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Now displaying: Page 5
Feb 10, 2023

5 TIPS FOR HEALTH ANXIETY DURING A DRS VISIT

If you want my five tips for health anxiety during a Drs visit, especially if you have a medical condition that concerns you, this is the episode for you.



Hello and welcome back everybody. Today, I’m going to share some updates about a recent medical issue I have had, and I’m going to share specific tips for dealing with health anxiety (also known as hypochondria). 

A lot of you who have been here with me before know I have postural orthostatic tachycardic syndrome. I also have a lesion on my left cerebellum and many other ups and downs in my medical history where I’ve had to get really good at managing my health anxiety. I wanted to share with you some real-time tips that I am practicing as I deal with another medical illness or another medical concern that I wanted to share with you. 

Here I’m going to share with you five specific tips, but I think in total, there’s 20-something tips all woven in here. I’ve done my best to put them into just five. But do make sure you listen to the end of the podcast episode because I’m also going to give some health anxiety journal prompts or questions that you can ask yourself so that you can know how to deal with health anxiety if you’re experiencing that at this time. 

Before we get into it, let me give you a little bit of a backstory. Several months ago, I did share that I’ve been having these what I call surges. They’re like adrenaline surges. They wake me up. My heart isn’t racing. It’s not like it’s racing fast, but the only way I can explain it is I feel like I have like a racehorse’s heart in my chest, like this huge heart that’s beating really heavily. Of course, that creates anxiety. And so then I would question like, is it the heartbeat or is it just my anxiety? You go back and you go forward trying to figure out which is which. But because this was a symptom that was persisting and was also showing up when I wasn’t experiencing a lot of stress or anxiety, I thought the right thing to do is to go and see the doctor. 

WHAT HEALTH ANXIETY FEELS LIKE

Before we get started, be sure to make sure you’re not avoiding doctors. Make sure you’re not dismissing symptoms. We do have to find a very, very wise balance between avoiding doctors but also not overdoing it with doctors. We’ll talk about that a little bit here in a minute. But first, I wanted to just share with you what health anxiety feels like for me. Because for me, I’m very, very skilled at identifying what is anxiety and what is not. I’ve become very good at catching that by experience, folks. It’s not something that comes naturally, but by experience, I can identify what is health anxiety and what is a real medical condition or what is something worthy of me getting checked out. 

For me, for the health anxiety piece, it’s really this sort of anxiety that is a sense of catastrophization and it’s usually in the form of thoughts like, what if this is cancer? What if this is a stroke? All the worst-case scenarios. What if this is life-threatening? What if I miss this and you are responsible, you should have picked it up. These are very common health anxiety intrusive thoughts or health anxiety thoughts that I think you really need to be able to catch and be aware and mindful of. First of all, that is the biggest symptom for me. 

The other thing is when you have health anxiety, you do tend to hyper-fixate on the symptom and all of the surrounding symptoms that are going with that. And then you can really catastrophize those like, “Well, my heart’s beating really heavily and I feel dizzy. Oh my gosh. And I’ve been having a headache. Yeah, you’re right, I’ve been having a headache. Oh my gosh.” I call it ‘gathering.’ That’s not an actual clinical term, but I do use it with my clients. We gather data that is catastrophic to make it seem like, yeah, we actually have a really big point, and this is actually a catastrophe. 

Some other health anxiety symptom that I experience is panic. When you notice a symptom, it is very common to start panicking. And then again, you go back to this chicken or the egg or is it the horse or the carriage in terms of I’m panicking, and now the panic has all these symptoms. Are these symptoms an actual medical condition or are they actually just anxiety and panic? You could spend a lot of time stuck in that cycle trying to figure that out. 

Let’s now talk about how to manage these symptoms and some tips and tools that you can use. 

Tip #1: No Googling

Let me tell you what has recently happened to me. I’ve been having these symptoms. I made an appointment to see my cardiologist. It was two months out and I was like, “It’s not a big deal. I can handle these symptoms.” I’m feeling super confident about my ability now to just ride out some pretty uncomfortable sensations and not catastrophize. I go in for my checkup, they do an echocardiogram, and it’s taking a long time. She’s asking me these strange questions like, “Why are you here again,” as she’s doing it. She’s checking, she’s looking, she’s squinting at the screen. “Why are you here again? What are your symptoms?” Click, click, click, looking at the heart, whatever. Again, I’m in my mind going, “Kimberley, let your brain have whatever thoughts it wants. We’re not going to catastrophize.” I was doing really, really well. I got up and I answered her questions. I did the whole appointment. She cleaned me off when I was done and said, “Great, you’ve got 24 hours and then the doctor will email you with your results.”

And then yesterday afternoon, I get a call from the nurse saying, “We need to book you a video appointment with the doctor to discuss your results.” As you can imagine, my brain went berserk. My health anxiety thoughts were saying, “This is really bad. Why would he need to make a video appointment? This can only end badly. This must be cancer. This must be heart problems. Am I going to have a heart attack and so forth?” Of course, my brain did that. I’m grateful my brain does that because that’s my brain being highly functioning and aware. 

But the number one rule I made with myself in that exact moment, even though that was very anxiety-producing, is no Googling. Kimberley, you are not allowed to pick up the computer or the iPhone and Google anything about this.

That is tip #1 for you. I’ll tell you why. A lot of my patients say, “But why? It’s no harm. I’m not doing any harm.” And I’ll say, “Yes.” I’ve actually just seen my cardiologist. But now that I’ve had my appointment, he encouraged me to do a little research. What was hilarious to me is every single website is different and some catastrophize and some don’t. Some go, “This could be very normal.” Other ones say, “This could be cancer, cancer, cancer, cancer.”

This is why I’m telling my patients all the time, don’t Google because what you read is different. It’s not like this is going to be a factual thing. Most of the time people who have articles that rank high on Google searches are the ones who have optimized their website to be very easy to Google. The reason they have become number one on the Google algorithm is because they’ve included keywords like cancer for blah, blah, blah, and all of these health issues and health names. The ones that are at the top, some of them are very reasonable, helpful, and accurate, but a lot of them are not. They’ve just really done a great job of putting in lots and lots of keywords that makes them highly searchable and come up high on the algorithm.

Please, number one, do not Google. Go to your doctor for questions if you have any. Unless they’ve encouraged you to do research, do not Google.

TIP #2: FOLLOW IMPORTANT HEALTH ANXIETY CBT TECHNIQUES

I’ve actually categorized this in a bigger category and I’ve called it important health anxiety CBT techniques, because there are some important CBT tools that you’re going to need here and here we go. 

While I was in getting my echocardiogram, I was laying and I was having some anxiety because she was squinting and asking some strange questions, not in the normal of what I’d experienced. I could feel the pull to check her face for reassurance like, does she look concerned? Does she look relaxed? What’s going on with her? I wonder what she meant. 

What I want to encourage you to do is acknowledge and catch when you’re checking their face to try to decipher what the nurse or the assistant or the doctor is doing and saying. Because really, all I’m doing there is mind reading because I have no idea what she’s thinking. I was laughing at myself because she was squinting and looking concerned. I was like, “I wonder if she’s trying not to pass gas.” We could mind read that she thinks I have cancer and that there’s a big problem, or maybe she’s just trying not to pass gas right now. Maybe she’s thinking about a fight she just had with her partner. My attempt to analyze her facial expression is a complete waste of my time. You could use that tip anytime you want. 

The next tip for you is no reassurance seeking with nurses or doctors. Now, I actually felt almost into this trap. If I’m being completely honest, I did fall into this trap, but I caught myself really quickly. As she was finishing up, she took off her gloves and got ready to discharge me, and I said, “So, you’d let me know if there was...” I paused because what I was going to say is, “You’ll let me know if there’s something wrong, right?” I was going to say that. And then I was like, “No, no, no.” I stopped myself and said, “You know what? I know the deal. I’ve done these enough times. I know I have to wait for the doctor.” But I caught myself wanting to get confirmation from the nurse and I already know that nurses are not allowed to give me any diagnosis anyway. I caught myself wanting to get some expression of relief from her like, “No, you’re fine. Everything looks good,” or whatever. Sometimes they accidentally give you that reassurance. But I caught myself seeking reassurance from her. 

In addition to that—let me talk to you a little later about how we do that with doctors as well—often if you’re in the office with a doctor, you may find yourself at the end of the session going, “I’ll be fine, right? It’s not bad, right?” It’s okay, we’re all going to ask some of those questions. I’m not going to be the reassurance-seeking police with you. But what I want you to do is really drop down into catching when we’re engaging in reassurance seeking and using it too much to reduce our own anxiety about it, to take away our own anxiety or fear.

Now, another CBT technique or sort of rule that we often set in clinical work when I’m talking with my clients who have health anxiety is also not swaying the doctor or the nurse to answer things in the way that you want. A lot of people fall into this trap. For me, I just had my doctor’s appointment. We are working through and there are some little problems that we will work out. But I caught myself there wanting to sway him to be very positive. We had talked about it ultimately. He had said, “There are some issues. It could be this, it could be that, it could be this.” He listed off three or four options. Some were very, very small, and of course, the third one is always like, it could be cancer. They always say at the end, like whatever.

When they give you these three or four or five options on what the problem might be, it’s very important that you be mindful and aware of how you’re trying to sway the doctor to give you certainty. This is what my doctor said, and I’m going to be brief. I’m not going to bore you with my medical stuff, but he’ll say, “It could be that you recently had COVID or an illness or a virus. It could also be this other condition, which is common, and if it’s so, we’ll treat that. It could also be that there could be some rheumatoid arthritis and that’s a longer treatment. And then the final thing, which we don’t think so, but it also could be cancer. “Let’s say he lists off these four options. 

Now, this is very common. Doctors will do this often because their job is to educate us on all of the possibilities so that we can create a treatment plan that doesn’t ignore big issues, but we have to be careful that we don’t spend their time and our time going, “You think it’s the first one, right? It’s probably just the first one. I probably just had a virus, right?” I’m really swaying him towards giving an answer when he’s already told us that he or she doesn’t know yet. He’s already said, “I don’t know yet. We’re going to need to do extra tests.”

Catch yourself trying to get them to reassure you and confirm that it’s definitely not the C word. The cancer word is what I’m saying there. Catch yourself when you’re doing those behaviors in the office with either the nurses or the technician or the doctors. Very, very important. 

Now, one other thing I want you to also catch is if you’re coming to them with something, let’s say you are coming to them with a concern that you’ve pretty much know is your health anxiety, but you want reassurance that it’s not, also be careful that you don’t overly list things to convince them that something is wrong. A lot of you don’t do this, I know, but I have had a lot of clients who’ve come back to me after seeing the doctor and said, “Do you have any other symptoms,” and they would list even minor symptoms that they had a month ago that they knew had nothing to do with it. But they felt like if they didn’t say it all, if they didn’t include every symptom, every stomach ache, every headache, everything, they could miss something. So also keep an eye out for that.

That’s some sort of overall general CBT techniques we use for health anxiety that help guide people into not engaging in those health anxiety compulsions.

TIP #3: HEALTH ANXIETY HELP DURING YOUR DOCTOR’S VISIT

This is a really important part of it. From the minute that I got the call from the nurse that he wanted a video call with me, my mind went to, again, the worst-case scenario. It just does. It just does. I think that that is actually really, really normal. I really do. I think that is what happens naturally for anybody. First of all, I don’t want to even go too over in terms of pathologizing that. I think that’s a normal thing for anybody to experience. 

The first thing I want you to practice is validating your anxiety. It’s a part of self-compassion practice. It’s going, “It makes complete sense, Kimberley, that this is concerning you.” That’s one of the most important self-compassionate statements you could make for yourself. “It makes complete sense that this is hard, this is scary. Of course, it’s making you uncomfortable.” It’s validating. 

You might even move to a common humanity, going, “Anybody in this situation would have anxiety.” Then you can also move into mindfulness skills, which is—this was one that I hold very true—just because I feel anxious doesn’t mean there’s danger or there’s a catastrophe. It’s my body’s natural response to create anxiety when it feels threatened. That keeps me alive. That’s a good thing. But just because I’m anxious and having thoughts about scary things doesn’t mean they’re facts. Remember, thoughts are not facts.

The next thing here is also being able to just observe them, again, while you’re sitting in the waiting room. They were playing the movie, what’s it called? Moana. And I love Moana. I remember watching it as a child. I’m sitting in the seat and my mind is offering me all of these health anxiety intrusive thoughts, and my mind really wants me to pay attention to them. 

A part of my mindfulness practice was to go, “I am noticing I’m having these catastrophic thoughts, but I’m also noticing Moana, and I’m going to choose which one I give my attention to.” I’m not going to push them away. I’m not going to make the thoughts go away because they’re naturally going to be there. I basically knew from yesterday afternoon until 9:00 AM this morning that the thoughts were going to be there and I accepted them there. I didn’t go in saying, “Oh gosh, I hope the next 24 hours aren’t filled with thoughts.” I was like, they’re going to be, “Hello thoughts, welcome. I know you’re going to be here,” and I’m going to train my brain to put attention on what matters to me. In this case, I’m not going to make these thoughts important. I’m going to watch Moana. I’m going to look at the colors, I’m going to listen to the sounds, I’m going to notice whatever it is that I notice. I’m going to notice the fabric of the seat underneath me as I’m waiting in the room. Last night as I went to bed, I’m just going to notice the feeling of the cushions underneath me. This is mindfulness and this is so important—being present and paying attention to what is currently happening instead of the worst-case scenario.

There’s one important point here, which is my mind kept saying, “By nine o’clock tomorrow, your life might change.” You guys know what? If you’re listening, I’m guessing you know what that’s like. You’re like, “After this appointment, this appointment may change your life for the worse.” My job was to go, “Maybe, maybe not. It could be that he just wants to tell me everything’s okay.”

It is what it is. It will be what it will be. I will work through it and solve it when it happens. I’m not going to live the next 24 hours or the next 12 hours coming from a place of the worst-case scenario until I have actual evidence of that. So we are not going to live your life as you wait for your appointment. We’re not going to live your life through the lens of the worst case. We’re going to live through it through being uncertain and accepting that in this moment, nothing is wrong. Until we know, we don’t know. 

MEDITATION FOR HEALTH ANXIETY

Now, other options for you, I’m just going to add a couple here, is I have found meditation for health anxiety to be very, very helpful, particularly when health anxiety is taking over. That has been very beneficial for me—to find a meditation that can actually sometimes give me some concrete skills to use in the moment to stay present. We are not going towards staying calm because maybe you’re going to have some anxiety. That’s okay. Really what we want to do is we want to be working in the most skillful fashion as we can. 

And then the last one, this one’s a little controversial. Some people don’t agree with this piece of advice, so take what you need and leave what doesn’t help. But for me, when I’m anxious, I tend to shallow breathe a lot. I hold my breath a lot. For me, it was just reminding myself just to breathe. Not breathe in any particular fashion or deep breathing, but just be like, “Take a breath, Kimberley, when you need. Take a breath when you need.”

TIP #4: WHAT TO DO WHEN HEALTH ANXIETY TAKES OVER?

Tip #4 is what to do when anxiety takes over in the biggest way, and that ultimately means, what can you do when your brain is setting on the full alarm. Now in this case, I’m just going to say it’s basically what to do if you’re panicking and the advice goes the same as it is whether there’s a health anxiety panic attack or a regular non-health anxiety panic attack, which is do not try to push the anxiety away. Let’s break it down.

If you’re having anxiety, and you are saying, “This is bad, I don’t want it, it shouldn’t be here,” you’re actually telling your brain that the anxiety is dangerous. Not just the health issue, but also the presence of anxiety is dangerous, which means it’s going to pump out more and more anxiety because you’ve told it that anxiety is dangerous. Your job here is to let the anxiety be there. Try not to push it away. What we know is what you try to push away comes stronger. 

You can talk to your anxiety. There’s actually research to show that when you talk to your anxiety and you talk to yourself in the third person, it can actually empower you and feel more of a sense of empowerment and mastery over that experience. For me, unfortunately, I’ve had quite the 24 hours. We actually had a very large earthquake last night here in southern California, which woke me up, so I had some anxiety related to that. And then of course, my brain was like, “Oh yeah, and by the way, you might have cancer. Ha-ha-ha!” You know what I mean? Of course, your brain’s going to tell you that. 

In that moment, I used the skill and the research around talking to myself in the third person. I said, “Kimberley, there’s nothing you can do right now. It makes total sense that you have anxiety. Let’s not push it away. Let’s bring your attention to what you can control, which is how kind you are to yourself, whether you’re clenching your body up, whether you’re breathing, whether what you’re putting your attention on. You can’t control anything. You can’t control this earthquake. You can’t control what’s happening tomorrow. All you can do is be here now.” Using a third person, using your name as the third person like, “Kimberley...” and saying what you need to do. Coaching yourself has been incredibly helpful for me and I know for a lot of people because that’s actually science-based. 

TIP #5: ENGAGE IN VALUE-BASED BEHAVIORS

The next thing I want you to do, and this is the final one before we go through some questions that I want you to ask yourself, is to engage in value-based behaviors. Now what that means is when we’re anxious, when we have health anxiety, it’s very normal for us to want to engage in safety behaviors. One for me was every morning, I drop my daughter off and my husband drops my son off at school and I could feel my anxiety wanting to stay home. I don’t want to go out. And so I almost was starting to say, “Maybe I’ll ask my husband to drop off my daughter and my son so I can stay home.” I recognize that would be me doing a fear-based behavior. I would be doing that only because I don’t want to face fear today. I just want to make it small. 

Number one, it’s okay. If you need to do that, that’s totally okay. But for me personally, I caught myself and I said, “No, you value being someone who drops off your daughter and shows up and doesn’t let anxiety win. You love dropping off your daughter. If you stayed home, you’d only be doing the dishes, circling around, maybe catastrophizing, just trying to get past time. You love taking your daughter to drop off.” And so engage in that. 

Another value-based behavior for me personally is humor. I’m texting friends and I’m telling them jokes about what I’m going to do to my doctor if he says something wrong or something, or I’m making jokes about some of the questions and statements that the nurses made. I’m making jokes about it, not to catastrophize, not to put them down, not to minimize my own discomfort, but humor is a very big part of my values. I’m making jokes about what we’ll do if it’s cancer and will you come to my funeral and silly things. Again, I really want to make sure you understand, I’m not doing that as depressed bad things are going to happen. I’m doing it because I’m literally saying, it will be what it will be. Let’s just move forward and let’s actually bring some light and joy and some laughter to this. 

Now you might not like that. If that’s not your values, don’t do it, but identify, what would the non-anxious me do right now? What would I do if this fear wasn’t here? And then do those behaviors. It’s really, really important that you make sure you hit this in as many ways as you can because fear can cause us just to clam up and sit still and ruminate. It’s very important that you practice not just ruminating and cycling and going over and over and over and over all of the worst-case scenarios because your brain will take you to some very dark places.

HEALTH ANXIETY JOURNAL PROMPTS

This is really important. I know I’ve given you the top five, but that’s more like 20 points. Let’s talk about some hypochondria or health anxiety journal prompts or questions you can ask yourself to stay as skilled as you can. 

  • What is in my control right now? 

What is in my control? My behaviors, my reactions. That’s ultimately what is in your control. What’s not in your control is how much anxiety you have and what thoughts you have about them. 

  • What is not in my control? 

You can be very specific here. In my case, it’s like, what’s not in my control is what the doctor says. What’s not in my control is what my health condition is. What’s not in my control is when he calls. You know what I mean? What’s not in my control is the treatment plan. I’m going to have to wait for him to do that. I’m identifying what is in my control and what is not. 

  • How am I going to gain a sense of control that is helpful to both my long-term health anxiety recovery goals and my health anxiety treatment plan? 

For me, I know that Googling is going to be a full sense of control and doesn’t help my long-term recovery, so I’m not going to do it. I know that me ruminating and doing tons of mental compulsions is going to give me a sense of control, but it’s not helpful. It’s not helpful. It doesn’t help my long-term recovery, it doesn’t help my long-term mental health, so I’m not going to do it. 

What will help my long-time health anxiety goals, it’s going to be all the tips that we covered today—no Googling, no checking faces, no reassurance seeking, no swaying the doctor, practicing my mindfulness, being as compassionate as I can, maybe taking some breaths. All of those are going to make me stronger in my health anxiety recovery instead of weaker the ones which would be ruminating and doing all of these. Not very helpful safety behaviors. 

  • How willing am I to be uncertain right now? 

You guys are going to have to tolerate a lot of uncertainty. That’s what this is all about. From the minute I got the call from that nurse saying that I needed to have this video appointment, from the minute he got onto the video appointment, all I had to focus on is, am I willing to be uncomfortable? Am I willing to be uncertain? Because the only reason I would’ve Googled was because I wanted certainty. Really, really important. 

  • What would the non-anxious me do right now? 

She’d get up and she’d go and drop her daughter off, and then she’d call your friend because that’s what you do every Wednesday morning. She’d respond to emails, she’d call. Do whatever it is that you’re doing. What would the non-anxious you do?

  • How can I be kind and gentle towards myself as I navigate this experience? 

Another code question for that is, what do I need right now that is skillful? What do you need? The most beautiful thing about this is my husband. He is the most gorgeous man. He sits down. He doesn’t reassure me, he just says, “I got you.” If your partner is giving you a lot of reassurance, you might want to mention to them, “That actually doesn’t help my long-term health anxiety. I just need you to be next to me and support me.” And so it’s very important that we make sure our partners aren’t giving us a whole bunch of reassurance and a whole bunch of certainty-seeking behaviors that keep us stuck. 

That’s it guys. There are my five tips for health anxiety which turned out to be more like 20, I know, but I try to always overdeliver. I really wanted to jam in as many skills as I could.

I hope you have a wonderful day. Please do not worry about me. I am actually fine. There’s a joke between my best friend and I. We say, “Are you fine number one or fine number two?” Fine number one is you actually are fine and fine number two is you’re not fine, but you’re saying you are, and I am fine number one. I actually have a lot of faith in my doctors. I have a lot of faith in my ability to handle these things and these are just another bump on the road in terms of being someone who has postural orthostatic tachycardic syndrome. So all is well. All is well. I am fine number one and I hope you are fine number one as well. 

I am sending you so much love. Do not forget, it is a beautiful day to do all the hard things, and I’ll see you next week.

Feb 10, 2023

5 TIPS FOR HEALTH ANXIETY DURING A DRS VISIT

If you want my five tips for health anxiety during a Drs visit, especially if you have a medical condition that concerns you, this is the episode for you.



Hello and welcome back everybody. Today, I’m going to share some updates about a recent medical issue I have had, and I’m going to share specific tips for dealing with health anxiety (also known as hypochondria). 

323 5 tips for health anxiety

A lot of you who have been here with me before know I have postural orthostatic tachycardic syndrome. I also have a lesion on my left cerebellum and many other ups and downs in my medical history where I’ve had to get really good at managing my health anxiety. I wanted to share with you some real-time tips that I am practicing as I deal with another medical illness or another medical concern that I wanted to share with you. 

Here I’m going to share with you five specific tips, but I think in total, there’s 20-something tips all woven in here. I’ve done my best to put them into just five. But do make sure you listen to the end of the podcast episode because I’m also going to give some health anxiety journal prompts or questions that you can ask yourself so that you can know how to deal with health anxiety if you’re experiencing that at this time. 

Before we get into it, let me give you a little bit of a backstory. Several months ago, I did share that I’ve been having these what I call surges. They’re like adrenaline surges. They wake me up. My heart isn’t racing. It’s not like it’s racing fast, but the only way I can explain it is I feel like I have like a racehorse’s heart in my chest, like this huge heart that’s beating really heavily. Of course, that creates anxiety. And so then I would question like, is it the heartbeat or is it just my anxiety? You go back and you go forward trying to figure out which is which. But because this was a symptom that was persisting and was also showing up when I wasn’t experiencing a lot of stress or anxiety, I thought the right thing to do is to go and see the doctor. 

WHAT HEALTH ANXIETY FEELS LIKE

Before we get started, be sure to make sure you’re not avoiding doctors. Make sure you’re not dismissing symptoms. We do have to find a very, very wise balance between avoiding doctors but also not overdoing it with doctors. We’ll talk about that a little bit here in a minute. But first, I wanted to just share with you what health anxiety feels like for me. Because for me, I’m very, very skilled at identifying what is anxiety and what is not. I’ve become very good at catching that by experience, folks. It’s not something that comes naturally, but by experience, I can identify what is health anxiety and what is a real medical condition or what is something worthy of me getting checked out. 

For me, for the health anxiety piece, it’s really this sort of anxiety that is a sense of catastrophization and it’s usually in the form of thoughts like, what if this is cancer? What if this is a stroke? All the worst-case scenarios. What if this is life-threatening? What if I miss this and you are responsible, you should have picked it up. These are very common health anxiety intrusive thoughts or health anxiety thoughts that I think you really need to be able to catch and be aware and mindful of. First of all, that is the biggest symptom for me. 

The other thing is when you have health anxiety, you do tend to hyper-fixate on the symptom and all of the surrounding symptoms that are going with that. And then you can really catastrophize those like, “Well, my heart’s beating really heavily and I feel dizzy. Oh my gosh. And I’ve been having a headache. Yeah, you’re right, I’ve been having a headache. Oh my gosh.” I call it ‘gathering.’ That’s not an actual clinical term, but I do use it with my clients. We gather data that is catastrophic to make it seem like, yeah, we actually have a really big point, and this is actually a catastrophe. 

Some other health anxiety symptom that I experience is panic. When you notice a symptom, it is very common to start panicking. And then again, you go back to this chicken or the egg or is it the horse or the carriage in terms of I’m panicking, and now the panic has all these symptoms. Are these symptoms an actual medical condition or are they actually just anxiety and panic? You could spend a lot of time stuck in that cycle trying to figure that out. 

Let’s now talk about how to manage these symptoms and some tips and tools that you can use. 

Tip #1: No Googling

Let me tell you what has recently happened to me. I’ve been having these symptoms. I made an appointment to see my cardiologist. It was two months out and I was like, “It’s not a big deal. I can handle these symptoms.” I’m feeling super confident about my ability now to just ride out some pretty uncomfortable sensations and not catastrophize. I go in for my checkup, they do an echocardiogram, and it’s taking a long time. She’s asking me these strange questions like, “Why are you here again,” as she’s doing it. She’s checking, she’s looking, she’s squinting at the screen. “Why are you here again? What are your symptoms?” Click, click, click, looking at the heart, whatever. Again, I’m in my mind going, “Kimberley, let your brain have whatever thoughts it wants. We’re not going to catastrophize.” I was doing really, really well. I got up and I answered her questions. I did the whole appointment. She cleaned me off when I was done and said, “Great, you’ve got 24 hours and then the doctor will email you with your results.”

And then yesterday afternoon, I get a call from the nurse saying, “We need to book you a video appointment with the doctor to discuss your results.” As you can imagine, my brain went berserk. My health anxiety thoughts were saying, “This is really bad. Why would he need to make a video appointment? This can only end badly. This must be cancer. This must be heart problems. Am I going to have a heart attack and so forth?” Of course, my brain did that. I’m grateful my brain does that because that’s my brain being highly functioning and aware. 

But the number one rule I made with myself in that exact moment, even though that was very anxiety-producing, is no Googling. Kimberley, you are not allowed to pick up the computer or the iPhone and Google anything about this.

That is tip #1 for you. I’ll tell you why. A lot of my patients say, “But why? It’s no harm. I’m not doing any harm.” And I’ll say, “Yes.” I’ve actually just seen my cardiologist. But now that I’ve had my appointment, he encouraged me to do a little research. What was hilarious to me is every single website is different and some catastrophize and some don’t. Some go, “This could be very normal.” Other ones say, “This could be cancer, cancer, cancer, cancer.”

This is why I’m telling my patients all the time, don’t Google because what you read is different. It’s not like this is going to be a factual thing. Most of the time people who have articles that rank high on Google searches are the ones who have optimized their website to be very easy to Google. The reason they have become number one on the Google algorithm is because they’ve included keywords like cancer for blah, blah, blah, and all of these health issues and health names. The ones that are at the top, some of them are very reasonable, helpful, and accurate, but a lot of them are not. They’ve just really done a great job of putting in lots and lots of keywords that makes them highly searchable and come up high on the algorithm.

Please, number one, do not Google. Go to your doctor for questions if you have any. Unless they’ve encouraged you to do research, do not Google.

TIP #2: FOLLOW IMPORTANT HEALTH ANXIETY CBT TECHNIQUES

I’ve actually categorized this in a bigger category and I’ve called it important health anxiety CBT techniques, because there are some important CBT tools that you’re going to need here and here we go. 

While I was in getting my echocardiogram, I was laying and I was having some anxiety because she was squinting and asking some strange questions, not in the normal of what I’d experienced. I could feel the pull to check her face for reassurance like, does she look concerned? Does she look relaxed? What’s going on with her? I wonder what she meant. 

What I want to encourage you to do is acknowledge and catch when you’re checking their face to try to decipher what the nurse or the assistant or the doctor is doing and saying. Because really, all I’m doing there is mind reading because I have no idea what she’s thinking. I was laughing at myself because she was squinting and looking concerned. I was like, “I wonder if she’s trying not to pass gas.” We could mind read that she thinks I have cancer and that there’s a big problem, or maybe she’s just trying not to pass gas right now. Maybe she’s thinking about a fight she just had with her partner. My attempt to analyze her facial expression is a complete waste of my time. You could use that tip anytime you want. 

The next tip for you is no reassurance seeking with nurses or doctors. Now, I actually felt almost into this trap. If I’m being completely honest, I did fall into this trap, but I caught myself really quickly. As she was finishing up, she took off her gloves and got ready to discharge me, and I said, “So, you’d let me know if there was...” I paused because what I was going to say is, “You’ll let me know if there’s something wrong, right?” I was going to say that. And then I was like, “No, no, no.” I stopped myself and said, “You know what? I know the deal. I’ve done these enough times. I know I have to wait for the doctor.” But I caught myself wanting to get confirmation from the nurse and I already know that nurses are not allowed to give me any diagnosis anyway. I caught myself wanting to get some expression of relief from her like, “No, you’re fine. Everything looks good,” or whatever. Sometimes they accidentally give you that reassurance. But I caught myself seeking reassurance from her. 

In addition to that—let me talk to you a little later about how we do that with doctors as well—often if you’re in the office with a doctor, you may find yourself at the end of the session going, “I’ll be fine, right? It’s not bad, right?” It’s okay, we’re all going to ask some of those questions. I’m not going to be the reassurance-seeking police with you. But what I want you to do is really drop down into catching when we’re engaging in reassurance seeking and using it too much to reduce our own anxiety about it, to take away our own anxiety or fear.

Now, another CBT technique or sort of rule that we often set in clinical work when I’m talking with my clients who have health anxiety is also not swaying the doctor or the nurse to answer things in the way that you want. A lot of people fall into this trap. For me, I just had my doctor’s appointment. We are working through and there are some little problems that we will work out. But I caught myself there wanting to sway him to be very positive. We had talked about it ultimately. He had said, “There are some issues. It could be this, it could be that, it could be this.” He listed off three or four options. Some were very, very small, and of course, the third one is always like, it could be cancer. They always say at the end, like whatever.

When they give you these three or four or five options on what the problem might be, it’s very important that you be mindful and aware of how you’re trying to sway the doctor to give you certainty. This is what my doctor said, and I’m going to be brief. I’m not going to bore you with my medical stuff, but he’ll say, “It could be that you recently had COVID or an illness or a virus. It could also be this other condition, which is common, and if it’s so, we’ll treat that. It could also be that there could be some rheumatoid arthritis and that’s a longer treatment. And then the final thing, which we don’t think so, but it also could be cancer. “Let’s say he lists off these four options. 

Now, this is very common. Doctors will do this often because their job is to educate us on all of the possibilities so that we can create a treatment plan that doesn’t ignore big issues, but we have to be careful that we don’t spend their time and our time going, “You think it’s the first one, right? It’s probably just the first one. I probably just had a virus, right?” I’m really swaying him towards giving an answer when he’s already told us that he or she doesn’t know yet. He’s already said, “I don’t know yet. We’re going to need to do extra tests.”

Catch yourself trying to get them to reassure you and confirm that it’s definitely not the C word. The cancer word is what I’m saying there. Catch yourself when you’re doing those behaviors in the office with either the nurses or the technician or the doctors. Very, very important. 

Now, one other thing I want you to also catch is if you’re coming to them with something, let’s say you are coming to them with a concern that you’ve pretty much know is your health anxiety, but you want reassurance that it’s not, also be careful that you don’t overly list things to convince them that something is wrong. A lot of you don’t do this, I know, but I have had a lot of clients who’ve come back to me after seeing the doctor and said, “Do you have any other symptoms,” and they would list even minor symptoms that they had a month ago that they knew had nothing to do with it. But they felt like if they didn’t say it all, if they didn’t include every symptom, every stomach ache, every headache, everything, they could miss something. So also keep an eye out for that.

That’s some sort of overall general CBT techniques we use for health anxiety that help guide people into not engaging in those health anxiety compulsions.

TIP #3: HEALTH ANXIETY HELP DURING YOUR DOCTOR’S VISIT

This is a really important part of it. From the minute that I got the call from the nurse that he wanted a video call with me, my mind went to, again, the worst-case scenario. It just does. It just does. I think that that is actually really, really normal. I really do. I think that is what happens naturally for anybody. First of all, I don’t want to even go too over in terms of pathologizing that. I think that’s a normal thing for anybody to experience. 

The first thing I want you to practice is validating your anxiety. It’s a part of self-compassion practice. It’s going, “It makes complete sense, Kimberley, that this is concerning you.” That’s one of the most important self-compassionate statements you could make for yourself. “It makes complete sense that this is hard, this is scary. Of course, it’s making you uncomfortable.” It’s validating. 

You might even move to a common humanity, going, “Anybody in this situation would have anxiety.” Then you can also move into mindfulness skills, which is—this was one that I hold very true—just because I feel anxious doesn’t mean there’s danger or there’s a catastrophe. It’s my body’s natural response to create anxiety when it feels threatened. That keeps me alive. That’s a good thing. But just because I’m anxious and having thoughts about scary things doesn’t mean they’re facts. Remember, thoughts are not facts.

The next thing here is also being able to just observe them, again, while you’re sitting in the waiting room. They were playing the movie, what’s it called? Moana. And I love Moana. I remember watching it as a child. I’m sitting in the seat and my mind is offering me all of these health anxiety intrusive thoughts, and my mind really wants me to pay attention to them. 

A part of my mindfulness practice was to go, “I am noticing I’m having these catastrophic thoughts, but I’m also noticing Moana, and I’m going to choose which one I give my attention to.” I’m not going to push them away. I’m not going to make the thoughts go away because they’re naturally going to be there. I basically knew from yesterday afternoon until 9:00 AM this morning that the thoughts were going to be there and I accepted them there. I didn’t go in saying, “Oh gosh, I hope the next 24 hours aren’t filled with thoughts.” I was like, they’re going to be, “Hello thoughts, welcome. I know you’re going to be here,” and I’m going to train my brain to put attention on what matters to me. In this case, I’m not going to make these thoughts important. I’m going to watch Moana. I’m going to look at the colors, I’m going to listen to the sounds, I’m going to notice whatever it is that I notice. I’m going to notice the fabric of the seat underneath me as I’m waiting in the room. Last night as I went to bed, I’m just going to notice the feeling of the cushions underneath me. This is mindfulness and this is so important—being present and paying attention to what is currently happening instead of the worst-case scenario.

There’s one important point here, which is my mind kept saying, “By nine o’clock tomorrow, your life might change.” You guys know what? If you’re listening, I’m guessing you know what that’s like. You’re like, “After this appointment, this appointment may change your life for the worse.” My job was to go, “Maybe, maybe not. It could be that he just wants to tell me everything’s okay.”

It is what it is. It will be what it will be. I will work through it and solve it when it happens. I’m not going to live the next 24 hours or the next 12 hours coming from a place of the worst-case scenario until I have actual evidence of that. So we are not going to live your life as you wait for your appointment. We’re not going to live your life through the lens of the worst case. We’re going to live through it through being uncertain and accepting that in this moment, nothing is wrong. Until we know, we don’t know. 

MEDITATION FOR HEALTH ANXIETY

Now, other options for you, I’m just going to add a couple here, is I have found meditation for health anxiety to be very, very helpful, particularly when health anxiety is taking over. That has been very beneficial for me—to find a meditation that can actually sometimes give me some concrete skills to use in the moment to stay present. We are not going towards staying calm because maybe you’re going to have some anxiety. That’s okay. Really what we want to do is we want to be working in the most skillful fashion as we can. 

And then the last one, this one’s a little controversial. Some people don’t agree with this piece of advice, so take what you need and leave what doesn’t help. But for me, when I’m anxious, I tend to shallow breathe a lot. I hold my breath a lot. For me, it was just reminding myself just to breathe. Not breathe in any particular fashion or deep breathing, but just be like, “Take a breath, Kimberley, when you need. Take a breath when you need.”

TIP #4: WHAT TO DO WHEN HEALTH ANXIETY TAKES OVER?

Tip #4 is what to do when anxiety takes over in the biggest way, and that ultimately means, what can you do when your brain is setting on the full alarm. Now in this case, I’m just going to say it’s basically what to do if you’re panicking and the advice goes the same as it is whether there’s a health anxiety panic attack or a regular non-health anxiety panic attack, which is do not try to push the anxiety away. Let’s break it down.

If you’re having anxiety, and you are saying, “This is bad, I don’t want it, it shouldn’t be here,” you’re actually telling your brain that the anxiety is dangerous. Not just the health issue, but also the presence of anxiety is dangerous, which means it’s going to pump out more and more anxiety because you’ve told it that anxiety is dangerous. Your job here is to let the anxiety be there. Try not to push it away. What we know is what you try to push away comes stronger. 

You can talk to your anxiety. There’s actually research to show that when you talk to your anxiety and you talk to yourself in the third person, it can actually empower you and feel more of a sense of empowerment and mastery over that experience. For me, unfortunately, I’ve had quite the 24 hours. We actually had a very large earthquake last night here in southern California, which woke me up, so I had some anxiety related to that. And then of course, my brain was like, “Oh yeah, and by the way, you might have cancer. Ha-ha-ha!” You know what I mean? Of course, your brain’s going to tell you that. 

In that moment, I used the skill and the research around talking to myself in the third person. I said, “Kimberley, there’s nothing you can do right now. It makes total sense that you have anxiety. Let’s not push it away. Let’s bring your attention to what you can control, which is how kind you are to yourself, whether you’re clenching your body up, whether you’re breathing, whether what you’re putting your attention on. You can’t control anything. You can’t control this earthquake. You can’t control what’s happening tomorrow. All you can do is be here now.” Using a third person, using your name as the third person like, “Kimberley...” and saying what you need to do. Coaching yourself has been incredibly helpful for me and I know for a lot of people because that’s actually science-based. 

TIP #5: ENGAGE IN VALUE-BASED BEHAVIORS

The next thing I want you to do, and this is the final one before we go through some questions that I want you to ask yourself, is to engage in value-based behaviors. Now what that means is when we’re anxious, when we have health anxiety, it’s very normal for us to want to engage in safety behaviors. One for me was every morning, I drop my daughter off and my husband drops my son off at school and I could feel my anxiety wanting to stay home. I don’t want to go out. And so I almost was starting to say, “Maybe I’ll ask my husband to drop off my daughter and my son so I can stay home.” I recognize that would be me doing a fear-based behavior. I would be doing that only because I don’t want to face fear today. I just want to make it small. 

Number one, it’s okay. If you need to do that, that’s totally okay. But for me personally, I caught myself and I said, “No, you value being someone who drops off your daughter and shows up and doesn’t let anxiety win. You love dropping off your daughter. If you stayed home, you’d only be doing the dishes, circling around, maybe catastrophizing, just trying to get past time. You love taking your daughter to drop off.” And so engage in that. 

Another value-based behavior for me personally is humor. I’m texting friends and I’m telling them jokes about what I’m going to do to my doctor if he says something wrong or something, or I’m making jokes about some of the questions and statements that the nurses made. I’m making jokes about it, not to catastrophize, not to put them down, not to minimize my own discomfort, but humor is a very big part of my values. I’m making jokes about what we’ll do if it’s cancer and will you come to my funeral and silly things. Again, I really want to make sure you understand, I’m not doing that as depressed bad things are going to happen. I’m doing it because I’m literally saying, it will be what it will be. Let’s just move forward and let’s actually bring some light and joy and some laughter to this. 

Now you might not like that. If that’s not your values, don’t do it, but identify, what would the non-anxious me do right now? What would I do if this fear wasn’t here? And then do those behaviors. It’s really, really important that you make sure you hit this in as many ways as you can because fear can cause us just to clam up and sit still and ruminate. It’s very important that you practice not just ruminating and cycling and going over and over and over and over all of the worst-case scenarios because your brain will take you to some very dark places.

HEALTH ANXIETY JOURNAL PROMPTS

This is really important. I know I’ve given you the top five, but that’s more like 20 points. Let’s talk about some hypochondria or health anxiety journal prompts or questions you can ask yourself to stay as skilled as you can. 

  • What is in my control right now? 

What is in my control? My behaviors, my reactions. That’s ultimately what is in your control. What’s not in your control is how much anxiety you have and what thoughts you have about them. 

  • What is not in my control? 

You can be very specific here. In my case, it’s like, what’s not in my control is what the doctor says. What’s not in my control is what my health condition is. What’s not in my control is when he calls. You know what I mean? What’s not in my control is the treatment plan. I’m going to have to wait for him to do that. I’m identifying what is in my control and what is not. 

  • How am I going to gain a sense of control that is helpful to both my long-term health anxiety recovery goals and my health anxiety treatment plan? 

For me, I know that Googling is going to be a full sense of control and doesn’t help my long-term recovery, so I’m not going to do it. I know that me ruminating and doing tons of mental compulsions is going to give me a sense of control, but it’s not helpful. It’s not helpful. It doesn’t help my long-term recovery, it doesn’t help my long-term mental health, so I’m not going to do it. 

What will help my long-time health anxiety goals, it’s going to be all the tips that we covered today—no Googling, no checking faces, no reassurance seeking, no swaying the doctor, practicing my mindfulness, being as compassionate as I can, maybe taking some breaths. All of those are going to make me stronger in my health anxiety recovery instead of weaker the ones which would be ruminating and doing all of these. Not very helpful safety behaviors. 

  • How willing am I to be uncertain right now? 

You guys are going to have to tolerate a lot of uncertainty. That’s what this is all about. From the minute I got the call from that nurse saying that I needed to have this video appointment, from the minute he got onto the video appointment, all I had to focus on is, am I willing to be uncomfortable? Am I willing to be uncertain? Because the only reason I would’ve Googled was because I wanted certainty. Really, really important. 

  • What would the non-anxious me do right now? 

She’d get up and she’d go and drop her daughter off, and then she’d call your friend because that’s what you do every Wednesday morning. She’d respond to emails, she’d call. Do whatever it is that you’re doing. What would the non-anxious you do?

  • How can I be kind and gentle towards myself as I navigate this experience? 

Another code question for that is, what do I need right now that is skillful? What do you need? The most beautiful thing about this is my husband. He is the most gorgeous man. He sits down. He doesn’t reassure me, he just says, “I got you.” If your partner is giving you a lot of reassurance, you might want to mention to them, “That actually doesn’t help my long-term health anxiety. I just need you to be next to me and support me.” And so it’s very important that we make sure our partners aren’t giving us a whole bunch of reassurance and a whole bunch of certainty-seeking behaviors that keep us stuck. 

That’s it guys. There are my five tips for health anxiety which turned out to be more like 20, I know, but I try to always overdeliver. I really wanted to jam in as many skills as I could.

I hope you have a wonderful day. Please do not worry about me. I am actually fine. There’s a joke between my best friend and I. We say, “Are you fine number one or fine number two?” Fine number one is you actually are fine and fine number two is you’re not fine, but you’re saying you are, and I am fine number one. I actually have a lot of faith in my doctors. I have a lot of faith in my ability to handle these things and these are just another bump on the road in terms of being someone who has postural orthostatic tachycardic syndrome. So all is well. All is well. I am fine number one and I hope you are fine number one as well. 

I am sending you so much love. Do not forget, it is a beautiful day to do all the hard things, and I’ll see you next week.

Feb 3, 2023

Today, we’re talking about the Top 5 Relationship Rules I have that have changed my life. This episode was inspired by a letter I wrote to all of you. For those of you who signed up for my newsletter, I give you tools and tips, and stories, and I tell you funny jokes sometimes. But I was writing the newsletter while I was in Australia just before I left when I was there in December, and I was reflecting on how beautiful my relationships are with my family now. And I was reflecting on why. Why are they so beautiful? Well, number one, they’re beautiful people. But number two, more importantly, I have learned these relationship rules, which have allowed me to have the most beautiful relationship with my family and the most beautiful relationship with my husband, my kids, my friends, and you guys.



Now, that doesn’t mean there are no bumps. That doesn’t mean there are no arguments. A few weeks ago, I wrote in the newsletter about how I had an argument with my husband. Of course, I was joking about how wrong he was and how right I was. But it doesn’t mean we don’t have conflict, but we get to coexist because of these relationship rules, and I want to share them with you. 

Before we proceed, I want to say, these mightn’t work for you. I think they work well, but I don’t want you to feel guilty, ashamed, embarrassed, angry, or whatever the feelings are if you feel like these don’t match you. So take what you need here. Leave what isn’t helpful for you; if it’s useful for you, wonderful. If it doesn’t sit right, one of them doesn’t sit right, that is not a problem. It’s totally okay to use what helps you. When I’m talking on this podcast, I’m giving you ideas, so be curious and consider them, but it doesn’t mean that I’m always right, I think I’m right, or I know what’s right for you. 

All right, here we go. I’m going to go through them quickly and then elaborate a little later once we get through, okay? But I want to remind you that these relationship rules help me stay solid in my relationships, and they’ve gotten me through some of the hardest periods and seasons of my life. So, let’s see if they’re helpful for you. 

Ep. 322 5 Relationship rules that have changed my life

1. It is not your job or my job to manage our family’s emotions. 

Their emotions are their responsibility, and it is their job to regulate their emotions when they’re upset with us. And it’s our job to regulate and manage our emotions when we are upset. Now, what does regulate mean? It means you’re allowed to have them. We’re not saying that no one’s allowed to be upset, but we have to communicate and share with them and regulate by not throwing things, lashing out, saying unkind things, saying things that aren’t true, saying ‘you’ statements like, “You’re so blah, blah, blah.” We want to use ‘I’ statements like, “I feel this way about that,” or “I would like this thing to happen.” So, we want to regulate as best as we can. Our job is to regulate what shows up for us, and their job is to regulate what shows up for them. 

2. It is not your job to please the people you are in relationship with.

Now, they get to have expectations and they get to communicate with you on what their expectations are, and you get to have expectations and you get to communicate their expectations. Now, this is so important, then we can have a respectful conversation. A lot of the time these days, I see people in relationships or even online where somebody disagrees and they’re so hurt. They’re like, “You’ve harmed me by saying that. I’m so hurt by what you said.” But the person gets to have their thoughts and their feelings. It’s not our job to manage it, and it’s not our job to please them either. So you get to have your beliefs and thoughts and ideas, and you get to disagree with other people as well. It’s as long as we’re able to do it respectfully. And when I say respectful, I’m not saying it in a people-pleasing way either. It is not our job to please people. It’s just not. 

Here’s a deeper one. Let me just jump into this a little: I’m still working on this and I get therapy. I have a lot of practice and I’ve read about the idea of my happiness. That’s my job. My happiness is my job. And I easily get caught up in, “No, if my partner would just do A, B, and C, then I can be happy,” or “If my kids just do A, B, and C, then I can be happy.” And that is true to a degree. But the problem with that rule, if you want to keep that rule, is you have no empowerment and no responsibility. It’s all up to them. Your life is in their hands. Your happiness is in their hands. 

And so, I like to think about, yeah, people can’t always please me, like I just said, and people are going to upset me. And then it’s my job to decide what I want to do with that, and it’s my job to determine how I’m going to cope today with the fact that they may not be living up to the way I want them to. So that’s really important. 

3. They are allowed to have their feelings about our choices. 

This is a big one for my husband and I. We say this to each other all the time. It’s like, “You’re allowed to have your feelings about that and so am I.” This one is so hard for me, especially in my marriage because if I upset him, I’d be like, “You shouldn’t be upset.” And he’s like, “I’m allowed to be upset. I’m allowed to have my feelings about it.” And I’m like, “No, but you shouldn’t.” And he’s like, “Yeah, but I am. I do.”

It is okay if they don’t like everything about us and if they disagree. It is our job to live according to our values, which doesn’t always align with their expectations of us. Our job is to go and live our lives and let them have their feelings about it. Then, we can communicate respectfully about our misalignment. “But that has been so beautiful for me.” To say, “You’re allowed to have your feelings about me, specifically me as a public person.” When I used to speak at a conference, or online or on Instagram, and someone would say something negative, I used to be like, “Oh, how dare they say something so mean? How could they disagree with me or not like me?” It was so painful because I had made this rule that they should only have good feelings about me. 

And now I’m okay. You can have all your feelings about me. You might like me, or you might hate me. You might like me one day and not like me the next. You might agree or not agree, and you get to have your feelings about me. I give you permission. It is so freeing to say, “I’m going to let everyone have permission to have their feelings about me.” That’s okay. I’m not for everyone. That sentence literally has healed me on the deepest level, probably more than any sentence. You’re allowed to have your feelings about me. So important.

4. It is okay if they struggle to understand us. 

In fact, I encourage you to accept that they will not always understand us. Sometimes people won’t have the capacity to understand us, and that doesn’t make us wrong. And it also doesn’t mean that you won’t be able to find a way to coexist and still love each other unconditionally. That’s so true. 

I always tell my patients, let’s say I come in and I’m wearing my favorite boots, which are a bit sassy, and you come in, and you’re like, “I hate your boots. They’re the ugliest boots ever.” I could even say, “Ah, you’re supposed to love my boots.” Or I could say, “That’s cool. You don’t have to love my boots. You get to have your feelings about them. And it’s okay if you don’t understand how rocking my boots are.” 

Now, this also goes for who you are. They get to have their feelings about who you are. They get to not like who we are, as long as they’re respectful, they don’t cross any boundaries, and they’re not abusive. They get to be upset, and it’s okay that they don’t understand us. As I said, some people can’t understand us. So important.

5. You get to (and they get to) change their mind or change, period. 

Again, this one was so hard for me. Now, for those of you who don’t know me, I’ve been married almost 20 years. It will be 20 years this year, which means my husband’s done a ton of changing, and so have my family, my friends, and so have you guys. There’s a lot of change. But they get to change. If somebody changes, we can’t go, “Wait, that’s not fair. I didn’t go into this relationship with you being this new version of you. You have to be the old version of you.” That’s not a real relationship. That’s saying you must stay the same and can’t express and be who you are. 

We could say, “You’ve changed, and these are my feelings about it,” as long as I’m doing it, not in a judgmental way or not in a way that’s trying to change them back because people get to change. They get to change their mind. So that’s another big one for me, is if someone says, “I like this,” and then they come back and say, “I actually really don’t,” I have to remind myself they’re allowed to change their mind because they’re allowed to have their feelings. And it’s okay that they don’t understand us, and they’re going to manage their own emotions, and I’m going to manage mine. 

We can’t hold ourselves to the expectation that will never change. As we go through different seasons in our life, we will change. And that might feel scary. But we can try using our mindfulness skills and our regulation skills to navigate the change and the emotions you have to feel. 

So those are the five relationship rules that have changed my life. Now, here’s the kicker. None of it is fun. None of it. This is some hard work. I nearly said that S word, which is fine. I’m allowed to swear, but it’s some hard shit. This is some terrible stuff to work through, but with it comes stronger and more unconditionally loving relationships. 

When I gave my husband permission to have his feelings about me, he was happier, and he loved me more because it meant that he didn’t have to pretend to be somebody else or he didn’t have to pretend to like something and get resentful because he actually didn’t like it. When I allowed myself to be different from my family, and I accepted that they might have feelings about that, and I gave them permission to have feelings about that, there wasn’t a problem anymore. 

The biggest problem, the biggest pain, the most suffering came when I was like, “No, they shouldn’t feel this way about me. That’s not fair”! But, it is fair. They get to have their feelings based on their own personal and their upbringing and their own incapacities and their own limitations. They get to have their feelings. It mightn’t be perfect, but I’m not perfect. 

You guys, I could add a fifth or sixth one here. I didn’t write this one in the email, but  I’m not perfect, and neither are they, and that’s okay. Sometimes I would say, “No, but they need to be this way because that’s the right way. This is the right way to be.” And I get it. Yeah, there is sometimes real right and wrong, like you shouldn’t harm people or say horrible things or critical things or racist things or misogynist things. We get that, and I agree with all that. But at the end of the day, the people in our lives will be imperfect, and we have to get better about not being black and white and cutting them off because they did a “bad” thing. 

I think cancel culture has taught us a lot in this idea of like, “You’re dead to me. You’re done. You’re canceled.”  Relationships don’t work like that. We’re human beings. We make mistakes. I’ve made a million mistakes. I’ve actually-- okay, now I’m going on and on. But we also have to learn to accept that we make mistakes and be willing to apologize for it. It’s a humble thing to do. It’s not fun, not fun at all, but we can also say we’re sorry too. 

So that’s it, you guys. There’s a humbling; there’s a humanity that we connect with when we can allow everyone to have their feelings, when we can allow ourselves to have our feelings when we can have limits and boundaries and clearly communicate that with our loved ones, but then also understand that sometimes they may not get it. 

Now there will be situations if you say, “I don’t like that,” and they will not respect you. You may need to make a limit and a boundary with them where they don’t have as much access to you. That’s 100% valid. And again, I’m not here telling you to accept other people’s bad behavior. Absolutely not. But we can accept that they have some feelings about it, as long as they’re communicating respectfully, kindly, compassionately, or at least they’re trying. At least they’re trying. 

So that’s it, folks. The five relationship rules that have literally changed my life and my relationships. I hope it’s helpful. It is a beautiful day to do hard things, and I will see you next week.

Feb 3, 2023

Today, we’re talking about the Top 5 Relationship Rules I have that have changed my life. This episode was inspired by a letter I wrote to all of you. For those of you who signed up for my newsletter, I give you tools and tips, and stories, and I tell you funny jokes sometimes. But I was writing the newsletter while I was in Australia just before I left when I was there in December, and I was reflecting on how beautiful my relationships are with my family now. And I was reflecting on why. Why are they so beautiful? Well, number one, they’re beautiful people. But number two, more importantly, I have learned these relationship rules, which have allowed me to have the most beautiful relationship with my family and the most beautiful relationship with my husband, my kids, my friends, and you guys.



Now, that doesn’t mean there are no bumps. That doesn’t mean there are no arguments. A few weeks ago, I wrote in the newsletter about how I had an argument with my husband. Of course, I was joking about how wrong he was and how right I was. But it doesn’t mean we don’t have conflict, but we get to coexist because of these relationship rules, and I want to share them with you. 

Before we proceed, I want to say, these mightn’t work for you. I think they work well, but I don’t want you to feel guilty, ashamed, embarrassed, angry, or whatever the feelings are if you feel like these don’t match you. So take what you need here. Leave what isn’t helpful for you; if it’s useful for you, wonderful. If it doesn’t sit right, one of them doesn’t sit right, that is not a problem. It’s totally okay to use what helps you. When I’m talking on this podcast, I’m giving you ideas, so be curious and consider them, but it doesn’t mean that I’m always right, I think I’m right, or I know what’s right for you. 

All right, here we go. I’m going to go through them quickly and then elaborate a little later once we get through, okay? But I want to remind you that these relationship rules help me stay solid in my relationships, and they’ve gotten me through some of the hardest periods and seasons of my life. So, let’s see if they’re helpful for you. 

Ep. 322 5 Relationship rules that have changed my life

1. It is not your job or my job to manage our family’s emotions. 

Their emotions are their responsibility, and it is their job to regulate their emotions when they’re upset with us. And it’s our job to regulate and manage our emotions when we are upset. Now, what does regulate mean? It means you’re allowed to have them. We’re not saying that no one’s allowed to be upset, but we have to communicate and share with them and regulate by not throwing things, lashing out, saying unkind things, saying things that aren’t true, saying ‘you’ statements like, “You’re so blah, blah, blah.” We want to use ‘I’ statements like, “I feel this way about that,” or “I would like this thing to happen.” So, we want to regulate as best as we can. Our job is to regulate what shows up for us, and their job is to regulate what shows up for them. 

2. It is not your job to please the people you are in relationship with.

Now, they get to have expectations and they get to communicate with you on what their expectations are, and you get to have expectations and you get to communicate their expectations. Now, this is so important, then we can have a respectful conversation. A lot of the time these days, I see people in relationships or even online where somebody disagrees and they’re so hurt. They’re like, “You’ve harmed me by saying that. I’m so hurt by what you said.” But the person gets to have their thoughts and their feelings. It’s not our job to manage it, and it’s not our job to please them either. So you get to have your beliefs and thoughts and ideas, and you get to disagree with other people as well. It’s as long as we’re able to do it respectfully. And when I say respectful, I’m not saying it in a people-pleasing way either. It is not our job to please people. It’s just not. 

Here’s a deeper one. Let me just jump into this a little: I’m still working on this and I get therapy. I have a lot of practice and I’ve read about the idea of my happiness. That’s my job. My happiness is my job. And I easily get caught up in, “No, if my partner would just do A, B, and C, then I can be happy,” or “If my kids just do A, B, and C, then I can be happy.” And that is true to a degree. But the problem with that rule, if you want to keep that rule, is you have no empowerment and no responsibility. It’s all up to them. Your life is in their hands. Your happiness is in their hands. 

And so, I like to think about, yeah, people can’t always please me, like I just said, and people are going to upset me. And then it’s my job to decide what I want to do with that, and it’s my job to determine how I’m going to cope today with the fact that they may not be living up to the way I want them to. So that’s really important. 

3. They are allowed to have their feelings about our choices. 

This is a big one for my husband and I. We say this to each other all the time. It’s like, “You’re allowed to have your feelings about that and so am I.” This one is so hard for me, especially in my marriage because if I upset him, I’d be like, “You shouldn’t be upset.” And he’s like, “I’m allowed to be upset. I’m allowed to have my feelings about it.” And I’m like, “No, but you shouldn’t.” And he’s like, “Yeah, but I am. I do.”

It is okay if they don’t like everything about us and if they disagree. It is our job to live according to our values, which doesn’t always align with their expectations of us. Our job is to go and live our lives and let them have their feelings about it. Then, we can communicate respectfully about our misalignment. “But that has been so beautiful for me.” To say, “You’re allowed to have your feelings about me, specifically me as a public person.” When I used to speak at a conference, or online or on Instagram, and someone would say something negative, I used to be like, “Oh, how dare they say something so mean? How could they disagree with me or not like me?” It was so painful because I had made this rule that they should only have good feelings about me. 

And now I’m okay. You can have all your feelings about me. You might like me, or you might hate me. You might like me one day and not like me the next. You might agree or not agree, and you get to have your feelings about me. I give you permission. It is so freeing to say, “I’m going to let everyone have permission to have their feelings about me.” That’s okay. I’m not for everyone. That sentence literally has healed me on the deepest level, probably more than any sentence. You’re allowed to have your feelings about me. So important.

4. It is okay if they struggle to understand us. 

In fact, I encourage you to accept that they will not always understand us. Sometimes people won’t have the capacity to understand us, and that doesn’t make us wrong. And it also doesn’t mean that you won’t be able to find a way to coexist and still love each other unconditionally. That’s so true. 

I always tell my patients, let’s say I come in and I’m wearing my favorite boots, which are a bit sassy, and you come in, and you’re like, “I hate your boots. They’re the ugliest boots ever.” I could even say, “Ah, you’re supposed to love my boots.” Or I could say, “That’s cool. You don’t have to love my boots. You get to have your feelings about them. And it’s okay if you don’t understand how rocking my boots are.” 

Now, this also goes for who you are. They get to have their feelings about who you are. They get to not like who we are, as long as they’re respectful, they don’t cross any boundaries, and they’re not abusive. They get to be upset, and it’s okay that they don’t understand us. As I said, some people can’t understand us. So important.

5. You get to (and they get to) change their mind or change, period. 

Again, this one was so hard for me. Now, for those of you who don’t know me, I’ve been married almost 20 years. It will be 20 years this year, which means my husband’s done a ton of changing, and so have my family, my friends, and so have you guys. There’s a lot of change. But they get to change. If somebody changes, we can’t go, “Wait, that’s not fair. I didn’t go into this relationship with you being this new version of you. You have to be the old version of you.” That’s not a real relationship. That’s saying you must stay the same and can’t express and be who you are. 

We could say, “You’ve changed, and these are my feelings about it,” as long as I’m doing it, not in a judgmental way or not in a way that’s trying to change them back because people get to change. They get to change their mind. So that’s another big one for me, is if someone says, “I like this,” and then they come back and say, “I actually really don’t,” I have to remind myself they’re allowed to change their mind because they’re allowed to have their feelings. And it’s okay that they don’t understand us, and they’re going to manage their own emotions, and I’m going to manage mine. 

We can’t hold ourselves to the expectation that will never change. As we go through different seasons in our life, we will change. And that might feel scary. But we can try using our mindfulness skills and our regulation skills to navigate the change and the emotions you have to feel. 

So those are the five relationship rules that have changed my life. Now, here’s the kicker. None of it is fun. None of it. This is some hard work. I nearly said that S word, which is fine. I’m allowed to swear, but it’s some hard shit. This is some terrible stuff to work through, but with it comes stronger and more unconditionally loving relationships. 

When I gave my husband permission to have his feelings about me, he was happier, and he loved me more because it meant that he didn’t have to pretend to be somebody else or he didn’t have to pretend to like something and get resentful because he actually didn’t like it. When I allowed myself to be different from my family, and I accepted that they might have feelings about that, and I gave them permission to have feelings about that, there wasn’t a problem anymore. 

The biggest problem, the biggest pain, the most suffering came when I was like, “No, they shouldn’t feel this way about me. That’s not fair”! But, it is fair. They get to have their feelings based on their own personal and their upbringing and their own incapacities and their own limitations. They get to have their feelings. It mightn’t be perfect, but I’m not perfect. 

You guys, I could add a fifth or sixth one here. I didn’t write this one in the email, but  I’m not perfect, and neither are they, and that’s okay. Sometimes I would say, “No, but they need to be this way because that’s the right way. This is the right way to be.” And I get it. Yeah, there is sometimes real right and wrong, like you shouldn’t harm people or say horrible things or critical things or racist things or misogynist things. We get that, and I agree with all that. But at the end of the day, the people in our lives will be imperfect, and we have to get better about not being black and white and cutting them off because they did a “bad” thing. 

I think cancel culture has taught us a lot in this idea of like, “You’re dead to me. You’re done. You’re canceled.”  Relationships don’t work like that. We’re human beings. We make mistakes. I’ve made a million mistakes. I’ve actually-- okay, now I’m going on and on. But we also have to learn to accept that we make mistakes and be willing to apologize for it. It’s a humble thing to do. It’s not fun, not fun at all, but we can also say we’re sorry too. 

So that’s it, you guys. There’s a humbling; there’s a humanity that we connect with when we can allow everyone to have their feelings, when we can allow ourselves to have our feelings when we can have limits and boundaries and clearly communicate that with our loved ones, but then also understand that sometimes they may not get it. 

Now there will be situations if you say, “I don’t like that,” and they will not respect you. You may need to make a limit and a boundary with them where they don’t have as much access to you. That’s 100% valid. And again, I’m not here telling you to accept other people’s bad behavior. Absolutely not. But we can accept that they have some feelings about it, as long as they’re communicating respectfully, kindly, compassionately, or at least they’re trying. At least they’re trying. 

So that’s it, folks. The five relationship rules that have literally changed my life and my relationships. I hope it’s helpful. It is a beautiful day to do hard things, and I will see you next week.

Feb 3, 2023

Today, we’re talking about the Top 5 Relationship Rules I have that have changed my life. This episode was inspired by a letter I wrote to all of you. For those of you who signed up for my newsletter, I give you tools and tips, and stories, and I tell you funny jokes sometimes. But I was writing the newsletter while I was in Australia just before I left when I was there in December, and I was reflecting on how beautiful my relationships are with my family now. And I was reflecting on why. Why are they so beautiful? Well, number one, they’re beautiful people. But number two, more importantly, I have learned these relationship rules, which have allowed me to have the most beautiful relationship with my family and the most beautiful relationship with my husband, my kids, my friends, and you guys.



Now, that doesn’t mean there are no bumps. That doesn’t mean there are no arguments. A few weeks ago, I wrote in the newsletter about how I had an argument with my husband. Of course, I was joking about how wrong he was and how right I was. But it doesn’t mean we don’t have conflict, but we get to coexist because of these relationship rules, and I want to share them with you. 

Before we proceed, I want to say, these mightn’t work for you. I think they work well, but I don’t want you to feel guilty, ashamed, embarrassed, angry, or whatever the feelings are if you feel like these don’t match you. So take what you need here. Leave what isn’t helpful for you; if it’s useful for you, wonderful. If it doesn’t sit right, one of them doesn’t sit right, that is not a problem. It’s totally okay to use what helps you. When I’m talking on this podcast, I’m giving you ideas, so be curious and consider them, but it doesn’t mean that I’m always right, I think I’m right, or I know what’s right for you. 

All right, here we go. I’m going to go through them quickly and then elaborate a little later once we get through, okay? But I want to remind you that these relationship rules help me stay solid in my relationships, and they’ve gotten me through some of the hardest periods and seasons of my life. So, let’s see if they’re helpful for you. 

Ep. 322 5 Relationship rules that have changed my life

1. It is not your job or my job to manage our family’s emotions. 

Their emotions are their responsibility, and it is their job to regulate their emotions when they’re upset with us. And it’s our job to regulate and manage our emotions when we are upset. Now, what does regulate mean? It means you’re allowed to have them. We’re not saying that no one’s allowed to be upset, but we have to communicate and share with them and regulate by not throwing things, lashing out, saying unkind things, saying things that aren’t true, saying ‘you’ statements like, “You’re so blah, blah, blah.” We want to use ‘I’ statements like, “I feel this way about that,” or “I would like this thing to happen.” So, we want to regulate as best as we can. Our job is to regulate what shows up for us, and their job is to regulate what shows up for them. 

2. It is not your job to please the people you are in relationship with.

Now, they get to have expectations and they get to communicate with you on what their expectations are, and you get to have expectations and you get to communicate their expectations. Now, this is so important, then we can have a respectful conversation. A lot of the time these days, I see people in relationships or even online where somebody disagrees and they’re so hurt. They’re like, “You’ve harmed me by saying that. I’m so hurt by what you said.” But the person gets to have their thoughts and their feelings. It’s not our job to manage it, and it’s not our job to please them either. So you get to have your beliefs and thoughts and ideas, and you get to disagree with other people as well. It’s as long as we’re able to do it respectfully. And when I say respectful, I’m not saying it in a people-pleasing way either. It is not our job to please people. It’s just not. 

Here’s a deeper one. Let me just jump into this a little: I’m still working on this and I get therapy. I have a lot of practice and I’ve read about the idea of my happiness. That’s my job. My happiness is my job. And I easily get caught up in, “No, if my partner would just do A, B, and C, then I can be happy,” or “If my kids just do A, B, and C, then I can be happy.” And that is true to a degree. But the problem with that rule, if you want to keep that rule, is you have no empowerment and no responsibility. It’s all up to them. Your life is in their hands. Your happiness is in their hands. 

And so, I like to think about, yeah, people can’t always please me, like I just said, and people are going to upset me. And then it’s my job to decide what I want to do with that, and it’s my job to determine how I’m going to cope today with the fact that they may not be living up to the way I want them to. So that’s really important. 

3. They are allowed to have their feelings about our choices. 

This is a big one for my husband and I. We say this to each other all the time. It’s like, “You’re allowed to have your feelings about that and so am I.” This one is so hard for me, especially in my marriage because if I upset him, I’d be like, “You shouldn’t be upset.” And he’s like, “I’m allowed to be upset. I’m allowed to have my feelings about it.” And I’m like, “No, but you shouldn’t.” And he’s like, “Yeah, but I am. I do.”

It is okay if they don’t like everything about us and if they disagree. It is our job to live according to our values, which doesn’t always align with their expectations of us. Our job is to go and live our lives and let them have their feelings about it. Then, we can communicate respectfully about our misalignment. “But that has been so beautiful for me.” To say, “You’re allowed to have your feelings about me, specifically me as a public person.” When I used to speak at a conference, or online or on Instagram, and someone would say something negative, I used to be like, “Oh, how dare they say something so mean? How could they disagree with me or not like me?” It was so painful because I had made this rule that they should only have good feelings about me. 

And now I’m okay. You can have all your feelings about me. You might like me, or you might hate me. You might like me one day and not like me the next. You might agree or not agree, and you get to have your feelings about me. I give you permission. It is so freeing to say, “I’m going to let everyone have permission to have their feelings about me.” That’s okay. I’m not for everyone. That sentence literally has healed me on the deepest level, probably more than any sentence. You’re allowed to have your feelings about me. So important.

4. It is okay if they struggle to understand us. 

In fact, I encourage you to accept that they will not always understand us. Sometimes people won’t have the capacity to understand us, and that doesn’t make us wrong. And it also doesn’t mean that you won’t be able to find a way to coexist and still love each other unconditionally. That’s so true. 

I always tell my patients, let’s say I come in and I’m wearing my favorite boots, which are a bit sassy, and you come in, and you’re like, “I hate your boots. They’re the ugliest boots ever.” I could even say, “Ah, you’re supposed to love my boots.” Or I could say, “That’s cool. You don’t have to love my boots. You get to have your feelings about them. And it’s okay if you don’t understand how rocking my boots are.” 

Now, this also goes for who you are. They get to have their feelings about who you are. They get to not like who we are, as long as they’re respectful, they don’t cross any boundaries, and they’re not abusive. They get to be upset, and it’s okay that they don’t understand us. As I said, some people can’t understand us. So important.

5. You get to (and they get to) change their mind or change, period. 

Again, this one was so hard for me. Now, for those of you who don’t know me, I’ve been married almost 20 years. It will be 20 years this year, which means my husband’s done a ton of changing, and so have my family, my friends, and so have you guys. There’s a lot of change. But they get to change. If somebody changes, we can’t go, “Wait, that’s not fair. I didn’t go into this relationship with you being this new version of you. You have to be the old version of you.” That’s not a real relationship. That’s saying you must stay the same and can’t express and be who you are. 

We could say, “You’ve changed, and these are my feelings about it,” as long as I’m doing it, not in a judgmental way or not in a way that’s trying to change them back because people get to change. They get to change their mind. So that’s another big one for me, is if someone says, “I like this,” and then they come back and say, “I actually really don’t,” I have to remind myself they’re allowed to change their mind because they’re allowed to have their feelings. And it’s okay that they don’t understand us, and they’re going to manage their own emotions, and I’m going to manage mine. 

We can’t hold ourselves to the expectation that will never change. As we go through different seasons in our life, we will change. And that might feel scary. But we can try using our mindfulness skills and our regulation skills to navigate the change and the emotions you have to feel. 

So those are the five relationship rules that have changed my life. Now, here’s the kicker. None of it is fun. None of it. This is some hard work. I nearly said that S word, which is fine. I’m allowed to swear, but it’s some hard shit. This is some terrible stuff to work through, but with it comes stronger and more unconditionally loving relationships. 

When I gave my husband permission to have his feelings about me, he was happier, and he loved me more because it meant that he didn’t have to pretend to be somebody else or he didn’t have to pretend to like something and get resentful because he actually didn’t like it. When I allowed myself to be different from my family, and I accepted that they might have feelings about that, and I gave them permission to have feelings about that, there wasn’t a problem anymore. 

The biggest problem, the biggest pain, the most suffering came when I was like, “No, they shouldn’t feel this way about me. That’s not fair”! But, it is fair. They get to have their feelings based on their own personal and their upbringing and their own incapacities and their own limitations. They get to have their feelings. It mightn’t be perfect, but I’m not perfect. 

You guys, I could add a fifth or sixth one here. I didn’t write this one in the email, but  I’m not perfect, and neither are they, and that’s okay. Sometimes I would say, “No, but they need to be this way because that’s the right way. This is the right way to be.” And I get it. Yeah, there is sometimes real right and wrong, like you shouldn’t harm people or say horrible things or critical things or racist things or misogynist things. We get that, and I agree with all that. But at the end of the day, the people in our lives will be imperfect, and we have to get better about not being black and white and cutting them off because they did a “bad” thing. 

I think cancel culture has taught us a lot in this idea of like, “You’re dead to me. You’re done. You’re canceled.”  Relationships don’t work like that. We’re human beings. We make mistakes. I’ve made a million mistakes. I’ve actually-- okay, now I’m going on and on. But we also have to learn to accept that we make mistakes and be willing to apologize for it. It’s a humble thing to do. It’s not fun, not fun at all, but we can also say we’re sorry too. 

So that’s it, you guys. There’s a humbling; there’s a humanity that we connect with when we can allow everyone to have their feelings, when we can allow ourselves to have our feelings when we can have limits and boundaries and clearly communicate that with our loved ones, but then also understand that sometimes they may not get it. 

Now there will be situations if you say, “I don’t like that,” and they will not respect you. You may need to make a limit and a boundary with them where they don’t have as much access to you. That’s 100% valid. And again, I’m not here telling you to accept other people’s bad behavior. Absolutely not. But we can accept that they have some feelings about it, as long as they’re communicating respectfully, kindly, compassionately, or at least they’re trying. At least they’re trying. 

So that’s it, folks. The five relationship rules that have literally changed my life and my relationships. I hope it’s helpful. It is a beautiful day to do hard things, and I will see you next week.

Jan 27, 2023

One of the most common questions I get asked is what do I do during or after an exposure? 

Number One, it’s so scary to do an exposure, and number two, there’s so many things that people have brought up as things to do, even me, this being Your Anxiety Toolkit. Maybe you get overwhelmed with the opportunity and options for tools that it gets too complicated. So, I want to make this super easy for you, and I want to go through step by step, like what you’re supposed to do during or after an exposure.



Now, I think it’s important that we first look at, there is no right. You get to choose, and I’m going to say that all the way through here, but I’m going to give you some really definitive goals to be going forward with as you do an exposure, as you face your fear. Now, make sure you stick around to the end because I will also address some of the biggest roadblocks I hear people have with the skills that I’m going to share. 

321 What do I do after (and during) exposures

Now, a lot of you know, I have ERP School if you have OCD and I have Overcoming Anxiety and Panic if you have panic, and I have BFRB School if you have hair pulling and skin picking. These are all basically courses of me teaching you exactly what I teach my patients. So, if you want a deeper in-depth study of that, you can, by all means, get the steps there of how to build an exposure plan, how to build a response prevention plan. Today, I’m going to complement that work and talk about what to do during and after an exposure. So here we go. 

Let’s say you already know what you’re going to face. Like I said, you’ve already created an exposure plan. You understand the cycle of the disorder or the struggle that you are handling, and you’ve really identified how you’re going to break that cycle and you’ve identified the fear that you’re going to face. Or just by the fact of nature being the nature, you’ve been spontaneously exposed to your fear. What do you do?

Now, let’s recap the core concepts that we talk about here all the time on Your Anxiety Toolkit, which is, number one, what we want to do is practice tolerating whatever discomfort you experience. What does that mean? It means being open and compassionate and vulnerable as you experience discomfort in your body. A lot of people will say, “But what am I supposed to do?” And this is where I’m going to say, this is very similar to me trying to teach you how to ride a bike on this podcast. Or I’ll tell you a story. My 11-year-old daughter was sassing me the other day and I was telling her I wanted her to unpack the dishwasher, and she said, “How?” She was just giving me sass, joking with me. And I was saying to her, “Well, you raise your hand up and you open your fist and you put your hand over the top of the dishwasher and you pull with your muscles down towards your--” I’m trying giving her like silly-- we’re joking with each other, like step by step.

Now, it’s very hard to learn how to do that by just words. Usually—let’s go back to the bike example—you have to get on the bike and feel the sensation of falling to know what to do to counter the fall as you start to lean to the left or lean to the right. And so, when it comes to willingly tolerating your discomfort, it actually just requires you practicing it, and if I’m going to be quite honest with you, sucking at it, because you will suck at it. We all suck at being uncomfortable. But then working at knowing how to counter that discomfort. Again, you’re on the bike, you’re starting to feel yourself move to the right and learning to lean to the left a little to balance it out. And that’s what learning how to be uncomfortable is about too. It’s having the discomfort, noticing in your body it’s tightening, and learning to do the opposite of that tightening. It is very similar to learning how to ride a bike. And it’s very similar in that it’s not just a cognitive behavior, it’s a physical thing. It’s noticing, “Oh, I’m tight.” For me, as I get anxious, I always bring my shoulders up and it’s learning to counter that by dropping them down. So, it’s tolerating discomfort. 

Now, often beyond that-- I’m going to give you some more strategy here in a second. But beyond that, it’s actually quite simple in that you go and do whatever it is that you would be doing if you hadn’t faced this hard thing. 

Here is an example. The other week during the holidays, one of my family members-- I’ll tell you the story. My mom and dad took a trip to Antarctica. This is a dream trip for them. They’re very well-traveled and they were going through what’s called the Drake Passage, which is this very scary passage of water. It took them 36 hours to sail through it and it can be very dangerous. And I noticed that the anxiety I was feeling in my body about the uncertainty of where they are and how far they’ve got to go and are they safe and all these things is I was sitting on the couch and I wasn’t engaging in anything. My kids were trying to talk to me and I was blowing them off. And I was scrolling on my phone instead of doing the things I needed to do. I was stuck and I was holding myself in this stuckness because I didn’t want to let go of the fear, but I did want to let go of the fear. It was this really weird thing where I was just stuck in a sense of freeze mode. And I had to remind myself, “Kimberley, they’re sailing through the Drake Passage. There’s nothing you can do. Go and live your life. Holding yourself on this couch is not going to change any outcome. You thinking about it is not going to change any outcome. Just go ahead with your life.”

And so, what I want to offer to you is—I’ve said this to my patients as well when they say, “What am I supposed to do now? I’ve done the exposure. What am I supposed to do?”—I say, do nothing at all. Just go about your day. What would you do if anxiety wasn’t here? What would you be doing if you didn’t do this exposure? What would the non-anxious you go and do? And as you do that-- so let’s say you’re like, “Well, I need to do the dishes or I need to unpack the dishwasher,” as you do that, you will notice discomfort rise and fall. And just like riding a bike, you are going to practice not contracting to it. Just like if you were riding a bike and you started to lean to the right, you would be practicing gently leading to the left. And if you go too far to the left, you would practice gently leading to the right. And that’s the work of being uncomfortable.

Now, you’re not here to make the discomfort go away. You’re here to practice willingly allowing it and not tensing up against it while you go and live your life. And I literally could leave the podcast there. I could sign off right now and be like, “That’s all I need you to know,” because that is all I need you to know, is practice not contracting. Meaning not tensing your muscles, not trying to think it away, fight it away, push it away. What you’re really doing is allowing there to be uncertainty in your life or discomfort or anxiety in your life and just go and do what you love to do. 

To be honest, the biggest finger, like the bird, I don’t know what you call it. Like the biggest in-your-face to anxiety, whatever anxiety you’re suffering, is to go and live your life. And so, I could leave it at that, but because I want to be as thorough as I can, I want to just check in here with a couple of things that you need to know. Often when, and we go through this extensively in ERP School and in Overcoming Anxiety and Panic, is when you are uncomfortable, there are a set of general behaviors that humans engage in that you need to get good at recognizing and create a plan for. And these are the things we usually do to make our discomfort go away. So, the first one is a physical compulsion. “I’m uncomfortable. How can I get it to go away? I’ll engage in a behavior.” 

So, remember here that exposures are really only as good as the response prevention. Now for those of you who don’t know what response prevention is, it’s ultimately not doing a behavior to reduce or remove the discomfort you feel that’s resulted from the exposure. So, you do an exposure, you’re uncomfortable, what behaviors would you usually do to make that discomfort go away? Response prevention is not doing those behaviors. 

So, the first one is physical compulsions. So, if you notice that you’re doing these physical repetitive behaviors, chances are, you’re doing a compulsion of what we call a safety behavior and you’re doing them to make the discomfort go away. So, we want to catch and be aware of those. 

We also want to be aware of avoidance. Often people will say, “Okay, I faced the scary thing, but I don’t want to make it any worse so I’m going to avoid these other things until this discomfort goes away.” Now, first of all, I’m going to say, good job. That’s a really good start. But we want to work at not doing that avoidant behavior during or after the exposure as well. In addition, we want to work at not doing reassurance-seeking behaviors during or after an exposure. 

So, an example that that might be, let’s say you’re facing your fear of going to the doctor. But as you’re facing your fear of going to the doctor, you’re sitting there going through WebMD or any other health Google search engine and you’re trying to take away your discomfort by searching and researching and getting reassurance or texting a friend going, “Are you sure I’m going to be okay? Are you sure bad things aren’t going to happen?”

Now, one of the things that are the most hardest to stop when you’ve done an exposure or during an exposure is mental compulsions. So, I want to slow down here for you and I want to say, this is a work in progress. We’re going to take any win that we can and celebrate it, but also acknowledge that we can slowly work to reduce these mental compulsions. Now a mental compulsion is rumination, problem-solving, thinking, thinking, thinking. Like I said to you, when I was on the couch, I was just sitting there going over all the scenarios going, “I wonder if they’re going up or down or what they’re doing. And I hope they’re avoiding the big waves and I hope they’re not stuck and I hope they’re not scared and I hope they’re okay.” All the things. All that I hope they are was me doing mental compulsions. 

And so, you won’t be able to prevent these all the time. But for me, it was observing again, when I’m contracting. The contraction in this case was mental rumination. And then again, just like a bike, noticing, I’m focusing in, very, very zoomed in on this one thing. How can I zoom out, just like it would be leaning from left to right if I was riding a bike—zoom out into what’s actually happening, which is my son’s right in front of me asking me to play Minecraft or play Pokemon or whatever it is that he was asking, and the dishes need doing. And I would really love to read some poetry right now because that’s what I love to do. 

So, it’s catching that and being aware of that. And again, it’s not something I can teach you, it’s something you have to practice and learn for yourself in that awareness of, “Ooh, I’m contracting. Ooh, I’m zooming in. I need to zoom out and look at the big picture here. I need to look at what my values are, engage in what I want to be doing right now.”

The last way that we contract is self-punishment. We start to just beat ourselves up. So, you did the exposure, you’re feeling uncertain, you might be feeling other emotions like guilt and shame and embarrassment and all the emotions. And so, in effort to avoid that, we just beat ourselves up. 

I have a client who does amazing exposures, but once they’ve done the exposure, they beat themselves up for not having done the exposure earlier. It’s like, ouch. Wow. So, you’re doing this amazing thing, facing this amazing fear, practicing not contracting, doing actually a pretty good job, but then engaging in punishing themselves. “Why didn’t I do this earlier? I should have done this years ago. I could have saved myself so much suffering. I could have recovered earlier. I could have gotten to college earlier. I could have succeeded more.” Again, that’s a contraction that we do during exposure to fight or react to the fact that you have discomfort in your body. 

And what I really want to offer you, again, let’s go back to basics—this is just about you learning to be a safe place while you have discomfort. So, you’re having discomfort, you’re riding the bike. Please don’t just use this podcast as a way to fill your brain with all the tools and not implement it. I will not be able to teach you to metaphorically ride a bike until you put your little tush on the bike seat and you give it a go and you fail a bunch of times. 

And so again, this is you learning to sit on the bike metaphorically, doing an exposure, noticing you’re falling to the right and learning to be aware of that and learning what the skill you need to use in that moment and then learn how to adjust in that moment. And that’s the work. That’s the work—gently, kindly, compassionately, tending to what shows up to you as if you really matter because you really, really matter. 

Let me say that again. You’re going to tend to yourself. I’m saying it twice because I need you to hear me. You’re going to tend to yourself compassionately because you matter. This matters. You are doing some pretty brave things. Right now, I’m wearing my “It’s a beautiful day to do hard thing” t-shirt. It’s what I wear every Wednesday because it’s my favorite day to record podcasts and to do this with you. So yeah, that’s what we’re going to do. We’re going to sit together, we’re going to do the hard thing, we’re going to do it kindly. 

But again, let me come back to the real simplicity of this, is just go do you and let it be imperfect. Exposures are not going to be perfect. You’re not going to do them perfect. Just like if I learn to ride a bike for the first time, probably going to crash, but the crashes will teach me what to do next time I’m almost about to crash.

Now, as I promised you, there are some common roadblocks, I would say, that get in the way and they usually are thoughts. Now if you have OCD, we go through this extensively in ERP School because it does tend to show up there the most, but it does show up with panic as well a lot, is there are roadblocks or thoughts that pull us back into contraction because when we think them, we think they’re real. An example would be, what if I lose control and go crazy? That’s a really common one. A lot of times, that thought alone can make us go, “Nope, I refuse to tolerate that risk,” and we contract, and we end up doing compulsions. And the compulsion or the safety behavior takes away the benefit of that initial exposure. 

Another one is, what if I push myself too hard, like have a heart attack or my body can’t take it and I implode? As ridiculous as it sounds, I can’t tell you how many of my patients and clients in the 10-plus years I’ve been practicing—way more, close to 15 years—I’ve been practicing as a therapist, clients have said, “I’ve completely ejected from the exposure because of the fear I will implode,” even though they know that that’s, as far as we know, not possible. Again, I’ve never heard of it before, I’ve never seen it before, except on cartoons. 

So, again, it’s being able to identify, I call them roadblocks, but there are things that come up that make us eject out of the exposure like you’re in Top Gun. I loved that movie, by the way. But that whole idea of like, you pull a little lever and you just boom, eject out of the exposure like you’re ejecting out of an airplane or a flight, fast jet, because of a thought they had. And so, your job, if you can, again, is to be aware of how you contract around thoughts that are catastrophic.

A lot of people, depending on the content of their obsessions, every little subtype of anxiety, every different disorder have their own little content that keep us stuck. Your job is to get really good at being aware of, specifically, I call them allowing thoughts. They’re thoughts that we have that give us permission to do, to pull the eject handle. I call them allowing thoughts. So, it might be, “No, you’ve done enough. You probably will lose control if you do that. So, you can do the safety behavior or the compulsion.” That’s an allowing thought. Your job is to get used to yours and know yours and be familiar with them so that you can learn to, again, have good skills at countering that and responding. Again, think of the bike. That allowing thought is you tilting to the right a little bit when you’re like, “Oops, nope, I’m going to fall if I keep tilting. I’m going to have to work at going against that common behavior I use that is continually contracting against tolerating discomfort.” 

Other bigger roadblocks are fear of panic, which is a common one. Again, mostly, people’s thoughts around “I can’t handle this.” You’re going to have specific ones. Again, I don’t want to put everyone in the same category. Everyone’s going to have different ones. But please get used to your roadblocks or become aware of them, okay? 

And that’s it, you guys. I feel silly saying it, but that is it. Your job is to lean in. 

One other thing I would say, and I often give my patients the option, is I’ll say to them, “Here are your choices. You’ve done an exposure. You ultimately have three choices.” 

So, let’s pretend—we’ll do a role-play—we’re in the room together or we’re on Zoom, and the client has willingly done the exposure and then they start to freak out, let’s say, in one specific situation. And I’ll say, okay, you got three choices. You could go and do a compulsion and get rid of it. Go and make this discomfort go away if that’s in fact possible for you. The other option is you could practice this response prevention and practice not contracting. That’s another option for you. You get to choose. And there is this very sneaky third option, and I will offer this to you as well. The third option is, you could go and make it worse. And I have hats off to you if you want to choose that option. So, the go and make it worse would be to find something else to expose yourself to in that moment. Make it worse. Bring it on. How can we have more? What thoughts can I have that would make this even more scary? How could I do flooding? How could I find ways to literally say to your fear, “Come on fear, let’s do this. I have so much more fear facing to do and I am not afraid and I’m going to do it.” 

So you have three options. Please be compassionate about all three because you may find that you’re choosing the first or the second or the third depending on the day, but they’re yours to choose. There is no right. There is more ideal and effective. Of course, the latter two options are the most effective options. But again, when we learn to ride a bike, no one does it perfectly. We fall a lot. Sometimes if you’ve ridden a bike for a very long time and you are a skilled bike rider-- in fact, we have evidence that even bike riders who do the Tour de France still fall off their bike sometimes for ridiculous reasons, and we are going to offer them compassion. And if you are one of those who are skilled at this, but fall off your bike sometimes, that’s not because anything’s wrong with you. That’s because you’re a human being. Okay? 

So that is what I’m going to offer you. The question, what do I do after and during I’ve done an exposure, is be aware of your contractions in whatever form they may be. Be kind. And if all else fails, just go and live your life. Go and do the thing you would do if you hadn’t have that, didn’t have that fear. It doesn’t matter if you’re shaking, doesn’t matter if you’re panicking, doesn’t matter if you’re having tightness of breath, you’re dizzy, all the things. Be gentle, be kind, keep going. Do what you can in that moment, and you get to choose. You get to choose. 

So, that is what I want you to hear from me today. I hope it has been helpful. I feel so good about making an episode just about this. Number one, I get asked a lot, so I really want to have a place to send them. And number two, I admit to making the mistake of sometimes saying go do an exposure and not actually dropping down into these very common questions that people have. 

For those of you who are interested, we do have ERP School, Overcoming Anxiety and Panic, BFRB School. We’ve got time management courses, all kinds of courses that you can get. The link will be in the show notes. I do encourage you to go check them out if you’re wanting step by step structural trainings to help you put together a plan. If you’ve got a therapist already or you’re just doing this on your own, that’s fine too. Hopefully, this will help lead you in the direction that’s right for you. 

All right. You know I’m going to say it. It’s a beautiful day to do hard things. And so, I hope that’s what you’re doing. I am sending you so much love and so much well wishes and loving-kindness. Have a wonderful day and I’ll see you next week with a very exciting piece of news.

Jan 20, 2023

MINDFULLY TENDING TO ANGER & RESENTMENT

Welcome back. I am so happy to have you here with me today to talk about mindfully tending to feelings of anger and resentment. 

Sometimes when we have relentless anxiety and intrusive thoughts, anger can feel like the only emotion we can access.  



For those of you who don’t know me, well, you might be surprised to hear maybe not to know that I actually have quite a hot temper. I get hot really quick emotionally, and I don’t know if it’s because as a child I didn’t really allow myself to feel anger. I think societally, I was told I shouldn’t be angry. And so, when it comes up inside me, it heats up really quick to a boiling point. And my goal for this year is not—let me be very clear—is not to say I am going to stop being angry because that is actually the problem. It is not to say I can’t feel angry and I shouldn’t feel angry. It’s actually to tend to my anger and start to listen to what anger is trying to communicate to me. My goal with you today is to walk you through how you can do that. And I’d love if you would stay with me for a short meditation where we mindfully tend to anger and resentment. 

IS ANGER & RESENTMENT HEALTHY?

I think the first thing I want to mention here is that anger and resentment are actually really normal healthy emotions. Nothing to be guilty of, ashamed of, annoyed by, nothing to judge, that the anger and resentment are actually healthy emotions. They come from a place of wishing things could be better or improved, and they usually show up when we experience some kind of injustice in the world or in our daily life. Maybe someone hurt your feelings or they acted in a way that made you feel unsafe. Maybe someone stopped you from succeeding. Maybe somebody judged you and you experienced that as a threat.

WHY DO I FEEL SO ANGRY? 

Anger can show up for many reasons. Maybe it’s because you’re noticing the injustices in the world and that makes you angry. That political things can really make people show up in anger. And again, that doesn’t mean there’s anything wrong, but expressing it in a healthy way can be really useful because bottling it up, it usually numbs other feelings, it can wear down your mental health, and it can mean—and I have learnt this the hard way—is that we then explode and end up saying things we don’t mean, or doing things we don’t want to do that don’t align up with our values or showing up the way that we want. And for me, that’s a big part of my goal this year. 

Now, the reason I actually am doing this, this is not a scheduled podcast, is yesterday my husband and I were having a disagreement. And sometimes I have to remind myself like, disagreements aren’t a problem. Because in my mind, disagreement is like, “Oh my gosh, terrible things are about to happen and I’m very scared. Please love me forever.” You know what I mean? And my husband has to keep gently saying like it’s okay that we don’t agree on everything. 

We were having a disagreement and I could feel the anger showing up in my body. And I was trying to really focus on just being mindful of that experience, because when I don’t do that, my immediate response is, “Fight. Let’s go to war. Let me show you how you are wrong. Let me be very clear in my boundary that you cannot cross,” which is all fine. Again, none of that’s wrong, but I could feel myself heating to a boiling point in a very, very short amount of time. I’ve been really trying to instead of acting on anger in certain situations-- again, there’s nothing wrong if you need to act on anger.

WHEN IS ANGER APPROPRIATE? 

Sometimes if you’re in a dangerous position, you need to act on anger. But I’m really working on allowing anger, befriending and tending to anger. Anger can be our friend. Like, what’s the problem? Let’s actually have it, Kimberley. Let’s actually feel it. Let’s actually feel it go through my body. Let’s allow it to burn itself off. And let’s do that, not because we got to make our point and make sure they know we’re right, but because you actually felt it. You allowed it, you rode the wave of it, it burnt off. And it always burns off. That’s the thing. That’s mindfulness—to recognize that everything is temporary. 

If you say-- I’m talking to myself here. If you say what you say when you’re angry, you mightn’t have said it in a way that is effective as if you had said that thing a few moments later when you’ve let a little bit of that anger burn off. Again, I’m not saying here that there’s anything wrong with just saying what you need to say, but for me personally, I’m really trying this year. One of my biggest goals is respect through my words. Respect through my words. Really pausing and being really intentional with my words. And I know that when I’m angry, that is absolutely not happening. 

So, we know that expressing anger is fine. We know that bottling it in is usually problematic. Pretending you’re not mad is also inauthentic. Sometimes my husband’s like, “You’re so clearly mad.” And I’m like, “No, I’m not.” And he’s like, “Yeah, it’s all over your face, my friend.” People can sense it. And then they’re questioning like, “Why isn’t she being honest with me?” 

WHY DOES ANGER FEEL DANGEROUS? 

But I want to acknowledge that anger can feel like an emotional rollercoaster. It does stress out the body. Anger can feel very dangerous sometimes. It can feel very scary to some people, particularly if you have anxiety about it. Some people are really afraid of what they’ll do if they get angry and so they avoid anger and they avoid confrontation and they avoid setting boundaries in fear that anger will come up. 

Now, there are a few ways you can bring mindfulness to anger, and that is, first, to recognize it, to observe it. Another way you can diffuse anger is to use your body. This is a big one for me because when I’m angry, I have so much adrenaline pumping through my body, which is a healthy response. We need that. Like if there was a burglar at my door, anger would show up and my brain would send out adrenaline and that would allow me to either fight or run away or wrestle him or whatever it may be. So, I feel a lot of that adrenaline in my body and it does take time to burn off. And so, sometimes moving my body can be really helpful—stretching, taking a walk, taking some breaths, which we’re going to do today. Some people want to journal, chat with a friend. That irritation and frustration that we feel in our body, it’s okay to move your body and tend to it in that way. 

The last thing I would add is often when we are angry or if we haven’t been mindful in the emotion and sensations and experiences that lead up to anger, we can actually notice that our thoughts are very distorted. Here is an example. 

My husband and I are having a disagreement about a very normal thing. It was a very pretty non-issue issue. But in my mind I could. Once I was really being mindful, I could notice thoughts like, we should agree, we’re going to always fight if we don’t agree. It’s like, okay, that doesn’t have to be the case. I was also having thoughts like if he doesn’t agree, well then, I won’t get my way and then I’ll be held down. I’m having this very catastrophic thought—I’ll be held down and ruled by my husband. It’s like, well, that’s not true either. He’s never going to do that. I’m noticing all these thoughts. If he disagrees with me, that means he’s judging me and thinking I’m bad. Can we actually look at that distortion as well? Because maybe that’s me mind reading.

I’m just giving you some examples. I’m not saying these are all ways happening, but these are some examples. Sometimes we have thoughts like, no, you should not think that way. You need to think my way. My way is the only way. PS, I do that a lot sometimes. I’m just telling you the truth here. But again, that doesn’t mean we have to act on those thoughts. If we can just acknowledge them and be like, “Okay, let’s be in choir.” Is that in fact true? Do we all have to agree? How wonderful is it that my husband and I don’t agree on some things because he has actually taught me how to change the way I think about some things that have benefited me. It just took a lot of stubbornness on my part to be flexible enough to see his side of the story. 

And so, if we can observe the distortions of our thinking, sometimes that can be really helpful. But let’s also reserve some space here for the situations where you don’t have any distortions and the person is being very unkind and they are hurting you. That’s different. Then, what we can do is we can use that anger as information so that we know what we need to do to protect ourselves. Sometimes it’s setting a boundary. “You can’t speak to me like that.” Sometimes it’s saying, “You can’t come into my house and do these things to me.” Sometimes it’s saying, “I’m going to not follow you on Instagram if it makes me angry.” Or if you’re seeing a bunch of things that’s not helpful to your mental health and is making you compare and get angry, maybe you might want to not follow that person anymore. 

And so, anger, again, if you can see it for what it is, is an opportunity to listen to what is going on and be mindful and just acknowledge, and then if need be, make some changes gently that line up with your values. And so, that’s really important for us to recognize. 

IS ANGER MASKING ANOTHER EMOTION? 

Now there’s one-- again, I keep saying that. There’s one other thing I want you to think about, which is, sometimes underneath anger is another emotion—fear, shame, guilt. For me, I actually realized about a month ago, and I’ll just share this with you, sorry, is I was noticing a lot of resentment showing up, particularly—if I’m being completely honest with you all, which I always want to be—a lot of resentment around the fact that I live in America. And I was noticing it showing up and going, “This is really weird. Why is resentment showing up? I chose to live here. I knew that was my choice, but a lot of resentment was showing up.” And through talking with a dear friend underneath this anger and resentment, and I felt myself having a tantrum over it, I realized I was deeply grieving and missing my family. Usually, I just feel miss like I’m missing them and I feel sad, but the anger and resentment was masking me from it. And when I acknowledged that, I realized I’m staying in anger because the sadness was “too painful.” In my mind, it felt unbearable. And so, my brain presented to me an opportunity to stay in resentment and anger and really cycle and ruminate on that instead of dropping down into the sadness that I felt. 

So, again, anger is complex but also quite simple if we talk about it, like two opposing things at the same time. But what I want to offer to you is, all of these feelings are completely normal. If we can just simply acknowledge them with a sense of kindness, if we can stay with the sensation, if we can stay in compassion for ourselves, we can actually write out these emotions and they can be, what I say to myself, it’s not a problem. That’s my new thing. I keep saying to myself like, “Oh, I’m noticing anger. That’s not a problem. It’s totally okay for you to feel this, Kimberley.” “Oh, I’m noticing anxiety. That’s totally not a problem, Kimberley. Let’s stay with it. Let’s feel it.”

ANGER AND RESENTMENT MEDITATION

And so, let’s begin with a short meditation to where you may practice that. Now, if you’re driving, number one, please do not close your eyes. Number two, if you’re feeling an urge to turn off this podcast now and be like, “I got what I needed,” please just listen. You don’t even have to practice. I just want you to listen to what I’m saying and see if anything lands.

Here we go. We’re going to mindfully tend to feelings of anger and resentment. 

Bring your awareness to whatever is going on for you right now... and allow your body to rest as you feel the pool of gravity down on the chair or the bed or whatever it is that you’re resting on. 

And as you are aware of your weight sinking down to that point of contact between you and the floor, the chair, or the bed, I want you to notice what sensations are you noticing right now. Where does anger show up for you? Where does resentment show up for you? Are they the same or are they different? And just take some time to notice any resistance towards noticing anger and resentment. 

And if you notice any tension or resistance, gently turn towards them. Maybe you offer a gentle hello to them. Good morning. Good evening. 

And as you notice them rise and fall in your body, offer some acceptance as best as you can that they’re there. If you notice that you’re tensing up around them with each outbreath, see if you can let go or release any tension in your muscles or in your mind. Again, not trying to get rid of them, but also not holding on to them. Soften your body as best as you can, bringing acceptance to those sensations. Continuing to breathe in no particular fashion at all, except whatever feels easy for you. 

Notice any thoughts as they arise and they pass through your mind. Notice if there’s any thoughts of blame or shame or guilt or aggression. And notice them for what they are, which is emotions, sensations. See if you can let them come and go, rise and fall without over-identifying with the content of those thoughts, without engaging with the content. Just note them. “Oh, I’m noticing blame. I’m noticing the urge to punish that person. I’m noticing the urge to create justice. I’m noticing the experience or urge to neutralize the pain they’ve caused me by punishing them.” And see if you can just notice them, maybe as clouds in the sky just floating by. No need to rip them out of the sky. Just notice them.

And as you notice they’re floating by, can you let go of them? Can you let go of needing to control them or make them go away? And we want to do this kindly and gently. Sometimes it’s helpful to gently bring the sides of your mouth up and gently smile. Not to make the feelings again go away, but to let your brain know that you’re here, that you’re not going to judge it for what it’s experiencing, and that you’ve got your back here. 

And now, allow your awareness to broaden and gather the whole experience of breathing into your body with ease. As you breathe in, knowing that you’re breathing in, and breathing out, knowing that you’re breathing out. 

Can you feel an awareness that flows through you as you breathe? And can your breath be an anchor in this present moment? Noticing each breath as you inhale and exhale. Noticing any judgment you have for yourself as you have these sensations, any self-criticism. Again, just note them, acknowledge them. Try to remind yourself that anger is a normal and healthy emotion. 

You may also want to congratulate yourself for tending to your anger in this moment, instead of internalizing it or displacing it onto other people. And every time you notice your mind has wandered, gently bring your mind back to the breath or the awareness of these sensations in your body. 

Now again, expand your awareness back to feeling gravity pull you down as it sits and stands or lies. If there’s anything left behind here, some pain, some discomfort, let’s set the intention to keep this practice going where we’re going to be non-judgmental and compassionate towards this experience. We’re going to cultivate acceptance and acknowledgment of this and your entire experience. 

Gently allow the breath to bring you back to the present. 

I want to thank you for having the courage to do this exercise with me. The more you offer this practice to your mind, the more the mind will start to see anger again as nothing but an emotion that is knowledge and information for us to make decisions about how we want to move forward. It’s a healthy action towards decision-making, boundary-setting, self-compassion, acceptance. And you’re doing this for the benefit of yourself and for the benefit of others. 

Slowly come back. Open your eyes. Notice what’s around you. And I’m going to offer to you to keep going into the day with this practice. 

Okay. Thank you for practicing with me today. I wish you nothing but a beautiful day of joy and kindness and warmth and love. Please also remember, it is a beautiful day to do hard things. I will look forward to seeing you next week. Thank you for spending your very valuable time with me today. I hope this was helpful.

Jan 13, 2023

In this week's podcast, I talked with Lynn Lyons about her new book, The Anxiety Audit (7 Sneaky Ways Anxiety Takes Hold and How to Escape Them).

We discuss: 

  • How repetitive negative thinking disguises itself as problem-solving 
  • How catastrophic thinking makes the world a dangerous place and demands you react accordingly 
  • How big conclusions and an all-or-nothing approach make the world smaller and harder to navigate. 
  • How a fear of judgment isolates and disconnects us from people 
  • How being busy and overscheduled both adds and masquerade anxiety and stress 
  • How we blame others when we are irritable
  • How self-care becomes not self-care at all



Transcript

This editable transcript was computer generated and might contain errors. People can also change the text after it is created.

Kimberley Quinlan: Okay, good. Well, welcome, Lynn Lyons. I am so thrilled to have you on the show today. Okay, so very exciting.

Lynn Lyons: Oh well, thanks for having me.

Kimberley Quinlan: You just wrote another book. I will say another book. It's amazing. Please tell me before we get started. Why did you choose that as the title?

Lynn Lyons:  Well, what happened was we have a podcast called flusterclux. And I do that with my sister-in-law Robin; she's married to my brother. And during the pandemic, one of the courses we created together, she called it the anxiety on it because we wanted to go through the patterns that maybe people were experiencing and they didn't, they didn't have words to them, they didn't know what was going on. And so we did this course, and we put it out there, and then my publisher said, Do you want to write a book? And I said, “Oh, okay”. And Robin and I said, Well, why don't you just make the course we did into a book? It'll be easy because she's never written a book before. Um, so that sort of was the genesis of it. So the publisher like the title, the anxiety on it. So the book ended up being much more expanded than the original course, but the title was from Robin. And the course we did for the podcast.

Kimberley Quinlan: Right. And I loved it because there is a degree of going through your book. We're going to talk today about the seven sneaky ways anxiety takes hold and how to escape that, but I love how it is. It feels like an audit, right? You're kind of auditing through these sneaky ways anxiety can take hold. So, I love that. So, let's go through today's those seven points, and then we will go deeper if we have time. Can you tell me a little about this first main concept of how repetitive thinking disguises itself as the problem?

Lynn Lyons: Yeah, it disguises itself as problem-solving. So when you are doing repetitive negative thinking,…

Kimberley Quinlan:  Aha.

Lynn Lyons is just the lingo we use to describe worrying and ruminating. We generally distinguish between worrying and ruminating in which direction and time they head. So if you are a worrier, you tend to worry about things that haven't happened yet. And if you're a ruminator, you're going back over things, which tends to be both. It can feel pretty obsessive. A ruminator will go back over things and ask those questions. And did I say the right thing? Did I do the right thing? Did I buy the right refrigerator? Did I make the right decision?

Lynn Lyons:  Repetitive Negative thinking. The problem with it is that the thinking feels like the solution. Remember, anxiety seeks that certainty.  If I just go over it, if I just think about it, if I just talk about it, if I just ask people about it, if I just get more information about it, that will lead me to a solution. But what we know is that the thinking is actually the problem because when you overthink,

Lynn Lyons: You're caught in that repetitive cycle. You're seeking that certainty. So you don't move forward, and you don't take action. It just feels like you're doing something productive. But unfortunately, you're when people go to therapy, if they have this kind of obsessive thinking and they get caught in it, is that the therapist will unknowingly say, Well, let's think about this, or Let's talk about this, some more. Let's explore this. Or What could that mean and the anxieties? Like, Yeah, I love this lady. Now we get to do our thing. 

Lynn Lyons:  What we know about people that tend to overthink and get into this repetitive negative thinking is that they are less likely to act on a solution if they come across one in their thinking. So they're saying, “Oh, I'm thinking to figure this out,” but then they never take the necessary action. Yeah. So it's a way to trick you into thinking you're doing the right thing. When you're just feeding your rumination feeding your worry,

Kimberley Quinlan: I love it, and you mentioned in your book Chewing the mental card, which I thought was just classic and…

Lynn Lyons: Mmm. M.

Kimberley Quinlan: hilarious. I grew up on a farm, so that was very appropriate. I love it. Let's go to number two, how catastrophic thinking makes a world, the world a dangerous place and demands. You react accordingly,…

Lynn Lyons: Sure. So catastrophic thinking this is like the meat of the anxiety sandwich…

Kimberley Quinlan: do you want to share about that?

Lynn Lyons: You're always wondering, worrying about, or vividly imagining the worst thing that could happen. And again, this feels like a solution. So if you are a parent and you have this catastrophic way of thinking, you're thinking, all right, so if I can imagine every bad thing that could happen to my child, then I can be ready for it. I can prepare for it; I can prevent it. But what we know is that the more catastrophic you are, the more you think about the bad things that could happen.

00:05:00

Lynn Lyons: The more fearful you are, doesn't mean that you're better prepared to manage things; it means that you start to avoid and remove things from your life. So, Yeah. So it just becomes again. It becomes this way of the anxiety dictating what you do and don't do.

Kimberley Quinlan: Right? You talked in this chapter about the pain. The Pain Catastrophizing Scale and…

Lynn Lyons:  Mmm.

Kimberley Quinlan: that's something that I didn't know a lot about, which I found. Very fascinating. Do you want to share your little thoughts on that?

Lynn Lyons: Sure. So what we know from pain and pain is such an interesting phenomenon, isn't it? It's such a rich place for research and study. If you could testify about your pain. So if you anticipate that your pain is going to be terrible, You will respond as if the pain is worse than it is. And one of the things that's interesting is I work a lot with kids and a lot with families and parents. One of the fascinating things is that, say, you've got a child in pain, and you ask the parent to rate the child's pain. Say the child rates their pain as a four. The parent weighs the child's pain as an eight.

Lynn Lyons: The parent's rating of the pain is a predictor of impairment in the child.

Kimberley Quinlan: Huh.

Lynn Lyons: Completely independent of, you know, maybe the child says Oh my pain is a two and the parent says, Oh the truck might try. I'm so worried about my child. I think their pain is an eight that parents catastrophizing about the pain. Predicts whether or not that child goes to school whether or not they predict an activities how much of their life is impaired by the pain. Even though the child is saying, Well like that, my mom thinks the pain is a lot worse than it is. It's the parents' catastrophizing that actually has the impact. Yeah.

Kimberley Quinlan: That is so interesting. And so what what really showed up for me was is that also true of like the pain of the suffering of anxiety, right? Like is if we are catastrophizing how painful the anxiety will be does that? That still the same concept scientifically

Lynn Lyons: Well, I don't know about the research in terms of the way they lay it out, so clearly with with pain but here's what we do know. Catastrophic parents being a catastrophic parent about anything. Is a high risk factor for developing anxiety as a chart for children. So, if you have a catastrophic parent, it increases your risk of creating an anxious child. We also know that parents who are anxious have a six to seven times greater risk of having an anxious child. We've got some genetics in there…

Kimberley Quinlan: Right.

Lynn Lyons: but there's an awful lot of modeling. So when we when we look at how parents talk about the world. one of the things that when parents talk about the world as a dangerous place, when they talk about their child as being incapable of functioning,

Lynn Lyons: When they step in so that their child doesn't have the opportunity to get to the other side, doesn't have the opportunity to independently problem solve, all of those things increased anxiety. And because we know that anxiety, untreated is one of the top predictors of depression, by the time you hit adolescence and young adulthood, we know that that that's that cycle is just going to continue. So when I am,…

Kimberley Quinlan: Mmm.

Lynn Lyons: when I am working with families and I am trying to interrupt this cycle, one of the things just as you said, one of the things I want to really target is, Is this parent catastrophizing?

Lynn Lyons:  About their child's ability to function and it may be catastrophizing about their mood catastrophizing about them, being upset or being nervous, right? So so my child is so anxious about this. There's no way I can send them off on this field trip or there's no way I can send them off to this summer camp because look they're so anxious. It absolutely is contagious for sure.

00:10:00

Kimberley Quinlan: And that's true of ourselves too. So if we're catastrophizing, when less likely to go on the field trip, ourselves is correct. Yeah.

Lynn Lyons: That's right. Yeah, well, so say, say you're gonna get on an airplane. And you're thinking, Oh gosh I'm going go on this airplane and you start catastrophizing and imagining bad things happening on the plane or the plane crashing and you activate your whole system. So you're having these symptoms and your your stomach feels weird and your heart is pounding. You say to yourself, Oh my gosh, if I feel this bad just thinking about getting on the airplane, it's going to be horrible. When I actually get on the airplane, I better not do it. Right. So we're just watching this scary movie and…

Kimberley Quinlan: Yeah.

Lynn Lyons: it makes sense if you're sitting there watching a terrible movie with a horrible outcome, Of course you want to avoid that thing but we have to recognize that that catastrophic thinking is a pattern of thinking not an actual predictor of outcome. Yeah.

Kimberley Quinlan:  Right.

Kimberley Quinlan: Yeah, and you talked about that about sleep as well.

Lynn Lyons:  Oh, yeah, well, the thing that most the thing, that people who are have difficulty sleeping people with insomnia, the number one thing they worry about is sleeping, right? So you can't sleep. And then you start worrying about not being able to sleep and off off the cycle goes. Yep.

Kimberley Quinlan: Yeah. Yeah of for me actually I remember when I had my newborn baby. It was the fear of being tired.

Lynn Lyons:  Mmm.

Kimberley Quinlan: So I would I would pressure myself to sleep because I'd catastrophized, what tiredness was gonna feel like,…

Lynn Lyons: Yes. Yes,…

Kimberley Quinlan: right. Yeah.

Lynn Lyons: I've certainly many people have that. I interestingly had this client long ago who catastrophized the feeling of being hungry. That she couldn't tolerate feeling hungry so you can you can grab onto anything in catastrophize about it for sure.

Kimberley Quinlan:  Right.

Kimberley Quinlan: Yeah. Fantastic. I agree. Yeah. Okay. Now this is cool and we've talked a little bit about this in the show before but let's just go over it really quick. How big conclusions and all or nothing approach make the world smaller and harder to navigate.

Lynn Lyons:  Mm-hmm.

Kimberley Quinlan: You talk about going global. Do you want to share a little bit about that?

Lynn Lyons:  Yeah. So so global thinking, so if you have a global attributional style or a global cognitive style it means that you come to big conclusions. Usually about yourself or other people, right? So oh I never get what I want or I always screw up or nobody understands me. These are these big huge words that then if you believe that well nobody likes me. Well then you're not gonna you're not gonna step out there and take any kind of risks or reach out to people because you've already come to the conclusion. So when people are global in their thinking, they're much more likely to one break things down into parts, so they can recognize, well, there's a sequence to making friends or there's a sequence to getting a new job, or there's a sequence to cleaning out my basement. So they, they get into this place of like, Well, it's a disaster. I, you know, I can't do it and then they also begin to believe that about other people. So when you're global about other people, it shuts,

Lynn Lyons:  Off. Right. Well, that group of people could never like me. Or that group of people is this or that group of people, is that So, the opposite of global and we know that global thinking huge risk factor for anxiety and depression. When we're confronted with that, or when we notice that we're doing with doing that, we want to back up from it and say, Okay, so I just heard myself using that global language, right? I just heard myself say, Oh, I'll never get this done. Oh, there it was right now. Why am I saying that? Well, I'm feeling a little overwhelmed. It does look like a big project in front of me. Maybe it is a big project in front of me. So now I'm gonna break it down and I'm gonna recognize there's the beginning and a middle and an end, there's a sequence, right? And that moves us out of that big global way of thinking that's just absolutely paralyzing. Yeah.

Kimberley Quinlan: Mmm. Yeah, I love that. Okay. How anxieties fear of judgment isolates, and disconnects us from the from people, right? And I, I will, if you could speak to where you also touched on the disconnection, happens on the inside. You won't share a little about that.

Lynn Lyons: Yeah. So so interestingly when when when people are lonely It can be in two categories, one is that it's situational. So you've just moved to a new city. You don't know anybody. You're starting college and you're there by yourself or it can be more of a pattern of the way you interact with the world. And again the conclusions that you come to, so you look at the way that the world is connecting and interacting and you conclude that one is that everybody does it better than you,…

Kimberley Quinlan: If?

Lynn Lyons: right? That it's easy for everybody that it comes naturally to everybody and that it's not gonna work for you.

Lynn Lyons:  And you go inside and I always say, You know, you have a meeting with your anxiety inside you're having meeting and and during the meeting, you say, You know that. Well there's this is, this is terrible. I don't have the skills. Nobody wants to connect with me and also you fear the judgment of other people. So one of the mistakes that we often make with somebody who's feeling this way who's feeling isolated, who doesn't feel like they can connect is we try and talk them out of it.

00:15:00

Lynn Lyons:  By saying things like, Well people don't judge or, um, you know, nobody's paying attention to you or, Oh, people aren't thinking that, right? That's just not true. People do judge, they judge all the time, and we notice people. And if I'm, if I'm on an airplane and somebody has this really crazy hairdo, I'm gonna be like, Wow, look at that hairdo. Or if I, you know, got an airplane and somebody has this really funky tattoo on their face, I'm gonna say, like, well I wonder how they decided to put that tattoo on their face. We do it all the time. And so what we have to develop is the ability to tolerate being vulnerable and we can do it in small steps, you know, you don't have to, you know, you don't want to share your life story with the person you met two minutes ago.

Lynn Lyons: But recognizing that when our anxiety shows up and says, I can't take a risk, I can't be vulnerable, everybody can connect, but me, you go inside and you convince yourself, not based on what's happening on the outside, but what's happening on the inside that you aren't capable of connecting? And then boy,…

Kimberley Quinlan: Right. Right?

Lynn Lyons: it just snowballs

Kimberley Quinlan: I love it and so true of the pandemic and where we're at in the World,…

Lynn Lyons:  You yeah, yeah.

Kimberley Quinlan: Right? Yeah. Okay. The next two chapters were my favorite. okay, and…

Lynn Lyons:  Yeah.

Kimberley Quinlan: so I wanted to talk about this a little bit, you talked about how being busy and over scheduled, Which like I raised my hand to ads and…

Lynn Lyons: Mm-hmm. Awesome.

Kimberley Quinlan: masquerades anxiety and stress.

Lynn Lyons:  Yeah, so the interesting thing about busy and I raise my hand too. I'm you know so I get it. Um, We love the idea of being busy it because it's, it's this currency now, right? We can't, we can't really brag about how money, how much money we make. We can't say to, you know, if you ran into a friend on the street you and they said, Oh, how are you doing? Kimberley you and say, like, Oh, I'm doing great. I am making so much money this year, it's fabulous because they say, Oh my gosh, that's so tasteless. Why is she saying that? But you can say, Oh I am so busy. My life is so crazy. That's become sort of our currency of importance.

Lynn Lyons: Of how busy we are. So the more busy we are the more we feel like we're worthy and the more busy we are the more we don't have time to feel things that we're going to feel so we keep ourselves busy as a way to just keep that that brain of ours in motion and we have difficulties sort of settling back in but it is interesting. It you know, when I was doing the research for this chapter it a few things were really we're really kind of amusing to me and true you read this. They say of course of course is it a life of leisure that used to be something to brag about right back in the old days…

Kimberley Quinlan: Yeah.

Lynn Lyons: because the farmers and the labors and the coal miners, right? But if you, if you could sit back and and relax and drink a mint julep, right? That meant you had social status, well, sort of flip. Now, we don't really admire people that sit back and…

Kimberley Quinlan: Yeah.

Lynn Lyons: don't work. So, that's an interesting thing I found and then the other

Lynn Lyons: Interesting thing I found is that people who brag a lot and sometimes it's that humble brag, right? Oh I wish I weren't so busy. Oh my gosh. Yeah. Um people who brag a lot about how much they work are very inaccurate about the hours that they work and the more hours that you say you work oftentimes the more you're off. So people say Oh I work a hundred hour week and I always think to myself No you don't right? Because Even if you worked 12 hours a day, seven days a week, that's not even a hundred hours a week.

Kimberley Quinlan: Right.

Lynn Lyons: And so what what they found is those people who say Oh I work 70 hours a week really are working about 40 But it's just it's just indicative of how much we want to keep ourselves busy.

Lynn Lyons: And how how often times it's it sounds kind of backwards in paradoxical but it's true that we really like that feeling of chaos that we create because it means that we don't have to sit back and sort of look at how things are really going. And we do it.

Kimberley Quinlan: Right.

Lynn Lyons: We do it with our kids, for sure. And a lot of kids right now, believe that the way that life is supposed to be in the way that we measure our success is, how busy we are.

Kimberley Quinlan: Yeah, I always think of like I I remember moments where I in early in my own anxiety recovery where I could feel and I've talked about this on the podcast like feel myself, typing really fast and it's funny when you're so focused on what you're doing. You do tend to have less anxiety so it feels like a relief. Almost it's a compulsion, right? It's a relief to your anxiety.

00:20:00

Lynn Lyons: It is, yeah. Yeah. Well.

Kimberley Quinlan: Like I don't have to be up here if I'm typing like crazy or I'm focusing.

Lynn Lyons:  That's right.

Kimberley Quinlan: And I think that that you use the word masquerade down, anxiety, and stress. I think that, that is right on the money, right, that where we are. Busying as an avoidant compulsion.

Lynn Lyons: Mmm. That's right.

Kimberley Quinlan: Do you agree with that?

Lynn Lyons: Yeah. Well because if you're, you know, if you're if you're if you've got a lot going on in your head, And maybe your thoughts are saying, You know, you're not good enough, you're not busy enough, you should be doing this right? You're shooting on yourself, you're doing all this stuff and if you can keep your brain in your body busy and occupied, And almost as if like, you can't keep up and you've got, you've got this little feeling of of urgency or emergency. Oh, I've got to do this, I've got to do this, it really distracts and sort of satisfies. Those thoughts in your head of, I, you know, what's gonna happen next. And it allows you to not really experience the worry and the anxiety because you're just busy, busy, busy busy. Well yeah,…

Kimberley Quinlan: Right.

Lynn Lyons: one of the things it's interesting. We did a podcast episode on this a little while ago, this this term high functioning anxiety.

Kimberley Quinlan:  Yeah.

Lynn Lyons: Which is sort of amusing to me, right? Because it's the city right, everybody wants to have these new categories, right? It's not this. It's this high functioning anxiety and they had this list of The list of symptoms this checklist, I saw in this article which was just silly like you know you chew your lip or you chew gum or you don't make eye contact, you know it's just silly but but when we look at it, high functioning anxiety is no different than any other kind of anxiety. It's just that you're getting the job done and…

Kimberley Quinlan: Yeah.

Lynn Lyons: then people are giving you a lot of positive feedback for that,…

Kimberley Quinlan: Yeah. Right.

Lynn Lyons: right? So yeah.

Kimberley Quinlan: Right. A busyness is another form of like, avoidance of the fear, right? Yeah. Yeah.

Lynn Lyons: That's right, that's right. And it because of the way our culture works It, it feels good in the moment and you get the payoff of somebody saying,…

Kimberley Quinlan:  Yeah.

Lynn Lyons: Oh my gosh, you are so busy. How do you do all that you do? Oh gosh, I've never met anybody. You know what? If we want a job done, we got to give it to Kimberley, she's gonna get it done and…

Kimberley Quinlan:  Right. Right.

Lynn Lyons: all of that feels so good, but it totally burns you out, if you, if you keep it up for sure.

Kimberley Quinlan: They'd like No, I'm just over here doing a bunch of avoidant compulsions.

Lynn Lyons: Yeah, right.

Kimberley Quinlan: That's why Right.

Lynn Lyons: We don't say that. Right? Oh my gosh. You're doing so much Kimberley. Oh no, I'm just avoiding compulsing. Yeah, no. We don't say that. Yeah. Yeah, they would. They would they be like, Oh okay. So maybe we won't give her that next assignment then. Yeah.

Kimberley Quinlan: Right. Well, and that brings me to the next part of this which again these were my two favorite pots and concepts mainly, I think because it's I still like, ooh, there's some truth there. I need to be listening. And I think it links so well together with the last one about being over scheduled and busy talking about irritability, right? Because And you had said here and I'll use your your terms exactly how irritability likes to blame others but can be a red flag for you. Do you want to share that? Because I feel like they go hand in hand with that over scheduling.

Lynn Lyons: Yes. Yeah.

Kimberley Quinlan: Do you tell me your thoughts?

Lynn Lyons: No, I agree. And in fact, like all of these patterns, sort of overlap, don't they?

Kimberley Quinlan:  You know.

Lynn Lyons: Because we can be catastrophic and over scheduled at the same time. Yeah, irritability is, is a red flag. So irritability. I talk about all these patterns and irritability is a sign that perhaps you're really not addressing what you need to address. One of the, the definitions of irritability that I talk about in the book is that it's described as blocked goal attainment. Okay, so that's it. A research term is that you can't get…

Kimberley Quinlan:  Yeah.

Lynn Lyons: what you want and something is in the way the other term that I read, and it's in the book, is they defined irritability as feeling angry and the ability to sustain that anger?

Kimberley Quinlan:  and,

Lynn Lyons: So it's this constant sense of not getting what you want, not being able to feel satisfied. And what happens is you start looking outside to find out why you're so irritable. It must be because my kids aren't doing what I told them to do. It must be because my partner is not fulfilling the agreement that we made. It must be because my boss is such a jerk, it must be because of the traffic, it must be because of the weather, it must be because of this and what we really want to step back and look at is How is this constant level of irritability?

Kimberley Quinlan: You.

00:25:00

Lynn Lyons: How are you sustaining it? What are you doing? Is it your perfectionism is it the fact that you want to compuls and people are getting in the way of your compulsing because you're in your mind if I can only compulsa and I'll feel better but people aren't letting you do what you want to do.

Lynn Lyons:  Is it because inside there is a constant conversation with you about how you're not meeting your own expectations. How are you creating this level of Sort of low-grade simmering this low-grade dissatisfaction that is just eating away both at you and and your your relationships. It's hard to hang out with somebody who's irritable all the time.

Kimberley Quinlan: And what would you suggest somebody do? If they've caught this red flag of irritability, how would you encourage them to navigate that?

Lynn Lyons: So, the first thing you want to do, and I think I say this about a lot of the patterns in the book. Is you just want to talk about it? Openly with the people you live with, because one of the things that's enormously helpful is for you to own your own stuff, right? So if you know that you're struggling with irritability or even just on a busy day you come home and you're feeling particularly irritable to say to the people that you love the people who are in your orbit. Hey you know what, I had a rough day. I'm feeling irritable, it is not you, it's me it's not your fault. So you're really gonna pay attention to that blaming and you can even say to the people around. You give me a few moments, right? I've got to go for a walk or I'm gonna listen to some music or man. I just need to eat a peanut butter and jelly sandwich.

Lynn Lyons: And then give yourself permission and, and more than permissions, sort of give yourself a little kick in the hello. That says, I'm gonna, I'm gonna work on releasing this irritability without going after other people. And that diffuses it very quickly and…

Kimberley Quinlan: Mmm.

Lynn Lyons: then if you're a parent, you're modeling that for your kids, which is a wonderful thing and…

Kimberley Quinlan:  Yeah.

Lynn Lyons: then you really have to look and see if it's a chronic thing. What do you keep doing over and over and over again? That's making you irritable.

Lynn Lyons:  How are you going to recognize that and accept that? Because a lot of times people say, Well I don't know why I'm so irritable and then we talk about it. And it's pretty obvious why they're so irritable. Now that means you have to adjust or adapt and it might be your schedule. Maybe you're not getting enough sleep. Maybe you're saying yes, too often. When you want to say, no, maybe you are ruminating in your head about how other people have, let you down all the time, maybe you're catastrophizing. So those horrible stories about what the world is going to look like are really making you irritable. So it's it's a way for you to to step back and say What am I doing? That's resulting in this state that I'm in. Yeah.

Kimberley Quinlan: And yeah, yeah. And I'll just for being transparent. I have found as soon as I'm irritable, it's because I'm refusing to feel some feeling like that is for me. I'm like, I don't want to feel this feeling.

Lynn Lyons: You.

Kimberley Quinlan: So I'm gonna be like Real shop and all edgy around everything. So I think that's just such a great point. It's like, I don't want to feel the anxiety. I'm feeling so I'm just like,…

Lynn Lyons:  Yeah.

Kimberley Quinlan: frightened reactionary. So I think that that is such a common. I see it a lot with my patients as well. Just a deep sense of frustration of like you said, they won't let me compuls and…

Lynn Lyons:  and,

Kimberley Quinlan: that. Okay, that's means that you're gonna have to feel some anxiety,…

Lynn Lyons:  Right. Right. Now.

Kimberley Quinlan: right? So I you're on the money there. I love. Okay. This was an interesting one and the last point how self-care is hijacked and becomes not self-care at all.

Lynn Lyons:  If well, and I think that you you sort of teed this up for me very well because oftentimes what we call self-care is really means of avoidance. Right trying to eliminate. So I'm trying to get rid of some feeling. I'm trying to avoid something that I need to address. I don't want to feel this way. We, I talk a lot about our elimination culture and how we're really focused on trying to get rid of things like feelings or discomfort or right. So we take on these practices that we call self care, that are really about getting rid of something or avoiding something and so that can be

Lynn Lyons: Anything from drinking or using other substances to spending money, you don't have to binging on Netflix and not getting the sleep. You need, because you feel like you want to escape, what's going on? When you are doing something that in the moment you're saying, you know what? This is really for me. And then the next day you feel regret about it, probably not self care. Right self-care.

Kimberley Quinlan: Mmm.

Lynn Lyons: If you do it consistently. After after I do something that is truly, you know, one of my good self-care things. I don't say to myself. Oh, I can't believe I did. I can't believe I got eight hours of sleep last night like, Oh, what a loser. I can't believe I went for a walk with my friend. Oh, right. But if I

00:30:00

Lynn Lyons: Spend too much money, or if I stay up too late, or if I skip my exercise, that helps me so much, or if I eat half the chocolate cake. The next day, I'm probably gonna say, Oh honey, like do that, You know,…

Kimberley Quinlan: Mmm.

Lynn Lyons: I should. So that's one of the easy ways to sort of determine for yourself whether or not you're engaged in self-care or self medication, but self care isn't a one hit wonder, right? It's not, it's not a quick fix. It's a consistent pattern. Moving.

Kimberley Quinlan: Right. Right. Yeah, I talk I wrote a book about self compassion and I talk about the same thing as people say. Well this is the self compassionate thing to do to not face my fear or…

Lynn Lyons:  You.

Kimberley Quinlan: to not, you know, to not get out of bed and yes, I understand some days we have to be gentle but I think we also rely on self compassion. Sometimes as a, as a way to avoid our feelings and…

Lynn Lyons:  That's right.

Kimberley Quinlan: wade fear as well. I think that really, you know, is so true. You did talk about self-medicating, and then you would said that, When you're able to identify these seven points, that's a form of self-care.

Lynn Lyons: That's right.

Lynn Lyons: That's right.

Kimberley Quinlan: Right. Do you want to share a little about that and…

Kimberley Quinlan: what that looks like?

Lynn Lyons:  Well, so if you are reading this book, or if you're listening to me now and you're beginning to recognize that you have a few of these patterns that really take over and then and you begin to own them. Just like I was talking about with irritability and you begin to see the pattern. It takes courage to change the pattern. It takes courage to say, Oh gosh, I look catastrophizer or boy, do I get caught up in a ruminating about things, as a way to solve problems? Or you know what? I have been saying that my two or three glasses of wine. Every night is self-care and I'm really noticing that I feel worse the next day, or I don't sleep very well. So once you begin to own them and once you begin to, you know, you can talk about them openly with the people you care about.

Lynn Lyons:  Things start to shift the biggest thing and I'm sure you see this with your patients as well. Kimberley The biggest roadblock that I run up to run up against is when people deny that they're doing the things that I know are causing them to stress. and then, when they blame other people, You know, I I say this all the time, I have this client, The daughter was struggling with OCD, Dad had OCD, he was highly perfectionistic. Things had to be perfect in the house. He would miss his kids, recitals, or their soccer games, because he had to come home after work. And make sure that everything in the house was perfect. And I was trying to explain this to him, this rigidity and his OCD. And he said to me, What's wrong with a neat and tidy house.

Lynn Lyons:  Now nothing except that, that's not what was going on here. But his denial of his patterns and his inability to own them and to talk to his family about them because you can imagine what his daughter did when he said that, right? She like threw herself back on the couch and rolled her eyes got in the way of him, being able to move forward. so, When you know people talk about it, say you say, you're phobic of something, we talk about the courage to face your fears, right? So if you're afraid of bridges, you have to have the courage to go across the bridge. Or if you're afraid of germs, you have to have the courage to touch germs. I feel like the courage is much more, the courage on the inside.

Lynn Lyons:  To acknowledge what's going on and then to work to do the opposite and to really be to really be honest. And vulnerable with yourself. The courage comes not on the bridge or with the germs, but the courage comes from saying, I'm really struggling with this pattern, with this issue with this compulsion, and it feels scary. I'm gonna face what's going on inside of me. And that's gonna help me face. What's going on outside of me?

Lynn Lyons:  Yeah. Yeah.

Lynn Lyons:  Mmm. Yeah.

Kimberley Quinlan: Awareness is the first step but that accountability. That's a hard one. Like it's it,…

Lynn Lyons:  It is a hard one. Yeah.

Kimberley Quinlan: it's a good one, but I had one and I think Do you have like I know where we're close to being finished? I want to be respectful of your time. But do you have any thoughts on how to work towards that accountability, particularly if you're someone who's rigid and doesn't like that,

Lynn Lyons: Well, I mean, one of the, one of the things that I think is really helpful is for people to recognize that these patterns and OCD and anxiety is really common, and people don't talk about it. But gosh,…

00:35:00

Kimberley Quinlan:  If?

Lynn Lyons: how many people have OCD in this world? How many people struggle with the things that we talk about on a daily basis? So I'm I say to people, you know, you're not unique. Your problem isn't special. It's it's, it feels big to you because it's your problem, but there are really a lot of things that we can do to help this. We know a lot about it, it's not mysterious the content of what your worried about or the content of your OCD is meaningless. This is a process. This is a thought process issue and let's just get over this idea that it's so special and that you're unique and that there's nothing anybody can do because you're worse than everybody else, right? So that's one of the things I do.

Lynn Lyons:  And then also really helping people. Learn about Other People's Stories. I think there are some wonderful books and resources where you read about other people's struggles. And you begin to realize gosh, This is so much of what I've experienced it is. It's a matter of being vulnerable in a matter of moving away from this idea that the perfect world that other people are presenting is not so perfect, after all. Yeah,

Kimberley Quinlan: Yeah, so true. So true. Lynn, I have loved getting all your wisdom. Thank you so much. Do you want to tell us where people can learn about you and about your book and all the things?

Lynn Lyons: Sure, sure. So my website is just Lynn Lyons.com. I'm on Instagram at Lynn Lyons anxiety. I'm fairly new to Instagram. My younger son is my is my Instagram helper, and then I'm on Facebook. If you go on Lynn Lyons, and just put in anxiety or psychotherapist, we've got the podcast fluster clocks with an X that comes out every Friday. Um, By the time, this comes out, by the time that people are hearing this, the audible book for the anxiety audit. Hopefully we'll be released because they told me it will be out in January. I just recorded it right before our Thanksgiving in November. So I'm excited to welcome that into the world. So yeah there's there's you know, all sorts of videos and things on my website and resources and things you can check out.

Kimberley Quinlan: Fantastic and I'll link all those in the show notes. Thank you so much for coming on.

Lynn Lyons:  Thank you.

Kimberley Quinlan: It's a delight to me meet with you.

Lynn Lyons:  Thank you for having me and thank you for all of your wonderful questions you made it so easy, which is nice.

Kimberley Quinlan:  Wonderful, thank you.

Lynn Lyons:  All right. Yeah, that was great. You are you are super easy to talk to so thank you. Yeah.

Kimberley Quinlan: Oh, I'm so glad I didn't tell you. I beforehand, you've written a book with Read Wilson.

Lynn Lyons: Yeah. He is.

Kimberley Quinlan: He's a very dear friend of mine. Yeah. Yeah,…

Lynn Lyons: Yeah. All right.

Kimberley Quinlan: so I'm

Lynn Lyons: Well, I'll tell you say hello. Yeah. We wrote two books together, I am.

Kimberley Quinlan:  yeah.

Lynn Lyons: I was just talking to him the other day. Yeah, that's how did you, how did you meet him just through working on OCD stuff.

Kimberley Quinlan: Yeah, through ICD. He's been on the show a bunch of times and…

Lynn Lyons:  Oh, that's awesome.

Kimberley Quinlan: and I consider him such a, I know a helpful resource and and support. So I just wanted, I want to mention that at the end.

Lynn Lyons: Oh yeah,…

Kimberley Quinlan: Yeah. Yeah,…

Lynn Lyons: that's awesome.

Kimberley Quinlan: I don't often usually we don't take guess…

Lynn Lyons: That's awesome.

Kimberley Quinlan: unless I'm sort of developed a relationship but your name went underneath the,…

Lynn Lyons:  Yeah.

Kimberley Quinlan: the read seal of approval.

Lynn Lyons: If? Well,…

Kimberley Quinlan: I was so glad to meet with you. And have you on the show? Yeah, you guys trained together.

Lynn Lyons: thank you. Thanks for having me.

Kimberley Quinlan: Is that what it was?

Lynn Lyons: Oh no, he we wrote the books together so I'd never I'd never met him before and we were presenting it. I was we were both presenting at a brief therapy conference. I think when was it like Like, 15 years ago, maybe. And so he just,…

Kimberley Quinlan:  Yeah.

Lynn Lyons: he just popped in and listened to my talk and then he emailed me a little while later and said, I want to write a book on kids, but I don't work with kids, and I need a co-author,…

Kimberley Quinlan:  Sure.

Lynn Lyons: would you want to write a book with me? So I was like, Yeah. So so we wrote the two books together. It was a period of four and a half years of writing. And, you know, the two books and I think God. I mean, I talked to him every day. Probably for, you know, three and a half years. So yeah, we've become, we've become good friends. Yeah, he is a good guy. Super helpful to me,…

Kimberley Quinlan: Yeah.

Lynn Lyons: too. I just, I just love what he's offered me. Yeah.

Kimberley Quinlan: Yeah, and and my clients and…

Lynn Lyons:  Mmm.

Kimberley Quinlan: my stuff to be honest. Like so often when I'm consulting with my staff, they'll like bring up a read Wilson comment.

Lynn Lyons:  Yeah, yeah, and his new OCD program is just amazing. Yeah.

Kimberley Quinlan: And it's really wonderful. Yeah.

Kimberley Quinlan: Amazing. Yeah. Really amazing. That the six the six-part plan is so cool. Yeah. I love the work that you're both doing.

Lynn Lyons:  Yeah.

00:40:00

Kimberley Quinlan: Thank you for all your work. I'm like a learner of your work, right? I'm yeah,…

Lynn Lyons:  Oh thanks. Thanks thanks. Yeah.

Kimberley Quinlan: it's really wonderful. Yeah, yeah, well, thank you so much. I it will be out on the 24th of February,…

Lynn Lyons:  Okay.

Kimberley Quinlan: and we usually link to Instagram. I'm really active on Instagram and…

Lynn Lyons:  Okay.

Kimberley Quinlan: it comes out on Friday, as well. I'll probably please come out and Friday. And so, if you want to have your assistant or a publisher, I'm not sure email me. All of the links to anything you want me to add in the show notes. That's usually an easy way to make sure I get it correct.

Lynn Lyons: Okay, okay.

Kimberley Quinlan: And I think that's it. Yeah.

Lynn Lyons:  All right. Great. Shoot. Me an email. Just to remind me before it comes out, so I can start to promote it on my stuff too. Okay.

Kimberley Quinlan:  Yeah, wonderful. Yeah, and it's really great to meet with you and chat. Alright. Take a have a good day.Lynn Lyons:  Okay, thank you very much. Bye.

Jan 6, 2023

This is Your Anxiety Toolkit - Episode 318, and welcome 2023. 

Welcome back, guys. Happy 2023. Happy New Year. I want you to imagine you and I are sitting down at a table and we both have the most wonderful, warm tea or coffee or water or whatever it is that you enjoy, and we are going to have a talk. You’re not getting a talking too, I’m not saying that. But I want you to imagine that I’m standing in front of you or sitting in front of you and we’ve got eyes locked, and I am dead serious in what I’m talking to you about because I believe it to be the most important thing you need for 2023. I really, really do. 

So, let’s talk. Okay, you’ve got your tea. I’ve got my tea. Let’s do this. Okay.



318 The ONE Thing I Want You to Focus On in 2023

So, I want you to imagine that you have a suffering in your life. We all have suffering. It’s a part of being a human. Life is 50/50. It’s 50% easy and 50% hard. We all are going to have suffering this year. But I want you to imagine this scenario. It could be something that’s hard for you that you’re already going through or could be imagined. And I want you to think about that there’s a circumstance or a situation that happened that is out of your control and it’s causing you suffering. Maybe it’s a thought that’s intrusive, maybe it’s anxiety, maybe it’s depression. Maybe you have a hole in your tire, maybe you-- if you hear some people walking, it’s because my whole family are upstairs playing. But maybe you have some financial stresses, relationship stresses. Maybe you feel very alone. Whatever you’re suffering is, I want you to acknowledge that you’re having this suffering. And then I want you to think about, who could I call to help me manage this pain in my life? Is it someone who could support me and nurture me during that suffering? Is it someone who has the solution to that problem? Is it somebody who’s been through it before and they can guide you on what to do? 

So what we do when we have suffering is we gather hopefully a list of people who we can help and we reach out to them. That’s good coping, right? But what I want you to do differently, or maybe you’re already doing this and I want you to do more of in 2023, is I want you to move you to the top of that list. I want you to be the first person you call to offer yourself the support and wisdom and guidance, right? 

I’m not here to say there’s anything wrong with calling the other people. In fact, I am a huge believer in gathering your peeps when things are hard, calling your speed-dial people, right? That’s cool. I want you to be doing that. But I want for this year for you to move yourself to the top of the list and ask yourself, what is it that you need while you suffer? How can I support you while you suffer? What do you need to hear as you suffer? How can I tend to this suffering in a kind, compassionate, non-abandoning way? How can we be that for ourselves? We have to be at the top of the list. And I don’t mean that in any preachy way. I mean it because let’s look at the problems when we’re not, when we don’t show up at the top of the list.

We build this belief that we need other people and we don’t have what it takes to get through it, right? When we put ourselves at the top of the list, we develop and grow muscles in our brain that have us start to see that we can cope really well by ourselves. That we have everything that we need, right? That is so, so beautiful. 

And the reason I’m sharing this with you in this hopefully not preachy way is I was journaling the other day and I was really asking myself like, what is it that I want to talk about? What is it that I’m so passionate about? What is it that lights a fire inside me? And while, yes, I love talking about anxiety and yes, I love talking about OCD and I love talking about mental health and all the things, this one thing I believe is the biggest game changer above and beyond all the tools that I give you in my toolkit. 

Oh, PS, I have to tell you, I was looking for-- I was doing a Google search on Your Anxiety Toolkit because I just had to pull up something and it’s easier for me just to Google it. And when I wrote it in, this teeny tiny wooden kids toolkit showed up, like this little toolbox. And I couldn’t help myself, but I had to buy it because I was like, that’s exactly it, right? This is all about me giving you an array of tools and tools that are super effective and tools that you know when to use them. Because imagine if you had a saw but you were using it for the wrong thing, that would be very ineffective. So, that’s the whole premise of this podcast. But I was thinking about, of all the tools in the toolkit, this might be the most important one, which is the one that teaches you how strong you are. That you are the most unconditional friend for yourself, the most unconditional friend. You are there non-stop, no matter what. No matter what happens, you have the capacity to sit with yourself in compassion while you suffer. 

So, that’s it, you guys. That’s all I have to say. That’s the goal I have for you this year. And I would love to hear and to know what outcomes you get from that. So, as you practice it, don’t be afraid to, if you signed up for our newsletter, reply and let me know. How’s that going for you? How’s that helping? 

Again, I want to really be clear here. We are not showing up for ourselves first because we don’t deserve other people’s help. We’re still going to ask for their help, but we are moving ourselves to the front of the line. We’re moving ourselves to the first person we speed dial, right? And we’re showing up for ourselves as much as possible so that if the person that’s second in line doesn’t have the capacity for us today, that’s all right because we already know that the first-speed dial person, which is us, is there ready to pick up whatever is left over. Okay? 

So that is my hope for 2023. That is my hope for you for the rest of the decade as well. And this is something I feel again so incredibly strong about. Sorry, that didn’t make sense. It’s something I feel so deeply about. Okay? 

All right. I am sending you the biggest love. I have got some super exciting, big things happening in the new year. Big for me, hopefully, helpful for you. Hopefully, that will, again, give you more tools, more effective tools, make you more clear on which ones to use and when. It will mean that the structure of the podcast will change just a little but hopefully for the better. Okay? 

All right. I’ll see you guys next week and we will go from there. 

Have a wonderful day and it is a beautiful day to move yourself to the top of the list. Have a good one, everyone.

Dec 30, 2022

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



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

317 How to change your habits (with Monica Packer)

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

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

HOW TO CHANGE YOUR HABITS 

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

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

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

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

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

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

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

HOW SOCIETY IMPACT OUR HABIT FORMATION 

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

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

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

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

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

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

HABITS SHOULD BE SUPPORTIVE 

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

Kimberley: It’s not a checklist.

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

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

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

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

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

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

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

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

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

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

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

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

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

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

Monica: Oh, yes.

Kimberley: Is this an intentional plan? Tell me.

SMALL, INTENTIONAL HABIT CHANGES

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

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

MEDITATION HABITS 

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

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

Kimberley: Like brushing your teeth. 

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

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

Monica: Love it. 

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

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

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

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

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

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

Monica: Exactly. 

Kimberley: Good. Baby steps.

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

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

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

CHANGING HABITS WITH CHRONIC ILLNESS 

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

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

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

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

CREATING A HABIT PLAN 

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

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

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

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

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

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

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

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

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

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

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

Monica: I love that. Thank you.

Kimberley: My pleasure. Thank you so much.

LINKS: 

PODCAST http://aboutprogress.com/podcast
STICKY HABIT METHOD https://www.workinprogressacademy.co/sticky-habit-method
FREE HABIT CLASS FOR WOMEN https://workinprogressacademy.mykajabi.com/women-habits-class

Dec 23, 2022

In this podcast:

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



Links To Things We Talk About:

Episode Sponsor:

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

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316 Overcoming Superstitious Obsessions (with Laura Ryan)

EPISODE TRANSCRIPTION

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

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

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

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

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

OVERCOMING SUPERSTITIOUS OBSESSIONS AND BREATH-HOLDING COMPULSIONS

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

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

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

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

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

00:05:00

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

Laura Ryan:  heard of ERP and OCD.

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

Laura Ryan:  Yeah.

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

SUPERSTITIOUS OBSESSIONS & SYMPTOMS

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

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

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

Kimberley Quinlan:  Inflecting.

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

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

Laura Ryan: Yeah, absolutely.

Kimberley Quinlan: It's so cool.

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

Laura Ryan: Yeah. Yeah.

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

00:10:00

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

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

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

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

Laura Ryan:  Yeah, absolutely.

MANAGING WHACK-A-MOLE OBSESSIONS

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

Laura Ryan:  um,

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

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

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

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

Kimberley Quinlan: It.

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

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

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

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

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

Laura Ryan: Yeah.

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

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

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

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

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

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

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

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

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

MOTIVATION FOR ERP

00:20:00

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

Kimberley Quinlan: If?

Laura Ryan: Functional things for those mental compulsions.

Laura Ryan:  I find it's a really

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

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

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

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

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

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

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

00:25:00

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

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

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

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

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

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

Laura Ryan:  Yeah.

HOW TO GET THROUGH THE HARD OCD DAYS

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

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

Kimberley Quinlan:  Yeah.

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

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

Kimberley Quinlan:  Yeah.

Laura Ryan: um, Yeah,…

Kimberley Quinlan: Yeah. Changes the game.

Laura Ryan: it's really cool. Definitely.

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

Laura Ryan:  Yeah.

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

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

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

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

Laura Ryan: Yeah.

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

00:30:00

Laura Ryan:  Yeah, absolutely.

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

Laura Ryan: Yeah.

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

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

PERFECTIONISM AND EXPOSURE & RESPONSE PREVENTION (ERP)

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

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

Kimberley Quinlan:  Mmm.

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

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

Laura Ryan:  Yeah.

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

Laura Ryan: Yeah. Yeah, absolutely.

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

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

Kimberley Quinlan: You like my schedule,…

Laura Ryan: no, it works.

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

Laura Ryan:  Yeah. Yeah.

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

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

Kimberley Quinlan: Yeah. I know,…

Laura Ryan: Yeah, it's awesome.

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

Laura Ryan:  Yeah.

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

Dec 16, 2022

SUMMARY: 

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



Links To Things I Talk About:

  • Instagram: @anxiouslybalanced

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

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

EPISODE TRANSCRIPTION

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

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

Kimberley Quinlan: So welcome.

A Peaceful Balance Wichita: I'm excited.

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

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

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

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

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

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

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

A Peaceful Balance Wichita:  Yeah.

SIBLINGS AND OCD

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

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

Kimberley Quinlan: Mmm.

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

Kimberley Quinlan: Mmm.

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

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

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

00:05:00

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

A Peaceful Balance Wichita: Okay.

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

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

A Peaceful Balance Wichita:  Yeah.

INCLUDING THE WHOLE FAMILY IN OCD TREATMENT

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

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

Kimberley Quinlan: What are your thoughts?

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

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

Kimberley Quinlan: um, And here.

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

Kimberley Quinlan:  Yeah.

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

Kimberley Quinlan:  Mm-hmm.

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

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

A Peaceful Balance Wichita: Yeah.

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

BE SEEN MODEL

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

Kimberley Quinlan:  Right.

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

00:10:00

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

Kimberley Quinlan: Such a crisp, man.

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

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

Kimberley Quinlan:  Hmm.

SUPPORTING SIBLINGS DURING OCD TREATMENT 

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

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

OCD FAMILY THERAPY: INCLUDING SIBLINGS AS “ASSISTANT COACHES” 

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

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

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

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

00:15:00

Kimberley Quinlan: Yeah.

DEVELOPING EMPATHY DURING OCD TREATMENT

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

Kimberley Quinlan:  Yeah.

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

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

Kimberley Quinlan:  Hmm.

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

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

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

Kimberley Quinlan:  Yeah. Yeah. Yeah.

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

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

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

A Peaceful Balance Wichita: And yeah. Absolutely.

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

A Peaceful Balance Wichita:  Yes. Yes.

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

A Peaceful Balance Wichita:  Correct.

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

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

00:20:00

Kimberley Quinlan: They're like,…

Kimberley Quinlan: conceptualizations. Okay.

A Peaceful Balance Wichita: Exactly it…

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

Kimberley Quinlan:  Okay.

Kimberley Quinlan:  Right.

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

Kimberley Quinlan: Yeah. Okay, thank…

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

A Peaceful Balance Wichita: Yep. Right.

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

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

Kimberley Quinlan: Mmm. Right.

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

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

Kimberley Quinlan: You.

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

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

A Peaceful Balance Wichita: That.

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

A Peaceful Balance Wichita:  Yeah.

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

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

00:25:00

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

Kimberley Quinlan: Yeah, right.

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

Kimberley Quinlan:  Right.

A Peaceful Balance Wichita: We go on to.

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

Kimberley Quinlan:  Yeah.

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

Kimberley Quinlan:  Right. And

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

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

A Peaceful Balance Wichita:  Absolutely.

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

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

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

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

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

Kimberley Quinlan: Yeah.

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

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

A Peaceful Balance Wichita:  Yeah.

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

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

00:30:00

Kimberley Quinlan: Mmm. Yeah.

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

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

Kimberley Quinlan: Yeah.

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

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

A Peaceful Balance Wichita:  Exact.

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

A Peaceful Balance Wichita:  Ly. Yeah.

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

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

Kimberley Quinlan:  And please.

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

Kimberley Quinlan: On a family,…

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

Kimberley Quinlan: I see.

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

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

Kimberley Quinlan:  Yes.

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

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

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

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

A Peaceful Balance Wichita: ah,

Kimberley Quinlan: You can An excellent resources.

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

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

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

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

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

Kimberley Quinlan:  Yeah.

00:35:00

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

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

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

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

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

Dec 9, 2022

SUMMARY: 

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

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

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

  4. Anxiety does not mean something needs solving

  5. Find an OCD community

  6. Self-compassion helps manage uncertainty

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



Links To Things I Talk About:

https://www.instagram.com/mentalhealthmhe/

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

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

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This is Your Anxiety Toolkit - Episode 314.

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

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

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

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

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

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

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

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

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

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

Introduction To Micah Howe

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

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

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

Intensive Treatment For Ocd 

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

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

Micah: Yeah. 

How To Know You Are Ready For Intensive Ocd Treatment

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

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

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

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

Micah’ Intensive Ocd Treatment Story

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

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

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

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

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

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

Micah: Oh, no, that’s great.

The 6 Most Important Turning Points Of OCD Recovery

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

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

Kimberley: Yeah, just lay them on.

  1. Anxiety Does Not Mean Something Needs Solving

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

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

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

  1. Compulsions Keep OCD

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

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

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

OCD Grief

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

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

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

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

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

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

  1. I Can Control My Reaction To OCD

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

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

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

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

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

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

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

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

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

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

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

  1. Find An OCD Community

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

  1. Self-Compassion Helps Manage Uncertainty

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

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

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

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

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

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

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

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

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

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

Dec 2, 2022

In This Episode:

What causes anxiety?

Is Anxiety "normal"?

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

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



What causes anxiety disorders?

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

What causes anxiety in the brain?

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

What causes anxiety and panic attacks?

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

Links To Things I Talk About:

Episode Sponsor:

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

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EPISODE TRANSCRIPTION

This is Your Anxiety Toolkit - Episode 313. 

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

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

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

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

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

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

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

WHAT CAUSES ANXIETY?

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

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

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

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

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

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

WHAT CAUSES ANXIETY DISORDERS?

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

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

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

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

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

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

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

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

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

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

WHAT CAUSES ANXIETY IN THE BRAIN?

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

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

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

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

WHAT CAUSES ANXIETY AND PANIC ATTACKS?

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

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

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

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

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

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

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

Nov 25, 2022

In This Episode:

  • Amy Mariaskin, PhD shares her new book, Thriving in relationships when you have ocd
  • What is Family accommodation and how does it apply to ocd
  • Ocd family accommodation vs family support, 
  • What is OCD reassurance and how it can creep into one’s relationship
  • Relationship ocd, also known as rOCD
  • Relationship issues with ocd and how to manage them
  • Sexual orientation OCD, Gender related OCD, and Harm OCD and the impact this has on relationships
  • Attachment styles in ocd and how to understand them to help you navigate communication. 



Links To Things I Talk About:

Thriving in Relationships When You Have OCD: How to Keep Obsessions and Compulsions from Sabotaging Love, Friendship, and Family Connections
Amy’s Instagram https://www.instagram.com/ocdnashville/?hl=en
ERP School: https://www.cbtschool.com/erp-school-lp
Episode Sponsor:This episode of Your Anxiety Toolkit is brought to you by CBTschool.com.  CBTschool.com is a psychoeducation platform that provides courses and other online resources for people with anxiety, OCD, and Body-Focused Repetitive Behaviors.  Go to cbtschool.com to learn more.

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EPISODE TRANSCRIPTION

This Your Anxiety Toolkit - Episode 312. 

Welcome back, everybody. This is going to be a really important episode for you to listen to. Today, we have the amazing Dr. Amy Mariaskin, who is what I consider to be a very dear friend, someone I very much respect. She has written a book about relationships and OCD, and we talk all about it. We go deep into some of the core skills and discussions she has in her upcoming book. And this is just going to be an episode I really feel like you could take away and put some skills together right away. I’m so thrilled. So, thank you, Amy, for coming on this show. 

But before we do that, I would like to do the review of the week, and I really hope you listen carefully to this. Not because it’s reviewing the podcast, but because I actually think the person who wrote this, who put in this review, is following some key points that I want you to consider. And this is what I encourage a lot of people to do. So, let’s go. 

This is from Detroitreview and they said:

“Thank you, I just started listening today after having a few weeks of anxiety and irregular thoughts that I never experienced. I randomly chose your podcast and am thankful for your experience, knowledge and personal and situations. As a 46-year-old father of two boys and loving wife, your podcast gives me a sense of calming. I’m taking notes on each cast.” Guys, I encourage you to do this. This is a free resource. It is jam packed full of skills. I encourage you to take notes. So, I love that you’re doing that Detroitreview. “While I started with the most recent, I have listened to #301/302/303.” And then they went on to say: “And they’ve already given me strategies that I’m using. I decided to start from your first podcast in 2016.” And that is what I encourage you all to do, mainly because those first 11 episodes are core content. I want you to take the content I talk with my patients about all the time. He went on to say, “I have been so impressed. I’ve listened to 1-2 daily. I’m up to 10 and 11. There’s so many things to listen to and I’m so grateful for you. The meditations are amazing. Keep up the great work.”

Thank you so much for that review, Detroitreview. That is exactly my intention. This is a free resource, you guys. I want you to take advantage of the skills and tools so that you can have a toolkit for yourself. And so, I’m so thrilled for that review. It just makes me feel like, yes, that’s exactly what I want you guys to take from this podcast.

Okay, before we get over to the show, let’s talk about the “I did a hard thing” segment. This one is from Kelly, and they said:

“I recently faced one of my biggest fears – general anesthesia.” Holy moly, Kelly, I feel you on so many levels with this. “I started struggling with some gallbladder issues and was told I needed to have it removed. I was terrified, and I didn’t think I could go through with it. Thoughts were racing out of control. I sought help with therapy and your podcast. Thoughts are thoughts and not facts was huge for me. It was calm the day of the surgery, and I did it. Thank you.”

That is amazing. You guys, listen, thoughts are thoughts. Just because you have them doesn’t mean they’re facts. I love that they’re bringing in that key concept as well. 

Alright, let’s go over to the show. This is the amazing Dr. Amy Mariaskin. She’s an OCD therapist. She’s an advocate. She’s an author of an upcoming book. You must go and check it out. I’ll leave the link in the show notes. I am so, so honored to have you on the show, Amy. Let’s get over to the episode.

312 Thriving in Relationships When You Have OCD (with Amy Mariaskin PhD) Your anxiety toolkit

Kimberley: Welcome, Amy Mariaskin. I am so excited for this episode today. Can you do a little introduction of who you are and all the good things about you?

Amy: Yes. Thank you so much. I’m excited to be here. I’m Dr. Amy Mariaskin. I’m a licensed clinical psychologist and owner and director of the Nashville OCD and Anxiety Treatment Center in Brentwood, Tennessee. I’ve been working with OCD and anxiety for over 15 years now, and I just absolutely love it.

Kimberley: And you wrote a book?

Amy: And I wrote a book. I know I need to get better about that. I was like, “Oh, do I say it now or do I say it later?”

Kimberley: You say it all the way.

Amy: All the time. I wrote a book. It was fun and not fun and everything in between. And I think we’ll be talking quite a bit about it. It’s called Thriving in Relationships When You Have OCD.

Kimberley: Right. Now, when you told me that you were going to write this book, I was so excited because I feel like at the crux of everything we do, a lot of the time, the reason people with OCD want to get better or the thing that propels them is how much their OCD impacts relationships. Not always, but I feel like that’s such a huge piece of the work. So, I am so grateful for you for writing this book, and it is an amazing book. I’ve read it myself. You did a beautiful job. And I want to cover some of the main pieces that you cover in your book today and go from there. So, first of all, congratulations. I know writing a book is not easy.

Amy: Thank you. Yeah, it’s been a dream for a long time. So, I’m excited about the accomplishment and I’m ready to figure out the next topic.

When Ocd Is The Third Wheel

Kimberley: Yeah. I love it. I love it. Okay. So, Chapter 1, I think it’s funny. I’ll have to tell you how, when I was reading your book, I was lucky enough to get an early manuscript. I remember sitting, it was with my kids at track and they were running. And I opened the book and the first chapter said, “The Third Wheel: Understanding OCD’s Role in Relationships.” And I was like, “That’s exactly it.” So, I was excited right off the bat. Tell me, what do you mean by the third wheel? Tell me a little bit about that.

Amy: Yeah. First, I should also thank you for writing the wonderful foreword for the book. So, if anybody is a fan of Kimberley, yet another reason that you might be interested in this book. Well, let me think. So, yeah, the third wheel analogy, it felt very apt because when I work with couples, I often imagine, and sometimes I’ll have couples imagine that the OCD is like this other presence in the room sitting there with us. Not physically, but in all the things that are important for relationships, all the ways that we develop intimacy, and that we even structure our time or the activities we choose to do together that OCD can wiggle right in there and can be this like third presence. And the thing is, it’s really easy, I think, for somebody without OCD if they don’t have good education or they don’t understand it, to get that third wheel confused with the person with OCD itself. So, like, “Well, you never want to go out,” as opposed to saying, “We both want to go out.” And here’s this other guy, OCD, really bossy, really pushy, really oppressive, who’s also coming along with us. And even when you do the things that you love, OCD can come along. 

So, it felt to me like this sense of something in the relationship that makes it both unbalanced and is this separate component and that both people, in coming together, have to find creative ways to connect around it or eventually connect and evict it more and more. And so, that’s why I chose that metaphor.

Kimberley: Yeah, I love that. And it’s funny because I remember when I was an intern and I was seeing a family or perhaps the wife who had OCD, what was interesting is I’m sitting in my chair and I noticed that the family members always sat across from her as if it was like her versus them, like who’s on which side of the team. And a big part of it was like, all you guys need to be over on that side of the room. You’re the team. I’ll be over here with OCD and we’ll work this out. But I think that that, even metaphorically, is such an important part of how OCD can turn everyone against each other. Is that how you’ve experienced it?

Amy: Yeah, I think at times there are a lot of conversations about how everybody has a common goal to figure out how to live with one another, develop intimacy, connections, be they friendships, parenting relationships, romantic relationships, even work relationships, and things like that, how to form those and how to come together around common goals. And sometimes OCD can be, again, confused as a goal that one person in the relationship has. And the truth is, everybody’s suffering in a way, and that everybody can be a part of that process of, again, reducing symptoms or evicting it, things like that. 

I do the thing as well when I have people in my office to just look at where are they sitting or when OCD comes up, what is the body language? Are both people really like arms crossed? Is the person with OCD hanging their head in shame, which we know could be such a powerful emotion and such an inhibitor of connection and vulnerability. So, I look for some of those and I remind them, “Head up, we’re all talking to OCD right now, and we’re all working with that, and we’re all on the same team.” 

Family Accommodation & Ocd

Kimberley: Such an important message. Thank you for that. I think that’s beautiful. So, let’s say the third wheel, I always think of like you go on a date and the third wheel shows up. And we know that definitely happens with OCD. You addressed a lot in your book about family accommodation. Can you share what that means and how that can impact a relationship?

Amy: Yeah, absolutely. Accommodation is this thing where we’re extending this metaphor. You’re on a date, you’re with somebody, and the third wheel rolls on up. It’s, “Hey, my buddy from college is here, what’s up?” Essentially, accommodation is like, “Hey, why don’t you have a seat right here? Here’s the menu, here’s a place mat.” It is anything that the person in the relationship without OCD is doing to make OCD have a comfortable place at the table. So, that’s the metaphorical way. That’s abstract, but bringing it down to practically what it looks like, it means doing things generally in the service of what feels comfortable in the moment for the person with OCD. We’re going on a trip and I have concerns about contamination and I really want you to check all the hotels, do all this research to make sure that none of these places have ever had bedbugs or things like that. Then when we get there, we’re dirty from traveling, so I’m going to need you to take a shower. And so, the person, the spouse is taking showers and doing research and perhaps taking over responsibilities from the person with the OCD in order to provide that short-term relief. But it ends up, again, making a place for OCD in the relationship. And it reduces that motivation for the person with OCD to change. 

Family Accommodation is tricky. There are a lot of ways that it can happen. I think reassurance-seeking is certainly one that I think we’ll talk about, but providing excessive reassurance about things to the person with OCD in a way to keep them comfortable but keep them caught up in compulsions. And I think it’s important to note that a lot of times, partners will hear about accommodation. And just as much as we think being apprised of accommodation and looking out for it is important, it’s also, I think, really important that partners understand that that’s nuanced and that they don’t take it to like, “Well, I’m not going to do that for you. That might be accommodation,” or, “I’m not going to reassure you about anything,” or “Is that your OCD?” I guess I say that to say that it’s a little tricky, but it’s really anything that is preventing the person with OCD from experiencing discomfort and thereby strengthening the cycle.

Kimberley: Right. No, I’m grateful that you bring that up actually, because probably the one that I get asked the most from parents, and this not in every relationship, but with parents, is like, okay, my child is having a really hard time getting homework done, their OCD is impacting them. So, if I don’t help accommodate them, if I don’t do some compulsions for them, read for them or so forth, they won’t do their homework. And then there’s an additional consequence. So, they’ll say like, “I feel like that’s too risky. I could actually be letting my kid fall behind, so I can’t stop doing this accommodation.” What are your thoughts on that? Again, how would you approach that type of situation? I mean, there’s many examples.

Amy: Sure. I think with a situation like that, first, I would validate the parents’ love and desire for their child to do as well as possible. Most accommodation is coming from a place of love and not a deliberate enabling or anything like that. Of course not. So, I really provide a lot of validation there. And then I help them reframe it as, “One way to be loving and supportive in the long run is to really cheer your child on in taking over, taking on more and more ownership of that.” So, does that mean, “I know that I’ve been reading. Right now, I’ve been reading for you, and that makes it easier to do your homework. We also know that you have OCD and we know that your brain tells you, you’ve got to reread and reread and reread. So, can we be on the same team together, fight that rereading? I’m not going to read it for you because I love you, because I know you can do this. Boy, is it going to be hard at first and I’m going to be there to cheer you on and motivate you.” I sit with kids, I’m always about gamifying it. “Do we want to just race through this? We don’t have to be perfect.” Again, it depends on the symptoms, if it’s perfectionism or what’s getting in the way. 

And then what I say is, if a parent says, “Well, then they’re really just not going to get their schoolwork done,” sometimes then I’ll say, “Well, if it gets to the point where it is interfering with things like that, then it may be that they need a little bit more support.” Because it’s like, with kids, your job is school and with the adults, your job can be a job or it can be care taking. It can be a lot of different things. But if one of those major domains of living is affected, then it may just mean that you need more support. So, we might up the number of sessions per week or refer out to another program or things like that. 

But those kinds of things would be the same things I would say in any kind of relationship where there’s an accommodator, which is, wow, you love your friend or partner or coworker so much that you’re willing to do this stuff for them so that they’re not suffering or so that they can demonstrate their potential as in the case of the kid with homework. But here’s why that’s not the loving response in the long run.

Ocd Family Accommodation Vs Ocd Support 

Kimberley: Right. You’re right. I mean, you mentioned like, then we have the complete other end of the spectrum where people are going, “No, I’m cutting you off completely.” And I think too, I think it’s important, as you said. Some accommodation happens in every relationship. I don’t particularly like cleaning hair out of the sink drain. That’s not my favorite. So, I’m going to ask my husband to do it, knowing that I take the trash out or whatever. We trade-off. So, how might people identify accommodation through the lens of OCD compared to loving exchanges of acts of service? 

Amy: Right. Oh, I love that question, because essentially, what we call compromise in relationships could be called accommodation – accommodation by a gentler name. And I think part of that has to do with, what’s the motivation there? You do such a wonderful job in your podcasts and online and everything of talking about how doing the hard things are important, and how if you’re not doing the hard things and you’re avoiding difficult things that can really shrink your world over time and put anxiety or OCD in the driver’s seat. So, if the motivation, if a child or a spouse or a friend is asking-- well, if you are asking a child or a friend or a spouse, if you’re saying, “Hey, can you do this for me,” or “I’d feel a lot more comfortable if you did this,” thinking about, is it a compulsion or a preference to me? There are so many different ways that we can look into that, but is it in the service of just like, I could, but I prefer not to? Or is it, I feel like if I do that, I’m going to be too anxious or I’m going to do too many compulsions, or something bad is going to happen? So, I think if the motivation there is more avoidance due to anxiety as opposed to just preferences, I think that’s helpful. 

Sometimes I’ll say to people when they’ll say to me like, “Well--” and I think division of labor in the house is such a good example. When people say, “Well, I don’t ever take the trash out,” I will often ask, “Well, what happens when your roommates are out of town?” Let’s say they’re living in a roommate situation. And if they say, “Well, it just piles up and I can’t deal with it,” then I say, “Aha, this might be a place that we need to work on and chip away.” And again, reducing accommodations doesn’t mean like all of a sudden, I’m a garbage master and I’m the only one doing it. It might mean that I’m doing some exposures to get up to the point where I can have that role in the household. 

So, I love that question of like, well, what if you had to do it? What would that be like? And if it’s really hard, then hey, let’s help break down some of those barriers and reduce accommodation.

OCD Reassurance

Kimberley: Yeah. I usually tell clients like, “Okay, let’s just do it so that we know you can, and then you can move on to the next exposure.” Tell us about reassurance. You talked about it a little bit. And in your book, actually, the thing I highlighted, because I read it in Kindle, that I love the most is your reassurance tracking. Tell us a little about that. 

Amy: Yes. Because again, I love that you’re highlighting this because reassurance is something that is okay. Reassurance happens in all relationships. Again, we might call it by different names. It might just be checking in. It might be clarification. It might be getting information from one another. So, I developed a worksheet that’s also available with the book that allows for people to track when they’re asking for reassurance from loved ones, and to answer a series of questions that aren’t going to give you a 100% certain answer of whether or not it’s compulsive, but are going to give you some clues. So, on the worksheet, it says, people write down the situation. So, for example, I was asking my friend if she was mad at me. That might be the situation. And then there’s a column that says, what were your emotions? 

Again, if we’re seeing anxiety, guilt, shame, some of those words might be a clue that our OCD is at play, but not always. And then people track, did you ask only once? Because we also know if it’s truly the type of reassurance, “Oh, I just need to know. I’m having a vulnerable moment. I just need to know, is this okay with you? Are you upset?” Then asking once and accepting the answer is generally how it goes. So, if you’re asking more than once, if you answer no to that, it’s a clue that it could be compulsive reassurance. And then also, was the source credible? 

I feel like I talk about this example a lot, but I just love it so much, which is that I worked with a little girl who was really worried about getting strep throat. She would ask everybody for reassurance about her tonsils. I mean, anybody and everyone. At one point, she took a picture and she was just old enough that she got social media. She put it on her Instagram and she was like, “Do you guys think I have a strep throat?” That was the caption. That was the little caption, which is like, she was laughing about it afterwards, but that’s not a credible source. I mean, she wasn’t even friends with all the docs in town or anything, or ear, nose, and throat specialist. So, was the source credible? 

Now, often if it’s social reassurance, it is a credible source. If I ask you, if I say, “Kimberley, was I too long-winded,” you’re going to be able to tell me. So, you would be a credible source. If I leave this room right now after doing this podcast and I ask somebody, “Do you think I was long-winded? Do you think I was?” and they’re like, “Well, we weren’t there,” that’s that answer. That’s that question about credibility. 

And then the last one is, did you accept the answer? Anxiety and OCD have this way of undermining. Well, pretty much everything, but undermining any answer we get and countering with it. ‘What if,’ or ‘Are you sure?’ ‘But I think...’ So, if it’s starting with a ‘but,’ a ‘maybe,’ a ‘what-if,’ then again, it may not be that helpful reassurance-seeking.

Relationship Ocd (Rocd) Vs Relationship Issues With Ocd

Kimberley: Yeah, I love that. And thank you for adding that because I just love that template so much. That is just like gold. I love it so much. Alright. So, as you move into Chapter 4, I believe it is, you talk about specific subtypes of OCD that are commonly impacted in relationships. Can you share just briefly what your thoughts are around that?

Amy: Yeah. I love this question too because as I’ve been talking about the book, a lot of people are like, “Oh, great, a book about ROCD, or relationship OCD.” And my answer to that, or my response to that is, “Yes, and...” Just a step back, any subtype of OCD can affect and often does affect relationships. Why? Because OCD goes after what’s important to us. And for many of us, our connectedness with one another is just so important. That being said, there are subtypes of OCD that are relational in nature. And so, I do have a chapter that is more devoted to these types, and one of which is relationship OCD. This is a passion of mine. I’ve done now a few iterations of an ROCD treatment group at my clinic, and I have other plans to expand that group and do some cool programming around that. 

But relationship OCD, it’s basically when OCD symptoms are about the relationship itself or about the person with whom you’re in relationship. So, it could be about-- we think about it a lot of times with romantic relationships, but it could be any relationship. To use a different one, it could be, am I a loving enough parent? Do I love my kids enough? How do I know? Do other parents have these thoughts? So, it could be about the relationship or it can be about the individual. Like, my spouse doesn’t like the same music that I do, and are we ever going to get past this? And so, something that might be seen as, yes, it’s an actual difference, but then there’s all this story making around the difference and how the difference is going to be the demise of the relationship. Those are the two flavors of ROCD, relationship and partner-focused. 

I also want to pause here and say that oftentimes when people talk about ROCD, I feel like there’s this pull to say, “Well, if you know you have ROCD, if relationship issues come up in your relationship, it’s probably your ROCD.” And that’s just like another backdoor to the certainty that we all want. I think all relationships have some crunchy bits and some edges that chafe. And so, I want the people with ROCD to feel empowered to also develop the relationships that they want and then notice that maybe the ROCD turns up the volume on some of their concerns, if that makes sense. 

Kimberley: It’s hard, isn’t it? Because so many times a patient will say, “But I don’t know if I really love-- is he the one?” And we’re like, “Well, we’ll never know.” There’s no way to objectively define that. And then someone, a friend is like, “Well, if you don’t know, it must be a problem.” It’s so hard for those people because people without OCD also don’t know all the time either, so it’s a common concern.

Sexual Orientation Ocd & Gender Related Ocd

Amy: Right. No, that’s a great point. So, I have some stuff about relationship OCD in there and then the identity subtypes of OCD as well. So, sexual orientation OCD and gender-related OCD. I put those in there because oftentimes our identity is the foundation from which we interact with others and create relationships and things like that. So, I talk a little bit about sexual orientation OCD, not just even in dating, but in finding a community and friendship and things like that. SOOCD can rear up and lead to lots of social comparisons or it can just really try to sabotage certain relationships, and with gender-related OCD as well, be it somebody who is cisgender and wondering if they are transgender or vice versa. I’ve worked with people in the transgender community who have OCD and have these unwanted thoughts about like, “Well, what if this is not who I am? What if I’ve been doing this for attention?” And then, therefore, are wanting to compulsively disengage from their community because of the feeling of like, “Well, I don’t feel authentic enough.” So, that’s a way in which that can root in relationally.

Kimberley: Right. So, we’ve got relationship OCD and identity. What are the other ones? 

Harm Ocd & Its Impact On Relationships

Amy: Yeah. And then the last one that I highlighted in here in that section is harm OCD. And I put that in there because harm OCD, which again is a huge category, which I would say under that are anything that’s violent. That could be sexual as well. So, sexual violence toward others or sexual intrusive-- obviously, all intrusive thoughts, but intrusive thoughts about being sexual with children. I would roll all that into the harm OCD category. And this one is just, it’s always so striking to me the ways in which OCD can take something that’s really important. Like, I want to be a good person, I want to be a kind person and then undermine it. So, the amount of people I’ve worked with harm OCD who are experiencing isolation and really the self-imposed isolation, the irony of which is “I’m isolating myself because I don’t want to harm others,” but then they’re withholding themselves as this fantastic person to be out in the world. And so, that’s what I always say, is you’re doing more harm isolating, but sort of. Get out there. You have so much to offer and in fact, your OCD has attacked this area because it’s important for you generally to have relations with others.

Kimberley: Yeah, I love that. So, I love how you’ve given us a way, and as you said, it can impact any relationship outside of those subtypes as well. What I’d love to do is give you the mic and tell us just now, in general, give us your best relationship ideas, advice, tips, tools, whatever you want to call them, for the person with OCD and the loved ones of people with OCD.

Amy: Yeah. Thank you. I feel like that’s a dangerous thing to be giving me the mic.

Kimberley: It’s all yours. Go for it. What’s the main thing you want people to know?

Amy: I think I want for people to be able to-- number one, there’s no right or wrong way to have a relationship provided that everything is consensual and respectful. And so, taking a step back-- and actually Russ Harris just put out this. I don’t know if you saw this, but this incredible list of relational values words. So, there’s an activity where-- or I don’t know if it’s new, it’s new to me. That’s clarifying what are your relational values and what are they with different relationships? Is it playfulness? Is it intimacy? And so, figuring out what you want and having your spouse do the same. In our relationship OCD group, most recently, we had people and their significant others, I shouldn’t say spouse, do this and figuring out ways to connect around those things. I think it comes down to connection and to supporting each person, like supporting each other’s goals. 

I think I’m bringing this up in part because I think sometimes there are these narratives out there about like, we have to have all the same interests or opposites attract. And again, to that, I say yes, and... For some people, they want people with really similar interests and for others, they want somebody who’s going to be different. But I think what we can do is support each other and try to see the world through your loved one’s eyes and try to celebrate when they’re celebrating. 

I think part of this is like, I’m married to somebody who’s a huge thrill seeker. He’s paragliding. He just got his private pilot’s license. He does things that are not in my nature. If he’s gone out and he’s done some sort of paragliding trip in a different country, and he’ll come back and he’ll say, “I found a lift here and there were thermals,” in my head, I’m like, “You didn’t die. You didn’t die. Yeah, you didn’t die.” And I have to stop my own anxious story about it or my own interpretation of “I wouldn’t like that” and just be there with him in that moment of sharing his joy. It’s finding joy in others’ joy. It’s being there with other people’s emotions about whatever they are. Because I think with anxiety and OCD, it can always be this upper-level analytical process of like, “Oof, I don’t like that. Is that okay?” or things like that. I know a lot of the Gottman’s research will talk as well about how very important it is to just support one another, be cheerleaders, et cetera. 

Attachment Style & Ocd 

I think too, knowing your attachment style. And this is a whole topic that we could spend forever on, but knowing if you’re somebody who-- when you get close to others, do you feel more resistance in getting closer or do you feel worries about like, “Ugh, I don’t want to lose myself by merging with someone else”? Or do you have more resistance around, “I’m worried they’ll abandon me, I’m worried they won’t love me enough?” And that’s a very, very, very rudimentary look at two of the concepts of attachment, that more avoidant attachment where it’s, “I’m worried I’ll be subsumed by the other person and I value independence,” or more anxious attachment, which is, “I’m worried they won’t love me enough or I’ll be abandoned.” Knowing that and knowing when those thoughts come up, take a pause, take a step back and check in with yourself and your body and the facts and things like that, instead of reacting in that moment. When anxiety is there, it wants us to just react to every alarming or provocative thought that we have. So, yeah, those are some things. I know that I had them scrolling through because I know I had more in the book from the Gottman. They’re top of mind.

Kimberley: I think back to when I was first married, I was so young. So, if someone had explained to me attachment styles, it would’ve made the first five years so much easier. You know what I mean? My husband would go away. He’s actually away right now. He would go away because he loves to fly fish. And for me, I would feel anxiety because he would leave and I would interpret, because I’m anxious, and I was like, “No, this isn’t hard for me to be alone.” It would quickly turn to anger towards him for having a hobby. I’m totally fine to say this too. I’m feeling anxious here by myself. He’s off doing something fun for him. So then I got angry that he’s doing fun things and leaving me to have my anxiety. He would come home not to a happy wife. He would come home to wife with her hands on her hips. You know what I mean? And I think that that is so common for people with anxiety. When you’re feeling anxious, you feel like they’re doing it to you like, “Why are you doing this to me?” And then that can create a whole narrative that can interfere in relationship. So, that’s just a personal example of how, if I had have known my anxious attachment early in our marriage, I think that would’ve saved us a lot of fights.

Amy: Yeah. Oh, I love that example. And I feel like for me, as somebody who tends toward the other side, I tend to feel more worried about being stifled by relationships. I want to be fully seen and encouraged. And so, sometimes, in particular with friendships, if I’ve had people who are like, “I’ve felt exactly the same way,” or “I had the same experience,” or “We should do this all together. Let’s get matching jackets,” I’m like, “I am an individual.” I get really threatened because my feeling is-- my brain’s automatic interpretation is they don’t see you because they think that you are just-- they assume like we’re all the same, whereas they’re just like, “We want to affiliate.” So, I’ve had to do some work there as well, even with friendships, to know like it’s not-- people aren’t trying to kidnap my identity and merge it with theirs. They’re actually just being loving. 

Kimberley: Right. But it feels threatening. Yeah, absolutely. I think the last question I have for you is, it goes back to that accommodation reassurance piece, particularly related to these dynamics. And maybe this is just my experience, I’d actually love to hear yours. What I do find is, when the person with OCD is coming from an anxious place, like often overanalyzing things, hyper-attending hyperawareness of things, their need for reassurance or their need for everyone to follow what OCD tells the family to do, I have found that the partner, because it’s so overwhelming for them, tends to flip to the other end of the spectrum where they don’t worry about anything or they’re like, “It’s fine.” Or maybe even they’re frustrated of like, “It’s fine, it’s fine.” Have you noticed that as a trend in dynamics of a relationship?

Amy: Yeah. Sometimes almost like there’s a dismissiveness. Yes, I have noticed that and I think that there are so many reasons why that can happen. And I think for the partner and their experience, getting at what that is and what’s motivating that is so interesting because, to the person with anxiety or OCD, it can feel really invalidating, or it can feel very comforting. But I think a lot of the times, it can feel invalidating and the partner might be doing it because they might be having their own feelings come up about, “I don’t know what to say.” I’ve tried to use facts and sometimes facts can bounce right off of OCD if you’re not in the mindset to accept them. OCD is skeptical about everything. So, I’ve tried everything and I’m really now at this place of like, “I am so tired.” And it’ll come out. “I’m so tired of hearing you talk about this.” And that’s when, as a clinician, I see time out. I think you’re both really tired of this cycle that OCD has you both in. 

So, yeah, I will see that. And I think sometimes when that’s the pattern as opposed to a lot of overly accommodating, I think when that’s the pattern, the element for me in working with couples to inject back in there is the validation of, “This is really hard.” And also for them to take a step back and realize, well, not everything is going to be OCD either. Sometimes if there is reassurance-- I mean, again, the irony is sometimes this pattern can lead to more reassurance because then it’s like, “Well, you just dismissed me. You said that there’s nothing wrong in our relationship that you did it in a manner that felt dismissive. And so, now I’m going to ask again.” 

So, yeah, deconstructing that pattern. Does the partner feel angry? If so, you’re angry at this pattern, not your partner. Does the partner feel helpless, hopeless? Did they feel scared? Are they grasping at straws? So, yeah, that would be how I would look at that when I see it come up.

Kimberley: Oh, thank you. I’m so grateful that you shared all that because I think they are all great questions that need to be addressed within the relationship. Thank you. So good. Okay, tell us about your book. I want to be respectful of your time. Tell us about your amazing book, which I think every family that has members should read. Tell us about it.

Amy: It’s called Thriving in Relationships When You Have OCD: How to Keep Obsessions and Compulsions from Sabotaging Love, Friendship, and Family Connections. It’s available for pre-order as of the recording of this, which is in October, but I think this is going to come out later. It will be hot off the presses December 1st from New Harbinger Publications, available on Amazon, available through New Harbinger, I think available on other websites. People keep sending me links and I’m like, “Wow, that’s really cool.” 

So, yeah, I tried to cover all different kinds of relationships. We talk about family relationships, parenting, romantic relationships, sex and intimacy and those kinds of relationships, friendships, work, and really just a relational lens to what can be a very isolating and security disorder. And I don’t want anyone to feel like they have to go at it alone.

Kimberley: Thank you. Again, hats off to you. Much respect. You did a beautiful job writing the book. It’s an honor. I was so honored to write the foreword. And I think, again, it’s like a handbook I think everybody needs to have on the onset of being diagnosed. Here’s the book to make sure you can protect your relationship and nurture the relationship outside of OCD. So, thank you.

Amy: Well, thank you for having me.

Nov 18, 2022

In This Episode:

  • What if people notice I am anxious?
  • How to handle the fear that people ill judge you 
  • Tools to manage anxiety



Episode Sponsor:

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

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

EPISODE TRANSCRIPTION

This is Your Anxiety Toolkit - Episode 311. 

Welcome back, everybody. I am so happy to have you with me today. Today, we’re talking about what to do if people notice how anxious you are. This is something that I’ve even thought about myself. When you’re having anxiety, it’s like, “Are people noticing how anxious I am?” And when you worry about that or you think about that, sometimes it can actually create more anxiety for you. Quite a few of you have asked this question to me in the past, specifically around when doing exposures. As you go to do your exposures, then you have this secondary thought of like, “Oh my goodness, are people actually seeing how anxious I am?” So, I wanted to do a podcast just about this topic. 

Before we get into the episode, let’s quickly run through the “I did a hard thing” for the week. This one is from Anonymous and they said:

“My son just started preschool this month. For context, my OCD and anxiety has me housebound for the last two years, and never in a million years did I think I was going to be able to handle this. I still feel discomfort and struggle with intrusive thoughts, but the sparkle in his eye when I pick him up makes it all worth it. This has reinforced the importance of pushing through even when it’s hard.”

Anonymous, this is so good. Look at you go. And I think we can all resonate with being so overwhelmed with anxiety, but we make decisions based on our values, not our fear. And then we get to see people sparkle in people’s eyes or our own eyes. And I’m so excited to have you share that with me. So, thank you so much.

All right, quickly, review of the week. This is from Sybil Cross and they said:

“Compassionate and competent care. My ERP therapist recommended this podcast to me and I love it! It is both educational and supportive. It helps me learn more about my OCD and feel comforted, all while retaining its therapeutic value. Thank you for all your hard work and love, Kimberley!”

It is my pleasure. Thank you, Sybil, for sharing that amazing review. Please do go and leave a review. I know I say it every week, but you do not understand how helpful it is to me. I am really doubling down in 2022 and next year on really making sure this podcast reaches as many people and makes a massive impact. So, your reviews mean so much to me. 

311 What If People Notice I am Anxious Your anxiety toolkit

All right, let’s get over to the show.

Have you ever been out and about doing your thing socially and then all of a sudden, you have anxiety and then you start to worry, what if people start to notice that I’m anxious? If this is you, you’re going to want to listen up because today we’re going to go through what to do if people do notice or what to do if you’re afraid of people noticing that you have anxiety. 

So, thank you so much for joining me again today. I love spending time with you, talking about all things anxiety. Let’s talk about what to do if people do notice that you have anxiety. So, the first thing to ask yourself, and I love asking questions because I think it really helps us to really understand the actual problem, but what I’m going to ask you is, what’s your actual fear? If you’re afraid of someone noticing that you are anxious, what are you actually saying there? Are you afraid that maybe they’re going to judge you for having anxiety? Or are you afraid that there may be some consequence for having anxiety? Sometimes people are afraid in certain work environments or school environments. Or is it that you’re afraid that if they notice you have anxiety, that then you’ll then have even more anxiety and then that creates a perpetual cycle? Let’s take a look at these outcomes depending on which one you struggle with. 

So, let’s talk about first the fear that they might judge you. Now, if this is you, there is a pretty good chance you may have social anxiety. Social anxiety is a specific anxiety disorder around the fear of being judged by others socially or feeling humiliation or embarrassment around others socially. And often what we understand about social anxiety is it’s actually not so much an anxiety disorder. Well, yes, you will feel a lot of anxiety, but we actually understand it to also be a shame disorder. Often people go out and then enter the social environment and they’re afraid that if someone notices an adequacy or a floor, that they’ll be judged and that will create a lot of shame for them. Remember, fear and shame is often associated together. They often go together. And shame is really about us having a thought that there’s something wrong with us, that we are inherently bad. 

So, if your fear is that you’re going to be noticed and they’ll catch you, and then you’re going to feel shame, what you’ll want to do here is work at being able to navigate your shame. Stay here and we’ll talk about that a little bit later. It could be also that you’re afraid of humiliation or embarrassment. Some people don’t want to be judged because then they know they’ll get stuck in a cycle of regret. “Why did I do that? Should I have done that? What could I have done different?” which looks a lot like mental rumination, which we know is a mental compulsion, a common behavior we do to try and reduce or remove anxiety. 

So, we can talk a little bit more in a second about how to manage that. First, let’s talk about another concern people have, which is that you’re afraid that if you get noticed for having anxiety, that you might have more. The thing to remember here, and you probably know this from me already, is the more you try to make fear go away, the more likely you are to have a strong wave of fear. So, remember, what you resist persists. So, if you’re saying, “What if someone notices that I’m anxious and then that makes me more anxious,” if you’re paying a lot of tension to their facial expression, trying to figure out what they’re thinking about you, chances are, you will have more anxiety because of how much attention you’ve put on their opinion of you.

The last piece here is, will there be consequences? So, let’s really talk about that. Some people are concerned that if they are visibly anxious, let’s say you’re giving a presentation at work or school or you’re meeting your boss for your yearly meeting or your teacher for a check-in and so forth, that there will be consequences if you’re visibly jittery, nervous, stuttering, shaky. Some people are afraid that they’ll get noticed for sweating. And sometimes there can be consequences. Maybe a part of your job or your schooling is to be able to perform. And if you’re engaging in avoidant behaviors, yes, there may be some consequences that go along with that. 

But what I’m going to encourage you to do to manage this is talk to your boss, talk to your teacher, talk to your coach, whoever it may be that you’re concerned will employ these consequences. Ask them what we can do and what they can do and how you can get supported as you manage your anxiety. Hopefully, it’s an environment that supports mental health struggles and supports mental health in general. And usually, I have found, if you go to your boss or your teacher or your dean or your parent or your coach or whoever it may be, and you let them know that you’re struggling, they may have some really helpful tools or they may actually be able to help you to manage that in that environment. So, 100%, while I know bringing it to their attention is actually your fear, that can often very much help. 

Now, if you’re in a situation where you don’t feel comfortable going to them and sharing that-- it could even be with a friend, or a partner, a boyfriend, girlfriend, someone you’re interested in. If you’re really afraid of that and you don’t want to share, that is entirely okay. But what it does mean is, and this is where we get to the tools, you’re going to have to give yourself permission to have anxiety. 

So, number one, the main thing I’m going to tell you if you have this fear in any certain way is, if you are going into this circumstance or this event saying you shouldn’t have anxiety, you’re going to have more anxiety. We know that to be true. So, what do you do instead? You can practice allowing your anxiety to be there and actually saying, “This is a good thing.” And I know it doesn’t feel good, it doesn’t feel fun, but what you’re saying is, “Here is an opportunity for me to have the anxiety and show up anyway.”

Number two, here is an opportunity for me to have the anxiety and show up and really see who are the true friends, who are the unconditional friends, who can be caring and compassionate in this environment, and can I face this fear, and baby steps, make small wins, and have small achievements where you’re able to increase your willingness to have the anxiety, increase your tolerance of discomfort and sensations that you don’t like. 

The next thing I want you to do is, number three, the most important, you will be shocked how important and how helpful it can be if you practice self-compassion. If you are using the tool of self-criticism to manage this, chances are, you’re going to make your anxiety a whole bunch worse. So, instead, try validating yourself. “It makes complete sense that this is hard for me. It makes complete sense that this would create anxiety for me.” Maybe you would say, “Anyone else in this situation would have anxiety.” And I know your brain is going to say, “No, no. Jack, John, and Jennifer could do this without anxiety.” The thing to remember is, they might be a few steps ahead of you and you can get there too. Our brains are neuroplastic. We can actually get there too with practice, small wins and self-compassion. The self-criticism is only going to make you more anxious. Really, I think you probably already know this, but I think it’s important for you to understand, self-criticism only makes it worse, and we want you to do great, and we know you can do great. 

Number four is, be an observer to what’s going on. So, let’s say you’re about to do this event or this social experience with somebody, or you’re about to have a conversation, and you’re shaking or you’re sweating or you’re stuttering, or whatever it may be. Your job is to be an observer of your thoughts about that. 

Now, here is an example. I am often with anxious people. It’s a normal part of my day. I’m an anxiety specialist, but I go into a lot of exposures with my patients. We go to Costco, we go to the supermarket, we go to the outdoor park, and my patients practice exposing themselves to the exact thing they’re afraid of. And what you’ll find here is the average human that they interact with are incredibly forgiving. Humans want to like you. They don’t want to not like you. They want to be in connection with you. They don’t want to be out of connection with you. And when you’re struggling, if that is the case, 99% of the time, they have enough empathy and compassion to help you along. And so, a part of this work is you increasing your ability to see the good of the human race. 

Now, I know you may have had a few experiences where people weren’t so kind, but the good people are out there. It’s just a matter of practicing. And when I go on exposures with my patients, they’re actually pleasantly surprised. We might go to the supermarket and we might say, “Okay, I want you to go and ask 10 people for the time, or I want you to look 15 people in the eye and say good morning to them. Or I want you to ask five people a question, where is the local bank, or can you tell me where such and such street is?” And 99% of the time, they walk away going, “Wow, people are actually kinder than I thought.” There are people who don’t want to talk to them, and that’s usually because they’re anxious too. And so, it’s important for us to understand and have an understanding of the human race here, and give ourselves permission to show up imperfectly when we’re around other people.

Now, another thing I want you to think about here is, how can I practice on purpose facing this fear. I know what you’re thinking. You’re like, “Let me just shut this down. Where’s the pause button?” But I really want you to understand that there are hundreds of opportunities in your day where you can practice showing up anxious on purpose and how many of those can you put in a day. Put them in your calendar, plan for them, leave work, or leave for school a little early so you could get an extra couple of practice runs in with this. 

If someone had, let’s say, a fear of being shaky, I actually encourage them to be shaky. Sometimes we even induce shakiness for them. We might have them have a cup of coffee before they do the exposure so that they’re on purpose feeling this feeling and they’ve got a lot of practice doing it.

And then the last thing I want you to remember is, once you’ve done all these steps and you’ve done the hard thing, because I always say it’s a beautiful day to do hard things, I want you to then practice what we call response prevention. Response prevention is, now that you’ve done the hard thing, you’re to practice not engaging in rumination and self-criticism, the things that actually you used to do, which only make you feel worse and actually reinforce the fear. You’re going to practice not doing those things and instead engage back into the world and just practice moving on, practice engaging in what you are showing up to do, practice engaging in the things that you love and that you value. Instead of sitting there looping about how it went and what they thought and what they think about you and how did they perceive you and you should have said this and you shouldn’t have said that, your job is actually to catch the urge to engage in that rumination and then bring yourself back to the present. Now, if you can do those things, you are leaps and bounds ahead of where you would be if you weren’t engaging in those things. And we know that small steps lead to medium size steps, which lead to massive steps forward. 

Now, what is the one thing I want you to take away? Because I really love giving you a takeaway here. Number one, the more you try and avoid the fear, the more you’re probably going to have it. And then the last thing here I’m going to say is, go gentle. Go easy. Catch how you’re engaging in self-criticism. The truth is, we have a lot of research to show that people aren’t thinking about you nearly as much as you think they are. Most of the time, they’re thinking about them. They’re thinking about what they’re going to have for lunch and their meeting that they have coming up and, “Whoops, I forgot to get milk at the grocery store.” They’re not hyper-attending to every little mistake that you make as much as you think they are. And if they are in fact judging you that heavily, that is a strong relation and reaction of what’s going on in their mind. It actually shows us a lot. It’s a reflection of what they value and what they’re judging about themselves. And so, really other people’s judgment is often just a reflection of their judgment about themselves and the way that they think. And our work is actually to focus on actually being the person you want to be or who do you want to be? How do you want to show up? What are your values? What kind of person do you want to be? 

So, I hope that’s been helpful. At the end of the day, you will be judged. This is something I have had to learn the hard way. I have had to learn that not everyone is going to like me, and that is okay. I am a messy human being. I am not perfect. I was never supposed to be perfect. And my job is to give myself some grace and some compassion for the fact that I’m just a human, messy person, just like you’re a human, messy person. And that’s true for every human. Okay? 

Have a wonderful day. Do remember it’s a beautiful day to do hard things and I look forward to talking to you again next week.

Nov 11, 2022

SUMMARY: 

  • What if you don’t identify with the concept of an obsession being a FEAR? It’s a repetitive thought or feeling, but you’re not scared of a specific outcome. 
  • What is the UNCERTAINTY when it comes to these obsessions? 



Guilt Obsessions: 

  • WHAT IS OCD GUILT? 
  • OCD Guilt over past mistakes
  • “I shouldn't have done that” 
  • “That was a mistake” 

OCD Guilt as a simple intrusive thought- no known mistake

  • “Is it bad that I did that” 
  • “Did I make a mistake?” 
  • “What could be the consequences” 

 REGRET obsessions. 

  • I’ve heard a lot about how guilt is a common intrusive feeling in OCD but not much about regret. 
  • “I wish I didn't do that” 
  • “I wish I had done it another way” 

Guilt and Regret accompanied with sadness?? 
How to stop OCD guilt? 
How to treat OCD guilt and regret

Links To Things I Talk About:

Episode Sponsor:

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

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

EPISODE TRANSCRIPTION

This is Your Anxiety Toolkit - Episode 310

Welcome back, everybody. We are at Episode 310. I just recorded it as 210 and I’m still in shock that we have hit 310 episodes. I recorded it and I was like, “Hang on a second. That doesn’t sound right.” And it wasn’t, and that still shocks me to this day. 

All right. Today, we are talking about a very important topic, which is guilt and regret. And I’ve called this episode Guilt and Regret: The Most Misunderstood Obsession, and I believe that to be true because a whole bunch of you are walking around wondering whether you have OCD or not because a lot of what you hear is that OCD is all about anxiety and uncertainty. But what about the folks who don’t have a lot of anxiety and a lot of uncertainty, but they’re having obsessive guilt and obsessive regret in the form of OCD guilt and OCD regret? So, I wanted to talk about that today. 

Before we do so, let’s quickly do the “I did a hard thing” segment. For those of you who are new, this is where listeners and followers share the hard thing that they’ve done. Why do I do this? Because so often, you guys forget that just because your hard thing is hard for you doesn’t mean there’s anything wrong with that. I want you to see that hard things are hard things and we should celebrate them and we should share them, and this is a platform I want to do that with. So, this one is from Mars, and Mars said:

“After many weeks and years of hard work, I finally managed to reach an important stage of my career, and I ended up with two job offers.” Amazing. “Both were great really for different reasons, and I couldn’t choose. I went back and forth and tortured myself four months trying to get certainty about which one is the right choice. I’d never been so anxious in my life. Finally, today, I sent the final email, even though I wasn’t certain about the choice, it was the hardest thing I’ve ever done, but I finally feel like I can move forward with my life again.” 

Mars, number one, congratulations. Sounds like you’ve worked really hard. And number two, you’re also doing this hard thing where you’re allowing the discomfort into your day, into your life, and you’re moving forward anyway. Thank you for sharing that. That is such an amazing accomplishment.

Interesting, isn’t it, how you’ve shared here too like it was around the certainty, but it sounds like that was similar to what we’re talking about today, and let’s talk about that. So, let’s start from scratch. Start from the beginning. So, often people will come into therapy and say, “I didn’t seek treatment for the longest time, because all I’m hearing is OCD is the uncertainty disorder, and I don’t feel a ton of uncertainty in the way that I’ve heard other people do with OCD.” What do I do if I don’t identify with this concept of the obsession being around fear and uncertainty? What about if you have a repetitive thought or a feeling, but you’re not scared of the specific outcome? And this is so important, guys, because we do hyper-focus on uncertainty and I really do believe that uncertainty is the root of lots of OCD obsessions and a lot of our suffering if we don’t accept that uncertainty. But what about those who have obsessive guilt and obsessive regret? So, let’s talk about it.

Guilt OCD - Guilt Obsessions

Let’s first talk about guilt obsessions. So, what is guilt obsessions, or what is OCD guilt? Ultimately, it’s a thought or an action that occurs. That’s the trigger. So, you had a thought or you did some behavior, and then you are having this onset of guilt. Remember, an obsession is an intrusive thought, feeling, sensation, urge, or image. And so, in this case, we’re talking about intrusive feelings. And so, what’s happening here is you’ve had a thought or you’ve done something and then you feel this very, very real feeling of guilt, very real feeling of guilt. Most of my patients who struggle with OCD guilt or obsessive guilt will say, “I genuinely feel like I’ve done the equivalent of killing a person. That’s how much guilt I feel.” Even though you might be very clearly able to identify like, I didn’t kill a person, or it doesn’t make total sense on why I’m feeling this high level of guilt, that’s so disproportionate. and that can be really confusing. And so, they’re really confused as to what’s going on. 

So, they might show up in-- the guilt may be accompanied by intrusive thoughts like, “I shouldn’t have done that. That was a huge mistake. I wish I didn’t do that. How can I avoid that in the future?” And then you can easily see why we then move into compulsions, like avoidance, rumination, tons of reassurance seeking. In therapy, a lot of people go to therapy, not even OCD therapy because they don’t even know they have OCD yet, and they spend all this time doing EMDR and biofeedback and hypnosis and all of this deep therapy work, exploring the deep meaning of the guilt, only then to realize like, “Wait a second, this is OCD. I’m doing all these compulsions and I’m even doing them in session.”

Now, as I mentioned, OCD could be as simple as an intrusive thought of you’re walking down the street and you just get the onset of guilt after some kind of trigger where there’s no known mistake. Or it could be that you did something that didn’t completely line up with your values, but again, then you have disproportionate degrees of guilt. Disproportionate. 

If it’s just a simple intrusive thought that has no known trigger or no known mistake, maybe your thoughts are related like, “Is it bad that I did that? Did I make a mistake? Was that right? Did that line up with my values? What could be the consequence of this?” And it can be incredibly painful. 

Regret OCD- Regret Obsessions

So, now let’s move over to regret obsessions and compulsion. So, with regret obsessions or regret ocd, they usually are presented more as, “I wish I didn’t do that. I wish I hadn’t done it that way. I wish I had done it in a different way.” It’s often accompanied with a deep feeling of sadness, like regret this deep feeling. Again, it can be an intrusive thought, but it often is just an intrusive feeling. This deep sense of, “I wish I didn’t do that.” Sometimes it’s accompanied with dread. “Oh, I hope I never do that, have this emotion, or do that thing again.” It can be incredibly painful. And again, people can get stuck in really the wrong kind of therapy, ruminating, ruminating, trying to solve what it was. 

Sometimes I’ve had patients even come to me and say, “Oh, I saw you because you do self-compassion and I want to be able to forgive myself,” and they’re doing compulsive forgiveness. I believe in forgiveness. I’m not saying there’s anything compulsive about forgiveness in the day-to-day. But if they’re doing it to get rid of an obsessive degree of regret, an OCD degree of regret, and that involves obsessions and compulsions, well then, that forgiveness practice can become impulsive. 

OCD Guilt Over Past Mistakes

I always laugh because I’m doing this breathing training, this meditation training right now. And some of them, the trainers who obviously are not OCD informed will say, “Breathe in your discomfort and breathe it out and let go of it and release it.” And I think that’s a beautiful practice. But for a person with OCD, that can become compulsive. And so, it’s important when you have OCD to catch these little nuances and these little behaviors and activities that can end up becoming a problem. 

So, let’s talk about how to stop this obsessive guilt or this OCD guilt, and let’s think about this a little bit in terms of how you might master this sensation and this feeling that you’re having. So, a couple of things before we move on is I have done quite a few episodes on guilt or letting go of things in the past in other episodes. So, I wanted to let you know, you can also go over, I did one episode about feeling guilty. It’s Episode 161. I did another episode, which was highly requested, Episode 70, which is called How to Let Go of the Past. And I did another episode, which was actually me talking about my own sense of getting through something that I felt regret and guilt for, which was Episode 293 and it was called I Screwed Up, Now What? So, we’d actually have tons of sources here on the podcast about that, and I wanted to share those in case you wanted to really delve a little deeper. But let’s talk about how to stop this OCD guilt. 

How To Treat OCD Guilt And Regret

All right? So, as you know, trying to stop an emotion usually doesn’t work. So, we don’t want to try that. That’s not going to work. Same with regret. How to treat OCD regret, I don’t encourage it. What we want to do instead is we want to be able to acknowledge it and observe it and do nothing about it. Now, I am a big believer in this. Truly I am. Whether you have OCD or not, when it comes to guilt, when it comes to regret, when it comes to shame, I’m going to encourage this very mindful approach. 

Number one, are you able to catch it in its tracks? That is number one. That is a tactical skill, is awareness, to be able to catch, “Oh, I am stuck in this guilt bubble or this regret bubble or this shame bubble.” Just like you would when you’re stuck in OCD. You’re able to catch, “Oh, I’m engaging in a pattern of behaviors that looks a lot like OCD.” Same goes for this situation. So, I’m observing and being aware of it. And then number two, catching where I’m wrestling with it. What safety behaviors do you have in relation to this feeling? Again, when it comes to OCD, it doesn’t matter what the obsession is, it doesn’t matter whether it’s associated to uncertainty or not, it doesn’t matter if it’s real or feels real or not. What we want to do is take a look at the safety behaviors we’re engaging in and first ask ourselves, are these helpful and effective? 

So, if you have guilt or regret, and your way of coping with that is to beat yourself up in hope that you never do it again, how effective is that? Is that working for you? Is it actually preventing you from doing things in the future that may trigger off regret and guilt? No. Are you avoiding certain things so that you don’t have to have this guilt and regret in the future? Do a quick assessment on those safety behaviors and ask yourself, does this help me in the grand scheme of things, knowing that OCD may pull guilt and regret on me for the most minor thing again tomorrow? Is it effective for me to try to make my life really small and avoid things because of an emotion that I may have to experience? 

Remember, the emotion will not hurt you. You’ll allow it to rise and fall. It is painful. I’m not going to lie, it is painful, but it won’t destroy you, especially if you have a relationship with guilt and regret and with this discomfort where you’re not resisting it. Remember, what you resist persists. 

So, you want to take a look at, do a functional analysis, do a review on how effective is my safety behaviors. Are you engaging in reassurance-seeking compulsions saying, “Do you think I did something wrong?” Going to your partner, “Do you think I did something wrong?” Maybe you’re confessing. “I feel guilty that I did this thing. I want to tell you what I did so that I can let it off my conscience.”

Now again, within a normal degree, we do this to some degree. I always laugh. Several years ago, my son, who was four at the time, came home and blurted out to my husband that mom had run through a red light, just out of the blue. He’d figured out that red lights were bad and you can’t drive through them and he’s like, “Mom went through a red light,” the minute he saw him. Of course, he was like, “No, you didn’t.” And I had to admit to it. But after that, I felt this urge to admit to things so that I could absorb myself of that guilt and regret that I had. And we all do it. I want to normalize that. I don’t want to pathologize those kinds of behavior. But if you’re doing that repetitively and it’s interfering with your relationships and it’s creating more and more stress for you, and you do it once and you don’t completely feel absolved and you feel like you need to confess again, this is a safety behavior that isn’t effective and that’s causing long term problems and is feeding the cycle of OCD. We want to break that, guys. We want to break that.

So, what I want you to look at here is, again, awareness. Are you able to acknowledge what’s going on? Are you able to identify the compulsions that are problematic? And then are you able to let it be there? Let it be there. Do nothing about it. Now, if you’re a real badass, which I know that you are, you will then, if you’re really ready, you might even do something fun and pleasurable while you feel guilt. Now that is doubling down. While you feel the obsessive guilt, while you feel the obsessive regret, you’re actually going to go have some fun and enjoy yourself. So important. This is a super important piece of the work that we do. 

How To Stop Relationship OCD Guilt

Now, for those of you who have relationship guilt or relationship OCD guilt in relation to your OCD, this is so important. It’s so important that you catch the safety behaviors that you’re doing and then you reengage with your loved one, because often what we do is we either do a whole bunch of compulsions or we shut down completely. We stop hanging out with them, we stop opening our heart with them, we stop engaging in intimacy with them. And that can become a big problem.

For those of you who have real-event OCD and guilt associated with real-event OCD, the same thing is applicable, which is we want to go through those steps, and then we want to practice opening up our life being fully engaged in our life, in the things that you value, whether the real event happened or not. I often get emails and DMs from people saying, “I feel like my real event is worse than other people’s real event, and so therefore I should suffer, or I should figure this out.” And I want to say, “That’s a very tactical trick that OCD plays on you to get you back into doing compulsions.” 

And so, I want you to be aware specifically to harm obsessions, relationship obsessions, real event obsessions, sexual obsessions. This is such an important piece because that’s often where it shows up. But again, it doesn’t have to be fear and uncertainty related. Sometimes the guilt and the regret can be the actual obsession that people experience. Okay? 

So, as always, we want to throw a massive dose of self-compassion onto this. Self-compassion in and of itself is an exposure for many people. and often people with specifically this OCD guilt and OCD regret when they practice self-compassion, it is like the ultimate exposure. The ultimate exposure. And I really want to encourage you guys to surround yourself with kindness, encourage yourself with kindness, motivate yourself with kindness, nurture yourself with kindness when you’re struggling and you’re experiencing a high level of discomfort. It doesn’t have to be fear. It can be around these other emotions that you experience, and shame. Shame often comes along with this. So, we want to make sure that we are doing everything we can to engage in self-compassion as much as we can. Okay?

All right. That’s it for now. Let’s quickly do the review of the week. This is from Triphonik and he or she said:

“Love this podcast. Kimberley’s podcast is so inspirational, relatable, and helpful. I have been dealing with OCD since my early 20s. I went through extensive therapy, medications, and lots of prayer! I got to the point where my OCD was not taking over my life anymore & hardly noticeable. I’m now 43 & I’ve recently gone through some lapses with it after these years. It really shook me to the core. Following Kimberley’s anxiety toolkit podcast was helpful in getting me back on track with the tools I’ve learned from my past along with some new ones! Her spirit and her level of sincerity with the knowledge and experience she has helped me so much! I’m so incredibly grateful to have found this podcast. Thank you, Kimberley!”

Thank you so much, Triphonik. Your reviews mean the world to me. Really, they do. And I’m just so happy to be on this journey with you. 

All right, folks, I’m going to see you next week and I’ll talk to you soon.

Nov 11, 2022

SUMMARY: 

  • What if you don’t identify with the concept of an obsession being a FEAR? It’s a repetitive thought or feeling, but you’re not scared of a specific outcome. 
  • What is the UNCERTAINTY when it comes to these obsessions? 



Guilt Obsessions: 

  • WHAT IS OCD GUILT? 
  • OCD Guilt over past mistakes
  • “I shouldn't have done that” 
  • “That was a mistake” 

OCD Guilt as a simple intrusive thought- no known mistake

  • “Is it bad that I did that” 
  • “Did I make a mistake?” 
  • “What could be the consequences” 

 REGRET obsessions. 

  • I’ve heard a lot about how guilt is a common intrusive feeling in OCD but not much about regret. 
  • “I wish I didn't do that” 
  • “I wish I had done it another way” 

Guilt and Regret accompanied with sadness?? 
How to stop OCD guilt? 
How to treat OCD guilt and regret

Links To Things I Talk About:

Episode Sponsor:

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

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EPISODE TRANSCRIPTION

This is Your Anxiety Toolkit - Episode 310

Welcome back, everybody. We are at Episode 310. I just recorded it as 210 and I’m still in shock that we have hit 310 episodes. I recorded it and I was like, “Hang on a second. That doesn’t sound right.” And it wasn’t, and that still shocks me to this day. 

All right. Today, we are talking about a very important topic, which is guilt and regret. And I’ve called this episode Guilt and Regret: The Most Misunderstood Obsession, and I believe that to be true because a whole bunch of you are walking around wondering whether you have OCD or not because a lot of what you hear is that OCD is all about anxiety and uncertainty. But what about the folks who don’t have a lot of anxiety and a lot of uncertainty, but they’re having obsessive guilt and obsessive regret in the form of OCD guilt and OCD regret? So, I wanted to talk about that today. 

Before we do so, let’s quickly do the “I did a hard thing” segment. For those of you who are new, this is where listeners and followers share the hard thing that they’ve done. Why do I do this? Because so often, you guys forget that just because your hard thing is hard for you doesn’t mean there’s anything wrong with that. I want you to see that hard things are hard things and we should celebrate them and we should share them, and this is a platform I want to do that with. So, this one is from Mars, and Mars said:

“After many weeks and years of hard work, I finally managed to reach an important stage of my career, and I ended up with two job offers.” Amazing. “Both were great really for different reasons, and I couldn’t choose. I went back and forth and tortured myself four months trying to get certainty about which one is the right choice. I’d never been so anxious in my life. Finally, today, I sent the final email, even though I wasn’t certain about the choice, it was the hardest thing I’ve ever done, but I finally feel like I can move forward with my life again.” 

Mars, number one, congratulations. Sounds like you’ve worked really hard. And number two, you’re also doing this hard thing where you’re allowing the discomfort into your day, into your life, and you’re moving forward anyway. Thank you for sharing that. That is such an amazing accomplishment.

Interesting, isn’t it, how you’ve shared here too like it was around the certainty, but it sounds like that was similar to what we’re talking about today, and let’s talk about that. So, let’s start from scratch. Start from the beginning. So, often people will come into therapy and say, “I didn’t seek treatment for the longest time, because all I’m hearing is OCD is the uncertainty disorder, and I don’t feel a ton of uncertainty in the way that I’ve heard other people do with OCD.” What do I do if I don’t identify with this concept of the obsession being around fear and uncertainty? What about if you have a repetitive thought or a feeling, but you’re not scared of the specific outcome? And this is so important, guys, because we do hyper-focus on uncertainty and I really do believe that uncertainty is the root of lots of OCD obsessions and a lot of our suffering if we don’t accept that uncertainty. But what about those who have obsessive guilt and obsessive regret? So, let’s talk about it.

Guilt OCD - Guilt Obsessions

Let’s first talk about guilt obsessions. So, what is guilt obsessions, or what is OCD guilt? Ultimately, it’s a thought or an action that occurs. That’s the trigger. So, you had a thought or you did some behavior, and then you are having this onset of guilt. Remember, an obsession is an intrusive thought, feeling, sensation, urge, or image. And so, in this case, we’re talking about intrusive feelings. And so, what’s happening here is you’ve had a thought or you’ve done something and then you feel this very, very real feeling of guilt, very real feeling of guilt. Most of my patients who struggle with OCD guilt or obsessive guilt will say, “I genuinely feel like I’ve done the equivalent of killing a person. That’s how much guilt I feel.” Even though you might be very clearly able to identify like, I didn’t kill a person, or it doesn’t make total sense on why I’m feeling this high level of guilt, that’s so disproportionate. and that can be really confusing. And so, they’re really confused as to what’s going on. 

So, they might show up in-- the guilt may be accompanied by intrusive thoughts like, “I shouldn’t have done that. That was a huge mistake. I wish I didn’t do that. How can I avoid that in the future?” And then you can easily see why we then move into compulsions, like avoidance, rumination, tons of reassurance seeking. In therapy, a lot of people go to therapy, not even OCD therapy because they don’t even know they have OCD yet, and they spend all this time doing EMDR and biofeedback and hypnosis and all of this deep therapy work, exploring the deep meaning of the guilt, only then to realize like, “Wait a second, this is OCD. I’m doing all these compulsions and I’m even doing them in session.”

Now, as I mentioned, OCD could be as simple as an intrusive thought of you’re walking down the street and you just get the onset of guilt after some kind of trigger where there’s no known mistake. Or it could be that you did something that didn’t completely line up with your values, but again, then you have disproportionate degrees of guilt. Disproportionate. 

If it’s just a simple intrusive thought that has no known trigger or no known mistake, maybe your thoughts are related like, “Is it bad that I did that? Did I make a mistake? Was that right? Did that line up with my values? What could be the consequence of this?” And it can be incredibly painful. 

Regret OCD- Regret Obsessions

So, now let’s move over to regret obsessions and compulsion. So, with regret obsessions or regret ocd, they usually are presented more as, “I wish I didn’t do that. I wish I hadn’t done it that way. I wish I had done it in a different way.” It’s often accompanied with a deep feeling of sadness, like regret this deep feeling. Again, it can be an intrusive thought, but it often is just an intrusive feeling. This deep sense of, “I wish I didn’t do that.” Sometimes it’s accompanied with dread. “Oh, I hope I never do that, have this emotion, or do that thing again.” It can be incredibly painful. And again, people can get stuck in really the wrong kind of therapy, ruminating, ruminating, trying to solve what it was. 

Sometimes I’ve had patients even come to me and say, “Oh, I saw you because you do self-compassion and I want to be able to forgive myself,” and they’re doing compulsive forgiveness. I believe in forgiveness. I’m not saying there’s anything compulsive about forgiveness in the day-to-day. But if they’re doing it to get rid of an obsessive degree of regret, an OCD degree of regret, and that involves obsessions and compulsions, well then, that forgiveness practice can become impulsive. 

OCD Guilt Over Past Mistakes

I always laugh because I’m doing this breathing training, this meditation training right now. And some of them, the trainers who obviously are not OCD informed will say, “Breathe in your discomfort and breathe it out and let go of it and release it.” And I think that’s a beautiful practice. But for a person with OCD, that can become compulsive. And so, it’s important when you have OCD to catch these little nuances and these little behaviors and activities that can end up becoming a problem. 

So, let’s talk about how to stop this obsessive guilt or this OCD guilt, and let’s think about this a little bit in terms of how you might master this sensation and this feeling that you’re having. So, a couple of things before we move on is I have done quite a few episodes on guilt or letting go of things in the past in other episodes. So, I wanted to let you know, you can also go over, I did one episode about feeling guilty. It’s Episode 161. I did another episode, which was highly requested, Episode 70, which is called How to Let Go of the Past. And I did another episode, which was actually me talking about my own sense of getting through something that I felt regret and guilt for, which was Episode 293 and it was called I Screwed Up, Now What? So, we’d actually have tons of sources here on the podcast about that, and I wanted to share those in case you wanted to really delve a little deeper. But let’s talk about how to stop this OCD guilt. 

How To Treat OCD Guilt And Regret

All right? So, as you know, trying to stop an emotion usually doesn’t work. So, we don’t want to try that. That’s not going to work. Same with regret. How to treat OCD regret, I don’t encourage it. What we want to do instead is we want to be able to acknowledge it and observe it and do nothing about it. Now, I am a big believer in this. Truly I am. Whether you have OCD or not, when it comes to guilt, when it comes to regret, when it comes to shame, I’m going to encourage this very mindful approach. 

Number one, are you able to catch it in its tracks? That is number one. That is a tactical skill, is awareness, to be able to catch, “Oh, I am stuck in this guilt bubble or this regret bubble or this shame bubble.” Just like you would when you’re stuck in OCD. You’re able to catch, “Oh, I’m engaging in a pattern of behaviors that looks a lot like OCD.” Same goes for this situation. So, I’m observing and being aware of it. And then number two, catching where I’m wrestling with it. What safety behaviors do you have in relation to this feeling? Again, when it comes to OCD, it doesn’t matter what the obsession is, it doesn’t matter whether it’s associated to uncertainty or not, it doesn’t matter if it’s real or feels real or not. What we want to do is take a look at the safety behaviors we’re engaging in and first ask ourselves, are these helpful and effective? 

So, if you have guilt or regret, and your way of coping with that is to beat yourself up in hope that you never do it again, how effective is that? Is that working for you? Is it actually preventing you from doing things in the future that may trigger off regret and guilt? No. Are you avoiding certain things so that you don’t have to have this guilt and regret in the future? Do a quick assessment on those safety behaviors and ask yourself, does this help me in the grand scheme of things, knowing that OCD may pull guilt and regret on me for the most minor thing again tomorrow? Is it effective for me to try to make my life really small and avoid things because of an emotion that I may have to experience? 

Remember, the emotion will not hurt you. You’ll allow it to rise and fall. It is painful. I’m not going to lie, it is painful, but it won’t destroy you, especially if you have a relationship with guilt and regret and with this discomfort where you’re not resisting it. Remember, what you resist persists. 

So, you want to take a look at, do a functional analysis, do a review on how effective is my safety behaviors. Are you engaging in reassurance-seeking compulsions saying, “Do you think I did something wrong?” Going to your partner, “Do you think I did something wrong?” Maybe you’re confessing. “I feel guilty that I did this thing. I want to tell you what I did so that I can let it off my conscience.”

Now again, within a normal degree, we do this to some degree. I always laugh. Several years ago, my son, who was four at the time, came home and blurted out to my husband that mom had run through a red light, just out of the blue. He’d figured out that red lights were bad and you can’t drive through them and he’s like, “Mom went through a red light,” the minute he saw him. Of course, he was like, “No, you didn’t.” And I had to admit to it. But after that, I felt this urge to admit to things so that I could absorb myself of that guilt and regret that I had. And we all do it. I want to normalize that. I don’t want to pathologize those kinds of behavior. But if you’re doing that repetitively and it’s interfering with your relationships and it’s creating more and more stress for you, and you do it once and you don’t completely feel absolved and you feel like you need to confess again, this is a safety behavior that isn’t effective and that’s causing long term problems and is feeding the cycle of OCD. We want to break that, guys. We want to break that.

So, what I want you to look at here is, again, awareness. Are you able to acknowledge what’s going on? Are you able to identify the compulsions that are problematic? And then are you able to let it be there? Let it be there. Do nothing about it. Now, if you’re a real badass, which I know that you are, you will then, if you’re really ready, you might even do something fun and pleasurable while you feel guilt. Now that is doubling down. While you feel the obsessive guilt, while you feel the obsessive regret, you’re actually going to go have some fun and enjoy yourself. So important. This is a super important piece of the work that we do. 

How To Stop Relationship OCD Guilt

Now, for those of you who have relationship guilt or relationship OCD guilt in relation to your OCD, this is so important. It’s so important that you catch the safety behaviors that you’re doing and then you reengage with your loved one, because often what we do is we either do a whole bunch of compulsions or we shut down completely. We stop hanging out with them, we stop opening our heart with them, we stop engaging in intimacy with them. And that can become a big problem.

For those of you who have real-event OCD and guilt associated with real-event OCD, the same thing is applicable, which is we want to go through those steps, and then we want to practice opening up our life being fully engaged in our life, in the things that you value, whether the real event happened or not. I often get emails and DMs from people saying, “I feel like my real event is worse than other people’s real event, and so therefore I should suffer, or I should figure this out.” And I want to say, “That’s a very tactical trick that OCD plays on you to get you back into doing compulsions.” 

And so, I want you to be aware specifically to harm obsessions, relationship obsessions, real event obsessions, sexual obsessions. This is such an important piece because that’s often where it shows up. But again, it doesn’t have to be fear and uncertainty related. Sometimes the guilt and the regret can be the actual obsession that people experience. Okay? 

So, as always, we want to throw a massive dose of self-compassion onto this. Self-compassion in and of itself is an exposure for many people. and often people with specifically this OCD guilt and OCD regret when they practice self-compassion, it is like the ultimate exposure. The ultimate exposure. And I really want to encourage you guys to surround yourself with kindness, encourage yourself with kindness, motivate yourself with kindness, nurture yourself with kindness when you’re struggling and you’re experiencing a high level of discomfort. It doesn’t have to be fear. It can be around these other emotions that you experience, and shame. Shame often comes along with this. So, we want to make sure that we are doing everything we can to engage in self-compassion as much as we can. Okay?

All right. That’s it for now. Let’s quickly do the review of the week. This is from Triphonik and he or she said:

“Love this podcast. Kimberley’s podcast is so inspirational, relatable, and helpful. I have been dealing with OCD since my early 20s. I went through extensive therapy, medications, and lots of prayer! I got to the point where my OCD was not taking over my life anymore & hardly noticeable. I’m now 43 & I’ve recently gone through some lapses with it after these years. It really shook me to the core. Following Kimberley’s anxiety toolkit podcast was helpful in getting me back on track with the tools I’ve learned from my past along with some new ones! Her spirit and her level of sincerity with the knowledge and experience she has helped me so much! I’m so incredibly grateful to have found this podcast. Thank you, Kimberley!”

Thank you so much, Triphonik. Your reviews mean the world to me. Really, they do. And I’m just so happy to be on this journey with you. 

All right, folks, I’m going to see you next week and I’ll talk to you soon.

Nov 4, 2022

SUMMARY:

  • Not having a subtype makes it hard to get diagnosed with OCD 

  • Not fitting into a subtype can make you doubt having OCD. 

  • When you don’t see other examples, you can feel like an outsider in the OCD community. 

  • All the subtypes seem to have their “people.”  

  • The doubt can make you feel that it really is about the content, not OCD. 



  • What if I don't fit into a typical OCD Subtype Examples: 
    • What if I picked the wrong name for my baby? 
    • Obsessions about the weather and whether you will enjoy the weather? 
    • This nail color makes me feel strange. 
    • What if I don't remember this the way it was? 
    • What if my partner cheats on me?
    • What if my child suffers? 
    • What if my taxes were not correct? 
    • How will I know when it is time to stop therapy? 

General Anxiety Vs Ocd?

  • Dimensional Obsessive COmpulsive Scale (Jon Abramowitz) 
    1. Concerns about germs and contamination
    2. Concerns about being responsible for the harm. Injury, Bad luck 
    3. Unacceptable thoughts 
    4. Concerns about symmetry, completeness, and the need for things to be “Just right.” 

  • Does ERP work for these obsessions? 

  • Does the process of treatment work any differently than it would with a “subtype”?  

  • Ideal Treatments for OCD
    • ERP 
    • ACT
    • SC
    • MINDFULNESS

Links To Things I Talk About:

Episode Sponsor:

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

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

309 What if my obsessions don't fit into a typical OCD subtype Your anxiety toolkit

EPISODE TRANSCRIPTION

What If I Don’t Fit Into The Typical Ocd Subtypes?

Welcome back, everybody. Thank you so much for joining me. I know your time is so valuable, and so I am so honored to spend this time with you to talk to you about today common question that I get asked. Well, actually, no, it’s not a common question, but it has been a question that I have been asked over the years by clients and followers, and listeners. And I was proposed with this idea as something that we really need to address. And so, here I am. And my goal is to always address the things that maybe aren’t getting addressed if possible. And so, today we are going to talk about, what if I don’t fit into the typical OCD subtype? So, what if my obsessions don’t line up with the typical classifications and categories that we have for OCD?

Ocd Subtypes

So, for those of you who maybe are new to this idea, we have OCD as a general diagnosis. And then under that umbrella of the diagnosis, we have-- over the years, the clinical and OCD community have created subtypes of OCD to help us, number one, categorize different groups of obsessions so that we can then direct the treatment to being very specific. We also do that to build a sense of community so that you feel less alone. Let’s say you have a harm obsession that can be very stigmatizing and feel very, very overwhelming, and you can have a lot of guilt and judgment about that for yourself. So, knowing you’re in a category, in a group with other people can actually soften the blow of the stigma and the judgment around that obsession. Same goes for sexual obsessions, pedophilia obsessions, and so forth.

Again, as a clinician, as I’m training my therapist, these subtypes are actually helpful so that we can help the newer therapists have a treatment plan specific to that person’s obsession. However, what about the group of people who don’t line up perfectly in those groups? And so, in today’s episode, we’re going to talk about what to do if that is you, what to do if you’re a therapist and you’re dealing with this, some skills that you might use, and maybe a few shifts and reframes here, I’ll use some clinical research that may help you shift the way you look at this problem. And maybe we can even stop calling it a problem. We could actually not address it as a problem and actually move through that together. Okay? 

Before we do that, let’s get straight to the “I did a hard thing.” I haven’t even read this hard thing you guys, so I’m as excited as can be. This one is from Hannah, and this is what Hannah had to say:

“Earlier this year, I suffered a debilitating OCD episode that focused on harm OCD,” so, there we are, we have a subtype already explained, “Specifically the fear of sleepwalking or going crazy and harming my family. At the time, I had no idea I had OCD as I had always been told I was just an anxious person. So, this well and truly threw me to the point that I couldn’t get off the couch, take my daughter to and from school or be alone. I wanted to admit myself into a mental health facility for fear that I was a real danger to my family and my daughter in particular. Long story short, after weekly ERP with a therapist and starting an SSRI, I did a very hard thing by being at home alone with my daughter for a whole weekend while my husband went away for work. I don’t think I’d be able to do it and I had been feeling anxious for months prior to knowing it was coming. But I did it and I actually ended up enjoying our time together despite some fairly consistent rumination.”

Hannah, oh my gosh, this is so good. You are such a walking billboard for how effective ERP and medication can be. I love that you did this. This is so good. And so, congratulations. I am so honored that you shared that with us. And look at you go. Look at you go.

All right. Again, quickly, let’s do the review of the week. This one is from Austin-mang, and they said:

“I finally did it and signed up for therapy. My session is this Friday. I’ve been doing my best to prepare and was uncertain about what to expect my first session. This show helped me to know exactly what to expect and gave me some great mindset tools going in. Thank you!”

Austin-mang, it sounds like you did a hard thing too. This is so wonderful. So, thank you guys for sharing your hard thing, and thank you so much for leaving a review. It does help me immensely build trust for those who are new to the show. 

All right, let’s get to it. 

A Common Question: “I Dont Fit Into A Typical Ocd Subtype?”

So, let’s backtrack to the main concern here, which is what if I don’t fit into a typical OCD subtype. Now, this is a hard thing for people, because not falling into that subtype can make it hard to be diagnosed. I was just thinking about this yesterday. Ten years ago or longer when I first started treating OCD – it’s been nearly 15 years now – if you typed into Google “What if I harm my baby,” maybe one or two articles would come up, but you would find an article about OCD and then you would slowly, if you’re able, get to treatment. Remember, our mission here is to reduce the amount of time it takes someone with OCD to get diagnosed and treated. Right now, it’s seven to 14 years, which is absolutely horrendous, but we’re getting better. We’re getting better. 

So, if you typed in “What if I harm my baby” or “What if I sinned,” you would probably come to an article that may lead you to, you may have OCD. What if I get sick and die? If you typed your what-if thought into Google, you’d probably find an article somewhere. But there are a group of people who if they typed their fear in, OCD would never come up. It would never show up on a Google search. If you told your doctor, they might not be able to identify this as OCD, because as far as we’ve come with educating, these subtypes have actually helped us educate doctors, nurses, teachers, and caregivers so that they can be more likely to pick up on children’s and young adult’s OCD. As much as we’ve done this, if you don’t have those specific subtypes, it can make it very difficult to get diagnosed.

The next piece here is a lot of people, and this is what I really hear a lot in my community online, on Instagram – if you follow me on Instagram, it’s @YourAnxietyToolkit – is some people will say, “Because I don’t fit into this subtype, I have a lot of doubt that I have OCD at all.” We know OCD is a doubting disorder, but often people with OCD even doubt, even if they fit into a subtype, they doubt that they have OCD. But if you don’t fit into one of these categories that we’ve put, these loose categories that we’ve put, that can make it even harder to really double down with your treatment and feel confident in your provider and feel confident in your diagnosis and so forth. 

There is a lot of times when people don’t talk about their specific obsession, when it doesn’t fall into that subtype in fear that someone would say, “You don’t have OCD. You don’t follow any of the subtypes.” And I’m sure maybe even some uneducated clinicians have shared that with their clients like, “No, you don’t meet criteria because you don’t meet a subtype.” And hopefully today we can actually get rid of that and hopefully resolve that issue. And what really comes and becomes apparent is, as we were talking before, let’s go to the “I did a hard thing.” They said they had harm OCD. And as I said before, it can feel really validating to know you have your community like, “Oh, I have perinatal OCD.” So, you have your little-- you can find a group of people who have the same obsessions, and that can be really validating. It can be very, very comforting to feel like you have that community. But for those who don’t feel like they fall into a subtype, they may actually feel quite isolated and alone, like unseen. And that doubt can really make it really difficult. 

And what I thought was really interesting is somebody said to me, the doubt can make you feel that it really is about the content, not the OCD. So, remember, we’re always talking about like, it’s not about the content. The content doesn’t matter. And in this case, they were saying, no, it really does feel like the content matters because if your content is within a category, well then you get that community, you get that reassurance. Not compulsive reassurance, but you get a little reassurance like, “This is OCD, you’re on the right track, keep going.”

So, I have such compassion. If you are somebody or your client is somebody who has an obsession that doesn’t fall into these categories, let’s really make sure we validate them. Let’s really make sure we slow down to understand what that is like for them.

Examples Of Ocd That Do Not Fit Into Traditional Subtypes

Let’s talk about some examples of what this might look like. So, examples of what it might look like if you don’t fit into a typical OCD subtype might be: What if I picked the wrong name for my baby? Some people could go, “Oh, that’s just a normal concern. Let’s come up with a solution.” You know what I mean? That would be probably, “Let’s work at making the right choice.” And I have had clients in the past who’ve gone as far as changing their baby’s name multiple times. I’ve seen this case multiple times, trying to just figure out the solution. But you can see here, it’s not a general fear. It’s something that is repetitive and they can’t seem to get rid of that uncertainty. And even if they do change it, the uncertainty still returns and it’s very urgent. Again, we can really see that’s OCD. Clear and clean OCD. It’s got the obsession, it’s got an urgent compulsion that is repetitive, that causes distress. It doesn’t line up with their values. So typically OCD.

Some people have obsessions about the weather and whether they’ll enjoy the weather. And you might immediately think, well, again, that doesn’t sound like OCD. But again, let’s look, it doesn’t matter about the content, it matters on the process. Is this person ruminating about this a lot? Are they stuck on trying to find the correct answer or the answer that resolves their uncertainty? Is there an incredible amount of distress? Are they trying to solve this with urgency? If that is the case, we have a very clean and clear case of OCD. 

I’ve had clients who’ve spent a lot of time obsessing and compulsing over the nail color that they picked or whether nail-- simple things like things they’ve chosen for their body – tattoos and so forth. And again, we could say that’s a generalized anxiety or that’s a common concern, but if it’s done repetitively and urgently and it’s causing them an extreme amount of distress, and it’s often targeted around uncertainty or anxiety or disgust, clean and clear OCD. 

Some clients I’ve had have said, “What if I don’t remember something the way that it actually was? What if I can’t remember it the exact way that it was? What if I lose a part of the memory?” Now, this might show up around, let’s say the loss of a loved one. What if I don’t remember them? And we might say that is a total normal stage of grief, except this person is trying to solve this memory issue repetitively, urgently over and over again, struggling in massive amounts of distress. The uncertainty of this is really destroying them. And again, clean and clear case of meeting criteria for OCD, but they don’t seem to make these into these categories. They don’t seem to slide into a category. 

I’ve had patients have obsessions about whether their partner cheats on them, and we could say, “Oh, well, they were probably--” in some cases, they have been cheated on before and we go, “That makes complete sense that they would worry about that. That’s not OCD.” But we look at the presentation and it goes far beyond generalized anxiety. It goes far beyond daily normal anxiety concerns for that situation. Again, it could become massive amounts of reassurance-seeking, rumination, avoidance, compulsions, self-criticism, self-punishment. And we can see that the way these compulsions are playing out meet criteria for OCD. And you might even say there, “Well, that’s kind of relationship OCD.” But that fits into the category. And we could argue that maybe you’re right, but I really wanted to highlight how often. Let’s say, if the partner had cheated on them and they’re having this obsession, usually, people would not put it in the category of relationship OCD because the partner had cheated on them or because a family member had cheated on their partner and they were somewhat traumatized by that event. We can sometimes miss cases because it doesn’t fall into a category. 

I’ve had people and clients who’ve worried obsessively and compulsively about their thought, what if my child suffers? What if my child goes through hard times? And again, we would go, “Oh, that makes complete sense. Every parent feels that. Every parent worries about that.” But then again, it crosses a line into massive amounts of rumination, massive amounts of checking, massive amounts of reactivity. It might not even be that it’s the typical compulsions. It might be just a great deal of reactivity done because the uncertainty of this is so overwhelming. 

I’ve had patients have obsessions about their taxes. What if they weren’t done correctly? They go back and they check them and then they go back and have a second opinion, and then they-- and again, we could say, “Well, isn’t that kind of like a bit of a moral obsession?” But when we ask the patient, they might say, “No, it’s not about that. It’s just about the fact that it’s uncertain.” Again, doesn’t fit into a typical subtype.

One other example I have is a lot of patients I’ve had have had the obsession, how will I know when it’s time to stop therapy? Now that’s a common rational concern. That’s actually a really good question to ask. Well, how will I know? But again, the obsession is excessive and causing them great distress. They spend a lot of time trying to figure it out. They can’t figure it out. There is no solution. The uncertainty is so overwhelming and overbearing and painful, they end up doing a lot of compulsions. 

And so, there we have all of these examples, and I’m sure you probably have more of where your obsession doesn’t fit into a typical subtype but is so clearly OCD. 

So, here is what I want to offer you. In this case, I’m going to give you the answer up front, and then we’re going to work through it together. The truth is, the subtypes really don’t matter. The only reason they matter is they help with treatment and they help with validation in helping people to feel not alone. But we must remember that nowhere in the criteria for OCD does it say you have to have a subtype. The only criteria you need to have is to have an obsession, a repetitive thought, feeling, sensation, urge, or image. And that obsession has to create a lot of distress in your life and can impact your functioning. Not always, but it can. And then must contain compulsions. And the compulsions are either covert or overt, meaning they’re behavioral, they’re physical, or they’re mental. They must cause a lot of distress in your life. They must take a certain amount of time. And if you meet that criteria, that’s all we really need for you to move forward with your recovery, and I want to encourage you to move forward as fast as you can. Try not to get caught up. Remember the subtypes. Just think about me being a therapist who trains staff. I have ERP School, which is our online course. That is for people who don’t have face-to-face therapy, who don’t have access to therapy, who want to learn how to structure ERP for themselves. I talk a lot about subtypes there, but only because it’s an education tool to help people get direction for their treatment. But if you don’t meet that criteria, that means nothing about whether you can recover or not. So, that’s the main point, and now we’re going to talk about how we can do this.

Now, first, before we do this, I actually want to introduce to you something that is a science-based measurement tool we use for OCD that may be very validating to you folks if you don’t have a specific subtype that you fall into that category.

Dimensional Obsessive Compulsive Scale (Jon Abramowitz) 

Now, Jon Abramowitz and his team has created what he calls the Dimensional Obsessive-Compulsive Scale. If you Google it, it should come up. I will do my best to link it in the show notes. And this ultimately doesn’t have anything about subtypes. It really just has four categories of concerns that people with OCD have. And what I found so wonderful about that is if we throw out all the subtypes and we just look at the symptoms, we look at the process that someone with OCD goes through, you’ll probably find you fall into one of these categories. If you don’t, still don’t worry because-- but I think that this is-- I love the way that they’ve really put this together because it simplifies everything. It makes it a whole lot less confusing. So, let’s go through them together. 

Number one, category 1 is concerns about germs and contamination, and they go through to explain that. If you download it, you’ll get more information about this. 

Category 2 - concerns about being responsible for the harm, injury, or bad luck. And so, for that one, that includes harm OCD, it includes religious obsessions, self-harm OCD, moral obsessions. A lot of those subtypes can fall into these little categories, but I like that these are really basic. 

The third is simple, unacceptable thoughts. And in these cases of people with OCD that don’t fit into the subtypes, we could easily just say, “You fall into the unacceptable thoughts category, that these thoughts are unacceptable to you. The uncertainty is unacceptable to you.” 

And then the fourth category is concerns about symmetry, completeness, and the needs for things to be just right. And what I think is so helpful about that is so often these cases where they don’t fall into these more typical subtypes, I find often they do fall into somewhere around this idea of the need for things to be completed or just right or resolved. Hopefully, this Dimensional Obsessive-Compulsive Scale helps catch a net underneath all of these subtypes that can validate you, that you still fall under the category of having OCD, that you can still move forward with your treatment. You go full fledged into your ERP and move forward ultimately. 

Ocd Vs General Anxiety Disorder (Gad) 

Now, that being said, we also need to look at the overlap, or maybe we should actually say the spectrum of where generalized anxiety can meet OCD. Some of these, as we said, some of these obsessions fall under maybe that’s more generalized anxiety, but we know that you could have generalized anxiety fears. But if they’re presenting with obsessions and compulsions, we’re actually going to treat it like OCD. And some people – I’ve actually really loved the OCD community – are now arguing that general anxiety and OCD are the same thing, just on a spectrum, from not so severe to very, very severe. And they’re doing that. People with generalized anxiety are doing obsessions, having obsessions, and doing compulsions. The biggest one being mental rumination and avoidance. 

So, let’s round this out by talking about what to do now. So, if this is you, here is what I want you to remember. At the end of the day, and this is what I say to my clients, at the end of the day, it doesn’t matter what we call this. We could call your set of symptoms bibbidi-bobbidi-boo, and we would still use the same tools to get you effective results because what do we know? It doesn’t matter. Whatever the content is, what do we know is the problem that you’re struggling to manage the uncertainty that you’re having, that you’re having a great deal of distress and discomfort, and we need tools to be able to manage and ride that out. 

So, again, if we call it this specific subtype, we call it OCD, we call it generalized anxiety, we call it bibbidi-bobbidi-boo, at the end of the day, they all require us to stop trying to suppress the thought because we know suppressing the thoughts make it worse. And then we can practice exposing ourselves to the situations where those thoughts come up without doing those compulsions. So, if you’ve taken ERP School or you’re interested in taking ERP School, we go thoroughly through what ERP is, which is exposure and response prevention. What it is, is that we expose you to the thought and fear and the obsession that you’re having. And then we practice, slowly but surely, reducing – this is called response prevention – reducing the compulsive behaviors that you do that reinforce that fear and obsession. That’s ERP. It’s actually pretty structured. We walk you through it in ERP School, but if you have an ERP therapist, they’re going to walk you through identifying your obsession, even if it doesn’t meet those categories, identifying what is your fear, and then practicing, exposing you to the life that you want to live, whether that fear shows up or not, and then practicing reducing those compulsions. The process of treatment is the same, disregarding the subtype, whether you have a subtype that you fall into or not. It is effective either way. 

Ideal Treatments For Ocd

And so, what I’m going to encourage you to do, and I’m just going to think of this as me finishing out the podcast, but giving you some direction, is if you meet criteria for OCD, and that involves doubting your disorder-- I remember once John Hirschfeld when I was training to become an OCD therapist. He said to me, if he had his way, he would add to the criteria for OCD that you must doubt your disorder because it’s so common for people with OCD to doubt whether they have the disorder. So, here we want to do is we want to have a plan where ERP is the meat and cheese of your treatment. And what you can do then is supplement treatment with either acceptance and commitment therapy, self-compassion, mindfulness. Sometimes people use DBT. There are new supplements coming to treatment all the time, which is wonderful, but the meat and cheese is to make sure you’re doubling down on that exposure and then the reduction of those compulsions. Okay? 

My message to you is you can still 100% recover from this disorder. Look at the “I did a hard thing” today and look at the review even, talking about the benefits of practicing ERP. So, that’s what I want you to focus on. 

If you don’t have access to an ERP therapist, we have a course available to you. It’s $197, which is actually less than one session with any of my staff or most ERP therapists. That is about seven hours long and will walk you through this process. So, if you’re interested, head over to CBTSchool.com. The course is called ERP School and hopefully, it will give you the tools and the education you need to feel like you can get the ball going here, even if you don’t fit these typical subtypes. 

Okay, that’s all I have to say about that. I hope that this has been absolutely jam-packed with helpful skills for you to learn. I hope it absolutely validated your concern if, in fact, this is a concern that you have, and it is my honor to be on this journey with you. 

So, as I always say at the end of almost every episode, it is a beautiful day to do hard things. Thank you so much again for supporting me. I just adore sending out these free resources for you and hopefully filling up your cup if your cup is feeling very empty. Please also, one thing I should have said, be gentle guys. OCD and anxiety in general can be a mean beast in our minds. And one of the best antidotes to that can be kindness, gentle self-care, loving, nurturing presence. And so, I hope that’s what I am for you and I hope that is what you are for you as well. 

Have a wonderful day, everybody.

Oct 28, 2022

In This Episode:

  • Andrew GottWorth shares his story of having Obsessive Compulsive Disorder (OCD) and how ERP allowed him to function again. 
  • addresses the benefits of ERP and how ERP is for Everyone 
  • How Exposure & response prevention can help people with OCD and for those with everyday stress and anxiety 



Links To Things I Talk About:

Episode Sponsor:

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

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

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

EPISODE TRANSCRIPTION 

This is Your Anxiety Toolkit - Episode 308. 

Welcome, everybody. I am really pumped for this episode. We have the amazing Andrew Gottworth on for an interview where he just shared so many nuggets of wisdom and hope and motivation. I think you’re going to love it. But the main point we’re making today is that ERP is for everyone. Everyone can benefit from facing their fears. Everyone can benefit by reducing their compulsive behaviors. Even if you don’t technically call them compulsions, you too can benefit by this practice. Andrew reached out to me and he was really passionate about this. And of course, I was so on board that we jumped on a call right away and we got it in, and I’m so excited to share it with you. Thank you, Andrew, for sharing all your amazing wisdom. 

Before we head into the show, let’s quickly do the “I did a hard thing” for the week. This one is from Christina, and they went on to say:

“Thought of you today, and you’re saying, ‘It’s a beautiful day to do hard things,’ as I went down a water slide, terrified, as I’m well out of my comfort zone.” This is such great. They’re saying that’s on their holiday, the first time they’ve taken a holiday in quite a while. “It’s difficult, but I’m doing it. I’m trying to lean into the discomfort.”

This is so good. I love when people share their “I did a hard thing,” mainly, as I say before, because it doesn’t have to be what’s hard for everybody. It can be what’s hard for you. Isn’t it interesting, Christina is sharing a water slide is so terrifying? Christina, PS, I’m totally with you on that. But some of the people find it thrill-seeking. And then I’m sure the things that Christina does, she might not have anxiety, but other people who love to thrill seek find incredibly terrifying. So, please don’t miss that point, guys. It is such an important thing that we don’t compare. If it’s terrifying, it’s terrifying, and you deserve a massive yay. You did a hard thing for it. So, thank you, Christina. 

Again, quickly, let me just quickly do the review of the week, and then we can set back and relax and listen to Andrew’s amazing wisdom. This one is from Anonymous. Actually, this one is from Sydneytenney, and they said:

“Incredible resource! What an incredible resource this podcast is! Thank you for sharing all of this information so freely… you’re truly making a difference in so many lives, including mine! (I am also reading through your book and I LOVE it. You nailed it in marrying OCD with self-compassion - what a gift!!!)”

So, for those of you who don’t know, I wrote a book called The Self-Compassion Workbook for OCD. If you have OCD and you want a compassionate approach to ERP by all means, head over to Amazon or wherever you buy books and you can have the resource right there. 

All right, let’s get over to the show.

308 ERP is for EVERYONE with Andrew Gottworth Your anxiety toolkit

Kimberley: Okay. Welcome, Andrew Gottworth. Thank you so much for being here.

Andrew: Yeah. So, happy to be here. Really excited to chat with you for a bit.

Kimberley: Yeah. How fun. I’m so happy you reached out and you had a message that I felt was so important to talk about. Actually, you had lots of ideas that I was so excited to talk about.

Andrew: I might bring some of them up because I think, anyway, it’s related to our big topic. 

Erp Is For Everyone

Kimberley: Yeah. But the thing that I love so much was this idea that ERP (Exposure and Response Prevention) is for everyone. And so, tell me, before we get into that, a little bit about your story and where you are right up until today and why that story is important to you.

Andrew: Yeah. So, there’s a lot, as you work in the OCD field that it takes so long between first experiencing to getting a diagnosis. And so, with the knowledge I have now, I probably started in early childhood, elementary school. I remember racing intrusive thoughts in elementary school and being stuck on things and all that. But definitely, middle school, high school got worse and worse. So, fast forward to freshman year of college, it was really building up. I was really having a lot of issues. I didn’t know what it was and really didn’t know what it was for nine, 10 years later. But I was having a really hard time in college. I was depressed. I thought I was suicidal. Learning later, it’s probably suicidal ideation, OCD just putting thoughts of death and jumping up a building and jumping in a lake and getting run over and all that. But I didn’t want to talk about it then, I think.

Andrew’s Story About Having Obsessive Compulsive Disorder

A bit about me, I come from Kentucky. I count Louisville, Kentucky as the Midwest. We have a bit of an identity crisis, whether we’re South Midwest, East Coast, whatever. But still there, there’s a culture that mental health is for “crazy people.” Of course, we don’t believe that. So, my tiptoe around it was saying, “I’m having trouble focusing in class. Maybe I have ADHD.” And that’s what I went in for. For some reason, that was more palatable for me to talk about that rather than talk about these thoughts of death and all that. And so, I did an intake assessment and thankfully I was somewhat honest and scored high enough on the depression scale that they were like, “Hey, you have a problem.” And so, ended up talking more.

So, back in 2009, freshman year of college, I got diagnosed with depression and generalized anxiety disorder, but completely missed the OCD. I think they didn’t know about it. I didn’t know about it. I didn’t have the language to talk about it at the time because I didn’t have hand washing or tapping and counting and these other things that I would maybe see on TV and stuff, which – yeah, I see you nodding – yes, I know that’s a common story. 

So, I entered therapy in 2009, and I’ve been in therapy and non-medication ever since. But I had problems. I still had problems. I would make progress for a bit. And then I just feel like I was stuck. So, I ended up being in three mental hospitals. One, when I was doing AmeriCorps up in Milwaukee, Wisconsin, and had a great experience there. Two, three days up there at Rogers, which I’m very grateful for. And then stabilized moving forward. So, I ended up-- I dropped outta college. I dropped out of AmeriCorps. I then went back to college and again went to a mental hospital in Bowling Green, Kentucky. I was at Western Kentucky University, stabilize, keep going. Learning lessons along the way, learning cognitive distortions and learning talk therapy, and all these. 

So, let’s keep fast-forwarding. Another mental hospital in Atlanta, Georgia. There’s a long-term outpatient stay, Skyline Trail. I’m thankful for all of these places along the way. And I wish somewhere along the way, I knew about OCD and knew about ERP, our big topic for the day. 

So, finally, gosh, I can’t quite remember. I think 2018, a few years ago, still having problems. I had gone from full-time at work to part-time at work. I was just miserable. I would get into my cubicle and just constantly think, I’m not going to make it. I got to go home. I got to find an excuse to get out of here early. I just need to stay sick or I got to go home, or something came up. And so, every day I’d have an excuse until I finally was like, “I’m going to get found out that I’m not working full-time. I’m going to jump the gun, I’ll voluntarily go down in part-time.” 

So, that worked for a bit until OCD kept going. And then I quit. I quit again. And at that point, I was like, “I’ve failed. I’ve quit so many things – college, AmeriCorps.” I was a summer camp counselor and I left early. “Now this job. I need something.” So, I went again to find more help. And finally, thankfully, someone did an intake assessment, came back, and said, “Well, one problem is you have OCD.” I was like, “What? No, I don’t have that. I don’t wash my hands. I’m not a messy person. I’m not organized.” Gosh, I’m so thankful for her. 

Kimberley: Yeah, I want to kiss this person. 

Andrew: Yeah. But here’s the duality of it. She diagnosed me with it. I am forever grateful. And she didn’t do ERP. She didn’t know it. So unbelievably thankful that I got that diagnosis. It changed my life. And then I spent several weeks, maybe a few months just doing talk therapy again. And I just knew something didn’t feel right. But I had this new magical thing, a diagnosis. And so, my OCD latched onto OCD and researched the heck out of it. And so, I was researching, researching, researching, and really starting to find some things like, “Oh, this isn’t working for me. I’ve been doing the same type of therapy for a decade and I’m not making progress.” Unbelievably thankful for the Louisville OCD Clinic. So, at this point in this story-- thanks for listening to the whole saga. 

Kimberley: No, I’ve got goosebumps.

Andrew: I’m unemployed, I have my diagnosis, but I’m not making any progress. So, I go, “Throw this in as well. Not really that important.” But I go to an intensive outpatient program in Louisville before the OCD clinic. And I remember this conversation of the group therapy leader saying, “I need you to commit to this.” And I said, “But I don’t think this is helping me either,” because the conversation was about relationships, my relationship was great. It was about work, I wasn’t working. It was about parents, my parents were great. They were supporting me financially. They’re super helpful and loving and kind. It’s like, “None of this is external.” I kept saying, “This is internal. I have something going on inside of me.” And she said, “Well, I want you to commit to it.” I said, “I’m sorry, I found a local OCD clinic. I’m going to try them out.” 

So, I did IOP, I did 10 straight days, and it is a magical, marvelous memory of mine. I mean, as you know, the weirdest stuff, oh gosh. Some of the highlights that are quite humorous, I had a thing around blood and veins. And so, we built our hierarchy, and maybe we’ll talk about this in a bit, what ERP is. So, built the hierarchy, I’m afraid of cutting my veins and bleeding out. So, let’s start with a knife on the table. And then the next day, the knife in the hand. And then the next day, the knife near my veins. And then we talked about a blood draw. And then the next day, we watched a video of a nurse talking about it. Not even the actual blood draw, but her talking about it. So, of course, my SUDs are up really high. And the nurse says in the video, “Okay, you need to find the juiciest, bumpiest vein, and that’s where you put it in.” And my therapist, pause the video. She said, “Perfect. Andrew, I want you to go around to every person in the office and ask to feel the juiciest, bumpiest veins.” Oh my gosh. Can you imagine? 

Kimberley: The imagery and the wording together is so triggering, isn’t it?

Andrew: Right. She’s amazing. So, she was hitting on two things for me. One, the blood and veins, and two, inconveniencing people. I hated the inconveniencing people or have awkward moments. Well, hey, it’s doing all three of these things. So, I went around. And of course, it’s an OCD clinic, so nobody’s against it. They’re like, “Sure, here you go. This one looks big. Here, let me pump it up for you.” And I’m like, “No, I don’t like this.”

Kimberley: Well, it’s such a shift from what you had been doing. 

Andrew: It’s totally different. I’ll speak to the rest because that’s really the big part. But ERP over the next few years gave me my life back. I started working again. I worked full-time. Went part-time, then full-time. Got into a leadership position. And then for a few other reasons, my wife and I decided to make a big jump abroad. And so, moved to Berlin. And I have a full-time job here and a part-time disc golf coach trainer. And now I’m an OCD advocate and excited to work with you on that level and just looking at where my life was four or five years ago versus now. And thanks to our big-ticket item today, ERP.

Kimberley: Right. Oh, my heart is so exploding for you.

Andrew: Oh, thank you. 

Kimberley: My goodness. I mean, it’s not a wonderful story. It’s actually an incredibly painful story.

Andrew: You can laugh at it. I told it humorously.

How Andrew Applied Erp For His Ocd

Kimberley: No. But that’s what I’m saying. That’s what’s so interesting about this, is that it’s such a painful story, but how you tell it-- would I be right in saying like a degree of celebration to it? Tell me a little bit about-- you’re obviously an ERP fan. Tell me a little bit about what that was like. Were you in immediately, or were you skeptical? Had you read enough articles to feel like you were trusting it? What was that like for you? Because you’d been put through the wringer.

Andrew: Yeah. There’s a lot to talk about, but there are a couple of key moments when you mention it. So, one, we’re going through the Y-BOCS scale, the Yale-Brown Obsessive Compulsive Scale, something like that. So, she asks me one of the questions like, how often do you feel like a compulsion to do something and you don’t do the compulsion? “Oh, never. I’ve never stopped. But you can do that?” It was just this moment of, “What do you mean?” If it’s hot, I’m going to make it colder. If it’s cold, I’m going to make it warmer. If I’m uncomfortable, I’m going to fidget. I’m a problem solver. Both my parents were math teachers. I was an all-A student and talk about perfectionism and “just right” OCD maybe in this context as well. But also, I love puzzles. I love solving things. And that was me. I was a problem solver. It never occurred to me to not solve the problem. And so, that was a huge aha moment for me. And I see it now and I talk about it now to other people. 

Am I Doing Erp “Just Right”?

But another part of ERP with the just right is, am I doing ERP right? Am I doing it right? Am I doing ERP right? And of course, my therapist goes, “I don’t know. Who knows? Maybe, maybe not.” So, depending on where you want to go with this, we can talk about that more. So, I think in general, I hated that at the time. I was like, “I know there is a right way to do it. There is. I know there is.” But now, I even told someone yesterday in our Instagram OCD circles, someone was posting about it, and I said exactly that, that I hated this suggestion at first that maybe you’re doing it wrong, maybe you’re not. 

I will say, as we talk about ERP for everyone, someone who maybe is going to listen to this or hears us talking on Instagram and wants to do it on their own, this idea of exposing yourself to something uncomfortable and preventing the response – I don’t know if this is wrong, but I will say for me, it was not helpful. In my first few weeks, I would do something like-- I was a little claustrophobic, so I maybe sit in the middle seat of a car. It’s good I’m doing the exposure. I’m preventing the response by staying there. I didn’t get out. But in my head, I’m doing, “Just get through this. Just get through this. I hate this. It’s going to be over soon. You’ll get through it and then you’ll be better. Come on, just get through it. Oh, I hate this. Ugh. Ugh.” And then you get to the end and you go, “Okay, I made it through.” And of course, that didn’t really prevent the response. That reinforced my dread of it. And so, I would say that’s definitely a lesson as we get into that. 

Kimberley: And I think that brings me to-- you bring up a couple of amazing points and I think amazing roadblocks that we have to know about ERP. So, often I have clients who’ll say early in treatment, “You’d be so proud I did the exposure.” And I’d be like, “And the RP, did that get included?” So, let’s talk about that. So, for you, you wanted to talk about like ERP is for everyone. So, where did that start for you? Where did that idea come from?

Andrew: I would say it’s been slow going over the years where-- I don’t know how to say this exactly, but thinking like, there must be higher than 2% of people that have OCD because I think you have it and I think you have it and I think you have it, and noticing a lot of these things. And so, maybe they’re not clinical level OCD and maybe it’s just anxiety or I think, as I emailed you, just stress. But it’s this-- I just wonder how many friends and family and Instagram connections have never had that aha moment that I did in my first week of IOP of, “Oh, I cannot try to solve this.” And so, I see people that I really care about and I joked with my wife, I said, “Why is it that all of our best friends are anxious people?” And I think that comes with this care and attention and that I’ve suffered and I don’t want anyone else to suffer. And so, I see that anxiety in others.

But getting back to what I see in them, maybe someone is socially anxious so they’re avoiding a party or they’re leaving early, or-- I mean, I did these two, avoided, left early, made sure I was in either a very large group where nobody really noticed me or I was in a one-on-one where I had more control. I don’t know. So, seeing that in some other friends, leaving early, I just want to say to them, you can stay. It’s worked for me. It really has. This staying, exposing yourself to the awkwardness of staying or maybe it’s a little too loud or it’s too warm. And then let that stress peak fall and see, well, how do you feel after 30 minutes? How do you feel after an hour? I want to scream that to my friends because it’s helped me so much. I mean, you heard how awful and miserable it was for so long and how much better. I’m not cured, I think. I’m still listening to your six-part rumination series because I think that’s really what I’m working on now. 

So, I think those physical things, I’ve made tremendous improvement on blood and veins and all that. But that’s also not why I quit work. I didn’t quit working. I didn’t quit AmeriCorps because there’s so much blood everywhere. No, it’s nonprofits, it’s cubicles. But it was this dread that built this dread of the day, this dread of responding to an email. Am I going to respond right? Oh no, I’m going to get a phone call. Am I going to do that? Am I going to mess this up? And because I didn’t have that response prevention piece, all I had was the exposure piece, then it’s-- I can’t remember who said it, but like, ERP without the RP is just torture. You’re just exposing yourself to all these miserable things. 

Kimberley: You’re white-knuckling. 

Andrew: Yeah. And it’s-- I love research. I am a scientist by heart. I’m a Physics major and Environmental Studies master’s. I love research and all this. And so, I’ve looked into neuroplasticity, but I also am not an expert. Correct me if I’m wrong, but from what I hear, you’re just reinforcing that neural pathway. So, I’m going into work and I dread it. I’m saying, “I hate this. I can’t wait to go home. I hate this.” So, that’s reinforcing that for the next day. And tomorrow I go in and that dreads bigger, and the next day the dreads bigger. 

And so, seeing that in other colleagues who are having a miserable time at work is just getting worse and worse and worse. But I also can see that there are parts they enjoy. They enjoy problem-solving, they enjoy helping students, they enjoy the camaraderie. And so, I want to help them with, well, let’s see how we can do ERP with the things you don’t like and so you’re not building this dread day after day and you can do the things you value. Seems like you value us coworkers, seems like you value helping the students, seems like you value solving this problem, and that’s meaningful. But I’m watching you get more and more deteriorated at work. And that’s hard to do that in others. 

ERP Is For Everyone

Kimberley: Yeah. I resonate so much from a personal level and I’ll share why, is I have these two young children who-- thankfully, I have a Mental Health degree and I have license, and I’m watching how anxiety is forming them. They’re being formed by society and me and my husband and so forth, but I can see how anxiety is forming them. And there’s so many times-- I’ve used the example before of both my kids separately were absolutely petrified of dogs. And they don’t have OCD, but we used a hierarchy of exposure and now they can play with the neighbor’s dogs. We can have dogs sitting. And it was such an important thing of like, I could have missed that and just said, “You’re fine. Let’s never be around dogs.” And so, it’s so interesting to watch these teeny tiny little humans being formed by like, “Oh, I’m not a dog person.” You are a dog person. You’re just afraid of dogs. It’s two different things.

Andrew: Yeah. So, it’s funny that my next-door neighbor, when I was young, had a big dog. And when we’re moving into the house for the very first time, very young, I don’t know, four or something, it ran into the house, knocked me over, afraid of dogs for years. So, same thing. Worked my way up, had a friend with a cute little pup, and then got to a scarier one. And also, funnily to me, my next-door neighbor, two in a row, were German, and they scared me, the scary dog, German. And then the next one was the “Stay off my lawn, don’t let your soccer ball come over.” So, for years, I had this like, “I’m not going to root for Germany in sports. I don’t like Germany.” And then here I am living in Germany now.

Kimberley: Like an association.

Andrew: Yeah. So, I think fear association, anxiety association. And then I’m also playing around with this idea, maybe do a series on Instagram or maybe another talk with someone about, is it anxiety or is it society? And so, talking about things that were made to feel shame about. So, I don’t know if you can see on our webcam that I have my nails painted. I would never have done this in Kentucky. So, growing up in this, I remember vividly in elementary school, I sat with my legs crossed and someone said, “That’s how a girl sits. You have to sit with your foot up on your leg.” So, I did for the rest of my life. And then I wore a shirt with colorful fish on it, and they said, “Oh, you can’t wear that, guys don’t wear that.” So, I didn’t. I stopped wearing that and all these things, whether it’s about our body shape or femininity or things we enjoy that are maybe dorky or geeky. I just started playing Dungeons and Dragons. We have a campaign next week. And I remember kids getting bullied for that. 

I don’t know if you agree, but I see this under the umbrella of ERP. So, you’re exposing yourself to this potential situation where there’s shame or embarrassment, or you might get picked on. Someone might still see these on the train and go, “What are you doing with painted nails?” And I’m going to choose to do that anyway. I still get a little squirmy sometimes, but I want to. I want to do that and I want that for my friends and family too. And I see it in, like you said, in little kids. A lot of my cousins have young kids and just overhearing boys can’t wear pink, or you can’t be that when you grow up, or just these associations where I think you can, I think you can do that.

Kimberley: I love this so much because I think you’re so right in why ERP is for everyone. It’s funny, I’ll tell you a story and then I don’t want to talk about me anymore, but--

Andrew: No, I want to hear it. That’s fine.

Kimberley: I had this really interesting thing happen the other day. Now I am an ERP therapist. My motto is, “It’s a beautiful day to do hard things.” I talk and breathe this all day, and I have recovered from an eating disorder. But this is how I think it’s so interesting how ERP can be layered too, is I consider myself fully recovered. I am in such good shape and I get triggered and I can recover pretty quick. But the other day, I didn’t realize this was a compulsion that I am still maybe doing. I went to a spa, it was a gift that was given to me, and it says you don’t have to wear your bathing suit right into the thing. So, I’m like, “Cool, that’s fine. I’m comfortable with my body.” But I caught myself running from the bathroom down into the pool, like pretty quickly running until I was like, that still learned behavior, it’s still learned avoidance from something I don’t even suffer from anymore. And I think that, to speak to what you’re saying, if we’re really aware we can-- and I don’t have OCD, I’m open about that. If all humans were really aware, they could catch avoidant behaviors we’re doing all the time that reinforces fear, which is why exposure and response prevention is for everybody. Some people be like, “Oh, no, no. I don’t even have anxiety.” But it’s funny what you can catch in yourself that how you’re running actually literally running. 

Andrew: Literally running. Yeah.

Kimberley: Away. So, that’s why I think you’ve mentioned how social anxiety shows up and how exposure and response prevention is important for that. And daily fears, societal expectations, that’s why I think that’s so cool. It’s such a cool concept.

Andrew: Yeah. And so, help me since I do consider you the expert here, but I’ve heard clinically that ERP can be used for OCD but also eating disorder, at least our clinic in Louisville serves OCD, eating disorder, and PTSD. And so, I see the similarities there of the anxiety cycle, the OCD cycle for each of those. So, then let’s say that’s what ERP is proposed for. But then we also have generalized anxiety and I think we’re seeing that. I’ve heard Jenna Overbaugh talk about that as well. It’s this scale between anxiety to high anxiety to subclinical OCD, to clinical OCD, and that ERP is good for all of that. So, we have those, and then we get into stress and avoidant behavior. So, I have this stressful meeting coming up, I’ll find a way to skip it. Or I have this stressful family event, I’ll find a way to avoid it. And then you get into the societal stuff, you get into these. And so, I see it more and more that yes, it is for everyone.

Kimberley: Yeah. No, I mean, clinically, I will say we understand it’s helpful for phobias, health anxiety, social anxiety, generalized anxiety. Under the umbrella of OCD are all these other disorders and, as you said, spectrums of those disorders that it can be beneficial for. And I do think-- I hear actually a lot of other clinicians who aren’t OCD specialists and so forth talking about imposter syndrome or even like how cancel culture has impacted us and how everybody’s self-censoring and avoiding and procrastinating. And I keep thinking like ERP for everybody. And that’s why I think like, again, even if you’re not struggling with a mental illness, imposter syndrome is an avoidant. Often people go, procrastination is an avoidant behavior, a safety behavior or self-censoring is a safety behavior, or not standing up for you to a boss is an opportunity for exposure as long as of course they’re in an environment that’s safe for them. So, I agree with you. I think that it is so widespread an opportunity, and I think it’s also-- this is my opinion, but I’m actually more interested in your opinion, is I think ERP is also a mindset.

Andrew: Yeah.

Kimberley: Like how you live your life. Are you a face-your-fear kind of person? Can you become that person? That’s what I think, even in you, and actually, this is a question, did your identity shift? Did you think you were a person who couldn’t handle stresses and now you think you are? Or what was the identity shift that you experienced once you started ERP?

Andrew: Yeah. That’s a good question. I’ve had a few identity shifts over the years. So, I mentioned-- and not to be conceited, although here I am self-censoring because I don’t want to come across as conceited anyway. So, I was an all-A student in high school, and then OCD and depression hit hard. And so, throughout college, freshman year I got my first B, sophomore year I got my first C, junior year I got my first D. And so, I felt like I was crawling towards graduation. And this identity of myself as Club President, all-A student, I had to come to terms with giving up who I thought I could be. I thought I could be-- people would joke, “You’ll be the mayor of this town someday, Andrew.” And I watched this slip away and I had to change that identity. And not to say that you can’t ever get that back with recovery, but what I will say is through recovery, I don’t have that desire to anymore. I don’t have that desire to be a hundred percent. I’m a big fan of giving 80%. And mayor is too much responsibility. I don’t know, maybe someday. So, that changed. 

And then definitely, through that down downturn, I thought, I can’t handle this. I can’t handle anxiety, I can’t handle stress. People are going to find out that this image I’ve built of myself is someone who can’t handle that. So, then comes the dip coming back up, ERP, starting to learn I can maybe but also-- I love to bounce all over the place, but I think I want to return a bit to that idea that you don’t have to fix it. You don’t have to solve the problem. I think that was me. And that’s not realizing that I was making it harder on myself, that every moment of the day I was trying to optimize, fix, problem-solve. 

If you allow me another detour, I got on early to make sure the video chat was working, sound was okay. And I noticed in my walk over to my computer, all the things my brain wanted me to do. I call my brain “Dolores” after Dolores Umbridge, which is very mean to me. My wife and I, Dolores can F off. But I checked my email to make sure I had the date right. Oops, no, the checking behavior. Check the time, making sure, because we’re nine hours apart right now. “Oh, did I get the time difference right?” I thought about bringing over an extra set of lights so you could see me better. I wanted to make sure I didn’t eat right before we talked, so I didn’t burp on camera, made sure I had my water, and it was just all these-- and if I wasn’t about to meet with an OCD expert, I wouldn’t have even noticed these. I wouldn’t have even noticed all of these checking, fidgeting, optimizing, best practicing. But it’s exhausting. 

And so, I’m going to maybe flip the script and ask you, how do you think other people that are not diagnosed with OCD, that are just dealing with anxiety and stress can notice these situations in their life? How do they notice when, “Oh, I’m doing an avoidant behavior,” or “I’m fixing something to fix my anxiety that gives me temporary relief”? Because I didn’t notice them for 10 years.

Kimberley: Yeah. Well, I think the question speaks to me as a therapist, but also me as a human. I catch every day how generalized anxiety wants to take me and grab me away. And so, I think a huge piece of it is knowledge, of course. It’s knowledge that that-- but it’s a lot to do with awareness. It’s so much to do with awareness. I’ll give you an example, and I’ve spoken about this before. As soon as I’m anxious, everything I do speeds up. I start walking faster, I start typing faster, I start talking faster. And there’s no amount of exposure that will, I think, prevent me from going into that immediate behavior. So, my focus is staying-- every day, I have my mindfulness book right next to me. It’s like this thick, and I look at it and I go, “Okay, be aware as you go into the day.” And then I can work at catching as I start to speed up and speed type. 

So, I think for the person who doesn’t have OCD, it is, first, like you said, education. They need to be aware, how is this impacting my life. I think it’s being aware of and catching it. And then the cool part, and this is the part I love the most about being a therapist, is I get to ask them, what do you want to do? Because you don’t have to change it. I’m not doing any harm by typing fast. In fact, some might say I’m getting more done, but I don’t like the way it makes me feel. And so, I get to ask myself a question, do I want to change this behavior? Is it serving me anymore? And everyone gets to ask them that solves that question.

Andrew: So, I think you bring up a good point though that I’m curious if you’ve heard this as well. So, you said you’re typing fast and you’re feeling anxious and you don’t like how that feels. I would say for me, and I can think of certain people in my life and also generally, they don’t realize those are connected. I didn’t realize that was connected. In college, I’m wanting to drop out, I drop out of AmeriCorps, I drop out of summer camp. I’m very, very anxious and miserable and I don’t know why. And looking back, I see it was this constant trying to fix things and being on alert. And I got to anticipate what this is going to be or else is going to go bad. I need to prevent this or else I’m going to have an anxious conversation. I need to only wear shorts in the winter because I might get hot. Oh no, what if I get hot? And it was constantly being in this scanning fear mindset of trying to avoid, trying to prevent, trying to-- thinking I was doing all these good things. And I saw myself as a best-practice problem solver. It’s still something I’m trying to now separate between Dolores and Andrew. Andrew still loves best practices. But if I spend two hours looking for a best practice when I could have done it in five minutes, then maybe that was a waste. And I didn’t realize that was giving me that anxiety. 

So, yeah, I guess going back to I think of family, I think of coworkers, I think of friends that I have a suspicion, I’m not a therapist, I can’t diagnose and I’m not going to go up, I think you have this. But seeing that they’re coming to me and saying, “I’m exhausted. I just have so much going on,” I think in their head, it’s “I have a lot of work.”

Kimberley: External problems.

Andrew: Yeah. I may be seeing-- yeah, but there’s all this tension. You’re holding it in your shoulders, you’re holding it here, you’re typing fast and not realizing that, oh, these are connected. 

Kimberley: And that’s that awareness piece. It’s an awareness piece so much. And it is true. I mean, I think that’s the benefit of therapy. Therapists are trained to ask questions so that you can become aware of things that you weren’t previously aware of. I go to therapy and sometimes even my therapist will be like, “I got a question for you.” And I’m like, “Ah, I missed that.” So, I think that that’s the beauty of this. 

Andrew: I had a fun conversation. I gave a mental health talk at my school and talked about anxiety in the classroom, and thanks to IOCDF for some resources there, there’s a student that wanted to do a follow-up. And I thought this was very interesting and I loved the conversation, but three or four times he was like, “Well, can I read some self-help books, and then if those don’t work, go to therapy?” “No, I think go to therapy right away. Big fan of therapists. I’m not a therapist. You need to talk to a therapist.” “Okay. But what if I did some podcasts and then if that didn’t work, then I go to therapy?” “Nope. Therapy is great. Go to therapy now.” “Should I wait till my life gets more stressful?” “Nope. Go now.”

Kimberley: Yeah, because it’s that reflection and questioning. Everyone who knows me knows I love questions. They’re my favorite. So, I think you’re on it. So, this is so good. I also want to be respectful of your time. So, quick rounded out, why is ERP for everybody, in your opinion?

Andrew: How do we put this with a nice bow on it? 

Kimberley: It doesn’t have to be perfect. Let’s make it purposely imperfect.

Andrew: Let’s make it perfectly imperfect. So, we talked before about the clinical levels – OCD, eating disorder, PTSD, generalized anxiety disorder. If you have any of those, take it from me personally, take it from you, take it from the thousands of people that said, “Hey, actually, ERP is an evidence-based gold standard. We know it works, we’ve seen it work. It’s helped us. Let it help you because we care about you and we want you to do it.” And then moving down stress from work, from life. You have a big trip coming up. There’s a fun scale, home’s rocky, something stress inventory. I find it very interesting that some of them are positive, outstanding personal achievement like, “Oh, that’s a stressful thing?” “Yeah, It can be.” And so, noticing the stressful things in your life and saying, “Well, because of these stressful things are the things I’m avoiding, things I’m getting anxious about, can I learn to sit with that?” And I think that mindfulness piece is so important. 

So, whether you’re clinical, whether you’re subclinical, whether you have stress in your life, whether you’re just avoiding something uncomfortable, slightly uncomfortable, is that keeping you from something you want to do? Is that keeping you-- of course, we-- I don’t know if people roll their eyes at people like us, “Follow your values, talk about your values.” Do you value spending time with your friends, but you’re avoiding the social gathering? Sounds like ERP could help you out with that. Or you’re avoiding this, you want to get a certification, but you don’t think you’ll get it and you don’t want to spend the time? Sounds like ERP could help with that. We’re in the sports field. My wife and I rock climbing, bouldering, disc golf. You value the sport, but you’re embarrassed to do poorly around your friends? Sounds ERP can help with that. You value this thing. I think we have a solution. I’ve become almost evangelical about it. Look at this thing, it works so well. It’s done so much for me.

Kimberley: Love it. Okay, tell me where-- I’m going to leave it at that. Tell me where people can hear about you and get in touch with you and hear more about your work.

Andrew: Mainly through Instagram at the moment. I have a perfectly imperfect Instagram name that you might have to put down. It’s JustRught but with right spelled wrong. So, it’s R-U-G-H-T.

Kimberley: That is perfect.

Andrew: Yeah. Which also perfectly was a complete accident. It was just fat thumbs typing out my new account and I said, “You know what, Andrew, leave it. This works. This works just fine.”

Kimberley: Oh, it is so good. It is so good.

Andrew: Yeah. So, I’m also happy I mentioned to you earlier that my wife and I have started this cool collab where I take some of her art and some of the lessons I’ve learned in my 12-plus years of therapy and we mix them together and try to put some lessons out there. But I’m currently an OCD advocate as well. You can find me on IOCDF’s website or just reach out. But really excited to be doing this work with you. I really respect and admire your work and to get a little gushing embarrassed. When I found out that I got accepted from grassroots advocate to regular advocate, I said, “Guys, Kimberley Quinlan is at the same level as me.” I was so excited.

Kimberley: You’re so many levels above me. Just look at your story. That’s the work.

Andrew: The imposter syndrome, we talked about that earlier.

Kimberley: Yeah, for sure. No, I am just overwhelmed with joy to hear your story, and thank you. How cool. Again, the reason I love the interviews is I pretty much have goosebumps the entire time. It just is so wonderful to hear the ups and the downs and the reality and the lessons. It’s so beautiful. So, thank you so much.

Andrew: I will add in, if you allow me a little more time, that it’s not magic. We’re not saying, “Oh, go do ERP for two days and you’ll be great.” It’s hard work. It’s a good day to do hard things. I think if it was easy, we wouldn’t be talking about it so much. We wouldn’t talk about the nuance. So, I think go into it knowing it is work, but it is absolutely worth it. It’s given me my life back, it’s saved my relationships, it’s helped me move overseas, given me this opportunity, and I’m just so thankful for it.

Kimberley: Yeah. Oh, mic drop.

Andrew: Yeah.

Kimberley: Thank you again.

Oct 28, 2022

In This Episode:

  • Andrew GottWorth shares his story of having Obsessive Compulsive Disorder (OCD) and how ERP allowed him to function again. 
  • addresses the benefits of ERP and how ERP is for Everyone 
  • How Exposure & response prevention can help people with OCD and for those with everyday stress and anxiety 



Links To Things I Talk About:

Episode Sponsor:

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EPISODE TRANSCRIPTION 

This is Your Anxiety Toolkit - Episode 308. 

Welcome, everybody. I am really pumped for this episode. We have the amazing Andrew Gottworth on for an interview where he just shared so many nuggets of wisdom and hope and motivation. I think you’re going to love it. But the main point we’re making today is that ERP is for everyone. Everyone can benefit from facing their fears. Everyone can benefit by reducing their compulsive behaviors. Even if you don’t technically call them compulsions, you too can benefit by this practice. Andrew reached out to me and he was really passionate about this. And of course, I was so on board that we jumped on a call right away and we got it in, and I’m so excited to share it with you. Thank you, Andrew, for sharing all your amazing wisdom. 

Before we head into the show, let’s quickly do the “I did a hard thing” for the week. This one is from Christina, and they went on to say:

“Thought of you today, and you’re saying, ‘It’s a beautiful day to do hard things,’ as I went down a water slide, terrified, as I’m well out of my comfort zone.” This is such great. They’re saying that’s on their holiday, the first time they’ve taken a holiday in quite a while. “It’s difficult, but I’m doing it. I’m trying to lean into the discomfort.”

This is so good. I love when people share their “I did a hard thing,” mainly, as I say before, because it doesn’t have to be what’s hard for everybody. It can be what’s hard for you. Isn’t it interesting, Christina is sharing a water slide is so terrifying? Christina, PS, I’m totally with you on that. But some of the people find it thrill-seeking. And then I’m sure the things that Christina does, she might not have anxiety, but other people who love to thrill seek find incredibly terrifying. So, please don’t miss that point, guys. It is such an important thing that we don’t compare. If it’s terrifying, it’s terrifying, and you deserve a massive yay. You did a hard thing for it. So, thank you, Christina. 

Again, quickly, let me just quickly do the review of the week, and then we can set back and relax and listen to Andrew’s amazing wisdom. This one is from Anonymous. Actually, this one is from Sydneytenney, and they said:

“Incredible resource! What an incredible resource this podcast is! Thank you for sharing all of this information so freely… you’re truly making a difference in so many lives, including mine! (I am also reading through your book and I LOVE it. You nailed it in marrying OCD with self-compassion - what a gift!!!)”

So, for those of you who don’t know, I wrote a book called The Self-Compassion Workbook for OCD. If you have OCD and you want a compassionate approach to ERP by all means, head over to Amazon or wherever you buy books and you can have the resource right there. 

All right, let’s get over to the show.

308 ERP is for EVERYONE with Andrew Gottworth Your anxiety toolkit

Kimberley: Okay. Welcome, Andrew Gottworth. Thank you so much for being here.

Andrew: Yeah. So, happy to be here. Really excited to chat with you for a bit.

Kimberley: Yeah. How fun. I’m so happy you reached out and you had a message that I felt was so important to talk about. Actually, you had lots of ideas that I was so excited to talk about.

Andrew: I might bring some of them up because I think, anyway, it’s related to our big topic. 

Erp Is For Everyone

Kimberley: Yeah. But the thing that I love so much was this idea that ERP (Exposure and Response Prevention) is for everyone. And so, tell me, before we get into that, a little bit about your story and where you are right up until today and why that story is important to you.

Andrew: Yeah. So, there’s a lot, as you work in the OCD field that it takes so long between first experiencing to getting a diagnosis. And so, with the knowledge I have now, I probably started in early childhood, elementary school. I remember racing intrusive thoughts in elementary school and being stuck on things and all that. But definitely, middle school, high school got worse and worse. So, fast forward to freshman year of college, it was really building up. I was really having a lot of issues. I didn’t know what it was and really didn’t know what it was for nine, 10 years later. But I was having a really hard time in college. I was depressed. I thought I was suicidal. Learning later, it’s probably suicidal ideation, OCD just putting thoughts of death and jumping up a building and jumping in a lake and getting run over and all that. But I didn’t want to talk about it then, I think.

Andrew’s Story About Having Obsessive Compulsive Disorder

A bit about me, I come from Kentucky. I count Louisville, Kentucky as the Midwest. We have a bit of an identity crisis, whether we’re South Midwest, East Coast, whatever. But still there, there’s a culture that mental health is for “crazy people.” Of course, we don’t believe that. So, my tiptoe around it was saying, “I’m having trouble focusing in class. Maybe I have ADHD.” And that’s what I went in for. For some reason, that was more palatable for me to talk about that rather than talk about these thoughts of death and all that. And so, I did an intake assessment and thankfully I was somewhat honest and scored high enough on the depression scale that they were like, “Hey, you have a problem.” And so, ended up talking more.

So, back in 2009, freshman year of college, I got diagnosed with depression and generalized anxiety disorder, but completely missed the OCD. I think they didn’t know about it. I didn’t know about it. I didn’t have the language to talk about it at the time because I didn’t have hand washing or tapping and counting and these other things that I would maybe see on TV and stuff, which – yeah, I see you nodding – yes, I know that’s a common story. 

So, I entered therapy in 2009, and I’ve been in therapy and non-medication ever since. But I had problems. I still had problems. I would make progress for a bit. And then I just feel like I was stuck. So, I ended up being in three mental hospitals. One, when I was doing AmeriCorps up in Milwaukee, Wisconsin, and had a great experience there. Two, three days up there at Rogers, which I’m very grateful for. And then stabilized moving forward. So, I ended up-- I dropped outta college. I dropped out of AmeriCorps. I then went back to college and again went to a mental hospital in Bowling Green, Kentucky. I was at Western Kentucky University, stabilize, keep going. Learning lessons along the way, learning cognitive distortions and learning talk therapy, and all these. 

So, let’s keep fast-forwarding. Another mental hospital in Atlanta, Georgia. There’s a long-term outpatient stay, Skyline Trail. I’m thankful for all of these places along the way. And I wish somewhere along the way, I knew about OCD and knew about ERP, our big topic for the day. 

So, finally, gosh, I can’t quite remember. I think 2018, a few years ago, still having problems. I had gone from full-time at work to part-time at work. I was just miserable. I would get into my cubicle and just constantly think, I’m not going to make it. I got to go home. I got to find an excuse to get out of here early. I just need to stay sick or I got to go home, or something came up. And so, every day I’d have an excuse until I finally was like, “I’m going to get found out that I’m not working full-time. I’m going to jump the gun, I’ll voluntarily go down in part-time.” 

So, that worked for a bit until OCD kept going. And then I quit. I quit again. And at that point, I was like, “I’ve failed. I’ve quit so many things – college, AmeriCorps.” I was a summer camp counselor and I left early. “Now this job. I need something.” So, I went again to find more help. And finally, thankfully, someone did an intake assessment, came back, and said, “Well, one problem is you have OCD.” I was like, “What? No, I don’t have that. I don’t wash my hands. I’m not a messy person. I’m not organized.” Gosh, I’m so thankful for her. 

Kimberley: Yeah, I want to kiss this person. 

Andrew: Yeah. But here’s the duality of it. She diagnosed me with it. I am forever grateful. And she didn’t do ERP. She didn’t know it. So unbelievably thankful that I got that diagnosis. It changed my life. And then I spent several weeks, maybe a few months just doing talk therapy again. And I just knew something didn’t feel right. But I had this new magical thing, a diagnosis. And so, my OCD latched onto OCD and researched the heck out of it. And so, I was researching, researching, researching, and really starting to find some things like, “Oh, this isn’t working for me. I’ve been doing the same type of therapy for a decade and I’m not making progress.” Unbelievably thankful for the Louisville OCD Clinic. So, at this point in this story-- thanks for listening to the whole saga. 

Kimberley: No, I’ve got goosebumps.

Andrew: I’m unemployed, I have my diagnosis, but I’m not making any progress. So, I go, “Throw this in as well. Not really that important.” But I go to an intensive outpatient program in Louisville before the OCD clinic. And I remember this conversation of the group therapy leader saying, “I need you to commit to this.” And I said, “But I don’t think this is helping me either,” because the conversation was about relationships, my relationship was great. It was about work, I wasn’t working. It was about parents, my parents were great. They were supporting me financially. They’re super helpful and loving and kind. It’s like, “None of this is external.” I kept saying, “This is internal. I have something going on inside of me.” And she said, “Well, I want you to commit to it.” I said, “I’m sorry, I found a local OCD clinic. I’m going to try them out.” 

So, I did IOP, I did 10 straight days, and it is a magical, marvelous memory of mine. I mean, as you know, the weirdest stuff, oh gosh. Some of the highlights that are quite humorous, I had a thing around blood and veins. And so, we built our hierarchy, and maybe we’ll talk about this in a bit, what ERP is. So, built the hierarchy, I’m afraid of cutting my veins and bleeding out. So, let’s start with a knife on the table. And then the next day, the knife in the hand. And then the next day, the knife near my veins. And then we talked about a blood draw. And then the next day, we watched a video of a nurse talking about it. Not even the actual blood draw, but her talking about it. So, of course, my SUDs are up really high. And the nurse says in the video, “Okay, you need to find the juiciest, bumpiest vein, and that’s where you put it in.” And my therapist, pause the video. She said, “Perfect. Andrew, I want you to go around to every person in the office and ask to feel the juiciest, bumpiest veins.” Oh my gosh. Can you imagine? 

Kimberley: The imagery and the wording together is so triggering, isn’t it?

Andrew: Right. She’s amazing. So, she was hitting on two things for me. One, the blood and veins, and two, inconveniencing people. I hated the inconveniencing people or have awkward moments. Well, hey, it’s doing all three of these things. So, I went around. And of course, it’s an OCD clinic, so nobody’s against it. They’re like, “Sure, here you go. This one looks big. Here, let me pump it up for you.” And I’m like, “No, I don’t like this.”

Kimberley: Well, it’s such a shift from what you had been doing. 

Andrew: It’s totally different. I’ll speak to the rest because that’s really the big part. But ERP over the next few years gave me my life back. I started working again. I worked full-time. Went part-time, then full-time. Got into a leadership position. And then for a few other reasons, my wife and I decided to make a big jump abroad. And so, moved to Berlin. And I have a full-time job here and a part-time disc golf coach trainer. And now I’m an OCD advocate and excited to work with you on that level and just looking at where my life was four or five years ago versus now. And thanks to our big-ticket item today, ERP.

Kimberley: Right. Oh, my heart is so exploding for you.

Andrew: Oh, thank you. 

Kimberley: My goodness. I mean, it’s not a wonderful story. It’s actually an incredibly painful story.

Andrew: You can laugh at it. I told it humorously.

How Andrew Applied Erp For His Ocd

Kimberley: No. But that’s what I’m saying. That’s what’s so interesting about this, is that it’s such a painful story, but how you tell it-- would I be right in saying like a degree of celebration to it? Tell me a little bit about-- you’re obviously an ERP fan. Tell me a little bit about what that was like. Were you in immediately, or were you skeptical? Had you read enough articles to feel like you were trusting it? What was that like for you? Because you’d been put through the wringer.

Andrew: Yeah. There’s a lot to talk about, but there are a couple of key moments when you mention it. So, one, we’re going through the Y-BOCS scale, the Yale-Brown Obsessive Compulsive Scale, something like that. So, she asks me one of the questions like, how often do you feel like a compulsion to do something and you don’t do the compulsion? “Oh, never. I’ve never stopped. But you can do that?” It was just this moment of, “What do you mean?” If it’s hot, I’m going to make it colder. If it’s cold, I’m going to make it warmer. If I’m uncomfortable, I’m going to fidget. I’m a problem solver. Both my parents were math teachers. I was an all-A student and talk about perfectionism and “just right” OCD maybe in this context as well. But also, I love puzzles. I love solving things. And that was me. I was a problem solver. It never occurred to me to not solve the problem. And so, that was a huge aha moment for me. And I see it now and I talk about it now to other people. 

Am I Doing Erp “Just Right”?

But another part of ERP with the just right is, am I doing ERP right? Am I doing it right? Am I doing ERP right? And of course, my therapist goes, “I don’t know. Who knows? Maybe, maybe not.” So, depending on where you want to go with this, we can talk about that more. So, I think in general, I hated that at the time. I was like, “I know there is a right way to do it. There is. I know there is.” But now, I even told someone yesterday in our Instagram OCD circles, someone was posting about it, and I said exactly that, that I hated this suggestion at first that maybe you’re doing it wrong, maybe you’re not. 

I will say, as we talk about ERP for everyone, someone who maybe is going to listen to this or hears us talking on Instagram and wants to do it on their own, this idea of exposing yourself to something uncomfortable and preventing the response – I don’t know if this is wrong, but I will say for me, it was not helpful. In my first few weeks, I would do something like-- I was a little claustrophobic, so I maybe sit in the middle seat of a car. It’s good I’m doing the exposure. I’m preventing the response by staying there. I didn’t get out. But in my head, I’m doing, “Just get through this. Just get through this. I hate this. It’s going to be over soon. You’ll get through it and then you’ll be better. Come on, just get through it. Oh, I hate this. Ugh. Ugh.” And then you get to the end and you go, “Okay, I made it through.” And of course, that didn’t really prevent the response. That reinforced my dread of it. And so, I would say that’s definitely a lesson as we get into that. 

Kimberley: And I think that brings me to-- you bring up a couple of amazing points and I think amazing roadblocks that we have to know about ERP. So, often I have clients who’ll say early in treatment, “You’d be so proud I did the exposure.” And I’d be like, “And the RP, did that get included?” So, let’s talk about that. So, for you, you wanted to talk about like ERP is for everyone. So, where did that start for you? Where did that idea come from?

Andrew: I would say it’s been slow going over the years where-- I don’t know how to say this exactly, but thinking like, there must be higher than 2% of people that have OCD because I think you have it and I think you have it and I think you have it, and noticing a lot of these things. And so, maybe they’re not clinical level OCD and maybe it’s just anxiety or I think, as I emailed you, just stress. But it’s this-- I just wonder how many friends and family and Instagram connections have never had that aha moment that I did in my first week of IOP of, “Oh, I cannot try to solve this.” And so, I see people that I really care about and I joked with my wife, I said, “Why is it that all of our best friends are anxious people?” And I think that comes with this care and attention and that I’ve suffered and I don’t want anyone else to suffer. And so, I see that anxiety in others.

But getting back to what I see in them, maybe someone is socially anxious so they’re avoiding a party or they’re leaving early, or-- I mean, I did these two, avoided, left early, made sure I was in either a very large group where nobody really noticed me or I was in a one-on-one where I had more control. I don’t know. So, seeing that in some other friends, leaving early, I just want to say to them, you can stay. It’s worked for me. It really has. This staying, exposing yourself to the awkwardness of staying or maybe it’s a little too loud or it’s too warm. And then let that stress peak fall and see, well, how do you feel after 30 minutes? How do you feel after an hour? I want to scream that to my friends because it’s helped me so much. I mean, you heard how awful and miserable it was for so long and how much better. I’m not cured, I think. I’m still listening to your six-part rumination series because I think that’s really what I’m working on now. 

So, I think those physical things, I’ve made tremendous improvement on blood and veins and all that. But that’s also not why I quit work. I didn’t quit working. I didn’t quit AmeriCorps because there’s so much blood everywhere. No, it’s nonprofits, it’s cubicles. But it was this dread that built this dread of the day, this dread of responding to an email. Am I going to respond right? Oh no, I’m going to get a phone call. Am I going to do that? Am I going to mess this up? And because I didn’t have that response prevention piece, all I had was the exposure piece, then it’s-- I can’t remember who said it, but like, ERP without the RP is just torture. You’re just exposing yourself to all these miserable things. 

Kimberley: You’re white-knuckling. 

Andrew: Yeah. And it’s-- I love research. I am a scientist by heart. I’m a Physics major and Environmental Studies master’s. I love research and all this. And so, I’ve looked into neuroplasticity, but I also am not an expert. Correct me if I’m wrong, but from what I hear, you’re just reinforcing that neural pathway. So, I’m going into work and I dread it. I’m saying, “I hate this. I can’t wait to go home. I hate this.” So, that’s reinforcing that for the next day. And tomorrow I go in and that dreads bigger, and the next day the dreads bigger. 

And so, seeing that in other colleagues who are having a miserable time at work is just getting worse and worse and worse. But I also can see that there are parts they enjoy. They enjoy problem-solving, they enjoy helping students, they enjoy the camaraderie. And so, I want to help them with, well, let’s see how we can do ERP with the things you don’t like and so you’re not building this dread day after day and you can do the things you value. Seems like you value us coworkers, seems like you value helping the students, seems like you value solving this problem, and that’s meaningful. But I’m watching you get more and more deteriorated at work. And that’s hard to do that in others. 

ERP Is For Everyone

Kimberley: Yeah. I resonate so much from a personal level and I’ll share why, is I have these two young children who-- thankfully, I have a Mental Health degree and I have license, and I’m watching how anxiety is forming them. They’re being formed by society and me and my husband and so forth, but I can see how anxiety is forming them. And there’s so many times-- I’ve used the example before of both my kids separately were absolutely petrified of dogs. And they don’t have OCD, but we used a hierarchy of exposure and now they can play with the neighbor’s dogs. We can have dogs sitting. And it was such an important thing of like, I could have missed that and just said, “You’re fine. Let’s never be around dogs.” And so, it’s so interesting to watch these teeny tiny little humans being formed by like, “Oh, I’m not a dog person.” You are a dog person. You’re just afraid of dogs. It’s two different things.

Andrew: Yeah. So, it’s funny that my next-door neighbor, when I was young, had a big dog. And when we’re moving into the house for the very first time, very young, I don’t know, four or something, it ran into the house, knocked me over, afraid of dogs for years. So, same thing. Worked my way up, had a friend with a cute little pup, and then got to a scarier one. And also, funnily to me, my next-door neighbor, two in a row, were German, and they scared me, the scary dog, German. And then the next one was the “Stay off my lawn, don’t let your soccer ball come over.” So, for years, I had this like, “I’m not going to root for Germany in sports. I don’t like Germany.” And then here I am living in Germany now.

Kimberley: Like an association.

Andrew: Yeah. So, I think fear association, anxiety association. And then I’m also playing around with this idea, maybe do a series on Instagram or maybe another talk with someone about, is it anxiety or is it society? And so, talking about things that were made to feel shame about. So, I don’t know if you can see on our webcam that I have my nails painted. I would never have done this in Kentucky. So, growing up in this, I remember vividly in elementary school, I sat with my legs crossed and someone said, “That’s how a girl sits. You have to sit with your foot up on your leg.” So, I did for the rest of my life. And then I wore a shirt with colorful fish on it, and they said, “Oh, you can’t wear that, guys don’t wear that.” So, I didn’t. I stopped wearing that and all these things, whether it’s about our body shape or femininity or things we enjoy that are maybe dorky or geeky. I just started playing Dungeons and Dragons. We have a campaign next week. And I remember kids getting bullied for that. 

I don’t know if you agree, but I see this under the umbrella of ERP. So, you’re exposing yourself to this potential situation where there’s shame or embarrassment, or you might get picked on. Someone might still see these on the train and go, “What are you doing with painted nails?” And I’m going to choose to do that anyway. I still get a little squirmy sometimes, but I want to. I want to do that and I want that for my friends and family too. And I see it in, like you said, in little kids. A lot of my cousins have young kids and just overhearing boys can’t wear pink, or you can’t be that when you grow up, or just these associations where I think you can, I think you can do that.

Kimberley: I love this so much because I think you’re so right in why ERP is for everyone. It’s funny, I’ll tell you a story and then I don’t want to talk about me anymore, but--

Andrew: No, I want to hear it. That’s fine.

Kimberley: I had this really interesting thing happen the other day. Now I am an ERP therapist. My motto is, “It’s a beautiful day to do hard things.” I talk and breathe this all day, and I have recovered from an eating disorder. But this is how I think it’s so interesting how ERP can be layered too, is I consider myself fully recovered. I am in such good shape and I get triggered and I can recover pretty quick. But the other day, I didn’t realize this was a compulsion that I am still maybe doing. I went to a spa, it was a gift that was given to me, and it says you don’t have to wear your bathing suit right into the thing. So, I’m like, “Cool, that’s fine. I’m comfortable with my body.” But I caught myself running from the bathroom down into the pool, like pretty quickly running until I was like, that still learned behavior, it’s still learned avoidance from something I don’t even suffer from anymore. And I think that, to speak to what you’re saying, if we’re really aware we can-- and I don’t have OCD, I’m open about that. If all humans were really aware, they could catch avoidant behaviors we’re doing all the time that reinforces fear, which is why exposure and response prevention is for everybody. Some people be like, “Oh, no, no. I don’t even have anxiety.” But it’s funny what you can catch in yourself that how you’re running actually literally running. 

Andrew: Literally running. Yeah.

Kimberley: Away. So, that’s why I think you’ve mentioned how social anxiety shows up and how exposure and response prevention is important for that. And daily fears, societal expectations, that’s why I think that’s so cool. It’s such a cool concept.

Andrew: Yeah. And so, help me since I do consider you the expert here, but I’ve heard clinically that ERP can be used for OCD but also eating disorder, at least our clinic in Louisville serves OCD, eating disorder, and PTSD. And so, I see the similarities there of the anxiety cycle, the OCD cycle for each of those. So, then let’s say that’s what ERP is proposed for. But then we also have generalized anxiety and I think we’re seeing that. I’ve heard Jenna Overbaugh talk about that as well. It’s this scale between anxiety to high anxiety to subclinical OCD, to clinical OCD, and that ERP is good for all of that. So, we have those, and then we get into stress and avoidant behavior. So, I have this stressful meeting coming up, I’ll find a way to skip it. Or I have this stressful family event, I’ll find a way to avoid it. And then you get into the societal stuff, you get into these. And so, I see it more and more that yes, it is for everyone.

Kimberley: Yeah. No, I mean, clinically, I will say we understand it’s helpful for phobias, health anxiety, social anxiety, generalized anxiety. Under the umbrella of OCD are all these other disorders and, as you said, spectrums of those disorders that it can be beneficial for. And I do think-- I hear actually a lot of other clinicians who aren’t OCD specialists and so forth talking about imposter syndrome or even like how cancel culture has impacted us and how everybody’s self-censoring and avoiding and procrastinating. And I keep thinking like ERP for everybody. And that’s why I think like, again, even if you’re not struggling with a mental illness, imposter syndrome is an avoidant. Often people go, procrastination is an avoidant behavior, a safety behavior or self-censoring is a safety behavior, or not standing up for you to a boss is an opportunity for exposure as long as of course they’re in an environment that’s safe for them. So, I agree with you. I think that it is so widespread an opportunity, and I think it’s also-- this is my opinion, but I’m actually more interested in your opinion, is I think ERP is also a mindset.

Andrew: Yeah.

Kimberley: Like how you live your life. Are you a face-your-fear kind of person? Can you become that person? That’s what I think, even in you, and actually, this is a question, did your identity shift? Did you think you were a person who couldn’t handle stresses and now you think you are? Or what was the identity shift that you experienced once you started ERP?

Andrew: Yeah. That’s a good question. I’ve had a few identity shifts over the years. So, I mentioned-- and not to be conceited, although here I am self-censoring because I don’t want to come across as conceited anyway. So, I was an all-A student in high school, and then OCD and depression hit hard. And so, throughout college, freshman year I got my first B, sophomore year I got my first C, junior year I got my first D. And so, I felt like I was crawling towards graduation. And this identity of myself as Club President, all-A student, I had to come to terms with giving up who I thought I could be. I thought I could be-- people would joke, “You’ll be the mayor of this town someday, Andrew.” And I watched this slip away and I had to change that identity. And not to say that you can’t ever get that back with recovery, but what I will say is through recovery, I don’t have that desire to anymore. I don’t have that desire to be a hundred percent. I’m a big fan of giving 80%. And mayor is too much responsibility. I don’t know, maybe someday. So, that changed. 

And then definitely, through that down downturn, I thought, I can’t handle this. I can’t handle anxiety, I can’t handle stress. People are going to find out that this image I’ve built of myself is someone who can’t handle that. So, then comes the dip coming back up, ERP, starting to learn I can maybe but also-- I love to bounce all over the place, but I think I want to return a bit to that idea that you don’t have to fix it. You don’t have to solve the problem. I think that was me. And that’s not realizing that I was making it harder on myself, that every moment of the day I was trying to optimize, fix, problem-solve. 

If you allow me another detour, I got on early to make sure the video chat was working, sound was okay. And I noticed in my walk over to my computer, all the things my brain wanted me to do. I call my brain “Dolores” after Dolores Umbridge, which is very mean to me. My wife and I, Dolores can F off. But I checked my email to make sure I had the date right. Oops, no, the checking behavior. Check the time, making sure, because we’re nine hours apart right now. “Oh, did I get the time difference right?” I thought about bringing over an extra set of lights so you could see me better. I wanted to make sure I didn’t eat right before we talked, so I didn’t burp on camera, made sure I had my water, and it was just all these-- and if I wasn’t about to meet with an OCD expert, I wouldn’t have even noticed these. I wouldn’t have even noticed all of these checking, fidgeting, optimizing, best practicing. But it’s exhausting. 

And so, I’m going to maybe flip the script and ask you, how do you think other people that are not diagnosed with OCD, that are just dealing with anxiety and stress can notice these situations in their life? How do they notice when, “Oh, I’m doing an avoidant behavior,” or “I’m fixing something to fix my anxiety that gives me temporary relief”? Because I didn’t notice them for 10 years.

Kimberley: Yeah. Well, I think the question speaks to me as a therapist, but also me as a human. I catch every day how generalized anxiety wants to take me and grab me away. And so, I think a huge piece of it is knowledge, of course. It’s knowledge that that-- but it’s a lot to do with awareness. It’s so much to do with awareness. I’ll give you an example, and I’ve spoken about this before. As soon as I’m anxious, everything I do speeds up. I start walking faster, I start typing faster, I start talking faster. And there’s no amount of exposure that will, I think, prevent me from going into that immediate behavior. So, my focus is staying-- every day, I have my mindfulness book right next to me. It’s like this thick, and I look at it and I go, “Okay, be aware as you go into the day.” And then I can work at catching as I start to speed up and speed type. 

So, I think for the person who doesn’t have OCD, it is, first, like you said, education. They need to be aware, how is this impacting my life. I think it’s being aware of and catching it. And then the cool part, and this is the part I love the most about being a therapist, is I get to ask them, what do you want to do? Because you don’t have to change it. I’m not doing any harm by typing fast. In fact, some might say I’m getting more done, but I don’t like the way it makes me feel. And so, I get to ask myself a question, do I want to change this behavior? Is it serving me anymore? And everyone gets to ask them that solves that question.

Andrew: So, I think you bring up a good point though that I’m curious if you’ve heard this as well. So, you said you’re typing fast and you’re feeling anxious and you don’t like how that feels. I would say for me, and I can think of certain people in my life and also generally, they don’t realize those are connected. I didn’t realize that was connected. In college, I’m wanting to drop out, I drop out of AmeriCorps, I drop out of summer camp. I’m very, very anxious and miserable and I don’t know why. And looking back, I see it was this constant trying to fix things and being on alert. And I got to anticipate what this is going to be or else is going to go bad. I need to prevent this or else I’m going to have an anxious conversation. I need to only wear shorts in the winter because I might get hot. Oh no, what if I get hot? And it was constantly being in this scanning fear mindset of trying to avoid, trying to prevent, trying to-- thinking I was doing all these good things. And I saw myself as a best-practice problem solver. It’s still something I’m trying to now separate between Dolores and Andrew. Andrew still loves best practices. But if I spend two hours looking for a best practice when I could have done it in five minutes, then maybe that was a waste. And I didn’t realize that was giving me that anxiety. 

So, yeah, I guess going back to I think of family, I think of coworkers, I think of friends that I have a suspicion, I’m not a therapist, I can’t diagnose and I’m not going to go up, I think you have this. But seeing that they’re coming to me and saying, “I’m exhausted. I just have so much going on,” I think in their head, it’s “I have a lot of work.”

Kimberley: External problems.

Andrew: Yeah. I may be seeing-- yeah, but there’s all this tension. You’re holding it in your shoulders, you’re holding it here, you’re typing fast and not realizing that, oh, these are connected. 

Kimberley: And that’s that awareness piece. It’s an awareness piece so much. And it is true. I mean, I think that’s the benefit of therapy. Therapists are trained to ask questions so that you can become aware of things that you weren’t previously aware of. I go to therapy and sometimes even my therapist will be like, “I got a question for you.” And I’m like, “Ah, I missed that.” So, I think that that’s the beauty of this. 

Andrew: I had a fun conversation. I gave a mental health talk at my school and talked about anxiety in the classroom, and thanks to IOCDF for some resources there, there’s a student that wanted to do a follow-up. And I thought this was very interesting and I loved the conversation, but three or four times he was like, “Well, can I read some self-help books, and then if those don’t work, go to therapy?” “No, I think go to therapy right away. Big fan of therapists. I’m not a therapist. You need to talk to a therapist.” “Okay. But what if I did some podcasts and then if that didn’t work, then I go to therapy?” “Nope. Therapy is great. Go to therapy now.” “Should I wait till my life gets more stressful?” “Nope. Go now.”

Kimberley: Yeah, because it’s that reflection and questioning. Everyone who knows me knows I love questions. They’re my favorite. So, I think you’re on it. So, this is so good. I also want to be respectful of your time. So, quick rounded out, why is ERP for everybody, in your opinion?

Andrew: How do we put this with a nice bow on it? 

Kimberley: It doesn’t have to be perfect. Let’s make it purposely imperfect.

Andrew: Let’s make it perfectly imperfect. So, we talked before about the clinical levels – OCD, eating disorder, PTSD, generalized anxiety disorder. If you have any of those, take it from me personally, take it from you, take it from the thousands of people that said, “Hey, actually, ERP is an evidence-based gold standard. We know it works, we’ve seen it work. It’s helped us. Let it help you because we care about you and we want you to do it.” And then moving down stress from work, from life. You have a big trip coming up. There’s a fun scale, home’s rocky, something stress inventory. I find it very interesting that some of them are positive, outstanding personal achievement like, “Oh, that’s a stressful thing?” “Yeah, It can be.” And so, noticing the stressful things in your life and saying, “Well, because of these stressful things are the things I’m avoiding, things I’m getting anxious about, can I learn to sit with that?” And I think that mindfulness piece is so important. 

So, whether you’re clinical, whether you’re subclinical, whether you have stress in your life, whether you’re just avoiding something uncomfortable, slightly uncomfortable, is that keeping you from something you want to do? Is that keeping you-- of course, we-- I don’t know if people roll their eyes at people like us, “Follow your values, talk about your values.” Do you value spending time with your friends, but you’re avoiding the social gathering? Sounds like ERP could help you out with that. Or you’re avoiding this, you want to get a certification, but you don’t think you’ll get it and you don’t want to spend the time? Sounds like ERP could help with that. We’re in the sports field. My wife and I rock climbing, bouldering, disc golf. You value the sport, but you’re embarrassed to do poorly around your friends? Sounds ERP can help with that. You value this thing. I think we have a solution. I’ve become almost evangelical about it. Look at this thing, it works so well. It’s done so much for me.

Kimberley: Love it. Okay, tell me where-- I’m going to leave it at that. Tell me where people can hear about you and get in touch with you and hear more about your work.

Andrew: Mainly through Instagram at the moment. I have a perfectly imperfect Instagram name that you might have to put down. It’s JustRught but with right spelled wrong. So, it’s R-U-G-H-T.

Kimberley: That is perfect.

Andrew: Yeah. Which also perfectly was a complete accident. It was just fat thumbs typing out my new account and I said, “You know what, Andrew, leave it. This works. This works just fine.”

Kimberley: Oh, it is so good. It is so good.

Andrew: Yeah. So, I’m also happy I mentioned to you earlier that my wife and I have started this cool collab where I take some of her art and some of the lessons I’ve learned in my 12-plus years of therapy and we mix them together and try to put some lessons out there. But I’m currently an OCD advocate as well. You can find me on IOCDF’s website or just reach out. But really excited to be doing this work with you. I really respect and admire your work and to get a little gushing embarrassed. When I found out that I got accepted from grassroots advocate to regular advocate, I said, “Guys, Kimberley Quinlan is at the same level as me.” I was so excited.

Kimberley: You’re so many levels above me. Just look at your story. That’s the work.

Andrew: The imposter syndrome, we talked about that earlier.

Kimberley: Yeah, for sure. No, I am just overwhelmed with joy to hear your story, and thank you. How cool. Again, the reason I love the interviews is I pretty much have goosebumps the entire time. It just is so wonderful to hear the ups and the downs and the reality and the lessons. It’s so beautiful. So, thank you so much.

Andrew: I will add in, if you allow me a little more time, that it’s not magic. We’re not saying, “Oh, go do ERP for two days and you’ll be great.” It’s hard work. It’s a good day to do hard things. I think if it was easy, we wouldn’t be talking about it so much. We wouldn’t talk about the nuance. So, I think go into it knowing it is work, but it is absolutely worth it. It’s given me my life back, it’s saved my relationships, it’s helped me move overseas, given me this opportunity, and I’m just so thankful for it.

Kimberley: Yeah. Oh, mic drop.

Andrew: Yeah.

Kimberley: Thank you again.

Oct 28, 2022

In This Episode:

  • Andrew GottWorth shares his story of having Obsessive Compulsive Disorder (OCD) and how ERP allowed him to function again. 
  • addresses the benefits of ERP and how ERP is for Everyone 
  • How Exposure & response prevention can help people with OCD and for those with everyday stress and anxiety 



Links To Things I Talk About:

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EPISODE TRANSCRIPTION 

This is Your Anxiety Toolkit - Episode 308. 

Welcome, everybody. I am really pumped for this episode. We have the amazing Andrew Gottworth on for an interview where he just shared so many nuggets of wisdom and hope and motivation. I think you’re going to love it. But the main point we’re making today is that ERP is for everyone. Everyone can benefit from facing their fears. Everyone can benefit by reducing their compulsive behaviors. Even if you don’t technically call them compulsions, you too can benefit by this practice. Andrew reached out to me and he was really passionate about this. And of course, I was so on board that we jumped on a call right away and we got it in, and I’m so excited to share it with you. Thank you, Andrew, for sharing all your amazing wisdom. 

Before we head into the show, let’s quickly do the “I did a hard thing” for the week. This one is from Christina, and they went on to say:

“Thought of you today, and you’re saying, ‘It’s a beautiful day to do hard things,’ as I went down a water slide, terrified, as I’m well out of my comfort zone.” This is such great. They’re saying that’s on their holiday, the first time they’ve taken a holiday in quite a while. “It’s difficult, but I’m doing it. I’m trying to lean into the discomfort.”

This is so good. I love when people share their “I did a hard thing,” mainly, as I say before, because it doesn’t have to be what’s hard for everybody. It can be what’s hard for you. Isn’t it interesting, Christina is sharing a water slide is so terrifying? Christina, PS, I’m totally with you on that. But some of the people find it thrill-seeking. And then I’m sure the things that Christina does, she might not have anxiety, but other people who love to thrill seek find incredibly terrifying. So, please don’t miss that point, guys. It is such an important thing that we don’t compare. If it’s terrifying, it’s terrifying, and you deserve a massive yay. You did a hard thing for it. So, thank you, Christina. 

Again, quickly, let me just quickly do the review of the week, and then we can set back and relax and listen to Andrew’s amazing wisdom. This one is from Anonymous. Actually, this one is from Sydneytenney, and they said:

“Incredible resource! What an incredible resource this podcast is! Thank you for sharing all of this information so freely… you’re truly making a difference in so many lives, including mine! (I am also reading through your book and I LOVE it. You nailed it in marrying OCD with self-compassion - what a gift!!!)”

So, for those of you who don’t know, I wrote a book called The Self-Compassion Workbook for OCD. If you have OCD and you want a compassionate approach to ERP by all means, head over to Amazon or wherever you buy books and you can have the resource right there. 

All right, let’s get over to the show.

308 ERP is for EVERYONE with Andrew Gottworth Your anxiety toolkit

Kimberley: Okay. Welcome, Andrew Gottworth. Thank you so much for being here.

Andrew: Yeah. So, happy to be here. Really excited to chat with you for a bit.

Kimberley: Yeah. How fun. I’m so happy you reached out and you had a message that I felt was so important to talk about. Actually, you had lots of ideas that I was so excited to talk about.

Andrew: I might bring some of them up because I think, anyway, it’s related to our big topic. 

Erp Is For Everyone

Kimberley: Yeah. But the thing that I love so much was this idea that ERP (Exposure and Response Prevention) is for everyone. And so, tell me, before we get into that, a little bit about your story and where you are right up until today and why that story is important to you.

Andrew: Yeah. So, there’s a lot, as you work in the OCD field that it takes so long between first experiencing to getting a diagnosis. And so, with the knowledge I have now, I probably started in early childhood, elementary school. I remember racing intrusive thoughts in elementary school and being stuck on things and all that. But definitely, middle school, high school got worse and worse. So, fast forward to freshman year of college, it was really building up. I was really having a lot of issues. I didn’t know what it was and really didn’t know what it was for nine, 10 years later. But I was having a really hard time in college. I was depressed. I thought I was suicidal. Learning later, it’s probably suicidal ideation, OCD just putting thoughts of death and jumping up a building and jumping in a lake and getting run over and all that. But I didn’t want to talk about it then, I think.

Andrew’s Story About Having Obsessive Compulsive Disorder

A bit about me, I come from Kentucky. I count Louisville, Kentucky as the Midwest. We have a bit of an identity crisis, whether we’re South Midwest, East Coast, whatever. But still there, there’s a culture that mental health is for “crazy people.” Of course, we don’t believe that. So, my tiptoe around it was saying, “I’m having trouble focusing in class. Maybe I have ADHD.” And that’s what I went in for. For some reason, that was more palatable for me to talk about that rather than talk about these thoughts of death and all that. And so, I did an intake assessment and thankfully I was somewhat honest and scored high enough on the depression scale that they were like, “Hey, you have a problem.” And so, ended up talking more.

So, back in 2009, freshman year of college, I got diagnosed with depression and generalized anxiety disorder, but completely missed the OCD. I think they didn’t know about it. I didn’t know about it. I didn’t have the language to talk about it at the time because I didn’t have hand washing or tapping and counting and these other things that I would maybe see on TV and stuff, which – yeah, I see you nodding – yes, I know that’s a common story. 

So, I entered therapy in 2009, and I’ve been in therapy and non-medication ever since. But I had problems. I still had problems. I would make progress for a bit. And then I just feel like I was stuck. So, I ended up being in three mental hospitals. One, when I was doing AmeriCorps up in Milwaukee, Wisconsin, and had a great experience there. Two, three days up there at Rogers, which I’m very grateful for. And then stabilized moving forward. So, I ended up-- I dropped outta college. I dropped out of AmeriCorps. I then went back to college and again went to a mental hospital in Bowling Green, Kentucky. I was at Western Kentucky University, stabilize, keep going. Learning lessons along the way, learning cognitive distortions and learning talk therapy, and all these. 

So, let’s keep fast-forwarding. Another mental hospital in Atlanta, Georgia. There’s a long-term outpatient stay, Skyline Trail. I’m thankful for all of these places along the way. And I wish somewhere along the way, I knew about OCD and knew about ERP, our big topic for the day. 

So, finally, gosh, I can’t quite remember. I think 2018, a few years ago, still having problems. I had gone from full-time at work to part-time at work. I was just miserable. I would get into my cubicle and just constantly think, I’m not going to make it. I got to go home. I got to find an excuse to get out of here early. I just need to stay sick or I got to go home, or something came up. And so, every day I’d have an excuse until I finally was like, “I’m going to get found out that I’m not working full-time. I’m going to jump the gun, I’ll voluntarily go down in part-time.” 

So, that worked for a bit until OCD kept going. And then I quit. I quit again. And at that point, I was like, “I’ve failed. I’ve quit so many things – college, AmeriCorps.” I was a summer camp counselor and I left early. “Now this job. I need something.” So, I went again to find more help. And finally, thankfully, someone did an intake assessment, came back, and said, “Well, one problem is you have OCD.” I was like, “What? No, I don’t have that. I don’t wash my hands. I’m not a messy person. I’m not organized.” Gosh, I’m so thankful for her. 

Kimberley: Yeah, I want to kiss this person. 

Andrew: Yeah. But here’s the duality of it. She diagnosed me with it. I am forever grateful. And she didn’t do ERP. She didn’t know it. So unbelievably thankful that I got that diagnosis. It changed my life. And then I spent several weeks, maybe a few months just doing talk therapy again. And I just knew something didn’t feel right. But I had this new magical thing, a diagnosis. And so, my OCD latched onto OCD and researched the heck out of it. And so, I was researching, researching, researching, and really starting to find some things like, “Oh, this isn’t working for me. I’ve been doing the same type of therapy for a decade and I’m not making progress.” Unbelievably thankful for the Louisville OCD Clinic. So, at this point in this story-- thanks for listening to the whole saga. 

Kimberley: No, I’ve got goosebumps.

Andrew: I’m unemployed, I have my diagnosis, but I’m not making any progress. So, I go, “Throw this in as well. Not really that important.” But I go to an intensive outpatient program in Louisville before the OCD clinic. And I remember this conversation of the group therapy leader saying, “I need you to commit to this.” And I said, “But I don’t think this is helping me either,” because the conversation was about relationships, my relationship was great. It was about work, I wasn’t working. It was about parents, my parents were great. They were supporting me financially. They’re super helpful and loving and kind. It’s like, “None of this is external.” I kept saying, “This is internal. I have something going on inside of me.” And she said, “Well, I want you to commit to it.” I said, “I’m sorry, I found a local OCD clinic. I’m going to try them out.” 

So, I did IOP, I did 10 straight days, and it is a magical, marvelous memory of mine. I mean, as you know, the weirdest stuff, oh gosh. Some of the highlights that are quite humorous, I had a thing around blood and veins. And so, we built our hierarchy, and maybe we’ll talk about this in a bit, what ERP is. So, built the hierarchy, I’m afraid of cutting my veins and bleeding out. So, let’s start with a knife on the table. And then the next day, the knife in the hand. And then the next day, the knife near my veins. And then we talked about a blood draw. And then the next day, we watched a video of a nurse talking about it. Not even the actual blood draw, but her talking about it. So, of course, my SUDs are up really high. And the nurse says in the video, “Okay, you need to find the juiciest, bumpiest vein, and that’s where you put it in.” And my therapist, pause the video. She said, “Perfect. Andrew, I want you to go around to every person in the office and ask to feel the juiciest, bumpiest veins.” Oh my gosh. Can you imagine? 

Kimberley: The imagery and the wording together is so triggering, isn’t it?

Andrew: Right. She’s amazing. So, she was hitting on two things for me. One, the blood and veins, and two, inconveniencing people. I hated the inconveniencing people or have awkward moments. Well, hey, it’s doing all three of these things. So, I went around. And of course, it’s an OCD clinic, so nobody’s against it. They’re like, “Sure, here you go. This one looks big. Here, let me pump it up for you.” And I’m like, “No, I don’t like this.”

Kimberley: Well, it’s such a shift from what you had been doing. 

Andrew: It’s totally different. I’ll speak to the rest because that’s really the big part. But ERP over the next few years gave me my life back. I started working again. I worked full-time. Went part-time, then full-time. Got into a leadership position. And then for a few other reasons, my wife and I decided to make a big jump abroad. And so, moved to Berlin. And I have a full-time job here and a part-time disc golf coach trainer. And now I’m an OCD advocate and excited to work with you on that level and just looking at where my life was four or five years ago versus now. And thanks to our big-ticket item today, ERP.

Kimberley: Right. Oh, my heart is so exploding for you.

Andrew: Oh, thank you. 

Kimberley: My goodness. I mean, it’s not a wonderful story. It’s actually an incredibly painful story.

Andrew: You can laugh at it. I told it humorously.

How Andrew Applied Erp For His Ocd

Kimberley: No. But that’s what I’m saying. That’s what’s so interesting about this, is that it’s such a painful story, but how you tell it-- would I be right in saying like a degree of celebration to it? Tell me a little bit about-- you’re obviously an ERP fan. Tell me a little bit about what that was like. Were you in immediately, or were you skeptical? Had you read enough articles to feel like you were trusting it? What was that like for you? Because you’d been put through the wringer.

Andrew: Yeah. There’s a lot to talk about, but there are a couple of key moments when you mention it. So, one, we’re going through the Y-BOCS scale, the Yale-Brown Obsessive Compulsive Scale, something like that. So, she asks me one of the questions like, how often do you feel like a compulsion to do something and you don’t do the compulsion? “Oh, never. I’ve never stopped. But you can do that?” It was just this moment of, “What do you mean?” If it’s hot, I’m going to make it colder. If it’s cold, I’m going to make it warmer. If I’m uncomfortable, I’m going to fidget. I’m a problem solver. Both my parents were math teachers. I was an all-A student and talk about perfectionism and “just right” OCD maybe in this context as well. But also, I love puzzles. I love solving things. And that was me. I was a problem solver. It never occurred to me to not solve the problem. And so, that was a huge aha moment for me. And I see it now and I talk about it now to other people. 

Am I Doing Erp “Just Right”?

But another part of ERP with the just right is, am I doing ERP right? Am I doing it right? Am I doing ERP right? And of course, my therapist goes, “I don’t know. Who knows? Maybe, maybe not.” So, depending on where you want to go with this, we can talk about that more. So, I think in general, I hated that at the time. I was like, “I know there is a right way to do it. There is. I know there is.” But now, I even told someone yesterday in our Instagram OCD circles, someone was posting about it, and I said exactly that, that I hated this suggestion at first that maybe you’re doing it wrong, maybe you’re not. 

I will say, as we talk about ERP for everyone, someone who maybe is going to listen to this or hears us talking on Instagram and wants to do it on their own, this idea of exposing yourself to something uncomfortable and preventing the response – I don’t know if this is wrong, but I will say for me, it was not helpful. In my first few weeks, I would do something like-- I was a little claustrophobic, so I maybe sit in the middle seat of a car. It’s good I’m doing the exposure. I’m preventing the response by staying there. I didn’t get out. But in my head, I’m doing, “Just get through this. Just get through this. I hate this. It’s going to be over soon. You’ll get through it and then you’ll be better. Come on, just get through it. Oh, I hate this. Ugh. Ugh.” And then you get to the end and you go, “Okay, I made it through.” And of course, that didn’t really prevent the response. That reinforced my dread of it. And so, I would say that’s definitely a lesson as we get into that. 

Kimberley: And I think that brings me to-- you bring up a couple of amazing points and I think amazing roadblocks that we have to know about ERP. So, often I have clients who’ll say early in treatment, “You’d be so proud I did the exposure.” And I’d be like, “And the RP, did that get included?” So, let’s talk about that. So, for you, you wanted to talk about like ERP is for everyone. So, where did that start for you? Where did that idea come from?

Andrew: I would say it’s been slow going over the years where-- I don’t know how to say this exactly, but thinking like, there must be higher than 2% of people that have OCD because I think you have it and I think you have it and I think you have it, and noticing a lot of these things. And so, maybe they’re not clinical level OCD and maybe it’s just anxiety or I think, as I emailed you, just stress. But it’s this-- I just wonder how many friends and family and Instagram connections have never had that aha moment that I did in my first week of IOP of, “Oh, I cannot try to solve this.” And so, I see people that I really care about and I joked with my wife, I said, “Why is it that all of our best friends are anxious people?” And I think that comes with this care and attention and that I’ve suffered and I don’t want anyone else to suffer. And so, I see that anxiety in others.

But getting back to what I see in them, maybe someone is socially anxious so they’re avoiding a party or they’re leaving early, or-- I mean, I did these two, avoided, left early, made sure I was in either a very large group where nobody really noticed me or I was in a one-on-one where I had more control. I don’t know. So, seeing that in some other friends, leaving early, I just want to say to them, you can stay. It’s worked for me. It really has. This staying, exposing yourself to the awkwardness of staying or maybe it’s a little too loud or it’s too warm. And then let that stress peak fall and see, well, how do you feel after 30 minutes? How do you feel after an hour? I want to scream that to my friends because it’s helped me so much. I mean, you heard how awful and miserable it was for so long and how much better. I’m not cured, I think. I’m still listening to your six-part rumination series because I think that’s really what I’m working on now. 

So, I think those physical things, I’ve made tremendous improvement on blood and veins and all that. But that’s also not why I quit work. I didn’t quit working. I didn’t quit AmeriCorps because there’s so much blood everywhere. No, it’s nonprofits, it’s cubicles. But it was this dread that built this dread of the day, this dread of responding to an email. Am I going to respond right? Oh no, I’m going to get a phone call. Am I going to do that? Am I going to mess this up? And because I didn’t have that response prevention piece, all I had was the exposure piece, then it’s-- I can’t remember who said it, but like, ERP without the RP is just torture. You’re just exposing yourself to all these miserable things. 

Kimberley: You’re white-knuckling. 

Andrew: Yeah. And it’s-- I love research. I am a scientist by heart. I’m a Physics major and Environmental Studies master’s. I love research and all this. And so, I’ve looked into neuroplasticity, but I also am not an expert. Correct me if I’m wrong, but from what I hear, you’re just reinforcing that neural pathway. So, I’m going into work and I dread it. I’m saying, “I hate this. I can’t wait to go home. I hate this.” So, that’s reinforcing that for the next day. And tomorrow I go in and that dreads bigger, and the next day the dreads bigger. 

And so, seeing that in other colleagues who are having a miserable time at work is just getting worse and worse and worse. But I also can see that there are parts they enjoy. They enjoy problem-solving, they enjoy helping students, they enjoy the camaraderie. And so, I want to help them with, well, let’s see how we can do ERP with the things you don’t like and so you’re not building this dread day after day and you can do the things you value. Seems like you value us coworkers, seems like you value helping the students, seems like you value solving this problem, and that’s meaningful. But I’m watching you get more and more deteriorated at work. And that’s hard to do that in others. 

ERP Is For Everyone

Kimberley: Yeah. I resonate so much from a personal level and I’ll share why, is I have these two young children who-- thankfully, I have a Mental Health degree and I have license, and I’m watching how anxiety is forming them. They’re being formed by society and me and my husband and so forth, but I can see how anxiety is forming them. And there’s so many times-- I’ve used the example before of both my kids separately were absolutely petrified of dogs. And they don’t have OCD, but we used a hierarchy of exposure and now they can play with the neighbor’s dogs. We can have dogs sitting. And it was such an important thing of like, I could have missed that and just said, “You’re fine. Let’s never be around dogs.” And so, it’s so interesting to watch these teeny tiny little humans being formed by like, “Oh, I’m not a dog person.” You are a dog person. You’re just afraid of dogs. It’s two different things.

Andrew: Yeah. So, it’s funny that my next-door neighbor, when I was young, had a big dog. And when we’re moving into the house for the very first time, very young, I don’t know, four or something, it ran into the house, knocked me over, afraid of dogs for years. So, same thing. Worked my way up, had a friend with a cute little pup, and then got to a scarier one. And also, funnily to me, my next-door neighbor, two in a row, were German, and they scared me, the scary dog, German. And then the next one was the “Stay off my lawn, don’t let your soccer ball come over.” So, for years, I had this like, “I’m not going to root for Germany in sports. I don’t like Germany.” And then here I am living in Germany now.

Kimberley: Like an association.

Andrew: Yeah. So, I think fear association, anxiety association. And then I’m also playing around with this idea, maybe do a series on Instagram or maybe another talk with someone about, is it anxiety or is it society? And so, talking about things that were made to feel shame about. So, I don’t know if you can see on our webcam that I have my nails painted. I would never have done this in Kentucky. So, growing up in this, I remember vividly in elementary school, I sat with my legs crossed and someone said, “That’s how a girl sits. You have to sit with your foot up on your leg.” So, I did for the rest of my life. And then I wore a shirt with colorful fish on it, and they said, “Oh, you can’t wear that, guys don’t wear that.” So, I didn’t. I stopped wearing that and all these things, whether it’s about our body shape or femininity or things we enjoy that are maybe dorky or geeky. I just started playing Dungeons and Dragons. We have a campaign next week. And I remember kids getting bullied for that. 

I don’t know if you agree, but I see this under the umbrella of ERP. So, you’re exposing yourself to this potential situation where there’s shame or embarrassment, or you might get picked on. Someone might still see these on the train and go, “What are you doing with painted nails?” And I’m going to choose to do that anyway. I still get a little squirmy sometimes, but I want to. I want to do that and I want that for my friends and family too. And I see it in, like you said, in little kids. A lot of my cousins have young kids and just overhearing boys can’t wear pink, or you can’t be that when you grow up, or just these associations where I think you can, I think you can do that.

Kimberley: I love this so much because I think you’re so right in why ERP is for everyone. It’s funny, I’ll tell you a story and then I don’t want to talk about me anymore, but--

Andrew: No, I want to hear it. That’s fine.

Kimberley: I had this really interesting thing happen the other day. Now I am an ERP therapist. My motto is, “It’s a beautiful day to do hard things.” I talk and breathe this all day, and I have recovered from an eating disorder. But this is how I think it’s so interesting how ERP can be layered too, is I consider myself fully recovered. I am in such good shape and I get triggered and I can recover pretty quick. But the other day, I didn’t realize this was a compulsion that I am still maybe doing. I went to a spa, it was a gift that was given to me, and it says you don’t have to wear your bathing suit right into the thing. So, I’m like, “Cool, that’s fine. I’m comfortable with my body.” But I caught myself running from the bathroom down into the pool, like pretty quickly running until I was like, that still learned behavior, it’s still learned avoidance from something I don’t even suffer from anymore. And I think that, to speak to what you’re saying, if we’re really aware we can-- and I don’t have OCD, I’m open about that. If all humans were really aware, they could catch avoidant behaviors we’re doing all the time that reinforces fear, which is why exposure and response prevention is for everybody. Some people be like, “Oh, no, no. I don’t even have anxiety.” But it’s funny what you can catch in yourself that how you’re running actually literally running. 

Andrew: Literally running. Yeah.

Kimberley: Away. So, that’s why I think you’ve mentioned how social anxiety shows up and how exposure and response prevention is important for that. And daily fears, societal expectations, that’s why I think that’s so cool. It’s such a cool concept.

Andrew: Yeah. And so, help me since I do consider you the expert here, but I’ve heard clinically that ERP can be used for OCD but also eating disorder, at least our clinic in Louisville serves OCD, eating disorder, and PTSD. And so, I see the similarities there of the anxiety cycle, the OCD cycle for each of those. So, then let’s say that’s what ERP is proposed for. But then we also have generalized anxiety and I think we’re seeing that. I’ve heard Jenna Overbaugh talk about that as well. It’s this scale between anxiety to high anxiety to subclinical OCD, to clinical OCD, and that ERP is good for all of that. So, we have those, and then we get into stress and avoidant behavior. So, I have this stressful meeting coming up, I’ll find a way to skip it. Or I have this stressful family event, I’ll find a way to avoid it. And then you get into the societal stuff, you get into these. And so, I see it more and more that yes, it is for everyone.

Kimberley: Yeah. No, I mean, clinically, I will say we understand it’s helpful for phobias, health anxiety, social anxiety, generalized anxiety. Under the umbrella of OCD are all these other disorders and, as you said, spectrums of those disorders that it can be beneficial for. And I do think-- I hear actually a lot of other clinicians who aren’t OCD specialists and so forth talking about imposter syndrome or even like how cancel culture has impacted us and how everybody’s self-censoring and avoiding and procrastinating. And I keep thinking like ERP for everybody. And that’s why I think like, again, even if you’re not struggling with a mental illness, imposter syndrome is an avoidant. Often people go, procrastination is an avoidant behavior, a safety behavior or self-censoring is a safety behavior, or not standing up for you to a boss is an opportunity for exposure as long as of course they’re in an environment that’s safe for them. So, I agree with you. I think that it is so widespread an opportunity, and I think it’s also-- this is my opinion, but I’m actually more interested in your opinion, is I think ERP is also a mindset.

Andrew: Yeah.

Kimberley: Like how you live your life. Are you a face-your-fear kind of person? Can you become that person? That’s what I think, even in you, and actually, this is a question, did your identity shift? Did you think you were a person who couldn’t handle stresses and now you think you are? Or what was the identity shift that you experienced once you started ERP?

Andrew: Yeah. That’s a good question. I’ve had a few identity shifts over the years. So, I mentioned-- and not to be conceited, although here I am self-censoring because I don’t want to come across as conceited anyway. So, I was an all-A student in high school, and then OCD and depression hit hard. And so, throughout college, freshman year I got my first B, sophomore year I got my first C, junior year I got my first D. And so, I felt like I was crawling towards graduation. And this identity of myself as Club President, all-A student, I had to come to terms with giving up who I thought I could be. I thought I could be-- people would joke, “You’ll be the mayor of this town someday, Andrew.” And I watched this slip away and I had to change that identity. And not to say that you can’t ever get that back with recovery, but what I will say is through recovery, I don’t have that desire to anymore. I don’t have that desire to be a hundred percent. I’m a big fan of giving 80%. And mayor is too much responsibility. I don’t know, maybe someday. So, that changed. 

And then definitely, through that down downturn, I thought, I can’t handle this. I can’t handle anxiety, I can’t handle stress. People are going to find out that this image I’ve built of myself is someone who can’t handle that. So, then comes the dip coming back up, ERP, starting to learn I can maybe but also-- I love to bounce all over the place, but I think I want to return a bit to that idea that you don’t have to fix it. You don’t have to solve the problem. I think that was me. And that’s not realizing that I was making it harder on myself, that every moment of the day I was trying to optimize, fix, problem-solve. 

If you allow me another detour, I got on early to make sure the video chat was working, sound was okay. And I noticed in my walk over to my computer, all the things my brain wanted me to do. I call my brain “Dolores” after Dolores Umbridge, which is very mean to me. My wife and I, Dolores can F off. But I checked my email to make sure I had the date right. Oops, no, the checking behavior. Check the time, making sure, because we’re nine hours apart right now. “Oh, did I get the time difference right?” I thought about bringing over an extra set of lights so you could see me better. I wanted to make sure I didn’t eat right before we talked, so I didn’t burp on camera, made sure I had my water, and it was just all these-- and if I wasn’t about to meet with an OCD expert, I wouldn’t have even noticed these. I wouldn’t have even noticed all of these checking, fidgeting, optimizing, best practicing. But it’s exhausting. 

And so, I’m going to maybe flip the script and ask you, how do you think other people that are not diagnosed with OCD, that are just dealing with anxiety and stress can notice these situations in their life? How do they notice when, “Oh, I’m doing an avoidant behavior,” or “I’m fixing something to fix my anxiety that gives me temporary relief”? Because I didn’t notice them for 10 years.

Kimberley: Yeah. Well, I think the question speaks to me as a therapist, but also me as a human. I catch every day how generalized anxiety wants to take me and grab me away. And so, I think a huge piece of it is knowledge, of course. It’s knowledge that that-- but it’s a lot to do with awareness. It’s so much to do with awareness. I’ll give you an example, and I’ve spoken about this before. As soon as I’m anxious, everything I do speeds up. I start walking faster, I start typing faster, I start talking faster. And there’s no amount of exposure that will, I think, prevent me from going into that immediate behavior. So, my focus is staying-- every day, I have my mindfulness book right next to me. It’s like this thick, and I look at it and I go, “Okay, be aware as you go into the day.” And then I can work at catching as I start to speed up and speed type. 

So, I think for the person who doesn’t have OCD, it is, first, like you said, education. They need to be aware, how is this impacting my life. I think it’s being aware of and catching it. And then the cool part, and this is the part I love the most about being a therapist, is I get to ask them, what do you want to do? Because you don’t have to change it. I’m not doing any harm by typing fast. In fact, some might say I’m getting more done, but I don’t like the way it makes me feel. And so, I get to ask myself a question, do I want to change this behavior? Is it serving me anymore? And everyone gets to ask them that solves that question.

Andrew: So, I think you bring up a good point though that I’m curious if you’ve heard this as well. So, you said you’re typing fast and you’re feeling anxious and you don’t like how that feels. I would say for me, and I can think of certain people in my life and also generally, they don’t realize those are connected. I didn’t realize that was connected. In college, I’m wanting to drop out, I drop out of AmeriCorps, I drop out of summer camp. I’m very, very anxious and miserable and I don’t know why. And looking back, I see it was this constant trying to fix things and being on alert. And I got to anticipate what this is going to be or else is going to go bad. I need to prevent this or else I’m going to have an anxious conversation. I need to only wear shorts in the winter because I might get hot. Oh no, what if I get hot? And it was constantly being in this scanning fear mindset of trying to avoid, trying to prevent, trying to-- thinking I was doing all these good things. And I saw myself as a best-practice problem solver. It’s still something I’m trying to now separate between Dolores and Andrew. Andrew still loves best practices. But if I spend two hours looking for a best practice when I could have done it in five minutes, then maybe that was a waste. And I didn’t realize that was giving me that anxiety. 

So, yeah, I guess going back to I think of family, I think of coworkers, I think of friends that I have a suspicion, I’m not a therapist, I can’t diagnose and I’m not going to go up, I think you have this. But seeing that they’re coming to me and saying, “I’m exhausted. I just have so much going on,” I think in their head, it’s “I have a lot of work.”

Kimberley: External problems.

Andrew: Yeah. I may be seeing-- yeah, but there’s all this tension. You’re holding it in your shoulders, you’re holding it here, you’re typing fast and not realizing that, oh, these are connected. 

Kimberley: And that’s that awareness piece. It’s an awareness piece so much. And it is true. I mean, I think that’s the benefit of therapy. Therapists are trained to ask questions so that you can become aware of things that you weren’t previously aware of. I go to therapy and sometimes even my therapist will be like, “I got a question for you.” And I’m like, “Ah, I missed that.” So, I think that that’s the beauty of this. 

Andrew: I had a fun conversation. I gave a mental health talk at my school and talked about anxiety in the classroom, and thanks to IOCDF for some resources there, there’s a student that wanted to do a follow-up. And I thought this was very interesting and I loved the conversation, but three or four times he was like, “Well, can I read some self-help books, and then if those don’t work, go to therapy?” “No, I think go to therapy right away. Big fan of therapists. I’m not a therapist. You need to talk to a therapist.” “Okay. But what if I did some podcasts and then if that didn’t work, then I go to therapy?” “Nope. Therapy is great. Go to therapy now.” “Should I wait till my life gets more stressful?” “Nope. Go now.”

Kimberley: Yeah, because it’s that reflection and questioning. Everyone who knows me knows I love questions. They’re my favorite. So, I think you’re on it. So, this is so good. I also want to be respectful of your time. So, quick rounded out, why is ERP for everybody, in your opinion?

Andrew: How do we put this with a nice bow on it? 

Kimberley: It doesn’t have to be perfect. Let’s make it purposely imperfect.

Andrew: Let’s make it perfectly imperfect. So, we talked before about the clinical levels – OCD, eating disorder, PTSD, generalized anxiety disorder. If you have any of those, take it from me personally, take it from you, take it from the thousands of people that said, “Hey, actually, ERP is an evidence-based gold standard. We know it works, we’ve seen it work. It’s helped us. Let it help you because we care about you and we want you to do it.” And then moving down stress from work, from life. You have a big trip coming up. There’s a fun scale, home’s rocky, something stress inventory. I find it very interesting that some of them are positive, outstanding personal achievement like, “Oh, that’s a stressful thing?” “Yeah, It can be.” And so, noticing the stressful things in your life and saying, “Well, because of these stressful things are the things I’m avoiding, things I’m getting anxious about, can I learn to sit with that?” And I think that mindfulness piece is so important. 

So, whether you’re clinical, whether you’re subclinical, whether you have stress in your life, whether you’re just avoiding something uncomfortable, slightly uncomfortable, is that keeping you from something you want to do? Is that keeping you-- of course, we-- I don’t know if people roll their eyes at people like us, “Follow your values, talk about your values.” Do you value spending time with your friends, but you’re avoiding the social gathering? Sounds like ERP could help you out with that. Or you’re avoiding this, you want to get a certification, but you don’t think you’ll get it and you don’t want to spend the time? Sounds like ERP could help with that. We’re in the sports field. My wife and I rock climbing, bouldering, disc golf. You value the sport, but you’re embarrassed to do poorly around your friends? Sounds ERP can help with that. You value this thing. I think we have a solution. I’ve become almost evangelical about it. Look at this thing, it works so well. It’s done so much for me.

Kimberley: Love it. Okay, tell me where-- I’m going to leave it at that. Tell me where people can hear about you and get in touch with you and hear more about your work.

Andrew: Mainly through Instagram at the moment. I have a perfectly imperfect Instagram name that you might have to put down. It’s JustRught but with right spelled wrong. So, it’s R-U-G-H-T.

Kimberley: That is perfect.

Andrew: Yeah. Which also perfectly was a complete accident. It was just fat thumbs typing out my new account and I said, “You know what, Andrew, leave it. This works. This works just fine.”

Kimberley: Oh, it is so good. It is so good.

Andrew: Yeah. So, I’m also happy I mentioned to you earlier that my wife and I have started this cool collab where I take some of her art and some of the lessons I’ve learned in my 12-plus years of therapy and we mix them together and try to put some lessons out there. But I’m currently an OCD advocate as well. You can find me on IOCDF’s website or just reach out. But really excited to be doing this work with you. I really respect and admire your work and to get a little gushing embarrassed. When I found out that I got accepted from grassroots advocate to regular advocate, I said, “Guys, Kimberley Quinlan is at the same level as me.” I was so excited.

Kimberley: You’re so many levels above me. Just look at your story. That’s the work.

Andrew: The imposter syndrome, we talked about that earlier.

Kimberley: Yeah, for sure. No, I am just overwhelmed with joy to hear your story, and thank you. How cool. Again, the reason I love the interviews is I pretty much have goosebumps the entire time. It just is so wonderful to hear the ups and the downs and the reality and the lessons. It’s so beautiful. So, thank you so much.

Andrew: I will add in, if you allow me a little more time, that it’s not magic. We’re not saying, “Oh, go do ERP for two days and you’ll be great.” It’s hard work. It’s a good day to do hard things. I think if it was easy, we wouldn’t be talking about it so much. We wouldn’t talk about the nuance. So, I think go into it knowing it is work, but it is absolutely worth it. It’s given me my life back, it’s saved my relationships, it’s helped me move overseas, given me this opportunity, and I’m just so thankful for it.

Kimberley: Yeah. Oh, mic drop.

Andrew: Yeah.

Kimberley: Thank you again.

Oct 28, 2022

In This Episode:

  • Andrew GottWorth shares his story of having Obsessive Compulsive Disorder (OCD) and how ERP allowed him to function again. 
  • addresses the benefits of ERP and how ERP is for Everyone 
  • How Exposure & response prevention can help people with OCD and for those with everyday stress and anxiety 



Links To Things I Talk About:

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EPISODE TRANSCRIPTION 

This is Your Anxiety Toolkit - Episode 308. 

Welcome, everybody. I am really pumped for this episode. We have the amazing Andrew Gottworth on for an interview where he just shared so many nuggets of wisdom and hope and motivation. I think you’re going to love it. But the main point we’re making today is that ERP is for everyone. Everyone can benefit from facing their fears. Everyone can benefit by reducing their compulsive behaviors. Even if you don’t technically call them compulsions, you too can benefit by this practice. Andrew reached out to me and he was really passionate about this. And of course, I was so on board that we jumped on a call right away and we got it in, and I’m so excited to share it with you. Thank you, Andrew, for sharing all your amazing wisdom. 

Before we head into the show, let’s quickly do the “I did a hard thing” for the week. This one is from Christina, and they went on to say:

“Thought of you today, and you’re saying, ‘It’s a beautiful day to do hard things,’ as I went down a water slide, terrified, as I’m well out of my comfort zone.” This is such great. They’re saying that’s on their holiday, the first time they’ve taken a holiday in quite a while. “It’s difficult, but I’m doing it. I’m trying to lean into the discomfort.”

This is so good. I love when people share their “I did a hard thing,” mainly, as I say before, because it doesn’t have to be what’s hard for everybody. It can be what’s hard for you. Isn’t it interesting, Christina is sharing a water slide is so terrifying? Christina, PS, I’m totally with you on that. But some of the people find it thrill-seeking. And then I’m sure the things that Christina does, she might not have anxiety, but other people who love to thrill seek find incredibly terrifying. So, please don’t miss that point, guys. It is such an important thing that we don’t compare. If it’s terrifying, it’s terrifying, and you deserve a massive yay. You did a hard thing for it. So, thank you, Christina. 

Again, quickly, let me just quickly do the review of the week, and then we can set back and relax and listen to Andrew’s amazing wisdom. This one is from Anonymous. Actually, this one is from Sydneytenney, and they said:

“Incredible resource! What an incredible resource this podcast is! Thank you for sharing all of this information so freely… you’re truly making a difference in so many lives, including mine! (I am also reading through your book and I LOVE it. You nailed it in marrying OCD with self-compassion - what a gift!!!)”

So, for those of you who don’t know, I wrote a book called The Self-Compassion Workbook for OCD. If you have OCD and you want a compassionate approach to ERP by all means, head over to Amazon or wherever you buy books and you can have the resource right there. 

All right, let’s get over to the show.

308 ERP is for EVERYONE with Andrew Gottworth Your anxiety toolkit

Kimberley: Okay. Welcome, Andrew Gottworth. Thank you so much for being here.

Andrew: Yeah. So, happy to be here. Really excited to chat with you for a bit.

Kimberley: Yeah. How fun. I’m so happy you reached out and you had a message that I felt was so important to talk about. Actually, you had lots of ideas that I was so excited to talk about.

Andrew: I might bring some of them up because I think, anyway, it’s related to our big topic. 

Erp Is For Everyone

Kimberley: Yeah. But the thing that I love so much was this idea that ERP (Exposure and Response Prevention) is for everyone. And so, tell me, before we get into that, a little bit about your story and where you are right up until today and why that story is important to you.

Andrew: Yeah. So, there’s a lot, as you work in the OCD field that it takes so long between first experiencing to getting a diagnosis. And so, with the knowledge I have now, I probably started in early childhood, elementary school. I remember racing intrusive thoughts in elementary school and being stuck on things and all that. But definitely, middle school, high school got worse and worse. So, fast forward to freshman year of college, it was really building up. I was really having a lot of issues. I didn’t know what it was and really didn’t know what it was for nine, 10 years later. But I was having a really hard time in college. I was depressed. I thought I was suicidal. Learning later, it’s probably suicidal ideation, OCD just putting thoughts of death and jumping up a building and jumping in a lake and getting run over and all that. But I didn’t want to talk about it then, I think.

Andrew’s Story About Having Obsessive Compulsive Disorder

A bit about me, I come from Kentucky. I count Louisville, Kentucky as the Midwest. We have a bit of an identity crisis, whether we’re South Midwest, East Coast, whatever. But still there, there’s a culture that mental health is for “crazy people.” Of course, we don’t believe that. So, my tiptoe around it was saying, “I’m having trouble focusing in class. Maybe I have ADHD.” And that’s what I went in for. For some reason, that was more palatable for me to talk about that rather than talk about these thoughts of death and all that. And so, I did an intake assessment and thankfully I was somewhat honest and scored high enough on the depression scale that they were like, “Hey, you have a problem.” And so, ended up talking more.

So, back in 2009, freshman year of college, I got diagnosed with depression and generalized anxiety disorder, but completely missed the OCD. I think they didn’t know about it. I didn’t know about it. I didn’t have the language to talk about it at the time because I didn’t have hand washing or tapping and counting and these other things that I would maybe see on TV and stuff, which – yeah, I see you nodding – yes, I know that’s a common story. 

So, I entered therapy in 2009, and I’ve been in therapy and non-medication ever since. But I had problems. I still had problems. I would make progress for a bit. And then I just feel like I was stuck. So, I ended up being in three mental hospitals. One, when I was doing AmeriCorps up in Milwaukee, Wisconsin, and had a great experience there. Two, three days up there at Rogers, which I’m very grateful for. And then stabilized moving forward. So, I ended up-- I dropped outta college. I dropped out of AmeriCorps. I then went back to college and again went to a mental hospital in Bowling Green, Kentucky. I was at Western Kentucky University, stabilize, keep going. Learning lessons along the way, learning cognitive distortions and learning talk therapy, and all these. 

So, let’s keep fast-forwarding. Another mental hospital in Atlanta, Georgia. There’s a long-term outpatient stay, Skyline Trail. I’m thankful for all of these places along the way. And I wish somewhere along the way, I knew about OCD and knew about ERP, our big topic for the day. 

So, finally, gosh, I can’t quite remember. I think 2018, a few years ago, still having problems. I had gone from full-time at work to part-time at work. I was just miserable. I would get into my cubicle and just constantly think, I’m not going to make it. I got to go home. I got to find an excuse to get out of here early. I just need to stay sick or I got to go home, or something came up. And so, every day I’d have an excuse until I finally was like, “I’m going to get found out that I’m not working full-time. I’m going to jump the gun, I’ll voluntarily go down in part-time.” 

So, that worked for a bit until OCD kept going. And then I quit. I quit again. And at that point, I was like, “I’ve failed. I’ve quit so many things – college, AmeriCorps.” I was a summer camp counselor and I left early. “Now this job. I need something.” So, I went again to find more help. And finally, thankfully, someone did an intake assessment, came back, and said, “Well, one problem is you have OCD.” I was like, “What? No, I don’t have that. I don’t wash my hands. I’m not a messy person. I’m not organized.” Gosh, I’m so thankful for her. 

Kimberley: Yeah, I want to kiss this person. 

Andrew: Yeah. But here’s the duality of it. She diagnosed me with it. I am forever grateful. And she didn’t do ERP. She didn’t know it. So unbelievably thankful that I got that diagnosis. It changed my life. And then I spent several weeks, maybe a few months just doing talk therapy again. And I just knew something didn’t feel right. But I had this new magical thing, a diagnosis. And so, my OCD latched onto OCD and researched the heck out of it. And so, I was researching, researching, researching, and really starting to find some things like, “Oh, this isn’t working for me. I’ve been doing the same type of therapy for a decade and I’m not making progress.” Unbelievably thankful for the Louisville OCD Clinic. So, at this point in this story-- thanks for listening to the whole saga. 

Kimberley: No, I’ve got goosebumps.

Andrew: I’m unemployed, I have my diagnosis, but I’m not making any progress. So, I go, “Throw this in as well. Not really that important.” But I go to an intensive outpatient program in Louisville before the OCD clinic. And I remember this conversation of the group therapy leader saying, “I need you to commit to this.” And I said, “But I don’t think this is helping me either,” because the conversation was about relationships, my relationship was great. It was about work, I wasn’t working. It was about parents, my parents were great. They were supporting me financially. They’re super helpful and loving and kind. It’s like, “None of this is external.” I kept saying, “This is internal. I have something going on inside of me.” And she said, “Well, I want you to commit to it.” I said, “I’m sorry, I found a local OCD clinic. I’m going to try them out.” 

So, I did IOP, I did 10 straight days, and it is a magical, marvelous memory of mine. I mean, as you know, the weirdest stuff, oh gosh. Some of the highlights that are quite humorous, I had a thing around blood and veins. And so, we built our hierarchy, and maybe we’ll talk about this in a bit, what ERP is. So, built the hierarchy, I’m afraid of cutting my veins and bleeding out. So, let’s start with a knife on the table. And then the next day, the knife in the hand. And then the next day, the knife near my veins. And then we talked about a blood draw. And then the next day, we watched a video of a nurse talking about it. Not even the actual blood draw, but her talking about it. So, of course, my SUDs are up really high. And the nurse says in the video, “Okay, you need to find the juiciest, bumpiest vein, and that’s where you put it in.” And my therapist, pause the video. She said, “Perfect. Andrew, I want you to go around to every person in the office and ask to feel the juiciest, bumpiest veins.” Oh my gosh. Can you imagine? 

Kimberley: The imagery and the wording together is so triggering, isn’t it?

Andrew: Right. She’s amazing. So, she was hitting on two things for me. One, the blood and veins, and two, inconveniencing people. I hated the inconveniencing people or have awkward moments. Well, hey, it’s doing all three of these things. So, I went around. And of course, it’s an OCD clinic, so nobody’s against it. They’re like, “Sure, here you go. This one looks big. Here, let me pump it up for you.” And I’m like, “No, I don’t like this.”

Kimberley: Well, it’s such a shift from what you had been doing. 

Andrew: It’s totally different. I’ll speak to the rest because that’s really the big part. But ERP over the next few years gave me my life back. I started working again. I worked full-time. Went part-time, then full-time. Got into a leadership position. And then for a few other reasons, my wife and I decided to make a big jump abroad. And so, moved to Berlin. And I have a full-time job here and a part-time disc golf coach trainer. And now I’m an OCD advocate and excited to work with you on that level and just looking at where my life was four or five years ago versus now. And thanks to our big-ticket item today, ERP.

Kimberley: Right. Oh, my heart is so exploding for you.

Andrew: Oh, thank you. 

Kimberley: My goodness. I mean, it’s not a wonderful story. It’s actually an incredibly painful story.

Andrew: You can laugh at it. I told it humorously.

How Andrew Applied Erp For His Ocd

Kimberley: No. But that’s what I’m saying. That’s what’s so interesting about this, is that it’s such a painful story, but how you tell it-- would I be right in saying like a degree of celebration to it? Tell me a little bit about-- you’re obviously an ERP fan. Tell me a little bit about what that was like. Were you in immediately, or were you skeptical? Had you read enough articles to feel like you were trusting it? What was that like for you? Because you’d been put through the wringer.

Andrew: Yeah. There’s a lot to talk about, but there are a couple of key moments when you mention it. So, one, we’re going through the Y-BOCS scale, the Yale-Brown Obsessive Compulsive Scale, something like that. So, she asks me one of the questions like, how often do you feel like a compulsion to do something and you don’t do the compulsion? “Oh, never. I’ve never stopped. But you can do that?” It was just this moment of, “What do you mean?” If it’s hot, I’m going to make it colder. If it’s cold, I’m going to make it warmer. If I’m uncomfortable, I’m going to fidget. I’m a problem solver. Both my parents were math teachers. I was an all-A student and talk about perfectionism and “just right” OCD maybe in this context as well. But also, I love puzzles. I love solving things. And that was me. I was a problem solver. It never occurred to me to not solve the problem. And so, that was a huge aha moment for me. And I see it now and I talk about it now to other people. 

Am I Doing Erp “Just Right”?

But another part of ERP with the just right is, am I doing ERP right? Am I doing it right? Am I doing ERP right? And of course, my therapist goes, “I don’t know. Who knows? Maybe, maybe not.” So, depending on where you want to go with this, we can talk about that more. So, I think in general, I hated that at the time. I was like, “I know there is a right way to do it. There is. I know there is.” But now, I even told someone yesterday in our Instagram OCD circles, someone was posting about it, and I said exactly that, that I hated this suggestion at first that maybe you’re doing it wrong, maybe you’re not. 

I will say, as we talk about ERP for everyone, someone who maybe is going to listen to this or hears us talking on Instagram and wants to do it on their own, this idea of exposing yourself to something uncomfortable and preventing the response – I don’t know if this is wrong, but I will say for me, it was not helpful. In my first few weeks, I would do something like-- I was a little claustrophobic, so I maybe sit in the middle seat of a car. It’s good I’m doing the exposure. I’m preventing the response by staying there. I didn’t get out. But in my head, I’m doing, “Just get through this. Just get through this. I hate this. It’s going to be over soon. You’ll get through it and then you’ll be better. Come on, just get through it. Oh, I hate this. Ugh. Ugh.” And then you get to the end and you go, “Okay, I made it through.” And of course, that didn’t really prevent the response. That reinforced my dread of it. And so, I would say that’s definitely a lesson as we get into that. 

Kimberley: And I think that brings me to-- you bring up a couple of amazing points and I think amazing roadblocks that we have to know about ERP. So, often I have clients who’ll say early in treatment, “You’d be so proud I did the exposure.” And I’d be like, “And the RP, did that get included?” So, let’s talk about that. So, for you, you wanted to talk about like ERP is for everyone. So, where did that start for you? Where did that idea come from?

Andrew: I would say it’s been slow going over the years where-- I don’t know how to say this exactly, but thinking like, there must be higher than 2% of people that have OCD because I think you have it and I think you have it and I think you have it, and noticing a lot of these things. And so, maybe they’re not clinical level OCD and maybe it’s just anxiety or I think, as I emailed you, just stress. But it’s this-- I just wonder how many friends and family and Instagram connections have never had that aha moment that I did in my first week of IOP of, “Oh, I cannot try to solve this.” And so, I see people that I really care about and I joked with my wife, I said, “Why is it that all of our best friends are anxious people?” And I think that comes with this care and attention and that I’ve suffered and I don’t want anyone else to suffer. And so, I see that anxiety in others.

But getting back to what I see in them, maybe someone is socially anxious so they’re avoiding a party or they’re leaving early, or-- I mean, I did these two, avoided, left early, made sure I was in either a very large group where nobody really noticed me or I was in a one-on-one where I had more control. I don’t know. So, seeing that in some other friends, leaving early, I just want to say to them, you can stay. It’s worked for me. It really has. This staying, exposing yourself to the awkwardness of staying or maybe it’s a little too loud or it’s too warm. And then let that stress peak fall and see, well, how do you feel after 30 minutes? How do you feel after an hour? I want to scream that to my friends because it’s helped me so much. I mean, you heard how awful and miserable it was for so long and how much better. I’m not cured, I think. I’m still listening to your six-part rumination series because I think that’s really what I’m working on now. 

So, I think those physical things, I’ve made tremendous improvement on blood and veins and all that. But that’s also not why I quit work. I didn’t quit working. I didn’t quit AmeriCorps because there’s so much blood everywhere. No, it’s nonprofits, it’s cubicles. But it was this dread that built this dread of the day, this dread of responding to an email. Am I going to respond right? Oh no, I’m going to get a phone call. Am I going to do that? Am I going to mess this up? And because I didn’t have that response prevention piece, all I had was the exposure piece, then it’s-- I can’t remember who said it, but like, ERP without the RP is just torture. You’re just exposing yourself to all these miserable things. 

Kimberley: You’re white-knuckling. 

Andrew: Yeah. And it’s-- I love research. I am a scientist by heart. I’m a Physics major and Environmental Studies master’s. I love research and all this. And so, I’ve looked into neuroplasticity, but I also am not an expert. Correct me if I’m wrong, but from what I hear, you’re just reinforcing that neural pathway. So, I’m going into work and I dread it. I’m saying, “I hate this. I can’t wait to go home. I hate this.” So, that’s reinforcing that for the next day. And tomorrow I go in and that dreads bigger, and the next day the dreads bigger. 

And so, seeing that in other colleagues who are having a miserable time at work is just getting worse and worse and worse. But I also can see that there are parts they enjoy. They enjoy problem-solving, they enjoy helping students, they enjoy the camaraderie. And so, I want to help them with, well, let’s see how we can do ERP with the things you don’t like and so you’re not building this dread day after day and you can do the things you value. Seems like you value us coworkers, seems like you value helping the students, seems like you value solving this problem, and that’s meaningful. But I’m watching you get more and more deteriorated at work. And that’s hard to do that in others. 

ERP Is For Everyone

Kimberley: Yeah. I resonate so much from a personal level and I’ll share why, is I have these two young children who-- thankfully, I have a Mental Health degree and I have license, and I’m watching how anxiety is forming them. They’re being formed by society and me and my husband and so forth, but I can see how anxiety is forming them. And there’s so many times-- I’ve used the example before of both my kids separately were absolutely petrified of dogs. And they don’t have OCD, but we used a hierarchy of exposure and now they can play with the neighbor’s dogs. We can have dogs sitting. And it was such an important thing of like, I could have missed that and just said, “You’re fine. Let’s never be around dogs.” And so, it’s so interesting to watch these teeny tiny little humans being formed by like, “Oh, I’m not a dog person.” You are a dog person. You’re just afraid of dogs. It’s two different things.

Andrew: Yeah. So, it’s funny that my next-door neighbor, when I was young, had a big dog. And when we’re moving into the house for the very first time, very young, I don’t know, four or something, it ran into the house, knocked me over, afraid of dogs for years. So, same thing. Worked my way up, had a friend with a cute little pup, and then got to a scarier one. And also, funnily to me, my next-door neighbor, two in a row, were German, and they scared me, the scary dog, German. And then the next one was the “Stay off my lawn, don’t let your soccer ball come over.” So, for years, I had this like, “I’m not going to root for Germany in sports. I don’t like Germany.” And then here I am living in Germany now.

Kimberley: Like an association.

Andrew: Yeah. So, I think fear association, anxiety association. And then I’m also playing around with this idea, maybe do a series on Instagram or maybe another talk with someone about, is it anxiety or is it society? And so, talking about things that were made to feel shame about. So, I don’t know if you can see on our webcam that I have my nails painted. I would never have done this in Kentucky. So, growing up in this, I remember vividly in elementary school, I sat with my legs crossed and someone said, “That’s how a girl sits. You have to sit with your foot up on your leg.” So, I did for the rest of my life. And then I wore a shirt with colorful fish on it, and they said, “Oh, you can’t wear that, guys don’t wear that.” So, I didn’t. I stopped wearing that and all these things, whether it’s about our body shape or femininity or things we enjoy that are maybe dorky or geeky. I just started playing Dungeons and Dragons. We have a campaign next week. And I remember kids getting bullied for that. 

I don’t know if you agree, but I see this under the umbrella of ERP. So, you’re exposing yourself to this potential situation where there’s shame or embarrassment, or you might get picked on. Someone might still see these on the train and go, “What are you doing with painted nails?” And I’m going to choose to do that anyway. I still get a little squirmy sometimes, but I want to. I want to do that and I want that for my friends and family too. And I see it in, like you said, in little kids. A lot of my cousins have young kids and just overhearing boys can’t wear pink, or you can’t be that when you grow up, or just these associations where I think you can, I think you can do that.

Kimberley: I love this so much because I think you’re so right in why ERP is for everyone. It’s funny, I’ll tell you a story and then I don’t want to talk about me anymore, but--

Andrew: No, I want to hear it. That’s fine.

Kimberley: I had this really interesting thing happen the other day. Now I am an ERP therapist. My motto is, “It’s a beautiful day to do hard things.” I talk and breathe this all day, and I have recovered from an eating disorder. But this is how I think it’s so interesting how ERP can be layered too, is I consider myself fully recovered. I am in such good shape and I get triggered and I can recover pretty quick. But the other day, I didn’t realize this was a compulsion that I am still maybe doing. I went to a spa, it was a gift that was given to me, and it says you don’t have to wear your bathing suit right into the thing. So, I’m like, “Cool, that’s fine. I’m comfortable with my body.” But I caught myself running from the bathroom down into the pool, like pretty quickly running until I was like, that still learned behavior, it’s still learned avoidance from something I don’t even suffer from anymore. And I think that, to speak to what you’re saying, if we’re really aware we can-- and I don’t have OCD, I’m open about that. If all humans were really aware, they could catch avoidant behaviors we’re doing all the time that reinforces fear, which is why exposure and response prevention is for everybody. Some people be like, “Oh, no, no. I don’t even have anxiety.” But it’s funny what you can catch in yourself that how you’re running actually literally running. 

Andrew: Literally running. Yeah.

Kimberley: Away. So, that’s why I think you’ve mentioned how social anxiety shows up and how exposure and response prevention is important for that. And daily fears, societal expectations, that’s why I think that’s so cool. It’s such a cool concept.

Andrew: Yeah. And so, help me since I do consider you the expert here, but I’ve heard clinically that ERP can be used for OCD but also eating disorder, at least our clinic in Louisville serves OCD, eating disorder, and PTSD. And so, I see the similarities there of the anxiety cycle, the OCD cycle for each of those. So, then let’s say that’s what ERP is proposed for. But then we also have generalized anxiety and I think we’re seeing that. I’ve heard Jenna Overbaugh talk about that as well. It’s this scale between anxiety to high anxiety to subclinical OCD, to clinical OCD, and that ERP is good for all of that. So, we have those, and then we get into stress and avoidant behavior. So, I have this stressful meeting coming up, I’ll find a way to skip it. Or I have this stressful family event, I’ll find a way to avoid it. And then you get into the societal stuff, you get into these. And so, I see it more and more that yes, it is for everyone.

Kimberley: Yeah. No, I mean, clinically, I will say we understand it’s helpful for phobias, health anxiety, social anxiety, generalized anxiety. Under the umbrella of OCD are all these other disorders and, as you said, spectrums of those disorders that it can be beneficial for. And I do think-- I hear actually a lot of other clinicians who aren’t OCD specialists and so forth talking about imposter syndrome or even like how cancel culture has impacted us and how everybody’s self-censoring and avoiding and procrastinating. And I keep thinking like ERP for everybody. And that’s why I think like, again, even if you’re not struggling with a mental illness, imposter syndrome is an avoidant. Often people go, procrastination is an avoidant behavior, a safety behavior or self-censoring is a safety behavior, or not standing up for you to a boss is an opportunity for exposure as long as of course they’re in an environment that’s safe for them. So, I agree with you. I think that it is so widespread an opportunity, and I think it’s also-- this is my opinion, but I’m actually more interested in your opinion, is I think ERP is also a mindset.

Andrew: Yeah.

Kimberley: Like how you live your life. Are you a face-your-fear kind of person? Can you become that person? That’s what I think, even in you, and actually, this is a question, did your identity shift? Did you think you were a person who couldn’t handle stresses and now you think you are? Or what was the identity shift that you experienced once you started ERP?

Andrew: Yeah. That’s a good question. I’ve had a few identity shifts over the years. So, I mentioned-- and not to be conceited, although here I am self-censoring because I don’t want to come across as conceited anyway. So, I was an all-A student in high school, and then OCD and depression hit hard. And so, throughout college, freshman year I got my first B, sophomore year I got my first C, junior year I got my first D. And so, I felt like I was crawling towards graduation. And this identity of myself as Club President, all-A student, I had to come to terms with giving up who I thought I could be. I thought I could be-- people would joke, “You’ll be the mayor of this town someday, Andrew.” And I watched this slip away and I had to change that identity. And not to say that you can’t ever get that back with recovery, but what I will say is through recovery, I don’t have that desire to anymore. I don’t have that desire to be a hundred percent. I’m a big fan of giving 80%. And mayor is too much responsibility. I don’t know, maybe someday. So, that changed. 

And then definitely, through that down downturn, I thought, I can’t handle this. I can’t handle anxiety, I can’t handle stress. People are going to find out that this image I’ve built of myself is someone who can’t handle that. So, then comes the dip coming back up, ERP, starting to learn I can maybe but also-- I love to bounce all over the place, but I think I want to return a bit to that idea that you don’t have to fix it. You don’t have to solve the problem. I think that was me. And that’s not realizing that I was making it harder on myself, that every moment of the day I was trying to optimize, fix, problem-solve. 

If you allow me another detour, I got on early to make sure the video chat was working, sound was okay. And I noticed in my walk over to my computer, all the things my brain wanted me to do. I call my brain “Dolores” after Dolores Umbridge, which is very mean to me. My wife and I, Dolores can F off. But I checked my email to make sure I had the date right. Oops, no, the checking behavior. Check the time, making sure, because we’re nine hours apart right now. “Oh, did I get the time difference right?” I thought about bringing over an extra set of lights so you could see me better. I wanted to make sure I didn’t eat right before we talked, so I didn’t burp on camera, made sure I had my water, and it was just all these-- and if I wasn’t about to meet with an OCD expert, I wouldn’t have even noticed these. I wouldn’t have even noticed all of these checking, fidgeting, optimizing, best practicing. But it’s exhausting. 

And so, I’m going to maybe flip the script and ask you, how do you think other people that are not diagnosed with OCD, that are just dealing with anxiety and stress can notice these situations in their life? How do they notice when, “Oh, I’m doing an avoidant behavior,” or “I’m fixing something to fix my anxiety that gives me temporary relief”? Because I didn’t notice them for 10 years.

Kimberley: Yeah. Well, I think the question speaks to me as a therapist, but also me as a human. I catch every day how generalized anxiety wants to take me and grab me away. And so, I think a huge piece of it is knowledge, of course. It’s knowledge that that-- but it’s a lot to do with awareness. It’s so much to do with awareness. I’ll give you an example, and I’ve spoken about this before. As soon as I’m anxious, everything I do speeds up. I start walking faster, I start typing faster, I start talking faster. And there’s no amount of exposure that will, I think, prevent me from going into that immediate behavior. So, my focus is staying-- every day, I have my mindfulness book right next to me. It’s like this thick, and I look at it and I go, “Okay, be aware as you go into the day.” And then I can work at catching as I start to speed up and speed type. 

So, I think for the person who doesn’t have OCD, it is, first, like you said, education. They need to be aware, how is this impacting my life. I think it’s being aware of and catching it. And then the cool part, and this is the part I love the most about being a therapist, is I get to ask them, what do you want to do? Because you don’t have to change it. I’m not doing any harm by typing fast. In fact, some might say I’m getting more done, but I don’t like the way it makes me feel. And so, I get to ask myself a question, do I want to change this behavior? Is it serving me anymore? And everyone gets to ask them that solves that question.

Andrew: So, I think you bring up a good point though that I’m curious if you’ve heard this as well. So, you said you’re typing fast and you’re feeling anxious and you don’t like how that feels. I would say for me, and I can think of certain people in my life and also generally, they don’t realize those are connected. I didn’t realize that was connected. In college, I’m wanting to drop out, I drop out of AmeriCorps, I drop out of summer camp. I’m very, very anxious and miserable and I don’t know why. And looking back, I see it was this constant trying to fix things and being on alert. And I got to anticipate what this is going to be or else is going to go bad. I need to prevent this or else I’m going to have an anxious conversation. I need to only wear shorts in the winter because I might get hot. Oh no, what if I get hot? And it was constantly being in this scanning fear mindset of trying to avoid, trying to prevent, trying to-- thinking I was doing all these good things. And I saw myself as a best-practice problem solver. It’s still something I’m trying to now separate between Dolores and Andrew. Andrew still loves best practices. But if I spend two hours looking for a best practice when I could have done it in five minutes, then maybe that was a waste. And I didn’t realize that was giving me that anxiety. 

So, yeah, I guess going back to I think of family, I think of coworkers, I think of friends that I have a suspicion, I’m not a therapist, I can’t diagnose and I’m not going to go up, I think you have this. But seeing that they’re coming to me and saying, “I’m exhausted. I just have so much going on,” I think in their head, it’s “I have a lot of work.”

Kimberley: External problems.

Andrew: Yeah. I may be seeing-- yeah, but there’s all this tension. You’re holding it in your shoulders, you’re holding it here, you’re typing fast and not realizing that, oh, these are connected. 

Kimberley: And that’s that awareness piece. It’s an awareness piece so much. And it is true. I mean, I think that’s the benefit of therapy. Therapists are trained to ask questions so that you can become aware of things that you weren’t previously aware of. I go to therapy and sometimes even my therapist will be like, “I got a question for you.” And I’m like, “Ah, I missed that.” So, I think that that’s the beauty of this. 

Andrew: I had a fun conversation. I gave a mental health talk at my school and talked about anxiety in the classroom, and thanks to IOCDF for some resources there, there’s a student that wanted to do a follow-up. And I thought this was very interesting and I loved the conversation, but three or four times he was like, “Well, can I read some self-help books, and then if those don’t work, go to therapy?” “No, I think go to therapy right away. Big fan of therapists. I’m not a therapist. You need to talk to a therapist.” “Okay. But what if I did some podcasts and then if that didn’t work, then I go to therapy?” “Nope. Therapy is great. Go to therapy now.” “Should I wait till my life gets more stressful?” “Nope. Go now.”

Kimberley: Yeah, because it’s that reflection and questioning. Everyone who knows me knows I love questions. They’re my favorite. So, I think you’re on it. So, this is so good. I also want to be respectful of your time. So, quick rounded out, why is ERP for everybody, in your opinion?

Andrew: How do we put this with a nice bow on it? 

Kimberley: It doesn’t have to be perfect. Let’s make it purposely imperfect.

Andrew: Let’s make it perfectly imperfect. So, we talked before about the clinical levels – OCD, eating disorder, PTSD, generalized anxiety disorder. If you have any of those, take it from me personally, take it from you, take it from the thousands of people that said, “Hey, actually, ERP is an evidence-based gold standard. We know it works, we’ve seen it work. It’s helped us. Let it help you because we care about you and we want you to do it.” And then moving down stress from work, from life. You have a big trip coming up. There’s a fun scale, home’s rocky, something stress inventory. I find it very interesting that some of them are positive, outstanding personal achievement like, “Oh, that’s a stressful thing?” “Yeah, It can be.” And so, noticing the stressful things in your life and saying, “Well, because of these stressful things are the things I’m avoiding, things I’m getting anxious about, can I learn to sit with that?” And I think that mindfulness piece is so important. 

So, whether you’re clinical, whether you’re subclinical, whether you have stress in your life, whether you’re just avoiding something uncomfortable, slightly uncomfortable, is that keeping you from something you want to do? Is that keeping you-- of course, we-- I don’t know if people roll their eyes at people like us, “Follow your values, talk about your values.” Do you value spending time with your friends, but you’re avoiding the social gathering? Sounds like ERP could help you out with that. Or you’re avoiding this, you want to get a certification, but you don’t think you’ll get it and you don’t want to spend the time? Sounds like ERP could help with that. We’re in the sports field. My wife and I rock climbing, bouldering, disc golf. You value the sport, but you’re embarrassed to do poorly around your friends? Sounds ERP can help with that. You value this thing. I think we have a solution. I’ve become almost evangelical about it. Look at this thing, it works so well. It’s done so much for me.

Kimberley: Love it. Okay, tell me where-- I’m going to leave it at that. Tell me where people can hear about you and get in touch with you and hear more about your work.

Andrew: Mainly through Instagram at the moment. I have a perfectly imperfect Instagram name that you might have to put down. It’s JustRught but with right spelled wrong. So, it’s R-U-G-H-T.

Kimberley: That is perfect.

Andrew: Yeah. Which also perfectly was a complete accident. It was just fat thumbs typing out my new account and I said, “You know what, Andrew, leave it. This works. This works just fine.”

Kimberley: Oh, it is so good. It is so good.

Andrew: Yeah. So, I’m also happy I mentioned to you earlier that my wife and I have started this cool collab where I take some of her art and some of the lessons I’ve learned in my 12-plus years of therapy and we mix them together and try to put some lessons out there. But I’m currently an OCD advocate as well. You can find me on IOCDF’s website or just reach out. But really excited to be doing this work with you. I really respect and admire your work and to get a little gushing embarrassed. When I found out that I got accepted from grassroots advocate to regular advocate, I said, “Guys, Kimberley Quinlan is at the same level as me.” I was so excited.

Kimberley: You’re so many levels above me. Just look at your story. That’s the work.

Andrew: The imposter syndrome, we talked about that earlier.

Kimberley: Yeah, for sure. No, I am just overwhelmed with joy to hear your story, and thank you. How cool. Again, the reason I love the interviews is I pretty much have goosebumps the entire time. It just is so wonderful to hear the ups and the downs and the reality and the lessons. It’s so beautiful. So, thank you so much.

Andrew: I will add in, if you allow me a little more time, that it’s not magic. We’re not saying, “Oh, go do ERP for two days and you’ll be great.” It’s hard work. It’s a good day to do hard things. I think if it was easy, we wouldn’t be talking about it so much. We wouldn’t talk about the nuance. So, I think go into it knowing it is work, but it is absolutely worth it. It’s given me my life back, it’s saved my relationships, it’s helped me move overseas, given me this opportunity, and I’m just so thankful for it.

Kimberley: Yeah. Oh, mic drop.

Andrew: Yeah.

Kimberley: Thank you again.

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