wanted to write a book about people who struggle with anxiety, but in the mainstream, because a lot of the literature out there is very self-help, and it’s in a certain niche. One of my biggest passions is to write something engaging with a nice plot where people are reading about something or a storyline that they’re interested in whilst inadvertently learning without realizing you’re learning. That’s my kind of entertainment—when I watch a show and I’ve learned a lot about something or when I’ve read a book and I’ve inadvertently learned loads of things because I’m taking in the plot. 

With this book, I wanted to write a book about therapy. Now, that initially might not get people to pick it up, might not interest you, might not interest you about anxiety therapy, but I wanted to write something that anyone could pick up and enjoy and learn lots because I want to share our world that we work in with the general public. And so, the hook that I focused on here was, have you ever wanted to know what your therapist is thinking? And I thought, well, I’m going to tell people what I’m thinking, and I’m going to invite people behind the therapy door, and you’re going to see what I do and what’s going on in my head as I’m trying to work with people who struggle with mental health. 

I wrote the pitch for it. People went bananas, and they loved it because it’s not been done before. Not necessarily a good thing if it’s not been done before. And here we are. I love it. I’m really proud of it. I want people to laugh, cry, be informed. If you go on a journey, learn more about therapy, learn more about anxiety. All in one book.

THERAPISTS ARE HUMANS TOO

Kimberley: Yeah. I think that one of the many cool things about it is, as a therapist, people seem to be always very curious or intrigued about therapists, about what it’s like and what it’s like to be in a room with someone who’s really struggling, or when you’re handling really difficult topics, and how to be just a normal human being and a therapist at the same time.

Joshua: Yeah. What I want to write about is to remind people that therapists are humans. We have our vices and flaws. I’m not talking on behalf of you, Kim. I’m sure you’re perfect. 

Kimberley: No, no. No, no. Flawed as flawed could be.

Joshua: Yeah, but to a level that it’s like, even our brains have different voices in them all the time, different thought processes as part of our rationalization. And I want people to peer inside that and have a look. So, one of them is like the book opens with me and a client and it’s going really well, and this person’s talking, this character’s talking about where they’re up to, and celebrating on the brink of something great. And then there’s the voice of biology that just pops into the room, into my head. And it’s the biology of you need to go to the toilet. Why did it? And then the voice of critic comes in and says, “Why did you drink an Americano moments before this client?” Now you’re sat here, and you can leave if you want, but it would be distasteful. And you’re on this brink of this breakthrough. 

And so, I’ve got this argument going on in my head, going, “You need the toilet.” “Yeah, but this person’s on a breakthrough.” And then I got empathy, like, “Yeah, but they feel so vulnerable. They want to share this.” And then you’ve got analytical and all the chaotic conversations that are happening as a therapist as I’m sat there nodding and really wanting the best for my client.

THE VOICES IN OUR HEAD

Kimberley: Exactly. That’s why I thought it was so brilliant. So, for those of you who haven’t read it, I encourage you to, but Josh really outlines at the beginning of the book all of these different voices that therapists and all humans have. There’s the anxiety’s voice and there’s biology, which you said, like, “I need to go to the restroom,” or there’s the critic that’s judging you, or there’s the analytical piece, which is the clinical piece that’s making sense of the client and what’s going on and the relationship and all the things. And I really resonated with that because I think that we think as clinicians, as we get better and more seasoned, that we only show up with this professional voice we’re on the whole time, but we’re so not. We’re so not on the whole time. This whole chatter is happening in the background. And I think you did a beautiful job of just normalizing that.

Joshua: Thanks, Kim. It’s a book that therapists will like, but do you know what? People will identify their own voices in this, particularly the anxiety. You and I talk about anxiety all day every day, always beginning with what if—that voice of worry that sits around a big table of thoughts and tries to shout the loudest and often gets our attention. And I tried to show that this happens to a lot of people as well. It’s just the what-if is different. So, for some people, it’s, “What if this intrusive thought is true?” For some people, it’s, “What if I have a panic attack?” For some people, it’s, “What if this catastrophe I’ve been ruminating on for so long happens?” For therapists, it’s, “What if the worst thing that happens here, even in the therapy room?” 

I’m an anxiety therapist that has been through anxiety, and I still get anxiety because I’m human. So, I celebrate these voices as well. Also, because I’m human, I can be critical almost always of myself in the book. So, I’m not just criticizing the people I’m working with. Absolutely not. But that voice comes in, and it’s about balancing it and showing the work and what a lot of training to be a therapist is. It’s about choosing the voice. And I didn’t realize how much training to be a therapist actually helps me live day-to-day. Actually, I’m more rational when making more life decisions because I can choose to observe each voice, which was integral to me overcoming an anxiety disorder, as well as just facing life’s challenges every day.

WHAT IS IT LIKE TO BE A THERAPIST? 

Kimberley: Right. Because we’re really today talking a lot about what it’s ACTUALLY like to be a therapist—and I emphasize the word ‘actually’—what is it actually like to be a therapist, if we were to be really honest?

Joshua: One thing I mentioned is that I talk about the therapeutic hour, which is how long, Kimberley?

Kimberley: Fifty minutes.

Joshua: Yeah. The therapy took out and I explained what we do in the 10 minutes that we have between clients on a busy day. And people imagine us doing meditation or grounding ourselves or reflecting or whatever. Sometimes I do do that. Sometimes I just scroll Reddit, look at memes, eat candy, and do nothing. And it’s different each time. That’s what I’m doing. I’m not some mystic sage in my office, sitting sinisterly under the lamplight waiting for you to come in. No, I’m usually faffing around, panicking, checking that I don’t look like a scruff, putting a brush through my hair, trying to hide the stains of food I’ve got on my shirt because I overzealously consume my lunch. 

And there’s obviously some funny stories in there, but also there’s dark stuff in there as well. When I trained to be a therapist, I went through grief, and I made some quite unethical decisions back when I was training. Not the ones I’m proud of, but it actually shows the serious side of mental health and that a lot of therapists become therapists because of their own journeys. And I know that that applies to a lot of therapists I know.

Kimberley: For sure. I have to tell a story. A few months ago—I’m a member of lots of these therapist Facebook groups—one of the therapists asked a question and said, “Tell me a little bit what your hour looks like before you see a client. What’s your routine or your procedure pre-clients?” And all these people were saying, “I journal and I meditate and all of these things.” Some people were like, “I water the plants and I get my laptop open.” And I just posted a meme of someone who’s pushing all the crap off my table and screeching into the computer screen and being like sitting up straight. And all of these people responded like, “Thank God,” because all the therapists were beautifully saying, and I just came in here honestly, “Sometimes I literally sit down, open the laptop, and it is a mess. But I can in that moment be like, ‘Take a breath,’ and be like, ‘Tell me how you’re doing.’” Like you said, how does that end? We start the therapeutic hour. And I think that we have to normalize therapists being that kind of person.

Joshua: Definitely. I think one of the barriers to people seeking therapy is that power dynamic, that age-old trope that someone stood leaning against a mahogany bookcase. You’ve probably got a mahogany bookcase. Your practice is really nice. I certainly have. I’ve got an Ikea KALLAX unit full of books I’ve never read. 

Kimberley: Exactly. Your books aren’t organized by color because mine are not.

Joshua: No, no. There’s just some filler books in there. Just like, why is Catcher in the Rye? Why is Catcher in the Rye? I don’t know, I just put it on there. I just want to look clever. Anyway, it’s like people are afraid of that power dynamic of some authority figure going in there about to judge them, mind-read them, shame them, or analyze them. And no, I think dispelling that myth by showing how human we are can challenge that power dynamic. It certainly did for me. I would much rather open up to someone who isn’t showing the pretense that they have all of life together. Don’t get me wrong, professionalism is essential, but someone who’s professional and human, because going to therapy is some of the most human experiences you’ll ever do. I don’t want someone who isn’t showing too scared to show that sign or certain elements of being human, but obviously professionally. And it’s a fine balance to get. But when you do find a therapist like that, for me personally, one who’s knowledgeable, compassionate, empathetic, has humility, I think beautiful things can happen.

Kimberley: Yeah. I think you use the word that I exactly was thinking of, which is, it’s such a balancing act to, as a therapist, honor your own humanity from a place of compassion. Like, yeah, we’re not going to have it all together and it’s not going to be perfect, and we won’t say the right thing all the time. But at the same time, be thoughtful and have the skills and the supervision to balance it so that you are showing up really professional and from that clinical perspective. 

DO THERAPISTS GET CONSULTATION? 

Tell me a little bit about consultation as a clinician. I know for me, I require a lot of consultation for cases, not because I don’t know what I’m doing, but I’m always going to be honest with the fact that maybe I’m seeing it from a perspective that I hadn’t thought of yet. What are your thoughts on that kind of topic?

Joshua: Therapy’s got to work for both people as well, because the therapeutic connection, I believe, is one of the drivers that promotes therapeutic growth and change. It promotes trust. I will consult with clients and my supervisor and make sure it’s right. I’m not everyone’s cup of tea, but for people, particularly with anxiety disorders, I think they like to know and come to therapy. I think I’ve used self-disclosure on my public platforms tastefully in the sense that I know what it’s like to have gone through an anxiety disorder, whether it’s OCD or panic disorder or agoraphobia, and come out the other side. 

But also, it’s balancing that with, “Actually, I’m your therapist here. I will help you in a therapeutic setting and use my training.” You know I’m not someone who’s got everything worked out, but you do know that someone who can relate that can step into your frame of reference, something I talk about a lot in the book frame of reference and empathy. If you feel like a therapist has done that and is in your frame of reference and it’s like, “Ah, yeah, they get it or they’re at least trying,” and we as therapists feel like there’s a connection there too on a professional and therapeutic level, I think magic can happen. And I love therapy for that. Not all therapy is great and beautiful and wonderful. Some of it is messy, and some of it just doesn’t work sometimes. And I do talk about that too, but it’s about when you get that intricate dance and match between therapist and client, I think it’s life-changing.

WHAT TYPE OF PERSON DO YOU NEED TO BE TO BECOME AN ANXIETY THERAPIST?

Kimberley: Yeah. What do you think about the type of person you would have to be to be an anxiety specialist, especially if you’re doing exposure and response prevention? The reason I ask that is I have a private practice in California. I have eight clinicians that work for me. Almost every time I have a position that’s open, and when I’m interviewing people to come on to my team, I would say 60% come in, and they’re good to go. They’re like, “I want to do this. I love the idea of exposure therapy.” But there is often 40% who say, “I’m not cut out for this work. This is not how I was trained. It’s not how I think about things.” After I’ve explained to them what we do and the success rate and the science behind it, they clearly say, “This isn’t for me.” What are your thoughts about what it takes or what kind of person it takes to be an anxiety specialist?

Joshua: That’s a great question. First of all, you’ve got to trust and believe in the modality that you’re trained in. You and I use the principles a lot of cognitive behavioral therapy and exposure response prevention. I’ve got first-hand experience of that. You’ve got to trust the science and what we know about human biology, which is really important. It’s about what you’re trading in that modality. What I talk about -- again, see how I’m segueing it back to the book. Brilliant. I’ve done my media training, Kim. It’s like, “Always go back to the book. Come on, Josh.” One of my favorite chapters in the book is explaining about modalities because a lot of people just think therapy is one big world where you see a therapist, they wave a magic wand, you feel better, and suddenly our parents love us again. No, that’s not how it works. 

Kimberley: It’s not?

DIFFERENT TYPES OF ANXIETY THERAPISTS

Joshua: No, it’s not. Mental health has different presentations, and a modality is a school of thought that approaches difficulties in mental health. So, the first modality I go to is person-centered, which is counseling skills, listening, empathy, unconditional positive regard. 

The Carl Rogers way of thinking—I think I love that. Is that good for OCD, intrusive thoughts, exposure therapy, and phobias? Not really. It’s nice to have a base of that because there’s more chance of a therapist being understanding, stepping in your frame of reference, and supporting you through that modality. But I wouldn’t say it’s equipped for that. 

Whereas in CBT, a lot of it is psychoeducation, which I love. And that’s a different modality. Cognitive behavioral sciences, whether it’s third wave, when you’re looking at acceptance commitment, where are you looking at exposure response prevention. There’s lots of song and dance about I-CBT at the moment and things like that. They’re all different modalities and skills of thought. 

Then you’ve got psychodynamic, which is the mahogany bookcase, lie on the sofa, let’s play word association. Oh yeah, you want to sleep with your mom, Josh? No, I don’t. That’s nothing to do with why I keep having panic attacks in the supermarket. Stop judging me. But that’s a different type of approach. Jungian approach can be quite insightful, but it’s got to match what the presentation is for you. 

I think CBT is my favorite, but it sucks for stuff like grief. When I was grieving, I did not want CBT. I did not want my grief formulated. I did not want to see that my behaviors were perpetuating discomfort. I was like, “Yeah, that’s just part of my grieving process.” And in this chapter, I just talk about the different modalities.

Therapists are very passionate about the modality of the school that they train in because you have to give part of yourself to it. You have to go through it yourself. And I’m very passionate about the modalities I’m trained in. And so, I play on this in the book. There’s a chapter called The Younger Games or The Yunger Games, a play on words. And basically, it’s once-a-year therapists from every modality, whether it’s hypnotherapy, transactional analysis, CBT, person-centered, the trauma-informed. All of these, they all meet up in a field, and we all fight to the death. And the last remaining person is crowned the one true modality. Now last year, it was hypnotherapy. And what I also say is that a betting tip for next year is the trauma-informed. So, every year, I’ll keep you updated on The Yunger Games. And basically, it’s a narrative device to explain that. 

Within the world of therapy, there are different types of therapists. You and I, we love CBT. We’ll bang the drum for that. We feel that there’s not enough ERP out there that certainly isn’t, particularly with the evidence and the points towards it and mountains of evidence. But other therapists may not feel the same. So, when people come to work at CBT School and they realize that Dumbledore, aka Kim Quinlan, is like, “No, we do ERP here; we’ve got to get down and dirty and do the horrible work,” they’re like, “That’s not conducive to the softer step-back approach that I’ve trained in, in my modality.”

Kimberley: Yeah. I’m always so happy that they just are honest with me. I remember as an intern at OCD Center in Los Angeles very clearly saying, “Are you okay talking about really very sexual, very, very graphic topics?” He listed off. Like, “Here is what you’re going to need to be able to talk about very clearly with a very straight face. You can’t have a wincing look on your face when you talk about intrusive, violent sexual thoughts. You’re going to have to be up for the game.” And I think that was a big thing for me. But what I think is really cool about your book, and you see now I’m bringing it back to your book, is it doesn’t mean the voice isn’t in your head sometimes questioning you. As I was reading it, I’m like, there is an imposter in therapists all the time saying, like you said, the critic that’s like, “You don’t know what you’re doing. You’re a failure. You’re a flake. You’re a complete fraud. You haven’t got it together. Maybe you haven’t even worked on the thing yourself yet.” That’s going to be there.

Joshua: Yeah, and I still get that. I can’t speak for you. But I think what makes a good therapist is a therapist who self-doubts. You don’t want to go and see a therapist who thinks that they’ve got it all worked out. That’s a red flag in itself. A good therapist is one that always wants to improve and uses that doubt and anxiety to make themselves a better therapist. Don’t get me wrong, I’m pretty confident in my ability to be a therapist now, but there are challenges.

In the book, the voices that come up, there’s 13 of them. One of them is escapist, which is, “I just want to get the hell out of you,” or “Maybe I want to get rid of this client. I’m not equipped for it.” And then the other voices come in and they’re like, “But maybe this is just you being critical,” or “The evidence suggests that actually you are trained for this,” and navigating that doubt, the anxiety that your therapist has. And I think it’s a beautiful thing. 

A lot of therapists are very harsh on themselves, but I think it’s a gift to have that inner critic. Because if you stand there like one of these therapists, and these therapists do exist, unfortunately, I have completed all my training. I know everything inside out. My word is gospel. I worked out what the problem was with this person within 10 minutes. You don’t want to talk to that person. What a close-minded moron. And there’s a judgmental voice from a therapist.

Kimberley: No, but I think that’s informed.

Joshua: So, it celebrates the vulnerability. You want a therapist who’s not got everything worked out. Absolutely. I do anyway.

Kimberley: Yeah, for sure. I’m wondering, how often have you had to work through your own shit in the room with a client? Meaning—I’ll give you a personal example—the very first time I ever experienced derealization for myself was with a client, and I was sitting across from them. They were just talking, and all of a sudden, I had this shift, like everything wasn’t real. Their head looked enormous and their body looked tiny. Like they were this tiny little bobbly head thing on the couch. And I knew what was happening. Thankfully, I knew what it was like. I knew what it was. Otherwise, I probably would have panicked, but I had to spend the rest of the session being as level and mindful as I could as I watched their head just bubble around in this disproportionate way. I got through it. I can say confidently I think I pulled it off really well, but it was hard. And I left the session being like, “What the heck just happened?” Has there been any experiences for you like that?

Joshua: Yeah, all the time. I mean, first of all, I’d question if you did have derealization. I was your client with a giant head and a tiny body. I was like, “What’s going on here?” There wasn’t derealization. That’s my body, Kim.

Kimberley: No, that’s just how I look, Kimberley. 

Joshua: It’s just how I look. 

Kimberley: “Stop judging.”

Joshua: But in general, no, it’s true. And again, one of the voices in my book, And How Does That Make You Feel?, it’s called trigger because therapists, they have to give a lot of themselves and they’re living a life and have had stuff in their past. One of the voices is trigger. One of the things I get asked a lot is, I don’t know about you, Kim, “If you’ve had anxiety, how can you work with it all day?” I’m like, “Because I’m all right with it. It’s okay now.” Sometimes it creeps in, though, if I’m tired or have not slept well. There’s stress in my personal life that you can’t avoid. Maybe I’ve not eaten too well. Maybe it’s just ongoing things. Sometimes trigger can happen, and it can be a stress-induced trigger or it could be a literal trigger from a traumatic event. 

So, in the book, I explain when people bring grief and death, that sometimes makes me feel vulnerable because of my own experiences with grief and death. No spoilers, but the book throughout, one of the themes is why I became a therapist. Not only because of my passion for anxiety disorders and to be self-righteous around other therapists, train different modalities, but also because it’s a very grief-informed decision to want to help people. 

And there’s several traumatic stories. One traumatic story around grief, that trigger, the voice of trigger will come up. So, a client could be talking about their life, like, “I’ve lost this person; I’m going to talk about it.” And of all these 13 voices around the table, what your therapist is thinking, trigger then shouts loudest. It goes, “Ah, trigger.” There’s some pain that you’ve not felt for a while and I’ve got to navigate it. You navigated the derealization, the dissociation. You’ve got to navigate it somehow by pulling on the other voices. And not only do therapists do this, but people do this as well sometimes, whether you’ve got to be professional or you don’t want to turn up to your friend’s birthday and just listen to trigger and anxiety and start crying all over your friend’s birthday cake. You might do. It’s quite funny, but not funny. 

Kimberley: I was going to say, what’s wrong with that? 

Joshua: Have you done it again? I thought you stopped that. 

Kimberley: Yeah. You haven’t done that? 

Joshua: It’s part of the interview at CBT School. You need to do really hard, tricky things. Go to your best friend’s birthday and make it all about you. 

Kimberley: Exactly.

Joshua: But yeah, it’s one of those. It crops up. The book’s funny a lot, but it’s good. It takes some really serious turns, and it shows you a lot of stuff can creep in and how I deal with it as a therapist. And I’m sure you related to it as well, Kim, because we do the same job, but you just do it in a sunnier climate.

SEEING CLIENTS IN PUBLIC 

Kimberley: Right. What I can say, and this will be the last thing that I point out, is you also address the awkwardness of being a therapist, seeing your clients in public and the awkwardness of that, or the, “Oh crap, I know this person from somewhere.” Again, no trigger. I don’t want to give the fun parts of the book, but as a therapist, particularly as someone who does exposure therapy, I might go across the road and take a client to have coffee because they’ve got to do exposures. We very often do see people, our clients, our friends in our work. How much does that impact the work that you do?

Joshua: If you ever bump into your therapist, just know that you have all the power there. Your therapist is squirming inside, “I don’t know what I’m doing. I don’t know. Do I completely blank this person?” But then I look like a dick. “Do I give a subtle nod? Oh, you’re breaking confidentiality. They’re out with loved ones.” It’s up to you. You can put your therapist out of their misery by just saying, “Hey, Kim.” “Hey, Josh.” And then I will say hi back because that shows that you’re okay with that. 

There is a very extreme shocking version of this story, of this incident in the book where, when I’m at my lowest, I do bump into a previous client. On a night out, when I’m off my face on alcohol. Oh, if you want to find out more about that... Media training’s really paid off. Get him on the hip. 

Kimberley: I didn’t want to give it all away, and you just did.

Joshua: No, no, not giving any more away. A media training woman said, “Entice them, then leave it, because then they’re more likely to read it.” So, I have listened to that media woman because my previous tactic of just begging and screaming into a camera doesn’t work. It’s like...

Kimberley: But going back exactly—going back, we are squirming. I think that is true that there is a squirm factor there when you see clients, and it happens quite regularly for me. But I think I’ve come to overcome that by really disclosing ahead of time. Like if I see you outside, you’re in the place of power, you decide what to do, and I’ll just follow your suit. It’s a squirm factor, though.

Joshua: See, that’s clever, good therapy stuff because you do it all part of the contracting and stuff. Actually, I told all my clients this is okay. But also, when you’re a new therapist or sometimes you forget, you’re like, “Oh no.” I used to run a music night in Manchester as part thing I did on the side. Enjoy it, love music, I was the host. One week I was on holiday, so a friend organized all the lineup of people to come down. Headline Act was a band name. Went along, and when I’m there, I’m having fun. I’ve got whiskey in my hand. I’m walking around telling irreverent, horrible jokes. No one in there would guess I was a therapist because I’m having fun and I’m entitled to a life outside the therapy room. 

What I didn’t know was that the Headline Act was a current client, and they’d just arrived dead late. They didn’t know, and they walked on stage, and I looked. It’s something that they’ve gone on publicly to talk about, so this is why I’m saying it now. I got permission to use it because they said it publicly on the radio and stuff like that. And we just looked at each other. It was like, “Oh my God.” And I stood there with this. I was like, “Oh my God.” And I’ve said all this bad language and cracking jokes, roasting people in the audience, my friends usually. And it’s like, yeah, I was squirming. 

So, at this point, I did just pretend I didn’t know them because it was the best I could do. And they got me out of trouble. They were obviously confident in performance mode. And they got onto mic and was like, “Can you believe that guy is my therapist?” And I was like, “What?” I was like, “Wow.” And then he said some really lovely things. And it wasn’t really awkward in therapy. If anything, it was quite something we laughed about in therapy afterwards, and it contributed to it. But yeah, the horror I felt. Oh, I felt sick, and oh. I don’t want to think about it.

FINAL CONCLUSIONS

Kimberley: I want to be respectful of time. Of course, before you share this all about you and where people can get a hold of you and learn about your book, is there anything you want to say final point about what it’s like to actually be an anxiety therapist?

Joshua: It’s the best job in the world for me. It’s the best job in the world. All my friends and family go, “I don’t care how you can do that.” I love it. I get to have the most human conversations with people without judgment. You mentioned before about intrusive thoughts. I’ve got the magic guitar in this room, and we make songs about horrible intrusive thoughts. There was one the other day about kicking babies down the stairs. You can’t say that out loud. Yes, we do in here, to the three chords of the guitar I only know, particularly postpartum mothers. 

Kimberley: You told me we couldn’t sing today. 

Joshua: No, I’m not singing.

Kimberley: I wanted to sing today, and now you’re telling me we can’t sing.

Joshua: I don’t think it’s going to be Christmas number one—a three-chord banger about harming loved ones or sexual intrusive thoughts—but you never know. Yeah, it’s the most beautiful job.

Kimberley: I am known to sing intrusive thoughts to happy birthday songs.

Joshua: That’s a good one. I have to close my window though in my office because I do get scared that people walk past and like, “Wow, that’s a very disturbed man.” No, he’s not. I’m confident in the powers of ERP and how it can help.

Kimberley: You are. I love it. Josh, tell us where we can hear more about your book and learn more about you.

Joshua: I’m Joshua Fletcher, also known as AnxietyJosh on social media and stuff. The book is called And How Does That Make You Feel?: Everything You (N)ever Wanted to Know About Therapy. It follows the stories of the four client case studies, obviously highly scrambled and anonymized, and gone through a rigorous ethical process there. So, don’t be like, “He’s talking about his clients.” No, that’s not what the book’s about. It’s about appearing in behind the therapy room door. It’s out in the US before the UK, which is here. I don’t know if anyone’s watching or whatever, but there it is. And it’s also been commissioned to be a television show for major streaming services. We don’t know which one yet, but it’s exciting. 

Go get yourself a copy. It should be in your bookstore. Get it at Barnes & Noble and all the other US ones. And I think you’ll really enjoy it. So, it’s a really lovely endorsement. Kim has also said it’s really good, and Kim is harsh. So, if Kim says it’s good, then it’s going to be good. And I hope you really enjoy it and pass it on to a loved one who doesn’t have anxiety, and you’ll find that, “Oh, I actually learned quite a lot there whilst laughing and being captivated by the absolute bananas behind-the-scenes life of being a therapist.”

Kimberley: Yeah, I love it. Josh, the way that you present it, if I was scared to go to therapy, I think it would make me less scared. I think it would make me feel like this is something I could do.

Joshua: And that’s the best compliment I can receive, because that’s why I wrote the book. So, thank you so much.

Kimberley: Yeah. So fun to have you. Thanks for being here.

Joshua: Thanks, Kim.

In the realm of mental health, the significance of structured daily routines for depression cannot be overstated. Kimberley Quinlan, an anxiety specialist with a focus on mindfulness, Cognitive Behavioral Therapy (CBT), and self-compassion, emphasizes the transformative impact that Daily Routines for Depression can have on individuals grappling with this challenging condition.

Depression, characterized by persistent feelings of sadness, hopelessness, and a lack of interest in once-enjoyable activities, affects every aspect of one's life. Quinlan stresses that while professional therapy and medication are fundamental in the treatment of depression, integrating specific daily routines into one's lifestyle can offer a complementary path toward recovery and mental wellness.

THE POWER OF MORNING ROUTINES FOR DEPRESSION

Starting the day with a purpose can set a positive tone for individuals battling depression. Quinlan recommends establishing a consistent wake-up time to combat common sleep disturbances associated with depression. Incorporating light physical activity, such as stretching or a gentle walk, can significantly boost mood. Mindfulness practices, including meditation, journaling, or gratitude exercises, can help foster a healthier relationship with one's thoughts and emotions. Additionally, a nutritious breakfast can provide the necessary energy to face the day, an essential component of "Daily Routines for Depression."

DAYTIME ROUTINES FOR DEPRESSION

Throughout the day, setting realistic goals and priorities can help maintain focus and motivation. Quinlan advocates for the inclusion of pleasurable activities within one's schedule to counteract the anhedonia often experienced in depression. Techniques like the Pomodoro Method can aid in managing tasks without becoming overwhelmed, breaking down activities into manageable segments with short breaks in between. Exposure to natural light and ensuring a balanced diet further contribute to improving mood and energy levels during the day.

EVENING ROUTINES FOR DEPRESSION

As the day draws to a close, engaging in a digital detox and indulging in relaxation techniques become crucial. Limiting screen time and investing time in hobbies or skills can provide a sense of accomplishment and fulfillment. Establishing a calming bedtime routine, including activities like reading or taking a bath, can enhance sleep quality, an essential factor in "Daily Routines for Depression."

WEEKLY ACTIVITIES TO OVERCOME DEPRESSION

Quinlan also highlights the importance of incorporating hobbies and community engagement into weekly routines. Finding a sense of belonging and purpose through social interactions and new skills can offer a much-needed respite from the isolating effects of depression.

NAVIGATING TOUGH DAYS WITH COMPASSION

Acknowledging that the journey through depression is fraught with ups and downs, Quinlan advises adopting a compassionate and simplified approach on particularly challenging days. Focusing on basic self-care and seeking support when needed can provide a foundation for resilience and recovery.

In conclusion, Daily Routines for Depression are not just about managing symptoms but about rebuilding a life where mental wellness is prioritized. Through mindful planning and self-compassion, individuals can navigate the complexities of depression and move towards a more hopeful and fulfilling future.

PODCAST TRANSCRIPT

If you’re living with depression today, we are going to go through some daily routines for your mental wellness. 

Welcome. My name is Kimberley Quinlan. I’m an anxiety specialist. I talk all about mindfulness, CBT, self-compassion, and skills that you can use to help you with your mental wellness. 

Let’s talk about living with depression, specifically about daily routines that will set you up for success. My goal first is to really highlight the importance of routines. Routines are going to be the most important part of your depression recovery, besides, of course, seeing your therapist and talking with your doctor about medication. 

This is the work that we do at home every day to set ourselves up for success, finding ways that we can manage our depression, overcome our depression by tweaking the way in which we live our daily life because the way we live our lives often will impact how severe our depression can get.

There are some behaviors and actions that can very much exacerbate and worsen depression. And there are some behaviors and routines that can very much improve your depression. So, let’s talk about them today.

DEPRESSION SYMTPOMS

Let’s first just get really clear on depression and depression symptoms. Depression is a common and can be a very serious mental illness and medical condition that can completely negatively impact your life—the way you feel, the way you think, the way you act. It often includes persistent feelings of sadness, emptiness, hopelessness, worthlessness that can really impact the way you see yourself and your own identity. It often includes a lack of interest in pleasure in the activities that you once enjoyed. 

Depression symptoms can vary from mild to very severe. They can include symptoms such as changes in appetite, sleep disturbances, loss of energy, excessive guilt, difficulty thinking or concentrating. Sometimes you can feel like you have this whole brain fog. And again, deep, overwhelming feelings of worthlessness and hopelessness. 

Now, it is important to recognize that depression is not just a temporary bout of sadness. It’s a chronic condition. It’s one that we can actually recover from, but it does require a long-term treatment plan, a commitment to taking care of yourself, including therapy and medication. So, please do speak to your medical professional and a mental health professional if you have severe depression or think you might have severe depression. 

It can also include thoughts of wanting to die and not feeling like you want to live on this earth anymore. Again, if that’s something that you’re struggling with, please go to your local emergency room or immediately seek out professional mental health or medical health care. 

It is so important that you do get professional help for depression because, again, depression can come down like a heavy cloud on our shoulders, and it tells a whole bunch of lies. We actually have a whole podcast episode about how depression is a big fat liar. And sometimes when you are under the spell of those lies, it’s hard to believe that anything else might be true. So, it’s very important that we take it seriously. And as we’re here today to talk about, it’s to create routines that help really nurture you and help you towards that recovery. 

TREATMENT FOR DEPRESSION

Before we move into those routines, I want to quickly mention the treatment for depression. The best treatment for depression is cognitive behavioral therapy. Now there is often a heavy emphasis on mindfulness and self-compassion as well. Cognitive behavioral therapy looks at both your thoughts and your behaviors. And it’s important that we look at both because both can impact the way in which this disorder plays out. 

If you don’t have access to a mental healthcare professional, we also have an online course called Overcoming Depression. Overcoming Depression is an on-demand online course where I teach you the exact steps that I use with my clients to propel them into setting up their cognition so that they’re healthy, their behaviors, so that they bring a sense of pleasure and motivation, and structure into their daily lives. And then we also very heavily emphasize self-compassion and that mindfulness piece, which is so important when it comes to managing highly depressive and hopeless thoughts. So, that’s there if you want to go to CBTSchool.com/depression, or you could go to CBTSchool.com, and we have all the links right there. 

DAILY ROUTINES FOR DEPRESSION

All right, so let’s talk about daily routines for depression. Research shows that, specifically for depression, finding a routine and a rhythm in your day can greatly improve the chances of your long-term recovery. And so, I really take time and slow down with my patients and talk to them about what routines are working and what routines are not. I’m not here to tell you or my patients, or my students how to live their lives and what to do specifically. I’m really interested at looking at what’s working for you and what’s not. Let’s first start with morning routines. 

What often very much helps—and maybe you already have this, but if not, this is something I want you to consider—is the importance of a consistent wake-up time. When you’re depressed, as I mentioned before, a common depression symptom is sleep disturbance. Often, people lay awake all night and sleep all day, or they sleep all night and they sleep all day, and they’re heavily overwhelmed with this sleepy exhaustion. It is really important when it comes to morning routines that you set a time to wake up every morning and you get up, even if it’s for a little bit, if that’s all you can handle. Try to set that really consistent wake-up time. 

What I want to emphasize as we go through these routines for depression is I don’t mind if you even do tiny baby steps. One thing you might want to start from all of the ideas I give you today, you might just want to pick one. And if that’s all you can do, that is totally okay. 

What we also want to do is we want to, if possible, engage in some kind of light movement, even stretching, to boost mood. There’s a lot of routine, even just stretching or gentle walks outside. It doesn’t have to be fast. It doesn’t have to be for an hour. It could be for a quarter of a block to start with. But that light exercise has been shown to boost mood significantly. And then if you’re able, maybe even to do that multiple times throughout the day. 

Another morning routine that you may want to consider is some type of mindfulness practice. Again, we cover this in overcoming depression and with my patients in CBT, but some kind of mindfulness practice. It might be journaling, it could be a gratitude practice, it could be preferably some kind of meditation. Often, what I will encourage my clients to do is just listen to a guided meditation, even if you don’t really follow along exactly. But you’re just learning about these concepts. You’re learning about the tools. You’re getting curious about them if that’s all you can do. Or if you want, you could even go more into reading a book about mindfulness, starting to learn about these ideas and concepts because they will, again, help you to have a better relationship with your thoughts and your feelings. 

Another morning routine I want you to maybe consider here is to have some type of nutritious breakfast, something that supports your mental health. We want to keep an eye out for excessive sugar, not that there’s anything wrong with sugar, but it can cause us to have another energy dump, and we want to have something that will improve our energy. With depression, usually, we don’t have much energy at all. So, whatever tastes yummy, even if nothing feels yummy, but there’s something that maybe slightly sounds good, have that. If it’s something that you enjoy or have good memories about, or if it’s anything at all, I’m happy just for you to eat anything at all if it’s not something that you’ve been doing. 

Let’s now move over to work-day or daytime strategies or routines. The first thing I want you to consider here throughout the day is setting realistic daily goals and priorities. We have a course at CBT School called Optimum Time Management, and one of the core concepts of that course, which teaches people how to manage their time better, is we talk about first prioritizing what’s most important. 

If you have depression, believe it or not, one of the most important things you can do to prioritize in your daily schedule is pleasure. And I know when you have depression, sometimes nothing feels pleasurable. But it’s so important that you prioritize and schedule your pleasure first. Where in the day can you make sure that you do something enjoyable, even if it’s this enjoyable, even if nothing is enjoyable, but you used to find it enjoyable? We want to prioritize your self-care, prioritize your eating, having a shower, brushing your teeth. If nothing else gets done that day, that’s okay. But we want to prioritize them depending on what’s important to you. 

Now, if you’re someone who’s depressed because you’re so overwhelmed with everything that you have to do—again, we talk about this in the time management course—we want to really look at the day and look at the schedule and say, “Is this schedule nurturing a mental health benefit to me? Is it maybe time for me to reprioritize and take things off my schedule so I can get my mental health back up to the optimum level?” 

I have had to do this so many times in the last few years, especially as I have suffered a chronic illness, really separate like an hour to really look at the calendar and say, “Are these things I’m doing actually helping me?” Sometimes I found I was doing things for the sake of doing them to check them off the list, but I was getting no mental benefit from them. No real value benefit from them either. 

Another daytime strategy you can use is a technique or a tool called the Pomodoro Technique or the Pomodoro Method. This is where we set a timer for a very short period of time and we go and we do the goal and we focus on the thing for a short period of time. So, an example might be I might set a timer for 15 minutes, and all I’m going to do during that 15 minutes is write email. If 15 minutes is too much for you, let’s say maybe you need to tidy up your dishes, you might set a timer for 45 seconds and just get done with what you can for 45 seconds and then take a short break. Then you set the timer again. All I have to do is 45 seconds or a minute and a half or three minutes or five minutes, whatever is right for you, and put your attention on just getting that short Pomodoro little bout done. 

This can be very helpful to maintain focus. It can be very helpful to maintain the stress of that activity, especially if it’s an activity that you’re dreading. And so, do consider the Pomodoro technique. You can download free apps that have a Pomodoro timer that will set you in little increments. It was actually, first, I think, created for exercise. So, it sets it like 45 minutes on, 20 seconds off, 45 seconds on. And so, you can do that with whatever task you’re trying to get done as well. 

Another daytime routine I want you to consider is getting some kind of natural light or going outdoors. There is so much research to show that going outside, even if it’s for three minutes, and taking in the green of the earth or the dirt under your feet, really getting in touch and grounding with some kind of nature, or being in the sunlight, can significantly improve mood. So, consider that as well. And again, I’m going to mention, make sure you eat lunch. Eat something that boosts your mood and boosts your energy levels. 

Now let’s talk about evening or wind-down routines for depression or practices. Now, number one, one of the things that we often do the most, which we really need to be better about, and this is me too, is doing some kind of digital detox in the evenings. Try your hardest to limit screen time before bed because we know screens before bed actually disturb our sleep. We also know that often we spend hours, hours of our day scrolling on social media. And even though that might feel pleasurable, it actually removes us from engaging in hobbies and things that actually make us feel good about ourselves. 

One of the best ways to feel good about who you are and to feel accomplished is to be learning something or mastering something. I don’t care if it’s something that you’re starting and you’re terrible at. We have a lot of research that even moving and practicing a skill will improve and boost your mood so much more than an hour of sitting and watching funny TikTok videos. 

Now, again, if all you want to do is that for right now, that’s fine. Maybe spend five minutes doing some hobby or task—something that you enjoy or used to enjoy—that you feel like you’re getting better at. Maybe you learn Spanish, you learn to crochet, you learn to knit, you do paint by number. It doesn’t matter what it is. Just pick something and work at something besides looking at a screen, especially in the evenings. 

Another evening routine I want you to consider is some kind of relaxation technique for depression—reading, take a bath, maybe do again some stretching or some light yoga, maybe dance to one song. Anything you can do to, again, move your body. Again, we have so much research to show that moving your body gently, especially in the evening, can help with mood. 

Another thing here is to find a comfortable sleep routine and bedtime routine. So, if you can, again, go back to your scheduling, and if you’re not good at this—we do have that online course for time management—create a nighttime routine that feels yummy in your bones. Maybe it’s reading a book, a lovely warm blanket, the pillow you love, a scent—sometimes an oil diffuser would be lovely for you. Dim the lights, close the blinds, create a nice, warm, cozy nook where you can then ease into your sleep. 

Overall, weekly activities and routines that you may want to consider for your mental wellness include again finding hobbies. It doesn’t have to be grand. You don’t have to sign up for a marathon. You don’t have to become an amazing artist. You can just pick something that you suck at. That’s okay. 

I always tell my patients to do paint by number. It requires very little mental energy, but you do have this cool thing that you did at the end that you can gift somebody, or you can even scrap it at the end, it doesn’t matter. Put it up on your wall—anything to get you out of your head and out of the mood piece—and really get into your body, moving your hands and thinking about focusing on other things. 

One of the most important things that you can do to help boost mood and decrease depression is to find a community of like-minded people. The social interaction and improving and maintaining connections between people are going to be so important. In fact, in some countries, the treatment per se for depression, no matter how depressed somebody is, the community go and get them, bring them out, they have a party for them, they cook for them, they surround them, they dance with them. And that’s how those communities and tribes help people get through depression. And we in our Western world have forgotten this beautiful, important piece of community and being a part of a big community family. 

Now, if you have struggled with this and it’s been difficult, I encourage you to reach out to support groups. There are so many ways—meet-up groups, local charities, volunteering, maybe finding again a hobby, but a place where you go and you’re with other people, even just doing that. You don’t have to spend a lot of time, but being around people. Even though when you’re depressed, I know it doesn’t feel like that’s a helpful thing. We do know that it does connect those neural pathways in our brain and does help with the management and maintenance of depression recovery. 

Now, what do we do, and how can we maintain these routines on the really tough days? When it comes to handling the tough days, I understand it can feel overwhelming. All of this can feel like so, so much. But what I’m going to encourage you to do is keep it really simple. Just doing your basic functioning is all that’s required on those really tough days. It doesn’t matter if you don’t get all the things done on your list. Be compassionate, be gentle, encourage yourself, look at the things you did do instead of the things you didn’t get to do, and also seek support. Reach out to your mental health professional or a support group or your medical doctor or family or a friend or a neighbor if you’re really needing support. 

There will be hard days. Depression is not linear. Recovery for depression is not linear. It’s up and down. There will be hard days. So, be as gentle as you can. Keep it as simple and as basic as you can. Do one thing at a time. Try not to focus at the whole day and all the things you have to do. That’s going to help you feel less overwhelmed and, again, help you get through one thing a day. 

Let me do a quick recap. The importance of routine is huge. Routines are going to be probably one of the most important parts of your long-term recovery, besides, of course, treatment and medication. It will help you to get through the hard and stressful days and will also allow you to slowly make steps into the life that you want, and often, because we have depression, depression can take away the life that we want. So, that routine can help you slowly build up to the things that you want to do and get back to the life that you do really value. 

I encourage you all to play around with this. Remember, look at the routine you have already, and maybe add one thing for now. Take what works for you, but if some of the things I mentioned today, don’t leave them. Please don’t feel judged or embarrassed if some of these aren’t really working for you. We have to look at what works for us and be very gentle with ourselves with that as well.

I hope this has been helpful. The routines have really saved me in my mental health. And so, I hope it helps you just as much as it’s helped me. 

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

In the insightful podcast episode featuring Joanna Hardis, author of "Just Do Nothing: A Paradoxical Guide to Getting Out of Your Way," listeners are treated to a deep dive into the concept of distress tolerance and its pivotal role in mental health and personal growth. Joanna Hardis, with her extensive background in treating anxiety disorders such as panic disorder, OCD, and Generalized Anxiety Disorder, shares her professional and personal journey toward understanding and teaching the art of effectively managing internal discomfort without resorting to avoidance or escape tactics.

The discussion begins with an exploration of the title of Joanna's book, "Just Do Nothing," which encapsulates the essence of her therapeutic approach: the intentional practice of stepping back and allowing thoughts, feelings, and sensations to exist without interference. This practice, though seemingly simple, challenges the common impulse to engage with and control our internal experiences, which often exacerbates suffering.

A significant portion of the conversation is dedicated to "distress intolerance," a term that describes the perceived inability to endure negative emotional states. This perception leads individuals to avoid or escape these feelings, thereby increasing vulnerability to a range of mental health issues including anxiety, depression, and substance abuse. Joanna emphasizes the importance of recognizing and altering the self-limiting beliefs and thoughts that fuel distress intolerance.

Practical strategies for enhancing distress tolerance are discussed, starting with simple exercises like resisting the urge to scratch an itch and gradually progressing to more challenging scenarios. This gradual approach helps individuals build confidence in their ability to manage discomfort and makes the concept of distress tolerance applicable to various aspects of life, from parenting to personal goals.

Mindfulness is highlighted as a crucial component of distress tolerance, fostering an awareness of our reactions to discomfort and enabling us to respond with intention rather than impulsivity. The podcast delves into the importance of connecting with our values and reasons for enduring discomfort, which can provide the motivation needed to face challenging situations.

Joanna and Kimberley also touch on the common traps of negative self-talk and judgment that can arise during distressing moments, advocating for a more compassionate and accepting stance towards oneself. The idea of "choice points" from Acceptance and Commitment Therapy (ACT) is introduced, encouraging listeners to make decisions that align with their values and move them forward, even in the face of discomfort.

The episode concludes with a message of hope and empowerment: everyone has the capacity to work on expanding their distress tolerance. By starting with small, manageable steps and gradually confronting more significant challenges, individuals can cultivate a robust ability to navigate life's inevitable discomforts with grace and resilience.

EPISODE HIGHLIGHTS: 

• The Concept of "Just Do Nothing":
  • This core idea revolves around the practice of intentionally not engaging with every thought, feeling, or sensation, especially when they're distressing. It's about learning to observe without action, which can reduce the amplification of discomfort and suffering.
• Understanding Distress Intolerance:
  • Distress intolerance refers to the belief or perception that one cannot handle negative internal states, leading to avoidance or escape behaviors. This concept highlights the importance of recognizing and challenging these beliefs to improve our ability to cope with discomfort.
• Building Distress Tolerance:
  • The podcast discusses practical strategies to enhance distress tolerance, starting with simple exercises like resisting the urge to scratch an itch. The idea is to gradually expose oneself to discomfort in a controlled manner, thereby building resilience and confidence in handling distressing situations.
• Mindfulness and Awareness:
  • Mindfulness plays a crucial role in distress tolerance by fostering an awareness of our reactions to discomfort. This awareness allows us to respond intentionally rather than react impulsively. The practice of mindfulness helps in recognizing when we're "gripping" distressing thoughts or sensations and learning to gently release that grip.
• Aligning Actions with Values:
  • The podcast emphasizes the significance of connecting actions with personal values, even in the face of discomfort. This alignment can motivate us to face challenges and make choices that lead to personal growth and fulfillment, rather than making decisions based on the urge to avoid discomfort.

These concepts together form a comprehensive approach to managing distress and enhancing personal well-being, as discussed by Joanna Hardis in the podcast episode.

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TRANSCRIPTION: 

Kimberley: Welcome, everybody, today. We have Joanna Hardis. Joanna wrote an amazing book called Just Do Nothing: A Paradoxical Guide to Getting Out of Your Way. It was a solid gold read. Welcome, Joanna.

Joanna: Thank you. Thank you for having me. Thank you for reading it, too. I appreciate it.

Kimberley: It was a wonderful read and so on point, like science-backed. It was so good, so you should be so proud.

Joanna: Thank you.

Kimberley: Why did you choose the title Just Do Nothing?

Joanna: I mean, it’s super catchy, but more importantly than that, it is really what my work involves on a personal level and on a professional level—learning how to get out of my own way or our own way by leaving our thoughts alone, learning how to leave uncomfortable feelings alone, uncomfortable sensations alone, uncomfortable thoughts alone. Because that’s what creates the suffering—when we get so engaged in them.

Kimberley: Yeah. It’s such a hard lesson. I talk about this with patients all the time. But as I mentioned to you, even my therapist is constantly saying, “You’re going to have to just feel this one.” And my instinct is to go, “Nope. No thanks. There has to be another way.”

Joanna: A hundred percent. Yes. I mean, it really is something on a daily basis. I have to remind myself and work really hard to do.

Kimberley: It is. But it is such powerful work when you do it. 

Joanna: Mm-hmm. 

Kimberley: Early in the book, you talk about this term or this concept called ‘distress intolerance.’ Can you tell us what both of those are and give us some ideas on why this is an important topic?

Joanna: Sure, and this is what got me interested in the book and everything. Distress tolerance is a perception that you can handle negative internal states. And those internal states can be that you feel anxious, that you feel worried, you feel bored, vulnerable, ashamed, angry, sad, mad, off. There’s an A to Z alphabet of those unpleasant and uncomfortable emotional states. And when we have that perception that we can handle it, our behavior aligns, so we tend to do things. 

When we are distress-intolerant, we have a perception—often incorrect—that we cannot handle negative internal states. So then we will either avoid them or escape them or try to figure them out or neutralize them or try to get rid of them, make them stop—all the things that we see in our work every day. 

Before I had my practice in anxiety disorders, I worked over a decade in an eating disorder treatment center, and we know that when someone has really low distress tolerance, they are more vulnerable to developing eating disorders, anxiety disorders, depressive disorders, substance use disorders. So, it’s a really important concept.

Kimberley: It’s such an important concept. And you talk about how the thoughts we have which can determine that. Do you want to share a little bit about that? Because there was a whole chapter in the book about the thoughts you have about your ability to tolerate distress.

Joanna: Sure, and I didn’t answer the second part of your question., I just realized, which will tie into that, which is how it sounds. How it sounds is, “I can’t bear to feel this way, so I’m going to avoid that party,” or “I’m having too good of a day, so I can’t do my homework,” or “I can’t bear if my kids see me anxious, so we’re not going to go to the playground.”

And so, what drives someone’s perception are their thoughts and these thoughts and these self-limiting stories that we all have, and that oftentimes we just buy into as either true, or perhaps at one point, they may have been true, but we’ve outlived them.

Kimberley: Yeah. We’re talking about distress tolerance, and I’m always on the hunt to widen my distress tolerance to be able to tolerate higher levels of distress. And I think what’s interesting is, first, this is more of a question that I don’t know the science behind it, but do you think some people have higher levels of distress which makes them more intolerant, or do you think the intolerance which is what makes the distress feel so painful?

Joanna: I don’t know the research well enough to answer it. Because I think it’s rare that you see -- I mean, this is just one construct. So it’s very hard to isolate it from something like emotional sensitivity or anxiety sensitivity or intolerance for uncertainty, or something else that may be contributing to it.

Kimberley: Yeah. No, I know. It’s just a question I often think about, particularly when I’m with patients. And this is something that I think doesn’t really matter at the end of the day. What matters is—and maybe this will be a question for you—if our goal is to increase our distress tolerance, how might somebody even begin to navigate that?

Joanna: Sure. I love that question. I mean, in the book, I take it down to such a micro level, which is learning how—and I think you’ve talked about it on podcasts—itch serve. So, one of the exercises in the book is learning how you set your timer for five minutes and you get itchy, which of course is going to happen. And it’s learning how to ride out that urge to scratch the itch. So, paying attention to. If you zoom in on the itch, what happens?  What happens when you zoom out? What else can you pay attention to? 

And so when someone learns that process, that is on such a micro level. I often tell patients it’s like a one-pound weight.

Kimberley: Yes.

Joanna: And then what are some two-pound weights that people can use? So then, for many people, it’s their phone. So, it’s perhaps not checking notifications that come in right away. They begin to practice in low-distress situations because I want people to get confident that they know how to zoom in, they know how to zoom out. They know if they’re feeling a sensation, the more that they pay attention to it, the worse it’s going to feel. And so, where else can they put their awareness? What else can they be doing? 

And once they get the hang of it, we introduce more and more distress. So then, it might be their phone, then it might be them intentionally calling up a thought. And we work up that way with adding in, very gradually, more distress or more discomfort. Exercise is a great way, especially if it’s not married to anxiety, to get people interacting with it differently.

Kimberley: Yeah. We use this all the time with anxiety disorders. It’s a different language because we talk about an ERP hierarchy, or your exposure menu, and so forth. But I love that in the book, it’s not just specific to that. It could be like you talked about. It’s for those who have depression. It’s those who have grief. It’s those who have eating disorders. It’s those who have anger. I will even say the concept of distress tolerance to me is so interesting because there’s so many areas of my life where I can practice it. Like my urgency to nag my kids another time to get out the door in time, and I have to catch like, “You don’t need to say it the third time.” Can you tolerate your own discomfort about the time it’s taking them to get out the door? And I think that when we have that attitudinal shift, it’s so helpful.

Joanna: Yes. I find parenting as one of the hardest places for me, but it was also a reminder like the more I keep my mouth shut, the better.

Kimberley: Yeah. And I think that’s really where I was talking before. I found parenting to be quite a triggering process as my kids have gotten older, but so many opportunities for my own personal growth using this exact scenario. Like your fear might come up, and instead of engaging in that fear, I’m actually just going to let it be there and feel it and parent according to my values or act according to my values. And I’ve truly found this to be such a valuable tool.

Joanna: Yes. And I have found what’s been really interesting, when my kids were at home, that was where my distress was. Now that the two of the three are out of the house, my distress is when we’re all together and everyone have a good time. And so, it morphs, because what I tell myself and my perception and the urgency, it changes. It’s still so difficult with them, but it changes based on what’s happening.

Kimberley: Yeah. And I think this is an opportunity for everyone, too. How much do you feel that awareness piece is important in being aware that you are triggered? For the folks listening, of course, you’re on the Your Anxiety Toolkit podcast. Most are listening because they have anxiety. Do you encourage them to be aware of other areas? They can be practicing this. 

Joanna: Yes.

Kimberley: Can you talk to me about that?

Joanna: 100%, because I feel like -- what is that metaphor about the onion? It’s like the layers of an onion. So, people will come, and they’ll think it’s about their anxiety. But this is really about any uncomfortable feeling or uncomfortable sensation. And so. It may be that they’re bored or vulnerable or embarrassed or something else. So, once someone learns how to allow those feelings and do what is important to them or what they need to do while they feel it, then yes, I want them to go and notice where else in their life this is showing up.

Kimberley: Talk to me specifically about how in real-time, because I know that’s what listeners are going to ask. 

Joanna: Of course.

Kimberley: I have this scary thing I want to be able to do, but I don’t want to do it because I’m scared, and I don’t want to feel scared. How might someone practice tolerating their distress in real-time?

Joanna: I’m going to answer two ways. One, I would say that might be something to scale. Sometimes people want to do the thing because doing the thing is like the goal or the sexy thing, but if it’s outside of their window of tolerance, they may not be able to do it. So, it depends on what they want to do. So, I might say, as just a preface, this might be something that people should consider scaling. 

Kimberley: Gradual, you mean?

Joanna: Yes. So, for instance, they want to go to the gym, but they’re scared of fainting on the treadmill or something. Pretty common for what we see. It would be like, scale it back. So it might be going to the parking lot. It might be taking a tour. It might be going and standing on the treadmill. It might be walking on the treadmill. But we have to put it in smaller pieces. 

In the moment that we’re doing something that is difficult, first, we have to notice if we’re starting to grip. I use this “if we’re starting to grip” something. If we’re starting to zoom in on what we don’t like, if we’re starting to zoom in on a sensation we don’t like, a thought we don’t like, a feeling we don’t like, I want people to notice that and you get better at noticing it faster. 

The first thing is you got to notice it, that it’s happening, because that’s going to make it worse. So, you want to be able to notice it. You want to be able to loosen your grip on it. So, that might be finding out what else is going on in my surroundings. So, I’m on the treadmill, I’m walking maybe at a faster pace, and I’m noticing that my heart rate is going up, and I’m starting to zoom into that. What else am I noticing, or what else am I hearing? What else do I see? What else is going on around me? Can we make something else a louder voice?

And so, every time that my brain wants to go back to heart focus, it’s like, no, no. It’s taking it back to something else that’s going on. And it helps to connect with why is this important to do? So, as I’m continuing to say, “I’m okay. I am safe. I’m listening. I’m focusing on my music, and I’m looking out the window," This is really important to do because my health is important. My recovery is important. It becomes that you’re connecting to something that’s important, and the focus is not on what we don’t like because that’s going to make it bigger and stronger.

Kimberley: Right. As you’re doing that, as we’ve already mentioned, someone might be having those can’t thoughts, like I can’t handle it, even if it’s within their window of tolerance, right? It’s reasonable, and it’s an appropriate exposure. How might they manage this ongoing “You can’t do this, this is too hard, it’s too much, you can’t handle it” kind of thinking?

Joanna: I like “This may suck, and I can do it.”

Kimberley: It’s funny. I will tell you, it’s hilarious. In the very beginning of the book, you make some comments about the catchphrases and how you hate them, and so forth. I always laugh because we have a catchphrase over here, but it’s so similar to that in that we always talk about, like it’s a beautiful day to do hard things. And that seems to be so hopeful for people, but I do think sometimes we do get fed, like over positive ways. You have a negative thought, so we respond very positively, right? And so, I like “This is going to suck, and I’m going to do it anyway.”

Joanna: Yes. So you’re acknowledging this may suck, especially if you’re deconditioned, especially if you’re scared. It may suck AND—I always tell people not the BUT—AND I can do it. Even in 30-second increments. So, if someone is like, “I can’t, I cant,” I’ll say, “You can do anything for 30 seconds.” So then we pile on 30 seconds.

Kimberley: Yeah. And that’s such an important piece of it too, which is just taking a temporary mindset of we can just do this for a little tiny bit and then a little tiny bit and then a little tiny bit. 

Joanna: Yes, I love that. I love that.

Kimberley: Why do we do this? What’s the draw? Sell me on why someone wants to do this work.

Joanna: To do...?

Kimberley: Distress tolerance. We talk about this all the time. Why do we want to widen our distress tolerance?

Joanna: Oh my goodness. Oh my gosh. I think once you realize all the little areas that may be impacting one’s life, it just blows your mind. But in a practical sense, people can stay stuck. When people are stuck. This is often a piece. It’s absolutely not the whole reason people are stuck, but this is such a piece of why people get stuck. And so I think for anyone that might feel stuck, perhaps they want a different job or they want to show up differently as a parent or they feel like they are people-pleasers, or they’re having trouble dating because they get super controlling. It can show up in any area of one’s life.

Kimberley: Yeah. For me, the selling point on why I want to do it is because it’s like a muscle—if I don’t continue to grow this muscle, everything feels more and more scary.

Joanna: Oh, sure. Yeah, hundred percent.

Kimberley: The more I go into this mindset of “You can’t handle it and it’s too much, it’s too scary” things start to feel more scary. The world starts to feel more unsafe, whereas that attitude shift, there’s a self-trust that comes with it for me. I trust that I can handle things. Whereas if I’m in the mindset of “I can’t,” I have no self-trust. I don’t trust that I can handle scary things, and then I’m constantly hypervigilant, thinking when the next scary thing's going to happen.

Joanna: Right. Another reason to also practice doing it, if you never challenge it, you don’t get the learning that you can do it.

Kimberley: Yeah. There’s such empowerment with this work.

Joanna: Yes. And you don’t have to do big, scary things. You don’t have to jump out of an airplane to do it or pose naked, because I see that on Instagram now, people who are conquering their fears by doing these. Very Instagram-worthy tasks, which could be very scary. We can do it, just like you say, with not nagging our kids, by choosing what I want to make for dinner versus making so many dinners because I am so scared that I can’t handle it if my kids are upset with me.

Kimberley: Right. And for those who have anxiety, I think from the work I do with my patients is this idea of being uncertain feels intolerable. That feeling. You’re talking about these real-life examples. And for those who are listening with anxiety, I get it. That feeling of uncertainty feels intolerable, but again, that idea of widening your tolerance or increasing your ability to tolerate it in 10-second increments can stop you from engaging in compulsions that can make your disorder worse or avoiding which can make your disorder worse. Do you have any thoughts on that?

Joanna: I 100% agree with you. I always say, let’s demote intolerable to uncomfortable. Because I feel sometimes like I have to know I can’t stand it, I’m crawling out of my skin. But if I’m then able to get some distance from it, that’s the urgency of anxiety.

Kimberley: Yeah. It’s such beautiful work.

Joanna: Yes, and especially the more people do, they’re able to say, “You know what? I can do things.” It may feel intolerable. That diffusion, it may feel intolerable. It’s probably uncomfortable. So, what is the smallest next step I can take in this situation to do what I need to do and not make it worse? That’s a big thing of mine—not making a situation worse.

Kimberley: Yes. And that’s where the do-nothing comes in.

Joanna: Yes. That’s the paradoxical part. 

Kimberley: Yeah. Is there any area of this that you feel like we haven’t covered that’s important to you, that would be an important piece of this work that someone may consider as they’re doing this work on their own?

Joanna: I think and I know that you are a big proponent of this too. I think it’s very hard to do this work without some mindful awareness practice. And I talk about it in the book. It’s just such an enhancer. It enhances treatment, but it also enhances our daily life. So, I can’t say strongly enough that it is so important for us to be able to notice this pattern when we are saying, “Oh my gosh, I can’t take this,” or “I can’t do this.” And then the behavior and to think about what’s the function of me avoiding. But if we’re going so fast and our gas pedal is always to the floor, we don’t have the opportunity to notice.

Kimberley: Yeah, the mindfulness piece is so huge. And even, like you’re saying, the mindfulness piece of the awareness but also the non-judgment in mindfulness. As you’re doing the hard thing, as you’re tolerating distress, you’re not sitting there going, “This sucks and I hate it.” I mean, you’re saying like it will suck, and that's, I think, validating. It validates you, but not staying in “This is the worst, and I hate it, and I shouldn’t be here.” That’s when that suffering does really show up. 

Joanna: Yes. The situation may suck. It doesn’t mean I suck. That was a hard lesson to learn. The situation may, but I don’t have to pour gas on it by saying, “How long is it going to last? Oh my gosh, this feeling’s never going to end. Do I still feel it? Oh my gosh, do I still feel it as much?” All the things that I’m prone to do or my clients are prone to do that extend the suffering.

Kimberley: Make it worse.

Joanna: Yeah, exactly.

Kimberley: It’s a great question, actually. And I often will talk with my patients about it, in the moment, when they’re in distress. Sometimes writing it down, like what can we do that would make this worse? What can we do that will make this better? And sometimes that is doing nothing at all. And you do talk about that in the book.

Joanna: Yeah.

Kimberley: The forward and the backward. 

Joanna: The choice points. Yes.

Kimberley: Can you share just a little bit about that?

Joanna: It’s a concept from ACT (Acceptance and Commitment Therapy) that says, when we have a behavior, a behavior can either move us toward or forward what’s meaningful in our values or can move us away from it. And so, as we’re thinking about doing whatever the hard thing maybe or it may not even be a hard thing; it just may be something you don’t want to do. Thinking about what your why is, what’s the forward move? Why is it meaningful to you? What do you stand to get? What’s on the other side? Because most of us are well versed, and if we give in, that’s an away move. And we have to be able to do this non-judgmentally because some days it’s just not in us, and that’s totally fine. But I want people to be honest with themselves and non-judgmental about whatever decisions they make. But it does help to have a reason that moves us forward.

Kimberley: Absolutely. I think that’s such an important piece of the work. Again, that’s the selling point of why we would want to be uncomfortable. There’s a goal or a why that gets us there.

Joanna: Yeah. And it’s amazing how much pain we will put up with. I mean, think about all the things people like—waxing and some of these exercise classes. It’s amazing because it’s important to someone.

Kimberley: Exactly. And I think that’s a great point too, which is we do tolerate distress every day when we really are clear on what we want. And I think sometimes we have these things like I can’t handle it, but you might even ask like, what are some harder things that I’ve actually tolerated in my lifetime?

Joanna: Yes, exactly because there’s a lot of things you’re so right that we do that are uncomfortable, but it’s worth it because, for whatever reason, it’s worth it.

Kimberley: Yeah, I love this. I have loved chatting with you. I know I’ve asked you this already, but is there any final words you want to share before we learn more about you and where people can get in touch with you?

Joanna: I just want people to know that anybody can do this. It may be that it’s just creating the right scale—a small enough step forward—but anybody can work on this. There are so many areas and ways in which we can strengthen this muscle. And so there is hope. No one is broken. It may be that people just don’t know the next best move.

Kimberley: I love that. Thank you. Where can people hear more about you and get in touch with you?

Joanna: My website is JoannaHardis.com and my Instagram is the same thing, @JoannaHardis. And excitingly, the book just came out in audio yesterday. 

Kimberley: Congratulations. 

Joanna: Thank you. Thank you. 

Kimberley: That’s wonderful. And we can get the book wherever books are sold. 

Joanna: Wherever books are sold, yes.

Kimberley: I really do encourage people to buy it. I think it’s a book you could pick up and read once a year, and I think that there’s messages. You know what I’m saying? There are some books where you could just revisit and take something from, so I would really encourage people to buy the book and just dabble in the many concepts that you share.

Joanna: Wonderful. Thank you.

Kimberley: Yeah. Thank you so much for being on the show. This is such a concept and a topic that I’m really passionate about, and for myself too. I think it’s something I’ll be working on until I’m 99, I think.

Joanna: Me too. I’m with you right there.

Kimberley: There’s always an opportunity where I’m like, “Oh okay. There’s another opportunity for me to grow. All right, let’s get on board. Let’s go back to the school.” So, I think it’s really wonderful. Thank you so much for being here.

Joanna: Thank you so much for having me.

Visual Staring OCD (also known as Visual Tourrettic OCD), a complex and often misunderstood form of Obsessive-Compulsive Disorder, involves an uncontrollable urge to stare at certain objects or body parts, leading to significant distress and impairment. In an enlightening conversation with Kimberley, Matt Bannister shares his journey of overcoming this challenging condition, offering hope and practical advice to those grappling with similar issues.

Matt's story begins in 2009, marked by a sense of depersonalization and dissociation, which he describes as an out-of-body experience and likened to looking at a stranger when viewing himself in the mirror. His narrative is a testament to the often-overlooked complexity of OCD, where symptoms can extend beyond the stereotypical cleanliness and orderliness.

Kimberley's insightful probing into the nuances of Matt's experiences highlights the profound impact of Visual Staring OCD on daily life. The disorder manifested in Matt as an overwhelming need to maintain eye contact, initially with female colleagues, out of fear of being perceived as disrespectful. This compulsion expanded over time to include men and intensified to such a degree that Matt felt his mind couldn't function normally.

The social implications of Visual Staring OCD are starkly evident in Matt's recount of workplace experiences. Misinterpretation of his behavior led to stigmatization and gossip, deeply affecting his mental well-being and leading to self-isolation. Matt's story is a poignant illustration of the societal misunderstandings surrounding OCD and its variants.

Treatment and recovery form a significant part of the conversation. Matt emphasizes the role of Cognitive Behavioral Therapy (CBT) and Exposure and Response Prevention (ERP) in his healing process. However, he notes the initial challenges in applying these techniques, underscoring the necessity of a tailored approach to therapy.

Kimberley and Matt delve into the power of community support in managing OCD. Matt's involvement with the IOCDF (International OCD Foundation) community and his interactions with others who have overcome OCD, like Chris Trondsen, provide him with valuable insights and strategies. He speaks passionately about the importance of self-compassion, a concept introduced to him by Katie O'Dunne, and how it transformed his approach to recovery.

A critical aspect of Matt's journey is the realization and acceptance of his condition. His story underscores the importance of proper diagnosis and understanding of OCD's various manifestations, which can be as unique as the individuals experiencing them.

Matt's narrative is not just about overcoming a mental health challenge; it's a story of empowerment and advocacy. His transition from a struggling individual to a professional peer support worker is inspiring. He is now dedicated to helping others navigate their paths to recovery, using his experiences and insights to offer hope and practical advice.

In conclusion, Matt Bannister's journey through the complexities of Visual Staring OCD is a powerful testament to the resilience of the human spirit. His story offers valuable insights into the disorder, challenges misconceptions, and highlights the importance of tailored therapy, community support, and self-compassion in overcoming OCD. For anyone struggling with OCD, Matt's story is a beacon of hope and a reminder that recovery, though challenging, is within reach.

Instagram - matt bannister27

Facebook - matthew.bannister.92

Facebook group - OCD Warrior Badass Tribe

Email :matt3ban@hotmail.com

Kimberley: Welcome back, everybody. Every now and then, there is a special person that comes in and supports me in this way that blows me away. And today we have Matt Bannister, who is one of those people. Thank you, Matt, for being here today. This is an honor on many fronts, so thank you for being here.

Matthew: No, thank you for bringing me on, Kim. This is a huge honor. I’m so grateful to be on this. It’s just amazing. Thank you so, so much. It’s great to be here.

Kimberley: Number one, you have been such a support to me in CBT School and all the things that I’m doing, and I’ve loved hearing your updates and so forth around that. But today, I really want you to come on and tell your story from start to end, whatever you want to share. Tell us about you and your recovery story.

Matthew: Sure. I mean, I would like to start as well saying that your CBT School is amazing. It is so awesome. It’s helped me big time in my recovery, so I recommend that to everyone.

I’m an IOCDF grassroots advocate. I am super passionate about it. I love being involved with the community, connecting with the community. It’s like a big family. I’m so honored to be a part of this amazing community.

My recovery story and my journey started back in 2009, when—this is going to show how old I am right now—I remember talking on MSN. I remember I was talking; my mind went blank in a conversation, and I was like, “Ooh, that’s weird. It’s like my mind’s gone blank.” But that’s like a normal thing. I can just pass it off and then keep going forward. But the thing is with me. It didn’t. It latched on with that. I didn’t know what was going on with me. It was very frightening.

I believe that was a start for me with depersonalization and dissociation. I just had no idea of what it was. Super scary. It was like I started to forget part of my social life and how to communicate with people. I really did start to dissociate a lot when I was getting nervous. And that went on for about three or four years, but it gradually faded naturally.

Kimberley: So you had depersonalization and derealization, and if so, can you explain to listeners what the differences were and how you could tell the differences?

Matthew: Yeah. I think maybe, if I’m right with this, with the depersonalization, it felt like I knew how it was, but I didn’t at the same time. It was like when I was looking in a mirror. It was like looking at a stranger. That’s how it felt. It just felt like I became a shell of myself. Again, I just didn’t know what was happening. It was really, really scary. I think it made it worse. With my former friends at that time, we’d make fun of that, like, “Oh, come on, you’re not used to yourself anymore. You’re not as confident anymore. What’s going on? You used to try and take the [03:19 inaudible] a lot with that.”

With the dissociation, I felt like I was having an out-of-body experience. For me, if I sat in a room and it was really hitting me hard, as if I were anxious, it would feel like I was floating around that room. I couldn’t concentrate. It was very difficult to focus on things, especially if it was at work. It’d be very hard to do so. That came on and off.

Kimberley: Yeah, it’s such a scary feeling. I’ve had it a lot in my life too, and I get it. It makes you start to question reality, question even your mental health. It’s such a scary experience, especially the first time you have it. I remember the first time I was actually with a client when it started.

Matthew: Yeah, it is. Again, it is just a frightening experience. It felt like even when I was walking through places, it was just fog all the time. That’s how it felt. I felt like someone had placed a curse on me. I really believe that with those feelings, and how else can I explain it? But that did eventually fade, luckily, in about, like I said, three to four years, just naturally on its own. When I had those sensations, I got used to that, so I didn’t put as much emphasis on those situations. Then I carried on naturally through that.

Then, well, with going through actually depersonalization, unfortunately, that’s when my OCD did hit. For me, it was with, I believe, relationship OCD because I was with someone at the time. I was constantly always checking on them, seeing if they loved me. Like, am I boring you? Because I thought of depersonalization. I thought I wasn’t being my full authentic self and that you didn’t want to be within me anymore. I would constantly check my messages. If they didn’t put enough kisses on the end of a message, I think, “Oh, they don’t love me as much anymore. Oh no, I have to check.” All the time, even in phone calls, I always made sure to hear that my partner would say, “Oh, I love you back,” or “I love you.” Or as I thought, I did something wrong. Like they’re going off me. I had a spiral, thinking this person was going to cheat on me. It went on and on and on and on with that. But eventually, again, the relationship did fade in a natural way. It wasn’t because of the OCD; it was just how it went.

And then, with relationship OCD, with that, I faded with that. A search with my friends didn’t really affect me with that. Then what I can recall, what I have maybe experienced with OCD, I’ve had sexual orientation OCD. Again, I was questioning my sexuality. I’m heterosexual, and I was in another warehouse, a computer warehouse, and it was all males there. I was getting what I describe as intrusive thoughts of images of doing sexual acts or kissing and stuff like that. I’m thinking, “Why am I getting these thoughts? I know where my sexuality is.”

There’s nothing wrong, obviously, with being homosexual or queer. Nothing wrong with that at all. It’s just like I said, that’s how it fades with me. I mean, it could happen again with someone who’s queer, and it could be getting heterosexual thoughts. They don’t want that because they know they’re comfortable with their sexuality. But OCD is trying to doubt that. But then again, for me, that did actually fade again after about five or six months, just on its own.

And then, fast forward two years later is when the most severe theme of OCD I’ve ever had hit me hard like a ton of bricks. And that for me was Visual Tourettic OCD, known as Staring OCD, known as Ocular Tourettic OCD. And that was horrendous. The stigma I received with this theme was awful.

I remembered the day when it hit me, when I was talking to a female colleague. Like we all do, we all look around the room and we try and think of something to say, but my eyes just landed on the chest, like just an innocent look. I’m like, “Oh my God, why did I do that? I don’t want to disrespect this person in front of me. I treat her as an equal. I treat everyone the same way. I don’t want to feel like she’s being disrespected.” So I heavily maintained eye contact after that. Throughout that conversation, it was fine. It was normal, nothing different. But after that, it really latched onto me big time. The rumination was massive. It was like, you’ve got to make sure you’re giving every single female colleague now eye contact. You have to do it because you know otherwise what stigma you could get. And that went on for months and years, and it progressed to men as well a couple of years later. It felt like my mind can’t function anymore.

I remember again I was sitting next to my friend, who was having a game on the PlayStation. And then I just looked at his lap, just for no reason, just looked at his lap, and he said, “Ooh, I feel cold and want to go and change.” I instantly thought, “Oh my God, is it because he thought I might have stared that I creeped him out?” And then it just seriously latched onto me big time.

As we all know, with this as well, when we think of the pink elephant allergy, it’s like when we don’t think of the pink elephant, what do we do? And that’s what it was very much like with this.

I remember when it started to get really bad, my eyes would die and embarrass somebody part places. It was like the more anxious I felt about not wanting to do it, the more it happened, where me and my good friend, Carol Edwards, call it a tick with the eye movement. So like Tourette, let’s say, when you get really nervous, I don’t know if this is all true. When someone’s really nervous, maybe they might laugh involuntarily, like from the Joker movie, or like someone swearing out loud. This is the same thing with eye movement. Every time I was talking to a colleague face-to-face to face, I was giving them eye contact, my mind would be saying to me, “Don’t look there, don’t look there, don’t look there,” and unfortunately think it would happen. That tick would happen. It would land where I wouldn’t want it to land.

It was very embarrassing because eventually it did get noticed. I remember seeing female colleagues covering their hi vis tops, like across their arms. Men would cover their crotches. They would literally cross their legs very blatantly in front of me. Then I could start to hear gossip. This is when it got really bad, because I really heard the stigma from this. No one confronted me by the way of this face-to-face, but I could hear it crystal clear. They were calling me all sorts, like deviant or creep or a perv. “Have you seen his eyes? Have you seen him looking and does that weird things with his eyes? He checks everyone out.”

It was really soul-destroying because my compulsion was to get away from everyone. I would literally hide across a room. Where no one else was around, I would hide in the cubicles because it was the only place where I wasn’t triggered. It got bad again. It went to my family, my friends, everyone around me. It didn’t happen with children, but it happened with every adult. It was horrendous.

I reached out to therapy. Luckily, I did get in contact with a CBT therapist, but it was talk therapy. But it’s better than nothing. I will absolutely take that. She was amazing. I can’t credit my therapist enough. She was awesome. If this person, maybe this is like grace, you’re amazing, so thank you for that. She was really there for me. It was someone I could really talk to, and it can help me and understand as best as she could.

She did, I believe, further research into what I had. And then that’s when I finally got diagnosed that I had OCD. I never knew this was OCD, and everything else made sense, like, “Oh, this is why I was going through all those things before. It all now makes concrete sense what I was going through.”

Then I looked up the Facebook group called Peripheral Vision/Visual Tourettic OCD. That was a game-changer for me. I finally knew that I wasn’t alone because, with this, you really think you’re alone, and you are not. There are thousands of people with this, or even more. That was truly validating. I was like, “Thank God I’m not the only one.”

But the problem is, I didn’t really talk in that group at first because I thought if other people saw me writing in that group, it’s going to really kill my reputation big time. That would be like the final nail in the coffin. Even though it was a private group, no one could do that. But I didn’t still trust it that much at that time.

I was doing ERP, and I thought great because I’ve researched ERP. I knew that it’s effective. Obviously, it’s the gold standard. But for me, unfortunately, I think I was doing it where I was white-knuckling through exposures. Also, when I was hearing at work, still going back to my most triggering place, ERP, unfortunately, wasn’t working for me because I wasn’t healing. It was like I was going through the trigger constantly. My mind was just so overwhelmed. I didn’t have time to heal.

I remember I eventually self-isolated in my room. I didn’t go anywhere. I locked myself away because I thought I just couldn’t cope anymore. It was a really dark moment. I remember crying. It was just like despair. I was like, “What’s happening to me? Why is all this happening to me?”

Later on, I did have the choice at work. I thought, I can either go through the stillest, hellacious process or I can choose to go on sick leave and give my chance to heal and recover. That’s why I did. And that was the best decision I ever made. I recommend that to anyone who’s going through OCD severely. You always have a choice. You always have a choice. Never pressure yourself or think you’re weak or anything like that, because that’s not the case. You are a warrior. When you’re going through things like this, you are the most strongest person in the world. It takes a lot of courage to confront those demons every single day to never ever doubt yourself with that. You are a strong, amazing individual.

When I did that, again, I could heal. It took me two weeks. Unfortunately, my therapy ended. I only had 10 sessions, but I had to wait another three months for further therapy in person, so I thought, “Oh, at least I do eventually get therapy in person. That’s amazing.”

And then the best thing happened to me. I found the IOCDF community. Everything changed. The IOCDF is amazing. The best community, in my opinion, the world for OCD. My god, I remember when I first went on Ethan’s livestream with Community Conversations. I reached out to Ethan, and he sent me links for OCD-UK. I think OCD Action as well. That was really cool of him and great, and I super appreciate that, and you knew straight away because I remember watching this video with Jonathan Grayson, who is also an amazing guy and therapist, talking about this. I was like, again, this is all that I have.

And then after that, I reached out to Chris Trondsen as the expert. What Chris said was so game-changing to me because he’s gone through this as well and has overcome it. He’s overcome so many severe themes of OCD. I’m like, “This guy is amazing. He is an absolute rock star. Literally like a true champion.” For someone to go through as much as he has and to be where he is today, I can’t ask for any more inspirement from that. It’s just incredible. He gave some advice as well in that livestream when we were talking because I reached out and said, how did you overcome this? He said, “With the staring OCD, well, I basically told myself, while I’m staring, well, I might as well stare anyway.” And that clicked with me because I’m thinking he’s basically saying that he just didn’t give it value anymore. I’m like, “That’s what I’ve been doing all this time. I’ve given so much value, so much importance. That’s why it keeps happening to me.” I’m like, “Okay, I can maybe try and work with this.”

Then I started connecting with Katie O'Dunne, who is also amazing. She was the first person I actually did hear about self-compassion. I’m like, “Yes, why didn’t I learn about this early in my life? Self-compassion is amazing. I need to know all about this.” It makes so much sense. Why’d I keep beating myself up when I treat a friend, like when I talked to myself about this? No, I wouldn’t. I just watched Katie’s streams and watched her videos and Instagram. It was just an eye-opener for me. I was like, “Wow, she’s talking about, like, bring it on mindset as well with this.” When you’re about to face the brave thing, just say, “Bring it on. Just bring on," like The Rock says. "Just bring it. I just love that.

That’s what I did. That’s what I started doing. I connected as well with my friend, Carol Edwards, who is also a former therapist and is the author of many books. One of them was Address Staring OCD. If anyone’s going through this as well, I really recommend that book. Carol is an amazing, amazing person. Such an intelligent woman. When I met Carol, it was like the first time in my life. I was like, “Wow, I’m actually talking to someone who’s got the same theme as me, and a lot of other themes I’ve gone through, she has as well.” We just totally got each other. I was like, “Finally, I’m validated. I can talk to someone who gets it truly.” And that really helped, let’s say, when I started to learn about value-based exposures.

I remember, again, Katie, Elizabeth McIngvale, Ethan, and Chris. I was like, “Yeah, I mean, I’m going to do it that way,” because I just did ERP before I was white-knuckling. I never thought of doing it in a value-based way. So I thought, okay, well, what is OCD taking away that I enjoy most doing? That’s what I did. I created a hierarchy, or like even in my mind. I thought, well, the cinema, restaurants, coffee shops, going to concerts, eventually going on holiday again, seeing my friends, family is most probably most important. I started doing baby steps.

I remember as well, I asked Chris and Liz, how do I open up to this to my family? Because I’ve got to a point where I just can’t hide behind a mask anymore. I need someone else to know who’s really close to me. Chris gave me some amazing advice, and Liz, and they said that if you show documents, articles, videos about this, long as they have a great understanding of mental health and OCD, you should be okay. And that’s what I did. They know I had OCD. I’ve told them I had OCD, but not the theme I had.

When I showed them documents and videos, it was so nerve-racking, I won’t lie. But it was the best thing I ever did because then, when they watched that, they came to me and said, “Why didn’t you tell us about this before? I thought you wouldn’t understand or grasp this.” I know OCD awareness in the UK is not the best, especially with this theme. But they said, “No, after watching that, we’re on your team; we will support you. We are here for you. We will do exposures with you.” And they gave me a massive hug afterwards. I was like, “Oh my God, this is the best scenario for me ever,” because then I can really amplify my recovery. This is where it started really kicking on for me now.

Everything I’ve learned, again, from those videos, watching with the streams from IOCDF, I’ve incorporated. Basically, when I was going to go to the cinema at first, I know that the cinema is basically darkness. When you walk through there, no one’s really going to notice you. Yeah, they might see you in their peripheral vision, but they’re going to be more like concentrating on that movie than me. That was my mindset. I was like, “Well, if I was like the other person and I didn’t have VTO and the other person did, would I be more concentrated on them or the movie?” And for me, it would be obviously the movie. Why would I else? Unless they were doing something really vigorous or dancing in front of me, I’m not going to look. And that’s my mindset.

The deep anxiety was there, I will be honest. It was about 80 percent. But I had my value because I was going to watch a film that I really wanted to watch. I’m a big Marvel fan. It was Black Panther Wakanda, and I really enjoyed that. It was a long movie as well. I went with my friend. We got on very, very well. For me as well, with this trigger, I get triggered when people can move as well next to me. I’m very hyper-vigilant with this. That can include me with the peripheral as well. But even though my eyes say they died, it was, okay, instead of beating myself up, I can tell myself this is OCD. I know what this is. It doesn’t define me. I’m going to enjoy watching this movie as much as I can and give myself that compassion to do so.

After that moment, I was like, “Wow, even though I was still triggered, I enjoyed it. I wasn’t just wanting to get out of there. I enjoyed being there.” And that was starting to be a turning point for me because then I went to places like KFC. I miss KFC. I love my chicken bucket. I won’t lie with that. That was a big value. You got to love the chicken bucket folks. Oh, it was great. Well, I had my parents around me so that they know I was pretty anxious still. But I was there. I was enjoying my chicken again. I was like, “I miss this so much.”

And then the best thing is, as far as I remember, when I left that restaurant, they said to me, “We’re so proud of you.” And that helps so much because when you’re hearing feedback like that, it just gives you a huge pat on the back. It’s like, yeah, I’ve just done a big, scary thing. I could have been caught. I could have been ridiculed. I could have been made fun of. People may have gossiped about me, but I took that leap of faith because I knew it’s better than keep isolating, where in my room, being in prison, not living a life. I deserve to live a life. I deserve to do that. I’m a human being. I deserve to be a part of human society.

After that, my recovery started to progress. I went to my friend Carol to more coffee shops. We started talking about advocacy, powerful stuff, because when you have another reason on a why to recover, that’s a huge one. When you can inspire and empower others to recover, it gives you so much more of a purpose to do it because you want to be like that role model, that champion for the people. It really gives you a great motive to keep going forward with that and that motivation.

And then I went to restaurants with my family for the first time in years, instead of making excuses, instead of compulsion. People would still walk by me in my peripheral, but I had the mindset, like Kate said, “You know what? Just bring it on. Just bring it.” I went in there. I know I was still pretty anxious, and I sat on my phone, and I’m going to tell myself using mindfulness this time that I’m going to enjoy the smell of the food coming in. I’m going to enjoy the conversation with my family instead of thinking of, let’s say, the worst-case scenario. The same with a waiter or waitress coming by. I’m just going to have my order. And again, yeah, my eyes die, they spit in my food—who knows? But I’m going to take that leap of faith because, again, it’s worth it to do this. It is my why to get my life back. That’s why I did it.

Again, I enjoyed that meal, and I enjoyed talking to my family. It was probably the first time in years where I wasn’t proper triggered. I was like, that was my aha moment right there. The first time in years where my eyes didn’t die or anything. I just enjoyed being in a normal situation. It was so great to feel that. So validating.

Kimberley: So the more triggered you were, the harder it was to not stare? Is that how it was?

Matthew: Yes. The more triggered I was going down that rabbit hole, the more, let’s say, it would happen because my eyes would die, like up and down. It would be quite frantic, up and down, up and down. Everyone’s not the same. Everyone’s different with this. But that’s what mine would be like. That’s why I would call it a tick in that sense. But when we feel calm, obviously, and the rumination is not there, or let’s say, the trigger, then it’s got no reason to happen or be very rare when it does. It’s like retraining. I learned to retrain my mind in that sense to incorporate that into doing these exposures.

Again, that’s what was great about opening up to my family. I could practice that at home because then, when I’m sitting with my family, I’d still be triggered to a degree, but they know what I have. They’re not going to judge me or reject me, or anything like that. So my brain healed naturally. The more I sat next to my family, I could bring that with, say, the public again and not feel that trigger. I could feel at ease instead of feeling constantly on edge.

Again, going to coffee shops late, looking around the room, like you say so amazingly, Kim, using your five senses. I did that, like looking around, looking at billboards, smelling the coffee again, enjoying the taste of it, enjoying the conversation, enjoying the surroundings where I am instead of focusing on the prime fear. And that’s what really helped brought me back to the present. Being in the here and the now. And that was monumental. Such a huge tool, and I recommend that to everyone. Mindfulness is very, very powerful for doing, let’s say, your exposures and to maintain recovery. It’s just a game-changer. I can’t recommend that enough.

One of my biggest milestones with recovery when I hit it, the first time again in years, I went to a live rock concert full of 10,000 people. There would be no way a year prior that would I go.

Kimberley: What rock concert? I have to know.

Matthew: Oh, I went to Hollywood Vampires.

Kimberley: Oh, how wonderful! That must have been such an efficient, like, it felt like you crossed a massive marathon finish line to get that thing done.

Matthew: Oh, yeah, it was. It was huge to see, like I say, Alice Cooper, Johnny Depp, and I think—I can’t remember this—Joe Perry from Aerosmith. I can’t remember the drummer’s name, I apologize, but it was great. You know what? I rocked out. I told myself, “I’ve come this far in my journey, I’m going to rock out. I’m going to enjoy myself. I don’t care, let’s say, where my eyes may go, and that’s telling OCD, though. I’m just going to be there in the moment and enjoy rocking out.” And that’s exactly what I did. I rocked out big time. I remember even the lead singer from the prior band pointing at me and waving. I would have been so triggered by that before, but now we’re back in the game, the rock on sign, and it was great.

Kimberley: There’s so much joy in that too, right? You were so willing to be triggered that you rocked out. That’s how willing we were to do that work. It’s so cool, this story.

Matthew: Yeah. The funny part is, well, the guy next to me actually spilled beer all over himself. That would have been so triggering against me before, like somebody’s embarrassing body part places. Whereas this time I just laughed it off and I had a joke with him, and he got the beer. It was like a normal situation—nothing weird or anything. His wife, I remember looking at my peripheral, was just cross-legged. But hey, that’s just a relaxing position like anyone else would do. That’s what I told myself. It’s not because of me thinking, “Oh, he’s a weirdo or a creep.” It’s because she’s just being relaxed and comfortable. That’s just retraining my mind out, and again, refocusing back to the concert and again, rocking out to Alice Cooper, which was amazing.

I really enjoyed it. I just thought it’s just incredible from where I was a year ago without seeing-- got to a point where I set myself, I heard the worst stigma imaginable to go to the other aspect, the whole end of the other tunnel, the light of the tunnel, and enjoy myself and being free. I love what Elizabeth McIngvale says about that, freedom over function. And that’s exactly at that point where that’s where I was. I’m very lucky to this day. That’s why I’ve maintained it.

Sometimes I still do get triggered, but it’s okay because I know it’s OCD. We all know there’s no cure, but we can keep it in remission. We can live a happy life regardless. We just use the tools that we’ve learned. Again, for me, values-based exposure in that way was game-changing. Self-compassion was game-changing.

I forgot to mention my intrusive thoughts with sexual images as well with this, which was very stressing. But when I had those images more and more, it’s basically what I learned again from Katie. I was like, “Yeah, you know what? Bring it on. Bring it on. Let’s see. Turn it up. Turn it up. Crank it up.” Eventually, the images stopped because I wasn’t giving fear factor to it. I was going to put the opposite of basically giving it the talk-to-the-hand analogy, and that worked so well.

I see OCD as well from Harry Potter. I see OCD as the boggart, where when you come from the boggart, it’s going to come to your most scariest thing. But you have that power of choice right there and then to cast the spell and say ridiculous, as it says in the Harry Potter movies, and it will transform into something silly or something that you can transform yourself with compassion and love. An OCD can’t touch you with that. It can’t. It becomes powerless. That’s why I love that scene from that film.

Patrick McGrath says it so well with the Pennywise analogy. The more fear we feed the beast or the monster, the more stronger it becomes. But when we learn to give ourselves self-compassion and love and, again, using mindfulness and value and knowing who we authentically are, truly, it can do nothing. It becomes powerless. It can stay in the backseat, it might try and rear its ugly head again, but you have the more and the power in the world to bring it back, and you can be firmly in that driver’s wheel.

Kimberley: So good. How long did it take you, this process? Was it a short period of time, or did these value-based exposures take some time?

Matthew: Yeah, at first, it took some time to master it, if that makes sense. Again, I was going to start going to more coffee shops with my friend Carol or my family. It did take time. I was still feeling it to a degree, but probably about after a month, it started to really click. And then overall, it took me about-- I started really doing this in December, January time. I went to that concert in July. So about, yeah, six, seven months.

Kimberley: Amazing. Were there any stages where there were blips in the road, bumps on the road? What were they like for you?

Matthew: Yeah. I mean, my eyes did that sometimes. Also, like I said, when I started to do exposures, where I’d walk by myself around town places, it could be very nerve-wracking. I could think I’m walking behind someone that all the might think I’m a stalker and things like that because of the staring. That was hard.

Again, I gave myself the compassion and told myself that it’s just OCD. It doesn’t define who I am. I know what this monster is, even though it’s trying its very best to put me down that rabbit hole. Yeah, that person might turn around and say something, or even look. I have the choice again to smile back, or I can even wave at them if I wanted to do so. It just shows that you really have all the power or choice to just throw some back into OCD space every single time.

Self-compassion was a huge thing that helped smooth out those bumps. Same with mindfulness. When I was getting dissociated, even when I was still getting dissociated, getting really triggered, I would use the mindfulness approach. For example, when I was sitting in pubs, and that was a value to me as well, sometimes that would happen. But I would then use the tools of mindfulness. And that really, really helped collect myself being present back in the here and the now and enjoying what’s in front of me, like having a beer, having something to eat, talking to my friend, instead of thinking like, are they going to see me staring at them weirdly? Or my eyes met out someone, and I don’t know, the waitress might kick me out or something like that. Instead of thinking all those thoughts, I just stay present.

The thing is with this as well, it’s like when you walk down places, people don’t even look at you really anyway. They just go about their business, like we all do. It’s just remembering that and keeping that mindfulness aspect. You can look around where you are, like buildings, trees, the ocean, whatever you like, and you can take that in and relearn. Feel the wind around you. If it’s an ice wind, obviously, that’s freezing right now. The smells—anything, anything if it’s a nice smell, or even if it’s a bad smell. Anything that use your senses that can just bring you back and feel again that peace, something you enjoy, surround yourself with.

Again, when I was seeing my friend Carol, the town I went to called Beverley, it’s a beautiful town, very English. It is just a nice place. That’s what I was doing—looking at the scenery around where I was instead of focusing on my worst worries.

Kimberley: This is so cool. It’s all the tools that we talk about, right? And you’ve put them into practice. Maybe you can tell me if I’m wrong or right about this, but it sounds like you were all in with these skills too. You weren’t messing around. You were ready for recovery. Is that true? Or did you have times where you weren’t all in?

Matthew: Yeah, there were times where I wasn’t all in. I suppose when I was-- I also like to ask yourself with me if I feel unworthy. That is still, I know it’s different to staring OCD and I’m still trying to tackle that sometimes, and that can be difficult. But again, I use the same tools. But with, like I say, doing exposures with VTO, I would say I was all in because I know that if I didn’t, it’s going to be hard to reclaim my life back. I have a choice to act and use the tools that I know that’s going to work because I’ve seen Chris do it. It’s like, “Well, I can do it. I’ve seen Carol do it. That means I can do it. So I’m going to do it.”

That’s what gave me the belief and inspiration to go all in. Because again, reach out to the community with the support. If it was a hard time, I’d reach out. The community are massive. The connection they have and, again, the empowerment and the belief they can give you and the encouragement is just, oh, it’s amazing. It’s game-changing. It can just light you up straight off the bar when you need it most, and then you can go out and face that big scary thing. You can do it. You can overcome it because other people have. That means you can do it. It’s absolutely possible. Having that warrior mindset, as some of my groups—the warrior badass mindset—like to call it, you absolutely go in there with that and you can do it. You can absolutely do it.

Kimberley: I know you’ve shared with me a little bit privately, but can you tell us now what your big agenda is, what your big goal is right now, and the work you’re doing? Because it’s really exciting.

Matthew: Sure, I’d be glad to do it. I am now officially a professional peer support worker. If anyone would love to reach out to me, I am here. It’s my biggest passion. I love it. It’s like the ultimate reward in a career. When you can help someone in their journey and recovery and even empower each other, inspire, motivate, and help with strategies that’s worked for you, you can pass on them tools to someone else who really needs it or is still going through the process where it’s quite sticky with OCD. There’s nothing more rewarding than that. Because for me, when I was at my most severe, when I was in my darkest, darkest place, it felt like a void. I felt like just walking through a blizzard of nothing. Having someone there to speak to who gets it, who truly gets it, and who can be really authentically there for you to really say, “You can do this. I’m going to do it with you. Let’s do it. Like really, let’s do it. Bring it on, let’s do it. Let’s kick this thing’s butt,” it’s huge. You really lay the smackdown on OCD. It’s just massive.

For me, if I had that when I was going through it, again, I had a great therapist, but if I had a peer support worker, if I was aware that they were around—I wasn’t, unfortunately, at that time—I probably would have reached out because it’s a huge tool. It’s amazing. Even if you’re just to connect with someone in general and just have a talk, it can make all the difference. One conversation, I believe, can change everything in that moment of what that person’s darkness may be. So I’m super, super excited with that.

Kimberley: Very, very exciting. Of course, at the end, I’ll have everyone and you give us links on how to get to you. Just so people know what peer support counseling is or peer support is, do they need to have a therapist? Who’s on the team? What is it that they need in order to start peer support?

Matthew: Yeah. I mean, you could have a therapist. I mean, I know peer support workers do work with therapists. I know Chrissie Hodges. I’ve listened to her podcast, and she does that. I think it may be the same with Shannon Shy as well. I’m not too sure. I think as well to the person, what they’re going through, if they would want to at first reach out to a peer support worker that they know truly understands them, that can be great. That peer support like myself can then help them find a therapist. That’s going to really help them with their theme—or not just their theme—an OCD specialist who gets it, who’s going to give them the right treatment. That can be really, really beneficial.

Kimberley: I know that we’ve worked with a lot of peer support, well, some peer support providers, and it was really good because for the people, let’s say, we have set them up with exposures and they’re struggling to do it in their own time, the peer support counselor has been so helpful at encouraging them and reminding them of the tools that they had already learned in therapy.

I think you’re right. I think knowing you’re not alone and knowing someone’s done it, and I think it’s also just nice to have someone who’s just a few steps ahead of you, that can be very, very inspiring for somebody.

Matthew: Absolutely. Again, having a peer support work with a therapist, that’s amazing. Because again, for recovery, that’s just going to amplify massively. It’s like having an infinite gauntlet on your hand against OCD. It’s got no chance down the long run. It’s incredibly powerful. I love that. Again, like you said, Kim, it’s like when someone, let’s say, they know that has reached that mountain top of recovery, and that they look at that and thinking, “Well, I want to do the same thing. I know it would be great to connect with that person,” even learn from them, or again, just to have that connection can make a huge, huge difference to know that they can open up to other people.

Again, for me, it’s climbing up that other mountain top with someone else from the start, but to know I’ve got the experience, I get to climb that mountain top with them.

Kimberley: Yeah, so powerful. Before we finish up, will you tell us where people can get ahold of you if they want to learn more? And also, if there’s anything that you feel we could have covered today that we didn’t, like a main last point that you want to make.

Matthew: Sure. People can reach out to me, and I’m going to try and remember my tags. My Instagram tag is matt_bannister27. I think my Facebook is Matthew.Bannister.92, if you just type in Matthew Bannister. It would be in the show notes as well. You can reach out to me on there. I am at the moment going to create a website, so I will fill more onto that later as well. My email is matt3ban@hotmail.com, which is probably the best way to reach out to me.

Kimberley: Amazing. Anything else you want to mention before we finish up?

Matthew: Everyone listening, no matter what darkness you’re going through, no matter what OCD is putting in your way, you can overcome it. You can do it. As you say brilliantly as well, Kim, it’s a beautiful day to do hard things. You can make that as every day because you can do the hard things. You can do it. You can overcome it, even though sometimes you might think it’s impossible or that it’s too much. You can do it, you can get there. Even if it takes baby steps, you’re allowed to give yourself that compassion and grace to do so. It doesn’t matter how long it takes. Like Keith Smith says so well: “It’s not a sprint; it’s a marathon.” When you reach that finish line, and you will, it’s the most premium feeling. You will all get there. You will all absolutely get there if you’re going through it.

Oh, Kim, I think you’re on mute.

Kimberley: I’m sorry. Thank you so much for being on. For the listeners, I actually haven’t heard your story until right now too, so this is exciting for me to hear it, and I feel so inspired. I love the most that you’ve taken little bits of advice and encouragement from some of the people I love the most on this planet. Ethan Smith, Liz McIngvale, Chris Trondsen, Katie O’Dunne. These are people who I learn from because they’re doing the work as well. I love that you’ve somehow bottled all of their wisdom in one thing and brought it today, which I’m just so grateful for. Thank you so much.

Matthew: You’re welcome. Again, they’re just heroes to me, and yourself as well. Thank you for everything you do as well for the community. You’re amazing.

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

Matthew: Anytime.

If you want to know the 5 Most Common Recovery Roadblocks with Chris Tronsdon (an incredible anxiety and OCD therapist), you are in the right place. Today Chris and I will go over the 5 Most common anxiety, depression, & OCD roadblocks and give you 6 highly effective treatment strategies you can use today. 

Kimberley: Welcome everybody. We have the amazing Chris Trondsen here with us today. Thank you for coming, Chris.

Chris: Yes, Kim, thanks for having me. I’m super excited about being here today and just about this topic.

Kimberley: Yes. So, for those of you who haven’t attended one of the IOCDF Southern California conferences, we had them in Southern California. We have presented on this exact topic, and it was so well received that we wanted to make sure that we were spreading it out to all the folks that couldn’t come. 

You and I spoke about the five most common anxiety & OCD treatment roadblocks, and then we gave six strategic solutions. But today, we’re actually broadening it because it applies to so many people. We’re talking about the five most common anxiety treatment roadblocks, with still six solutions and six strategies they can use. Thank you for coming on because it was such a powerful presentation.

Chris: No, I agree. I mean, we had standing room only, and people really came up to us afterwards and just said how impactful it was. And then we actually redid it at the International OCD Foundation, and it was one of the best-attended talks at the event. And then we got a lot of good feedback, and people kept messaging me like, “I want to hear it. I couldn’t go to the conference.” I’d play clips for my group, and they’re like, “When is it going to be a podcast?” I was like, “I’ll ask Kim.” I’m glad you said yes because I do believe for anybody going through any mental health condition, this list is bound, and I think the solutions will really be something that can be a game changer in their recovery.

Kimberley: Absolutely, absolutely. I love it mostly because, and we’re going to get straight into these five roadblocks, they’re really about mindset and going into recovery. I think it’s something we’re not talking about a lot. We’re talking about a lot of treatment, a lot of skills, and tools, but the strategies and understanding those roadblocks can be so important.

Chris: Yeah. I did a talk for a support group. They had asked me to come and speak, and I just got this idea to talk about mindset. I did this presentation on mindset, and people were like, “Nobody’s talking about it.” In the back of my head, I’m like, “Kim and I did.” But we’re the only ones. Because I do think so many people get the tools, right? The CBT tools, they get the ERP tools, the mindfulness edition, and people really find the tools that work for them. But when I really think of my own personal recovery with multiple mental health diagnoses, it was always about mindset. And that’s what I like about our talk today. It’s universal for anyone going through any mental health condition, anxiety base, and it’s that mindset that I think leads to recovery. It shouldn’t be the other way around. The tools are great, but the mindset needs to be there.

Kimberley: Yeah. We are specifically speaking to the folks who are burnt out, feeling overwhelmed, feeling a lack of hope of recovery. They really need a kickstart, because that was actually the big title of the presentation. It was really addressing those who are just exhausted with the process and need a little bit of a strategy and mindset shift.

Chris: Yeah. I don’t want to compare, but I broke my ankle when I was hiking in Hawaii, and I have two autoimmune diseases. Although those ailments have caused problems, especially the autoimmune, when I think back to my mental health journey, that always wore me out more because it’s with you all the time, 24/7. It’s your mental health. When my autoimmune diseases act up, I’m exhausted, I’m burnt out, but it’s temporary. Or my ankle, when it acts up, I have heating pads, I have things I can do, but your brain is with you 24/7. I do believe that’s why a lot of people resonate with this messaging—they are exhausted. They’re busting their butt in treatment, but they’re tired and hitting roadblocks. And that’s why this talk really came about.

Kimberley: Yeah, exactly. All right, let’s get into it here in a second. I just want to give one metaphor with that. I once had a client many years ago give the metaphor. She said, “I feel like I’m running a marathon and my whole family are standing on the out, like on the sidelines, and they’re all clapping, but I’m just like faceplant down in the middle of the road.” She’s like, “I’m trying to get up, I’m trying to get up, and everyone’s telling me, ‘Come on, you can do it.’ It’s so hard because you’re so exhausted and you’ve already run a whole bunch of miles.” And so I really think about that kind of metaphor for today. If people are feeling that way, hopefully they can take away some amazing nuggets of information. 

Chris: Absolutely. That’s a good visual. Faceplant.

Kimberley: It was such a great and powerful visual because then I understood this client’s experience. Like, “Oh, okay. You’re really tired. You’re really exhausted.”

ROADBLOCK #1: YOU BEAT YOURSELF UP!

Okay, let’s get into it. So, I’m going to go first because the number one roadblock we talked about, not that these are in any particular order, but the one we came up first was that you beat yourself up. This is a major roadblock to recovery for so many disorders. You beat yourself up for having the disorder. You beat yourself up for not coping with it as well as you could. You beat yourself up if you have OCD for having these intrusive thoughts that you would never want to have. Or you’re beating yourself up because you don’t have motivation because you have, let’s say, some coexisting depression. 

The important thing to know there is, while beating yourself up feels productive, it might feel like you’re motivating yourself, or you may feel like you deserve it. It actually only makes it harder. It only makes it feel like you’ve got this additional thing. Again, a lot of my patients—let's use the marathon example—might yell at themselves the whole way through the marathon, but it’s not a really great experience if you’re doing that, and it takes a lot of energy. 

SOLUTION #1: SELF-COMPASSION

So what we offered here as a strategic solution is self-compassion—trying to motivate and encourage yourself using kindness. If you’re going through a hard day, maybe, just if you’ve never tried this before, trial what it would be like to encourage yourself with kind words or asking for support, asking for help so that you’re not burning all that extra energy, making it so much harder on yourself, increasing your suffering. Because I often say to patients, the more you suffer, the more you actually deserve self-compassion. It’s not the other way around. It’s not that the more you suffer, the less you deserve it. Do you have any thoughts on that, Chris?

Chris: Oh yeah. I would say I see that across the board with my clients, this harshness, and there’s this good intention behind it, this idea that if I can just bully myself into recovery. I always try to remind clients that anxiety-based disorders, it’s a part of our bodies as well. Our brain is a part of our body, just like our arm, our tibia, our leg, all these other bones, but there’s a lack of self-empathy that we have for ourselves, as if it’s something that we’re choosing to do. Someone with a broken leg doesn’t wake up in the morning and get mad at themselves that their leg is still broken. They have understanding, and they’re working on their exercises to heal. It’s the same with these disorders. 

So, the reason I love self-compassion is when we go and step in to help one of our friends, we use a certain tone, we use certain words, we tap into their strengths, we use encouragement because we know that method is going to be what boosts them up and helps them get through that rough patch. But for some reason, when it’s ourselves, we completely abandon everything we know that’s supportive, and we talk to ourselves in a way that I almost picture like a really negative boot camp instructor, like in the military, just yelling and screaming into submission.

The other thing is when we’re beating ourselves up like that, we’re more likely to tap into our unhelpful habits. We’re more likely to shut down and isolate, which we see a lot in BDD, social anxiety, et cetera. But that self-compassion isn’t like a fake pop culture support. It’s really tapping into meeting yourself where you’re at, giving yourself some understanding, and tapping into the strategies that have worked in the past when you’re in a low moment. 

I know sometimes people are like, “I don’t know how to do that,” but you’re doing it to everybody else in your life. Now it’s time to give yourself that same self-compassion that you’ve been giving to everybody important to you.

Kimberley: Yeah, and we actually have a few episodes on Your Anxiety Toolkit on exactly how to embrace self-compassion, like how that might actually look. So, if people are really needing more information there, I can add in the show notes some links to some resources there as well. 

ROADBLOCK #2: THERE WILL BE HARD DAYS 

Okay. Now, Chris, can you tell us about the second most common or another common anxiety roadblock around this idea that there will be hard days?

Chris: There’s always these great images if you Google about what people think recovery will look like versus what recovery looks like. I love those images because there is this idea. We see a lot of perfectionism in anxiety disorders. In OCD, we see perfectionism. So, this idea of, like, I should be here and I should easily scoot to the end. It’s not going to be like that; it’s bumpy, it’s ups and downs. We know so much factors into or impact how our mental health disorder shows up. We can’t always control our triggers. Sometimes if we haven’t slept well or there’s a lot of change in our life, we could have more anxiety. So, it’s going to ebb and flow. 

So, when we have this fixed mindset of like, it has to be perfect, there has to be absolutely no bumps on the road, no turbulence, we’re going to set ourselves up for failure because the day we have a hard day, we want to completely shut down.

So I really believe, in this case, the solution is thinking bigger. If you’re thinking day to day, sometimes if you’re too in it, you’re dealing with depression, you’re really feeling bad, you skipped school because you have a presentation, social anxiety is acting up. You think bigger picture. Why am I here? Why am I doing this? Why have I sought out treatment? Listen to this podcast. What am I trying to accomplish? 

SOLUTION #2: KNOW YOUR WHY

I know for me in my own recovery, knowing my why was so important. There were certain things in my life that I found important to achieve, and I kept that as the figurative carrot in front of the mule to get me to go. So, that way, if I had a rough day, I thought bigger picture. What do I need to do today to make sure that I meet my goals? And so, I believe everybody needs to know their why. 

Now, it doesn’t have to be grandiose. Some people want to build a school and teach kids in underprivileged countries. Amazing why. But other people are sometimes like, “I just want to be able to make my own choices today and not feel like I base them out of anxiety.” There’s no right or wrong why, but if you can know what beacon you’re going to, it really helps you get through those hard days. 

What about for you? When we talk about this, what comes up for you?

Kimberley: Well, I think that for me personally, the why is a really important mindset shift because often I can get to this sort of, like you said, perfectionistic why. Like, the goal is to have no anxiety, or the goal is to have no bad days. We see on social media these very relaxed people who just seem to go with the flow, and that’s your goal. But I have to often with myself do a little reality check and go, “Okay, are you doing recovery to get there? Because that goal might be setting you up for constant disappointment and failure. That mightn’t be your genetic makeup.” 

I’m never going to be like the go-with-the-flow Kimberley. That’s just not who I am. But if I can instead shift it to the why of like, what do I value? What are the things I want to be able to do despite having anxiety in my life? Or, despite having a hard day, like you said, how do I want that to look? And once I can get to that imagery, then I have a really clear picture. So, when I do have a bad day, it doesn’t feel so defeating, like what’s the point I give up, because the goal was realistic.

Chris: For me, a big part of my why in recovery, once I started getting into a place where I was managing the disorders I was dealing with—OCD, body dysmorphic disorder, I had a lot of generalized anxiety, and major depressive disorder—I was like, “I need to give back. There’s not people my age talking about this. There’s not enough treatment providers.” There was somewhere, like in the middle of my treatment, that I was like, “I don’t know how I’m going to advocate. I don’t know what that’s going to look like, but I have to give back.”

And so, on those hard days when I would normally want to just like, “Well, I don’t care that it’s noon, I’m shutting it down, I’m going into my bed, I’m just going to sleep the rest of the day,” reminding myself like there’s people out there suffering that can’t find providers, that can’t find treatment, may not even know they have these disorders. I have to be one of the voices in the community that really advocates and gets people education and resources. And so, I didn’t let myself get in bed. I looked at the day as quarters. Okay, the morning and the afternoon’s a little rough, but I still have evening and night. Let me turn it around. I have to go because I have this big goal, this ambitious dream. I really want to do it. So that bigger why kept me just on track to push through hard days.

ROADBLOCK #3: YOU RUN OUT OF STAMINA

Kimberley: Amazing. I love that so much. All right. The third roadblock that we see is that people run out of stamina. I actually think this is one that really ties into what we were just talking about. Imagine we’re running a marathon. If you’re sprinting for the first 20 miles, you probably won’t finish the race. Or even if you sprint the first two miles, you probably won’t finish the marathon. 

One of the things is—and actually, I’ll go straight to the strategy and the thing we want you to practice—we have to learn to pace ourselves throughout recovery. As I said, if you sprint the first few miles, you will fall flat on your face. You’re already dealing with so much. As you said, having a mental health struggle is the most exhausting thing that I’ve ever been through. It requires such of your attention. It requires such restraint from not engaging in it and doing the treatment and using the tools. It’s a lot of work, and I encourage and congratulate anyone who’s trying. The fact that you’re trying and you’re experimenting with what works and what doesn't, and you’re following your homework of your clinician or the workbook that you’ve used—that's huge. But pacing yourself is so important. So, what might that look like?

Often, people, students of mine from CBT School, will say, “I go all out. I do a whole day of exposures and I practice response prevention, and I just go so hard that the next day I am wiped. I can’t get out of bed. I don’t want to do it anymore. It was way too much. I flooded myself with anxiety.” So, that’s one way I think that it shows up. I’ll often say, “Okay, let’s not beat yourself up for that.” We’ll just use that as data that that pace didn’t work. We want to find a rhythm and a pace that allow you to recover. It’s sort of like this teeter-totter. We call it in Australia a seesaw. You want to do the work, but not to the degree where you faceplant down on the concrete. We want to find that balance. 

I know for me, when I was recovering from postural orthostatic tachycardic syndrome, which is a chronic illness that I had, it was so hard because the steps to recovery was exercise, but it was like literally walking to the corner and back first, and then walking half a block, and then walking three-quarters of a block, and then having my husband pick me up, then walking one block. And that’s all I was able to do without completely faceplanting the next day, literally and figuratively. 

My mind kept saying to me, “You should be able to go faster. Everybody else is going faster. Everyone else can walk a mile or a block. So you should be able to.” And so, I would push myself too hard, and then I’d have to start all over again because I was comparing myself to someone who was not in my position. 

SOLUTION #3: PACE YOURSELF

So, try to find a pace that works for you, and do not compare your pace with me or Chris or someone in your support group, or someone you see on social media. You have to find and test a pace that works for you. Do you have any thoughts, Chris?

Chris: Yeah. I would say in this one, and you alluded to it, that comparison, that is going to get you in this roadblock because you’re going to be looking to your left and your right. Why is that person my age working and I’m not? It’s not always comparing yourself. Sometimes, like you said, it is people in your support group. It’s people that you see advocating for the disorder you may have. But sometimes people even look at celebrities or they’ll look at friends from college, and can I do that? The comparison never motivates you, it never boosts you; it just makes you feel less than. That’s why one of my favorite quotes is, “Chase the dream, not the competition.” It’s really finding a timeline that works best for you. 

I get why people have this roadblock. As somebody who’s lived through multiple mental health disorder diagnoses, it’s like, once we find the treatment, we want to escalate to the finish line, and we’ll push ourselves in treatment sometimes too much. And then we have one of those days where we can’t even get out of bed because we’re just beat up, we’re exhausted, and it’s counterproductive. 

I wanted to add one thing too. The recovery part may not even be what you’re doing with your clinician in a session that you are not pacing yourself with. My biggest pacing problem was after recovery, not that the disorders magically went away, they were in remission, I was working on doing great, but it was like, I went to martial arts, tennis, learned Spanish, started volunteering at an animal shelter, went back to school, got a job, started dating. It was so much. Because I felt like I was behind, I needed to push myself. 

The problem that started to happen was I was focusing less on the enjoyable process of dating or getting a job, or going back to school. I was so fixated on the finish line. “I need to be there, I need to be there. What’s next? What’s next?” I got burnt out from that, and I was not enjoying anything I was doing. 

So, I would say even after you’re managing your disorder, be careful about not pacing yourself, even in that recovery process of getting back into the lifestyle that you want.

Kimberley: Yeah, absolutely. I would add too, just as a side point, anyone who is managing a mental health issue or an anxiety disorder, we do also have to fill our cup with the things that fill our hearts. I know that sounds very cliche and silly, but in order to pace ourselves and to have the motivation and to use the skills, we do have to find a balance of not just doing all the hard things, but making sure you schedule time to rest and eat and drink and see friends if that fills your cup, or read if that fills your cup. So, I think it’s also finding a rhythm and a balance of the things that fill your cup and identifying that, yes, recovery is hard. It will deplete your stores of energy. So, finding things that fill that cup for you is important.  

Chris: Well, you just made a good point too. In my recovery, all those things you mentioned, I thought of those as like weakness, like I just wasted an hour reading. Sometimes even with friends. That one, not as much, because I saw value in friendship. But if I just watched a movie or relaxed, or even just hung out with friends, it felt like a waste. I’m like, “How dare I am behind everybody else? I should be working. I should be this. I should move up.” A lot of should statements, a lot of perfectionist expectations of myself. 

So, the goal for me or the treatment for me wasn’t to then go to the other extreme and just give up everything; it was really to ask myself, like you said, how can I fill my cup in ways that are important and see value and getting a breakfast burrito with a friend and talking for three hours and not thinking like, “Oh, I should have been this because I got to get my degree.” I’m glad that you brought that up. I always think of like we’re overflowing our cup with mental health conditions. We have to be able to have those offsets that drain the cup so we have a healthy balance. So, a great point.

ROADBLOCK #4: NOT OWNING YOUR RECOVERY

Kimberley: I agree. So important. Would you tell us about owning your recovery? Because you have a really great story with this.

Chris: Yeah. People ask me all the time how I got better. A lot of people with body dysmorphic disorder struggle to get better. Obviously, we know that with obsessive-compulsive disorder, major depressive disorder, et cetera. So, a lot of people will ask sometimes, and I always say to them, if I had to come up with one thing, it was because I made my mental health recovery number one. I felt that it was like the platform that I was building my whole life on. I’m so bad with the-- what is it? The house, the-- I’m not a builder. 

Kimberley: Like the foundation.

Chris: Thank you. Clearly, I’m not going to be making tools tomorrow or making things with tools. But yeah, like a house has to have a nice foundation. You would never build a house on a rocky side of the mountain. And so, I had to give up a lot, like most of us do, as we start to get worse. I became housebound and I dropped out of college, and I gave up a job. I was working in the entertainment industry, and I really enjoyed it. I was going to film school, and I was happy. I had to give all that up because I couldn’t even leave my house because of the disorder. 

SOLUTION #5: MAKE YOUR RECOVERY THE MOST IMPORTANT THING

So, when I was going to treatment and I was really starting to see it work, I was clear to that finish line of what I needed to do. So I made it the most important thing. It wasn’t just me; it was my support system. My treatment was about a four-hour round trip from my house, so my mom and I would meet up every day. We drive up to LA. I go to my OCD therapist, and I’d go to my psychiatrist and then my BDD therapist and support group, and then come home. There’s times I was exhausted, I wanted to give up, I was over it, but I never ever, ever put it to number two or three. I almost had this top three list in my head, and number one was always my recovery. My mom too, I mean, when she talks, she’ll always say it's the most important thing. If my job was going to fire me because I couldn’t come in because I had to take my kid on Wednesdays to treatment, I was going to get fired and find a new job. We just had to make this important.  

As I was getting better, there were certain opportunities that came back to me from my jobs or from school. My therapist and I and my mom just decided, “Let’s hold off on this. Let’s really, really put effort into the treatment. You’re doing so well.” One of the things that I see all the time, my mom and I run a very successful family and loved ones group. A lot of times, the parents aren’t really making it the priority for their kids or the kids, or the people with the disorders aren’t really making it a priority. It’s totally understandable if there’s things like finances and things, barriers. But that’s not what I’m talking about. I’m talking about when people have access to those things, they’re just not owning it. Sometimes they’re not owning it because they’re not taking it seriously or not making it important. Or other times, people are expecting someone else to get them better. 

I loved having a team. I didn’t have a big team. I came from nothing. It was a very small team. I probably needed residential or something bigger. I only really had my mom’s support, but we all leaned on each other. But I always knew it was me in the driver’s seat. At the end of the day, my therapist couldn’t save me, my mom couldn’t save me, they couldn’t come to my house and pull me out of bed or do an exposure for me, or have me go out in public during the daytime because of BDD. I had to be the one to do it. I could lean on them as support systems and therapists are there for, but at the end of the day, it was my choice. I had to do it. When my head hit the pillow, I had to make sure that I did everything I possibly could that day to recover. 

When I took ownership, it actually gave me freedom. I wasn’t waiting for someone to come along. I wasn’t focusing on other things. I made it priority number one. I truly believe that that was the thing that got me better. Once again, didn’t have a lot of resources, leaned a lot on self-help books and stuff because I needed a higher level of care, but there was none and we couldn’t afford it. I don’t want anyone to hear this podcast and think, “Well, I can’t find treatment in my area.” That’s not what I’m saying. I’m just saying, whatever you have access to, own it, make it a priority, and definitely be in that leader’s seat because that’s going to be what’s going to get you better.

Kimberley: Yeah, for sure. I think too when I used to work as a personal trainer, I would say to them, “You can come to training once a week, but that once a week isn’t going to be what crosses you across that finish line.” You know what I mean? It is the work you do in the other 23 hours of that day and the other seven days of the week. I think that is true. If you’re doing and you’re dabbling in treatment, but it’s not the main priority, that is a big reason that can hold you back. I think it’s hard because it’s not fair that you have to make it priority number one, but it’s so necessary that you do. 

I really want to be compassionate and empathize with how unfair it is that you have to make this thing a priority when you see other people, again, making their social life their priority or their hobby their priority. It sucks. But this mindset shift, this recalibration of this has to be at the top. When it gets to being at the top, I do notice, as a clinician, that’s when people really soar in their recovery.

Chris: Yeah. We had a very honest conversation with my BDD therapist, my OCD therapist, and my psychiatrist, and they’re like, “You need a higher level of care. We understand you can’t afford it. There’s also a lot of waiting lists.” They’re like, “You’re really going to have to put in the work in between sessions. You’re supposed to be in therapy every day.” We just couldn’t. All we can afford is once a week. They said, “Look, when you’re not in our session, you need to be the one.” 

So, for instance, with depression, my psychiatrist is like, “Okay, you’re obviously taking the medication, but you need to get up at the same time every day. Open up all your blinds, go upstairs, eat breakfast on the balcony, get ready, leave the house from nine to five.” I didn’t have a job. “But you need to be out of the house. You need to be in nature. You need to do all these things.” I never wanted to, but I did it. Or with my OCD and BDD recovery, I didn’t want to go out in public. I felt like it looked horrendous. I felt like people were judging me, but I did. Instead of going to the grocery store at 2:00 in the morning, I was going at noon. When everyone’s there for OCD, it was like, I didn’t want to sit in public places. I didn’t want to be around people that I felt I could potentially harm. 

My point is like every single day, I was doing work, I was tracking it, I was keeping track, and I had to do that because I needed to do that in order to get better based on the setup that I had. 

I do want to also say a caveat. I always have the biggest empathy for people or sympathy for people that are a CEO of a company or like a parent and have a lot of children, or it’s like you’re busy working all day and you’re trying to balance stuff. I mean, the only good thing that came from being housebound is I didn’t have a lot of responsibilities. I didn’t have a family. I wasn’t running a company. I wasn’t working. So, I did have the free time to do the treatment. So, I have such sympathy for people that are parents or working at a company, or trying to start their own small business and trying to do treatment too. But I promise you, you don’t have to put your recovery first forever. Really dive into it, get to that place where you’re really, really stable. It’ll still be a priority, but then you will be a better parent, a better employee, a better friend once you’ve really got your mental health to a level that you can start to support others. You may need to support yourself first, like the analogy with a mask on the plane.

ROADBLOCK #5: YOU HAVE A FIXED MINDSET

Kimberley: Agreed. That’s such an important point. All right, we’re moving on to roadblock number five. This is yours again, Chris. Tell us about the importance of specific mindsets, particularly a fixed mindset being the biggest roadblock.

Chris: One of the things that makes me the most sad about people having a mental health condition because of how insidious they are is it starts to have people lose their sense of identity. It has them start to almost re-identify who they are, and it becomes a very fixed mindset. So, if you have social anxiety or social phobia, it’s like, “Oh, I’m somebody that’s not good around people. I say embarrassing things. I never know what kind of conversation to lead with. I should probably just not be around people.” Or, let’s say generalized anxiety. “Deadlines really caused me too much strain. I can’t really go back to school.” BDD. “I’m an unattractive person. Nobody wants to date me. I’m unlovable.”  

We get into these fixed mindsets and we start to identify with them, and inevitably, that person’s life becomes smaller and smaller and smaller. So, the more they identify with it, the more that they become isolated from others, and they have this very fixed mindset.

I think of like OCD, for instance, isn’t really about guidelines; it’s all about rules. This is how things are supposed to be. What happens is when I work with a client specifically, somebody that’s pretty severe, it’s trying to get them to see the value in treatment and to even tap into their own personal values is really difficult. It’s like, “Treatment doesn’t work. I’ve tried all the medications. I don’t know what I’m going to do. I’m just not somebody that can get better.”

SOLUTION #5: GROWTH MINDSET

What I tell clients instead is, “Let’s be open. Let’s be curious. Let’s move into a growth mindset. Let’s focus on learning, obtaining education, being open to new concepts. Look, when you were younger and the OCD didn’t really attack you, or when you were younger and you didn’t deal with social anxiety, you were having friends, you had birthday parties, you were going to school, and everything. Maybe that’s the real you, and it’s not that you lost it. You just have this disorder that’s blocked you from it.” And so, when clients become open and curious and willing to learn, willing to try new things, and to get out of their comfort zone, that’s where the growth really happens. 

If you’re listening to this podcast or watching it right now and you’re determined like, “This isn’t working; nothing can help me,” that fixed mindset is never something that’s going to get you from where you are to where you want to be. You have to have that growth, that learning, that trying new things, expanding. 

I always tell clients, “If you try something with your therapist and it doesn’t work, awesome. That’s one other thing that doesn’t work. Move on to something else.” That openness. What I always love after treatment is people are like, “I am social. I do love to be around people. I am somebody who likes animals. I just was avoiding animals because of harm thoughts.” People start to get back into who they really are as soon as they start to be more open to recovery.

Kimberley: Yeah, for sure. The biggest fixed mindset thought that I hear is, “I can’t handle it.” That thought alone gets in the way of recovery so many times. We go to do an exposure, “I can’t handle this.” Or, “What if I have a panic attack? I cannot handle panic attacks.” It’s so fixed. So I often agree with you. I will often say, this work, this mental health work, or this human work that we do is shifting the way we see ourselves and life as an experiment. We always have these black-and-white beliefs like “I can’t handle this” or “I can’t do this. I can’t get in an elevator. I can’t speak public speaking,” or whatever it might be. But let’s be curious. Like you said, let’s use it as an experiment. Let’s try, and we’ll see. Maybe it doesn’t go great. That’s okay, like you said, but then we know we have data, and then we have information on what got in the way, and we have some information. 

I think that even just being able to identify when you’re in a fixed mindset can be all you need just to be like, “Oh, okay, I’m having a very black-and-white fixed mindset.” Learning how to laugh and giggle at the way our brain just gets so determined and black-and-white, like you can’t do this, as you said, I think is so important because, like you said, once you get to recovery, then you go on to live your life and actually do the things that you dream, the dream that you’re talking about. It might be you want to get a master’s degree or you might want to go for a job, or you want to go on a date. You’re going to be able to use that strong mindset for any situation in life. It applies to anything that you’re going to conquer. 

I always say to clients, if you’ve done treatment for mental health, you are so much more prepared than every student in college because they haven’t gone through, they haven’t had to learn those skills.

Chris: Yeah, no, exactly. I remember like my open mindset was one of the assets I had in recovery. I remember going to therapy and being like, “I’m just going to listen. These people clearly know what they’re doing. They’ve helped people like me. Why would it be any different?” And I was open. I can see the difference with clients that have a more growth mindset. They come in, they’re scared. They’re worried. They’ve been doing something for 10, 15, 16 years, and they’re like, “Why is this guy going to tell me to try to do different things or to think different or have different thinking patterns?” But they’re open. I always see those people hit that finish line first. It’s the clients that come and shut down. The family system has been supporting this like learned helplessness. Nobody really wants to rock the boat. Everything shut down and closed. It’s like prying it open, as most of the work. And then we finally get to the work, but we could have gotten there quicker. Everybody’s at their own pace, but I really hope that people hear this, though, are focused on that openness.

You were talking about like people thinking they can’t handle it. The other thing I hear sometimes is people just don’t think they deserve it. “I just don’t even deserve to get better.” You do. You do. That’s what I love about my job the most. Everybody that comes into my office, and I’m like, “You deserve a better life than you’re living. Whatever it is you want to do. You want to be a vet. How many animals are you going to save just by getting into being a vet? You got to do it.” My heart breaks a little bit when people have been dealing with mental health for long enough that they start to believe they don’t even deserve to get better. 

SOLUTION #6: IT’S A BEAUTIFUL DAY TO DO HARD THINGS

Kimberley: I love that. So, we had five roadblocks, and we’ve covered it, but we promised six strategies. I want to be the one to deliver the last one, which everyone who listens already knows what I’m going to say, but I’m going to say it for the sake that it’s so important for your recovery, which is, it’s a beautiful day to do hard things. It is so important that you shift, as we talked about in the roadblock number one, you shift your mindset away from “I can’t do hard things” to “It’s okay to do hard things.” It doesn’t mean you’ve failed. Life can be hard. 

I say to all my patients, life is 50/50 for everybody. It’s 50% easy and 50% hard. I think some people have it harder than others. But the ones who seem to do really well and have that grit and that survivor’s mindset are the ones who aren’t destroyed by the day when it is hard. They’re willing to do the hard thing. They’re okay to march into uncertainty. They’re willing to do the hard thing for the payoff. They’re willing to take a short-term discomfort for the long-term relief or the long-term payout. I think that mindset can change the game for people, particularly if you think of it like a marathon. Like, I just have to be able to finish this marathon, I’m going to do the hard thing, and think of it that way. There’ll be hills, there’ll be valleys, there’ll be times where you want to give up, but can I just do one hard thing and then the next hard thing, and then the next hard thing? Do you have any thoughts on that?

Chris: I’m glad that this is the message that you put out there. I’d say, obviously, when I think of Kim Quinlan as a friend, I think of other things and all the fun we’ve had together. But as a colleague, I always think of both. Obviously, self-compassion. But this idea of it’s a beautiful day to do hard things, I like it because we’ve always talked about doing hard things as this negative thing before you came along, and by adding this idea of it’s a beautiful day.

When I look at all the hard things I did in my own recovery, or I see clients do hard things, there’s this feeling of accomplishment, there’s this feeling of growth, there’s this feeling of greatness that we get. Just like you were saying, beyond the mental health conditions that I dealt with, when I start getting into real life after the mental health conditions now are more in recovery, every time I choose to do hard things, there’s always such a good payoff.

I was convinced I would never be able to get through school and get a degree and become a licensed therapist because I struggled with school with my perfectionism. It was difficult for me to get back in there and to humble myself and say, “Hey, you may flop and fail.” But now I’m a licensed therapist because of that willingness to do hard things. 

I could give a plethora of examples, but I want people to hear that doing hard things is your way of saying, “I believe in myself. I trust myself that I can accomplish things, and I’m going to tap into my support system if I need to, but I am determined, determined, determined to push myself to a level that I may not think I can.” I love when clients do that, and they always come in, they’re like, “I’m so proud of myself, I can’t wait to tell you what I did this weekend.” I love that. So, always remember hard things come with beautiful, beautiful, beautiful outcomes and accomplishments.

Kimberley: Yeah. I think the empowerment piece, when clients do scary, hard things, or they feel their hard feelings, or they do an exposure, they’ll often come in and be like, “I felt like I could do anything. I had no idea about the empowerment that comes from doing hard things.” I think we’ve been trained to think that if we just avoid it, we then will feel confident and strong, but it’s actually the opposite. The most empowered you’ll ever feel is right after you’ve done a really, really hard thing, even if it doesn’t go perfectly.

Chris: Yeah, and so much learning comes out of it. That’s why I always tell clients too, going back to one of our first roadblocks, beating yourself up prevents the learning. Let’s say you try something and it doesn’t go well. I was talking to a colleague of ours who I really, really like. She was telling me how her first treatment center failed. Now she’s doing really well for herself down in San Diego. She’s like, “I just didn’t know things, and I just did things wrong, and I learned from it, and now I’m doing well.” 

It’s like, whenever we look at something not going the way we’d like as an opportunity to learn and collect data, it just makes us that much better when we try it the other time. A lot of times these anxiety disorders were originally before treatment, hopefully trying to find ways to avoid our way through life—tough words—and trying to figure out, like, how can I always be small and avoid and still get to where I want to be?

When people hear this from your podcast—it’s a beautiful day to do hard things—I hope that they recognize that you don’t have to live an avoidant lifestyle, an isolated lifestyle anymore. Really challenging yourself and doing hard things is actually going to be so rewarding. It’s incredible what outcomes come with it.

Kimberley: Amazing. Well, Chris, thank you so much for doing this with me again. We finally stamped it into the podcast, which makes me so happy. Tell us where people can hear about you, get in contact with you, and learn more about what you do.

Chris: I am really active in the International OCD Foundation. I’m one of their board members. I also am one of their lead advocates, just meeting as somebody with the disorder. I speak on it. Then I lead some of their special interest groups. The Body Dysmorphic Disorder Special Interest Group is one of them, but I lead about four of them. One of their affiliates, OCD Southern California, I am Vice President of OCD SoCal and a board member. We do a lot of events here locally that Kim is part of, but also some virtual events that you could be a part of.

And then, as a clinician, I’m a licensed clinician in Costa Mesa, California. I currently work at The Gateway Institute. You can find me either by email at my name, which is never easy to spell. So, ChrisTrondsen@GatewayOCD.com, or the best thing is on social media, whether it’s Instagram, Facebook, or X, I guess we’re calling it now. Just @christrondsen. You could DM me. I always like to hear from people and get people’s support, and anything I can do to support people. I always love it.

Kimberley: Oh my gosh, you’re such a light in the community, truly. A light of hope and a light of wisdom and knowledge. I want to say, because I don’t tell you this enough as your friend and as your colleague, thank you, thank you for the hope that you put out there and the information you put out there. It is so incredibly helpful for people. So, thank you.

Chris: I appreciate that. I forgot to say one thing real quick. Every first, third, and fourth Wednesday of the month at 9 a.m. Pacific Standard Time on the IOCDF, all of their platforms, including iocdf.org/live, I do a free live stream with Dr. Liz McIngvale from Texas, and we have great guests like Kim Quinlan on, so please listen. But thank you for saying that. I always try to put as much of myself in the community, and you never know if people are receiving it well.

I want to throw the same thing to you. I mean, this podcast has been incredible for so many. I always play some of this stuff for my clients. A lot of clients are looking for podcasts. So, thanks for all that you do. I’m really excited about this episode because I think it’s something that we touch so many people. So, now to share it on a bigger scale, I’m excited about it. But thank you for your kind words. You’re amazing. It’s all mutual.

Kimberley: Thank you. You’re welcome back anytime.

Chris: And we’re going to get Greek food soon. It’s funny [inaudible] I’m telling you. It’s life-changing. Thanks, Kim. Listen to other episodes.

Kimberley: Thank you.

Welcome back, everybody. This is Part 2 of Your 2024 Mental Health Plan, and today we are going to talk about the specific tools that you need to supercharge your recovery. This podcast is called Your Anxiety Toolkit. Today, we are going to discuss all the tools that you are going to have in your tool belt to use and practice so that you can get to the recovery goals that you have. Let’s go.

For those of you who are here and you’re ready to get your toolkit, what I encourage you to do first is go back to last week and listen to Part 1 of this two-part series, which is where we do a mental health recovery audit. We go through line by line and look at a bunch of questions that you can ask yourself, journal them down, and find specifically what areas of recovery you want to work on this year. 

Now, even if you’re listening to this as a replay and it’s many years later, that’s fine. You can pick this up at any point. This episode and last week’s episode actually came from me sitting down a few weeks ago and actually going, “Okay, Kimberley, you need to catch up and get some things under control here.” You can do this at any time in a month from now or a year from now. We’re here today to talk about tools, so let’s get going. 

First, we looked at, when we did our audit, the general category. The general question was, how much distress are you under? How much time is it taking up, and how do you feel or what are your thoughts about that distress? That is a very important question. Let’s just start there. That is an incredibly important question because how you respond to your distress is a huge indicator of how much you will suffer. 

If you have anxiety and your response is to treat it like it’s important, try to get it to go away, and spend your time ruminating and wrestling, you’re going to double, triple, quadruple your suffering. You’re already suffering by having the anxiety, but we don’t want to make it worse. 

If you’re having intrusive thoughts and you respond to them as if they’re important and need to be solved, again, we’re going to add to our suffering. If you have grief, shame, or depression and you’re responding to that by adding fuel to the fire, by adding negative thoughts, or by saying unkind things to yourself, you’re going to feel worse. How do you respond? 

WILLINGNESS

Tool #1 you’re going to need in this category is willingness. When you identify that you’re having an emotion, how willing are you to make space for that emotion? I’m not saying give it your attention; I’m saying, are you willing to just allow it to be there without wrestling it, trying to make it go away? Are you willing to normalize the emotion? Yeah, it makes complete sense that I’m having a hard time, or that all humans have these emotions. How willing can you be? 

Often, what I will ask my patients is, out of 10, if 10 being the highest, how willing are you? We’re looking for eights, nines, and tens here. If you’re at like a six, seven, that’s okay. Let’s see if we can get it up to the eights, nines, and tens. 

VALUES OVER FEAR

Another tool (Tool #2) is respond with values, not fear or emotion. We want to work at being very clear on what our values are, what is important to us. Because if we don’t, emotions will show up. They will feel very, very real. When they feel very, very real, you’re likely to respond to them as if they’re real. Again, adding fuel to the fire, adding to the suffering. Instead, we want to respond with values. 

If you have fear, you’re going to ask yourself, do I want to respond based on what fear is telling me, or my values, my beliefs, the principles, the things that are important to me? If you’re depressed, do you want to respond based on what depression is telling you to do? Like, "Give up, it’s hopeless, there’s no point." Or do you want to get back in touch with what matters to you? What would you do if depression wasn’t here? What would you do if anxiety was not here? 

The third tool I’m going to give you, and this is a huge one—I’m going to break it down into different categories—is mindfulness. Now, if you’ve been here on Your Anxiety Toolkit, you already know that I think mindfulness is the most important tool, one of the most important tools you will have in your tool belt. You should be using it in your tool belt every day. It’s like if you actually had a tool belt, it’d be like the hammer, the thing you probably use the most. 

Mindfulness involves four things, and this is the way I want you to think about it. 

MINDFULNESS

Number one, it’s awareness. Mindfulness is being present and aware of what is happening to you internally. Being able to identify, I feel sad, I feel anxious, I notice uncertainty, I’m noticing I’m having thoughts about A, B, and C. That awareness can help you stay in line with your values, but stay present enough to respond wisely. 

Mindfulness is also presence. I’ve already given you that word. It’s being in the here and now. Fear always wants us to look into the future; mindfulness is being in the here and now. Depression often always wants us to look at the past and ruminate on the past and what went wrong or what will potentially go wrong in the future; mindfulness is only tending to the here and now, what’s actually happening. 

When I’m anxious and I become present in my body, I realize that the thing that I’m afraid of hasn’t happened yet. If it is happening, if the thing that I’m afraid of is happening, then I can still go, “Okay, what’s happening in the present? How can I relate to it?” As we’ve discussed in earlier tools, how can I relate to it in a way that doesn’t add to my suffering? Can I make some space for it? Can I be willing to have it? Can I respond with values? Really getting present in this moment will give you some space to act very skillfully. 

NON-JUDGMENT

The next mindfulness tool is non-judgment. We have to be non-judgmental. Often, when I’m with my patients or with my students, they will often say, “I’m having anxiety, and it is bad and wrong, and I’m wrong for having it, and it shouldn’t be here.” All of that is a judgment. 

I often bring them back to the fact that anxiety, while yes, it is uncomfortable, it is neutral. Let me say that again. Anxiety, while it is uncomfortable—it’s not fun—it is neutral. It is neither good nor bad. It just is your present experience. This work becomes how willing are you to feel discomfort. How willing are you to widen your distress tolerance for this thing that you’re experiencing, and how can you practice not judging it as bad? 

The thing to remember is, if you have an emotion, a sensation, or a thought, and you appraise it as bad, your brain will remember that for next time. So next time you have it, it will more likely send out a bunch of cortisol and adrenaline and a bunch of stress hormones when you have that emotion, that sensation, or that thought. And that’s how we can break this cycle by practicing non-judgment. 

WISDOM AND INSIGHT

The fourth piece of mindfulness that I want you to consider is wisdom and insight. This is not a typical mindfulness tool, I would say, but it’s an important piece of our work.

When we have mental struggles, when we have emotional struggles, it’s very easy to fall into the trap of believing our thoughts and our feelings, going into that narrative, and getting into that story. When we do that, again, we make things worse. We tend to act on those emotions and that distress instead of our values.

A lot of mindfulness, if you can practice being present, if you can practice being aware, if you can practice being non-judgmental, you then get to be steady in wisdom. You get to check the facts and respond according to the facts and the reality. You get to be level in how you respond. It doesn’t mean your anxiety will go away. It just means that you’re thinking in a way where you can make decisions. You’re connected to your prefrontal cortex, where you can make good decisions for yourself, not just respond to the emotions that you’re having. That’s sort of like a bigger picture, but that’s sort of more like the result of practicing mindfulness. 

When we last week went through the audit of your mental health recovery, we also addressed safety behaviors. Now these were avoidance, reassurance seeking, mental compulsions, physical compulsions, and there is a fifth one, but we’ll talk about that later. We really went through and thoroughly investigated, did an audit, did an inventory of how many of these behaviors and what specific behaviors you do. Again, if you didn’t listen to that episode, go back and look at that because it will help you put together a really good inventory of what’s going on for you.

Now, I want to address a couple of things when it comes to these. If you’re someone who does a lot of avoidance, I’m going to strongly encourage you to use Tool #4, which is find ways to face your fear. Identify all the things that you are afraid of and you’re avoiding, and find creative ways to face your fear and make it fun.

If you’re afraid of something, try to find ways to make it fun that line up with your values. If you’re afraid of airplanes but love to travel, pick a place when you first start this that you’re interested in going to. Have it be something that you have been wanting to go to for a long time. Do it with someone you enjoy doing it with. If it’s something miscellaneous around the house, include the people around you, make it fun, put the music on that you want. You’re not doing that to take the discomfort away; you’re doing it so that it’s so deeply based on your values, so deeply based on what’s important to you, and purposely every day, find ways to face your fears. 

Now, if you have OCD specifically and you want help with this, we have a full, comprehensive course called ERP School. If you go to CBTSchool.com, you can get access to that, and it will take you step by step on how to do that for OCD. 

If you have generalized anxiety or panic disorder, we have a step-by-step process for how you can do that. It’s called overcoming anxiety and panic. 

If you have depression, we actually have a whole comprehensive course for depression as well on how you can face the depression, how you can undo the way that depression has you avoiding things and procrastinating, and how it’s demotivating you. That course is there for you as well at CBT School. 

If you’re someone who struggles with mental compulsions, we actually have a free six-part mental compulsion series here on Your Anxiety Toolkit. It’s completely free. I’ll leave the links for that in the show notes below. But that will help you walk through it with six amazing clinicians from around the world, like the best ones that we can get, talking specifically about different ways to manage mental compulsions. But it does involve a lot of the tools we’ve already talked about—a lot of mindfulness, a lot of facing your fear, a lot of willingness, a lot of awareness. These are things that you can be using specifically to interrupt those safety behaviors.

Now, another tool (Tool #5) is distress tolerance, because as you face your fear, you’re going to have some uncomfortable feelings. Distress tolerance is an opportunity for you to lean into that discomfort a little more. It’s very skill-based. Let me give you a couple of ideas. 

BEGINNERS MIND

Number one would be this idea of a beginner’s mind. Usually, when we’re uncomfortable, our natural human instinct is to get out of here. Like, “Let’s go. I don’t want to be here. I don’t want to feel it. Let’s run away.” Another instinct is to fight. Like, “Oh, I want to wrestle with it.” 

Beginner’s mind is the opposite of that. It’s the practice of being curious. We actually have a whole podcast episode on beginner’s mind. Think of it like you’re a baby. I always say, imagine you’re like one or two and you hand the baby a set of keys. Now, if you handed a set of keys to an adult, they’d be like, “Yeah, that’s keys.” They wouldn’t really stop to look at the keys. But if you give it to the baby, they’re so curious, they’re so open-minded, and they look at the keys like I’ve never seen these. They’re shiny, but they’re hard, but they’re bumpy. They have these round things. What do you do with them? I’ll put them in my mouth. What do they taste like? What do they feel like? They’re so willing to see these keys as if it’s the first time they’ve ever seen them because it's the first time they’ve ever seen them. 

As adults, we have to practice being curious, just like that. When we’re uncomfortable, we can be curious instead of nonjudgmental and go, “Okay, let’s be curious about this. What does it feel like? I wonder what it’s like if I’m willing to feel it. How long does it last? Can I let it be there? I wonder what will happen if I let it be there and go and do this or face the fear.” Let’s be curious instead of having a fixed mindset of, “I can’t feel this. I can’t handle it. I don’t want to,” and so forth. Beginner’s mind is very important in helping you relearn the perceived stress or the perceived danger of a certain thing. 

Another really important distress tolerance skill is radical acceptance. Radical acceptance is a sort of badass response to fear and emotions by going, “Bring it. Let’s have it. It’s here. There’s nothing I can do. Trying to stop it only makes things worse. And so I’m committed to radically accepting it being here.” Then you can go on to use other tools like your values and willingness, ERP, CBT, and any of those. You can use any of those skills. But you’re coming from a place of just radically accepting that it’s there. 

UNCERTAINTY

Another distress tolerance skill is to be uncertain on purpose. “Bring it on.” If you have anxiety, you’re going to have uncertainty anyway. Bring it on. Let’s let it be there. Let’s make another relationship with uncertainty—one that’s not stressful and one where it’s like, I’m allowing it to be there. I actually have some mastery over it because I’ve practiced letting it be there before, and I tolerated it then, and I’m sure I’ll tolerate it again. 

Remember here, you have gotten through 100% of the hard things in your life. You can do it again, and each time we can make this 1% improvement in how skillful we are in response to it.

SELF-KINDNESS AND SELF-COMPASSION

The next category that we had in the audit was kindness. We talked about questions such as, how do you treat yourself throughout the day? How kind are you? Do you punish yourself for having emotional struggles? And of course, you guys know this is number six, which is self-compassion. We know that self-punishment doesn’t work. In fact, it makes us feel worse. 

Self-compassion is the practice of making you a safe place to have any emotion, any discomfort, have any thought, have any anxiety. You’re willing to have them all, and you’re going to promise yourself and commit to yourself that you’ll be gentle with yourself no matter what. That’s the work. 

Truly, so many of you have said that you’ve been working on that, and you’ve actually made huge strides in that area. We have so much content on Your Anxiety Toolkit on self-compassion. I’d encourage you to go back and listen to any of those. This year I’m going to really heavily emphasize this work, but I really want you to really consider creating a safe place for you to have any emotion, any intrusive thought, any feeling, any discomfort at all, any pain, so that you know that you’re always in a safe place to have those feelings. 

MINDSET 

The last category of the audit that we did last week was on mindset. We asked questions like, how willing are you to experience these emotional struggles? When you wake up, what’s the thing you think? Do you think, “Oh no, I can’t handle it, this is going to be terrible, I hope I don’t have any anxiety today, I hope my emotions don’t come or I hope I don’t have any thoughts”? Or do you have a more positive outlook of the day? 

Now, we already talked about willingness. It was one of the first tools that we used. But here, I want you to consider the idea of being positive. Now, I’m not saying positive like, “Oh no, my bad things won’t happen,” or “No, I’m not a bad person, and my fears won’t come true.” That’s not what I’m talking about being positive. I’m talking about remind yourself of your strengths. That is a tool. 

Being complementary and positive is a tool that we don’t use enough. We spend all the time thinking about the worst-case scenario, and we very rarely take time to really think, “I’m actually pretty strong. I’ve actually handled a lot. I’m actually very, very resilient.” Is it possible that you do that too? What can we do to get you to see yourself the way I see you? 

Often, I’ll say to clients, “Oh my gosh, you’re doing so well.” And they’ll be like, “Oh, I kind of am, you’re right.” Or I’ll say, “Wow, look at how you got through that really hard thing.” And they’re like, “No, it’s not a big deal; everyone can do it.” But I’m like, “No, you did that.” 

CELEBRATE YOUR WINS 

Please practice being positive towards yourself, having positive regard for yourself, celebrating your wins, thinking positive about your strengths, not just focusing on your weaknesses. 

Now Tool #8, we all know. I say it every single week, which is it’s a beautiful day to do hard things. When we wake up and we think, “Oh no, I don’t want bad things to happen,” we become a victim. What we want to do is we want to stand up and say, “Today is a really beautiful day to do really freaking hard things, and I’m going to practice doing those.”

I want you to think of #8 as a motto, a mantra that you can take with you everywhere. “It is a beautiful day to do hard things.” We don’t need perfect conditions to do hard things either. We don’t need motivation to do hard things. Sometimes we just have to do them, whether we’re motivated or not. And then we see the benefit. We don’t have to wait until you have the right thought, the right feeling, or the right situation. 

Often, I’ll catch myself like, “Oh, I had a little bit of an argument with my husband. No, I’m not going to do hard things today.” No, that’s the day to go do the hard thing. Do it because it’s what brings you closest to your recovery. It brings you closest to the goals that you have. 

TIME MANAGEMENT

Now, Tool #9 is time management. When you wake up in the morning, if dread is the first thing on your mind, time management will help. We have a whole course on CBTSchool.com on time management, and what it is about is teaching you a few core things.

Number one, schedule your recovery homework first because it has to be the priority. It has to be. Secondly, schedule fun time first. Don’t schedule work. Don’t schedule your chores. Make sure you’re prioritizing these things because recovery requires rest, it requires fun, it requires lightness and brightness, and fulfillment. Doing these hard things takes up a lot of energy, so any way you can, even if it’s for two minutes, manage your time so that you have set in your calendar, set a reminder, the time where you’re going to do the things that you need to do to get your recovery on its way. Prioritize it. 

We have a whole course called Time Management for Optimum Mental Health. You can get it at CBTSchool.com, and it really outlines how you can do this and how you can practice prioritizing these things, which brings us to Tool #10, which is find a community of people who are doing the same things as you. 

I get it, everyone on Instagram looks like they’re having a jolly time and their life is easy. The truth is, no, they’re not. Find the people who are also struggling with similar adversity. You could go to CBT School Campus, which is a Facebook group we have. On social media, there are so many amazing advocates sharing what it’s like to be doing this work. Come on over and follow me on Instagram at Your Anxiety Toolkit, where I talk a lot about this all the time. There is a community of people who make the most gorgeous comments and are so supportive and encouraging.

FIND COMMUNITY

Find a community, because if you feel like you’re the only one who’s struggling, it makes it really, really hard. Just know that you’re not alone and that other people are going through hard things. They might not be going through exactly what you’re going through, but this community is filled with millions of listeners. There are other people who are struggling too, so try to find them. Use them as accountability buddies. Touch base with them. 

My best friend and I meet once a week, fire the phone, and check in. How are you doing? What are you doing well with? How are you doing with the goals you set for last week? Try to find someone, if you can, who can be your accountability buddy. If not, maybe ask a loved one or a friend who might be willing to do that. 

There are the 10 tools that I want you to have in your toolkit. You’re not going to use them all the time. You’re not even going to be good at them. I’m even willing to say you’re going to suck at using them, and that is okay. I suck at using these sometimes too. This is not about perfection; this is about pausing, looking at the problem, asking yourself, which of these tools would be most helpful right now? And be curious. Again, use your beginner’s mind. Be curious about trying them, experimenting, giving yourself a lot of celebration in the fact that you tried. 

Again, this doesn’t have to be perfect. We make 1% improvements over here. That’s all I’m looking for—a 1% improvement. Is there something you can do today that will get you 1% closer to your recovery goal? If that is possible, go for it. Give it your best. You will not regret it. I’ve never once had someone regret moving towards their recovery. In fact, I’ve only seen people say, “I’m so grateful I did it.” Even though it might have been late, it’s never too late. 

All right. Have a wonderful day. I know you can do this. I cannot wait for this year. I have so many things I want to talk to you about. 

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

f you need a mental health plan for 2024, you are in the right place. This is a two-part series where we will do a full recovery audit. And then next week, we’re going to take a look at the key tools that you need for Your Anxiety Toolkit. We call it an anxiety toolkit here, so that's exactly what you’re here to get.

The first step of this mental health plan for 2024 is to look at what is working and what isn’t working and do an inventory of the things that you’re doing, the safety behaviors, the behaviors you’re engaging in, and all the actions that you’re engaging in that are getting in the way of your recovery.

Now what we want to do here is, once we identify them, we can break the cycle. And then we can actually start to have you act and respond in a very effective way so that you can get back to your life and start doing the things that you really, really wanted to do in 2023 but didn’t get to.

If you’re listening to this in many years to come, same thing. Every year, we have an opportunity to do an audit—maybe even every month—to look at what’s working and what’s not. Let’s do it.

Now, one thing I want you to also know here is this is mostly an episode for myself. A couple of weeks ago, I was not coping well. I consider myself as someone who has all the skills and all the tools, and I know what to do, and I’m usually very, very skilled at doing it. However, I was noticing that I was engaging in some behaviors that were very ineffective, that had not the best outcomes, and were creating more suffering for myself. 

Doing what I do, being an anxiety specialist, and knowing what I know as a therapist, I sat down and I just wrote it all out. What am I engaging in? What’s the problem? Where am I getting stuck? And from there, naturally, I did a mental health audit. And I thought, to be honest with you, you guys probably need such a thing as well, so let’s do it together. Here is what I did. Let’s get started with this mental health audit that we’re going to do today. 

FOUR RECOVERY AUDIT CATEGORIES 

1. General Perspective 

2. Safety Behaviors 

3. Safety 

4. Mindset 

What we’re going to do is we’re going to break it down into four main categories. The first category is your general perspective of your mental health, your recovery, and your internal emotional experience. 

The second category is the safety behaviors you’re engaging in. A safety behavior is a behavior that you do to reduce or remove your discomfort, to get a sense of safety, or to get a sense of control. Sometimes they’re effective, sometimes they’re not, and we’re going to go through that today. 

The third category is actually just safety—looking at how safe you are inside your body with your internal experience. And I’ll explain a lot more of that here in a little bit, so let’s just move on to section number four, which is mindset. What is your mindset about recovery? And we’re going to go through this together. 

LET’S PROMISE TO DO THIS KINDLY 

As we move forward, I want you to promise me and vow to me as we do this. We are only doing it through the lens of being curious and non-judgmental. This audit should not be a disciplinary action where you wrap yourself over the knuckles and you beat yourself up, and you just criticize yourself for the fact that you’re not coping well. That is not what we’re doing here.

WE ARE JUST GATHERING DATA

We are ultimately just taking data. We’re just looking at the data of what’s working and what’s not. And then we get to decide what we do differently. And we get to be honest with ourselves about what’s actually happening from a place of compassion, from a place of understanding, knowing that we’re doing the best we can with what we’ve got. Again, I could beat myself up and be like, “You’re a therapist. You do this for a living. What is wrong with you?” But instead, I just recognize.

Of course, you fell off the wagon. Things don’t always work out perfectly when you’re under a high amount of stress or when it’s the holidays, when things feel out of your control. We naturally gravitate to safety behaviors that often aren’t the most effective. That’s just the facts. 

BE NON-JUDGMENTAL

Let’s do this from a non-judgmental standpoint. We are literally just gathering data. How we handle this is a big part of recovery. Okay? Let’s do it. 

YOUR RECOVERY AUDIT 

Let’s first look at the first section of your recovery audit. This is a general category. We’re going to ask some questions. You can get a pen and notepad, or you could just listen and think about this, pause it, take some stock of what’s been going on for you. But I do strongly encourage you to pause, sit down, write your answers on a piece of paper, on a Google Doc, or whatever you love to do. All right, here we go. 

GENERAL  

Number one, generally, how much of the day do you experience anxiety, hopelessness, or some kind of emotional distress, whatever it is that you experience? You could give a percentage, a grade, or an amount of hours. How much of the day do you experience emotions that are out of your control? We’re only here to get data on how much this thing is impacting your life.

You might say all day, every day. That’s okay. You might say, “A couple of hours every day that I experience panic,” or “A couple of hours every day I’m having intrusive thoughts.” It doesn't matter; just put it down. If you’re someone who has more depressive symptoms, you might say, “For six hours of the day, I experience pretty severe depression.” Whatever you’re experiencing, you can write it down. 

The second question in this category is, what are your thoughts about the emotional distress that you just documented? What are your thoughts about them? If you have anxiety, are your thoughts “I shouldn’t have anxiety”? Because what we gather there is if for, let’s say, two hours a day, you’re having anxiety, but for four hours a day, you’re saying, “I shouldn’t have it. I’m bad for having it. What’s wrong with me? Something is wrong. I’m terrible,” and so forth, we want to understand, what are the specific thoughts you’re having about the emotional distress? 

If you have OCD and you’re having a lot of intrusive thoughts, what are your thoughts about that? “Oh, my thoughts make me a bad person. Oh, my intrusive thoughts mean I must want to do the thing that I’m having thoughts about.” If you’re having depression, what are your thoughts about that? “Oh, I’ll never get better, that I’m weak for having this struggle, that I should be able to handle it better. I should be able to get out of bed and function normally.” We want to really understand your general mindset and perspective of what you’re going through. 

Often, we spend a lot of time thinking about why we have the problem. Why do I have this? What’s wrong with me? What did I do wrong? Why is this happening? Was it my past? Was it something that happened to me? Spending a lot of time trying to figure out why. That’s the general category. 

SAFETY BEHAVIORS

The second category, safety behaviors, is probably one of the most important, but there is a good chance I’m going to say that about every category, so let’s just go through them. 

The first question in safety behaviors is, how much of the day do you spend ruminating, thinking, going over and over the problem, trying to solve it? How many minutes, how many hours, or what percent of the day do you spend ruminating? 

We’ve already identified how much of the day you spend with the original, initial problem. But how much of the time do you actually spend engaging in the behavior of mental compulsions, mental rumination, sort of that real stressful solving practice? Write it down. Again, we’re not judging here. Even if you wrote 100% of the day, all day, every day for a year or 10 years, it doesn’t matter, okay? 

The next question in safety behaviors is, if you zoomed out and looked at your entire life, what is it that you are avoiding because of this internal emotional experience, whether it be anxiety, uncertainty, depression, grief, whatever it might be, panic? Whatever it is, what is it specifically that you’re avoiding? 

Some people say, “I’m avoiding a certain street. I’m avoiding a certain person. I’m avoiding a certain event. I’m avoiding an emotion. I’m avoiding a feeling. I’m avoiding a thought. I’m avoiding a specific book on a specific bookshelf. I’m avoiding a specific movie on the internet or on TV. I’m avoiding a specific topic in every area of my life.” Be as specific as you can. What is it that you are avoiding to try and reduce or remove your distress inside your body? Document all of it. 

I tell my patients, it doesn’t matter if this takes 17 pages; just document it down. Don’t judge yourself. Once we have the data, we can next week meet and work on a solution here. Or as you go through this, if you’ve already clearly identified that you have, let’s say, OCD, generalized anxiety, panic, or depression, we have specific courses on CBTSchool.com that will walk you through these and give you specific solutions to specific problems. That is there for you as well. 

We will next week go through the main tools you’re going to need. But if you really want to target a specific issue, we may have a course specifically in that area that will help you. If not, there are other areas where you can get resources and therapy as well. But this is going to help you get really clear on what specifically is going on for you. What is it that you’re engaging in that’s getting in the way?

The next safety behavior category is, how do you carry your body throughout the day? Are you hypervigilant? Are you tense? Are you rushing around? That was me. That’s when I was like, “Oh, Kimberley, you are going down the wrong channel.” Because I noticed in many areas of my day, I was rushing, trying to avoid some emotions, trying to check boxes, rushing around, hypervigilant, looking around, what bad thing is going to happen next. How are you carrying this in your body? 

If you had an eating disorder, it might be, “I’m tensing my stomach and pulling it in and trying to not eat and trying to suppress hunger and thirst.” If that’s happening, okay, let’s document. If you’re having panic, are you squinting, pushing away thoughts, trying to avoid a sensation in your body? We want to get to know what is happening with our bodies.

A patient of mine a couple of weeks ago said, “I just hold my breath all day. I really do. I probably take half the breath that someone without anxiety takes.” Write it down if you notice that’s what you’re doing in your body. Again, not your fault; we’re just here to look at the data. 

The next category of safety behaviors is, how often do you seek reassurance per day? How often do you consult with Google to reduce your anxiety? How often do you ask family and friends questions about your fear to get a sense of certainty or to reduce your anxiety? 

Sometimes this can be tricky. You might even just mention a topic to notice their facial expression to see how they respond, or you might report to them something that happened to see if they’re alarmed so that you then know whether you should be alarmed and engage in some behavior, worrying, ruminating, and so forth. 

How often are you trying to get to the bottom of anxiety and you’re noticing that it’s repetitive, and over and over again, you’re getting stuck in these rabbit holes of Googling or asking friends and families, often asking them questions they don’t even know the answer to? 

Often, our family members, because they love us, will give us an answer based on probability, but they actually don’t know. And therefore, your brain-- you’re very smart. I know this because all my clients with anxiety often in depression are. You’re very smart. You know they don’t know the answer, so your brain doesn’t compute it as a real certainty anyway. Your brain is going to immediately go, “Well, how do they know? They probably don’t know any better than I do,” and it’s going to want more and more questions to be asked. How often do you seek reassurance per day, or how much of the day do you spend seeking reassurance? 

And then the last safety behavior here is physical behaviors. This is more common for folks with OCD, phobias, or health anxiety. What physical behaviors do you engage in? Meaning, do you rearrange things? Do you move things? Do you check things? Do you turn things on and off? Lock doors, unlock doors, lock them again. How much are you engaging in physical behaviors to reduce your anxiety? 

Again, I will also say this is very true for generalized anxiety. Often, people with generalized anxiety disorder spend a lot of time just engaging in this high-level functioning of checking boxes, getting things done, always being the busiest person in the room. And while yes, that does get rewarded by our society because, “Oh, look at them go, they’re getting all the things done,” they’re doing it to avoid or remove discomfort or uncertainty. So we want to get a thorough documentation of all of those things. Again, do not beat yourself up if it’s a long list. Those will help us next week when we talk about tools. 

KINDNESS AND SAFETY 

We move on now to the third category, which is kindness and safety. And now we’re talking about how do you respond to yourself and your experience of anxiety. We also talked about this through the lens of safety. Safety is when you’re feeling uncomfortable, you’re having an emotion such as anxiety, grief, sadness, dread, anger. When you have those emotions, is your brain and body a safe place to allow those emotions to exist, or is it an unsafe place in that you push it away, judge yourself, tell it shouldn’t be there, rid it out, get rid of it, banish it, avoid it, abandon it, all the things? 

Question #1: How do you treat yourself throughout the day? Out of 10, how kind are you to yourself? Really think about it. How do you treat yourself? 

If you thought objectively about yourself as a friend, would you want yourself as a friend around? Probably not. Maybe you’ve been listening to Your Anxiety Toolkit for some time and you’ve already really developed these skills, but really, really honestly, how kind are you to yourself? If you were another friend, would you invite yourself over? Probably not because you wouldn’t invite a friend over who’s like, “What is wrong with you? You’re crazy. You shouldn’t be doing that. You’re so silly. Why are you spending all this time? You’re lazy. You’re dumb. You’re stupid for asking these questions.” So really think about that. 

The second question is, do you punish yourself for having these emotional struggles? And if so, how? Do you blame yourself? Do you shame yourself? Do you engage in a lot of guilt behavior, guilting yourself for these behaviors? Do you withhold pleasure from yourself? 

I’ve had so many clients tell me that they will not allow themselves to have the nice toilet paper, and they get themselves the scratchy, one-ply toilet paper because of their intrusive thoughts or because they’re depressed and they don’t check the boxes that their friends on Instagram have checked. Therefore, they don’t deserve the nice shampoo, or they don’t deserve nice sheets, or they don’t deserve to rest. They basically punish themselves for their emotional struggles, and we don’t want to do that. 

I know you know this already, but we want to know specifically. Do an inventory. Give yourself some days here to really do a thorough audit of what’s going on in your life. You might find that you don’t eat or you eat foods that aren’t delicious. One thing in my eating disorder recovery was, let’s really try to eat foods that are genuinely delicious. And if it’s not delicious, don’t eat it. Well, of course, if you need to eat and you need to function and you don’t have great options, that’s fine. Just eat for the sake of nourishment. But if you’re at a restaurant, eat the thing that’s delicious. Are you engaging in not allowing yourself to have those pleasurable things?

The last question in the area of kindness and safety is, what specifically do you say to yourself when things get hard? What specifically do you say to yourself? 

Often, people say, “No, I’m really kind to myself. I’m really good. I work out.” But then, when things get hard, everything goes down the drain. They start beating themselves up. When they don’t win at work or they don’t get a good grade or when they’re having a bad anxiety or depression day, that’s when they start beating themselves up. What do you say to yourself specifically when things get hard or when things get painful? Write it down. 

MINDSET

All right. We’re moving into the last section, which is mindset, because remember, we’re looking at 2024. We’re looking at the next six months, three months, or one month, and we’re really looking at how can we supercharge your recovery. 

Here’s the question: How willing are you to experience these emotional struggles in your body? Out of 10, how willing are you? 

Most of my patients report like a four, five, and a six, which is still great. I’m happy with that. It’s better than one, two, and three. And if you’re at a one, two, and three, it’s okay. We can start somewhere. Okay? What I’m looking for when I’m with my patients or when I’m with myself is a solid eight, nine, and 10 of willingness. 

Of all the things that I push the most, how willing are you to actually have your emotional discomfort? Often, people are like, “I don’t want it. I’m in too much pain. I’ve had too much pain, Kimberley. Don’t even ask me to. You don’t even understand. I’ve been in pain for years,” and I get it. What we do resist persists. So we want to first ask ourselves, how willing are we to allow this discomfort to be in our body, this emotion to be in our body, or this thought to be present in our awareness? 

The last question here is, when you wake up, what is your mindset about tackling the day? Do you wake up and go, “Oh no, God, I don’t want this,” or do you wake up and go, “No, no, no, no. Please, no anxiety today. Please, no thoughts today. Please, no depression today. Please, let this be a good day,” or do you wake up and say, “This will be a bad day”? Just take note of it. You’re not wrong for any of them, but we want to get a little bit of a temperature check on how you start the day. 

Now, one thing to know, often these thoughts are automatic. You don’t have control of them. Again, I’m not here to say they’re wrong, but what we will talk about next week is ways in which you can change how you respond to some of those automatic negative thoughts, or even your intrusive thoughts, and really look at how we can create a mindset for you. 

Let me give you just a quick rundown before we move forward. 

Number one, we will be doing tools next week, and I’ll be going deep into that. And that will be the focus of mine for 2024. My biggest focus for 2024 is really doubling down on making sure you guys know what the tools are in your toolkit and which ones work for you, and you get to work from that. 

Then I’m actually recording another podcast with Chris Trondsen, where we talk about common mindset roadblocks when it comes to recovery, and we will be giving you strategies there as well. Stick around for that. If you are listening to playbacks here, make sure you listen to all three episodes of this, because I think it will be so important now that you’ve done an inventory and you know what’s going on. 

All right. That’s that. That is your mental health audit. Write it all down. Give yourself plenty of love. Congratulate and celebrate the fact that you did this hard thing, and I will see you next week to talk about the tools you need—the specific tools in your anxiety toolbelt—to help you go and live a life where anxiety is not in charge, not in the driver’s seat, and where you live according to your values, what is important to you. Anxiety and emotions do not get to make your decisions, and that’s my goal for you. 

Have a great day. As always, I always say it’s a beautiful day to do hard things. You did a hard thing today. Thank you for sticking with me. This is not fun work. I get it. But it is important work, and you do deserve to get this really out on paper so that we can get you going in the direction that you want to go. 

As always too, take what you need, leave the rest. If some of these questions don’t really fly for you or they’re very triggering, just do the best you can. I don’t ever want people to feel like what I’m saying is the rule and you have to do it. 

Take what you need. Leave the rest, and I’ll see you next week. Have a good one, everyone.

Kimberley: Could I have PTSD or trauma? This is a question that came up a lot following a recent episode we had with Caitlin Pinciotti, and I’m so happy to have her back to talk about it deeper. Let’s go deeper into PTSD, trauma, what it means, who has it, and why we develop it. I’m so happy to have you here, Caitlin.

Caitlin: Yes, thank you for having me back.

INTRODUCING CAITLIN PINCIOTTI

Kimberley: Can you tell us a little bit about you and all the amazing things you do?

Caitlin: Of course. I’m an assistant professor in the Psychiatry and Behavioral Sciences Department at Baylor College of Medicine. I also serve as the co-chair for the IOCDF Trauma and PTSD in OCD Special Interest Group. Generally speaking, a lot of my research and clinical work has specifically focused on OCD, PTSD, and trauma, in particular when those things intersect, what that can look like, and how that can impact treatment. I’m happy to be here to talk more specifically about PTSD.

WHAT IS PTST VS TRAUMA?

Kimberley: Absolutely. What is PTSD? If you want to give us an understanding of what that means, and then also, would you share the contrast of—now you hear more in social media—what PTSD is versus trauma?

Caitlin: Yeah, that’s a great question. A lot of people use these words interchangeably in casual conversation, but they are actually referring to two different things. Trauma refers to the experience that someone has that can potentially lead to the development of a disorder called post-traumatic stress disorder. When we talk about these and the definitions we use, trauma can be sort of a controversial word, that depending on who you ask, they might use a different definition. It might be a little bit more liberal or more conservative. 

I’ll just share with you the definition that we use clinically according to the DSM. Trauma would be any sort of experience that involves threatened or actual death, serious injury, or sexual violence, and there are a number of ways that people can experience it. We oftentimes think of directly experiencing trauma. Maybe I was the one who was in the car accident. But there are other ways that people can experience trauma that can have profound effects on them as well, such as witnessing the experience happening to someone else, learning that it happened to a really close loved one, or being exposed to the details of trauma through one’s work, such as being a therapist, being a 911 telecommunicator, or anyone who works on the front lines. 

That’s what we mean diagnostically when we talk about trauma. It’s an event that fits that criteria. It can include motor vehicle accidents, serious injuries, sexual violence, physical violence, natural disasters, explosions, war, so on and so forth—anytime when the person feels as though their bodily integrity or safety is at risk or harmed in some way. 

Conversely, PTSD is a mental health condition. That’s just one way that people might respond to experiencing trauma. In order to be diagnosed with trauma, the very first criterion is that you have to have experienced trauma. If a person hasn’t experienced an event like what I described, then we would look into some other potential diagnoses that might explain what’s going on for them, because there are lots of different ways that people can be impacted by trauma beyond just PTSD.

PTSD SYMPTOMS AND PTSD DIAGNOSIS 

Kimberley: Right. What are some of the specific criteria for being diagnosed with PTSD?

Caitlin: PTSD is comprised of 20 potential PTSD symptoms, which sounds like a lot, and it is. It can look really different from one person to the next. We break these symptoms down into different clusters to help us understand them a little bit better. There are four overarching clusters of PTSD symptoms. There’s re-experiencing, which is the different ways that we might re-experience the trauma in the present moment, such as through really intrusive and vivid memories, flashbacks, nightmares, or feeling really emotionally upset by reminders of the trauma. 

The second cluster is avoidance. This includes both what we would call internal avoidance and external avoidance. Internal avoidance would be avoiding thinking about the trauma, but also avoiding any of the emotions that might remind someone of the trauma. If I felt extremely powerless at the time of my trauma, then I might go to extreme lengths to avoid ever feeling powerless again in my life. In terms of external avoidance, that’s avoiding any cue in our environment that might remind us of the trauma. It could be people, places, different situations, smells, or anything involving the senses. That’s avoidance. 

The third cluster of PTSD symptoms is called negative alterations, cognitions, and mood, which is such a mouthful, but it’s basically a long way of saying that after we experience trauma, it’s not uncommon for that experience to impact our mood and how we think about ourselves or other people in the world. You’ll see some symptoms that can actually feel a little bit like depression, maybe feeling low mood, or an inability to experience positive emotions. But there’s also this kind of impact on cognition—an impact on how I view myself and my capabilities, maybe to the extent that I can trust other people or feel that the world is dangerous. Blame is really big here as well.

And then the last cluster of symptoms is called hyperarousal. This is basically a scientific word for your body—sort of kicking into that overdrive feeling of that fight, flight, freeze response. These include symptoms where your body is constantly in a state of feeling like there’s danger or threat. This can impact our concentration. It can impact our sleep. We might have angry outbursts because we’re feeling really on edge. We may feel as though we have to constantly watch our backs, survey the situation, and make sure that we are definitely going to be prepared and aware if another trauma were to happen. 

Those are the four overarching symptom clusters. But somebody only actually needs to have at least six of those symptoms to a clinically significant and impairing way.

Kimberley: Right. Now, I remember early in my own treatment, a clinician using terms like little T trauma and big T trauma. The example that I was discussing is I grew up on a ranch, a very large ranch. My dad is and was a very successful rancher. Every eight to 10 years, we would have this massive drought where we would completely run out of water and we’d have to have trucks bring in water, and there were dead livestock everywhere. It was very financially stressful. I remember her bringing up this idea of what is a little T trauma and what is a big T trauma—not to say that that’s what was assigned to me, but that was the beginning of when I heard this term.

WHAT IS BIG T TRAUMA VS LITTLE T TRAUMA? 

What does it actually mean for someone to say big T trauma versus small T trauma?

Caitlin: Yeah, this is another common term that people are using. I’m glad that there is language to describe this because a lot of times, when I provide the definition that I gave a few minutes ago about what trauma is according to the DSM, people will hear that and think, “Wait a minute, my experience doesn’t really fit into that criteria, but I still feel like I’ve been really impacted by something. Maybe it’s even making me experience symptoms that really look and feel a lot like PTSD.” Some people can find that really invalidating, like, “Wait a minute, you’re saying that what I experienced wasn’t traumatizing and it feels like it was traumatizing.” 

Those terms can be used to separate out big T trauma, meaning something that meets the DSM definition that I provided—that really more strict definition of trauma. Whereas little T trauma is a word that we can use to describe these other experiences that don’t quite fit that strict criteria but still subjectively felt traumatizing to us and have impacted us in some way. 

What’s interesting is that there’s some research that suggests that the extent to which somebody subjectively feels like something was traumatic is actually more predictive of their mental health outcomes than whether or not it meets this strict definition because we see people all the time who experience big T traumas and they might be totally fine afterwards. And then there are people who experience little T traumas and are really struggling. 

We can use little T trauma to describe things like racial trauma, discrimination, minority stress, the experiences that you described, and even just significant interpersonal losses and things like that.

Kimberley: Yeah. Maybe even COVID. For some, it was a capital T trauma, would you say, because they did almost lose their lives or witness someone? Is that correct? Would you say that some others would have interpreted it as a smaller T and then some wouldn’t have experienced it as a trauma at all?

Caitlin: Yes, I think that’s a great example because there are definitely a lot of folks who don’t necessarily know someone who became really ill, lost their life, or didn’t have that personally happen to them. But there was this looming stress, maybe even related to quarantine and isolation and things like that.

WHO GETS PTSD AND TRAUMA?

Kimberley: This is really fascinating. I wonder if you could share a little, like, of all the people, what are the factors that you mentioned that increase someone’s chances of going on to have PTSD? Who goes on to get PTSD, and who doesn’t? How can we predict that? What do we know from the research?

Caitlin: This is an interesting question because I think that some people might intuitively think, “Well, somebody experienced this really horrible trauma. Of course, they’re going to go on to develop PTSD.” We actually know that people on the whole can be pretty resilient even in the face of experiencing pretty horrible tragedies. 

Our estimates of exposure to what we would call potentially traumatic experiences range from 70% to 90% of the population, and most of us will experience something at some point in our lives that would need that definition—that strict definition of a trauma. Yet, only about 6 to 7% of people will be diagnosed with PTSD at some point in their lives. So there’s this huge discrepancy here. 

There are lots of factors, and of course, we don’t have this perfectly nailed down where we can exactly predict, “Okay, this person is going to be fine. This person is going to have PTSD.” It’s really an interaction of lots of factors. But we know that there are some things that can either provide a buffering effect against PTSD or have the opposite effect, where they might put somebody at greater risk. 

One of the biggest things that’s come up in research is social support or the lack thereof, so that when people have really great social support after their trauma, whether it’s after a sexual assault or they’ve come home from combat, that can really buffer against the likelihood of developing PTSD. The reverse is true as well when people don’t have social support. We saw this, for example, after the Vietnam War, where a lot of veterans came home and really were mistreated by a lot of people. Unfortunately, that’s a risk factor for developing PTSD. 

But there are other things too, like coping. Not necessarily using one particular coping skill, but rather having a variety of coping strategies that somebody can use flexibly, even something like humor. We see this as a resilience factor. Obviously, there are times when using humor can serve as a distraction or avoidance, and there are times when it can be really adaptive too.

Obviously, of course, genetics that people may have a predisposition in general towards having mental health concerns. Sex, we know that people assigned female at birth have a higher likelihood of developing PTSD after trauma. 

And then there are things that may be specific to the experience itself, so the type of trauma. Sexual assault is unfortunately a really big risk factor for developing PTSD, whereas there are other trauma types where fewer people go on to develop PTSD from those. 

And then there’s something that we call peritraumatic fear, and that just means the fear that you were experiencing at the time that the event was happening. In the moment that the trauma was happening to me, how scared was I? How much did I feel like I might lose my life? People who experience more of that fear at the time of the event are more likely to go on and develop PTSD. 

But it’s pretty interesting too, because, as with everything, there isn’t just this binary, like you either have it or you don’t have it. I want to normalize this too for anyone who might be listening and maybe has recently experienced something really horrible and is struggling with some of these symptoms that we talked about. It doesn’t necessarily mean that you have PTSD or that you’re going to continue to have PTSD. 

Most people, about 50 to 65%, will experience mild to moderate post-traumatic stress symptoms after the event that will just gradually go away on their own. We call that a resilience trajectory. We also have about 10 to 15% of people who have what we call a recovery trajectory, where maybe right away they did have a spike in post-traumatic stress symptoms, right away in that first month or so. But after a year, again, it’s resolved itself. 

And then we have two trajectories that go on to describe people who will have PTSD. That would be a chronic trajectory where somebody would have this elevation in symptoms after the trauma that persists. That’s usually about 15 to 20% of people. And then less likely is what we call a delayed trajectory. This is about only 5 to 10% of people who may have had really mild symptoms right away or perhaps no symptoms at all. And then, after about six to 12 months, it might just all of a sudden skyrocket for whatever reason.

IT IS OCD OR AM I IN DENIAL? 

Kimberley: Right. So interesting. I was actually wondering what you often hear about people who, especially as someone who treats OCD and anxiety disorders, often questioning whether there was a trauma they had forgotten. Like, did I repress or am I in denial of a trauma? What can you share statistically about that?

Caitlin: Yeah, that’s a really great question. It’s definitely more of a controversial topic in the field, not because people don’t have the experience of having these recovered memories, but rather because of what we know about how memory works and how fragile it can be, that as clinicians, we have to be really careful that we’re not, in our efforts to help someone, inadvertently constructing a false memory. 

I would say that most of the time, this delayed trajectory of PTSD symptoms is less so about the person not remembering the event, but more so like they just have continued on with their life and are probably suppressing, avoiding, and doing all sorts of things that are maybe keeping it at bay temporarily. And then there may be, in a lot of cases, some big life event that may bring it up, or perhaps another traumatic experience or something like that.

WHAT IF I HAVE REPEATED TRAUMAS? 

Kimberley: Yeah. I was going to ask that as well, as I was wondering. Let’s say you’ve been through a trauma. You recovered on that trajectory you talked about. Are you more likely to then go on to have PTSD if you repeat different events, or do we not have research to back that up?

Caitlin: That’s a great question. I’m not sure specifically about, depending on which trajectory you were initially on, how that increases the likelihood later on. I can say that repeated exposure to trauma in general is associated with a greater likelihood of PTSD. I would say that, probably regardless of how quickly your symptoms onset, if at all initially, experiencing more and more trauma is going to increase the likelihood of PTSD.

WHO CAN DIAGNOSE PTSD AND TRAUMA? 

Kimberley: Right. Amazing. Thank you for sharing that. I know that was very in-depth, but I think it helps us to really understand the complexity and the way that it can play out. 

Who can make these diagnoses? I know, as I mentioned to you before, even my daughter has said she found herself on some magazine website that was having her do some online tests to determine whether there was trauma. It seems to be everywhere, these online tests. Can you get diagnosed through an online test? Would you recommend that or not? Who can we trust to make these diagnoses?

Caitlin: That’s a great question. I would not recommend using something like an online test or even a self-report questionnaire to help you figure out if you have PTSD. Now, it can give you a sense of the specific areas that I might be struggling with that I could then share with a licensed provider, who can then make the diagnosis. But if you were to just find a quiz online and take it, and it says you have PTSD, that would not be something that we would consider to be valid or reliable in any way. 

I would recommend talking with a psychologist, a psychiatrist, any sort of general practitioner, an MD, or maybe even someone’s primary care physician. Definitely, if you can get in touch with a licensed provider who specializes in PTSD and can really be sure that that’s what’s going on for you. 

Now, TikTok and all these things exist out there. As with anything on the internet, it can be used for good and it can also be very harmful. I think it just comes down to gathering information that may be helpful but then passing it on to someone who can sift through the misinformation and give you a clearer answer.

Kimberley: Yeah. Thank you for that. I think, as someone myself who’s had their own mental journey, I do remember during different phases of my own recovery where our brains just don’t make sense. I had an eating disorder—a very bad eating disorder—and my brain just couldn’t see clearly in some areas, and me being so frustrated with that. I know lots of people with, let’s say, panic disorder feel the same way or health anxiety, their condition feels so confusing and makes no sense that in the moment of being grief-stricken by this and also very confused, it’s pretty easy to start wondering, “Could this have been a trauma or is this PTSD? This doesn’t make sense. Why am I having this mental health issue?” Especially if it’s not something that was genetically set up in your family. I’m wondering if you can speak to the listeners who may have dabbled in thinking maybe there is a trauma, a big T, a little T, or PTSD. Can you speak to how someone might navigate that?

Caitlin: Most definitely. I’ll validate too that it’s really complex. We use the DSM to help us understand these different diagnoses, but there’s so much overlap. Panic disorder—obviously, panic attacks are the hallmark feature of panic disorder, but people can have panic attacks in PTSD as well. People with eating disorders might have issues with their self-image and their self-esteem. That can happen in PTSD as well, as I mentioned, even with mood disorders. There are symptoms in PTSD that sure look and sound a lot like depression. 

If it feels confusing, “Well, wait a minute, I have this symptom. What does it belong to? What does it mean?” We do really have this very imperfect and overlapping classification system that we use. That being said, it’s a legit question to ask if somebody feels like, as you were saying, “I’ve been struggling with these symptoms, but it really feels like there’s something more here.” 

When we diagnose PTSD, we go through all of the 20 symptoms, some of which I referenced earlier. For each symptom, we’ll ask about when that symptom started for the person relative to trauma and whether or not it’s related to trauma in some sort of way, if there’s some content there to work with. 

For example, somebody maybe wasn’t having any issues with their mood whatsoever, and then they experienced trauma, and all of a sudden, it was just really hard for them to get out of bed. Well, that could potentially be a symptom of PTSD because it started after the trauma. 

One thing that I hear a lot, because unfortunately, childhood trauma is really common, when I ask folks about this, they’ll say, “I don’t know. The trauma happened when I was so young that I don’t even remember who I was before this person that I am now, who’s really struggling.” In that case, people usually have a pretty good insight into this. Like, do you think that this is related in any way? Or maybe, if you have any recollection, you had a little bit of this experience and this symptom initially, and it got worse after the trauma. That, again, could potentially indicate that that’s a symptom of PTSD. 

I would say for those folks who are listening, who are struggling with things like panic attacks, difficulty with eating, mood, whatever it might be, even OCD, which we talked about recently, really checking in with yourself about how and if those symptoms are related to your trauma. If they are, then find someone that you trust that you can talk to about it. Hopefully, a therapist who can help you piece this apart. 

It could still be maybe the disorder you thought it was, maybe it is panic disorder, maybe it is OCD, maybe it is an eating disorder that’s still informed by trauma in some way or impacted in some way, which would be important to be able to process in treatment. Or it could just be PTSD entirely. And then that would be really important to know because that would significantly change what the treatment approach would be.

Kimberley: Yeah. It’s so true of so many disorders. You could have social anxiety and panic attacks because of social anxiety, and a mental health professional will help you to determine what’s the primary, like, “Oh, you have social anxiety and social interactions are causing you to have panic,” and that can sort of help. I think as clinicians, we’re constantly ruling out disorders using our professional hat to do that. I think you’re right. Speak to a professional and have them do our assessment to help you pass that apart. Because I think in general, any mental health disorder will make you feel like something doesn’t feel right, and that’s the nature of any disorder. 

Caitlin: Right. The good news, too, is that, within reason, some of the treatment techniques that we have can be used more broadly. Interoceptive exposures, we can use that for people who have panic disorder, just people who struggle with panic attacks, or maybe people who have OCD or GAD and just feel really sensitive to those sensations in their body that suggest that they might be anxious. Same thing with behavioral activation. We use that for depression, and that can really easily be added to any treatment, whether it’s treatment for PTSD or something else. You’re exactly right, getting clarity on what’s going on for folks, and then what are some of these techniques that might be most helpful for these symptoms?

PTSD AND TRAUMA TREATMENT 

Kimberley: Yeah. Thank you. You perfectly segue this into the next question, which is, can you describe the treatment or give us names of the treatment for this comparison of trauma versus PTSD? Are they the same treatments? Does it matter whether it’s a big T trauma or a little T trauma? Can you give us some idea of the treatments for these struggles?

Caitlin: Definitely. Most of the evidence-based treatments that exist are specifically for PTSD. Obviously, they touch on trauma, of course, as the reason why somebody has PTSD and where all of these symptoms stem from. But there aren’t as many treatments that are, let’s say, specifically for trauma, at least not in terms of a standardized way of working through that. If somebody’s experienced trauma and they don’t have PTSD, and let’s say they don’t have any diagnoses, but they are still impacted by this experience, just doing behavioral therapy or whatever treatment feels like a good fit for what somebody is trying to work through might be sufficient. And then we have these evidence-based treatments that have been shown to really target PTSD symptoms and help reduce them.

A few years back, I think it was 2017, the American Psychological Association reviewed all of the research on PTSD treatments. They reviewed it using lots of different criteria for what it means to feel better after treatment beyond just reducing PTSD symptoms, but also looking at other things too, like mood and suicidality and things like that. They essentially created this list of treatments that they rank orders in different tiers, depending on how effective they were shown to be. 

In the top tier are four treatments. There’s cognitive behavioral therapy just broadly, cognitive therapy also broadly, and then the two specialized treatments are prolonged exposure (PE) and cognitive processing therapy or CPT. I can talk a little bit more about those two if you’d like. 

In the second tier are things like acceptance and commitment therapy, EMDR—these treatments that people may have used themselves and have found really effective, and they are effective. They’re just maybe a little bit less effective for fewer people, if that makes any sense. It’s not to say that EMDR doesn’t work, but rather that there’s just more of an evidence base for things like PE and CPT.

DIFFERENCE BETWEEN PTSD AND TRAUMA TREATMENTS 

Kimberley: Great. To speak to those two top-tier treatments, can you compare and contrast them for someone just so that they feel they understand the difference?

Caitlin: Yeah. If I had a whiteboard, I would just draw out the CBT triangle, but hopefully, folks listening know that in the CBT triangle, you have your emotions, your behaviors, and your thoughts, and all these things are constantly interacting with one another. We could say, just on a really simplified level, that when we are seeking treatment for PTSD, we want our emotions to be different. We want to feel less emotionally impacted by the trauma that we’ve experienced.

PE and CPT are both under the umbrella of cognitive behavioral therapy, so they both use that triangle. They just get at it a different way. PE starts with the behaviors, knowing that the thoughts and emotions come along for the ride. CPT starts with the thoughts, knowing that the behaviors and the emotions come along for the ride. 

Now, they’re both extremely effective at reducing PTSD symptoms. They’ve done head-to-head comparisons. They’re both great. You’re not going to find one that’s significantly better than another, but you might find one that feels like a better fit for what you’re currently struggling with. 

Cognitive processing therapy, again, starting with the thoughts, cognitive processing, basically involves-- I almost think of this as looking at our thoughts and our beliefs about things and examining them from different lenses. I always picture plucking an apple from a tree. Like, okay, this is a belief that I developed from my trauma. This was really adaptive for me at the time because this belief told me that I can’t trust anyone and I have to always watch my back. Boy, did that help me when I was in combat and I was always watching my back and making sure I was safe. But as I look at it from these different angles, I might realize, well, I’m not in combat anymore, and I’m living in a pretty safe environment with safe people. So maybe this belief doesn’t really serve me anymore. 

You work with your therapist to identify what we call stuck points, which are these really deep-seated beliefs that somebody has about themselves, other people, or the world that either developed from trauma or were reinforced by trauma, because sometimes people will say, “Well, I’ve never trusted people. I’ve always been in an environment where things weren’t safe.” And then there we go, the trauma happened, and it just proved me right. Cognitive processing therapy helps people work through these stuck points and come up with alternative perspectives on these thoughts. 

Prolonged exposure is a lot more similar to what I imagine lots of the folks listening may have done with exposure therapy generally, or exposure and response prevention for OCD. Again, we’re starting with the behavior, knowing that if we target the behavior first, that’s going to change our cognitions, and it’s going to change our emotions. 

PE involves two different types of exposure. The first one being in vivo exposure, which is really similar to just any sort of ERP exposure where you expose yourself to something in the environment that triggers a thought about the trauma or some sort of emotional reaction. You do those over and over again until they feel like no big deal to you, you feel really awesome about yourself, and you can conquer the world because you can. 

And with your therapist, you do an imaginal exposure, which is where, in a really safe environment, you talk through the experience of your trauma and what happened to you. You do this actually in a unique way to really engage with that memory because, as we talked about, that internal avoidance is so common in people with PTSD. This imaginal exposure would be describing the experience in the present tense, painting a picture as though it was a film that was playing out right in front of our eyes, and really digging into the details of, what am I feeling in the moment that this trauma is happening? What am I hearing? What am I sensing? And doing that imaginal exposure, again, with your therapist in a really safe space until it doesn’t have an impact on you anymore. 

I always say this to people when they start PE with me: I know that this may sound nuts right now. But a lot of people who do PE will get to a point where they’ll look at me and say, “I’m so bored telling this story again. I’ve told this story so many times. It doesn’t even bring up this emotional response for me anymore.” That feels really unlikely for people who are just starting out in treatment and are so impacted by this memory, and they do everything in their power to avoid it. But people can and very much do get to a place where they feel like they’ve conquered this memory and it doesn’t control them anymore. 

That’s how PE and CPT work. Again, they both eventually target the same thing. It’s just sort of, which route do you go?

COMPLIMENTARY PTSD TREATMENTS 

Kimberley: Right. Amazing. Thank you. From my experience too, and actually, this is a question, not a statement—my experience, some people who I’m close with or clients who have been through PTSD treatment also then had to develop some coping skills, mindfulness skills, compassion skills, or maybe sometimes even DBT skills to get them across the finish line. Has that been your experience? What is your feedback from a more scientific perspective?

Caitlin: Yeah, it really depends on the person. There are also combinations of these treatments. There’s a combined DBT and PE protocol out there for folks who do need a little bit more of those skills. Some people do feel like they would benefit from having some of these coping skills, maybe upfront or throughout the course of treatment. But they’ve also done research where they’ve started with that skill-building before they go into PE or CPT, compared to people who go right in. Actually, what they often find is that starting with skill building, sometimes it’s just colluding with avoidance, and it just lengthens the amount of time that somebody needs before they start to feel better. 

I’m glad you asked this question because it’s so common for people with PTSD to feel like, “I can’t. I can’t do this thing. I can’t feel this thing. I can’t talk about this thing.” And they really can. Sometimes if we allow people to really challenge those “I can’t” beliefs, then they’ll realize, “I really thought that I was going to need all this extra support or I was going to need this or this, and I was able to just move right through this treatment.”

Now, of course, again, that’s not the case for everyone. There are some folks who maybe have much more severe PTSD, maybe have some different comorbidities like personality disorders or something else where it might be helpful to involve some of that, or people who had really chronic exposure to, say, childhood trauma. But far and away, people are often much better able to jump right into some of these treatments than they think they are.

HOW TO FIND A PTSD TRAUMA THERAPIST 

Kimberley: Thank you for sharing that. I think that’s super helpful for us to feel hopeful at the end. One more question before you tell us about you and some of the amazing things that you’re doing. Where might people go? As we know, with OCD and health anxiety, we want a specialist to be helping us, ideally. I’ve noticed as a consumer that everybody and their Psychology Today platform says they treat trauma. I’m wondering how we might pass through that and find treatment providers who are skilled in this area. How might they find a trained professional?

Caitlin: I’m glad you mentioned that about Psychology Today. That’s the advice that I give people when they’re using Psychology Today, or really any sort of platform. If this person is saying that they treat everything under the sun, then it’s probably not a person that you want to link up with for something really specialized because it’s-- what is the saying? “Jack of all trades, master of none.” And I start to get suspicious even that this person even does evidence-based treatment for trauma and PTSD when they’ve listed a thousand things. It’s definitely a red flag to consider for those who are listening and maybe have had this experience. 

In terms of finding a therapist, if folks are interested in PE or CPT, there’s actually directories of therapists who’ve been trained and certified in those modalities. You can find them on-- I’m trying to think of the exact website. If you Google “Prolonged Exposure providers,” something will come up, I believe it’s through Penn. You can do the same for cognitive processing therapy. If you Google, I think it’s like “CPT provider roster,” you’ll get a whole list of providers as well.

Now, just because somebody isn’t on there doesn’t mean that they haven’t been trained in these things. There’s just a certification process that some people go through, and then they can get added to this list. If your provider says, “I’m trained in PE, I’m trained in CPT,” I would probably trust that person that, for one thing, they even know what those things are, and I’d be willing to give them a shot.

Also, and I know we mentioned this on the last episode too, for anyone listening who might have PTSD and OCD, I’ve compiled a list of providers on my website—providers who are trained to treat both OCD and PTSD. I have that broken down by state and then a couple of international providers as well. My website is www.cmpinciotti.com. 

In terms of broad resources beyond finding a provider, there are lots of organizations that have put out some really great content about PTSD—videos, handouts, blogs, articles, all sorts of things. I think the biggest place that I send people is the National Center for PTSD. This is technically run through the Veterans Administration, but anyone can use these resources. They’re not only for veterans. It’s very, very helpful. I’d recommend people who want more information to go there. 

You can also find things on the Anxiety and Depression Association of America, the National Institute of Mental Health, the National Alliance on Mental Illness, and so on. And then, of course, I mentioned the Trauma and PTSD in OCD Special Interest Group that I co-chair, that folks can sign up for that too, and we send out materials through there as well.

Kimberley: Amazing. I am so grateful for you because I think we’ve covered so much in a way that feels pretty easily digestible, helps put things in perspective, and hopefully answers a lot of questions that people may be having but didn’t feel brave enough to ask. Where can people find out more about you? You’ve already listed your website. Is there any other thing you want to tell us about the work that you’re doing so that we can support you?

Caitlin: On my website, in addition to the treatment provider directory, I also have some handouts and worksheets. Again, these are specific to co-occurring OCD and PTSD. That might be helpful for some folks. I also usually list on there different studies that are ongoing. I have two right now that are ongoing that I can-- oh, actually, I have three—I lied to you when I said two—that people can participate in if they’re interested. There’s one study that we’ll be wrapping up at the end of December. That’s about OCD and trauma. People can email OCDTraumaStudy@bcm.edu for more information. We also have a study that’s specific to LGBTQIA+ people with OCD that also covers some things related to trauma and minority stress in that study. If folks are interested in participating in that, they can email me at PrideOCD@bcm.edu. 

And the last one, and I’ll plug this one the most, that if folks are like, “Well, I want to participate in a study, but I don’t know which of those,” or “I only really have a few minutes of my time,” we have a really, really brief survey, and we’re trying to get a representation of folks with OCD from all over the country. For anyone who’s listening and who has OCD and is willing to participate, it’s a 10-minute survey. You can email me at NationalOCDSurvey@bcm.edu. All of these cover the topic of trauma and PTSD within them as well.

Kimberley: Thank you. I’m so grateful for you. You’ve come on twice in one month, and I can’t thank you enough. I do value your time, but I so value as well your expertise in this area and your kindness in discussing some really difficult topics. Thank you.

Caitlin: No, I appreciate it. Thanks for having me on. I hope that folks who are listening can feel a little bit more hopeful about what the future can hold for them.

PTSD & TRAUMA LINKS AND RESOURCES 

Find a PE provider: https://www.med.upenn.edu/ctsa/find_pe_therapist.html

Find a CPT provider: https://cptforptsd.com/cpt-provider-roster/

For educational resources on PTSD: https://www.ptsd.va.gov/

To participate in a brief, 10-minute national survey on OCD: NationalOCDSurvey@bcm.edu

To participate in the OCD/Trauma Overlap Study (closing at the end of December): OCDTraumaStudy@bcm.eduTo participate in a study for LGBTQIA+ people with OCD: PrideOCD@bcm.edu

Radical acceptance when things get hard can be a very difficult practice. In fact, it can be almost impossible. When things get hard, one of the things we often do is we spend a lot of time ruminating about why it’s so hard and what we could have done to prevent it from being so hard. And, instead of using radical acceptance, we often go into beating ourselves up, telling ourselves, “We should have done this; we could have done that. If only we had looked at it this way or treated it this way.” I want us to really zoom in on these safety behaviors that you’re probably doing. Hopefully, today, you leave here committing to reducing or eliminating those behaviors.

Now, I get it. When things are hard, we don’t want to feel the suffering that goes with it. I get it. I don’t want to feel it either. You’re not alone. But when things are hard, often, instead of letting it be hard and feeling our feelings and being kind to ourselves so that we can move into effective behaviors, we get stuck resisting the emotions and doing these other behaviors that increase the shrapnel of the event. I call it ‘shrapnel’ because it does look like that. It creates more damage around us. Let’s look at how we might prevent this. 

HUMANS SUFFER

You’re suffering. The reason I know this is because you’re a human being, and all human beings have sufferings in their lives. Some of us, more than others. If you’re in a season where the suffering is high, I would basically say, the higher the level of suffering, the more you need to listen in. Maybe listen to this multiple times, get your notepad out, and let’s really go to work. 

SOLVING DOESN’T ALWAYS WORK

When you’re suffering and your suffering is high, again, it’s very normal to want to solve why you’re suffering, thinking that yes, that may prevent it from happening in the future, prevent us from having more pain, or prevent us from having to feel our feelings. That’s effective behavior, except... if you’re relying on that and you’re spending too much time doing that, chances are, you’re increasing your shrapnel. If that’s the case, let’s talk about other alternatives. 

When we’re going through difficult things, there is a strong pull toward figuring out why. But my guess is, if you haven’t solved it yet, chances are you won’t. I know this is true for me. It might be true for you, but you’ve probably already identified the problem of one of the things that may be if, in 20/20 hindsight, you could have done differently. And that’s okay, right? There’s many times I’ve looked back and been like, “Yeah, it didn’t handle that well,” or “That didn’t go as well. Maybe now, knowing what I know, I could have done something different.” But often, we spend too much time resisting the fact that it is hard right now. 

If you’re someone who’s spending a lot of time going over and over on repetition, all the things you could have done, chances are, you’re not radically accepting what is. What we want to do first is move to radical acceptance as fast as we can. We’re not saying that you can’t go back and do some effective addressing of what went wrong and what went right. You can do that for short periods of time. But if you’re someone who’s doing it repetitively, catch yourself. We want to move into radical acceptance that yes, things are hard right now.

WHY DOES RADICAL ACCEPTANCE SUCK?

Often, we resist practicing radical acceptance because of one core reason, and that’s because we don’t want to feel bad. We don’t want to feel the guilt. We don’t want to feel shame. We don’t want to feel the uncertainty. We don’t want to feel sad. We don’t want to feel angry, grief, or panic, whatever it might be. It might be physical pain. We don’t want to feel it.

And so hand in hand goes this work of radically accepting the suffering that you’re experiencing in whatever form, whether it be emotional, physical, spiritual, or other, and then really being willing and creating a safe place to feel those feelings. I’m not saying ruminate on those feelings, make them worse, or agree with everything you’re thinking and feeling. No. I’m just saying, being able to observe that yes, sadness is here, or grief is here, or anxiety is here. It’s showing up in these ways in my chest, in my head, in my shoulders, in my neck, in my hips, in my tummy, wherever it’s showing up for you. First radically accepting it and then being willing to feel those experiences and those sensations. We alternate between those two. We radically accept, then be willing and open. Then we have to go back and radically accept, be willing, and be open.

RADICAL ACCEPTANCE IS REPETITIVE

I want to remind you that it’s okay that you have to do this on repeat. Often, with my patients—and I do this too, I have to admit—we practice radical acceptance, we practice self-compassion, we practice willingness for a little while, and then we get frustrated because it’s not making it go away. It’s not fixing it. It’s not making it disappear. So we go back to trying to solve, “Why is this happening? Why shouldn’t it be this way? What did I do wrong?” instead of knowing that this is a repetitive practice that we commit to over and over again. It’s like brushing our teeth. We don’t do it once and go, “Great, it should be done.” No, we go back, and we’ve accepted that we’ll do it every morning and we’ll do it every night. For some of you, at lunchtime too.

I really want you guys to catch this deep urge and urgency to resist what really is and resist the feelings that go ahead and accompany that experience. We want to move back as fast as we can into radically accepting that it is what it is. 

RESISTING RADICAL ACCEPTANCE

Now, if you’re anything like me, a part of your brain is going to go, “But it’s not fair. This is not fair. It is too much. Other people don’t seem to be having these problems. It’s not fair that I have this problem. It’s not fair that mine is so big right now and theirs is not.” I get that too. 

Also just acknowledge, you may even want to just validate and go, “Yeah, this is my season. They’ll have theirs.” I promise you, they’ll have theirs. Hopefully not. We don’t want to spread more pain around. But with being a human, it’s 50/50. It’s 50% hard and 50% wonderful, and that’s a part of being human. They’ll have their season; you’re in yours. It is temporary. 

Again, resist the urge to stay in the rumination of “It’s not fair.” You can validate that by going, “Yes, it is not fair. This is a hard deck of cards that I’ve been dealt right now. I’m going to again try to reduce the shrapnel by not engaging in the why me and why did this happen and it shouldn’t have, and it’s not fair.” 

I want to also say it’s okay that you land there. That is a normal part of the grief process to land in that bargaining phase of grief. What we’re really speaking to today is when you get caught in that. 

I NEED RADICAL ACCEPTANCE TOO

Now, I am speaking to you about this because I needed to hear this message more than any of you today. This is actually as much for me as it is for you. I think that as I go through very difficult seasons in my life, I find them incredibly humbling because it helps me to see the story that I have told myself, the story that things should go well for me, that things shouldn’t be hard, that I shouldn’t suffer as much as I do in certain areas, that I should somehow magically be able to solve this or control this, and that other people want me to be able to handle this, so therefore, I should be able to. 

I forget my humanness. I keep getting humbled by my humanness. I feel like the world keeps coming to show me, “Kimberley, you’re just like everybody else.” Everybody suffers. How can you lean in and have this be an opportunity to deepen your self-compassion practice, deepen your mindfulness practice, and deepen your ability to feel any emotion that shows up? Because they will, many times in my lifetime. They will continue to show up in different ways because I’m a human, not because I’m a faulty person. All humans have these feelings. 

For you, you also have to remember, these are normal human feelings. You didn’t do anything wrong. It’s not your fault that you’re having them so strong right now. Resist the urge to go into self-punishment for the fact that you’re suffering. 

Again, radically accept that it is painful right now, and then move into willingness and openness to feel those feelings and create the safest, softest, gentlest landing for you as you navigate these really difficult emotions. As you do it, not to replace it, not to make them go away, but to help guide you through them. 

YOU CANNOT BYPASS EMOTIONS

You can’t bypass emotions. I have learned that one the hard way. You can’t bypass them. If you do, you’re probably increasing your problems. If you’re doing compulsions to get your uncertainty and your anxiety to go away, you’re going to have more of that obsession. If you’re avoiding the thing that’s hard, you’re probably going to feel disempowered, and it’s going to be a bigger problem. If you’re resisting your emotions and you’re resisting your experience, at some point, they will probably blow up and explode, and you’ll feel them a lot. 

Our job, again—and this is my goal for myself, and I hope it’s your goal too—is I want to be a place, a container. I want to be able to experience the full range of emotional experiences safely so that in the future, when hard days come, when I lose loved ones, when I go through hard times, when I witness difficult things, I already know that I have the ability to wade through this. 

WHEN YOU FEEL LIKE YOU CANNOT HANDLE IT ANYMORE 

The people who are struggling with “I can’t handle this,” they’re the ones who have done everything they can to avoid feeling their feelings, and they haven’t gotten much experience with learning to master emotions. When we do learn that we can have emotions and we do learn that we can tolerate them, then we do learn that we can ride them out. There’s a sense of empowerment, like, “I can do really, really hard things.”

As I’m navigating a tough season, I’m actually blown away and in awe of myself, knowing that I can handle a lot. I’ve handled a lot in other difficult seasons in my life, and I come out of it usually being like, “Wow.” Actually pretty impressed. I feel that way, especially when I stay out of that sort of rumination. I call it the inner tantrum. I have a tantrum like, “It’s not fair, and it shouldn’t be.” 

RADICAL ACCEPTANCE SUMMARY

I wanted to make this a very quick episode. Hopefully, it’s exactly what you needed to hear. 

Number one, if you’re in a difficult season, that doesn’t mean there’s anything wrong with you. That’s just a human thing. 

Number two, if you’re in a difficult season, let’s back off from trying to solve what you could have done better because, coulda, woulda, shoulda, it’s all 20/20 hindsight. You had no idea. Let’s just leave that alone. Be very aware of that and work towards catching it and moving towards radical acceptance, willingness, and self-compassion. 

If you’re somebody who really needs to improve your self-compassion, we have a whole mindfulness vault called The Meditation Vault. You can go to CBTSchool.com, and it will guide you through self-compassion practices that were led by me. It’s all audio. It’s all there. I’ll teach you how to do it, and that hopefully will help you have my voice in your head so that you can start to practice self-compassion no matter what shows up for you, no matter what emotion you’re experiencing, no matter what hardship you’re experiencing. 

I hope that’s helpful. Have a wonderful day. I’m sending you all the love, and I will talk to you next week.

Kimberley: Is ERP traumatizing? This is a question I have been seeing on social media or coming up in different groups in the OCD and OCD-related disorders field. Today, I have Amy Mariaskin, PhD, here to talk with us about this idea of “Is ERP traumatizing” and how we might work with this very delicate but yet so important topic.

Thank you, Amy, for being here.

WHY MIGHT PEOPLE THINK ERP IS TRAUMATIC? 

Kimberley: Let’s just go straight to it. Why might people be saying that ERP is traumatic or traumatizing? In any of those kinds of terms, why do you think people might be saying this?

Amy: I think there’s a number of reasons. One of which is that a therapy like ERP, which necessitates that people work through discomfort by moving through it and not moving around it or sidestepping it, is different than a lot of other therapies which are based more on support, validation, et cetera, as the sole method. It’s not to say that ERP doesn’t have that. I think all good therapy has support and validation. However, I think that’s part of it. The fact that’s baked into the treatment, you’re looking at facing discomfort and really changing your relationship with discomfort. I think when people hear about that, that’s one reason that it comes up.

And then another reason, I think, is that there are people who have had really negative experiences with ERP. I think that while that could be true in a number of different therapeutic modalities and with a number of different clinicians and so forth, it is something that has gained traction because it dovetails with this idea of, well, if people are being asked to do difficult things, then isn’t that actually going to deepen their pain or worsen their condition rather than alleviate it? That’s my take.

Kimberley: When I first heard this idea or this experience, my first response was actual shock because, as an ERP therapist and someone who treats OCD, I have seen it be the biggest gift to so many people. I’ve heard even Chris Trondsen, who often will say that this gave him his life back, or—he’s been on the show—Ethan Smith, or anyone really who’s been on the show talk about how it’s the most, in their opinion, like the most effective way to get your life back and get back to life and live your life and face fear and all of those things. 

DO PEOPLE FEEL ERP IS A DIFFICULT TREATMENT?

I had that first feeling of surprise and shock, but also then asked more questions and asked about their experience of ERP being very pressured or feeling too scared or too soon, too much too soon, and so forth. Do you have any other ideas as to why people might be experiencing this difficult treatment?

Amy: I do. I think that sometimes, like any other therapy, if you’re approaching therapy as a technician and not as a clinician, and you’re not as a therapist really being aware of the cues that you’re getting from the very brave people sitting in front of you, entrusting their care to you—if we’re not being clinicians rather than technicians, we can sometimes just follow a protocol indiscriminately and without respect to really important interpersonal dynamics like consent and context, personal history, if there’s not an awareness of the power dynamic in the room that a therapist has a lot of power. 

We work with a lot of people as well who might have people pleasing that if you’re going to be quite prescriptive about a certain treatment, you do this, and then you do this, and then you do this without taking care to either lay the foundation to really help somebody understand the science of how ERP works or get buy-in from the front end. I know we’ll talk a little bit more about that, as well as there’s a difference between exposure and flooding. There’s a difference between exposure that serves to reconnect people with the parts of their lives that they’ve been missing, or, as I always call it, reclaims. We want to have exposures that are reclaims, as opposed to just having exposures that generate negative emotion in and of itself. 

Now, sometimes there are exposures that just generate negative emotions, because sometimes that’s the thing to practice. There are some people who feel quite empowered by these over-the-top exposures that are above and beyond what you would do to really have a reclaim. I’m going to go above and beyond for an exposure, and I’m going to do something that is off the wall. I am eating the thing off of the toilet, or I have intrusive thoughts about harming myself, and I’m going to go to the top of the parking garage, and I’m really going to lean all the way over. Would I do that in my everyday life? No. There are some clients for whom that is not something that they’re willing to do or it’s not something that’s important for them to do to reconnect with the life that they want to live, and there are others who are quite empowered. 

If you’re a therapist and you don’t take care to listen to the feedback from clients and let their voice be a part of that conversation, then you may end up, again, as a technician, prescribing things that aren’t going to land right, and that could result in some harm. My heart goes out to anyone who’s had that experience, because I think that’s valid.

Kimberley: I will be completely honest. I think that my early training as an ERP therapy clinician, because I was new, meant that I was showing up as a technician. When I heard this, again, I said my first thought was a little bit of shock, but then went, “Oh, no, that does make sense.” When I was an intern, I was following protocols and I was learning. We all, as humans, make mistakes. Not mistakes so much as if I feel like I did anything wrong, but maybe went too fast with a patient or pushed too hard with a patient or gave an exposure because another person in supervision was saying that that worked for their client, but I was learning this skill of being attuned to my client, and that was a learning process. I can understand that some people may have had that experience, even me. I’m happy to admit to that early in my training, many years ago.

Amy: That’s a great point. I think if we’re all being honest with ourselves, whether it be within the context of ERP or otherwise, there is a learning curve for therapists as well. I think going back to the basic skills and tenets of what it means to have a positive therapeutic relationship is that so much of that has to do with the repair as well. If there are times, because there will be times when you misjudge something or a client says, “I really think that I’m ready to try this,” then we say things like when exposures go awry, when the worst-case scenario happens, or what have you. 

That’s another philosophical question because I think in doing exposures, we’re not necessarily, at least my style, saying the bad thing’s not going to happen. It’s about accepting the risk and uncertainty, which is a reasonable amount. However, I think when those things happen where it does feel like, “Hey, this felt like too much too soon,” or this felt like, “Wow, I wasn’t ready for this,” or “I don’t feel like that’s exactly what I consented to. You said we were going to do this, and then you took an extra step”—I think being able to create an environment where you can have those conversations with clients and they feel comfortable bringing it up with you and you can do repair work is also important. That it’s not just black or white like, “This happened and I feel traumatized.” Again, I don’t want to sound like I’m blaming anybody who’s had that experience, but I’m just saying that I think that happens on a micro level, probably to all of us at some point. 

I think it’s also important to acknowledge, and later we’re going to talk about it, but the notion of the word ‘traumatizing’ is a little bit difficult for me to hear as well because I think from the perspective of an evidence-based practitioner, the treatments that we have, even for so-called big T trauma, many of them integrate in exposure. All of my first-line treatments, including ones that maybe come at it a little bit more obliquely like EMDR or something like that, which is not something that I personally use, are certainly out there as like a second-line trauma treatment. But things like prolonged exposure and cognitive processing therapy, they all have this exposure component to them. Even the notion that if there’s trauma, you can’t go there or that talking about hard things is traumatizing. I don’t know. Can we talk a little bit about that? Because I don’t know if that’s something you’ve thought about too, that it’s hard to reconcile.

Kimberley: Yeah. Let me give a personal experience as somebody who had a pretty severe eating disorder. I was doing exposure therapy, but I didn’t get called that, and I didn’t know what to be that at the time. But I had to go and eat the thing that I was terrified to eat. While some people might think, “Well, that’s not a hard exposure,” for me, it was a 10 out of 10. I wanted to punch my therapist in the face at the idea that she would suggest that I eat these things. I’m not saying this is true for other people; I’m just giving a personal experience. I’m actually really glad that she held me to these things because now I can have full freedom over the things that used to run my life. I know that there is nothing on any menu I can’t eat. If I had to eat on any plane, whatever they served me, I knew I was able to nourish my body with what was served to me, which I didn’t have before I did that. 

The other piece is somebody who has also been through trauma therapy. A lot of it required me to go back and relive that event over and over. Even though I again wanted to run away and it felt like my brain was on fire, that too was very helpful. But what was really helpful was how I reframed that event. If I was doing it and, as I was doing it, I was saying, “This is re-traumatizing me,” it was a very bad experience. But if I was saying, “This is an opportunity for me to learn how to have our full range of emotions, even the darker stuff,” that ended up being a very important therapeutic experience for me. That’s just my personal experience. Do you want to speak to that?

Amy: Yeah. I wasn’t planning on speaking to this part of it, but I will say as well that having had a traumatic event—a single event, big T trauma—that happened at my place of employment years ago. This is over 10 years ago now, which involved being held at gunpoint, which involved a hostage-type situation. It’s interesting when you talk about trauma, that you want to tell the whole story, but I’m like, “Oh, we don’t have enough time,” which is interesting because our brains first don’t want to tell the stories or we want to bury them. But suffice to say that after this very painful, very terrifying experience, after which all the hallmark symptoms of hypervigilance and quick to startle and images in my head and avoidance of individuals who looked like this particular individual and what have you. The most powerful thing for me in knowing this as somebody who works in exposure protocols, going back to work and being so kind to myself as I was, again, I come back to this word reclaim. It doesn’t happen overnight. It’s not something I wish there were. I do wish there’s, “Oh yeah, we just push this button in our brains, and then that’s just where we feel resilient again.” 

But the process of building resilience for me was confronting this environment, reclaiming this environment. I think any exposure protocol has the ability to have that same effect if the framing is there and if it resonates with the person. Being somebody who’s such a believer in exposure therapy for my clients, I was able to step into a role where I came out of that situation feeling so empowered and the ability to hold all of my experience gently and with compassion, as opposed to sweeping it under the rug and then having it come out sideways.

Kimberley: I really appreciate you bringing that up because, similarly, I stowed mine down for many years because I refused to look at it until I was forced by another event to have to look at it. I think that’s a piece of this work too. You have to want to face it as part of treatment. In my case, I either avoid the things that are so important to me or I am going to have to face this; I am going to have to. I showed up and made that choice. I think that’s also a piece of it, knowing that that’s an opportunity for you to go and be kind and to train your brain in different ways. 

HOW TO MAKE ERP ETHICAL AND RESPECTFUL

We’re speaking directly now about some ideas and solutions to making ERP ethical and respectful. Are there other ways that someone who’s undergoing ERP, considering ERP, or has been through it—other things we might want to encourage them to do moving forward that might make this a more empowering and validating experience for them?

Amy: That’s a great question because I think we can talk about it both from the perspective of clients who are looking for a new therapist as well as what therapists can do. But if we start first with clients and maybe you’re out there, and it’s been something you’ve either been hesitant to engage with because of some of these ideas about it being harmful or you’ve had a negative experience in the past, I do think that there is a mindset shift into feeling really empowered and really willing. 

The empowerment part is coming in and bringing in-- your fears about ERP are also fears that can be worked on. If you’re white-knuckling from the first moment of like, “Okay, I’m in here, I know I’m supposed to do this. I already hate it and it hasn’t started,” sharing that with a clinician. I know I’m used to hearing that. I’m very used to hearing that. I’ve had folks come in who have been in supportive therapy, talk therapy, or other modalities that haven’t been effective for many, many years. There is a part of me-- I’m sorry, this is a tangent, but it’s a little soapboxy tangent. I feel like when I think about my clients who’ve had therapy for sometimes 10, 20 years and it hasn’t been effective, I don’t think we talk enough about how harmful that is for people, like putting your life on hold for 10 or 20 years. I don’t hear the word necessarily ‘traumatizing,’ but that can be harmful as well. People will go through that. 

BE OPEN WITH YOUR ERP THERAPIST

After these contortions to maybe even avoid ERP because it’s scary, they’ll come in, and I welcome them, saying, “I’m really nervous about this,” because guess what? Saying that aloud is a step in the direction of exposure. You’re owning it. And then having a therapist who can say, “I’m so proud of you for being here.” This is exposure number one. Sitting down on this couch, here we are. Well done, check and check. Because I think that a therapist who’s looking at exposure, not just as what’s on a strict hierarchy, or even from an inhibitory learning perspective, like a menu—exposure is what you’re doing day to day to help yourself get closer to the life that you want and the values you have. When you said, “I can eat anything because I want to nourish my body,” that’s a value.

When I say ‘empowerment,’ like empowerment to discuss that with your therapist. And then that shift into willingness versus motivation or comfort or like, “Oh, I want to wait till the right moment,” or “Things are tough now. I don’t want to add an extra tough thing.” I know you’re not here to tell anybody, “Well, this is the way you should think.” But if there’s any room to cultivate even a nugget of willingness to say, “I can do something difficult, and I am willing to do difficult things on the path toward the life that I want,” those would be two things that come to mind right away.

Kimberley: Yeah, I agree. It takes me to the second piece for a client. I think a huge piece of it is transparency with your therapist or clinician. There have been several times where we’ve discussed an exposure—again, this was more in my earlier days—agreed that that would be helpful for them, gone to do it, and then midway through it, them saying, “I felt like I had to please you, but I’m so not ready for this,” or “I was too embarrassed because this is such a simple daily task and I should be able to do it.” I think it’s okay to really speak to your therapist and share like, “I don’t know how I feel about this. Can we first just talk about if I’m ready?” We don’t want to do that to the degree of it becoming compulsive, but I want to really encourage people who are undergoing treatment of any kind to be as completely honest as you can.

Amy: Right. I think that, again, it’s an interesting dynamic because people are coming to specialists because we do have the knowledge and awareness of protocols and so forth. But again, I think mental health is-- well, I wish all medical health folks were a little bit more open to these kinds of conversations too. But that being said, I think having that honesty and knowing that-- if you go in and you say, “Oh, I’m a little bit nervous,” and you’re getting pushback of, “Well, I’m the doc, this is what you do. Here’s step one, here’s step two,” frankly, there are going to be therapists who are like that regardless of modality. 

It was interesting because I was talking to somebody about this and about—I think if we frame it as a question—"Is ERP inherently harmful” is a really different question than “Can ERP be harmful?” I think any modality implemented without that clinical touch can be potentially harmful. 

I know your motto is, “You can do hard things.” That kind of shift as well is so powerful at the beginning of ERP. You’ve been transparent. You’ve said, “Look, here are my fears about this.” 

And then often, what I will do as a clinician if people don’t get to that place of like, I” can do things through the discomfort, there’s no going around it,” is ask them about things. If they’re adults, it could even be like, “When you were a little kid, did you have any fears, and how did you get over those? What was that like?” Not always, of course, but 9 nine times out of 10, it is some kind of like, “Well, I did the thing.” Or sometimes it’s more complicated, “Well, I did the thing and then I got support from others, and then I learned more.”

But I think people have this innate capacity to learn by changing behavior and to do things that are outside of their comfort zone, and that doesn’t have to mean way outside of their comfort zone. Often, that notion of these hard experiences or these difficult thoughts that you need to-- people will come in and feel like, “Well, I need not to be thinking about them.” That’s not really an option. Being a human with a full life, there are going to be things that are provocative. But I think I’ve heard you talk about this notion of shifting from wanting protection from negative thoughts or discomfort to almost willingness and acceptance. I love that as well.

Kimberley: I agree. I want to also maybe back up a little bit and speak to that just a little bit. I do hear the majority of people saying this, coming from those who are seeking treatment from unspecialized people. Even this morning, people are emailing me saying, “I’m following this OCD coach online, and they’re saying, ‘Follow my six-month program and you will be OCD-free.’” That sounds good. I’ll do whatever you say if that’s what I can give you. There is a power dynamic. 

But then you’re in the program and being told that you have literally two months to go and you better double down or you will fail my program. I think that urgency to get better can cause you to sometimes agree to things or seek out treatment from people who aren’t super trained and who aren’t taking an approach of, “Let’s practice being uncomfortable, let’s practice having every single emotion kindly and compassionately so that there is no emotion you can’t ever have in your lifetime through the darkest ages.” They’re more coming from a, “I’m on a timeline here and I have to get this done, so I’m going to do these things that are absolutely terrifying.” I think a lot of people are speaking to this.

Amy: I think that’s right. A lot of times, people have been-- I think we, as a field, like mental health professionals, there’s this delicate balance of wanting to instill hope and really talk about like this works and to not overpromise or not simplify the circuitous way that we get there together as a therapist and client, because there are a lot of sound bites out there. I know you and I have talked about this. It’s like these “better in 12 weeks” or “better in with these five tips” or what have you.

I think even looking at research, and I have a strong research background, I was training to be a researcher when I was in grad school. I think it’s important as well to remember that even with research, we are looking at-- if we say like, “Hey, this is a 12-week protocol that’s been effective.” Okay, what does effective mean? Does effective mean that you get to pick up your baby again? Or does it mean, oh no, it probably means an X amount reduction in the Y box? Does effective mean it was that amount of reduction for everyone? Well, no, it’s averages and things like that. 

I can wear both hats and say, this is an incredibly empirically validated treatment that works for many people. It’s not going to work the same way for every person, so why would we as clinicians go in and be like, “Here’s a timeline?” You can’t do that.

Kimberley: Yeah. Let’s speak to the therapist now. What can therapists be doing to make this a more effective, compassionate, and respectful practice? Do you have anything that you want to speak to first?

Amy: Yes. I think that if we start at the beginning of therapy itself and the steps that you go through, the very first step is assessment because exposure is something that we know is very effective for anxiety, to a lesser degree, disgust, and not quite right feelings as well, and some sensory issues, to a lesser extent. But exposure is effective for certain things. We want to make sure that those are the things that are occurring. So, making sure because somebody can have OCD, or can have anxiety, or something like that and also have other things going on.

I think sometimes when exposure is treated-- exposure and response prevention. I know we talk a lot about exposure, but even response prevention, that side of things, it’s just this one size fits all. Okay, something you don’t like doing, we’re going to expose you to it, and something that alleviates your distress, we’re going to eliminate those. If you’re doing that outside of the context of where it’s clinically indicated for OCD, i.e., areas that provoke obsessions and compulsive behaviors, then you’re really missing the target. 

I know there’s been a lot of discussion about neurodiversity and for autistic people who may have routines and things like that or may have stereotypies or stimming behaviors, things that are pleasant for them or self-regulatory to really get a good assessment in there. Again, you’re not having people do exposures or engage in response prevention in places where it’s not clinically indicated.

I think even if somebody has a trauma history, for something like PTSD, exposure is often, as I mentioned, a part of treatment protocols. The way in which we are doing those kinds of exposures and really centering the sense of agency in the client who’s had that sense of agency taken away by prior experiences is really important. I think assessment is the first thing that comes to mind, followed--

Kimberley: I would add-- sorry, I didn’t mean to cut you off, but I would add even assessment for depression. A lot of what we teach in ERP school for therapists and what I teach my staff is, if a client has depression, I might do more exposures around uncertainty and not around their worst-case scenario happening because sometimes that can make the depression come in so strong that they can’t get out of bed the next day. We can tailor exposure even to make depression, and so forth. 

I think it is so important that we do get that assessment and really understand the big picture before we proceed. Even understanding other anxiety disorders, health anxiety, the history of trauma with health, and so forth, or even the things you were taught as a child, can be really important to understand before we proceed with exposure.

Amy: I love that you added that in—the things that we were taught as a child—because I love this story. I mean, I love it and hate it, and you’ll understand why in a moment. But when I was on my internship—this was back in 2008, 2009—there was a fellow intern. He and I were co-presenting on a case, and we had the other interns. They were asking questions, and this was a makeshift IOP case. We were both doing a little bit of individual therapy, and people in the audience were asking questions, and somebody asked about childhood. This was an adult. The other intern said, “We don’t care about that stuff.” I said, “Time out, I care about it,” and we all laughed. 

I get where he was coming from in the sense that he was like, “Hey, here are the symptoms, here’s the protocol for the symptoms, and it is important.” Like you said, I mean, even from a CBT, this is very consistent with CBT and how we form core beliefs and schemas and our ideas about the world and fairness and justice, and all of that is a part of it. We don’t want to lose the C part, the cognitive part as well in ERP. But I love that you said that about depression as well, because even something co-occurring can just nudge. It just nudges the way that we do exposure and so forth.

Kimberley: Yeah. I think culturally too. Think about the different traditions that come with different cultures or religions. Sometimes some of their rituals can seem compulsive. If I didn’t know that that’s why they’re doing these, I could easily, as an untrained or ineffective therapist, be like, “Just expose yourself.” We’ve got to break this ritual, without actually understanding, like, is this actually a value-based ritual that you’re doing because of a religion or a culture or tradition that is in line with your values? I think that’s very, very important. After assessment, what would you say the next steps are?

Amy: I think that-- and this is the part where I’m really going to own that. I get really excited, and I just want to jump into treatment. This is me, I’m calling myself out. But I think psychoeducation, that not only very clearly lays out the evidence and the why, like here’s the process, here’s why we’re asking you to do these things that are really difficult, here are the underlying patterns, and here’s what we’re looking out for, and so forth. 

I think not only that, but also laying out very clearly what the expectations are. “This is how this is going to look,” and maybe at that point as well, clinicians saying—this is very collaborative—"I am here to provide this information, and then together we are going to formulate a treatment plan and formulate these exposures.” I have heard so many people who do a lot of ERPs say how proud they are by the end of therapy when clients come in and they say, “I was thinking I need to do this as my exposure.” They’re really taking that ownership. 

I think not only again talking about the science and all the charts and things like that, but really talking about this as a collaborative, consensual process, that it’s like, “I’m handing this off to you, and this is going to be something you have for the rest of your life.”

Kimberley: Yeah. I’ll tell a similar story. I had a patient who-- I’ll even be honest, I don’t think this was in my internship. This was in my career as an OCD therapist. But my client was just doing the exposures that he and I had agreed to. He would come back and be very frustrated with this process until he came to me and said, “I need you to actually stop and explain to me why I’m doing this.” I thought I had done a thorough job of that. I truly, really, honestly did. But he needed me to slow down and explain. We got out the PET scans of the brain, and I had a model of the brain. I showed him what part of the brain was being triggered and where the different parts of why-- from that moment, he was like, “I got you. I know what we’re doing. I’m on board now. I got this.” 

I think that I was so grateful that he was like, “Hold up, you need to actually slow down and help me to understand because this still doesn’t make sense to me.” This was a very important conversation. In my case, I think it’s checking in and saying, “Do you understand why we’re doing this? Do you understand the science of this?” I think it’s so important. What else might a therapist do?

Amy: I love that. I was just going to say, I love that you create that culture because that’s what I was talking about earlier. Sometimes we don’t quite get it right. And then it’s like, “What can I do better?” It’s such a powerful question. 

Knowing the why of ERP and then also the why, like, why is it worth it for you? Why is this? ACT has these wonderful metaphors about it. We’ve heard the monsters on the bus analogy. You’re driving the bus, and all your symptoms are the passengers yelling out or different fears you might have. But so often we don’t talk about, where are you driving the bus toward? Where are you going? 

I get misty when I think about this. I get almost a little teary because I think that people with OCD have such incredible imaginations, and yet, having OCD can make it so hard to dream and dream about what you truly want. Especially if it’s quite entrenched, it can just feel like, “Well, that’s a life that other people have. I don’t get to have that.” On the one hand, there’s this expansive imagination about illnesses, danger, harming others, or what have you. These things that are just dystonic—you don’t want to be thinking about them. 

I love to see people exercise that other part of their imagination and really encourage them to dream because if you have that roadmap, or rather that end destination of what you want your life to be, those very concrete moments that you want-- for some people, it’s like, “I want to have a family,” or “I want to travel,” or “I want to have the freedom to be around whomever I want to be around, regardless of the thoughts that come up,” whatever it is. Sometimes it can feel scary to even dream and envision that, either through values work or if it’s somebody who had a later onset thinking about where were you heading before. How did this derail you? What were you heading toward? I think that’s really important as well. If we don’t do that-- I mean, frankly, I wouldn’t want to do anything if I didn’t know my why.

Kimberley: No, agreed. I think that another thing—I often talk about this with my therapists in supervision—is one thing that I personally do-- and this is just me personally. Every therapist has their own way of doing it, but I often will ask my patients, “What kind of Kimberley do you need today?” I have the question as an opening where they can be like, “No, we’re good. Let’s just get to work.” We knew what we were going to do and so forth. My patients now know to say, “I need you to actually push me a little today.” They’re coming to me saying, “I want you to push you.” Or they’ll say, “I’m feeling very vulnerable today. I’m on my period,” or “It’s been a hard week,” or “I haven’t slept.” I don’t consider that me accommodating them. I consider that me being attuned to them. It might be that I might go, “Okay, but there’s been several weeks in a row that you’ve said that. Can we have a conversation?” It’s not that I’m going to absolutely let them off with avoidant compulsions, but I love offering them the opportunity to ask, what kind of Kimberley do you need? Sometimes they’ll say, “I need you to push me today, but I also need you to really encourage me because I have run out of motivation and I don’t have a lot.” 

I think that as clinicians, the more we can offer an opening of, what is it that you’re ready for? What do you want to expose yourself today? Is there something coming up that you really need to be working on? I think those conversations create this collaborative experience instead of like, “I’m the master of treatment, and you’re my follower” kind of model.

Amy: Right. I love that, and I love the idea that we can be motivational, encouraging, and celebratory in the face of exposure. Like exposures, I do feel like there has been a shift, and perhaps with the shift away from the strict habituation paradigm in the field, where it’s not like you have to just do the thing and be scared, be scared, be scared, be scared, be scared, and then it goes down. You can explore, “Hey, are you feeling stronger now? Are you feeling like I’m nervous, but I’m also curious?” 

Again, some of this is just personal style, but I use a lot of humor. There are often a lot of inside jokes with clients and things like that. I don’t see that as incompatible with really good exposure work because you’re learning that you can be scared and laughing. You’re learning that you can feel discomfort and empowerment. These kinds of things are huge. But again, I think when I was newer to ERP, there was a little bit of like, “Nope, we’re not cracking a joke, because that would be avoiding negative emotion.”

Kimberley: Yes. I remember that. Or being like, “I hope I don’t trigger them. I’m not going to [unintelligible].” The joke is what created an attunement and a collaboration between the two of us, which I think can be so beautiful. Another question I ask during exposure is, would you like to keep going? Would you like to make it a little harder? How could we? Even if we don’t, how might we? No pressure, but how might we make it so that they’re practicing this idea of being curious about making decisions on their own? Because the truth is, I’m only seeing you for 50 minutes a week. You have to then go and do this on your own. We want the clients, us as therapists, to model to them a curiosity of like, “Oh, it’s here.” Am I going to tell myself this is terrible and I can’t handle it? Or am I going to be curious about what else I could introduce? Would I like to send them a text to a loved one while I do this exposure? How would I like to show up? What values do I want to show up with? Those questions can take the terror out of it.

Amy: Yes. I think that all of this is hitting on something. I’ve noticed that oftentimes this notion of ERP is traumatizing. Again, not to discount anybody’s personal experiences with it if that has been negative, but it’s often based on this caricature of ERP that all those things that we’re saying don’t need to have that element of consent. It needs to have that collaborative nature, really good assessment, really good psycho-ed. I think that’s something I just realized because I don’t like feeling defensive about things. If I feel defensive, I’m like, “Uh-oh, this is a me thing.” I think in this case, it’s because I’m seeing a lot of misinformation about ERP, or perhaps just poorly applied ERP.

Kimberley: Yeah, for sure. I want to be respectful of time. We could make this into a whole training easily, but let’s end here on the healing because we’ve talked about everything today—ideas, concepts, mindsets, conceptualizations. But I also want to really make sure we are slowing down and creating a safe place where some people may actually, like you said, have had not great experiences. What might we do, and what might patients do in terms of healing moving forward?

Amy: It’s a good question. There’s a couple of things. I think if it’s something that we were talking about with the transparency and the talking, number one, finding support and finding support from, ideally, somebody who’s going to understand ERP enough that they can speak to. That doesn’t have to be the type of therapy that you’re getting with them, but understands it well enough to have a conversation like this. Just knowing it should never feel disrespectful, it should never feel non-consensual, and if that was your experience, then—I mean, I hate to say this, but I do think it’s true—I know I would want to know if somebody felt that way. If somebody was working with me and they felt that way, I know that can be quite a burden for people to reach out to someone with whom they’ve had a negative experience. 

But I think if you’re able to do that, that can be really helpful and really restorative, even if you’re not looking for a response, even if it’s just something that you’re letting them know. If you still have a relationship with that therapist, or let’s say it’s a clinic where you saw a therapist and you ended up moving to a different therapist, consider sharing it with them directly. I think we live in a very contentious culture of, “Well, I’ve made my mind up. That’s bad, and I’m moving on.” 

But truly, I think validation also starts with self-validation. My hope is that even though we’re both clearly ERP therapists who believe very strongly in its positive application for many people, we want to validate that if you’ve felt any harm, that’s valid. I think that also starts with self-validation as a first means of healing and then seeking support.

Kimberley: Yeah. What I think too, if you’re not wanting to do that, which I totally understand, sharing with your new clinician. One of the questions we have about our intake is what therapy was helpful and why, and what therapy wasn’t helpful and why. As you go with a new therapist, share with them, “This was my experience. This is what I found to be very effective. This is what I am very good at, but these are the things that I struggled with, and here’s why.” And then giving them the education of your process so they can help you with that, I think, is really important. 

I think you hit the nail on the head—also being very, very gentle. The administering of therapy is not a perfect science; it’s a relationship. It’s not always going to go well. I wish it could. I truly wish there was a way we could, but that doesn’t mean that you’re bad, that therapy won’t work for you in the future, or that all therapists are similar to what your experience was. I think it’s important to know that there are many therapists who want to create a safe place for you.

Amy: That’s so well said.

Kimberley: Anything else you want to add before we finish up?

Amy: No, no, I think this has been great. Again, anybody out there, I don’t know. I feel like, as therapists, sometimes we’re the holders of hope. If this could give you any hope, and again, ERP may not be the route that you choose, but just anyone who’s felt like therapy hasn’t been what you wanted, you deserve to find what’s going to feel like the best, most helpful fit.

Kimberley: Amy, I have wanted to do this episode for months now, and there is no one with whom I would feel as comfortable doing it as much as you. Thank you for creating a place for me to have this very hard conversation and a conversation I think we need to have. I’m again so grateful for you, your expertise, your kind heart, and your wisdom.

Amy: Thank you. 

Kimberley: Welcome back, Ethan Smith. I love you. Tell me how you are. First, tell me who you are. For those who haven’t heard of your brilliance, tell us who you are.

Ethan: I love you. My name is Ethan Smith, and I’m a national advocate for the International OCD Foundation and just an all-around warrior for OCD, letting people know that there’s help and there’s hope. That’s what I’ve dedicated my life to doing.

Kimberley: You have done a very good job. I’m very, very impressed.

Ethan: I appreciate that. It’s a work in progress.

Kimberley: Well, that’s the whole point of today, right? It is a work in progress. For those of you who don’t know, we have several episodes with Ethan. This is a part two, almost part three, episode, just catching up on where you’re at.

The last time we spoke, you were sharing about the journey of self-compassion that you’re on and your recovery in many areas. Do you want to briefly catch us up on where you’re at and what it’s been like since we met last?

Ethan: Yeah, for sure. We’ll do a quick recap, like the first three minutes of a TV show where they’re like, “So, you’re here, and what happened before?” 

Kimberley: Previously on.

Ethan: Yeah, previously, on real Ethans of Coweta County, which sounds super country and rural. The last time we spoke, I was actually really vulnerable. I don’t mean that as touting myself, but I said for the first time publicly about a diagnosis of bipolar. At that time, when we spoke, I had really hit a low—a new low that came from a very hypomanic episode, and it was not related to OCD. I found myself in a really icky spot.

Part of the reason for coming or reaching that bottom was when I got better from OCD into recovery and maintenance, navigating life for the first time, really for the first time as an adult man in Los Angeles, which isn’t an easy city, navigating the industry, which isn’t the nicest place, and having been born with OCD and really that comprising the majority of my life. The next 10 years were really about me growing and learning how to live. But I don’t know that I knew that at the time. I really thought it was about, okay, now we’re going to succeed, and I’m going to make money, live all my dreams, meet my partner, and stuff’s going to happen because OCD is not in the way. That isn’t to say that that can’t happen, and that wasn’t necessary. I had some amazing life experiences. It wasn’t like I had a horrible nine years. There were some wonderful things.

But one of the things that I learned coming to this diagnosis and this conclusion was how hard I was being on myself by not “achieving” all the goals and the dreams that I set out to do for myself. It was the first time in a long time, really in my entire life, that I saw myself as a failure and that I didn’t have a mental illness to blame for that failure. I looked at the past nine years, and I went, “Okay, I worked so hard to get here, and I didn’t do it. I worked so hard to get here in a personal relationship, and I didn’t get there. I worked so hard to get here financially, and I didn’t even come close."

In the past, I could always say, “Oh, OCD anxiety.” I couldn’t do it. I couldn’t finish it. I dropped out. That was always in the way. It was the first time I went, “Oh wow, okay, this is on Ethan. This is on me. I must not be creative enough, smart enough, good enough, strong enough, or brave enough.” That line of thinking really sent me down a really dark rabbit hole into a really tough state of depression and hypomania and just engaging in unhealthy activities and things like that until I just came crashing down.

When we connected, I think I had just moved from Los Angeles to Atlanta and was resetting in a way. At that time, it very much felt like I was taking a step back. I had left Los Angeles. It just wasn’t a healthy place for me at that time. My living situation was difficult because of my upstairs neighbor, and it was just very complicated. So, I ended up moving back to Georgia for work, and I ended up moving back in with my parents. I don’t remember if we talked about that or not, but it was a good opportunity to reset.

At that time, it very much looked and felt like I was going backwards. I just lived for 10 years on my own in Los Angeles, pursuing my dreams and goals. I was living at home when I was sick. What does this mean? I’m not ready to move. I’m not ready to leave. I haven’t given up on my dream. What am I doing?

I think if we skip the next three years from 2019 on, in retrospect, it wasn’t taking a step back; it was taking a step forward. It was just choosing a different path that I didn’t realize because that decision led to some of the healthiest, most profound experiences in my life that I’m currently living. I can look back at that moment and see, “Oh, I failed. I’ve given up.” This is backwards. In reality, it was such a beautiful stepping stone, and I was willing to step back to move forward, to remove myself from a situation, and then reinsert myself in something.

Where I am now is I’m engaged, to be married. I guess that’s what engaged means. I guess I’m not engaged with a lawyer. I’m engaged, and that’s really exciting.

Kimberley: Your phone isn’t engaged.

Ethan: Yeah, for sure, to an amazing human being. I have a thriving business. I’m legitimately doing so many things that I never thought I would do in life ever, whether it had to do with bipolar or more prominently in my life, OCD, where I spent age 20 to 31, accepting that I was home-ish bound and that was going to be my life forever and that I’m “disabled” or “handicapped,” and that’s just my normal. I had that conversation with my parents. That was just something that I was going to have to live with and accept.

I’m doing lots of things that I never expected to do. But what I’ve noticed with OCD is, as the stakes seem raised because you’re engaging yourself in so many things that are value-driven and that you care about, the stakes seem higher. You have more to lose. When you’re at the bottom, it’s like, okay, so what? I’m already like all these things. Nothing can go wrong now because I’m about to get married to my soulmate, and my business is doing really well. I have amazing friends, and I love my OCD community.

The thoughts and the feelings are much more intense again because I feel like I have a lot more to lose. Whereas I was dismissing thoughts before, now they carry a little bit more weight and importance to me because I’m afraid of losing the things that I care about more. There’s other people in my life. It’s not just about me. With that mindset came not a disregard but almost forgetting how to be self-compassionate with myself.

One of the things that came out of that bipolar diagnosis in my moving forward was the implementation of active work around self-compassion. I did workbooks, I worked very closely with my therapist, and we proactively did tons and tons of work in self-compassion. You can interrupt me at any time, because I’ll keep babbling. So, please feel free to interrupt.

I realized that I was not practicing self-compassion in my life at all. I don’t know that I ever had. Learning self-compassion was like learning Japanese backwards. It was the most confusing thing in the world. The analogy that I always said: my therapist, who I’ve been with for 13 years, would say to me, “You just need to accept where you are and embrace where you are right now. It’s okay to be there. Give yourself grace.” She would say all these things. 

I always subscribe to the likes of, “You have to work harder. You can’t lift yourself off the hook. Drive, drive, drive, drive.” That was what I knew. I tried to fight her on her logic. I said, “If there’s a basketball team and they’re in the finals and it's halftime and they’re down by 10, does the coach go to the basketball team and say, ‘Hey guys, let’s just appreciate where we are right now; let’s just be in this moment and recognize that we’re down by 10 and be okay with that.’” I’m like, “No, of course not. He doesn’t go in there and say that. He goes, ‘You better get it together and all this stuff.’” I remember my therapist goes, “Yeah, but they’re getting out of bed.” I’m like, “Oh, okay, that’s the difference.” They’re actually living their life. I’m completely paralyzed because I’m just beating myself down. 

But what I’ve learned in the last three or four years is that self-compassion is a continuous work in progress for me and has to be like a conscious, intentional practice. I found myself in the last year really not giving myself a lot of self-compassion. There’s a myriad of reasons why, but I really wanted to come on and talk about it with you and just share some of my own experiences, pitfalls, and things that I’ve been dealing with. 

I will say the last two years have probably been the hardest couple of years and the most beautiful simultaneously, but hard in terms of OCD, thoughts and triggers, anxiety, and just my overall baseline comfort level being raised because, again, there’s so many beautiful things happening. That terrifies me. I mean, we know OCD is triggered by good stress or bad stress. So, this is definitely one of those circumstances where the stakes seem higher. They seem raised, so I need more certainty. I need it. I have to have more certainty. I don't, really. I’m okay with uncertainty, but part of that component is the amount of self-compassion that I give myself. I haven’t been the best at it the last couple of years, especially in the last six months. I haven’t been so good.

Kimberley: I think this is very validating for people, myself included, in that when you are functioning, it doesn’t seem like it’s needed. But when we’re not functioning, it also doesn’t feel like it’s needed. So, I want to catch myself on that. What are some roadblocks that you faced in the implementation of this journey of self-compassion or the practice of self-compassion? What gets in the way for you?

Ethan: I will give you a specific example. It’s part of my two-year journey. In the last year and a half, I started working with a nutritionist. Physical health has become more important to me. It may not look like that, but getting there, a work in progress. But the reality of it is, and this is just true, I’m marrying a woman who’s 12 years younger than me. I want to be a dad. I can’t wait to have children. The reality of my life—which I’m very accepting of my current reality, which was something I wasn’t, and we were probably talking about that before—was like, I wanted to be younger. I hated that everything was happening now. I wasn’t embracing where I was and who I was in that reality. I’m very at peace with where I am, but the reality of my reality is that I will be an older father.

So, a value-driven thing for me to do is get healthier physically because I want to be able to run around and play catch in 10 years with my kid. I would be 55 or 60 and be able to be in their lives for as long as I possibly could. I started working with a nutritionist, and for me, weight has always been an issue. Always. It has been a lifelong struggle for me. I’ve always yo-yoed. It’s always been about emotional eating. It’s always been a coping mechanism for me.

I started working with a nutritionist. She’s become a really good friend, an influence in my life, and an accountability partner. I’m not on a diet or lifestyle change. There’s no food off the table. I track and I journal. But in doing this, I told her from the beginning, "In the first three months, I will be the best client you’ve ever had,” because that’s what I do—I start perfectly. Then something happens, and I get derailed. I was like, my goal is to come back on when I get derailed. That is the goal for me. And that’s exactly what happened. I was the star student for three months. I didn’t miss a beat. I lost 15 pounds. The goal wasn’t weight loss, mind you; it was just eating healthier and making more intentional choices. Then I had some OCD pipe up, my emotions were dysregulated, and I really struggled with the nutrition piece. I did get back on track. 

Over the last year, I gained about seven pounds doing this nutrition. Over the last six months, I was so angry at myself for looking at my year’s journey. This is just an example of multiple things with self-compassion, but this is the most concrete and tangible I can think of at the moment. But looking at my year and looking at it with that black-and-white OCD brain and saying, “I failed. I’m a piece of crap. I’m not where I want to be on my journey. I’ve had all of the support I could possibly have. I have all the impetus. I want to be thinner for my wedding. I want to look my best at my wedding. What is wrong with me? In these vulnerable emotional states or these moments of struggle, why did I give in?”

In the last couple of months, I literally refused to give myself any compassion or grace around food, screw-ups, mess-ups, and any of that. I refused. My partner Katie would tell me, “Ethan, you have to love--” I’m like, “No, I do not deserve it.” I’m squandering this opportunity. I just wholeheartedly refused to give myself compassion. Because it’s always been an issue, I’m like, “What’s it going to take?” Well, compassion can’t be the answer. I need tough love for myself. 

I think I did this in a lot of areas of my life because, for me, I don’t know, there’s a stigma around self-compassion. Sometimes, even though I understand what it is on paper-- and I’ve read your workbook and studied a lot of Kristin Neff, who’s an amazing self-compassion expert. On paper, I can know what it is, which is simply embracing where you are in the moment without judgment and still wanting better for yourself and giving yourself that grace and compassion, regardless of where it is. 

I felt like I couldn’t do that anymore because I wasn’t supposed to. I wasn’t allowed. I suddenly reframed self-compassion as a weakness and as an excuse rather than-- it was very much how I thought about it before I even learned anything about self-compassion, and I found myself just not a very loving person myself. My internal self-talk was really horrible and probably the worst. If somebody was talking to me like this, you always try to make it external and be like, “Oh, if somebody talked to you like this, would they be your friend? Would you listen to them?” I was calling myself names. I gave myself a room. It was almost in every facet of my life, and it was really, really eating at me. It took a significant-- yeah, go ahead.

Kimberley: When I’m with clients and we’re talking about behaviors, we always talk about the complex outcomes of them, like the consequences that you were being hard on yourself, that it still wasn’t working, and so forth. But then we always spend some time looking at, let’s say, somebody is drinking excessively or doing any behavior that’s not helpful to them. We also look at why it was helping them, because we don’t do things unless we think they’re helping. What was the reason you engaged in the criticism piece? How did that serve you in those moments?

Ethan: It didn't, in retrospect. In the moment, I think behaving in that way feels much like grabbing a spear and putting on armor. I don’t know if it’s stigma or male stigma. I mean, I’ve always had no problem being sensitive, being open to sensitivity, and being who I am as an individual. But with all of this good in my life, my emotions are more intense. My thoughts are more intense. My OCD is more intense. I felt like I needed to put on-- I basically defaulted to my original state of thinking before I even learned about self-compassion, which is head down, bull horns out, and I’m just going to charge through all of this because it’s the only way. It’s just like losing insight. When you’re struggling with OCD, it’s like you lose insight, you lose objectivity. It’s like there’s only one way through this. 

I think it’s important to note, in addition to the self-compassion piece, this year especially, there’s been some physical things and some somatic symptoms that I’ve gotten really stuck on. I’m really grateful that-- and I love to talk about it with advocacy. It’s like, advocates, all of us, just because we’re speaking doesn’t mean that we have an OCD-free life or a struggle-free life. That’s just not it. I always live by the mantra: more good days than bad. That is my jam. I’m pleased to report that in the last 13 years, I’ve still had more good days than bad, but it doesn’t mean that I don’t have a tough month. 

I think that in the last couple of years, I’ve definitely been challenged in a new way because there’s been some things that have come up that are valid. I have a lot of health anxiety, and they’ve been actual physical things that have manifested, that are legitimate things. Of course, my catastrophic brain grabs onto them. You Google once, and it’s over. I have three and a half minutes to live for a brown toenail, and--

Kimberley: You died already.

Ethan: I’m already dead. I think it all comes back around to this idea of self-stigma, that even if you know all this stuff like, I’m not allowed to struggle, I’m not allowed to suffer, I have to be a rock, I have to be all things to all people—it’s all these very black and white rules that are impossible for a human being to live by because that’s just not reality. I mean, I think that’s why the tough exterior came back because it was like, “All right, life is more challenging.”

The beautiful thing about recovery is, for the most part, it didn’t affect my functioning, which was amazing. I could still look at every day and go, “I was 70% present,” or “I was 60% present and 40% in my head, but still being mindful and still doing work and still showing up and still traveling.” From somebody that was completely shut down, different people respond in different ways to OCD. From somebody who came from completely shutting down and being bedridden, this was a huge win. But for me, it wasn’t a huge win in my head. It was a massive failing on my part. What was I doing wrong? How was it? 

Just as much as I would talk every week on my live streams and talk about, it’s a disease, not a decision, it’s a disorder. I can say that all day long, but there are times when it tricks me, and I stigmatize myself around it. 

It’s been very much that in the last year, for sure. It’s been extremely challenging facing this new baseline for myself. Because, let’s face it, I’m engaging in things that I’ve never experienced before. I’ve never been in a three-year relationship with a woman. I’ve never been engaged. I’ve never bought a house. Outside of acting, I’ve never owned a business or been a businessperson. I mean, these are all really big commitments in life, and I’m doing them for the first time. 

If I have insight now and it’s like, I can have this conversation and say, “Yeah, I have every reason to be self-compassionate with myself.” These are all brand new things with no instruction manual. But it’s very easy to lose sight of that insight and objectivity and to sit there and say-- we do a lot of comparing, so it’s very easy to go, “Well, these are normal human things. Everybody gets married. Everybody works. This should be easy.” You talk about, like, never compare struggles, ever. If somebody walks to the mailbox and you can’t, never compare struggles. But that’s me going, “Well, this is normal life stuff. It’s hard. Well, what’s wrong with me?”

Kimberley: Right. I think, for me, when I’m thinking about when you’re talking, I go in and out of beating myself up for my parenting, because, gosh, I can’t seem to perfect this parenting gig. I just can’t. I have to figure it out. What’s so interesting is when I start beating myself up and if I catch myself, I often ask myself, what would I have to feel if I had to accept that I’m not great at this? I actually suck at this. It’s usually that I don’t want to feel that. I will beat myself up to avoid having to feel the feelings that I’m not doing it right. That has been a gateway for me, like a little way to access the self-compassion piece. It’s usually because I don’t want to feel something. And that, for me, has been really helpful. 

I think that when you’re talking about this perceived failure—because that’s what it is. It’s a perceived failure, like we’re all a failure compared to the person who’s a little bit further ahead of us—what is it that you don’t want to feel?

Ethan: It’s a tough question. You’ve caught me speechless, which is rare for me. I’m glad you’re doing video because otherwise, this would be a very boring section of the podcast. For me, the failing piece isn’t as much of an issue. It was before. I don’t feel like I’ve failed. In fact, I feel like I’m living more into where I’m supposed to be in my values. I think for me, the discomfort falls around being vulnerable and not in control. I think those are two areas that I really struggle with.

I always say, sometimes I feel like I’m naked in a sandstorm. That’s how I feel. That’s the last thing you want to be. Well, you don’t want to be in a sandstorm—not naked, but naked in a sandstorm—you don’t want to see me naked at all. That’s the bottom line. No nudity from Ethan. But regardless, you’re probably alone in the sandstorm. You feel the stinging and all of that. No, I’m just saying that’s what I picture it feels like. 

Kimberley: Yeah, it’s an ouch. That feels like an ouch.

Ethan: It feels like a big ouch. I think that vulnerability, for me, is scary. I’m not good at showing vulnerability. Meaning, I have no problem within our community. I’ll talk about it all day long. I’ll talk about what happened yesterday or the day before. I’ll be vulnerable. But for people who don’t know me, I struggle with it. 

Kimberley: Me too.

Ethan: Yeah. We all have our public faces. But vulnerability scares me in terms of being a human being, being fallible, and not being able to live up to expectations. What if I have to say I can’t today? Or I’m just not there right now and not in control of things that scare me.

Those feelings, I think, have really thrown me a bit more than usual, again. I keep saying this because things feel more at stake, and they’re not, but I feel like I have so much more to live for. That’s not saying that I didn’t feel like I didn’t have a reason to live before. That’s not what I’m saying at all. I’m simply saying, dreams come true, and how lucky am I? But when dreams come true with OCD, it latches onto the things we care about most and then says, “That’s going to be taken away from you. Here are all the things you have to do to protect that thing.” I think it’d been a long time since I’d really faced that. 

To answer your question in short, I think, for me, vulnerability and uncertainty around what I can’t control, impacting the things that I care about most, are scary.

Kimberley: I resonate so much with what you’re saying. I always explain to my eating disorder clients, “When you have an eating disorder and you hit your goal weight, you would think we would celebrate and be like, ‘Okay, I hit it. I’m good now.’” But now there’s the anxiety that you’re going to go backwards. Even though you’ve hit this ridiculous goal, this unhealthy goal, the anxiety is as high as it ever was because the fear of losing what you’ve got is terrifying. I think that’s so true for so many people.

And I do agree with you. I think that we do engage in a lot of self-criticism because it feels safer than the vulnerability, the loss of control, or whatever that we have to feel. What has been helpful for you in moving back towards compassion? I know you said it’s like an up-and-down journey, and we’re all figuring this out as we go. What’s been helpful for you?

Ethan: A couple of things. I think it’s worth talking about, or at least bringing up this idea of core fear. I’ve done some recent core fear work, just trying to determine, at the root of everything, what is my core fear? For me, it comes down to suffering. I’m afraid of suffering. I’m not afraid of dying; I’m afraid of suffering. I’m afraid of my entire life having to be focused on health and disease because that’s what living with OCD when I was really sick was about. It’s all I focused on. So, I’m so terrified of my life suddenly being refocused on that. 

Even if I did come down with something awful, it doesn’t mean that my life has to solely focus on that thing. But in my mind, my core fear is, what if I have to move away from these values that I’m looking at right now and face something different? That scares the crap out of me. 

The first thing around that core fear is the willingness to let that be there and give myself compassion and grace, and what does that look like, which is a lot of things. This fear—this new fear and anxiety—hasn't stopped me from moving forward in any way, but it sure has made it a little bit more uncomfortable and taken a little bit of the joy out of it. That’s where I felt like I needed to put on a second warrior helmet and fight instead of not resisting, opening myself up, and being willing to be naked in a sandstorm. 

One of the things that I’ve learned most about is, as a business owner yourself, and if you’re a workaholic, setting boundaries in self-care is really hard. I didn’t really connect until this year the connection, the correlation between self-care and self-compassion. If I don’t have self-compassion, I won’t allow myself to give myself self-care. I won’t. I won’t do it because I don’t deserve it.

There’s a very big difference between time off, not working, sleeping, but then actually taking care of yourself. It’s three different things. There’s working, there’s not working, and then there’s self-care. I didn’t know that either. It was like, “Well, I didn’t work tonight.” Well, that’s not necessarily self-care. You just weren’t in a meeting, or you weren’t working on something. Self-care is proactive. It’s purposeful. It’s intentional. 

Giving myself permission to say no to things, even at the risk of my own reputation, because I feel like saying no is a big bad word, because that shows that I can’t handle everything at once, Kim. I can’t do it all. And that is a no-no for me. Like, no, no, no, everybody needs to believe that you can do everything everywhere all at once, which was a movie. That’s the biggest piece of it. 

Recently, I was able to employ some self-care where it was needed at the risk of the optic seeming. I felt like, "Here I am, world. I’m weak, and I can’t handle it anymore." That’s what I feel like is on the other end. 

I was sick, and I had been traveling every week since the end of March. I don’t sleep very well. I just don’t. When I’m going from bed to bed, I really don’t sleep well. I had been in seven or eight cities in seven or eight weeks. I had been home for 24 hours. This was only three weeks ago, and I was about to head out on my last trip, and the meeting that I was going for, the primary reason, got canceled, not by me. I was still going to meet with people that I love and enjoy. I woke up the day before I was traveling, and I was sick. I was like, “Oh man, do I still go?” The big reason was off the table, but there were still many important reasons to go, but I was exhausted. I was tired. I was sick. My body was saying, “Enough.” I had enough insight to say, I’m not avoiding this. This isn’t anxiety. This is like straight up. 

When I texted the team—this is around work and things that I value—I was like, “I’m not coming.” I said, “I’m not coming.” They responded, “We totally understand. Take care of yourself.” And what I read was, “You weak ass bastard. You should suck it up and come here, because that’s what I would have done. Why are you being so lame and lazy?” That is what I read. This is just an instance of what I generally feel if I can’t live up to an expectation. I always put these non-human pressures on myself. 

But making this choice, within two days, I was able to reset intentionally. This doesn’t mean I’m going to go to bed and avoid life. I rested for a day because I needed to sleep to get better. But the next few days were filled with value-driven decisions and choices and walks and exercising and getting back on nutrition and drinking lots of water and spending quality time with people that I care about, and my body and brain just saying, “You need a moment.” Within a couple of days, everything changed. My OCD quickly dropped back down to baseline. My anxiety quickly dropped back down. I had insight and objectivity. 

When I went back to work later that week—I work from home—I was way more effective and efficient. But I wouldn’t have been able to do that. It was very, very hard to give myself self-compassion around making that simple decision that everybody was okay with.

Kimberley: I always say my favorite saying is, “I’m sorry, but I’m at capacity right now.” That has changed my life because it’s true. It’s not even a lie. I’m constantly at capacity, and I find that people do really get it. But for me to say that once upon a time, I feel this. When I was sick, the same thing. I’m going to think I’m a total nutcase if I keep saying no to these people. But that is my go-to sentence, “I’m at capacity right now,” and it’s been so helpful. 

Ethan: In max bandwidth. 

Kimberley: Yes. What I think is interesting too is I think for those who have been through recovery and have learned not to do avoidant behaviors and have learned not to do compulsions, saying “I need a break” feels like you’ve broken the rules of ERP. They’re different things.

Ethan: You hit them down. I was literally going to say that. It also felt when I made that decision that it felt old history to me, like old Ethan, pre-getting better. I make the joke. It was true. I killed my grandfather like 20 times while he was still alive. Grandpa died. I can’t come to the thing. I can’t travel. I can’t do the thing. This was early 2000s, but I had a fake obituary that I put into Photoshop. I would just change the date so I can email it to them later and be like, it really happened. I would do this. It’s like, here was a reason. It was 100% valid. Nobody questioned it. It was not based on OCD. It was a value-driven decision, and it felt so icky. My body felt like I might as well have sent a fake obituary to these people about the fake death of my grandfather. It felt like that. So, I wholeheartedly agree with you.

Kimberley: I think it’s so important that we acknowledge that post-recovery or during recovery is that saying acts of compassion sometimes will feel like and sound like they’re compulsions when they’re actually not. 

Ethan: That’s such a great point. I totally agree with you.

Kimberley: They’re actually like, I am actually at capacity. Or the expectation was so large, which for you, it sounds like it is for me too—the expectation was so large, I can’t meet that either. That sucks. It’s not fun. 

Ethan: No, it’s not. It’s not because, I mean, there’s just these scales that we weigh ourselves on and what we think we can account for. I mean, the pressure that we put on ourselves. And that’s why, like the constant practice of self-compassion, the constant practice of being mindful and mindfulness, this constant idea of-- I mean, I always forget the exact thing, but you always say, I strive to be a B- or C+. I can never remember if it’s a B- or C+, but--

Kimberley: B-.

Ethan: B-. Okay, cool. 

Kimberley: C+ if you really need it.

Ethan: Yeah. To this day, I heard that 10 years ago, and I still struggle with that saying because I’m like, I don’t even know that I can verbally say it. Like, I want to be a B... okay, that’s good enough. Because it sounds terrifying. It’s like, “No, I want to be an A+ at everything I do.” 

I know we’re closing in on time. One of the things I just wanted to say is thank you not only for being an amazing human being, an amazing advocate, an amazing clinician, and an okay mom, as we talked about.

Kimberley: Facts. #facts.

Ethan: But part of the reason I love advocating is I really didn’t come on here to share a specific point or get something across that I felt was important. I think it’s important as an advocate figure for somebody who doesn’t like transparency or vulnerability to be as transparent and vulnerable as possible and let people see a window into somebody that they may look at and go, “That person doesn’t struggle ever. I want to be like that. I see him every week on whatever, and he’s got it taken care of. Even when it’s hard, it isn’t that hard.” 

For me, being able to come on and give a window into Ethan in the last six months is so crucial and important. I want to thank you for letting me be here and share a little bit about my own life and where I met the goods and the bads. I wouldn’t trade any of it, but I appreciate you.

Kimberley: No, thank you. I so appreciate that because it is an up-and-down journey and we’re all figuring it out, myself included. You could have interviewed me and I could have done similar things. Like here are the ways that I suck and really struggle with self-compassion. Here are the times where I’ve completely forgotten about it as a skill until my therapist is like, “Uh, you wrote this book about this thing that you might want to practice a little more of.” I think that it’s validating to hear that learning it once is not all you need; it is a constant practice.

Ethan: Yeah, it definitely is. Self-compassion is, to me, one of the most important skills and tools that we have at our disposal. It doesn’t matter if you have a mental health issue or not. It’s just an amazing way of life. I think I’ll always be a student of it. It still feels like Japanese backwards sometimes. But I’m a lot better at putting my hand-- well, my heart’s on that side, but putting my hand in my heart, and letting myself feel and be there for myself.

I never mind. I’m a huge, staunch advocate of silver linings. I’ve said this a million times, and I’ll always say, having been on the sidelines of life and not being able to participate, when life gets hard and stressful, deep down, I still have gratitude toward it because that means I’m actually living and participating. Even when things feel crappy or whatever, I know there’ll be a lesson from it. I know good things will come of it.

I try to think of those things as they're happening. It’s meaningful to me because it gives me insight and lets me know that there’ll be a lesson down the road. I don’t know if it’ll pay itself back tomorrow or in 10 years, but someday I’ll be able to look at that and be like, “Well, I got to reintroduce myself to self-compassion. I got to go on Kim Quinlan’s podcast, Your Anxiety Toolkit, and be able to talk to folks about my experience.” While I didn’t quite enjoy it, it was a life experience, and it was totally worth it for these reasons. Now I get to turn my pain into my purpose. I think that’s really cool.

Kimberley: Yeah, I do too. I loved how you said before that moving home felt like it was going backwards, but it was actually going completely forward. I think that is the reality of life. You just don’t know until later what it’s all about. I’m so grateful for you being on the show. Thank you so much for coming on again.

Ethan: Well, thanks for having me, and we’ll do one in another 200 episodes.

Kimberley: Yes, let’s do it.

Ethan: Okay.

Today, we are going to talk about what to do when feeling hopeless. Today’s episode was actually inspired by one of our amazing Your Anxiety Toolkit podcast listeners. They wrote in and asked a question about hopelessness, and I thought it was so important and so relevant in today’s day, with the news being scary and everybody struggling and still readjusting to COVID, mental health, and mental illnesses at an all-time high. I really felt that this was important for us to talk about. So, let’s do this together. We’re going to take it step by step, and we’re going to do it with a whole lot of self-compassion. So let’s talk about what to do when feeling hopeless.

 Alright folks, here is the question that was posed to me. It goes like this:

“I have been really struggling with hopelessness lately. It feels like my life has no real meaning, and I feel pretty aimless. The things in my life that I want to improve need so much work to improve, such as career, relationship, family stuff. And I have large parts that are out of my control, which feels pretty discouraging despite lots of effort to improve them. I’m working to accept these feelings and trying to stay out of rumination, but it does feel hopeless a lot of the time. What are you telling folks who are in a similar position?”

Now, number one, I so resonate with this question. As a clinician, a human, a mom, and someone with a chronic illness, I hear you in this question, and I don’t think you’re alone. In fact, I am a member of a pretty large online group of therapists, and I wanted to do my homework for today. So I left the question, saying, when you have clients who are experiencing hopelessness and they’re feeling stuck, what do you say? A lot of them were coming with these such humble responses of saying, “To be honest, I tell them the truth, which is I don’t know the answer. I too struggle with this.” Or they’ll say, “I often let them know that they’re not alone in this and that this is such something that collectively we’re all going through.” And I loved that they were so real and dropped into reality on the truth of this, the pain of this, and the confusion of this topic. 

Now, in addition to that, there were also some amazing pieces of advice, and some of them I really agreed with. I’m going to include them here when we go through specifically some tools that you can use to help you when you’re struggling with this feeling of hopelessness or feeling like what’s the point and feeling like there’s no meaning to life. 

Let’s talk about it. Number one—let me just be real with you—is I too have struggled with this. In fact, it wasn’t that long ago that I actually sought out therapy for this specific issue. I looked around my life, and I have these two beautiful children, I have two businesses and a career that I love, and I still felt hopeless. I still felt like this sense of what’s the point? What’s the meaning of all this? I’m working my butt off, trying to manage all the things. What is the real point? It felt a little like an existential crisis, to be honest. 

I love that this person reached out to ask this question. I do encourage you all, if you’re struggling with this and navigating this, do go and seek therapy. I’m going to be giving you some tools on how to manage this today, but in no way do I think that my solutions are going to be exactly what you need to hear. There may be some of them that are super helpful for you, but I strongly encourage you to go and navigate them on your own. 

Through exploring this, I found that there were some unmet needs that I was not paying attention to. I found that I was grieving living in a country that’s not my home country. So many parts of it were also related to my chronic illness. And so it was very personal work, and I encourage you too to do that personal work. 

But, given that we’re here today, I also want to give you some strategies, skills, and direction if you too are wondering what to do when feeling hopeless. Let’s do this together.

THERAPY FOR HOPELESSNESS

The first thing here is I love that the person who wrote this said, “I’m working at accepting the feelings.” I think that that is probably the biggest key here, which is not accepting that they’ll be there forever but instead accepting that they’re here right now and reminding yourself that they’re temporary. 

HOPELESSNESS IS A TEMPORARY EMOTION

Hopelessness, like any other emotion, is a temporary emotion. It will rise and fall, rise and fall, and rise and fall. It doesn’t mean that you’ll always feel this way. What we can do is, while we’re accepting it, I often ask my patients, “As you accept it, let’s also be very curious about any resistance you have in your body as you practice accepting.” 

I’ve had clients who’ve sat on the couch of my office and said, “No, no, I’m accepting it.” But every part of their body is clenched up. Every part of their face is resistant. They’re obviously accepting that it is here, but also trying to push against it, also trying not to feel it. Yes, accepting feelings is important, but are you creating a safe place for that emotion to rise and fall within you? 

Here, we can check in with our bodies. Where is this discomfort in my body? Where am I holding tension around it? Is there a way I can soften around this experience of hopelessness first? And that can be so important as we’re navigating hopelessness and finding meaning in our lives. 

HONOR THAT THIS IS HARD FOR YOU

The next thing I’m going to encourage you to do is first honor just how hard things are for you. Often, that might be just a moment of saying, “This is really hard for me. Absolutely. This is very hard for me.” 

OFFER SELF-COMPASSION WHEN YOU FEEL HOPELESS

The next piece here is we want to offer as much compassion as we can. We want to nurture the fact that you’re going through an incredibly hard thing or things. You’re trying so hard. You’re exhausted. You’re feeling lost. You might even be feeling like, “I don’t even know which direction I’m going. I’m just going and getting through the day.” We want to create as much compassion as we can for that. 

Now, if you are new to the work of self-compassion, there are so many resources online. We have a meditation vault with tons of different meditations for self-compassion at CBT School. They’re there for you if you’re really wanting to embark on this practice. We’ve also got tons of other episodes of Your Anxiety Toolkit on self-compassion as well. 

KEEP AN EYE OUT FOR CATASTROPHIZATION

The next thing I want you to think about here is keep an eye on how you’re doing things throughout the day. I’ll tell you a story. Actually, as I did this work for myself when I went into therapy, I looked at my schedule every morning, and all I could see was just a whole bunch of things I had to do. It was just like a list of things that I had to do. It felt like trash things I had to do, even though many of them were joyful things that I love doing and that I’ve signed up to do. But what I noticed was I was looking at the day as if it was just a mountain of chores instead of staying very present and mindful, doing one thing at a time, and practicing non-judgment, curiosity, and kindness as I do those things. 

BREAK THINGS DOWN INTO SMALL, DOABLE STEPS

What I’m going to encourage you to do is break things down into small, doable steps. When you look at your life and you think, oh my goodness, in the case of this question of relationships, career, work—when you look at all of that, it can become so overwhelming. Maybe sit down, get a notepad, and just pick one thing you want to work on right now, one thing that you can do from a place of wisdom and being effective and kind, and just focus on seeing if you can achieve and accomplish that one thing. Chances are, you might already be doing that, but there’s a piece that you’ve missed, and I can guarantee you’ve missed it—you’ve forgotten to celebrate the fact that you got a small step done. 

Often, when things feel so huge, we finish something, and then we just move on to the next thing that we have to do. And that’s when things do feel like there’s no meaning, there’s no point to this life. We’re just in the motions, going with the cycles. We forget to celebrate, validate, and recognize the accomplishments that we’ve made. We forget to go, “Yeah, that’s a big deal. Good for you, you did that,” and take that time to celebrate it. Because again, as I said to you, I was looking at my life going, “Everything looks mostly pretty good. I’ve got this pretty severe chronic illness, but otherwise, things are going well.” But I realized I was just doing thing after thing after thing and after thing and not stopping to go, “Wow, good job. You’re taking care of your kids. Great job, you did something for yourself today,” or “Wow, you accomplished that one thing, and that was really hard.” We’ve got to celebrate our wins. 

STOP COMPARING YOURSELF TO OTHERS

The next piece of that is, often, people who get stuck in the day-to-day feeling like it’s Groundhog’s Day and there’s no real point, that’s because they’re comparing their experience to somebody else’s. They’re comparing their day-to-day with someone on social media who has made it look beautiful, they’ve got beautiful filters on, and everything looks really great. We’re making a lot of comparisons between how they’re doing and how we’re doing. I want to encourage you, please do not compare your wins and struggles to other people’s wins and struggles. That is a recipe for feeling hopeless, it’s a recipe for feeling depressed, and it’s a recipe for feeling like you’re never going to be enough. It’s so important. 

THREE THEMES OF DEPRESSION

The next thing I want you to do is catch yourself in the distorted thinking. Now, here is something you must take away from today—depression commonly has three themes. The first one is hopelessness—feeling like there is no hope. The second one is helplessness, feeling like no one can help you, that there’s no point, there’s no one can help you with your problem. And the last one is worthlessness, which is “I have no value.” 

These three themes show up in our thinking and in our cognitions. I’ve done episodes in the past where I’d say depression is a liar. It tells lies all day. If you aren’t able to detect and correct those lies, you’re going to start believing them. Thoughts that are just depressive thoughts will start to become beliefs. Once they become beliefs, you start acting them out in many ways in your life.

 What we want to do when we’re treating depression in therapy is actually slow down and be very mindful of your thoughts about the world, your thoughts about yourself, and your thoughts about your future. Look at where the distorted thoughts are and correct them. 

We have a course on CBTSchool.com called Overcoming Depression, and the whole middle section of that course is teaching you how to identify cognitive distortions or errors in thinking and how to correct them. And that is a crucial part of managing depression. Because depression tells us lies all day. It tells us, “There’s no hope. You’re not doing good enough. You’re not good. There’s no hope for you. No one can help you. You’re just a piece of trash. You’re a loser. It should be easy. Why is it so hard for you?” It might even say, “Look at you, you’ve got A, B, and C, and other people have it so much worse than you. So, what’s your problem?” It just tells you all of these judgmental, horrible, mean things that are not true. 

What we can do and what we do in the course, Overcoming Depression, is we identify those thoughts. We understand and acknowledge the presence of them. We maybe take a little look into what they’re trying to get to, what they’re trying to say. And then we work at coming up with alternative thoughts that feel helpful, compassionate, effective, and true.

One of the tools we use in overcoming depression is we pretend that we’re in a court of law, and we have this scene where we say, “Okay, if you were to bring your depressive thoughts to a court of law, would the jury agree or disagree? Would the judge throw your case out?” Often, what happens is we have thoughts. Like, minimizing the positive is one kind of distorted thought we go through. There are many different types of distorted thoughts, but let’s say minimizing the positive. Let’s say you did something positive and you say, “No. I know I completed that, but it should have been easier,” or “I should have done it faster,” or “It shouldn’t have been that difficult.” That’s minimizing the positive.

We would go, “Okay, if we were to take that to court, if we were to take that claim to court, what would the jury and what would the judge say?” The judge would not agree with that. They would say, “No, you completed the thing, and it’s okay that it’s hard. I’m tossing this out of the court. You’re wasting my time.” And so we want to be able to identify that and look at another example being a labeling distorted thought, like, “You’re a loser. You should be doing better.”

In a court of law, the jury would look at the evidence and go, “No, it looks like you’re handling a lot right now. It looks like you’re handling many things. It makes sense that you feel that way, but it looks like you have many pieces of evidence to show that you’re not a loser. Let’s throw the case out. Case dismissed.” We want to make sure you’re doing that because the chances are, as you’re going through these hard things, as you’re navigating the day, you’re forgetting to check the facts. We’ve got to check the facts in depression. It’s so important.

REMEMBER, YOU CAN DO HARD THINGS

The next thing we have to do is remind yourself that you can do hard things. When the world feels like it’s a mountain of just chores and things in check boxes and to-do’s, we often just get overwhelmed with it, and it’s like, “I can’t do this.” I will say to you, when I actually was struggling the most with my chronic illness and I did get therapy for this, the thought we identified the most was this repetitive, consistent, nagging thought, “I can’t do this.” I probably thought “I can’t do this” about 150 times a day, minimum. Even as I was doing things, I was having the thought, “I can’t do these things.” As I was taking an MRI or helping my kids or working on my business—even as I was doing them, I was telling myself, “You can’t do this,” as I was doing them, which again shows how our thinking can really distort and make things so much worse if we don’t catch them. 

We have to remind ourselves we can do hard things. We’re already doing hard things. That baby steps at a time can make small progress. There’s no race. There’s no finish line. We’re not here to beat other people or compare ourselves to other people’s timelines. This is our timeline, and we’re going to let it take as long as it needs. We’re going to be gentle. We’re just going to do one hard thing at a time. 

FIND SUPPORT

Another thing I want you to remember here when you’re struggling with hopelessness is to find support. When we feel hopeless, we feel alone. When we feel hopeless, we feel isolated. We feel like we’re the only one going through this. But there are so many people who are experiencing this. Sometimes it’s just saying, “This is a hard season for me.” You’d be shocked at how many other people come out and go, “Yeah, me too.” 

So find support in others who are in the thick of it, who are also trying to work on hopelessness, what’s the real meaning, and so forth. 

FIND PLEASURABLE ACTIVITIES

And then the last piece here that I think is the foundation of this work is, make sure you’re implementing pleasurable activities in your day. When somebody has depression and hopelessness, what we often do in therapy, and we do this in Overcoming Depression, the course as well, is we look at your day, and often people with depression do not schedule pleasure. They do not input pleasurable, value-driven exercises into their day because depression often will say, “What’s the point? Don’t even bother. You used to like doing painting, but what’s the point? You’re not going to enjoy it, so don’t do it,” or “You’re not good. You’re never going to be good at it, so don’t do it.” 

As we take pleasure out of our lives, it adds to this feeling of what is the meaning because the truth is, the meaning of life, who knows what it truly is? It’s different for every person. But a big piece of you finding what’s meaningful to you is acting according to your values and doing the things that feel lovely, nourishing, and yummy to you. My guess is, you’re not doing a lot of that. You’re not doing a lot of yummy, nourishing, pleasurable, fun activities. 

I get it, depression isn’t going to let you have all the fun. It’s not going to let you have a 10 out of 10 fun. But even if we get a 2 out of 10 pleasure or 4 out of 10 pleasure, let’s take it. Let’s do it even just to get the 4 out of 10 pleasure, 10 being the highest level of pleasure. Try not to rid yourself of activities that used to bring you joy.

 It’s also a big piece here when we find meaning. This is a really big topic in the field of therapy and psychotherapy. There is a beautiful book, which I would encourage you to read, called Man’s Search for Meaning. It’s by Viktor Frankl. It was one of the first books that were recommended in my master’s degree as I was training to become a therapist. It will bring a beautiful sense of understanding of making meaning in your life, and hopefully would be a beautiful supplement to the work that we’re doing here, and a compliment to you, finding what’s meaningful to you. Sometimes it means we have to reshuffle our lives a little bit. 

 When I did this work personally, I had to really go, “Okay, you’re working too much. I know it’s scary to slow down, but you’re lost. You’ve lost yourself. You’re going to have to slow down.” Or it might be, “Wow, your schedule is too full with just appointments and soccer practice and swim lessons and all the things. We’re going to have to slow down and have a little more fun. Play a little more. Sit a little more. Read a little more. Be with your family. Actually, be with them instead of just going through the motions.” We can’t get caught up in the day-to-day and not implement that pleasurable thing.

 And then the last part of that is, I’m going to offer to you one sort of final idea for what to do when feeling hopeless, and it is, please try to stop fixing yourself all the time. In my experience as a clinician, the people who often do get hopeless and helpless and feel depressed are the ones who constantly tell themselves they need to be more, need to be better, that something has to change, that there’s something fundamentally wrong with them. I want to offer to you that there is nothing wrong with you, even if you’re struggling with a mental illness right now. Try to catch your constant need to fix yourself. Try to just live. Identify what your values are and see if you can get your behaviors and life to line up with those. 

This striving that we have today in our pop culture of constantly having to be better, constantly having to have self-help books and being better, that is exhausting, and that is not the meaning of life. The meaning of life for me now that I’ve done the work isn’t the grand things and achievements. The meaning of life is actually quite silly and simple. In comparison, it’s sitting in the sunlight and letting the sun hit my face. It’s just hearing a laugh of my child. Nothing huge, doesn’t need to require massive wins. It might be just holding space for my emotions, honoring my needs, identifying my unmet needs, and doing what I can to meet those. 

I’m not here to tell you in any way that I know what the meaning of your life is. I’m just telling you what the meaning of mine is. But I encourage you to enter this practice, to leave today, doing this as kindly, as gently, and as respectfully and compassionately as you can.

 You’re going through a hard season. These are hard times. These are confusing times. I hope that with little baby steps, you changing your perspective and giving yourself the opportunity to just do one thing at a time and slow it all down will be helpful for you. 

Have a wonderful day. If you’re wanting any of the resources that we have listed today, you can check the show notes, or you can also go to CBTSchool.com and learn more about our online resources there. 

Have a wonderful day, everybody.

Kimberley: Welcome, everybody. This is a very exciting episode. I know I’m going to learn so much. Today, we have Caitlin Pinciotti and Shala Nicely, and we’re talking about when OCD and PTSD collide and intertwine and how that plays out. This is actually a topic I think we need to talk about more.

Welcome, Caitlin, and welcome, Shala.

Caitlin: Thank you.

Shala: Thanks.

Kimberley: Okay. Let’s first do a little introduction. Caitlin, would you like to go first introducing yourself?

Caitlin: Sure thing. I’m Caitlin Pinciotti. I’m a licensed clinical psychologist and an assistant professor in the Department of Psychiatry and Behavioral Sciences at Baylor College of Medicine. I also serve as a co-chair for the IOCDF Trauma and PTSD and OCD SIG. If people are interested in that special interest group as well, that’s something that’s available and up and running now.

Most of my research specifically focuses on OCD, trauma, and PTSD, and particularly the overlap of these things. That’s been sort of my focus for the last several years. I’m excited to be here and talk more about this topic.

Kimberley: Thank you. You’re doing amazing work. I’ve loved being a part of just watching all of this great research that you’re doing. Shala, would you like to introduce yourself?

Shala: Yes. I’m Shala Nicely. I am a licensed professional counselor, and I specialize in the treatment of OCD and related disorders. I am the author of Is Fred in the Refrigerator?: Taming OCD and Reclaiming My Life, which is my story, and then co-author with Jon Hershfield of Everyday Mindfulness for OCD: Tips, Tricks, and Skills for Living Joyfully. I also produce the Shoulders Back! newsletter. It has tips and resources for taming OCD.

Kimberley: Shoulders Back! was actually the inspiration for this episode. Shala, you recently wrote an article about post-traumatic OCD or how PTSD and OCD collide. Can you tell us about your story, particularly going back to, I think you mentioned, May 2020, and what brought you to write that article?

Shala: Sure, and thank you very much for having Caitlin and me on today because I really appreciate the opportunity to talk about this and to get more information out in the world about this intertwined combination of PTSD and OCD. In May of 2020, I moved to a new house, the house that I’m in now. Of course, we had just started the pandemic, and so everybody was working at home, including me. The house that I moved into was in a brand new neighborhood.

While the houses on this side of me were completed, the houses behind me and on that side were not completed. I didn’t think anything of that when I moved in. But what I moved into was a situation where I was in a construction zone all the time. I was working at home, so there was no escape from it.

One day I was walking behind my house, where most of the houses were in the process of being built and there were no sidewalks. As I was walking down the street, I saw, down at the end of the street, a big forklift come down the street where I was walking with my two little dogs backwards at a really high rate of speed, and the forklift driver seemed to be looking that way, and he was going that way. It happened so fast because he was going so quickly that all of a sudden I realized he was going to hit us, my dogs and me, and there was no place for us to go because we were on the road because there was nowhere else for us to be. I screamed bloody murder, and he heard me. I mean, that’s how loud I screamed, and he stopped. That was not all that pleasant. I was upset. He was not happy. But we moved on. But my brain didn’t move on. 

After that incident, what I noticed was I was becoming really hypervigilant in my own house and finding the construction equipment. If I go outside, I tense up just knowing that construction equipment is there. Over time, my sleep started becoming disturbed. I started to have flashbacks and what I call flash-forwards, where I would think about all these horrible things that could happen to me that hadn’t happened to me yet but could. I’d get lost in these violent fantasies of what might happen and what I need to do to prevent that. 

I realized that I seemed to be developing symptoms of PTSD. This is where being a therapist was actually quite helpful because I pulled the DSM open one night and I started going through symptoms of PTSD. I’m like, “Oh my gosh, I think I have PTSD.” 

I think what happened, because having a forklift driver almost hit you, doesn’t seem like that could possibly cause PTSD. But if you look at my history, I think that created a link in my brain to an accident I was in when I was four where I did almost die, which is when my mom and I were standing on the side of a road, about to cross. We were going to go between two parked cars. My mom and I stepped between two parked cars, and there was a man driving down the road who was legally blind, and he mistook the line of parked cars where we were standing as moving traffic. He plowed into the end of all the parked cars, which of course made them accordion in, and my mom and I were in the middle of that. I was very seriously injured and probably almost died. My mom was, too. Several months in the hospital, all of that. 

Of course, at that point—that was 1975—there was no PTSD, because I think— Caitlin, you can correct me—it didn’t become a diagnosis until 1980. I have had symptoms—small, low-level symptoms of PTSD probably on and off most of my life, but so low-level, not diagnosable, and not really causing any sort of problems. But I think what happened in my head was that when that forklift almost hit me, it made my brain think, “Oh my gosh, we’re in that situation again,” because the forklift was huge. It was the same scale to me as an adult as that car that I was crushed between was when I was four. I think my brain just got confused. Because I was stuck with this construction equipment all day long and I didn’t get any break from it, it just made my brain think more and more and more, “Boy, we are really in danger.” Our lives are basically threatened all the time. 

That began my journey of figuring out what was going on with me and then also trying to understand why my OCD seemed to be getting worse and jumping in to help because I seemed to get all these compulsions that were designed to keep me safe from this construction equipment. It created a process where I was trying to figure out, "What is this? I’ve got both PTSD now, I’ve got OCD flaring up, how do I deal with this? What do I do?"

The reason why I wanted to write the article for Shoulders Back! and why I asked Caitlin to write it with me was because there just isn’t a lot of information out there about this combination where people have PTSD or some sort of trauma, and then the OCD jumps in to help. Now you’ve got a combination of disorders where you’ve got trauma or PTSD and OCD, and they’re merging together to try to protect you. That’s what they think they’re doing. They’re trying to help you stay safe, but really, what they’re doing is they’re making your life smaller and smaller and smaller. 

I wanted to write this article for Shoulders Back! to let people know about my experience so that other people going through this aren’t alone. I wanted to ask Caitlin to write it with me because I wanted an expert in this to talk about what it is, how we treat it, what hope do we have for people who are experiencing this going forward.

THE DIFFERENCE BETWEEN OCD AND PTSD (AND POST-TRAUMATIC OCD) 

Kimberley: Thank you for sharing that. I do encourage people; I’ll link in the show notes if they want to go and read the article as well. Caitlin, from a clinical perspective, what was going on for Shala? Can you break down the differences between OCD and PTSD and what’s happening to her?

Caitlin: Sure. First, I want to start by thanking Shala again for sharing that story. I know you and I talked about this one-on-one, but I think really sharing personal stories like that obviously involves a lot of courage and vulnerability. It’s just so helpful for people to hear examples and to really resonate with, “Wow, maybe I’m not so different or so alone. I thought I was the only one who had experiences like this.” I just want to publicly thank you again for writing that blog and being willing to share these really horrible experiences that you had. 

In terms of how we would look at this clinically, it’s not uncommon for people to, like Shala described, experience trauma and have these low-level symptoms for a while that don’t really emerge or don’t really reach the threshold of being diagnosable. This can happen, for example, with veterans who return home from war, and it might not be until decades later that they have some sort of significant life event or change. Maybe they’ve retired, or they’re experiencing more stress, or maybe, like Shala, they're experiencing another trauma, and it just brings everything up. This kind of delayed onset of PTSD is, for sure, not abnormal. 

In this case, it sounds like, just like Shala described, that her OCD really latched onto the trauma, that she had these experiences that reinforced each other. Right now, I’ve had two experiences where being around moving vehicles has been really dangerous for me.

Just like you said, I think you did such a beautiful job of saying that the OCD and PTSD colluded in a way to keep you “safe.” That’s the function of it. But of course, we know that those things go to the extreme and can make our lives very small and very distressing. 

What Shala described about using these compulsions to try to prevent future trauma is something that we see a lot in people who have comorbid OCD and PTSD. We’re doing some research now on the different ways that OCD and trauma can intersect. And that’s something that keeps coming up as people say, “I engaged in these compulsions as a way to try to prevent the trauma from happening to me again or happening to someone else. Or maybe my compulsions gave me a sense of control, predictability, or certainty about something related to the trauma.” This kind of presentation of OCD sort of functioning as protection against trauma or coping with past trauma as well is really common.

STATISTICS OF OCD AND PTSD

Kimberley: Would you share a little bit about the statistics between OCD and PTSD and the overlap?

Caitlin: Absolutely. I’m excited to share this too, because so much of this work is so recent, and I’m hopeful that it’s really going to transform the way that we see the relationships between OCD and PTSD. We know that around 60% of people who have comorbid OCD and PTSD tend to have an experience where PTSD comes first or at the same time, and the OCD comes later. This is sort of that post-traumatic OCD presentation that we’re talking about and that Shala talked about in her article. 

For folks who have this presentation where the PTSD comes first and then the OCD comes along afterwards, unfortunately, we see that those folks tend to have more severe obsessions, more severe compulsions. They’re more likely to struggle with suicidality or to have comorbid agoraphobia or panic disorders. Generally speaking, we see a more severe presentation when the OCD comes after the PTSD and trauma, which is likely indicative of what we’re discussing, which is that when the OCD develops as a way to cope with trauma, it takes on a mind of its own and can be really severe because it’s serving multiple functions in that way.

What we’ve been finding in our recent research—and if folks want to participate, the study will still be active for the next month; we’re going to end it at the end of the year, the OCD and Trauma Overlap Study—what we’re finding is that of the folks who’ve participated in the study, 85% of them feel like there’s some sort of overlap between their OCD and trauma. Of course, there are lots of different ways that OCD and trauma can overlap. 

I published a paper previously where we found that about 45% of people with severe OCD in a residential program felt that a traumatic or stressful event was the direct cause of their OCD on setting. But beyond that, we know that OCD and trauma can intersect in terms of the content of obsessions, the function of compulsions, as we’ve been talking about here, core fears. Some folks describe this, and Shala described this to this, like cyclical relationship where when one thing gets triggered, the other thing gets triggered too. 

This is really where a lot of the research is focusing on now, is how do these things intersect, how often do they intersect, and what does that really look like for people?

Kimberley: Thanks. I found in my practice, for people who have had a traumatic event, as exactly what happened to Shala, and I actually would love for both of you maybe to give some other examples of how this looks for people and how it may be experienced, is let’s say the person that was involved in the traumatic event or that place that the traumatic event was recent that recently was revisited just like Shala. Some of them go to doing safety behaviors around that person, place, or event, or they might just notice an uptick in their compulsions that may have completely nothing to do with that. Shala, can you explain a little bit about how you differentiated between what are PTSD symptoms versus OCD, or do you consider them very, very similar? Can you give some insight into that?

SYMPTOMS OF OCD & PTSD 

Shala: Sure. I’ll give some examples of the symptoms of OCD that developed after this PTSD developed, but it’s all post-traumatic OCDs. I consider it to be different from PTSD, but it is merged with PTSD because it’s only there because the PTSD is there. 

For instance, I developed a lot of checking behaviors around the doors to my house—staring, touching, not able to just look once before I go to bed, had to be positively sure the doors were locked, which, as somebody who does this for a living, who helps people stop doing these compulsions, created a decent amount of shame for me too, as I’m doing these compulsions and saying, “Why am I not taking my own advice here? Why am I getting stuck doing this?” 

But my OCD thought that the construction equipment was outside; we’re inside. We need to make sure it stays outside. The only way we do that is to make sure the door stays locked, which is ridiculous. It’s not as if a forklift is going to drive through my front door. As typical with OCD, the compulsions don’t make a lot of sense, but there’s a loose link there.

Another compulsion that I realized after a time was probably linked with PTSD is my people-pleasing, which I’ve always struggled with. In fact, Kimberley, you and I have done another podcast about people-pleasing, something I’ve worked really hard on over the years, but it really accelerated after this. I eventually figured out that that was a compulsion to keep people liking me so that they wouldn’t attack me. That can be an OCD compulsion all by itself, but it was functioning to help the PTSD. 

Those would be two examples of compulsions that could be OCD compulsions on their own, but they would not have been there had the PTSD not been there.

Kimberley: Caitlin, do you want to add anything about that from symptoms or how it might look and be experienced?

Caitlin: Sure, yeah. I think it’s spot on that there’s this element of separation that we can piece apart. This feels a little bit more like OCD; this feels a little bit more like PTSD, but ultimately they’re the same thing, or it’s the same behavior. 

In my work, I usually try to, where I can, piece things apart clinically so that we can figure out what we should do with this particular response that you’re having. When it comes to differentiating compulsions, OCD compulsions and PTSD safety behaviors, we can look towards both the presentation of the behavior as well as the function of it. 

In terms of presentation, I mean, we all know what compulsions can look like. They can be very rigid. There can be a set of rules that they have to be completed with. They’re often characterized by a lot of doubting, like in Shala’s case, the checking that, “Well, okay, I checked, but I’m not actually sure, so let me check one more time.” Whereas in PTSD, although it’s possible for that to happen, those safety behaviors, usually, it’s a little bit easier to disengage from. Once I feel like I’ve established a sense of safety, then I feel like I can disengage from that. There doesn’t tend to be kind of that like rigidity and a set of rules or magical thinking that comes along with an OCD compulsion. 

In terms of the function, and this is where it gets a little bit murky with post-traumatic OCD, broadly speaking, the function of PTSD safety behaviors is to try to prevent trauma from occurring again in the future. Whereas OCD compulsions, generally speaking, are a way to obtain certainty about something or prevent some sort of feared catastrophe related to someone’s obsession. But of course, when the OCD is functioning along with the PTSD to cope with trauma, to prevent future trauma, that gets a little bit murkier. 

In my work, like I said, I try to piece apart, are there elements of this that we can try to resist from more of an ERP OCD standpoint? If there’s a set of rules or a specific way that you’re checking the door, maybe we can work on reducing some of that while still having that PTSD perspective of being a little bit more lenient about weaning off safety behaviors over time.

TREATMENT FOR OCD AND PTSD

Kimberley: It’s a perfect segue into us talking about the treatment here. Caitlin, could you maybe share the treatment options for these conditions, specifically post-traumatic OCD, but maybe in general, all three?

Caitlin: Absolutely. The APA, a few years back, reviewed all the available literature on PTSD treatments, and they created this hierarchy of the treatments that have the most evidence base and went down from there. From their review of all the research that’s been done, there were four treatments that emerged as being the most effective for PTSD. That would be broadly cognitive behavioral therapy and cognitive therapy. But then there are two treatments that have been specifically created to target PTSD, and that would be prolonged exposure or PE, and cognitive processing therapy or CBT. These all fall under the umbrella of CBT treatments, but they’re just a little bit more specific in their approach.

And then, of course, we know of ACT and EMDR and these other treatments that folks use as well. Those fall in the second tier, where there’s a lot of evidence that those work for folks as well, but that top tier has the most evidence. 

These treatments can be used in combination with OCD treatments like ERP. There are different ways that folks can combine them. They can do full protocols of both. They could borrow aspects of some treatments, or they could choose to focus really on if there’s a very clear primary diagnosis to treat that one first before moving on to the secondary diagnosis.

TREATMENT EXAMPLES FOR POST-TRAUMATIC OCD

Kimberley: Amazing. Shala, if you’re comfortable, can you give some examples of what treatment looked like for you and what that was like for you both having OCD and PTOCD? 

Shala: Yes, and I think to set the ground for why the combined treatment working on the PTSD and the OCD together can be so important, a couple of features of how all this was presenting for me was the shift in the focus of the uncertainty. With OCD, it’s all about an intolerance of uncertainty and not knowing whether these what-ifs that OCD is getting stuck on are true or going to happen. But what I noticed when I developed PTSD and then the OCD came in to help was that the focus of the uncertainty shifted to it’s not what if it’s going to happen. The only what-if is when it was going to happen because something bad happening became a given. 

The uncertainty shifted to only when and where that bad thing was going to happen, which meant that I had lower insight. I’ve always had pretty good insight into my OCD, even before I got treatment. Many people with OCD too, we know what we’re doing doesn’t make any sense; we just can’t stop doing it.

With this combined presentation, there was a part of me that was saying, “Yeah, I really do need to be staring at the door. This is really important to make sure I keep that construction equipment out.” That lowered insight is a feature of this combined presentation that I think makes the type of treatment that we do more important, because we want to address both of the drivers, both the PTSD and the OCD.

The treatment that I did was in a staged process. First, I had to find a treatment provider, and Caitlin has a wonderful list of evidence-based treatment providers who can provide treatment for both on her website, which is great. I found somebody actually who ended up being on Caitlin’s list and worked with that person, and she wanted to start out doing prolonged exposure, which I pushed back on a little bit. Sometimes when you’re a therapist and you’re being the client, it’s hard not to get in the other person’s chair. But I pushed back on that because I said, “Well, I don’t think I need to do prolonged exposure on the original accident,” because that’s what she was suggesting we do, the accident when I was four. I said, “Because I wrote a book, Is Fred in the Refrigerator? and the very first chapter is the accident,” and I talked all about the accident. She explained, “That’s a little bit different than the way we would do it in prolonged exposure.”

What’s telling, I think, is that when I worked on the audiobook version of Fred—I was doing the narration, I was in a studio, and I had an engineer and a director; they were on one side of the glass, I’m on the other side of the glass—I had a really hard time getting through that first chapter of the book because I kept breaking down. They’d have to stop everything, and I had to get myself together, and we had to start again, and that happened over and over and over again. 

Even though I had relived, so to speak, this story on paper, I guess that was the problem. I was still reliving it. That’s probably the right word. Prolonged exposure is what I needed to do because I needed to be able to be in the presence of that story and have it be a story in the past and not something that I was experiencing right then. 

I started with prolonged exposure. After I did that, I moved on to cognitive processing therapy because I had a lot of distorted beliefs around life and the trauma that we call “stuck points” in cognitive processing therapy that I needed to work through. There were a good 20 or so stuck-point beliefs. “If I don’t treat people perfectly nicely, they’re going to attack me somehow.” Things that could be related directly to the compulsions, but also just things like, “The world is dangerous. If I’m not vigilant all the time, something bad is going to happen to me.” I had to work on reframing all of those because I was living my life based on those beliefs, which was keeping the trauma going. 

I recreated a new set of beliefs and then brought exposure in to work on doing exposures that helped me act as if those new beliefs were the right way to live. If my stuck point is I need to be hypervigilant because of the way something bad is going to happen to me, and I’m walking around like this, which was not an exaggeration of really how I was living my life when this was all happening—if I’m living like that, if I’m acting in a hypervigilant way, I am reinforcing these beliefs. I need to go do exposures where I can walk by a dump truck without all the hypervigilance to let all that tension go, walk by it, realize what I’ve learned, and walk by it again. 

It was a combination of all these and making sure that I was doing these exposures, both to stop the compulsions I was doing, like the door checking, but also to start living in a different way so that I wasn’t in my approach to life, reinforcing the fact that my PTSD thought the world was dangerous. 

I also incorporated some DBT (dialectical behavior therapy) because what I found with this combination was I was experiencing a lot more intense emotions than I’d really ever experienced in having OCD by itself. With OCD, it was mostly just out-of-this-world anxiety, but with the combination of PTSD and OCD, there were a lot more emotional swings of all sorts of different kinds that I needed to learn and had to deal with.

Part of that too was just learning how to be in the presence of these PTSD symptoms, which are very physiological. Not like OCD symptoms aren’t, but they tend to be somewhat more extreme, almost panicky-like feelings. When you’re in the flashbacks or flash forwards, you can feel dissociated, and you’re numbing out and all of that.

I'm learning to be in the presence of those symptoms without reacting negatively to them, because if I’m having some sort of feelings of hypervigilance that are coming because I’m near a piece of construction equipment and I haven’t practiced my ERP (Expsoure & Response Prevention) for a while, if I react negatively and say, “Oh my gosh, I shouldn’t be having these symptoms. I’ve done my therapy. I shouldn’t be having these feelings right now,” it’s just going to make it worse.

Really, a lot of this work on the emotional side was learning how to just be with the feelings. If I have symptoms, because they happen every now and then—if I have symptoms, then I’m accepting them. I’m not making them worse by a negative reaction to the reaction my PTSD is having. 

That was a lot of the tail end of the work, was learning how to be okay with the fact that sometimes you’re going to have some PTSD symptoms, and that’s okay. But overreacting to them is going to make it worse.

 Kimberley: Thank you so much for sharing that. I just want to maybe clarify for those who are listening. You talked about CPT, you talked about DBT, and you also talked about prolonged exposure. In the prolonged exposure, you were exposing yourself to the dump truck? Is that correct?

Shala: In the prolonged exposure, I was doing two different things. One is the story of the accident that I was in. Going back to that accident that I thought I had fully habituated to through writing my book and doing all that, I had to learn how to be in the presence of that story without reliving it while seeing it as something that happened to me, but it’s not happening to me right now. That was the imaginal part of the prolonged exposure. 

This is where the overlap between the disorders and the treatment can get confusing of what is part of what. You can do the in vivo exposure part of prolonged exposure. Those can also look a lot like just ERP for OCD, where we’re going and we’re standing beside a dump truck and dropping the hypervigilant safety behaviors because we need to be able to do that to prove to our brain we can tolerate being in this environment. It isn’t a dangerous environment to stand by a jump truck. It’s not what happened when I was four. Those are the two parts that we’re looking at there—the imaginal exposure, which is the story, and then we’ve got the in vivo exposures, which are going back and being in the presence of triggers, and also from an OCD perspective without compulsive safety behaviors.

Kimberley: Amazing. What I would clarify, but please any of you jump in just for the listeners, if this is all new to you, what we’re not saying is, let’s say if there was someone who was abusive to you as a child, that you would then expose yourself to them for the sake of getting better from your PTSD. I think the decisions you made on what to expose yourself were done with a therapist, Shala? They helped you make those decisions based on what was helpful and effective for you? Do either of you want to speak to what we do and what we don’t expose ourselves to in prolonged exposure?

Caitlin: Yeah. I’m glad that you’re clarifying that too, because this is a big part of PE that is actually a little bit different from ERP. When somebody has experienced trauma, when they have PTSD, their internal alarm system just goes haywire. Just like in Shala’s example, anything that serves as a reminder or a trigger of the trauma, the brain just automatically interprets as this thing is dangerous; I have to get away from it. 

In PE, a lot of what we’re doing is helping people to recalibrate that internal alarm system so that they can better learn or relearn safe versus actual threat. When you’re developing a hierarchy with someone in PE, you might have very explicit conversations about how safe is this exposure really, because we never want to put someone in a situation where they would be unsafe, such as, like you described, interacting with an abuser. 

In ERP, we’d probably be less likely to go through the exposures and say, “This one’s actually safe; I want you to do it,” because so much of the treatment is about tolerating uncertainty about feared outcomes. But in PE, we might have these explicit conversations. “Do other people you know do this activity or go to this place in town?” There are probably construction sites that wouldn’t be safe for Shala to go to. They’d be objectively dangerous, and we’d never have her go and do things that would put her in harm’s way.

Kimberley: Thank you. I just wanted to clarify on that, particularly for folks who are hearing this for the first time. I’m so grateful that we’re having this conversation again. I think it’s going to be so eye-opening for people. Caitlin, can you share any final words for the listeners? What resources would you encourage them to listen to? Is there anything that you feel we missed in our conversation today for the listeners?

Caitlin: I think, generally, I like to always leave on a note of hope. Again, I’m so grateful that Shala is here and gets to describe her experience with such vulnerability because it gives hope that you can hear about someone who was at their worst, and maybe things felt hopeless in that moment. But she was able to access the help that she needed and use the tools that she had from her own training too, which helped, and really move through this. 

There isn’t sort of a final point where it’s like, “Okay, cool, I’m done. The trauma is never going to bother me again.” But it doesn’t have to have that grip on your life any longer, and you don’t need to rely on OCD to keep you safe from trauma. 

There are treatments out there that work. Like it was mentioned, I have a directory of OCD and PTSD treatment providers available on my website, which is www.cmpinciotti.com that folks can access if they’re looking for a therapist. If you’re a therapist listening and you believe that you belong in this directory, there’s a way to reach out to me through the website. 

I’d also say too that if folks are willing and interested, participating in the research that’s happening right now really helps us to understand OCD and PTSD better so that we can better support people. If you’re interested in participating in the OCD and trauma study that I mentioned, you can email me at OCDTraumaStudy@bcm.edu.

I also have another study that’s more recent that will help to answer the question of how many people with OCD have experienced trauma and what are those more commonly endorsed ways that people feel that OCD and trauma intersect for them. That one’s ultra-brief. It’s a 10-minute really quick survey, NationalOCDSurvey@bcm.edu and I’m happy to share that anonymous link with you as well/

Kimberley: Thank you. Thank you so much. Shala, can you share any final words about your experience or what you want the listeners to hear?

Shala: One thing I’d like to share is a mistake that I made as part of my recovery that I would love for other people not to make. I’d like to talk a little bit about that, because I think it could be helpful. The mistake that I made in trying to be a good client, a good therapy client, is I was micro-monitoring my recovery. “How many PTSD symptoms am I having? Well, I’m still having symptoms.” I woke up in the middle of the night in a panic, or I had a bad dream, or I had a flash forward. “Why am I having this? I must not be doing things right.”

And then I took it a step further and said, “It would be great if I could track the physiological markers of my PTSD so I can make sure I’m keeping them under control.” I got a piece of tracking technology that enabled me to track heart rate and heart rate variability and sleep and all this stuff. At first, it was okay, but then the technology that I was using changed their algorithm, and all of a sudden my stats weren’t good anymore, and I started freaking out. “Oh my gosh, my sleep is bad. My atrophy is going down. This is bad. What am I doing?” I was trying with the best of intentions to quantify, make sure I’m doing things right, focus on recovery. But what I was doing was focusing on the remaining symptoms that were there, and I was making them worse. 

What I have learned is that eventually, things got so bad—in fact, with my sleep—that I got so frustrated with the tracking technology. I said, “I’m not wearing it anymore.” That’s one of the things that helped me realize what I was doing. When I stopped tracking my sleep, when I let go of all of this and said, “You know what? I’m going to have symptoms,” things got better. 

I would encourage people not to overthink their recovery, not to be in their heads and wake up in the morning and ask, “How much PTSD am I having? How much OCD am I having? If I could just get rid of these last little symptoms, life would be great,” because that’s just going to keep everything going. 

I’ll say this year, two has been a challenging one for me. I’ve been involved in three car accidents this year; none of them my fault. One of my neighbors, whom I don’t know, called the police on me, thinking I was breaking into my own house, which meant that a whole army of police officers ended up at my house at nine o’clock at night. That’s four pretty hard trauma triggers for me in 2023. 

Those kinds of things are going to happen to all of us every now and then. I had a lot of symptoms. I had a lot of PTSD symptoms and a lot of OCD symptoms in the wake of those events, and that’s okay. It’s not that I want them to be there, but that’s just my brain reacting. That’s my brain trying to come to terms with what happened and how safe we are and trying to get back to a level playing field. 

I think it’s really important for anybody else out there who’s suffering from one or the other, or both of these disorders to recognize we’re going to have symptoms sometimes. Just like with OCD, you’re going to have symptoms sometimes. It’s okay. It’s the pushing away. It’s the rejecting of the symptoms. It’s the shaming yourself for having the symptoms that causes the symptoms to get worse. 

Really, there is an element of self-compassion for OCD here. I like having bracelets to remind me. This is the self-compassion bracelet that I’ve had for years that I wear. By the way, this is not the tracking technology. I’m not using tracking technology anymore. But remembering self-compassion and telling yourself, “I’m having symptoms right now, and this is really hard. I’m anxious; I feel a little bit hypervigilant, but this is part of recovery from PTOCD. Most people with PTOCD experience this at some point. So I’m going to give myself a break, give myself permission to feel what I’m feeling, recognize how much progress I’ve made, and, when I feel ready, do some of my therapy homework to help me move past this, but in a nonhypervigilant, nonmicro monitoring way.”

As I have dropped down into acceptance of these symptoms, my symptoms have gotten a lot better. I think that’s a really important takeaway. Yes, we want to work hard in our therapy, yes, we want to do the homework, but we also want to work on accepting because, in the acceptance, we learn that having these symptoms sometimes is just a part of life, and it’s okay. 

I would echo what Caitlin said in that you can have a ton of hope if you have these disorders, in that we have good treatment. Sometimes it takes a little bit longer than working on either one or the other, but that makes sense because you’re working on two. But we have good treatment, and you can get back to living a joyful life. 

Always have hope and don’t give up, because sometimes it can be a long road, especially when you have a combined presentation. But you can tame both of these disorders and reclaim your life.

Kimberle: You guys are so good. I’m so grateful we got to do this. I feel like it’s such an important conversation, and both of you bring such wonderful expertise and lived experience. I’m so grateful. Thank you both for coming on and talking about this with me today. I’m so grateful.

Shala: Thank you for having us.

Caitlin: Yes, thank you. This was wonderful.

Kimberley: Thank you so much, guys.

RESOURCES: 

The two studies CAITLIN referenced are:

• OCD/Trauma Overlap Study: An anonymous online survey for any adult who has ever experienced trauma, and can be accessed at https://bcmpsych.sjc1.qualtrics.com/jfe/form/SV_0j4ULJv3DxUaKtE or by emailing OCDTraumaStudy@bcm.edu
• National OCD Survey: An anonymous 10-minute online survey for any U.S. adult who has ever had OCD, and can be accessed at https://bcmpsych.sjc1.qualtrics.com/jfe/form/SV_9LdbaR2yrj0oV7g or by emailing NationalOCDSurvey@bcm.edu

When things get hard, it’s really quite difficult to find a reason to keep going. Today, we have an incredible guest, Shaun Flores, talking about what keeps us going. This was a complete impromptu conversation. We had come on to record a podcast on a completely different topic. However, quickly after getting chatting, it became so apparent that this was the conversation we both desperately wanted to have. And so, we jumped in and talked about what it’s like in the moments when things are really difficult, when we’re feeling like giving up, we are hopeless, we’re not sure what the next step is. We wanted to talk about what does keep us going. 

This is, again, a conversation that was very raw. We both talked about our own struggles with finding meaning, moving forward, and struggling with what keeps us going. I hope you find it as beautiful a conversation as I did. My heart was full for days after recording this, and I’m so honored that Sean came on and was so vulnerable and talked so beautifully about the process of finding a point and finding a reason to keep going. I hope you enjoy it just as much as I did.

Shaun: Thank you so much for being able to have this conversation.

Kimberley: Can you tell us just a little background on you and what your personal, just general mental health journey has looked like?

Shaun: Yeah. My own journey of mental health has been a tumultuous one, to say the very least. For around five to six years ago, I would say I was living with really bad health anxiety to the point where I obsessed. I constantly had an STI or an STD. I’d go to the clinic backward and forward, get tested to make sure I didn’t have anything. But the results never proved to be in any way, shape, or form sufficient enough for me to be like, “Okay, cool. I don’t have anything.” I kept going back and forward. 

How I knew that became the worst possible thing. I paid 300 pounds for the same-day test results. Just to give people’s perspective, 300 pounds is a lot. That’s when I was like, “There’s something wrong. I just don’t know what it is.” But in some ways, I thought I was being a diligent citizen in society, doing what I needed to do to make sure I take care of myself and to practice what was safe sex.

But then that fear migrated onto this sudden overnight change where I woke up and I thought, “What if I was gay?”  overnight. I just quite literally woke up. I had a dream of a white guy in boxes, and I woke up with the most irrational thought that I had suddenly become gay. I felt my identity had come collapsing. I felt everything in my world had shaken overnight. 

I threw up in the toilet that morning, and at that time I was in the modeling industry. Looking back now, I was going through disordered eating, and I’m very careful with using the word “eating disorder.” That’s why I call it “disordered eating.” I was never formally diagnosed, but I used to starve myself. I took diuretics to maintain a certain cheekbone structure. Because in the industry that I was in, I was comparing myself to a lot of the young men that were there, believing that I needed to look a certain kind of way. 

When I look back at my photos now, I was very gaunt-looking. I was being positively affirmed by all the people around me. I hated how round my face was. If I woke up in the morning and my face was round, I would drink about four liters of water with cleavers tincture. I took dandelion extracts. Those are some of the things that I took to drain my lymphatic system. I went on this quest for a model face.

And then eventually, I left the industry because it just wasn’t healthy for me in any way, shape, or form. I was still living with this fear that I was gay. If I went to the sauna and steam room in the gym, I would just obsess 24/7 that if I could notice the guy’s got a good-looking body, or if he’s good-looking, this meant I’m gay. It was just constant, 24/7. From the minute I slept to the minute I woke up, it was always there. 

Then that fear moved on to sexual assault. I had a really big panic attack where I was terrified. I asked one of my friends, “Are you sure I haven’t done anything? Are you sure I haven’t done anything?” I kept asking her over and over. I screamed at her to leave because I was so scared. I must’ve been hearing voices, and I was terrified that I could potentially hurt her. I tried to go to sleep that night, and there were suicide images in my head, blood, and I was like, “There’s something up.” I just didn’t know what was going on. I had no scooby, nothing. 

That night, I went to the hospital, and the mental health team said that they probably would suggest I get therapy. I said, “It’s cool. I’ll go and find my own therapist.” I started therapy, and the therapy made me a hundred times worse. I was doing talk therapy. We were trying to get to the root of all my thoughts. We were trying to figure out my childhood. Don’t get me wrong, there’s relevance to that. By that time, it was not what I needed. 

And then last year, this is when everything was happening in regards to the breakdown that I had as well. I got to such a bad point with my mental health that I no longer wanted to be alive. I wanted time to swallow me up. I couldn’t understand the thoughts I was having. I was out in front of my friends, and I had really bad suicidal thoughts. I believed I was suicidal right off the bat. I got into an Uber, called all my friends, and just told them I’m depressed and I no longer want to be alive. I’m the kind of guy in the friendship group everyone looks up to, almost in some ways, as a leader, so people didn’t really know what to do. That’s me saying as a self-elected leader. That’s me being reflective about my friendship group.

But I woke up one day, and it was a Saturday, the 4th of June, and I just said, “I can’t do this anymore.” I said, “I can’t do this.” I was prepared to probably take my life, potentially. I reached out to hundreds of people via Instagram, LinkedIn, WhatsApp, email, wherever it was, begging for help because I looked on the internet and was trying to figure out what was it that was going on with me. I was like, “Why am I having certain thoughts, but I don’t want to act on them?” And OCD popped up, so I believed I had OCD. 

When I found this lady called Emma Garrick (The Anxiety Whisperer) on Saturday, the 4th of June, I just pleaded with her for a phone call. She picked up the phone, and I just burst out in tears. I said, “What’s wrong with me?” I said, “I don’t want to hurt anyone. Why am I having the thoughts I’m having?” And she said, “Shaun, you have OCD.” From there on, my life changed dramatically. We began therapy on Monday. I would cry for about two hours in a session. I couldn’t cope. I lost my job. There were so many different things that happened that year. 

In that same year, obviously, I had OCD. I tore my knee ligaments in my right knee. Then I ended up in the hospital with pneumonia. Then my auntie died. Then my cousin was unfortunately murdered. Then my half-brother died. Then my auntie—it’s one of my aunties that helped to raise me when my dad died on Christmas day when I was six—her cancer spread from the pancreas to the liver. 

Then fast-forward it to this year, about a couple of months ago, that same auntie, the cancer became terminal and spread from the liver to the spleen. I watched her die, and that was tough. Then I had my surgery on August the 14th. But I’m still paying my way through debt. It was an incredibly tough journey. I’m still doing the rehab for my knee, still doing the rehab for OCD. 

That’s my journey. I’m still thinking about it to this day. Me and my therapist talk about this, and he has lived experience of OCD. I still don’t even know what’s kept me alive at this point, but that’s the best way to describe my story. That’s a shortened, more condensed version for people listening.

Kimberley: Can I ask, what does keep you going?

Shaun: What keeps me going? If I’m being very honest, I don’t know sometimes. There are days when I’ve really struggled with darkness, sadness, and a sense of hopelessness sometimes. I ride it out. I try not to give in to those suicidal thoughts that pop up. And then I remember I’ve got a community that I’ve been able to create, a community that I’m able to help and inspire other people. I think I keep going on my worst days because the people around me need someone to keep inspiring them. What I mean by that is some of the messages I’ve got on the internet, some of them have made me cry. Some of them have made me absolutely break down from some people who have opened up to me and shared their entire story. They look up to me, and I’m just like, “Wow, I can’t give up now. This isn’t the end.” I’ve had really dark moments, and I think a lot of people look at my story and perhaps look at my social media, and they think I’m healed and I’ve fully recovered. But my therapist has seen me at my worst, and they see me at my absolute best. 

I think I stay here. What keeps me pushing is to help other people, to give other people a chance, and to let them know that you can live a life with OCD, anxiety. Depression I’m not sure if I fully align with. Maybe to some degree, but to let them know they can live a life in spite of that. I don’t know. Again, I keep saying this to my therapist. There’s something in me that just refuses to quit. I don’t know what it is. I can’t put it into words sometimes. I don’t know. Maybe it’s to leave the world in a better place than I found it. I really do not know. 

Kimberley: I think I’m so intrigued. I’m so curious here. I think that this is such a conversation for everyone to have. I will tell you that it’s interesting, Shaun, because I’m so grateful for you, number one, that we’re having this conversation, and it’s so raw. Somebody a few months ago asked me, what’s the actual point of all this? It was her asking me to do a podcast on the point, what’s the point of all this? I wrote it down and started scripting out some ideas, and I just couldn’t do the episode because I don’t know the answer either. I don’t know what the point is. But I love this idea that we’re talking about of what keeps us going when things are so hard. Because I said you’re obviously resilient, and you’re like, “No, that’s not it.” But you are. I mean, so clearly you are. It’s one of your qualities. But I love this idea of what keeps you going. 

In the day, in the moment to moment, what goes through your mind that keeps you moving towards? You’re obviously getting treatment; you’re obviously trying to reduce compulsions, stop rumination, or whatever that might be. What does that sound like in your brain that keeps you going?

Shaun: Before I answer that, I think I’ve realized what my answer would be for what keeps me going. I think it’s hope because it makes me feel a bit emotional. When I was at my absolute worst, I had lost hope, lost everything. I lost my job. I end up in mountains of debt that I’m still paying off. It’s to give hope to other people that your life can get better. I would say it has to be hope. 

In those day-to-day moments, one of my really close friends, Dave, has again seen me at my worst and my best. Those day-to-day moments are incredibly tough. I’ve had to learn to do things even when I don’t want to do them. I’ve had to learn to eat when I don’t always want to eat, to stick to the discipline, to stick to the process, to get out of bed, and to keep pushing that something has to change. These hard times cannot last forever. But those day-to-day moments can be incredibly tough when my themes change, when I mourn my old life with OCD in the sense that I never thought consciously about a lot of my decisions. Whereas now, I think a lot more about what I do, the impact I have on the world, and the repercussions of certain decisions that I make. 

I would say a lot of my day-to-day, those moment-to-moments, is a bit more trepidation. I think that would be the best way to describe my day-to-day moments. I was just going to say, I was even saying to my friend that I can’t wait to do something as simple as saving money again. I’m trying to clear off everything to restart and just the simple things of being able to actually just save again, to be able to get into a stable job to prove to myself that I can get my life back.  

Kimberley: To me, the reason that I’m so, again, grateful that we’re here talking about this is it really pulls on all of the themes that we get trained in in psychology in terms of taking one step at a time. They talk about this idea of grit, like you keep getting up even though you get knocked down. I don’t think we talk about that enough. Also, the fact that most people who have OCD or a mental health issue are also handling financial stresses and, like you said, medical conditions, grief, and all of these things. You’re living proof of these concepts and you’re here telling us about them. How does that land for you? Or do you want to maybe speak to that a little more?

Shaun: I was reading a book on grits. I was listening to it, and they were talking about how some people are just grittier than other people. Some people may not be as intelligent or may not be as “naturally gifted,” but some people are grittier than other people. A lot of people who live with chronic conditions such as OCD or whatever else, you have to be gritty. That’s probably a quality you really have to have every single day without realizing it. To speak to that, even on the days when I have really struggled, as I said, I don’t know what always gets me up. There’s something inside. 

I look around at the other people around me who've shown grit as well—other people around me who have worked through it. The therapist I have, he’s a really good therapist. I listen to his story, Johnny Say, and he talks about something called gentle relentlessness, the idea that you just keep being relentless very gently. You know that one step-a-day kind of mentality that, “Okay, cool, I’m having these thoughts today. I’m going to show myself some compassion, but I’m going to keep moving.” For me, when I speak to him, I tell him he inspires me massively because he’s perfected and honed his skills so much of OCD that he’s able to do the job that he does. He’s able to help other people, and that inspires me.

When I look at the other people around me, I’m inspired by other people’s grit and perseverance as well. That really speaks to what I need to be able to have. I think it’s modeled a lot for me. Even in my own personal life with my mom, there’s a lot of things that we’ve gone through—my father, who died on Christmas Day when I was six—and she had to be gritty in her own way to raise a single boy in the UK when she was in a country she didn’t want to be in because of my granddad. 

I think grit has been modeled for me. I think it really has been role-modeled for me in so many different ways. When people say, “Just get up and keep going,” I think it’s such a false notion that people really don’t understand the complexity of human emotions and don’t understand that, as humans, we go up and we go down. A very long time ago, I used to be that kind of human where I was like, “Just get out, man. Suck it up. Just keep going, bro. You can do this. You’ve got this.” I think going through my own stuff has made me realize sometimes we don’t always feel like we’ve got it. We have to follow the plan, not the mood sometimes. But I honestly have to say, I think grit has been role-modeled a lot for me.

Kimberley: Yeah. It’s funny, as you were talking, I was thinking too. I think so often—you talked about this idea of hope—we need to know that somebody else has achieved what we want to achieve. If we have that modeled to us, even if it’s not the exact thing, that’s another thing that keeps us going. You’ve got a mentor, you’ve got a therapist. Or for those of you who don’t have a mentor or therapist, it might be listening to somebody on a podcast and being like, “Well, if they can do it, there has to be hope for me.” I think sometimes if we haven’t got those people in our lives, we maybe want to look for people to inspire and model grit and keep going for us, would you say? 

Shaun: Absolutely. Funnily enough, when I was going through depression as a compulsion, my friend sent me your podcast about depression as a compulsion. The idea is that you feel this depressive feeling, you start investigating it, trying to figure out if you’re depressed, and then it becomes a compulsion. And then, after that compulsion happens, you stay in this spiral with depression or whatever it might be. That’s something else I realized—that having your podcast and listening to talking about being kind, self-criticism, and self-compassion was role modeled a lot for me because, again, growing up, I didn’t have self-compassion. It’s not something we practice in the household or the culture I’m from. But having it role-modeled for me was so big. It is huge. I cannot even put into words how important it is to have people around you who still live with something you live with, and they keep going, because it almost reminds you that it’s not time to give up. 

Sadly, I’ve lost friends to suicide. I found out that someone had died in 2021 at what I thought he had died. We met at a modeling agency when I was modeling. We met at the Black Lives Matter march as well, regardless of whatever your political opinions are for anyone listening. I found that he had died. I remember I messaged some of the friends we had in common. I was like, “What happened?” And nobody knew. A couple of weeks ago, I just typed in his name. Out of nowhere, I just typed, and I was like, “What happened to him?” I found that he had taken his life when he was in university halls. I was just like, "You really don’t know what people are going through." Some people have messaged me and said what I talk about has kept them going. I’m just sitting there like, “Wow, other people have kept me going.” I think that becomes a role-modeled community almost in some ways. 

Kimberley: For sure. It’s funny you mention that. I too have lost some very close people to me from suicide. I think the role model thing goes both directions in that it can also be hard sometimes when people you really love and respect have lost their lives to suicide. I think that we do return to hope, though. I think for every part of me that’s pained by the grief that I feel, hope fuels me back into, how can I help? Maybe I could save one person’s life. Actually, sometimes helping just gets me through a hard day as well. I can totally resonate. I think you’re right. There is a web of inspiration. You inspire somebody else. They inspire you. They’ve been inspired by somebody. It’s like a ladder.

Shaun: Absolutely. I once heard someone say, the best way to lose yourself is in the service of others. One of the things that really got me through depression when I was at the thickest of my OCD was when I said, "How am I going to go and serve other people? How am I going to go and help other people?" When I asked my first therapist, I said, “Why are you so kind to me? Why do you believe in me?” she told me something that really sat with me. She said, “I believe you’re going to go on to help so many other people.” When I released my first story on August the 14th, and I had so many people reach out to me that I knew, people I didn’t know speaking about OCD, I was like, “This is where it begins. That in the suffering, there is hope. In the suffering, I can live. In the suffering, I can find purpose. In the suffering, I can use that to propel me out of pain.” 

But you are right. This conversation has really made me think a lot about how I keep going, like how I’ve been able to just keep pushing because my friends are, again, around me. My therapist knows that there are days when I don’t want to do my therapy. I’ve gone to my physiotherapist, and I’ve said, “You have no idea what I’ve gone through.” I said, “I’m not feeling to do anything. I just want to give up right now.” I said, “I’m tired of this.” I said, “Why is life so hard on me?” Death is one thing. Physical injury is another thing. OCD is another thing. Chasing money is another thing. Everything is a constant uphill battle. It really has made me think a lot about life. It’s made me think a lot about my friends who have opened up to me about their struggles. 

Very similar to you, Kimberley, I want to go on to, at some point, become a therapist and change people’s lives. When people reach out to me, I would love to be able to say to someone, if someone said, “I can’t afford a therapist,” I’d be like, “Let me try and help you and see what I can do on my part.” That kind of kindness or that kind of empathy, that kind of lived experience, that understanding—it's something I really want to give back to other people. It’s hope. Hope is everything.  

Kimberley: Yeah. It’s ever-changing, too. Some days you need one thing, and the next day you need others. For me, sometimes it’s hope. Sometimes it’s, like you said, day-to-day grit. Sometimes it’s stubbornness, like I’m just straight-up stubborn. You know what I mean? 

Shaun: It’s funny you say that. 

Kimberley: We can draw on any quality to get us through these hard things that keep us going. My husband always says too, and now that we’re exploring it and I’m thinking about it, because you and I did not prepare for this, we are really just riffing here—my husband always says when I’ve had a really hard time, which in the moment sounds so silly and so insignificant, but it has also helped, amongst these other things, “Put on the calendar something you’re really looking forward to and remind yourself of that thing you’re going towards every day. It doesn’t even have to be huge, but something that brings you joy, even if it’s got nothing to do with the hard thing you’re going through.” I’ve also found that to be somewhat beneficial, even if it’s a dinner with friends or a concert or an afternoon off to yourself, off work. That has also been really beneficial to me.

Shaun: Yeah. Taking aim at things in the future can give you things to really look forward to. In the thickest of my OCD, I had nothing to look forward to sometimes. I remember I turned down modeling jobs because of my anxiety. The only thing I could look forward to was my therapist, and that was my silver lining in many, many ways. I remember I would say to her, “I’ve been waiting for this session the whole week. I’ve needed this.”

Another thing you touched on that I think made me laugh is stubbornness. There is a refusal. There’s a refusal to lay down. For example, I make jokes about this. I go to the gym sometimes, and I’ll say to the guys, “I’ve had a knee injury. Why are my legs bigger than yours?” That small little bit of fun and a little bit of gest, a bit of banter, as we would say. I’ll go to them, and I’ll be like, “I need to show these guys that my legs are still bigger than theirs and I’ve got an injury. I’m not supposed to be training legs.” Just small things like that have really given me things to look forward to. Something as silly as male ego has been-- I say this to everyone—male, female, anyone. I’m like, “How dare I get sexy? How dare I be mentally unwell but still sexy?” There is an audacity to it. There’s a temerity, a gumption, a goal. There is a stubbornness to go out there into the world and to really show people that, again, you can live with it.

When I delivered my TEDx talk in 2022 at Sheffield Hallam University about masculinity, I remember a lady came up to me afterwards. This is when I was doing something called German Volume Training. It was heavy, very intense training. I put on a lot of muscle in that short space of time. She came up to me and said, “You do not look like a guy who suffered with his mental health at all.” She said, “You look like the complete opposite.” Because people have this idea that people who live with illness are—there’s this archetype in people’s heads—timid, maybe a bit unkempt. They don’t look after themselves. 

It really said a lot to me that there really is no one image of how people look. Even where I live, unfortunately, there’s a lady who screams at people. She shaves her hair. She just sits down there. A very long time ago, I would look at people and judge them. One thing I’ve really learned from living with illness has been we never know what’s happened in people’s lives that has pushed them to the place of where they are. 

There was also another older gentleman, and he smelt very strongly of urine and alcohol. I was on the train with him, and the train was packed. You could just see he was minding his own business. He had a bag on him, and clearly he had alcohol in it. There were two girls that were looking at him with such disgust, contempt, and disdain. It really got to me. It really irked me about the way people looked at him because, in my head, I’m like, “You don’t know what that guy’s gone through. You just have no idea what led him to become clearly an alcoholic. He probably is potentially homeless as well.” I got off that train, and I just felt my views on things had really changed, really changed in life. Dealing with people just-- I don’t know. I’ve gone off on a tangent, but it’s just really sat with me in the sense of looking forward to things—how I look forward to how my views are evolving and how my views on life are changing.

Kimberley: Yeah. I’m sort of taking from what you’re saying. You bring up another way in which you keep going, which is humor, and I’ve heard a lot of people say that. A lot of people say humor gets me through the hardest times. You say you make jokes, and that, I think, is another way we can keep going.

Shaun: Yeah, you are correct. When I go to the gym and I banter all the guys, I’m laughing at them, and typical male ego—that has really helped me on many, many occasions. Even people around me who we have sit down and we have a laugh. There’s times when I quite honestly say to people, my life is a Hollywood movie at this point. I need a book. I need a series of unfortunate events, a trilogy, whatever it might be at this point, because it’s almost as if it can’t be real. Humor has been a propelling agent in me helping to get better, but it’s also been an agent in everything that I do. 

My first therapist, Emma, said to me, “OCD leaves you with a really messed-up sense of humor because you’ve got to learn how to laugh at the thoughts. You’ve got to learn how to not take everything seriously.” I have had some of the most ludicrous thoughts I could imagine. I told my friend, and she started cracking up at me. She started laughing. She’s like, “Do you know how ludicrous this is?” And I said to her, “I know.” 

Or, for example, again, at my absolute worst, I couldn’t even watch MMA, UFC, or boxing because guys were half naked. I couldn’t be around guys who were half naked because of how my sexual orientation OCD used to really play with my head. There were so many ridiculous situations. I would walk outside and I’d have a thought, “Kill the dog,” and I’d be like, “Oh, well, this is bloody fantastic now, isn’t it?” I’ve had images of all sorts in my head. I told my friend, and he started laughing. I was like, “Bro, why are you laughing?” But it made me laugh because it took the seriousness out of what was going on. It really did. 

Humor—it's been huge. It’s funny how that can even maneuver into the concept of cancel culture because there was a comedian who has OCD, and he said, “When was being clean really a bad thing?” I know, obviously, we know the way people see OCD, but he drew light on the fact that he has quite severe OCD himself. He’s using humor clearly to help him get better. But humor has been another thing. Humor, stubbornness, grit, resilience—all these things in my life experience have really helped me to still be here. I still say that as a guy who hasn’t been paid this month from work. I’m on sick leave. I’m still trying to find ways to make money. I’m still trying to train to become a therapist. I’m applying for courses. I’ve applied for a hundred jobs within the National Health Service over here in the UK. That’s just to put it into perspective. Again, as my therapist would say, a gentle relentlessness to keep pushing humor to find some of the joy and some of the sadness that happens.

Kimberley: I cannot tell you how grateful I am that you have allowed us to go here today. I think this is the conversation that we needed to have today, both of us. My heart is so full. Can people hear more about where they can get in touch with you, hear more about you? You’ve talked so beautifully about the real hard times and what’s gotten you through. Where might people get ahold of you?

Shaun: I say to people, you can reach out to me on Instagram, TikTok, wherever you want. I say to people, just reach out, and please feel free to message me. I don’t know whether this has happened to you, Kimberley. Some people reach out to me when they’re really struggling with their OCD, and then some people I never hear from again. Some people don’t turn up to phone calls. I think for a lot of people, there’s a big fear that if they reach out to me, I’m going to hear something that I’ve never heard. I can honestly say to people, I’ve had every thought you could imagine. I’ve had the most ludicrous thoughts. I’ve had pretty much every single theme at this point. I really want, and I really encourage people to please reach out and have a conversation with me. You can find me anywhere on social media.

Kimberley: I have so enjoyed this conversation. Are there any final statements you want to make to finish this off?

Shaun: If you give up now, you’ll never see what life would look like on the other side. That’s the one thing I think I have to really say.

Kimberley: It’s amazing. Thank you.

If you want to know how to be uncomfortable without making it worse, you’re in the right place. Today, we’re talking all about being uncomfortable and learning how to be uncomfortable in the most skillful, compassionate, respectful, and effective way. This applies to any type of discomfort, whether it be your thoughts, your feelings, any physical sensations, or the pain that you’re feeling. Anything that you’re experiencing as discomfort, we’re here to talk about it today. Let’s do it. 

Welcome back, everybody. For those of you who are new, welcome. My name is Kimberley Quinlan. I’m a marriage and family therapist in the state of California. I’m an anxiety specialist, and I love to talk about being uncomfortable. It’s true, I don’t like being uncomfortable, but I love to talk about being uncomfortable, and I love talking about skillful ways to manage that. 

WHAT IS DISCOMFORT, REALLY? 

Now, before we get started, let’s first talk about what we mean by being uncomfortable. There are different forms of discomfort. One may be feelings or emotions that you’re having—shame, guilt, anxiety, sadness, anger. Whatever it is that you experience as a feeling can be interpreted and experienced as uncomfortable. 

Another one is sensations. Physical sensations of anxiety, physical sensations of shame, and physical sensations of physical pain. I myself have a chronic illness. Physical sensations can be a great deal of discomfort for us as human beings. We’re also talking about that as well. 

We’re also talking about intrusive thoughts, because thoughts can be uncomfortable too. We can have some pretty horrific, scary, mean, and demanding thoughts, and these thoughts can create a lot of discomfort within us. 

What we want to do here is we want to first acknowledge that discomfort is a normal, natural part of life. It truly is. I know on social media, and I know in life, on TV, and in movies, it’s painted that there are a certain amount of things you can do, and if you were to attain those, well, then you would have a lot less discomfort. But as someone who is a therapist who has treated the widest range of people, I’ve learned that even when they reach fame, a lot of money, or a degree of success, we can see that they have some improved wellness. They do have some decrease in discomfort, but over time, they’re still going to have uncomfortable thoughts. Sometimes having those things creates more uncomfortable thoughts. They’re still going to have physical pain, and they’re still going to have emotions that cause them pain, particularly when they’re not skillful. 

What I’ve really learned as a human being as well is we can have a list of all the things that we think we need in these circumstances to be happy. But if our thoughts and our feelings and our reactions to them aren’t skillful, compassionate, wise, and respectful, we often create more suffering, and we’re right back where we started. 

Now, I don’t want it to be all doom and gloom, because the truth is, I’m bringing you some solutions here today—things that you can apply right away and put into practice, hopefully, as soon as you’ve listened to this podcast. Let’s get to it. 

WHAT MAKES DISCOMFORT WORSE? 

First, I’m wondering whether we can first discuss what it means to make it worse because a lot of you go, “What? Make it worse? Are you telling me I’m to blame?” And that’s not what I’m doing here. But I do think that we can do some kind of inquiry, nonjudgmental inquiry into how we respond to our suffering. 

LIFE IS 50/50

Think of it this way: I am a huge proponent of some Buddhist philosophy here, which is that suffering is a part of life. Discomfort is a part of life. I believe that life is 50/50. There is 50% wonderful, but you’re still going to have 50% hard. Sometimes that percentage will be different, but I think it creates a lot of acceptance when we can come to the fact that there’s going to be good seasons, but there’s also going to be some really hard seasons in our lives. It doesn’t have to be that it’s 50/50 all the time. Sometimes you might be in a really wonderful season. Maybe you’re in a really tough season right now. I’m guessing that’s the case because you’re listening to this episode. I recently went through a really tough season, which inspired me to make this episode for you. But in life, there is suffering. But what we know about that is how we respond to that suffering can actually determine whether we create more and more suffering. 

WE RESIST IT

One way that we make it worse is, when we are experiencing discomfort, we resist it. We try to get rid of it. We clench up around it. We try to push it away. What often happens there is, what you resist persists. That’s a common saying we use in psychotherapy. Another thing to consider here is, the more you try to push it down, the more it’s going to bubble up anyway, but in ways that make you feel completely out of control, completely lost in this experience, and maybe overwhelmed with this experience. Another thing is, the more you resist it, the more you’re feeding your brain a story that it’s important and scary, which often means that it’s going to send out more anxiety hormones when you have that situation come up again. That’s one way we make it worse. 

WE JUDGE IT 

Another way we make it worse is, we judge it. When we have discomfort, we judge it by going, “This is wrong. This is bad. You’re a bad person for having this discomfort. What’s wrong with you for having this discomfort? It shouldn’t be here.” 

WE THROW “TANTRUMS” 

I’ve done a whole episode about this, and this is something that is my toxic trait, which is I go into this emotional tantrum in my head where I’m like, “This is bad. This is wrong. It shouldn’t be happening. It shouldn’t be this way. It should be this other way. It’s not fair. I can’t believe it’s this way.” I totally can catch myself going down a rabbit hole of judging the situation, the circumstance, and myself and my discomfort, which only creates more discomfort for myself. 

WE RUMINATE

Another way we make things worse is rumination, which is similar to what I was just talking about. But rumination is, we try and solve things, we loop on them. Again, it could be a looping on, “Why is this happening? It shouldn’t be happening,” like I just explained. Or maybe it’s trying to figure it out. Often, we ruminate on things that actually don’t have a solution in the long run anyway. 

Maybe you have chronic pain. Let’s say you do, and you’re ruminating, “What could it be? Why is it there?” I mean, the truth is, we don’t usually have a medical degree. Our rumination, it might feel productive, but we don’t actually have the details to know the answer. 

Let’s say something went wrong at work and you made a big mistake, and we ruminate about what we did, how bad it was, and how humiliating it was. But in that situation, we’re trying to solve something that’s already happened that we have no control over anymore. 

For people who have anxiety, maybe they’re trying to ruminate, trying to solve whether bad things will happen in the future, but we all know we can’t solve what’s going to happen in the future. That’s a dead end. That’s a dead-end road, and it again creates more suffering on our part.

WE PUNISH OURSELVES 

The next piece here is, we punish ourselves. We punish ourselves for having discomfort. We might withhold pleasure. We might treat ourselves poorly. We might not show up in ways that really honor our mental health and our self-care because we’ve made a mistake, we are going through a hard time, or we’re having this uncomfortable experience. These things, while in the moment they feel warranted and they feel productive and effective, they’re actually not. All they’re doing is adding to the suffering you’re already experiencing. 

For those of you who say, “Yeah, no, but I deserve to suffer more,” that’s actually not true either. We have to really catch that because punishing someone with this sort of very corporal punishment kind of method—or we need to beat you up—actually, we’ve got so much research to show it doesn’t make you better. It doesn’t prevent uncomfortable things from happening. It doesn’t make it so that you don’t make a mistake. You’re a human being. We’re all struggling. We’re all doing the best we can, and we’re not going to do it perfectly. 

HOW TO BE UNCOMFORTABLE, EFFECTIVELY & COMPASSIONATELY

What can you do differently? Let’s now talk about how we can be uncomfortable in an effective, productive,  compassionate, and respectful way. For me, one of the first things that helps me is to really double down on my mindfulness practice. Sometimes the best thing you can do with mindfulness is to become aware that you’re engaging in these behaviors, to catch them, and to label them when you are. It might be as simple as labeling it as “I’m in resistance.” You might just say ‘resistance’ or ‘rumination.’ You’re bringing to your mind and you’re bringing to your attention that you’re engaging in something that you’ve identified as not helpful. That in and of itself can be so helpful.

Now, for those of you who are new to me, I have two episodes that I’ve done on this type of situation in the past. Number one was Episode 188, where I talked about how to tolerate uncomfortable sensations specifically. The other one is Episode 113, which is where we talk about specifically how to manage intrusive thoughts. You can go on there after you’ve listened to this, but stay with me here because I’m going to give you a little step-by-step process. 

MINDFULESS

Number one, with mindfulness, we’re going to identify and become aware that we’re in resistance, that we’re ruminating, that we’re beating ourselves up, and we’re also going to practice non-judgment as best as we can. Think of this like a muscle in your brain. You’re going to practice strengthening that muscle. But once we are aware of it and once we’ve acknowledged that we’re judging, we’re then going to be aware of or bring our attention to where we are in resistance to allowing it to be there because that’s ultimately a part of our work. 

Discomfort rises and falls so much faster when you do nothing about it. What I want to offer you is, the solution, in some way, can be quite simple, which is to do nothing about the discomfort except love it. Be careful and gentle with yourself. Do nothing at all about trying to make it go away. Do nothing at all about punishing yourself. 

NON-JUDGMENT

The non-judgment piece is where we allow it to be there without making a meaning about it. Here’s an example. You’ve had an intrusive thought that was really, really scary, and you wish you didn’t have it. You actually are concerned about it. It alarmed you. What you can do is, in that moment, acknowledge that thoughts are thoughts. They’re not facts. They don’t mean anything. They’re just sentences that our brains come up with. What we often do is, when we have it, we think, “What does that mean about me? Why am I having this thought? Why am I having this sensation? Why am I having this anxiety? Why am I having this anger? Why am I having this shame? Why am I anxious in this social situation? Why is this hard?”

NOT OVER-IDENTIFYING

What we want to come back to is not making meaning of it, not over-identifying with it and just acknowledging that this is a normal part of human life. This is a normal part of being a human. We all have intrusive thoughts. We all have strong emotions, some more than others. But if you’re someone who has strong emotions more than you maybe think others are, there’s a couple of things I want you to remember. Number one, we actually don’t know how other people are doing, so you can’t actually say that they’re not having these emotions. Maybe they are. 

Often, people will say to me, “You always seem so calm.” I’m like, “Oh, you have no idea.” Like, yeah, I am calm in many situations, but it doesn’t mean I don’t have anxiety about certain things or big, big, big emotions about certain things. You just don’t see it. You don’t see it on the camera; you don’t see it in the podcast. You don’t see it in my daily life. It’s at home in my mind when I’m experiencing it as I’m regulating. But we want to work at not over-identifying with “What does it mean about me” and that “I’m bad for having these experiences.”

One thing you must take away, and I say it quite often, is there is no thought, feeling, sensation, urge, or image that makes you bad. The meditation vault, which we just launched, is an online vault, a collection of meditations for people with sticky thoughts, intrusive thoughts, anxiety, and so forth. They’re very, very specific in almost every single one. I work at getting them to not overidentify with the experience they’re having. 

Oh, you’re having an intrusive thought. Let’s not make meaning of what that means about you. 

Oh, you’re having shame. Your shame is telling you that you’re bad. Let’s not agree with it. Let’s acknowledge that it is a thought and a feeling, but it’s not a fact about you. 

You’ve made a mistake; you failed. Okay, we can acknowledge that, but that doesn’t make you a failure. We want to catch over-identifying with what our discomfort is experiencing and how we’re experiencing that discomfort. The over-identification, the labeling, and the making meaning often is what contribute to us feeling double the discomfort. 

MAKE SPACE FOR THE DISCOMFORT

The next thing you want to do is make space for the discomfort. My clients roll their eyes because they know I’m going to say it. I’m going to say, “Why can’t we make some space for this emotion,” or “Would you be willing to make some space for this emotion as it rises and falls?” If we make space for it to be here while we go about our day, while you interact with your child or your loved one, or your client, or your employer or your employee—if we can just make space for it to be there, nonjudgmentally, it tends to be less loud. 

BE WILLING TO BE UNCOMFORTABLE

The whole point of the work that I do here with my patients and with you is to nurture a sense of you having any emotion, any feeling, or any discomfort in a safe way, in a way where you make space for it. I often will say, we want to work towards you being able to have any thought, feeling, sensation, urge, or image so that you know that there’s nothing you can’t handle. If you’re really willing to feel it all, if you’re really willing and have practiced giving yourself permission to feel all the discomfort, there’s very little that can be painful for you. There’s very little that can stump you. There’s very little that can hold you back. 

Often, when people ask me, “How do you do what you do? You spend all day with clients who are suffering, and you’re in the suffering with them. And then you get online and do these videos, or you do social media. How do you do all that?” The only reason, there’s nothing special about me, truly. The only thing about me is I’m willing to feel a lot of discomfort. I really am. The more I practice having it, the more I feel empowered that I can handle anything. 

Confidence to do things isn’t something you just learn and have; you get it by feeling feelings. Having them willingly and making space for them—truly, this is the work. If there’s really anything I’ve learned, it’s that—we have to be better at making space and feeling our feelings and having the discomfort and saying, “Great, this is a wonderful opportunity for me to practice being uncomfortable.” If something gets thrown out of whack this week for you, I urge you to say, “Okay, good. This is another great opportunity for me to practice being uncomfortable. Where do I notice my resistance to being uncomfortable? Where do I notice the judgment? Where do I notice that I overidentify with it? Where do I notice that I’m punishing myself for it?” Okay, good. Now that we know, we’re aware, and we’re non-judgmental, let’s use this as an opportunity to be able to feel any experience that comes up. Things get a whole lot less scary if you’ve already practiced feeling your feelings. 

FEEL YOUR FEELINGS

I actually did a whole podcast on that as well. It’s Episode 65, where I talk about how your feelings are meant for feelings. That’s another resource if you want to jump into that kind of topic as well. But then once you’ve done all that—we’ve done this zooming in and now we zoom out—then you move on with your day. You don’t just sit there and feel your feelings and sit on the couch and stare at the floor going, “I’m feeling my feelings. I’m feeling my feelings. Here they are.” That’s fine if that’s what you feel right about. But ideally, you would take the feelings with you and go mow the lawn or do the things you love or do the things that you need to get done today, your chores or whatever that might be. 

But take this practice with you, because if you can get good at feeling discomfort, then you can marry that skill. It’s a skill. It’s not something that you were born with; it’s something that you can learn to do. But once you get good at that, then you can marry it with, “Now I’m going to go live my life while I use that skill.” And then you 10x your life, truly, 10x your ability. You’re still going to be uncomfortable. You’re still going to have hard days. You’re still going to have some discomfort, but your experience of it will not be one of, “Oh no, geez, I hope it goes away. I hope it’s not strong today. I hope it doesn’t stay all day because it really messes me up.” It won’t be like that. You’ll be like, “It doesn’t matter. I know it’s here, and I’m going to be here with it, and I’m going to make space for it. I’m going to be kind. I’m going to be non-judgmental about it. But it can come. I’ve done it as much.”

One thing I did learn, and I’ll use this as an example, is I used to have the most excruciating sleep anxiety. I used to worry about not sleeping. Because if I didn’t sleep, I’d have massive anxiety. The next day, I’d be teary. I just couldn’t function well. As I got pregnant and went to have my first child, I was so worried about how my mental health would go. 

Don’t get me wrong; not having sleep did impact my mental health for sure. But getting less sleep and having to get up and take care of a baby, and then having to get up and go to work once I’m done with maternity leave, and learning that I can actually get through a day, using my skills, seeing my patients, and managing my emotions, a lot of my sleep anxiety went away because all I could think of was that I’ve done worse. I’ve literally gone a night where I slept for 25 minutes and I still was able to cope. Even if I can’t fall asleep tonight, I know I can handle it. That empowerment is gold. That change in perspective. That attitude shift about discomfort is a game changer. 

Now, of course, you know what I’m going to say. This has to be done with an immense degree of compassion. This has to be done in small, baby steps. I’m not here to tell you to throw yourself into 10 out of 10 discomfort, but if you have to, I still trust and believe wholeheartedly that you can still handle it. I always say to my patients, no one has ever died from discomfort itself. It won’t kill you. It’s just going to be really hard. We can practice holding ourselves kindly as best as we can as we ride that wave. That’s the work. 

A RECAP: BRING ON THE DISCOMFORT

To recap, what makes it worse? Discomfort and uncomfortability get worse when we do anything to try and make it go away. We won’t resist it with this urgency to get it go away. But the solution is acceptance, willingness, non-judgment, compassion, making space for it, and then engaging with your life. Again, I’ll say it again. The solution is accepting the discomfort. Willingness is the willingness to be uncomfortable. The non-judgment of being uncomfortable. It’s neither good nor bad; it’s neutral. It is still uncomfortable, but it doesn’t mean you are bad or it’s bad. We’re going to be self-compassionate as we feel this uncomfortable feeling. And then we’re going to keep making space and moving back into our lives, doing maybe baby steps at a time. Even if you do this for 10 seconds, I applaud you. Let’s celebrate you. If you do it for 30 seconds and you’re able to do that multiple times a day, you are on the right track. If you can be uncomfortable for three minutes at a time, you’re basically winning at life. I want to encourage you, this is huge. 

Sometimes, when things are really hard at the Quinlan household and I want to scream, yell, or totally do something that I know I will regret, stopping and saying, “Okay, this is discomfort. Can you stay with it? Can you make space for this for three minutes or 30 seconds,” has given me an opportunity to not say things I don’t mean, to not react in ways that will end up causing me more suffering that keep me in line with my values. This ability to be uncomfortable has saved me from making some big mistakes in my life. Not all of them. I’ve still made mistakes, of course, but relationally, huge mistakes I could have made had I not slowed down and made a little space for the fact that I’m angry. “Okay, I’m going to make space for this anger,” or that I’m hurt, or that I’m really anxious.

There’s been times where I’ve wanted to run away from my anxiety, but my ability to, for 30 seconds at a time or 10 minutes at a time, make space for the anxiety, not judge it, allow it, and bring it on has meant that I've been able to face some really scary things, and that’s what I want for you.

That’s how you’re uncomfortable. Is it easy? No way is not easy. Is it doable? Absolutely. I want to remind you, this is a practice in which you can grow. Before you know it, there will be these moments of empowerment that will shock you, and you can’t believe that you’ve made these changes out of nowhere. I fully and wholeheartedly believe that. I’ve heard it from so many patients and so many students. A lot of you have also shared how helpful it’s been. That is why I say it’s a beautiful day to do hard things, because when we do hard things in a very skilled way, they actually make us feel really empowered, and we have a sense of “I can handle things now.”

All right. It’s a beautiful day to do hard things. Again, please go to CBT School if you’re interested in any of our online courses. They talk about all these kinds of things. We have courses for OCD, anxiety, depression, BFRBs, meditation, mindfulness, time management—the whole deal. My hope is that this type of message can be taken in any area of your life, and hopefully, it makes it so much better. 

Have a great day. 

In today’s episode of Your Anxiety Toolkit podcast, you will learn how to meditate to reduce anxiety. You’ll also learn which meditation is best for anxiety and how to find a meditation practice that suits your lifestyle and your recovery needs.

With the pressure of today’s society and the news being so scary, people are rapidly turning to meditation as a powerful tool to calm their minds and ease their anxiety. My name is Kimberley Quinlan. I am a licensed therapist and anxiety specialist, and my hope today is to teach you how you can use meditation to help manage and reduce your anxiety.

What Is Meditation? 

Now, what is meditation? Meditation is a training in awareness, and the goal is to help you get a healthy awareness and understanding of what is going on in your mind. So often, our minds are like a puppy. They are just going all over the place, jumping, skipping, yelling, screaming, and going in all different directions. If we aren’t skilled, and if we aren’t intentional with that, we can be off with that, off down the track in negative thinking, scary thinking, and depressive thinking. 

The Benefits Of Meditation For Anxiety Relief

There are many benefits of meditation for anxiety relief. Meditation helps train your brain. Now, there are so many benefits to meditation for anxiety relief, and I want to share with you some of those benefits.

The first one is, it rewires your brain. It reduces the activity in the amygdala, which is the part of the brain that is responsible for the fear response. Meditation can also lower stress hormones such as cortisol. It can increase the production of those feel-good neurotransmitters like serotonin and dopamine. This is really important, particularly if you struggle with depression. 

It can also shift the brain chemistry and lead to improved mood, reduced anxiety, and an overall sense of well-being. We could also argue that this would be helpful for anybody, even if they don’t have anxiety. 

We also know that meditation cultivates mindfulness, which we talk a lot about here on Your Anxiety Toolkit, which is the practice of being fully present and nonjudgmental in the moment.

Meditation increases self-compassion and acceptance, which I think we all agree can help us with our mental health, and it helps reduce negative thinking patterns and also reduces self-criticism. 

Common Problems People Have With Meditation

Now, there are a couple of problems here, though, with meditation. Often, when people come to me, they'll say, “I don’t know about this whole meditation thing. It sounds a bit like a cult or a bit like a scam or a fad, a psychology fad.” Often, that’s because people have a misled idea about what meditation is and how it works. 

One of the main problems that I hear is that people expect that meditation will, poof, make their anxiety go right away. As they’re practicing meditation—and it is a meditation practice—as they’re starting to practice this meditation, they’re getting frustrated because they’re thinking, “This isn’t working. It’s not making my anxiety go away.” 

We want to first challenge the idea that meditation is not a quick fix. It’s not something that’s going to, poof, make your anxiety go away, but there are so many benefits that I will talk to you about here in just a second. 

Another problem that people have with meditation is they get frustrated with the practice. They have these expectations that they should be able to do it. Well, simply because it’s often sitting or very stationary, they assume, “I must be really good at this. It’s such a basic task.” But the truth is, it’s not. We have to remove those expectations that we will be excellent at it, that it should be easy, or that discomfort won’t arise. 

Another problem people have is that they do experience anxiety while they’re meditating, and they’ll say, “I’m here to get away from my anxiety, but when I’m meditating, everything is still, and I actually feel more anxious.” We’ll talk about that here in just a second. 

People also don’t like meditation because they have been told that the solution to anxiety is to make it go away. And so, what would this mindfulness meditation practice really do if we’re actually just sitting there thinking? What a waste of time, actually putting more focus on the actual problem of anxiety. Again, not true, but these are the common problems people have. 

The last one is, people say, “I don’t have time for meditation.” I always laugh because I do know that the Dalai Lama said, “For those who don’t have time to meditate, they’re the ones who need to meditate twice as long.” That always made me laugh because there’s been many times where I’ve said, “Oh, I don’t have time today,” and I laughed thinking, okay, even more important that these are the days that I focus on meditation. 

Which Meditation Is Best For Anxiety?

Let’s talk about which meditation is best for anxiety, because I know you’re here to talk about how meditation can help with your anxiety. Now, there are many types of meditation. No one really agrees what the best one is, and no one really even agrees on the specific types because there are so many and so many modifications. But here are some options—we will also talk about later how to apply these to your anxiety disorder—that you may want to consider. 

• VIPASSANA MEDITATION

The first one is mindfulness, or what we call Vipassana meditation. Now, this is a meditation that really helps you become skillful in how you respond to your intrusive thoughts, your feelings, and your sensations.

• BODY SCAN MEDITATION

Another type of meditation is body scan meditation. This is very body- and somatic-centered in that we’re focusing on different parts of the body, often with some kind of relaxation technique to slowly move down the body and move us into a place of relaxation. 

Now, there are pros and cons to this meditation. Some people find it very relaxing, especially when we’re looking at getting sleep. Others find that, again, their expectations are very high, and then they get quite frustrated when they’re unable to get relaxed, because the truth is, when we’re anxious, when that amygdala is firing in our brain, it is really hard to relax. Sometimes meditation in and of itself is not going to fix that. But a body scan meditation is a really effective one, particularly if you’re trying to slow down the nervous system. Maybe look at trying to get some sleep, a nap, or some rest. 

• VISUALIZATION MEDITATION

Another type of meditation is visualization meditation. This is where you actually visualize something happening to you. Maybe you’re walking along a path or along a beach. You’re in a relaxed setting. Let’s say you’re an athlete. It might be visualizing you doing the activity, the exercise, or the skill that you’re practicing—a layup for basketball, running a marathon, or so forth. The visualization can help with empowerment. It can help promote creativity. It can help create a sense of mastery over something that you haven’t yet mastered. 

• WALKING MEDITATION

Another type of meditation is walking meditation. This is a great one, particularly if you’re someone who is very sedentary during your work. I am one of those people. I sit a lot during my day. Walking meditation is similar to mindfulness meditation in that you’re very aware of the present moment, what it feels like for your feet to touch the ground, for the balls of your feet to touch the ground compared to the heel of your feet, what it feels like for the wind to blow on your face, or what it feels like for the weight balance, going from left foot to right foot, and so forth.

• SELF-INQUIRY MEDITATION

Another type of meditation practice is self-inquiry meditation. This often involves inquiry or curiosity to who I am in this moment. It might be, who am I as I hear these sounds? Who am I when I have these thoughts? There are some pros and cons to this for those with anxiety. Sometimes, when we have anxiety, we already spend a lot of time doing a lot of self-inquiry or self-rumination about who we are. What’s our identity? Are we good? Are we bad? This type of meditation can be beneficial for some, but for many people with anxiety, they may find it not helpful at all unless they’re with someone who can very much direct them and keep them on track with the active inquiry instead of going into rumination.

• MANTRA MEDITATION

Another type of meditation is mantra meditation. This is where you repeat a mantra, a phrase, or a sound over and over again. It’s about the training of the mind and the training of discipline for one specific sound, tone, or word. It can be very helpful, again, if there’s a particular intention you’re trying to go towards. But again, for those folks with anxiety, this can be very frustrating because, again, there’s sort of this attachment and expectation and clinging to a certain outcome. For those of us who have anxiety, that can actually create a lot of distress in our bodies. Not to say that any of these are bad or good; it’s just dependent on your specific set of situations.

• LOVING KINDNESS MEDITATION

One that I always love and talk about all the time is loving-kindness meditation. This is an act of compassion where you send yourself others and all sentient beings loving kindness and care. It is a way of generating, practicing, and nurturing self-compassion. It is a beautiful way to be in connection with people out in the world that maybe we don’t have a connection with, particularly if we’re lonely or feeling isolated and alone. Loving-kindness meditation can be so beneficial to people with anxiety or depression, OCD, health anxiety, and so forth if they’re feeling so alone and they’re really very hard on themselves. Loving kindness is absolutely a beautiful meditation for people with anxiety. 

• ZAZEN MEDITATION

Another type of meditation is zazen meditation, which is a specific zen meditation where the goal is to be focused on a direct experience of this present moment. The main goal is non-attachment. The goal is to allow everything to be just as it is. It’s a very disciplined practice, but can be very beneficial to people who have anxiety. 

• BREATHE MEDITATION

The last two: number one, breath meditation where you focus on the breath and you have that as your focal point. This is very beneficial for people with anxiety. The only thing I would say is, for those who have somatic obsessions of a specific type of OCD, if your somatic obsession is already focused on the breath, we actually then wouldn’t practice this because it would actually add to their hyper-awareness. But overall, breath meditation is a very beneficial practice for people with anxiety. 

• SOUND MEDITATION

And the last one is a sound meditation. This is where your focal point is on sound. Very beneficial for those with somatic obsession and very beneficial for people who really like the vibration of sound and really love music, and music is something that grounds them, lifts them up, motivates them, and so forth. 

There are different types of meditations and some pros and cons, but there are some specific things I want you to know and remember as you start a meditation practice and while meditating, because so many people have come to me to say, “I don’t like meditating. It doesn’t help me. Therefore, I’m not going to do it.” I feel that that is such a shame because meditation can be such a powerful mental health practice. It can be such powerful training for the brain. 

I often say to my clients, when you start to notice some tightness in your knee or some shoulder pain, you don’t just ignore it. You think, okay, I have an opportunity to strengthen that muscle around the knee or stretch out that shoulder. We usually move in and do some work, exercises, and practices to create an environment where that pain can go away. I think of meditation as being exactly that. It’s like physical therapy for the brain, and it can help. Like I talked about, there are so many benefits to meditation, but it does require that we do it specifically in a way that doesn’t make more anxiety.

Now I have a really exciting thing I want to mention to you before I get into all the things I want you to remember as you move into your meditation practice. Because so many people have come to me and said that they’ve listened to meditations online, they’ve gone to meditation trainings, and they actually found it to be not helpful for their anxiety, for their intrusive thoughts, or for their depression. 

I have created an online meditation vault specifically for those who have anxiety and repetitive intrusive thoughts. My goal with this meditation vault is to make it very informative for the person who struggles with high expectations and rapid, repetitive intrusive thoughts, and I try to bring that concept into the meditations so they’re specific for people with anxiety. 

There are over 28 meditations. There are specific meditations for people with OCD, health anxiety, social anxiety, panic, generalized anxiety, and depression. There are meditations on sleep, meditations on compassion, meditations on mindfulness, and meditations on strong emotions like guilt and shame. I did my best to pack them all into one specific place so that you have a wide range of guided meditations specifically for whatever it is that you need. There’s even a meditation for people who don’t want to meditate. I felt that that was really, really important. 

You can click the link in the show notes below if you’re interested. You can also go to CBTSchool.com to get information about the vault. It is very low-cost. I want it to be low-cost so everyone can access it, and I’m so excited for you guys to check that out.

How To Meditate To Reduce Anxiety

If you are wondering how to meditate to reduce anxiety, there are things you need to remember as you practice meditation. 

Do not expect anxiety to magically disappear. Number one, if that were to happen, it probably wouldn’t be for very long anyway. 

I want you to imagine this practice as the slow and steady growth of a muscle. If you were going to train at the gym, you wouldn’t go straight in and pick up a hundred pounds right away. You would start low; 10, 15, maybe 10 to 12 and a half, then to 15, and you would slowly work your way up. You wouldn’t have these expectations that your body would be able to pick up a hundred pounds at a time without pain afterwards. You would go in knowing that the cost of this is going to be that I may get pain if I overdo it, and I want you to think about that with your meditation practice as well. Not that you’ll have pain, but that it’s healthy to take baby steps and do it slowly and steadily.

Another thing I want you to think about is, again, to think of this as an opportunity to change the way your brain responds to anxiety. Think of this as an opportunity to change how you respond to discomfort, how you act in your daily life, and how you can change your habits to benefit your mental health.

How Long Does It Take For Meditation To Reduce Anxiety And Stress?

Often, people will ask: how long does it take for meditation to reduce anxiety and stress? The answer here is very simple, which is, let’s not put pressure on that to be the outcome. I know you came here to learn that exact answer, but the thing to remember here is, the more we resist anxiety, the more we want it to go away, the more we try and avoid it, the more we’re feeding to our brain that it’s dangerous and scary, and it will make our brain send out more stress hormones.

We want to use meditation as an opportunity to train our brains that we are no longer going to run away from anxiety and stress. Instead, we’re going to open up a space for anxiety and stress and have it be a safe place. Have our bodies and our minds be a safe place for anxiety to rise and fall. It’s important that we understand that this, again, is an opportunity for you to change your specific emotional reaction to having anxiety and stress.

Now that being said, I will still answer the question, which is, I think within time, you will probably see a very significant improvement. Most research shows that a short meditation practice of four to six weeks will significantly reduce people’s stress and significantly improve people’s relationship with their anxiety.

I often say to my patients, give it 30 days. Go in with a solid commitment to practicing as often as you can for 30 days. Track your anxiety; maybe even put it on a scale from 1 to 10. If you’re able to do it in this way, where you’re not trying to get rid of anxiety but instead trying to make it a place where you can have anxiety and not respond with judgment, criticism, and resistance, you’ll probably find that you’ll have significantly reduced levels of anxiety and stress after 30 days. 

Now, again, I want to emphasize that there is significant research to show that meditation for stress is very beneficial. In fact, we’ve found that practicing meditation again downregulates your stress response. It reduces your nervous system’s activity and reactivity to stressful events in your life and can greatly benefit your overall well-being. Definitely, if you’re someone who’s struggling with a very stressful time, and I think we all are given that the news is so, so painful right now, I think it’s a beautiful opportunity for us to start a meditation practice. 

Another thing I want you to remember here is that by practicing meditation, you widen your window of tolerance. Now, what does this mean? I’ve talked about it on the podcast before. If your window of tolerance is very narrow, it means, as soon as you have any kind of strong emotion, strong experience, sensation, or pain in your body because you haven’t practiced being able to tolerate that, you are very much more likely to rely on unhelpful safety behaviors to cope with that distress. 

In discomfort, as I mentioned, we actually widen our window of tolerance. The wider we can have this window of tolerance, the more likely we are to be regulated when we have a lot of emotions. We can be steady and really intentional in how we respond. We are more likely to act according to our values than according to our fears. So we want to practice widening that window of tolerance. There is so much benefit to doing that. 

Another thing to remember, and I’ve mentioned this already, but I think it’s really important as we finish up, is to not put pressure on yourself to get this right. I will often say to clients, and I say it all the time in the meditation vault over and over again, expect anxiety to show up over and over again. Expect your mind to go off track and go off and think about the grocery list. Your job is to bring it back to the present moment. 

Don’t be upset with your brain for going off track. That’s its job. Its job is to be highly functioning and thinking about all the things. But the training and the benefit is that discipline to bring you back to the focal point that you’re on right now, depending on the type of meditation that you’re doing. 

I hope that you can practice letting meditation be messy, because it is. Even very, very skilled monks who practice meditation for hours a day still report that there are days when meditation is messy. There are days when your brain will be all over the place like that puppy dog, but with practice, you will start to see an improvement in your ability to be disciplined and intentional with where you put your attention, which again, as I mentioned, reduces the chances of you engaging in safety behaviors that aren’t helpful, reduces the chances of you engaging in compulsions, and reduces your chances of going back down into those negative thought processes. There are so many benefits.

The last thing I want you to remember is, as you begin this practice, be curious. Be open. Instead of being judgmental and rigid about what you think will happen, be curious about what might come from inquiring and moving into this practice. 

Meditation has changed my life. It has calmed me in the darkest hour. It has been there for me when I needed support, and I hadn’t had anybody else to lean on. Meditation, as I mentioned, is a practice where you teach yourself to be a safe place for you to experience any emotion at all, and you know that it’s there; you can take it with you wherever you’re at. It costs nothing to practice meditation in the moment, and I hope that it’s something that will bring you as much joy and as much wellness as it has for me. 

Have a wonderful day, everybody. As always, it is a beautiful day to do hard things. Again, if you’re interested in the mindfulness meditation vault, you can click the link in the show notes.

Have a wonderful day.

If you are scared to take medication, you are in the right place. Today, we are going to take a deep dive into a very common fear that impacts many people and their recovery, and that is the fear of taking medication. If you’re someone who needs help with this, I think this is going to be really helpful for you. 

Hello, my name is Kimberley Quinlan. I am an anxiety specialist, and I help people with anxiety. My hope is to make it an easy and a kind recovery for you. 

FEAR OR TAKING MEDICATION

Now, today we’re talking about the fear of taking medication, and a lot of what I do with my patients in my private practice, which is in California, is really helping them work through that fear. In addition, on my online platform called CBT School, I often get a lot of questions about this, such as whether or not people can take meds, should they take meds, and so forth. But before we get into all that, what I want to share with you first are a few housekeeping points that will keep us on point and in the right direction today. 

If you’re someone who is scared to take meds, we first have to acknowledge that this episode is not going to cover whether you should take meds or not. I am not a medical doctor. I am not a medical professional. I am a mental health professional, and I do not prescribe medication. I am not licensed to do that. But I am here to help you manage the fear around it. If you are someone who wants to take medication but is afraid of it because of the side effects, or maybe because of the shame, the guilt, and the stigma around it, my hope today is that we can work on managing that fear and getting you the information and skills you need so that you can speak with your medical professionals and make a decision based on what is best for you. 

It is important to remember that every person is different, and it’s important that you make these decisions with your medical doctor so that we’re making a decision based on your medical history, where you’re at in your mental health recovery, your genetics—all of the things that you need to discuss with your medical doctor. But today, let’s get going. We’re talking about managing medication anxiety. 

Where did this episode come from? I actually made a post about this on Instagram not long ago, and the response was overwhelming, with people saying, number one, “I’m too afraid to do it. Help me,” and number two, a lot of people said, “I had a lot of anxiety around taking medication. I got the help I needed and I managed it, and now I’m so relieved that I did.” I wanted to spend some time today talking about the reasons people are scared to take an antidepressant or other psychiatric medications or even medications in general. 

REASONS PEOPLE A SCARED TO TAKE AN ANTIDEPRESSANT OR OTHER PSYCHIATRIC MEDICATIONS

There are multiple reasons patients do not take their medications, due to fear. In this episode, we are coming the core reasons fears stops people from taking their antidepressants or other medicines. 

1. FEAR THAT MEDICATION WILL CAUSE SIDE EFFECTS

The number one reason that people reported being scared to take medication is the fear that medication will cause side effects. This is a very common fear around taking medication, and it is true. We will talk about the side effects here later in this episode, but that is a valid concern. But often, people are afraid of the side effects, even though they are not afraid of it being a catastrophic side effect. They’re often afraid of just change, or they’re afraid of what is uncertain and unknown, and that is a big thing for them. 

2. OCD FEAR OF TAKING MEDICATION

Another reason that people are afraid to take any kind of medication is an OCD fear of taking medication. The reason I say it like that is, it’s beyond just a generalized fear of the side effects. It’s often around a belief of what this medication will do to you. 

One example I’ve had in my private practice has been the subtype of OCD called emotional contamination. They’re afraid that by taking the medication, it will dramatically change their personality or that they’ll turn into a different person. There’s a lot of compulsions around that, rumination around that, and avoidance around that. They’re also doing this kind of avoidant compulsions in other areas of their lives as well. 

3. HEALTH ANXIETY: WHAT IF MEDICATION CAUSES AN ILLNESS

Another OCD fear of taking medication is under the umbrella of health anxiety. A lot of people are afraid that the side effects will be catastrophic, that it will give them some catastrophic medical condition if they were to take this psychiatric drug or any medication in general. 

4. PHARMACOPHOBIA (PHOBIA OF DRUGS AND ALCOHOL)

Now, in addition to that, there is actually a specific medication phobia called pharmacophobia, which is a phobia of drugs and alcohol. This is a specific phobia where people are afraid of any and all drugs. Often, in this case, they’re afraid to take headache medication or allergy medication. They’re even afraid to look at pills for reasons that could be plentiful. It could be a learned behavior around medication, particularly if they’ve heard stories of people who have misused drugs and bad things that have happened. That is another reason why people are often scared to take meds. 

5. FEAR OF MEDICATION SEXUAL SIDE EFFECTS

Another common fear, as we’ve already discussed, is fear of medication’s sexual side effects. Now, for those of you who have a specific fear around the side effects, you have a valid concern. There are some medications that do cause sexual side effects, and we did an entire episode on Your Anxiety Toolkit talking specifically about the sexual side effects of anxiety medications. We had a psychiatrist come on and speak about this. It’s episode 332, and I will link to it in the show notes if your interest is specifically more in-depth information about that. But I will also give some tips and tools to use around that later on here in this episode. 

6. I AM ASHAMED TO NEED MEDICATION (MEDICATION STIGMA)

Another fear around taking medication includes the fear of being ashamed or the fear that you’re weak or that you’re stigmatized for taking medication. This is a really, really big one. A lot of people feel that they are weak, faulty, or wrong for needing medication. Now, this is where I slow down and get very transparent. I am very comfortable sharing that I take medication for anxiety. I have, through different stages of my life, needed to take medication for this, and I’m an anxiety specialist, guys. I want to tell you that, not because I want to make this about me, but because I want to share with you that you can have all the tools and skills, and they really do work. 

Research does show that if you were to compare medication and CBT, especially for anxiety disorders, Cognitive Behavioral Therapy is actually the number one way to get recovery from these anxiety disorders. But even better than that, the research shows that combining medication and cognitive behavioral therapy is the gold standard. And so, if you’re really struggling, by combining these, this is where you can get massive help with your mental health struggle. 

Again, I want to really share with you that even though I have the skills and the tools, I take medication. There’s no shame in that. A lot of times, we often will compare that you wouldn’t feel ashamed for taking diabetic medication. You wouldn’t feel ashamed if you needed medication for another medical condition. There is no shame, no guilt, and no stigma that I want you to take away from this episode from taking medication. 

Now, I want to also validate, yes, there is still a stigma. There will be some people out there who may even respond to this episode by saying, “You shouldn’t take meds, and you should try this other treatment,” and so forth. That’s still going to be there. But I want to offer you a degree of compassion and a degree of education that there is absolutely nothing wrong with you if you want to take medication or need to take medication. 

7. FEAR THAT I WILL BECOME ADDICTED TO MEDICATION

Last, the fear about taking drugs is the concern that the medication will be addictive or that the person will become reliant on the medication. We’ll talk about that here in just a little bit, but the one thing I want to mention here is, if you are in contact with your doctor—you’re being constantly followed by your doctor and checked in by your doctor—you can bring up these concerns with them, and they can help determine that. Again, each of the questions you have, you should go to your doctor and bring it up because if you do have a history or if, in generations above you, you have a history of addiction, then absolutely bring that up to your doctor and they can help make decisions around different medications that can help prevent that for you.

MANAGING MEDICATION ANXIETY (SKILLS & STRATEGIES) 

Now let’s go into managing medication anxiety. This is where the good stuff comes in. Number one is, I want you to prioritize finding a skilled and trustworthy psychiatrist or medical professional. It doesn’t have to be a psychiatrist. In fact, there are other people who can help prescribe your medication, whether it be your pediatrician, your medical doctor, or your intern. It could be a nurse. There are psychiatric nurses who can prescribe medication. You want to find somebody who’s going to slow down, take their time with you, not just push you through really fast, and answer your specific questions. 

Now, when it comes to managing anxiety, OCD, or health anxiety, we usually discourage asking compulsive questions, repetitive questions, or going overboard with the questions. But I do think that it’s important that you give yourself permission and honor your need to ask the questions that you have about the medications you want to go on. That will help you understand the medication, understand the side effects, and understand the pros and cons so you can make an informed decision.

As we’ve said before, we want to understand questions about side effects, sexual side effects, addiction, how long you should be on medications, and what specific side effects you should be looking out for. We want to understand this. We want to know what the norm is for these medications on what it would look like, how fast you can see results, and what this process is going to look like. Don’t be afraid to ask lots of questions. 

Now, if you have OCD fear of taking medication or pharmacophobia, a thing you might want to consider is finding an ERP therapist. I’ve had a lot of clients come to me who have consulted with their doctor, and they’ve agreed that medication would be helpful for their recovery and that they required some mental health advice in moving in that direction. What we did is either start by just looking at pictures of medication or we might fill the prescription of the med that they need to take and just have it with them, hold the medication, put it in their hand, smell the medication, and take one with the care and following of a medical professional. Start that process by slowly exposing them and practicing being around that medication to start with. 

If you are someone who’s struggling in that area, absolutely consider seeking out an ERP therapist (exposure and response prevention) who can help manage all of that as we go and help with the response prevention piece. Because remember, exposure is not the main work; it’s also catching any compulsions that you’re doing around the medication. Maybe you’re doing a lot of compulsive checking with the medication and so forth. 

Another thing I want you to think about is being able to challenge your faulty thoughts and beliefs about the medication. As we talked about before, with those reasons that people are afraid, there is often a lot of faulty, catastrophic thinking around medication. Ones that are common that I see with my patients are, “I won’t be able to handle the side effects.” Let’s say a common side effect for a medication might be some nausea. Then we will say, “Okay, let’s talk about your ability to handle nausea. Have you handled nausea in the past?” Let’s say it’s headaches. “Okay, what could you do if those headaches were to appear? How might you speak with your doctor about those? How might you be able to plan for that?” Maybe it’s like, “What if I have a panic attack if I take the medication?” “Okay, let’s talk about some skills and talk about challenging your ability to manage the anxiety that you feel.” 

A lot of people say, “I already have a lot of anxiety. I don’t want to do things that create more anxiety.” Again, we’ll say, “Are you willing to tolerate that anxiety? What are you telling yourself about your own mastery of riding waves of discomfort and so forth?” If you have, let’s say, emetophobia, the fear of nausea and vomiting, “What do we believe about vomit? Do you believe that you can’t handle that?” And again, you may need to defer to an ERP therapist to help you if you have emetophobia, the fear of vomiting and nausea, to help you manage that so that you can take the medications if that’s something you’re wanting to do. We do want to challenge faulty thoughts, and we want to challenge faulty beliefs about medication. 

Again, here is where I get really, really passionate about saying: There is absolutely no shame in taking medication. Taking medication does not mean you’re weak, does not mean you’re lazy. It doesn’t mean you’re doing anything wrong. It doesn’t mean that you’re never going to get better, and it doesn’t mean you need to be on it forever. Again, we’re here to encourage you to consult with your medical doctor and be flexible with your recovery. 

Now, being flexible is so important here. So often, patients of mine will say, “But what if I don’t like the medication? What if I get on it and I really don’t like it, or it makes me feel terrible and I can’t function?” Well, okay, we’ll cross that bridge when we get there. We’re going to be flexible with this. We don’t have to stay on it forever. Once you get on it, if then there is an issue, we will address that issue. Then we’re not going to spend time before taking the medication trying to troubleshoot all the possible catastrophes and scenarios. We’re only going to take one day at a time, and with each day, we’re going to make measured, skillful, and wise decisions based on the actual events of that day, not on the possible scenarios that may happen, that may be catastrophic that haven’t happened yet. 

So often, people who have a fear of medication are responding to things that haven’t even happened yet. I know when I got POTS (postural orthostatic tachycardia syndrome), I was not functioning, my anxiety was through the roof, I was depressed, and the doctors strongly advised me to take medication. A big part of me was absolutely like, “What if this makes it worse?” and all these things. I had to just say, “Kimberley, be present. Stay with what’s happening today, and we will address that as it goes. We’ll cross that bridge when that happens. If that does happen, we will speak with a medical professional. We will take one step at a time and we will do what we need to do.” We want to catch that anticipatory anxiety about medications and the anticipatory anxiety about the side effects. It’s very, very important that we catch and manage that as we go. 

Another thing to remember here is, you have to be willing to have side effects. As you go on medication, you have to be willing to feel some feelings that may be uncomfortable. As I mentioned, common side effects: headaches, nausea, tiredness, maybe a little jittery, and so forth. Again, I want to keep prefacing: please speak to your medical professional about the side effects because each medication is different. But be willing to have side effects. Again, being flexible, knowing that if this medication doesn’t work for me, we can try something else. I know for me personally, I had to try five medications before I found one that fit me. Five. It took a long time. I had to taper up and then I had to taper down, and I had to try another one, which brings me to the next skill I want you to practice, which is patience. 

I just kept honoring my own needs and said, “I’m going to be patient with this process.” A lot of my patients have found one medication that was prescribed by their medical professional and found that it was great. It’s worked for them straight away. But we want to be patient, and we want to be willing to have a lot of different sensations. I’m not saying you will, but we want to be willing. I actually have a whole other episode on Your Anxiety Toolkit called How to Have Uncomfortable Sensations. If you’re struggling with that, that may be a good resource for you to use as you go through this process as well. 

Now, if you have, or if you’re afraid of sexual side effects, again, I talked about listening to that episode, but I will also say one thing that they did say in that episode: It is okay to seek out a sex therapist or try other skills, such as a skill called sensate focus, or speak to your medical professional about that. 

Now, there are a lot of meds that do not have sexual side effects. If that’s something that is a concern for you, please mention that when you’re seeing your psychiatrist or your medical professionals so that they can pick a medication that will reduce the likelihood of that. Again, we don’t want to catastrophize about potential problems that haven’t happened, but it is okay to bring that up if that’s important to you. 

Now, of all the things and skills I’m going to give you today, the one thing I really want to emphasize is, please give yourself lots of space and lots of permission to rest during this process as you begin medication. I remember when I first went on medications, my mom actually said to me, “Hun, why don’t you just use this time? Thin out your schedule and give yourself lots of time to rest. If you do have side effects, then you won’t be overwhelmed with trying to work and push through.” 

Any way you can during this process, take as much help as you can, whether that be neighbors helping you pick up the kids, grocery delivery, whether it be you don’t clean the house this week and you just let things sort of slide a little. You let your colleagues, your teacher, or your coworkers know that you’ve started a medication and that you might be feeling well. 

Take as much space and take as much care as you can as you start this process. It is scary. It is anxiety-provoking. I’m not here to tell you that it won’t be, but what I am here to say is we can do hard things. How can we support you as you make this value-based decision? How can you find help, support, and care as you lead forward with your values? You’re not letting fear stop you anymore. You’re doing the hard thing. You’re taking the step for your long-term recovery, even though it’s the hard one. How can we be very kind, compassionate, and effective moving forward as you move through this process? 

The next tool I want you to think about is being mindful around the side effects. What I mean by that is, when we do have side effects, we can be non-judgmental, we can stay present, and we can stay in non-resistance to that side effect if you have any. What we know here is, research does show that mindfulness practice does reduce people’s experience of suffering. What we mean by that is, if you’re suffering, your experience of it could be, “This is very, very bad,” or your experience could be, “This is tolerable and doable, and I can handle it.” 

How can you take the judgment out of the side effects? When you’re having them, are you catastrophizing, saying, “This is terrible, this is bad, I can’t handle this,” or are you saying, “This is neutral and tolerable, and I can manage this”? If you’re having a side effect, are you resisting it, pushing it, and fighting it, or are you giving yourself permission to be uncomfortable, and are you willing to allow those sensations to rise and fall? 

As I’ve already discussed, one of the points I had here in my notes is to remind you to always put your values first. If you believe that medication is the right choice for you, lead with that value. Do not let fear interfere with your decision here. That was a lot of rhyming words, but we’re going to go with it. 

The next thing I want you to think about is to talk with your doctor about whether it would be helpful for you to log any changes. I find that it’s very beneficial to log your symptoms. The day you start taking your meds and how many days you take that meds, you probably will need to taper up maybe, depending on what your doctor has told you to do. Take note of when you change any medications. Are there any changes in your anxiety? Is there any change in your mood? What side effects are you experiencing? And that will be there to help when you talk with your doctor next about how it’s going and whether it’s actually the medication. 

I know a lot from my patients, they’ll say, “The medication is definitely causing this problem for me. I’m tired all the time.” But actually, if they’ve logged, we can see, “Actually, around that same time, you started getting less sleep for reasons like around school, or maybe you had a lot of travel, or it was the holidays. Could that be what’s actually causing your symptoms?” Take that log to your medical professional and let them help you decipher whether it is in fact the medication or if this is actually a lifestyle change that has happened in your life.

Again, let’s challenge the stigma here. My main hope here with this whole episode is to take the stigma out of it. There is absolutely no reason for you to feel ashamed for taking medication. There is no reason to believe that you are weak for needing medication. I personally am proud of myself for saying and honoring that I matter. My wellness matters. I will do nothing but put my wellness, my mental health, and my medical health as number one, and I will do that proudly. If that means taking medication, so be it. If other people want to judge me, that’s fine. I don’t really mind if they judge me. Yes, it hurts my feelings sometimes, but they can have their opinion. I’m still going to do what’s best for me. 

I hope that that empowers you to, again, learn from your medical professional what’s best for you. Decide for yourself whether this is a value-based decision. Decide whether you’re going to let fear stop you, and take baby steps. I cannot emphasize how important it is to take baby steps and to stay present. Only deal with problems as they arise. Do not make decisions based on potential problems that may show up in the future. Because if that’s the case, you’ll never move forward with your values. You’ll always move forward with fear. We recently did a whole episode about how to act according to your values, not fear. This is another very important step for your recovery. 

The last thing I’m going to say is, it’s a beautiful day to do hard things, and you can do hard things too. If you have a fear of taking medication, if you’re scared to take medication and it’s impacting your recovery, I hope that this has helped you to manage medication anxiety, to give you a little bit of empowerment, a lot of hope, and hopefully help you to manage your anxiety as you move forward. 

Have a wonderful day, everybody. It has been a pleasure being with you again. I know your time is incredibly valuable, and I’m so honored that you chose to spend your time with me today. I’ll see you next week.