Your Anxiety Toolkit - Practical Skills for Anxiety, Panic & Depression

If you are scared to take medication, you are in the right place. Today, we are going to take a deep dive into a very common fear that impacts many people and their recovery, and that is the fear of taking medication. If you're someone who needs help with this, I think this is going to be really helpful for you.  Hello, my name is Kimberley Quinlan. I am an anxiety specialist, and I help people with anxiety. My hope is to make it an easy and a kind recovery for you.  FEAR OR TAKING MEDICATION Now, today we're talking about the fear of taking medication, and a lot of what I do with my patients in my private practice, which is in California, is really helping them work through that fear. In addition, on my online platform called CBT School, I often get a lot of questions about this, such as whether or not people can take meds, should they take meds, and so forth. But before we get into all that, what I want to share with you first are a few housekeeping points that will keep us on point and in the right direction today.  If you're someone who is scared to take meds, we first have to acknowledge that this episode is not going to cover whether you should take meds or not. I am not a medical doctor. I am not a medical professional. I am a mental health professional, and I do not prescribe medication. I am not licensed to do that. But I am here to help you manage the fear around it. If you are someone who wants to take medication but is afraid of it because of the side effects, or maybe because of the shame, the guilt, and the stigma around it, my hope today is that we can work on managing that fear and getting you the information and skills you need so that you can speak with your medical professionals and make a decision based on what is best for you.  It is important to remember that every person is different, and it's important that you make these decisions with your medical doctor so that we're making a decision based on your medical history, where you're at in your mental health recovery, your genetics—all of the things that you need to discuss with your medical doctor. But today, let's get going. We're talking about managing medication anxiety.  Where did this episode come from? I actually made a post about this on Instagram not long ago, and the response was overwhelming, with people saying, number one, "I'm too afraid to do it. Help me," and number two, a lot of people said, "I had a lot of anxiety around taking medication. I got the help I needed and I managed it, and now I'm so relieved that I did." I wanted to spend some time today talking about the reasons people are scared to take an antidepressant or other psychiatric medications or even medications in general.  REASONS PEOPLE A SCARED TO TAKE AN ANTIDEPRESSANT OR OTHER PSYCHIATRIC MEDICATIONS There are multiple reasons patients do not take their medications, due to fear. In this episode, we are coming the core reasons fears stops people from taking their antidepressants or other medicines.  FEAR THAT MEDICATION WILL CAUSE SIDE EFFECTS The number one reason that people reported being scared to take medication is the fear that medication will cause side effects. This is a very common fear around taking medication, and it is true. We will talk about the side effects here later in this episode, but that is a valid concern. But often, people are afraid of the side effects, even though they are not afraid of it being a catastrophic side effect. They're often afraid of just change, or they're afraid of what is uncertain and unknown, and that is a big thing for them.  OCD FEAR OF TAKING MEDICATION Another reason that people are afraid to take any kind of medication is an OCD fear of taking medication. The reason I say it like that is, it's beyond just a generalized fear of the side effects. It's often around a belief of what this medication will do to you.  One example I've had in my private practice has been the subtype of OCD called emotional contamination. They're afraid that by taking the medication, it will dramatically change their personality or that they'll turn into a different person. There's a lot of compulsions around that, rumination around that, and avoidance around that. They're also doing this kind of avoidant compulsions in other areas of their lives as well.  HEALTH ANXIETY: WHAT IF MEDICATION CAUSES AN ILLNESS Another OCD fear of taking medication is under the umbrella of health anxiety. A lot of people are afraid that the side effects will be catastrophic, that it will give them some catastrophic medical condition if they were to take this psychiatric drug or any medication in general.  PHARMACOPHOBIA (PHOBIA OF DRUGS AND ALCOHOL) Now, in addition to that, there is actually a specific medication phobia called pharmacophobia, which is a phobia of drugs and alcohol. This is a specific phobia where people are afraid of any and all drugs. Often, in this case, they're afraid to take headache medication or allergy medication. They're even afraid to look at pills for reasons that could be plentiful. It could be a learned behavior around medication, particularly if they've heard stories of people who have misused drugs and bad things that have happened. That is another reason why people are often scared to take meds.  FEAR OF MEDICATION SEXUAL SIDE EFFECTS Another common fear, as we've already discussed, is fear of medication's sexual side effects. Now, for those of you who have a specific fear around the side effects, you have a valid concern. There are some medications that do cause sexual side effects, and we did an entire episode on Your Anxiety Toolkit talking specifically about the sexual side effects of anxiety medications. We had a psychiatrist come on and speak about this. It's episode 332, and I will link to it in the show notes if your interest is specifically more in-depth information about that. But I will also give some tips and tools to use around that later on here in this episode.  I AM ASHAMED TO NEED MEDICATION (MEDICATION STIGMA) Another fear around taking medication includes the fear of being ashamed or the fear that you're weak or that you're stigmatized for taking medication. This is a really, really big one. A lot of people feel that they are weak, faulty, or wrong for needing medication. Now, this is where I slow down and get very transparent. I am very comfortable sharing that I take medication for anxiety. I have, through different stages of my life, needed to take medication for this, and I'm an anxiety specialist, guys. I want to tell you that, not because I want to make this about me, but because I want to share with you that you can have all the tools and skills, and they really do work.  Research does show that if you were to compare medication and CBT, especially for anxiety disorders, Cognitive Behavioral Therapy is actually the number one way to get recovery from these anxiety disorders. But even better than that, the research shows that combining medication and cognitive behavioral therapy is the gold standard. And so, if you're really struggling, by combining these, this is where you can get massive help with your mental health struggle.  Again, I want to really share with you that even though I have the skills and the tools, I take medication. There's no shame in that. A lot of times, we often will compare that you wouldn't feel ashamed for taking diabetic medication. You wouldn't feel ashamed if you needed medication for another medical condition. There is no shame, no guilt, and no stigma that I want you to take away from this episode from taking medication.  Now, I want to also validate, yes, there is still a stigma. There will be some people out there who may even respond to this episode by saying, "You shouldn't take meds, and you should try this other treatment," and so forth. That's still going to be there. But I want to offer you a degree of compassion and a degree of education that there is absolutely nothing wrong with you if you want to take medication or need to take medication.  FEAR THAT I WILL BECOME ADDICTED TO MEDICATION Last, the fear about taking drugs is the concern that the medication will be addictive or that the person will become reliant on the medication. We'll talk about that here in just a little bit, but the one thing I want to mention here is, if you are in contact with your doctor—you're being constantly followed by your doctor and checked in by your doctor—you can bring up these concerns with them, and they can help determine that. Again, each of the questions you have, you should go to your doctor and bring it up because if you do have a history or if, in generations above you, you have a history of addiction, then absolutely bring that up to your doctor and they can help make decisions around different medications that can help prevent that for you. MANAGING MEDICATION ANXIETY (SKILLS & STRATEGIES)  Now let's go into managing medication anxiety. This is where the good stuff comes in. Number one is, I want you to prioritize finding a skilled and trustworthy psychiatrist or medical professional. It doesn't have to be a psychiatrist. In fact, there are other people who can help prescribe your medication, whether it be your pediatrician, your medical doctor, or your intern. It could be a nurse. There are psychiatric nurses who can prescribe medication. You want to find somebody who's going to slow down, take their time with you, not just push you through really fast, and answer your specific questions.  Now, when it comes to managing anxiety, OCD, or health anxiety, we usually discourage asking compulsive questions, repetitive questions, or going overboard with the questions. But I do think that it's important that you give yourself permission and honor your need to ask the questions that you have about the medications you want to go on. That will help you understand the medication, understand the side effects, and understand the pros and cons so you can make an informed decision. As we've said before, we want to understand questions about side effects, sexual side effects, addiction, how long you should be on medications, and what specific side effects you should be looking out for. We want to understand this. We want to know what the norm is for these medications on what it would look like, how fast you can see results, and what this process is going to look like. Don't be afraid to ask lots of questions.  Now, if you have OCD fear of taking medication or pharmacophobia, a thing you might want to consider is finding an ERP therapist. I've had a lot of clients come to me who have consulted with their doctor, and they've agreed that medication would be helpful for their recovery and that they required some mental health advice in moving in that direction. What we did is either start by just looking at pictures of medication or we might fill the prescription of the med that they need to take and just have it with them, hold the medication, put it in their hand, smell the medication, and take one with the care and following of a medical professional. Start that process by slowly exposing them and practicing being around that medication to start with.  If you are someone who's struggling in that area, absolutely consider seeking out an ERP therapist (exposure and response prevention) who can help manage all of that as we go and help with the response prevention piece. Because remember, exposure is not the main work; it's also catching any compulsions that you're doing around the medication. Maybe you're doing a lot of compulsive checking with the medication and so forth.  Another thing I want you to think about is being able to challenge your faulty thoughts and beliefs about the medication. As we talked about before, with those reasons that people are afraid, there is often a lot of faulty, catastrophic thinking around medication. Ones that are common that I see with my patients are, "I won't be able to handle the side effects." Let's say a common side effect for a medication might be some nausea. Then we will say, "Okay, let's talk about your ability to handle nausea. Have you handled nausea in the past?" Let's say it's headaches. "Okay, what could you do if those headaches were to appear? How might you speak with your doctor about those? How might you be able to plan for that?" Maybe it's like, "What if I have a panic attack if I take the medication?" "Okay, let's talk about some skills and talk about challenging your ability to manage the anxiety that you feel."  A lot of people say, "I already have a lot of anxiety. I don't want to do things that create more anxiety." Again, we'll say, "Are you willing to tolerate that anxiety? What are you telling yourself about your own mastery of riding waves of discomfort and so forth?" If you have, let's say, emetophobia, the fear of nausea and vomiting, "What do we believe about vomit? Do you believe that you can't handle that?" And again, you may need to defer to an ERP therapist to help you if you have emetophobia, the fear of vomiting and nausea, to help you manage that so that you can take the medications if that's something you're wanting to do. We do want to challenge faulty thoughts, and we want to challenge faulty beliefs about medication.  Again, here is where I get really, really passionate about saying: There is absolutely no shame in taking medication. Taking medication does not mean you're weak, does not mean you're lazy. It doesn't mean you're doing anything wrong. It doesn't mean that you're never going to get better, and it doesn't mean you need to be on it forever. Again, we're here to encourage you to consult with your medical doctor and be flexible with your recovery.  Now, being flexible is so important here. So often, patients of mine will say, "But what if I don't like the medication? What if I get on it and I really don't like it, or it makes me feel terrible and I can't function?" Well, okay, we'll cross that bridge when we get there. We're going to be flexible with this. We don't have to stay on it forever. Once you get on it, if then there is an issue, we will address that issue. Then we're not going to spend time before taking the medication trying to troubleshoot all the possible catastrophes and scenarios. We're only going to take one day at a time, and with each day, we're going to make measured, skillful, and wise decisions based on the actual events of that day, not on the possible scenarios that may happen, that may be catastrophic that haven't happened yet.  So often, people who have a fear of medication are responding to things that haven't even happened yet. I know when I got POTS (postural orthostatic tachycardia syndrome), I was not functioning, my anxiety was through the roof, I was depressed, and the doctors strongly advised me to take medication. A big part of me was absolutely like, "What if this makes it worse?" and all these things. I had to just say, "Kimberley, be present. Stay with what's happening today, and we will address that as it goes. We'll cross that bridge when that happens. If that does happen, we will speak with a medical professional. We will take one step at a time and we will do what we need to do." We want to catch that anticipatory anxiety about medications and the anticipatory anxiety about the side effects. It's very, very important that we catch and manage that as we go.  Another thing to remember here is, you have to be willing to have side effects. As you go on medication, you have to be willing to feel some feelings that may be uncomfortable. As I mentioned, common side effects: headaches, nausea, tiredness, maybe a little jittery, and so forth. Again, I want to keep prefacing: please speak to your medical professional about the side effects because each medication is different. But be willing to have side effects. Again, being flexible, knowing that if this medication doesn't work for me, we can try something else. I know for me personally, I had to try five medications before I found one that fit me. Five. It took a long time. I had to taper up and then I had to taper down, and I had to try another one, which brings me to the next skill I want you to practice, which is patience.  I just kept honoring my own needs and said, "I'm going to be patient with this process." A lot of my patients have found one medication that was prescribed by their medical professional and found that it was great. It's worked for them straight away. But we want to be patient, and we want to be willing to have a lot of different sensations. I'm not saying you will, but we want to be willing. I actually have a whole other episode on Your Anxiety Toolkit called How to Have Uncomfortable Sensations. If you're struggling with that, that may be a good resource for you to use as you go through this process as well.  Now, if you have, or if you're afraid of sexual side effects, again, I talked about listening to that episode, but I will also say one thing that they did say in that episode: It is okay to seek out a sex therapist or try other skills, such as a skill called sensate focus, or speak to your medical professional about that.  Now, there are a lot of meds that do not have sexual side effects. If that's something that is a concern for you, please mention that when you're seeing your psychiatrist or your medical professionals so that they can pick a medication that will reduce the likelihood of that. Again, we don't want to catastrophize about potential problems that haven't happened, but it is okay to bring that up if that's important to you.  Now, of all the things and skills I'm going to give you today, the one thing I really want to emphasize is, please give yourself lots of space and lots of permission to rest during this process as you begin medication. I remember when I first went on medications, my mom actually said to me, "Hun, why don't you just use this time? Thin out your schedule and give yourself lots of time to rest. If you do have side effects, then you won't be overwhelmed with trying to work and push through."  Any way you can during this process, take as much help as you can, whether that be neighbors helping you pick up the kids, grocery delivery, whether it be you don't clean the house this week and you just let things sort of slide a little. You let your colleagues, your teacher, or your coworkers know that you've started a medication and that you might be feeling well.  Take as much space and take as much care as you can as you start this process. It is scary. It is anxiety-provoking. I'm not here to tell you that it won't be, but what I am here to say is we can do hard things. How can we support you as you make this value-based decision? How can you find help, support, and care as you lead forward with your values? You're not letting fear stop you anymore. You're doing the hard thing. You're taking the step for your long-term recovery, even though it's the hard one. How can we be very kind, compassionate, and effective moving forward as you move through this process?  The next tool I want you to think about is being mindful around the side effects. What I mean by that is, when we do have side effects, we can be non-judgmental, we can stay present, and we can stay in non-resistance to that side effect if you have any. What we know here is, research does show that mindfulness practice does reduce people's experience of suffering. What we mean by that is, if you're suffering, your experience of it could be, "This is very, very bad," or your experience could be, "This is tolerable and doable, and I can handle it."  How can you take the judgment out of the side effects? When you're having them, are you catastrophizing, saying, "This is terrible, this is bad, I can't handle this," or are you saying, "This is neutral and tolerable, and I can manage this"? If you're having a side effect, are you resisting it, pushing it, and fighting it, or are you giving yourself permission to be uncomfortable, and are you willing to allow those sensations to rise and fall?  As I've already discussed, one of the points I had here in my notes is to remind you to always put your values first. If you believe that medication is the right choice for you, lead with that value. Do not let fear interfere with your decision here. That was a lot of rhyming words, but we're going to go with it.  The next thing I want you to think about is to talk with your doctor about whether it would be helpful for you to log any changes. I find that it's very beneficial to log your symptoms. The day you start taking your meds and how many days you take that meds, you probably will need to taper up maybe, depending on what your doctor has told you to do. Take note of when you change any medications. Are there any changes in your anxiety? Is there any change in your mood? What side effects are you experiencing? And that will be there to help when you talk with your doctor next about how it's going and whether it's actually the medication.  I know a lot from my patients, they'll say, "The medication is definitely causing this problem for me. I'm tired all the time." But actually, if they've logged, we can see, "Actually, around that same time, you started getting less sleep for reasons like around school, or maybe you had a lot of travel, or it was the holidays. Could that be what's actually causing your symptoms?" Take that log to your medical professional and let them help you decipher whether it is in fact the medication or if this is actually a lifestyle change that has happened in your life. Again, let's challenge the stigma here. My main hope here with this whole episode is to take the stigma out of it. There is absolutely no reason for you to feel ashamed for taking medication. There is no reason to believe that you are weak for needing medication. I personally am proud of myself for saying and honoring that I matter. My wellness matters. I will do nothing but put my wellness, my mental health, and my medical health as number one, and I will do that proudly. If that means taking medication, so be it. If other people want to judge me, that's fine. I don't really mind if they judge me. Yes, it hurts my feelings sometimes, but they can have their opinion. I'm still going to do what's best for me.  I hope that that empowers you to, again, learn from your medical professional what's best for you. Decide for yourself whether this is a value-based decision. Decide whether you're going to let fear stop you, and take baby steps. I cannot emphasize how important it is to take baby steps and to stay present. Only deal with problems as they arise. Do not make decisions based on potential problems that may show up in the future. Because if that's the case, you'll never move forward with your values. You'll always move forward with fear. We recently did a whole episode about how to act according to your values, not fear. This is another very important step for your recovery.  The last thing I'm going to say is, it's a beautiful day to do hard things, and you can do hard things too. If you have a fear of taking medication, if you're scared to take medication and it's impacting your recovery, I hope that this has helped you to manage medication anxiety, to give you a little bit of empowerment, a lot of hope, and hopefully help you to manage your anxiety as you move forward.  Have a wonderful day, everybody. It has been a pleasure being with you again. I know your time is incredibly valuable, and I'm so honored that you chose to spend your time with me today. I'll see you next week.

If you are wondering if you have (Generalized Anxiety Disorder) GAD vs. OCD (Obsessive Compulsive Disorder) and how to tell the difference, this episode is going to be exactly what you need.  My name is Kimberley Quinlan. I'm a cognitive behavioral therapist. I specialize in all anxiety disorders, and I help people overcome their anxiety in the kindest way possible. Now, I have treated generalized anxiety disorder and OCD for over 15 years, and I want to share with you that it is true—there is a massive overlap between OCD and GAD. They do look very similar. So I'm going to break it down and address the GAD and OCD overlap. Let's go. GAD versus OCD. You might know this, but in the world of anxiety disorders, this is actually a very controversial topic right now. I've been to conferences and master classes where clinicians will very much disagree on how we differentiate between the two. In fact, some people believe that they are so similar that they should be labeled as the same thing. We don't all agree, and the reason for that, as I said, is that they do look similar. They do follow a very similar cycle.  My hope is that in order to understand what GAD is and what OCD is, we need to actually go through the diagnostic criteria. And that's what we're going to do for you today so that you too can understand the difference between GAD and OCD and determine for yourself what you think will help move you in the right direction. Let's talk about it.  GENERALIZED ANXIETY DISORDER SYMPTOMS As I mentioned, in order to get a GAD diagnosis, you do have to have a specific set of symptoms, and we're going to go through them.  Number one, if you have GAD, the first symptom you need to have is anxiety and worry, and that's usually focused on everyday events like work, school, relationships, money, and so on. Now, the frequency of GAD needs to occur more days than not for at least six months. The person needs to find it difficult to control this worry and anxiety, and it focuses on areas that are not consistent with other mental health struggles.  What we mean by that is, let's say the focus was on being judged by other people. Well, that's better understood as social anxiety. Or if the focus of your worry was on your health, then we would actually be better diagnosing you or understanding your symptoms as health anxiety. If it was focused on a specific thing, like planes, needles, or vomit, we would better understand that as a specific phobia. In order to have the diagnosis of GAD, it needs to not be under the umbrella of a different diagnosis. Other things that we would rule out when we're thinking about GAD are things like panic disorder, body image, or even a previous trauma.  Now, the fifth symptom is it needs to cause distress and impairment. That's very, very important here because, again, we're talking about a disorder. What that means is a lack of order, no order. So what we want to see here is that it's highly impacting their daily lives, highly impacting their ability to function.  And then the sixth criteria is it has to be ruled out that these symptoms could be from a medical condition or substance abuse. An example of that might be even me with POTS. I have postural orthostatic tachycardia syndrome. A lot of the symptoms of POTS can actually look a little bit like generalized anxiety.  The seventh criteria are the specific symptoms, and this is important to recognize because this might be true of a lot of different situations, symptoms, diagnoses, medical and mental. You need to have symptoms such as restlessness or being on edge. You need to be either easily fatigued, have difficulty concentrating, or have what we call a blank mind. You might have irritability, you might have muscle tension, and you could also have sleep disturbances.  That is the breakdown for GAD. As I said, it's very easy to mix it up with other mental health disorders, such as OCD, because they can look very, very similar.  OBSESSIVE COMPULSIVE DISORDER SYMPTOMS Let's talk about OCD now. What is OCD? Now, in order to understand what OCD is, we need to again address the specific criteria to get a diagnosis of OCD. The symptoms of OCD include the presence of obsessions and compulsions or one. Sometimes, again, you might have obsessions without the compulsions, but usually, at the onset of the disorder, you will have both. You'll also have intrusive, unwanted, repetitive thoughts, feelings, sensations, urges, or images, and these cause a very high degree of distress and anxiety, as we mentioned with GAD. The individual with OCD will often attempt to avoid or suppress these thoughts, feelings, sensations, or urges, and they will try to neutralize them using what we call compulsions.  Now there are five different types of compulsionS. A lot of you who have followed Your Anxiety Toolkit will know about these compulsions. We've talked about them. We actually go over them extensively in our online course for OCD called ERP School. If you're interested to learn more about that, you can go to CBTSchool.com. We have a whole array of courses there to help you work through this and get help if you don't have access to treatment of your own.  We do have five different types of compulsions. The first one is avoidance. The second one is mental compulsions. The third one is reassurance-seeking, whether it be from Google or a loved one. The fourth one is physical compulsions, like checking or jumping over cracks or washing your hands, just to give a few examples. The last one is self-punishment. So there are five types of compulsions.  Now, these compulsions are not connected in a realistic way and the way that they're designed to neutralize or prevent. They're usually clearly excessive behaviors done repetitively and done usually from a place of not wanting to do them, but more that the person with OCD feels like they have to do them to reduce or remove their obsessions.  Now, obsessions or compulsions are time-consuming. The frequency here is that they need to take up more than one hour per day or cause a significant degree of distress and impairment in their social, occupational, or other areas of functioning in their lives. The next criteria is that the obsessive-compulsive symptoms are not attributable to physiological symptoms, substance abuse, or a medical condition. Similar to GAD, again, we want to always check for medical and substance abuse issues before we go ahead and get a diagnosis of either GAD or OCD.  And then, last of all, the disturbance is not better explained by another mental health condition. Again, if the worry or the obsession is around needles, like we talked about before, or being judged by somebody else or health conditions—if that were the case, we would give them a different diagnosis. Now, this is also true for trauma. Again, I want to make sure we understand that. Often, this same cycle will play out in different anxiety disorders—PTSD, BFRBs, phobias, health anxiety, BDD (body dysmorphic disorder). Once we have ruled those out, we can then move forward and acknowledge that this might be OCD or it might be GAD.  OCD VS GAD  Now that we've gone through all that, we can actually slow down a little and really take a look and talk about OCD versus GAD and how to tell the difference. Let's break it down.  Both GAD and OCD have intrusive thoughts or what we call obsessions. A repetitive thought. Now, both have the presence of rumination compulsions and reassurance-seeking compulsions. That is true for both conditions.  DIFFERENTIATING GAD FROM OCD OCD tends to be more on irrational topics and subjects, whereas GAD tends to be more focused on daily stresses and rational actual events in the person's life, but not always. Again, sometimes the person with GAD may engage in a lot of catastrophic thinking or irrational thinking that can actually make this disproportionate to their daily life stresses.  ARE YOUR FEARS INTRUSIVE AND REPETITIVE?  Questions that you might want to ask yourself when you're considering how to tell the difference between GAD and OCD are questions like, are your worries related to a daily stressor, or are your fears intrusive and repetitive?  People with OCD tend to identify that their thoughts are very intrusive, that they can't stop them, they're relentless, they're repeating themselves over and over, whereas people with GAD tend to find that these are more preoccupations with problems in their lives, and they're trying to solve them.  ARE MY FEARS REALISTIC OR ARE THEY IRRATIONAL/DISTORTED?  Another question to ask is, are my fears realistic or are they irrational and distorted? That question too can help us differentiate whether your symptoms are more related to OCD or GAD. GENETICS AND GAD VS OCD Another question to ask is, does anyone in your family have GAD or OCD? We know that these conditions are very, very genetic. If you've got someone with OCD in your family, it might actually help us to determine, is this something that's going on for you? Are you better understood as having symptoms of OCD than you are GAD?  GAD TESTS & OCD TESTS Another question or thing you might want to do is, you can take a GAD test or an OCD test. We have specific diagnostic tests that can help determine these. I strongly encourage, if you're still having a hard time differentiating after you've listened to this episode, please do go and speak to a mental health professional who can help you determine and do those tests so that you can really be clear on what you've got and help you get the correct treatment. CAN YOU HAVE BOTH OCD AND GAD?  Let's answer some questions about this topic that commonly come up, which hopefully will help you get even more clarity on this topic. One of the most common questions we get asked in this area is, can you have OCD and GAD? Often, some of you are looking at these criteria going like, "Yes, yes, yes, yes, yes, yes, yes." And the truth here is, yes, commonly, people do have OCD and GAD. There is a very strong GAD-OCD overlap here. So it could be that you have both.  TREATMENT FOR OCD & GAD The good news here, if that is the case, is that the treatment for GAD and the treatment for OCD are very, very similar. In fact, again, like I said, it's very controversial. Some clinicians say it doesn't even matter. We don't have to differentiate between OCD and GAD because the treatment is going to be so, so similar.  We're going to use a combination of cognitive behavioral therapy and exposure and response prevention. We call cognitive behavioral therapy CBT, and we call exposure and response prevention ERP for short. Those treatments are focused on reducing those safety behaviors or compulsions, such as rumination, avoidance, reassurance-seeking, physical compulsions, and self-punishment, and also encourage you to identify your fears and learn to face them as much as you can. Learn to navigate those fears by experiencing them, tolerating them, being kind to yourself as you ride the wave of distress, and practice mastering your ability to be uncomfortable. That's a huge piece of this. Also, master your ability to be uncertain, because in both conditions, they often require you to spend a lot of time trying to seek certainty, to get clarity, to solve the fear, and to prevent the fear. And we actually instead work at reducing that by increasing our willingness to be uncertain.  We also have an online course called Overcoming Anxiety and Panic, and we go through the same steps with that. They're two separate courses because we want to make sure the person feels very understood and feels like they have a really good plan. Again, if you're interested in that, you can go to CBTSchool.com. We have two courses for specific diagnoses, and that will help you make a plan for yourself. They are there specifically for people who do not have access to or do not have the means to access mental health services. These are self-led, on-demand courses. You can take them as many times as you want to put a plan together for you.  WHAT ABOUT OTHER ANXIETY DISORDERS VS OCD?  Let's get back to the questions. What about other anxiety disorders vs OCD? Well, what we've talked about already—hopefully, we'll clear that up—is the real way to determine what your specific problem or struggle is, what is the focus of your intrusive, repetitive thoughts? Again, if it's on your body and your body image, we would look at an anxiety disorder, an eating disorder, or maybe even BDD. If the focus is on your health, we're going to look towards health anxiety or hypochondria. If your fear is around being judged, we're going to look towards social anxiety. If your fear is in response to an actual trauma you've been through, we're going to look at PTSD and other trauma symptoms that you might be having. It's important to identify the core fear, and that can actually help determine what specific struggle and diagnosis you have.  CAN GAD LEAD TO OCD? Another important question that people ask is, can GAD lead to OCD? We don't actually have a lot of research on this, so it's important that we recognize that yes, they can overlap, that yes, you can have GAD, and then you can proceed into having OCD. But I wouldn't actually say that GAD leads to it or causes it. Usually, again, we don't really have a lot of clarity on what causes OCD, but we do know that there is a genetic component and an environmental component that are contributing to having OCD. Lastly, what's the difference between having OCD and general anxiety or just anxiety in and of itself? Often, again, we're going to look at that core fear. Now the thing to remember here is, everybody has anxiety. Everybody experiences anxiety. It is a normal part of being a human. But if that anxiety is starting to impact the functioning and quality of your life, if it's starting to take up a lot of time, if it's starting to stop you from being able to do the things you want to do, that's usually when anxiety becomes what we call an anxiety disorder. When that happens, I'm going to urge you to seek help. There are treatments, there are solutions, and there are practices that can help you overcome this anxiety and get you back to living the life you want to live. You don't have to live a life where we just accept anxiety at this rapid rate without getting help, skills, and tools to help you move forward. The whole reason I created Your Anxiety Toolkit is because there are tools that can help you navigate anxiety in the most effective, wise, and kind way. So my hope here is that today, as we've learned to differentiate the difference between GAD and OCD and even other anxiety disorders, you can then go to get resources to help you overcome those specific struggles and challenges.  Again, if you're interested, please go to CBTSchool.com. We are also here on Your Anxiety Toolkit, where we have over 350 free episodes to help you navigate these conditions. It is an honor and pleasure to help you with these struggles in your life, and I'm so grateful to be able to do that. I hope that's been helpful. Have a wonderful, wonderful day, and I'll talk to you soon.

If you want to live a life according to your values, not fear, you're in the right place. I am going to give you a detailed look at how you can do this for yourself, but I will also show you how not to do this. Lots of people are talking about this idea of living life according to their values, not fear. I want to really inspire you, highlight the way that you can do this, and also show you how it cannot be done so well. I'll actually give you some personal experiences. Hopefully, my goal here is to inspire you to live a life where your values lead the way and fear no longer makes your decisions. Your fear is no longer in the driver's seat; you are. If that's good for you, let's go.  Hello, my name is Kimberley Quinlan. I'm a marriage and family therapist. I, myself, have struggled for many years with anxiety. In little ways, anxiety just took away the things I wanted, took me away from doing the things I wanted, showing up the way I wanted, and learning how to live a life according to my values, not fear, has literally changed my life.  Now, my hope here is that I can explain this to you. There have been times where my clients have said, "I'm hearing about this idea of values, but it literally doesn't make any sense to me. Like, how would I navigate that?" So my hope here is to make it nice and clear, give you some clarity and some directions so that you too can live your life according to your values and not fear.  Now, the thing to remember here is that this idea of values has probably been spoken about in many different modalities, but the one that's really popular right now that people are talking about is a type of therapy modality called Acceptance and Commitment Therapy. What they do is they talk about values as this idea of principles that govern how you want to act. Again, it's not being perfect. It's principles that are going to guide you.  Now, unlike just setting goals, values are never fully accomplished. They're something that involves continuous behaviors. They're small baby decisions and little pivots that you are going to make throughout your entire life, and they guide your choices and your decisions according to the person that you want to be, the kind of person you want to see yourself as, or that you identify with.  Now, often when we're talking about values, the biggest question I get asked is, "How do I determine these values?" Let's just stop for a minute and just talk about how we're going to apply this.  As you probably already know, fear is a very, very good motivator, and it's a driver of behaviors. Let's say you're just walking along or you're at home enjoying your day, and then you have a thought or a feeling of danger, like what if something really bad happens? For you, it will be a specific thought or feeling, but for the sake of just making this really broad, basically, your brain has interpreted, "There might be something wrong. There could be danger. Bad things could happen. I feel uncertain about the future."  When that happens, our natural human instinct is to fight that fear, run away from that fear, freeze in that fear, or go into people-pleasing mode. We call it the fight, flight, freeze, and fawn response. This is a normal human reaction. We all do it. It's nothing to be ashamed of. It doesn't mean that you're wrong or bad.  If there was actual danger, if there was somebody who was intruding on you or making you uncomfortable and that you were in danger, this 5Fs, the FFFFF approach, is a very appropriate response to being in danger. But when our brain tricks us or sets off the alarm, the danger alarm too fast or inappropriately, we often perceive there to be danger, and we go into a response where we respond to that fear as if it is a real danger, and before we know it, we've completely gone in the wrong direction from the way we wanted our day to be.  Again, I might be dropping off my children at school, and I might have the thought, "What if something happens to them today?" I have to make a decision in that moment whether I'm going to respond to that fear, that thought, that feeling as if it's fact, or if it is just a thought, a feeling, or an experience or sensation.  The first step here is being able to stop and identify when fear is showing up and identify then, "How do I want to respond?" And that's where your values come in.  What I'm going to encourage you to do once you've finished listening to this is go onto Google or whatever search engine you use and Google 'Values List PDF.' There are hundreds of them, and they're going to give you a list of all of the different values that you then may want to think about as things that can guide you in the direction that lines up with the way you want to show up in your life.  Again, think of it like a crossroads. You're going up to this crossroad; there's a stop sign. The stop sign says, "There could be danger here." You have to make a decision. Am I going to take a right or a left, which doesn't matter, towards fear and trying to resolve that fear, or am I going to make a left where I act according to my values? On these lists that you've Googled, you will see an extensive list of ways in which you can respond right now. Some examples of values would be patience, kindness, strength, integrity, and honesty. That's just a few. Like I said, there's hundreds of these. And then you can start to decide for yourself which value you want to lead with your step forward. What do they say? Put your best foot forward. That's what we're talking about here—the value that you pick is going to be the one that helps you in the long term, is the most skilled response, and is the one that lines up with who you want to be and how you want to be. Again, think of it through the lens of the one-year-old or the three-month-old you. What would you want that person to do? And that's how we can then start to choose values over fear. So, so important now.  A lot of people get overwhelmed with the list. Let me help you get clear on how to determine the values that you're going to choose. Number one, pick values that have always led you in the right direction. Do a little inventory on when was the time that I really showed up for myself, or I showed up in a way I wanted to in an uncomfortable situation. What was one of the values that led me in the right direction? Often, with patients, I'll ask them, "What was a time where you really had to muster through a really difficult time?" And they'll think about, "Oh, there was this one time where there was this one sort of emergency, or I was running a marathon." I'll say, "Okay, great. You were able to achieve that. What were the values that got you through that uncomfortable time?" And there it falls very quickly without even looking at the list. It could be some values that matter to you or that have been effective for you.  Another option is, pick values that give you a sense of purpose that helps you look in the long term, not just with short-term relief, but long-term accomplishment, long-term mastery, and long-term relief. In addition to that, pick a value that feels like it serves you in the 'you-est you' you can be. I know that's a funny way. I say that with my patients all the time, like, "What's the 'you-est you' that you can be? What value would lead you towards the 'you-est you' that you can be?" Because we're all different and we all show up in different ways. We have different strengths and different challenges. So we want this to be very specific to you.  But there is an important thing to remember here. There are no "right values." You are going to look at this list. And as I did when I first started doing this work, I was like, "Oh my gosh, which ones should I pick?" Often, and this is one of the problems that I found, when I looked at them, I ended up with this long list of all the things I wanted to be. I was like, "Check, check. Yes, I want to be that. Yes, I want to be that. Yes, that's a value of mine. Yes, that's a value." It was kind of like a want-to-be list. I had basically highlighted the majority of the values on the list. They were all important to me.  But what we're talking about here is, yes, they might be all important to you, but the goal is just pick two or three to start with. What we want to do here is pick two or three that will help you with this specific struggle or problem that you're working through. If it's fear and it's anxiety, well, let's work on that. But if you're going through a medical condition, a family issue, a relationship issue, or an academic issue, you can then make a decision on, "What are the two or three values that will help me get through that particular problem?" Another issue that often people ask me about is that theyre getting overwhelmed with this idea of "I want all these things in my life." What we end up doing is using this idea of values as a way to fix their humanness, that these values work can become a breeding ground for perfectionism. This was the case for me. I was like, "Yes, a good person would check off that one," and "I wish I was more generous. Yes, I'll check that off." It really just ended up making me feel guilty about who I was. I was really picking values based on what I thought a "good person" would pick.  We want to move away from that because, yes, you're going to look at this list of values as I did and be like, "I want to be all those things. I want to show up in those ways all the time, every day." But the truth is, you're a human being. You're a messy human being, as am I, and we don't want to overload ourselves with values and these ideas in a way that just is a way of being perfectionistic, hyper-responsible, and overly moral. We want these values to guide us towards being the person we want to be, but we don't want to pick them with this idea that we have to fix our humanness. We're still going to be human. We're still going to make mistakes. We're still going to hurt people and say things that we wish we didn't, and we can still go and repair that and show up as best as we can and be the best that we can. But please don't use values as a way of raising the level so high and the expectation so high that you are destined to fail and destined to feel bad about yourself. We want to be as compassionate and realistic as we can as we do this valued work.  The solution is to be gentle and kind as you peruse these values. Maybe you need to put your pen down and your highlighter down and just take a second to acknowledge that you might not be in a season where you can choose the "good Samaritan" values. You mightn't be in a season where you can choose some of the values on the list. I know when I was really sick from a chronic illness, and I looked at this values list, generosity was a big value that showed up where I was like highlighting, "Yes, I want to be more generous." But I wasn't in a season where I had the capacity to give back. I was in a season where I needed help from other people. And so I had to stop in that moment and look at the list and say, "Given the season I'm in, which of these values will help me recover?" I had to work through a little bit of self-judgment and a little disappointment and sadness that I wasn't in a season where being generous was the priority, at the top of the list.  You can still be a respectful, compassionate person while you work on whatever struggle you're working on. Absolutely. It doesn't mean we're giving you permission to not be a good person. But we have to be able to prioritize and bring things up to the top, but without discounting or thinking black and white that because they're not at the top, that makes us a bad person. Just because I couldn't put generosity at the tippy top of my list and priorities for values didn't make me a bad person. It just meant that because I was in this season, I had to reprioritize values to get me through this season so I could move on to being in the next season, which might have generosity at the top.  Here is a pro tip with this, and I talked about this before. Find one area that you want to improve, and pick one to two values that might help you course-correct. Just do a small pivot. We don't want to overcorrect. We want to do just a very slight course correction to start.  Today, we're talking about choosing values over fear. In this case, it might be a small value. Something that's there for you that will help you face that fear. That being said, let me also say, if your fear is really loud and really aggressive and it's hitting you from every angle, you might need to pick a value that's actually very, very, very important to you, the most important to you, and have just that one thing. Often, and here's an example—but please, I don't want you guys to feel you have to use this or feel like you're a bad person if you don't use this—a lot of my patients put family at the top of their values when they're talking about managing their anxiety. If they have an anxiety disorder that's taken so much from their life, they might say, "My kid is my highest value. And so when fear shows up, I'm going to imagine a picture of my kid, and I'm going to move towards that fear because that allows me to be with that kid," or that partner or that parent.  Other people might say, "My career matters to me so much that when fear shows up, because I want that career so much, I'm willing to be uncomfortable. I'm willing to ride some big, big waves of discomfort. I'm not going to choose fear anymore when I get to that crossroads; I'm going to choose that one really important fear." Underneath, there might be a smaller one like compassion, hopefully. But again, you get to choose. You get to choose what's right for you. This is your journey. Please do not let anybody tell you what your values should and should not be.  Now, one of the reasons that I was so committed to doing this episode today was that I recently have come upon a realization about values that I didn't know were there, which is that sometimes your values can compete. Now, I talk to my patients about this all the time. That wasn't the part that shocked me. Let's talk about what that might look like. Often, people get confused. "Well, if I have these values, what if they compete with each other?" Let me give you a personal example.  For me personally—but please don't use this as your values unless they line up with your values—I highly value, number one, work ethic and discipline. It is a huge part of how I was raised. I love the fact that I have a very strong work ethic, and I'm very, very disciplined. It is something I hold as a very high priority, has gotten me through some very difficult times, and has allowed me to have the life that I am trying to create. My second value is compassion, and I'm still working on that. It doesn't mean I'm perfect at it, but it's still a high value. The third is family—my family. My husband and my children are probably the most important things to me above all. The fourth is my mental health. Now they're in order, but depending on the day, they will switch, as I've talked to you about before. But then patients will often ask me if I share that: "But that doesn't make sense. If work ethic is a value, but family is a value, how do I make both of those happen? Does that mean I have to choose to be a stay-at-home mom and be with my family? But if I go to work, obviously, I'm not valuing my family. They're competing with each other." Some people will say, "I really value rest, but I really value exercise or being strong. How do I make room for both of those? They're competing."  The thing to remember here with values is, it's not always, as I said, in the same order. Throughout our day, because we have to be flexible, we can make room for multiple values at a time, and we can find balance within these values. I can show up to work or right here today and give everything I have, and then still show up for my kids later on. It doesn't mean I have to give my whole attention to that one value all day, every day, consistently at a hundred percent. Because I value compassion, some days that will mean I take a break, or I value mental health means I don't have a strong work ethic or be with my kids. I take a drive, I go to the beach, or I take a walk and have some time to myself.  It's important to recognize that while it might feel like these values are competing, it's not. It's about us finding a balance of using them to guide us, but not, again, making them perfect.  Any time, when we're using these values, when we're going overboard with them, we want to catch our rigidity in making them the only thing that we do, the only way we think, and the only way we act. We want this to be a flexible, moving target. As we said, values are never finished. They're never completed. They're something that we are constantly checking in with ourselves. What do I need? The most beautiful, compassionate question—what do I need? And using values to guide us, not fear—values. Allowing those values to decide what's important to us, decide how we want to show up, and decide what the future me would want me to do.  Now, this is where I have gotten stuck, and here is where I've found a-- how would I say it? A problem. Maybe it's just me. Maybe it's just me. But I want to bring it up in case this is true for you too. Now, I've already shared with you my core values. There's work ethic and discipline, compassion, my family, and my mental health. These are all incredibly important to me, depending on the season, the day, the hour, and the minute. But I realized recently that work ethic, while it's one of my biggest values, is actually partially fueled by fear. I'm holding it as a value, but it's actually a partial fear response. Let me explain.  Often, and this is something I want you to look out for, fear will dress up as values and pretend to be values when really it's just fear. Think of it as a Halloween costume. Fear is like, "Oh, I know how to trump this system. I'm going to dress up as a value and show up in Kimberley's life (or in your life), and I'm going to pretend I'm a value, but I'm actually really fear. I hope she doesn't catch that I'm actually in a costume and I'm actually really fear. And so I'm going to see if this works." I do genuinely value work ethic and discipline. Like I said to you before, it has really given me so many beautiful things in my life and has allowed me to show up and serve you guys, and it's been wonderful. But when I was with a client, we were talking about this exact problem, and I asked them a question, which was, if that value—when we're talking about values—if that showed up, what would the non-anxious, trusting version of you do in this moment? And they realized that it was not the values they'd been working on. And then I thought, "Oh my goodness. I'm going to actually check in with myself on this, because if I asked myself, what would the non-anxious, trusting version of myself do in this moment, a lot of the time it wouldn't be work ethic and discipline." I realized that a small part of my work ethic and discipline is coming from a place of fear that if I don't stay disciplined, that if I don't hold my work ethic, everything will fall apart and bad things will happen.  This stopped me in my tracks because—again, I want to reinforce this—my values were being tricked by fear. Fear was actually leading a part of that important value, or maybe I could say it was coming in and taking advantage of that value, and it might do that for you as well.  And so what I want you to think about when you're looking at values—and again, please don't put pressure on yourself that you have to get this perfect. It's a work in progress. I've been doing this work for a decade, and only now I'm realizing this—is slow down and just check in on "What would the non-anxious, trusting version of myself do in this moment?" I think that is where we can actually really get to the crux of "What are your values?" Again, they will be ever-changing. Again, we will be forgiving and kind to the fact that we're still messy human beings. We don't have to get it perfect. But it did open me up to realizing a value that I didn't know was so important to me.  When I asked myself this question, I actually realized that the answer is playfulness and stillness—these two values that I've never really relied on. As I look back at my PDF of values, I've never highlighted them. When I asked myself this question of what would the trusting version and the non-anxious part of me do, playfulness and stillness was the value that rose up to the surface. It was a beautiful moment. I actually cried. Now, from that, and I'm actually going to tell you a little bit of my news, I thought to myself, how could I implement playfulness and stillness into my life where I still value work ethic, compassion, family, and mental health? Into my mind came the image of a Volkswagen bus. Do you remember the old hippie buses? We call them Kombis in Australia. That was what showed up for me. Like, if I could show up in my business from a place of playfulness and stillness, I wouldn't be working from this office. I would be working from a 45-year-old Volkswagen bus. And so I did. I did exactly that. I went and bought a Volkswagen van. It's a 1985 Volkswagen Westfalia. I love, love vintage cars. I am actually a car person. I don't know if you know that about me, but I love vintage cars, and I never allowed myself to really think about doing this. I've loved them forever. I've looked at them forever. I've wanted one forever, but I've always thought, "That's not high on my priority list right now." Until I realized that if I'm going to move towards trusting myself and honoring this bigger piece of me, playfulness and stillness have to come up on that list as well. So if you live in Los Angeles and you see a gold Volkswagen Westfalia—it has, like I said, 195,000 miles on it—if you see one of those driving around Los Angeles and you see me, please beep your horn. That will be me driving around and parking my van at a beautiful place and working from there from now on, and that is my hope. That is my hope for myself, and I hope that you can use values to discover who you are so that you can be the 'you-est you' you can be. I love the idea of implementing values into recovery. That is why I think act is so important as a complementary treatment to anxiety. I think that with some care, compassion, and some thoughtfulness, you too can identify the values that are important to you and learn to live and act from those values, not fear. I hope that has been helpful for you today. I have had so much fun chatting with you about values. I am sending you so much love. Do not forget, it is a beautiful day to do hard things. I will see you next week. Have a wonderful day.

Perfectionism anxiety almost destroyed my life. If you are someone who suffers from perfectionism, you know exactly what it's like to be stuck in the perfectionistic trap. It's hell, quite frankly. We're here today to talk about how to overcome perfectionism and how to create a life where you can still succeed. You can still do the things you want just without being constantly anxious and depressed and never feeling like you're enough.  Hello, my name is Kimberley Quinlan. I'm a marriage and family therapist. I'm an anxiety specialist, and I personally have walked the walk of perfectionism and have had to overcome it as it was starting to severely impact my life. I am so excited to be here with you today to talk all about perfectionism and perfectionism anxiety.  Now I am 15 years recovered from an eating disorder. I was personally completely overwhelmed with perfectionism anxiety, and I was in a perfectionism trap. So, let's talk about it. First, let me give you a little bit of a personal update or a background. When I went off to college, I was really naive. I was wise and smart, but I had no idea what I was getting myself into. I had lived at home with my family on a rural farm, on a ranch, if you live in America, for my entire life. And then I went off to what was considered the big city for college, and I felt like I had to be perfect.  I had this belief as soon as I left my family that if I could be perfect, I would be safe. I would be emotionally safe. I would be physically safe, and as long as I could keep everything perfect, nothing bad would happen.  I also believe that if I could be perfect, people would not abandon me, disprove of me, or judge me. And so, I went out of my way to make sure everything was as perfect as I could make it, even though I understood that I wasn't perfect. I was on a mission to try and get to the top of that hill and stay at the top of that hill. It was a protective measure, a safety behavior I engaged in to manage the anxiety and overwhelm I felt going off to college.  I also believe that if I could stay perfect, it would protect me from really uncomfortable emotions like shame and guilt, and it would help me feel like I'm in control. I would try to give myself a false sense of control in a world where I felt very out of control. THE PERFECTIONISM TRAP Now, a big part of this was me understanding what we call the 'perfectionism trap.' The perfectionism trap is, yes, when you start perfecting yourself and perfecting your life, you start to get praised from people around you. You start to get rewarded for your perfectionistic behaviors. My grades started to improve because I was being perfectionistic. My bosses gave me extra shifts because I was so good at my job.  But the problem with that is, as I was getting better and trying to perfect everything in my life and please all of the people, I started to feel overwhelmed with all that I had taken on. In addition to that, once I had gotten to this 'perfect place,' which again, I totally understood that I wasn't perfect, but as I started to climb that mountain and get to the peak and start to have the relief of anxiety that I made it, I'm at the top, I'm doing really well, then I started to have the influx of anxiety. "What if I can't maintain this? What happens if I make a mistake and fall off this perfectionism mountain that I have climbed?" And then I was constantly anxious and constantly feeling hopeless about the fact that I can't maintain staying at this high level for as long as I was.  This is the perfectionistic trap. The more you try to become perfect, the more pressure, stress, and anxiety you feel. The more hopeless you feel about being able to maintain that, the more depressed you feel that you're stuck in this cycle, and all of a sudden, nothing is worth it. Often, people completely fall down. They can't go on in this way. They burn out, they get sick, which happened to me, or they become so paralyzed with anxiety that they have to avoid things and start telling little white lies just to get through the day because they've built up this idea of being perfect on the people around them. If you're experiencing this, you're not alone. Please do not feel bad about this. This is a common experience, particularly if you're someone who's set up for anxiety.  PERFECTIONISM ANXIETY SYMPTOMS OR SIGNS Let's go through some additional perfectionism anxiety symptoms or signs. The first one is, people with perfectionism have a severe fear of failure. They're overwhelmed by the idea that they might mess up, they might make a mistake, and when they do make a mistake, they see it as a failure. Not a blip on the road, not a challenge that they will learn from, but it's that they are a failure, that their mistake and their failure mean that that person is. In fact, their identity is a failure, and that can be incredibly emotionally painful. Another perfectionism anxiety symptom is shame and vulnerability. There is so much shame around making mistakes or being seen as vulnerable, weak, not perfect, or not keeping up with the Joneses. And that can be so emotionally painful that that's what propels them into continuing perfectionistic behaviors, pushing themselves harder than they can maintain, putting them or raising their hands in situations that they really honestly shouldn't be saying yes to. They don't even have the capacity for what they've already signed up for. You may know the quote that says, "If you want something done, find the busiest person." That's commonly the perfectionist because they're the ones who can get jobs done and they're willing to put their own mental and physical wellness aside to get the job done. Another sign of perfectionism often shows up at work. When you have perfectionism anxiety, work can become very frustrating or depressing, and this is often, again, because of the expectations you've put on yourself. You associate work with being an incredibly stressful environment because, as you walk into work, you're bringing in these expectations. You're bringing this goal of being perfect and not making mistakes. And that can create an incredible amount of anxiety and distress.  It also creates, as I said, a lot of depression, hopelessness, or helplessness because often people with perfectionism are suffering in silence. They don't feel like they can share with other people how much they're suffering or how they're succeeding. They make it look maybe even so easy, but underneath they're really struggling, and they don't want people to find out. They feel like that would be letting other people in on the lie that you're actually not the person that you're perceived to be. Another really important sign is this ongoing fear or belief that I'll never be good enough. This deep-down belief that you don't have the worth of just being who you are, that you have to show up being more and more and more in order to be respected, to be loved, to be accepted by people. And that can be incredibly stressful. PERFECTIONISM AND PROCRASTINATION A big overlap is between perfectionism and procrastination. Again, as I said, when you raise the bar so high, often the only thing that people can do is to avoid the thing because they're overwhelmed at the prospect of making a mistake. They're overwhelmed by the expectations they've put for themselves. They go into a freeze mode where they can't even move forward. It's too overwhelming. Their nervous system is shutting down. They're having an increased heart rate, tightness in their chest, nausea, stomach issues, muscle aches, headaches, and migraines. And so, because of that, they just procrastinate and keep pushing, pushing, pushing the deadline away. Often, when I see someone, they have been told they're not perfectionistic because they've procrastinated and avoided so long. A professional or a doctor has said no, that you can't be perfectionistic because you're not getting anything done. But often, those who are avoiding are more perfectionistic than the people who they know are succeeding. It's the heavy layer of expectation that causes them to stall and avoid moving forward in any way.  Now, when you suffer from perfectionist anxiety, relationships can also become really strained. Really common imperfectionism is people pleasing, or the fear that you have let people down. You spend a lot of time worrying about what they think of you. In addition to that, it's not just worrying about what they think of you. Often, people with perfectionism become highly judgmental of their loved ones, their friends, their children, or their partner. They may also become easily annoyed when other people can't maintain that perfectionism. Often in relationships, if there's a person with perfectionism and their partner is struggling, the person with perfectionism gets quite frustrated because, in their mind, they're like, "Just be perfect. Get it fixed. Fix it. I'm doing all the perfectionistic behaviors; why can't you?" And that can cause an incredible amount of strain on the relationship. They also might experience a degree of anger, frustration, and irritability. And that's not because they're horrible people; it's because they've raised the bar and the expectations so high to be perfect that even if their loved ones are struggling by association, they feel like that's jeopardizing their perfectionism. And this is a really common thing that comes into couples counseling. Once they get there, the relationship has been so strained without identifying that perfectionism could be a massive driver behind their relationship issues.  IS THERE A PERFECTIONISM ANXIETY DISORDER? Now there is something to note here. There is no such thing as a perfectionism anxiety disorder. A lot of people are searching for those terms to see if this is, in fact, a disorder. But there are common disorders such as eating disorders, generalized anxiety disorder, and OCD that do co-occur with perfectionism.  PERFECTIONISM OCD Now, there are specific types of OCD, one of them being perfectionism OCD. That is a specific subtype of OCD where the underlying force towards the compulsion is perfectionism, and it's often coming from a place of anxiety and uncertainty. Usually, people with perfectionism OCD, they're not doing their compulsions or safety behaviors from a place of wanting to; they usually feel like they can't stop doing them. They feel like they're stuck in a loop of doing these behaviors even though they don't want to. This is very common alongside other subtypes, like just right OCD, symmetry OCD, and moral and religious OCD as well.  PERFECTIONISM VS PERFECTIONISM OCD Now, often people do ask. Let's weigh it out. Perfectionism versus perfectionism OCD, how do we know the difference? Well, a thing to remember here is that often perfectionism is what we call 'ego-syntonic,' meaning it's in line with their values. They want to be perfect. It's a driving force to be perfect. It actually reduces their discomfort by moving in that direction.  For those with perfectionism OCD, it's actually ego-dystonic, which means they don't want this obsession. It's intrusive. It's repetitive. They really don't believe in the point of perfectionism, but they feel compelled to engage in this behavior, and they feel like they can't stop engaging in this behavior.  Now I want to really slow down here because that's not always true for everybody. I've often seen where clients will have a combination of the two, or maybe on a spectrum, they might be closer to the perfectionism OCD end, but they do still have some ego syntonic perfectionism that's showing up. So, I want to make sure that if you are having these perfectionism symptoms, go to a mental health professional so you can work out specifically what's true for you. So that's an important point to make here. Please don't misdiagnose yourself here. This perfectionism can also show up in PTSD. It can show up in depression. It can show up in other disorders as well. I want us to use this as information, but please do not use this as a way to diagnose yourself. PERFECTIONISM OCD TREATMENT Now if you do have perfectionism OCD, there is a specific OCD treatment that is helpful for that. For those of you with perfectionism, I'm actually going to go through that right here in a second. But first, let's just address that OCD treatment usually will involve a type of cognitive behavioral therapy called ERP (exposure and response prevention).  Now, in this case, we actually expose you to being imperfect on purpose. We have you practice reducing your safety behaviors and compulsions around perfectionism so that you can practice riding the wave of discomfort, uncertainty, or anxiety, and learn that by riding that wave, you can actually tolerate that discomfort and move on without engaging in behaviors that make your life more stressful. It often involves saying no. It often involves slowing down. It often involves, again, being imperfect on purpose.  HOW TO STOP BEING A PERFECTIONIST But now let's move over to how you can stop being a perfectionist and how you can overcome perfectionism if that is in fact what you're dealing with.  I again want to share with you, I get how painful this is. I worked through this for close to a decade, and I still see it come up. I still see it show up in my life where I have to catch it. It shows up in a way that's sneaky and it feels, in my experience, as it's a powerful feeling when you're engaging in perfectionism, but I also notice that when I'm starting to feel really burnt out and really overwhelmed and my anxiety and depression are going up, it's usually because I've allowed that sneaky perfectionism to get into my life more than I would've wanted to. OVERCOMING PERFECTIONISM So when we're talking about overcoming perfectionism, here are a few things that were really helpful for me.  Identify how perfectionism keeps you trapped Number one is, identify the ways that perfectionism is keeping me trapped. For me, when I had an eating disorder and a lot of perfectionism, I actually had to do a deep study on how it was impacting my life because, as my therapist was trying to get me to change these behaviors, I was showing up with a lot of restriction and a lot of resistance. I did not want to stop. I said to her, "I'm not ready to get rid of these behaviors. They keep me safe. They keep me feeling like I'm in control. I don't want to feel out of control. I don't want to feel imperfect. I don't want to feel shame. I don't want to feel vulnerable. I don't want to take these behaviors away." But as I looked at how they were impacting my life, I then started to realize how they're actually keeping me trapped and holding me back.  Explore how society encourages perfectionism The second piece was, I had to then do a deep exploration and look at how society had encouraged me to maintain my perfectionism. I had people all around me cheering me on. "Good job. Keep going." "You're so thin. Look at you thrive." "You're so successful. I can't believe how you do it." "I'm so impressed. You inspire me." I was constantly fed reinforcement. That kept me trapped in perfectionism and made me want to stay in perfectionism, but kept me anxious, kept me feeling like I was a complete fraud, kept me feeling like I was an imposter who, if anyone would ever find out that I'm actually this imperfect, terrible, hopeless human being with no worth, I couldn't bear the idea of that, And so, I really had to look at how society had fed me into this system as a woman, but also as a human being and as a young person, how this had kept me stuck, and how it was going to keep keeping me stuck if I didn't start to change some things.  Determine how YOU want to live your life Now, the next thing I had to do is really look and determine how I wanted to live my life, and that was really influenced by my personal values. What was important to me? Is my uncle's opinion of me or my coworker's opinion of me more important than my own opinion of me? I used to first say yes, but with practice and really looking at it, I started to realize I'm going to die with everyone thinking I was perfect and I'm going to die miserable. I wouldn't have done the things I wanted to do. I was living a life based on what other people thought of me and living a life basically hiding from all of my feelings, which brings me to the next big, big, big point of my recovery.  Learn to feel your feelings If I could say one thing was the most important in my recovery, it would be this: I had to learn how to feel my feelings, and I had to be willing to ride out some really uncomfortable feelings that I had about myself. I had to write out shame and still do. I had to write out feelings of being worthless, and still do. They still show up, and when they do, I instinctually go to run away from them, and then I have to slow myself down and say, "Kimberley, just stay. Be here with it. Running from this emotion, patching it up, or making it look pretty is only going to keep you trapped and create a life where you're more and more and more anxious."  Develop a self-compassion practice I also had to develop a very strong self-compassion practice, but that actually came last for me. I'm really doing my best with my patients and with you here today to have that be a beginning part of your recovery. But for me, I refused it. I hated the idea, and I didn't want to do it. I felt it was weak, and I actually thought it would override my perfectionism and make me into some kind of weak loser who can't control their life, and all these words, like, I'll be a failure, I won't be successful, it'll make me lazy. I had a whole belief about what self-compassion would do to me. But with time, I did start to see the benefit of it. And again, it's something I still have to work on.  Understand that this is a life-long process of recovery I had to also recognize that this was a lifelong practice. I do remember, and I will share a story with you, that early in my perfectionism treatment, I actually stopped treatment. I told them, "I'm fine. I'm doing great. I don't need you anymore," and off I went. A part of that was me, because I think I was really afraid to do the next level of work, but I think another part of me truly thought that that was all it took. But then, as I struggled with different stresses in my life, or as it continued to show up in my relationships and at my work, I realized this is a lifelong practice. This is something I'm going to need to practice for some time.  BELIEFS THAT WILL HELP YOU OVERCOME PERFECTIONISM Now, before I finish up with you, I want to share with you some beliefs that I had to adopt to help me overcome perfectionism, and I had to remember these every step of the way. Now, I was really lucky I had a therapist who would reinforce this with me every single week, but maybe you don't. And so, I wanted to just be here to share them with you, just in case they're helpful with you managing your own perfectionism. So, here they are.  IT IS OKAY TO MAKE MISTAKES  The first belief I had to adopt is, it's okay to make mistakes. It's human to make mistakes. I also had to reframe what a mistake meant. As I said before, a mistake didn't make me a failure anymore. Instead, a mistake was data to help me learn and challenge this problem I was having. And now I've done my best. I've even done episodes on Your Anxiety Toolkit, talking about how I went out and purposely made mistakes a hundred times in less than a year because I still realized I had to challenge this idea that getting a no, getting rejected, or making a mistake is a problem. IT IS OKAY IF PEOPLE DO NOT UNDERSTAND ME OR LIKE ME Another thing I had to adopt is, it's okay if people do not understand me or like me, and this one still breaks my heart. I'm not going to lie, it's still really, really hard for me. But it is important to recognize that most of the time, you can be imperfect, and people will still make space for you. It is okay to not be perfect. In fact, I have learned the more perfect I tried to be, the more disconnected I was with people. The more perfect I tried to be, the more I sabotaged relationships. I made other people feel judged and uncomfortable. I made it feel unsafe for them to be imperfect, therefore impacting our ability to be vulnerable and in deep connection with each other. WHEN I AM IMPERFECT, I BECOME MORE CONNECTED So by being imperfect, I actually learned that the real relationships started to show up, that I could be vulnerable, and then they would be vulnerable. And I would feel seen, and they would feel seen. And then I would feel worthy and they would feel worthy. And it healed itself in that respect through the relationships, through showing up imperfectly in relationships and letting them see that I'm actually struggling. I'm actually really having a hard time.  I remember talking to my therapist and saying, "Nobody would know." Nobody would know that I'm having such a hard time. But when I actually started sharing, other people started sharing, and I realized that I didn't have to be perfect because nobody was getting through this life without going through their own struggles and challenges. MY WORTH IS NOT RELATED TO MY OUTPUT Another really important thing I had to adopt is that my worth is not related to my output. And this is one I still have to remind myself that I do not deserve self-care and kindness just because I kicked butt at work today. That I'm allowed to have compassion, self-care, and pleasure, whether I was successful, made money, or achieved the things on my to-do list. That I'm always deserving of self-care and pleasure. That that is something innate inside of me and that I can use at any time if my body needs it. LISTEN TO MY BODY. IT IS WISE And then the last thing I had to adopt was truly listen to your body. Stop pushing through discomfort in a way where you know that you're pushing your body too hard or too fast. I would say yes to everything, even if my body was exhausted. I had to learn to listen to my body and listen to when my body was gently nudging me, saying, "Stop. I'm tired. I need to rest." That is still something I'm working on and something that I'll always have to be working on as I age and as my limitations change as well. So that's the things I want you to adopt to help you overcome depression. Now, you may have some other things that you need to adopt as well, and that's okay. I want you to make this as personalized as possible. But I do hope that this, number one, validated you and your perfectionism anxiety. I hope that it informed you of ways that it shows up for people. And third, I hope it gives you some inspiration that you too can overcome perfectionism anxiety and depression, and hopefully go on to live a very fulfilling life.  Have a wonderful day, everybody, and always remember it is a beautiful day to do hard things.

What if I never get better? This is a common and distressing fear that many people worry about. It can feel very depressing, it can be incredibly anxiety-provoking, and most of all, it can make you feel so alone. Today, I'm going to address the fear, "What if I never get better?" and share tools and strategies to stay hopeful and focused on your recovery. If you have the fear, "What if I never get better?" I want you to settle in. This is exactly where you need to be. I want to break this episode down into two specific sections. So, when we are talking about "What if I never get better?" we're going to talk about first the things I don't have control over, and then the things we do have control over. That will determine the different strategies and tools we're going to use. Before we do that, though, let's talk about first validating how hard it is to recover. Recovery is an incredibly scary process. It can feel defeating; it can feel, as I said, so incredibly lonely. When we're thinking about recovery, we often compare it to other people's recovery, and that's probably what makes us think the most. Like, will I ever recover? Will I get to be like those people who have? Or if you see people who aren't recovering, you might fear, "What if I don't recover either?" even if you're making amazing steps forward. It can be an exhausting process that requires a lot of care, compassion, and thoughtful consideration. Most of all, recovery requires a great deal of hard work. Most people, by the time they come to me, are exhausted. They've given up. They don't really feel like there's any way forward. And I'm here to share with you that there absolutely is, and we're going to talk about some strategies here today. Now, that being said, while all of those things are true—that it is hard and distressing and can be defeating—I wholeheartedly believe that recovery is possible for everyone. But what's important is that we define recovery depending on the person. I do not believe that there is a strict definition of recovery, mainly because everybody is different, everybody's values are different, and everybody's capacity is different. So we want to be realistic and compassionate, and we want to make sure our expectations are safe and caring as we move towards recovery. Let's talk about what that might look like. Again, it's going to be different for every person.  WHAT IF I DON'T GET BETTER FROM OCD?  If we're talking about recovery for OCD, let's say we're going to be talking about what's realistic. Again, what's compassionate? So, if someone comes to me and says, "I want my goal of recovery to be never to have anxiety and never have intrusive thoughts ever again," I'm going to say to them, "That sounds really painful and out of your control. Let's actually work at controlling your reaction to them instead of trying to tell your brain not to have thoughts and not to have feelings, because we all know how that works. You're going to have more of them, right?" But again, the degree in which you recover is entirely up to you. WHAT IF I DON'T GET BETTER FROM GENERALIZED ANXIETY DISORDER?  Recovery for anxiety or generalized anxiety is going to be the same. I am probably going to use me as an example. I have generalized anxiety disorder—it doesn't stop me from living my life as fully as I can. It's still there, but I'm there to gently, compassionately respond to it and think about how I can respond to this effectively. I think I'm genetically set up to have anxiety, so my goal of recovery being like never having anxiety again is probably not kind; it's probably not compassionate or realistic. WHAT IF I DON'T GET BETTER FROM DEPRESSION?  Recovery for depression—again, it's going to look different for different people. Some people are going to have a complete reduction of depressive symptoms. Other people are going to have a waxing and waning, and I consider that to still be a part of recovery. It might be that your definition of recovery is, "As long as I'm functioning, I can take care of my kids, and I can go to work and do my hobbies." If that's your definition of recovery, great. Other people might say, "My definition of recovery is to make sure I get my teeth cleaned, go to the doctor once a year, and have an exercise schedule," and whatever's right to them. Really, again, I want to be clear that you get to decide what recovery looks like for you. I've had people in the past say, "I've considered my recovery to be great. I'm not ready to take those next extra hard steps. I'm happy with where I am, and I'm actually going to work at really accepting where I'm at and living my life as fully as I can, whether these emotions or these feelings are here or not," and I love that. WHAT IF I DON'T GET BETTER FROM HAIR PULLING AND SKIN PICKING?  Recovery for hair pulling and skin picking—another disorder that we treat at our center in Calabasas, California—might be some reduction of those behaviors. For others, it might be complete elimination, but you get to decide. WHAT IF I DON'T GET BETTER FROM MY CHRONIC ILLNESS?  I know that for me, the recovery of a chronic illness was not the absence of the chronic illness. It was getting in control of the things I knew I could control and then working at compassion, acceptance, care, support, and resources for what I could not control. So I really want to emphasize here first that we want to be respectful. I want to be respectful of your definition of recovery before we talk about this fear specifically related to "what if I don't recover." Some people have the fear that they won't recover, and that might be valid because they've put their expectations so high that the expectation in and of itself causes some anxiety. WHAT DON'T I HAVE CONTROL OVER?  So let's talk about it first. We're going to first talk about what I don't have control over, and this is what we're talking about here in regards to how I manage this fear.  Now, the first thing to do when we're talking about what we don't have control over is, we don't have control over the fact that we have this fear. Of course, this fear is coming up for you because you want to recover, you want to live your best life, and you deserve that. You deserve to have a life where you go on to succeed in whatever definition that means to you. But we can't control the fact that your brain offers you the thought, "What if I don't recover?" We don't have control over that, so let's try not to stop or suppress those thoughts. We know that with research, the more you try and suppress a thought, the more often you're going to have it. The other thing we don't have control over, and I actually mentioned this before, is, we have to acknowledge our genetics and acknowledge that genetics does have a play in this. I'm never going to probably be someone who is anxiety-free. My brain comes up with some ridiculous things. My brain loves to catastrophize. My brain loves to find problems where there aren't problems. That is my brain. As much as I can work at eliminating how I react to that, I'm probably not going to stop that entirely. So I'm going to accept that I don't have control over my genetics, and that's okay. A quick note here too is, if you do have anxiety and it is a part of your genetic—DNA, your family team tends to have it—also catch your anger around that. You're allowed to be angry; you're allowed to be dissatisfied or have grief about that. But we also want to catch that as well. Again, we do have to just acknowledge that no one has control over their genetic makeup. The third thing to remember here is that recovery is a series of valleys and peaks. That we do not have control over. Some people have extreme fear that they will never recover because they believe or were led to believe that recovery should be this very straightforward recovery process where you go from A to B, there's no peaks and valleys, and it's all straightforward from there. We do have to accept that it is normal. Recovery will always have peaks and valleys. It will always have highs and lows. And that actually doesn't mean you are relapsing or anything bad is happening. I actually say to my clients a lot of the time, and I often will demonstrate to them as I'll say, "You're in the messy middle. You've started recovery, so you've made that huge step. You've gone through that chapter where you're learning and you're ready for it, and you've educated yourself and you're prepared. And now you're starting to make some strides. You're seeing where you're doing well. We're also seeing where there's challenges. You're in the messy middle, and this is where valleys and peaks, ups and downs are going to happen. Our job isn't to beat you up when you're in a valley or a low; our job is to stop and just inquire, nonjudgmentally, what's going on? What can we learn from this? What could help me with this if I were to navigate this in the future?"  This has been a huge piece of my work managing a chronic illness because I could wake up tomorrow and not be able to get out of bed, but today I feel like I'm full of energy and all good. It's completely out of my control sometimes. On the days where I don't feel like I can get out of bed, my job is to recognize that this is normal. This doesn't mean it's going to be forever. Can I be gentle with myself around this hard day and not catastrophize what that means? So, there are the three things we can't control.  WHAT DO YOU HAVE CONTROL OVER?  Now we're going to move over to the things we can control. There are actually seven of these things, and we're going to go through them, and they will inform the tools and strategies you are going to use when you're handling the fear, "What if I don't ever recover?" HOW DO I RESPOND TO THIS THOUGHT? Number one, something that we do have control over, is: how do I respond to this thought? Now, you must remember, the fear, "What if I don't recover?" or "What if I never get better?" is actually just a thought. It's not a fact. It's not the truth. It's a thought your brain is offering to you, and we want to thank it for that thought because your brain's trying to help you along. It's saying, "Just so you know, Kimberley, there is a small possibility that you won't recover. What can we do about that?" But if you have that thought and you take it as a fact, like you won't recover, or recovery is not in your future, and you respond to it that way, you're going to probably respond in a way that increases anxiety, increases depression, increases hopelessness, and isn't kind or effective. So we want to first acknowledge, okay, in this present moment, maybe it's Tuesday at 9:30 in the morning and I'm having the thought "what if I don't recover," knowing that on Tuesday at 9:40, I might be having different thoughts, which is again evidence that thoughts are not facts. They're fleeting. They're things that show up in our minds. We can decide whether to respond to them or not. Now, what we want to do when we do have this thought is respond to it in a kind, compassionate way. For those of you who know me and have followed me for some time, I'm always talking about this idea of a kind coach. The kind coach would say, "Okay, I acknowledge that's a thought. Okay. What do we need to do? Kimberley, you've got this. Keep going. Keep trying. You know you've done this valley and this peak before. What did you do in the past that was helpful? What did you do in the past that wasn't helpful? Great, let's do more of that." The kind coach cheers you on. It's there to encourage you. It's there to remind you of your strengths.  HOW COMPASSIONATE ARE YOU TOWARDS YOURSELF  It's not there to bring your challenges and use them against you, which brings us right to tip number two, which is, you have 100% control over how kind you are to yourself throughout the process.Actually, let me renege that maybe not a hundred percent because I know a lot of you are new to the practice of self-compassion, and sometimes we do it without even knowing. So let's also be realistic about that as well. Forgive me. We can really work at changing how kind we are to ourselves when we have that thought. Let's say you've been through the wringer. It's a very Australian frame or quote, but you've been through the wringer, which means you've been through a really tough time, and you're thinking, "I only have evidence that things go bad or things get worse." A kind coach, your compassionate voice, or your compassionate self—that compassionate part of you would be there to offer gentle, wise guidance on what you need to do for the long term to move you forward. Again, that compassionate voice will validate how hard it's been. It will not invalidate you. It will say, "I understand it has been hard. I understand that this is really, really challenging." It will also offer you kind, effective, wise ideas for what you could do in that moment. Sometimes the kindest thing we can do is just acknowledge the thought and keep going. Sometimes the kindest thing we can do is to say, "No, brain," or "No, anxiety," or "No, I'm not buying into this today. Thank you very much for offering it to me, but you do not get to determine where I'm headed. I get to determine where I am headed." So, compassionate reactions aren't just gentle. Sometimes they're quite assertive and they'll say, "No." Sometimes they might even swear, like, "Bug off, anxiety. I'm not dealing with you today. You're not going to tell me what to do. You can come along for the day's ride. I know I can't get rid of you. I know it's out of my control to try and get rid of you, but you will not determine what I'm going to do today. You'll not get to tell me that my life will be bad, or my life will be terrible or unsuccessful, or I won't have recovery." You get to stand up to fear in that way and let that then inform the actions you take from there. HOW MUCH TIME ARE YOU DEDICATING TO RECOVERY?  The tip or tool number three is, also take a look at how much time you're dedicating to recovery. I've had patients who've come to me really struggling with this fear that "what if I never recover?" We actually find that they're not engaging enough in the recovery skills and tools throughout the day. It's sort of like going to the gym. If I went to the gym for an hour, once a week, yes, I would have some improvements, but to really maintain those improvements, I do need to be doing my homework, my stretches, my walks, and my weight training in a way that's effective and not overdone throughout the week. So a lot of you, if you're struggling with this, be gentle around this question, because we don't want to overdo it either. But we may want to check in and say, "Let's be strategic here." I know that in our online course—we have an online course called Time Management for Optimum Mental Health. It's a course to help people schedule and manage their time so that they can prioritize mental health and other things they have to get done. There are other priorities, chores, and things they have to do. We often talk about, let's put mental health first. Have you scheduled it in your day to do your homework if you're doing ERP? Have you done that? Have you scheduled a time or an alarm to go off to remind you to sit and journal, do some self-compassion practice, or meditate? For me, a big one from my mental health is an alarm to say, "It's time to leave the house. You need to get outside." I work from home. I'm often indoors with my patients. "It's time for you to go outside." That is important for your long-term mental health or your medical health. And so, it's important that we are very strategic and effective about scheduling. I call it calendaring. We calendar recovery-focused behaviors. That is something you do have control over. Again, you do not have control over the fact that the fear is here. You don't have control over whether it will return tomorrow, but you do have control over your recovery and the steps you take, acknowledging that there will still be peaks and valleys. It will not be perfect. One thing I want to stress to you—and I shouldn't laugh because it's actually not funny; it's actually very serious—is that so many people start recovery and get perfectionistic about it, which is often why they're having the fear "what if I never recover," because they've told themselves there is this one way that they are going to recover and that it again shouldn't have peaks and valleys and it should be this way, and I shouldn't be hijacked by any other things. But the truth is, life happens along the way. You might be cruising along with recovery for your specific struggle, and then all of a sudden, a life stressor happens, like COVID. Here in LA, my husband works in the film industry. There's a huge strike happening. It's a huge stressor for a lot of families. It's been going on for months. A lot of families. I have all kinds of stresses—financial, relationship, and scheduling struggles. Life does happen, and so we have to be gentle with ourselves on the times when our recovery isn't going to the speed we would've liked because of the life hiccups that happen along the way that slow our progress. When that happens, we can gently encourage ourselves that we are doing the best we can. We're going to be okay with the fact that it's a little slower. We're going to let ourselves have our emotions about the fact that it's slower than we would've liked, and we're going to gently just keep taking one step at a time in the direction you want to go in. HOW WILLING AM I TO RIDE THIS WAVE OF DISCOMFORT? Now the fourth thing you want to remember here, and something that is in your control when it comes to the fear "What if I don't recover?" or "What if I never get better?" is how willing am I to ride waves of discomfort? This question is key, you guys, and will determine a huge degree of how speedy your recovery is. Maybe it's not even speedy. For some people, it's speedy, but for others, it's how deep the recovery process goes. I know for me that I often will try to get things to move along nice and fast and on schedule and so forth, but I've really missed the true meaning, which is, have I actually learned how to be with myself when I'm uncomfortable? Have I actually slowed down and really had a degree of willingness to be with whatever discomfort it may be—tightness in my chest, racing thoughts, not in my throat, an upset stomach? Am I actually willing to allow that to be there AND still moving in the direction towards my long-term wellness? Often, when discomfort comes up, we're like, "I don't want to feel this. I don't want to have this experience." And that's often when we engage in behaviors that keep us stuck and keep us out of recovery, keep the disorder going. We know that when we engage in behaviors like compulsions, avoidances, and mental rumination, that often just keeps us stuck and keeps us cycling on the same anxiety and the same disorder. The big question: How willing am I to ride this wave of discomfort? You may want to even put it on a scale of 1 to 10. You might say, "Out of 10, how willing am I to ride this wave? 10 being the most, 1 being not at all." I always say to my patients, and I've said it here before, we want to be up around the 7s, 8s, 9s, and 10s. Even 7 is fine. It's all fine, but we're looking for 8s, 9s, and 10s here of how willing you are to really, truly just allow discomfort to be there and observe it as it's there and not engage in it again, as if it were a fact. HOW ACCEPTING AM I OF THE UPS AND DOWNS? Number five is, how accepting am I of the ups and downs? Now, we've talked about this, the peaks and the valleys. When you're going through peaks and valleys, how accepting are you of that? Or when they happen, are you like, "No, this shouldn't happen. I don't like it. I don't want it. It's not fair"? I want to validate you. That response is normal and human, but we want to be careful not to stay there too long because when we're there, we're actually not moving forward. We're then often so much more likely to beat ourselves up, put ourselves down, and compare ourselves to other people. What we want to do is just gently accept. I understand. I validate that this is hard and that we may have taken a step back, and I do accept that. I take responsibility for that in the most compassionate way, and I'm still going to stand up and keep moving forward. It's like that song. I may be aging myself here, but they say, "I get knocked down, but I get up again." He talks about how nothing's going to get him down. This is what recovery is. You get knocked down; you get up again. Maybe it should be your theme song—you get knocked down, you get up again; you get knocked down, you get up again. And that is so brave. I celebrate any of my clients or any of my students when they say, "I got knocked down, but I got back up again." That is so powerful. So courageous. So resilient. I just have all the words to say. I celebrate anybody who is willing to get knocked down and still get up again. So I hope that you can practice that for yourself.  HOW PATIENT AM I WITH THIS PROCESS? Number six is, how patient am I with this process? A lot of these are similar, I know, but patience is actually something I talk with clients about all the time. Often, particularly when they have the fear, "What if I never get better?" it's often because they're struggling to really connect with patience. They're doing the actions. They're engaging in their homework. They're moving forward. The only thing that's getting in the way is they're losing patience with the process.  This takes time, guys. Changing your brain takes time. It is a long-term process. Just like any muscle that you're building, whether it be bicep curls, quadriceps, or your brain, it does take time. We do have to practice the mindfulness of being patient, steady, and slow, letting it be a process. I know, I hate it too. No one wants to be patient. It would be so much easier if it just happened fast, and you're probably seeing other people where their successes happen faster than yours. But again, go back to: how willing am I to be uncomfortable? How accepting am I of my ups and downs? How can I be accepting of my own genetic makeup and the way that my brain responds? How patient can I be with myself in this process? AM I ASKING FOR HELP?  And then that brings us to tip number seven, which is, are you asking for help? Please, guys, as you navigate recovery and as you navigate the fear that you won't recover, please do not hesitate to ask for help. Ask for support. Ask for resources. We have over 350 episodes here at Your Anxiety Toolkit. They're there to support you, to cheer you on, and to celebrate your wins. There are therapists there who are there to help you and guide you. We have a practice in Calabasas, California, where we help people move towards their values as well. There are clinicians in your area. If you don't live in California, we have a whole range of vaults of online courses, if you're needing more resources or reminders.  A lot of the people who take out online courses at CBTSchool.com actually have been through treatment, but taking a course helps remind them of the core concepts. "Ah, yes. I needed to remember that. I forgot about that." It's okay. The courses are there. You can watch them as many times as you want. They're on demand. Again, you've got unlimited access. They're there to encourage and support you and push you towards the same concepts of moving towards your definition of recovery.  They're the seven tips I want you to think about. We are here to encourage and support you as best as we can and give you those strategies and tools. But the big question again is, are you putting them into practice? Please don't listen to this podcast and go on your way. The only right way that this podcast will truly help is if you put the skills, the tips, and the tools into practice. I always say it's a beautiful day to do hard things, and I really believe that. So I hope today has been helpful. We have really gone over what is in your control and what is not in your control. Please focus on the things that are in your control, and I hope you have a wonderful, wonderful day. I'll see you next week.

[00:00:00] If social media causes anxiety, you will find this incredibly validated. Today, we are covering the nine reasons why social media causes anxiety and depression, and we will get specific about how you can overcome social media anxiety and depression. In a way that feels right to you, so let's go. If you hear yourself saying, social media gives me anxiety, you are not alone. In fact, many people say it gives them such overwhelm and panic they just want to shut it down completely. That is a common experience, and I want to provide a balanced approach here today. So, let's first look at some social media stats. Research shows that people use an average of 6.6 social media networks monthly. When I heard that, I thought that couldn't be true, but I counted the ones that I use, and it is. I thought that was [00:01:00] very interesting. That sounds like an incredibly massive amount of social media networks. But the average time spent on social media daily is two hours and 24 minutes, not weekly, daily. While 67% say they have a drop in self-esteem as they compare their lives to others they see on social media, 73% of people report. They also find solace and support in these platforms during tough times. We all experienced that during COVID-19, and I know that as someone who lives in America but is Australian, social media has allowed me to be friends with people from high school & college; I get to be connected with my parents' friends. I have found it to be an incredibly beautiful process, but today, we're looking specifically at how social media impacts our mental health, particularly how it causes anxiety and depression.  Now [00:02:00], we have some social media depression stats here as well. We do have research to show a link between social media use and depression. More than three hours on social media daily does increase your risk of mental health problems.  This study was done specifically for teens, but I think as adults, we could all agree that's probably true as well. There are also some social media addiction statistics that we want to know. We know that 39% of social media users report being addicted to social media, meaning they want to get off but can't. Or, they experience adverse experiences and consequences when they're not using it in moments of distress and needing to regulate. We may also look at some social media anxiety disorder statistics. Studies showed that around 32% of teenagers say social media increases their anxiety and hasn't had a [00:03:00] negative impact on people of their age.  However, I found it interesting that only 9% believed it was the case for themselves, but they believed that for others. Interesting statistic. 67% of adolescents report feeling worse about their own lives after using social media, and most teenagers say that social media has had neither a positive nor a negative effect on themselves. So, we are getting some mixed statistics here. The real point for you is to decide for yourself. Is it helping me, or is it hindering my mental health? And if it is, let's discuss some skills we can use. So here we go.  NINE REASONS SOCIAL MEDIA CAUSES ANXIETY We have nine reasons social media causes anxiety. Now, to be clear, this needs to be scientifically backed. I did a review from people on Instagram. It's funny how it's a social media platform. Still, I did interview them and did a poll and also have a question box where they get to put [00:04:00] their specific reasons why some social media has impacted them negatively. And here are the results.  SOCIAL MEDIA COMPARISON So, the number one reason social media causes anxiety is comparison. Social media comparison seems to be the biggest reason for increasing anxiety and depression, and I think it's important that we identify how social media comparison impacts us. Now, what I've found as a clinician and a marriage and family therapist in helping people with anxiety is how often social media reinforces untrue beliefs they have about themselves. Or, we could say negative beliefs that they had already.  Examples: I'm not good enough.  I'm not doing enough.  I'm not happy enough.  I'm not making enough money.  I don't have enough followers.  I'm not succeeding enough.  And that constant, having it in your face of what they're doing and seeing their highlight reels makes us feel like we're not doing enough [00:05:00] and maybe bringing up the insecurities that we aren't enough.  So, it's really important that we first use social media as an opportunity to take a look at those beliefs and those thoughts. What thoughts does social media bring up for you? Are the thoughts true? Are they helpful? Do they determine facts, or are they just feelings and thoughts you've had on a whim because of your anxiety?  When we look at those thoughts, we can then determine whether we want to respond as if those thoughts are true. It's also important to recognize that people only post what I call their "A-roll." They don't post their B roll. They don't post their C roll. They only post the highlights. They post the things they're most excited about. They post the things they want you to think about. No one wants you to see their dirty socks, laundry, meltdowns [00:06:00], and relationship struggles.  People are talking about that on social media, but even those people, we can't assume they're not showing us, you know, only the good stuff. It could be that they're also showing, you know, only the good stuff.  FEAR OF BEING JUDGED BY OTHERS Now, we can move on from there and look at the number two reason that social media causes anxiety and depression, and that is the fear of being judged by others. The truth is that social media can cause social anxiety, which is the fear of being judged, humiliated, and shamed publicly. I'm going to really encourage you guys to use social media as an opportunity to practice letting people have their opinions of you. One thing I have learned. Being on social media a lot and being a public figure in many, you know, this small area that I'm a public figure in is I've had to learn how to let people have [00:07:00] their opinions about me. I've had to give them permission not to like me. I've had to practice allowing the right in writing the wave of discomfort that I'm not for everyone. The truth is, when we are on social media, we have to face the fear that our opinions may upset people.  People may say things about or critique us, which may impact how we feel about ourselves. I've been through a lot of therapy here, so I can speak about this a lot. I'm okay with people not agreeing with me, not liking me, or understanding me. I've gotten really good at allowing them to have their feelings and thoughts about me. I'm going to have my feelings and my thoughts about them too. Does that mean I don't care about what they think? Absolutely not. I deeply care what they think, but I have learned not to let it imprint how I show up on social media [00:08:00] and how I feel and think about myself. TROLLS The number three reason that social media causes anxiety is trolls. Getting bullied is a huge piece of social media; we see it daily. I have been trolled. People have insisted on taking me down for years, and I have, through what I just talked about, learned to give them permission to really not like me. I've even considered their opinion and really thought about, "Do they have a point?" How can I look at this from a place of compassion? Is it true? Is what they're saying? Factual In many cases, no. Right. Um, the truth is, hurt people hurt people. So, the people online who are saying horrible things usually come from a great deal of hurt, harm, and pain. That doesn't mean I'm saying it's okay that they're doing this behavior. [00:09:00] We must also recognize from a place of compassion that most trolls out there are doing it, not because they're happy, fulfilled people, but because they're on a mission to take people down with them. And that really helps me to be compassionate and not take on their opinion, um, and allow it just to be a part of social media and not take it personally right now.  FEAR OF BEING CANCELLED The fourth reason social media can cause anxiety is the fear of being canceled. You may see that these points are growing on each other. Cancel culture is a thing, folks, and I get it. It is scary out there. Many of you say that being on social media, even commenting on your friend's posts, creates the fear that you might say something that will offend them and cause you to get canceled [00:10:00] Maybe you feat that on a whim, you say something or you make a joke that causes you to get canceled. This is a widespread one as well. A lot of folks who weighed in were saying that this is a true fear for them. As someone who has come head to head with this, what was really helpful for me was actually to write down a cancel campaign of my own, which is like, what is the worst thing someone could say about me, you know? What would it, what would they say? Sometimes people will say negative things, which doesn't hurt my feelings, and sometimes I'm afraid they'll say certain things that would really hurt my feelings. I use that as an opportunity to look at those and ask, why are those things so important to me? Is it my values? Is there something about that where I was taught to be ashamed of those qualities as a child? Am I afraid of how people will stand up for me? Or am I afraid of how I will handle this sort of public shaming that goes on.  [00:11:00] It was a super helpful experiment that I did with a therapist to really help me get to the bottom of what the fear is, um, and go from there. Of course, I won't say anything mean on social media. I'm not concerned about that, but I am worried at how people will go out and attack me, because it has been something that I've dealt with in the past, and it sounds like it's something that's bothering you guys as well. FOMO Now, we move on to number five. The fifth reason that social media causes anxiety is FOMO. The fear of missing out is a real thing. If you fear missing out, social media can make this so much worse because you will often see other people going off to college, and you see somebody else starting a job in their hometown. You might be thinking that maybe I should have done that. Maybe that the fear of you're missing out on that opportunity. Perhaps you chose to go [00:12:00] to the movies, and then you see a social media post about other people who decided to go to a party, or maybe you went to the movies not knowing there was a party, and then you had deep hurt feelings about not being invited. These are true real emotions, and I want you to slow down for all of these points, but especially this one and give yourself a ton of compassion. And understand that social media does have everybody's a-rolls, and it will mean tou will have emotions. Normal human emotions like jealousy, envy, anger, and resentment. That is a normal human emotion. When we're on social media, we judge ourselves for the emotions we feel about what we see on social media. I shouldn't be judging them. I shouldn't be jealous. I shouldn't be angry. I wanna give you permission to acknowledge and feel all of those feelings [00:13:00] 'cause they're normal human experiences. SOCIAL MEDIA HIGHLIGHTS NEGATIVITY The sixth reason that social media causes anxiety and depression is that social media highlights negativity.  Many of you said that you have tried your best to turn off the news. I don't sign onto the news apps, but other people post about things that frighten me when I go on social media. Shootings, global warming, politics, religion, and they were saying that this really creates a lot of anxiety and stress on their nervous system as they just want to have some fun on social media and have a few laughs and watch a few baby dogs and kittens. Have a little fight over a piece of string or something. I get it. I've had that same experience, too. It's the end of the day you're thinking, "ah, I just want to check out and do a little deep breath and then zone out on social media, " yet you're faced and [00:14:00] bombarded with negativity. If that's the case, and this goes for all of the points we're making, do an intention check as you log on to social media. Check in. Do I have the capacity to see things I don't want to see when you see them? Have I got the discipline to turn it off if it's unhealthy for me? It is really, really important piece that we have to remember here. Similar to that.  SOCIAL MEDIA TRIGGERS MY ANXIETY DISORDER The seventh reason social media causes anxiety is seeing things that trigger my anxiety. A lot of you said that you go on social media, and lo and behold, your exact fear shows up in somebody's feed, right? Maybe you're afraid of spiders and they've posted a photo of a funny spider, or maybe you're afraid of throwing up or getting sick. Someone's posting about getting cancer and having to be admitted into the hospital. I know [00:15:00] personally, when I was sharing about, you know, all of the medical issues I was having in 2019 and 2020, a lot of people were so kind and so loving, and some people actually reached out and said, I am so incredibly triggered. What's happening to you right now is literally my worst fear coming true. And so I get it. Again, we have to do an intention check when we go on social media and be prepared to see what we don't want. Right? One thing to know here, too, and this is a skill I want you to take on or more, it's actually a strategy, is you can train the algorithm to do what you want it to. So, as you've probably already experienced, if you wanna see more videos of dogs, Google or search for dogs and it will start to show you more, particularly if you watch the video from start to end. You can also click on specific content. When you see something you don't want to see, you can click a button and say, see less of this, [00:16:00] or block this topic, or block this hashtag. And that can be a way to help you keep your social media clean. Right. Another thing to remember here and going back to seeing other people's a role, is you can actually mute your friends. They won't even know if what they're doing is too triggering and it's causing you so much depression, right? Because we do know that social media can cause depression. It's okay to take a break from them, particularly if they're in your face a lot with all their successes and wins. You can mute them. You don't have to unfollow them or block them. You can mute them, so you're still remaining friends. They still know that you're important to them and they're important to you, but you don't have to be seeing their content. You can take a break and set healthy boundaries with social media so that you're not continually being bombarded by what they're posting. That goes with things that trigger you as well, anxiety-wise. Now, the eighth thing that causes [00:17:00] social media, um, to cause anxiety is perfectionism. Now I've put two things in one here, which are perfectionism and exceptionalism.  Perfectionism is the hope to be perfect and not make mistakes. The truth is, on social media and off social media, you will make mistakes. You're not going to be perfect, and you have to bathe yourself in a ton of self-compassion when engaging on social media and giving yourself permission again to be imperfect is to let it be a little rough. You don't have to be perfect and make it curated. And all the things some people posted about how they even had anxiety about what graphics they use, um, how they're making their posts, whether they line up perfectly, whether the music is exactly the right thing. Again, just be real. No one wants to be friends [00:18:00] with perfect people. Believe me, I have found much more success on social media being a normal human being who is imperfect and is just regular old Kimberly. And yes, there are perfectly polished accounts, but you have to ask yourself, is that helpful for my social media? Maybe what they're doing is good for their mental health. Is it good for me? 9. SOCIAL MEDIA CAUSES OVER-STIMULATION Right now, the last one, the last point on why social media causes anxiety is overstimulation. This is a big one, and I finished with this one for a reason is social media posts are made to keep you on the platform. That's how they make money. The posts that get sent to you and are suggested to you are so short, fast, and funny because they're promoting the exact videos and campaigns that will keep you engaged. But the problem with that is if you're [00:19:00] engaging and consuming content that is fast-paced, short, the content is very quick and it changes 1, 2, 3, 4, really, really fast and example would be TikTok, it actually will leave your nervous system quite overstimulated. This is a problem, folks. The overstimulation. How social media content is delivered to us increases people's anxiety and stress levels. It increases the chance that they engage in safety behaviors such as compulsions because you put the phone down and you're literally vibrating from overstimulation. I'm going to encourage you again to do a check-in. Is this good for me? Does this makes sense.?Are the benefits outweighing the negative? And a lot of the time the answer is no. How do we fix this?  A lot of it that I have found is around setting strong [00:20:00] boundaries with social media. I created a course called Time Management for Optima Mental Health, and a reason for that wasn't because of social media; it was because many people with anxiety and depression tend to engage in behaviors that make their anxiety and depression worse. What we do in this course is work at scheduling the healthy behaviors first and then building your day around that. If social media is a problem for you, we're going to set some limits and intentionally put some parameters and boundaries in to help you manage your mental health.  Other resources include that most phones have a shut off time or an alarm that will alert you to when you've gone over or you have spent too much time.  Some phones also will give you a usage report. [00:21:00] I know my iPhone sends me a usage report every Sunday. Kimberly, your social media uses up by such and such a percentage. Or it's down, or you know, you're within your limits if you set limits for yourself. I know my daughter set a social media limit for herself because after a certain amount of time, she was getting overstimulated, and she was starting to feel lethargic and crappy. And then she wanted not to eat, exercise, sing, or do the things she loved to do. And that was an effective move on her part very, very wise. Another thing to remember is many phones. Well, all phones will have an app. There are many apps you can access that will shut your phone off so that you actually cannot access that social media app or pro platform once you've used a certain amount of time. And if you are someone who struggles with boundaries and really disciplined in that area. Go ahead and get [00:22:00] those apps. Invest in them because they will be better than therapy that you get. Maybe, probably not, but it will contribute and complement your therapy in that you've invested in this tool to help shut down. These apps if they're not helping you. Now, once again, I'm not saying all social media is bad. Again, social media has lifted me out of depression in many cases. When I was having a lousy day showing me funny things, you know, me passing back, . Funny, you know, reels between my husband and I is a way for us to connect when he's at work, when he's away, or when he's upstairs and I'm downstairs. It's not all that. It's about being intentional and checking in on what's helping you. What's not, it's going to be different for every person. So truly listen to yourself and go from there. Now, as I always say, it is a beautiful day to do hard things, and what that means [00:23:00] is setting limits is hard. It's not fun. It actually takes a lot of willpower. So do employ your support systems, ask for help, get a therapist if you need one, who can help you implement some of these tools. As always, I hope this has been helpful, and I look forward to talking with you next week.

Am I doing ERP correctly? This is a common roadblock I see every week in my private practice. I think it is a common struggle for people with anxiety and OCD. Today, we will talk about the three common OCD traps people fall into and how you can actually outsmart your OCD and overcome it. https://youtu.be/Ngb_lQK5Fnk?si=9FU42GZZZDJ58f-W Now, when we're talking about Expsoure & response prevention ERP, we must go over the basics of ERP therapy, so let's talk about what that means before we talk about the specific traps that we can fall into.  ERP is exposure and response prevention. It's a specific type of cognitive behavioral therapy and is the gold standard treatment for OCD to date.  And it's a detailed process, right? It's something that we [00:01:00] have to go through slowly. It's a detailed process where we first identify OCD obsessions and OCD intrusive thoughts. So, you'll identify precisely the repetitive, intrusive, and distressing things for you. Once we have a good inventory of your OCD obsessions, we then identify what specific OCD compulsions you are doing now. A compulsion is a behavior that you do to reduce or remove your anxiety, uncertainty, or doubt, or any kind of discomfort that you may be experiencing. And once we do that, then we can move towards exposing you to your fears. Exposure therapy for OCD involves exposing yourself to those specific obsessions. And then engaging in [00:02:00] response prevention, which is the reduction of using those compulsive safety behaviors. Now, common OCD response prevention will involve reducing physical behaviors, reducing avoidant behaviors, or reducing thought suppression. It's reducing reassurance, seeking, reducing mental compulsions, and in reducing any kind of self-punishment that you're engaging in to beat yourself up for the obsessions that you're having. Then we get you engaged back into doing the things you love to do; getting you back to engaging in your daily life, your daily functioning, the things that you find pleasurable, and your hobbies as soon as possible.  That's the whole goal of ERP. Right?  The important thing to remember here is that ERP therapy for OCD is greatly improved by adding in [00:03:00] other treatment modalities, such as acceptance and commitment therapy or mindfulness-based cognitive therapy, DBT, and medication.  I should have mentioned medication first because most of the science shows that that's one of the most helpful to really augment ERP therapy for OCD. If you want to go deeper into that, I strongly encourage you to check out Exposure and Response Prevention School. I'll show you how to do all of those steps in ERP school, our online course for OCD. You must know how to do those steps and that you're doing them in a way that's careful and planned so that we're not overwhelming you and throwing you in a direction that you're not quite prepared for; you don't have the tools for yet. And so today, I wanted to discuss three questions that come directly from people who've taken ERP school [00:04:00], and they're really trying to troubleshoot these three common OCD traps that OCD gets them stuck into. So, let's get to the good stuff now.  OCD TRAP #1: IF I DON'T ENGAGE WITH AN OBSESSION, AM I THOUGHT SUPPRESSING?   What if I don't engage with an obsession? Am I thought suppressing? One of our listeners said, "I know what you resist persists. We talk about that in ERP school, but I also know that obsessive thinking and worrying can become compulsive. Is it possible I could be caught in both situations, and how common is this?"  So I want to really be clear here in what we're saying when we say to practice ERP. So when you have an obsession or the onset of an intrusive thought or intrusive feeling, sensation, urge, it could also be an image. When you have that,[00:05:00] you're old way of dealing may have been to try and push that thought away with some urgency and aggression.  We call that thought suppression and that's an avoidant compulsion, so yes. This student of mine is correct. That becomes compulsive, right? But we also know if we go into the obsession, try and figure the obsession out, give it too much of our attention. We're also engaging too much with it in terms of using mental compulsions. That too is a compulsion. So we want to see that these two things can happen. But when we have the thought, and we observe that it's there the obsession, we've noticed it's there. Right? We talked about this in previous episodes of your Anxiety Toolkit podcast. When you identify it's there and then you say, I am gonna let it be there and still move on. To what you love to do, [00:06:00] what you value that is not resisting it, that is engaging back into what you find important and effective, and valuable for your life. It's not avoidance, it's not thought suppression. Now, if you do that in a way where you're like, oh, I don't want that thought. I want to engage in what I'm doing. Now you're crossing into that reaction being with . Urgency and resistance, and anytime we're doing anything in a sense of urgency and resistance, well, yes, it may be becoming a compulsion, right? And what we're talking about here, the way to manage this trap, right, is to find middle ground, and it often involves slowing. Down being a little more thoughtful in how you respond, and that's often using mindfulness. We talk a lot about mindfulness here in your, your anxiety toolkit [00:07:00] in observing, okay, this is happening. I. I'm going to respond in a way without urgency, and I'm going to come back to what I'm practicing. That isn't thought suppression. It's also not avoidance. It's also not doing a mental compulsion or ruminating. It's what we call occupation. You're engaging back into what you need to be doing. Right, which brings me right to trap number two, which is did I expose myself to the thought enough?  OCD TRAP #2: DID I EXPOSE MYSELF ENOUGH TO THE FEAR?  The fear, "Did I expose myself enough to my fear?" and, "if I dont engage with an obsession, am I thought suppressing? These are two very close obsessions. But, there's a nuance difference that I want to ensure we address here. So the student says, right now when anxiety sets in, I divert my attention to something else to focus on my values. Beautiful. Right? Then usually anxiety will wear off pretty quickly and I choose to move on. The problem is what happens next? So, so far this is beautiful. [00:08:00] Just like what we said they go on to say, my mind immediately points out the fact that I didn't quote, unquote, savor the anxiety or look it in the eye, right? And that they're doing that to prove they're not scared of it. Or that they can they can tolerate it, right? And so they go on to say, "OCD accuses that my diversion wasn't in fact occupation or being functional and effective, that it was avoidance and, and that I'm avoiding to deal the anxiety feeling that I have. And they then go on to say, this makes me more scared of the intrusive thoughts in the long run." So, if we were to break this down, this person had a thought, they responded really effectively. But then, this is the trap. OCD will usually tell you there's a way you're doing this wrong or there's a way that there's an additional thing you haven't addressed yet. It usually [00:09:00] is like you who I have more to say, have you thought about this? Like it's saying, you know, there's other things you should be worried about. And in this case, they have dealt with it really beautifully. But then OCDs come in and said, no, you didn't look at it long enough. You didn't face it enough. If you don't face it enough, well then you're gonna keep having this anxious feeling in the long run. And really in that situation, all we need to do, I. Is practice exactly the same tools we use with the first obsession, which is to go maybe, maybe not, but I'm not tending to you. I'm not trying to make this perfect. I'm going to move forward with what I am going to do and allow the uncertainty that I may or may not have anxiety about this in the future, or I may or may not have looked my fear in the face enough, right? Remember here that O C D. Is always going to try and bring you back into doing [00:10:00] a compulsion to try and get that uncertainty. And your job is to catch the many ways OCD consistently pulls you out of using effective behaviors and tries to get you to use compulsions. If you can find those trends, you can identify them as, okay, we know what to do when they come. When it tells me I'm not doing it enough, or I'm not looking at my fear enough, or I'm avoiding it, or whatever, you can go, I'm not tending to that. I'm moving back to my values. Right. Which beautifully now brings us onto the final trap, trap number three, which is, how do I know I'm doing ERP correctly? OCD TRAP #3: HOW DO I KNOW IF I AM DOING ERP CORRECTLY?    People often ask, "How do I know if I am doing ERP correctly?" This is a very common one. In fact, I have consulted with dozens of different OCD therapists, including the ones in my private practice. For those of you [00:11:00] who don't know, I have a private practice in Calabasas. We have eight incredible licensed OCD therapists. We are constantly consulting on this kind of question or these traps in particular, and it's often around, how do I know I'm doing this right? And it makes sense, right? If you're doing ERP therapy, you want to get better, you're here to get the job done, and you want your life back. You're not putting in all this time and paying all this money and investing your valuable resources, um, to just . Have a good time and waste it, right? You're here to get better. And so it makes sense that you're going to have some anxiety about how well you're doing it, and you're obviously wanting to do it well, like you're someone who is thorough and is invested, so it makes sense that you're going to have this fear. But this is the thing to remember. This is another trap of OCD to try and get you to go back to rumination, right? To try and figure something out. [00:12:00] Here is the facts. No one does ERP correctly. You are going to do ERP, and you are going to fall and you're going to try again, and you're going to fail again, and you're going to try again, and you may fail again. That is a normal progression of ERP. I tell my patients all the time, you're not backsliding. Nothing is particularly wrong right now. This is just the normal progression that we get better over time. Just like when we're learning to walk. You stand up, you fall down. It's not like you say, I'm not able to walk, I'll never be able to do it. You get back up, you walk three steps, you fall down, then you get back up, you walk five steps, you fall down. That's normal, right? We are not going to say to a young baby like, oh, you're not walking correctly. You know, this is bad. You're never gonna be able to walk because you're not walking correctly. No, we're going to say to them, keep going, keep trying. Just keep trying. And with time, those muscles will strengthen. And you'll be able to stand up and do this work a little longer each time, but do not fall into the trap [00:13:00] of O C D telling you it has to be done perfectly and you have to do mindfulness correctly, and you have to do response prevention correctly, and you can't do any thought suppression or you'll never get better. That is another trap, and your job is to say, good one, OCD. Thank you for your input, but I'm still over here with the focus of not trying to engage in rumination and trying to get certainty, but to, to move towards my values, to allow fear to be there imperfectly, right imperfectly, knowing that it won't be perfect every time. You may engage in some compulsions. I'm going to keep saying that that is not particularly a problem. Right. Especially if as you're doing it, you're using your tools and you're doing the best you can, try to just focus on doing one minute at a time and doing it as you can. And we're not here to do it perfectly. Right? And at the end of the day, if you're someone who struggles [00:14:00] with this thought, like, am I doing it correctly or am I doing it perfectly? You can just say, "Maybe I am. Maybe I'm not. I'm also not getting caught in that trap."  So I hope that that has been helpful to really get to know these traps. And for you, it mightn't be specifically these three common traps. It may be something a little different. That's okay. Your job is to catch these trends, the things that keep pulling you back into rumination, pulling you back into avoidance, pulling you back into reassurance-seeking, and identify them. Come up with another plan. Again, if you need more help with this, you can use E R P school. It's an online course. It's on demand. You can listen to it and watch it as many times as you want in your PJs. It's there for you to troubleshoot these issues. We have a whole bunch of modules talking about how to troubleshoot these issues, but I wanted to do this publicly because I knew A lot [00:15:00] of you who don't have access to care are probably struggling with the same thing. So that's it for me today. Thank you so much for being here. I love talking with you about the nitty gritty of how this can, you know the real hard stuff and I hope it's been helpful for you. Please do remember, and I say this at the end of every podcast episode, you know I'm gonna say it. It is a beautiful day to do hard things.  Do not let society tell you that you're weak or that you're not supposed to. And it should be easy because that's not real life. I know it's hard to accept that, but we can shift this narrative to a narrative where we can do hard things. We can see ourselves as strong. We can see ourselves as courageous, and we will do the hard thing because in the long run, we build resilience and freedom that way. Have a wonderful day, everybody, and I can't wait to see you next week.​[00:16:00]

If you are interested in stopping compulsions using attention control, this is the episode for you.  I am really excited for this episode. This was a deep dive into really how to fine-tune your mindfulness practice for anxiety and OCD. Today we have the amazing Max Maisel, who is an OCD and anxiety specialist here in California. He came on to talk about these really nuanced differences of mindfulness, where we might go wrong with mindfulness, how we can get a deeper understanding of mindfulness, and this idea of attentional control. The real thing that I took away from this is how beneficial it can be at reducing mental compulsions, putting our attention on the things that we value, putting our attention on what we want to put attention on, not in a compulsive way at all. In fact, we addressed that throughout the episode, and it's just so, so good. I'm so grateful to you, Max, for coming on, and I just know you guys are going to love this episode. Now, we are talking about some pretty difficult things, like things that are hard to do. I even roleplayed and explained how hard it was for me to do it. I want, as you listen to this, for you to please practice an immense amount of self-compassion and recognition and acknowledgment of just how hard it is to do these practices and how we can always learn more. Hopefully, something in this episode clicks for you and feels very true for you and is hopefully very, very beneficial.  I'm going to go take you straight to the show because that's what you're here for. Have a wonderful day everybody, and enjoy this interview with Max Maisel.  Kimberley: Welcome. I am so excited for this episode, mainly because I actually think I'm going to leave learning a ton. We have the amazing Max Maisel here today. Welcome. Max: Thank you, Kim. It's really good to be here. I'm super excited for our conversation. MINDFULNESS FOR OCD  Kimberley: Yeah. Okay. You know I use a lot of mindfulness. I am a huge diehard mindfulness fan, but I love that you have brought to us today, and hopefully will bring to us today, some ways in which we can drop deeper into that practice or zone in, or you might say a different word, like how to focus in on that. Tell me a little bit about how you conceptualize this practice of mindfulness and what you use to make it more effective for people with anxiety and OCD. Max: Yes, for sure. So, I'm a major proponent of mindfulness practices. I use it myself in my personal life. I integrate it in the clinical work that I do with clients with OCD and anxiety. But one of the concerns that I've seen in my clinical work is that mindfulness is such a broad concept and it covers so many different types of psychological suffering. The research behind mindfulness is just like hundreds, maybe even thousands of studies. But when it comes to very specific and nuanced concerns like OCD and anxiety, it could be a little bit confusing for people sometimes to figure out, "Well, how do I apply this really healthy, beautiful, amazing tool to how my own brain is wired in terms of like sticky thoughts or just to engage in all sorts of compulsive behaviors." I like to think about mindfulness from Jon Kabat-Zinn's definition at the core—paying attention to the present moment in a way that's non-judgmental and with this curious intentionality to it. But then within that, there's some really nuanced details that we can talk more about how to make that really relevant to folks with OCD and anxiety. THE DIFFERENCE BETWEEN ATTENTION & AWARENESS Kimberley: Tell me a little bit. When we're talking about mindfulness, we often talk about this idea of awareness. Can you differentiate first—and this is using some terminology just to set the scene—can you differentiate the difference between attention, awareness, and even a lot of people talk about distraction? Can you share a little bit about how they may be used and what they may look like? Max: I love that question. I think in a good OCD treatment, people really need to have a good solid understanding of those differences. I'm actually going to borrow from a neuroscientist named Amishi Jha. She's this incredible professor at the University of Miami. In her research lab, they look at the neurological underpinnings of mindfulness, and that very much includes attention and awareness. I highly encourage anybody to look up her work. Again, it's Amishi Jha. She talks about attention or focused attention. If you imagine there's a dark room, and if you turn on a flashlight and you shine that beam of light into that room and say that beam of light hits a vase on a table, again, what happens to that vase? What's different compared to all the things in the background? Kimberley: Is that a question for me? Max: Yeah. If you imagine a beam of light, what goes on with that? Kimberley: You would see the front of the vase, maybe it's a bit shiny, or you would see the shadow of the vase. You would see the colors of the vase. The texture of the vase. Max: That's exactly right. From this vivid and detailed, you can see all the different descriptions of it and it becomes privileged above everything else in the room. That vase is that beam of light. And then somebody might take that flashlight and shine it to the right a little bit, and then it goes from the vase, let's say, to a chair next to it. All of a sudden, that vase is still there, but it's fallen into the background. We might call that our awareness, which we'll talk about in a second. But then that table that we shine on or the chair is now privileged over the vase. That's how you can think about focused attention, is this beam of light. Whereas awareness, instead of a focused beam, you can think about that more as a broad floodlight where it's effortless, it's receptive, and you're noticing what is present in the moment without privileging one thing over the next. We're not focusing or hooked on anything particular in that room, it's just observing whatever comes up in the moment. Does that make sense? WHAT IS DISTRACTION?  Kimberley: It totally makes sense. Excellent. What about distraction?  Max: Distraction, when we think about that broad floodlight of awareness, where again, where what's privileges the present moment, distraction is trying to get things out of that. It's trying to suppress or not think about or get something that is in your awareness, outside of your awareness. But unfortunately, the trap that people fall into is in order to get something out of your awareness, what you need to do first is shine your beam of attention onto it. Inadvertently, while it might seem like a good idea in the short term, especially if it's something really scary, that pops up in your awareness like, "Oh, I don't want this. I want to get this thing out of my awareness." But in doing that, you're literally shining your attention. That flashlight is right on the scary thing. The very act of trying to distract, trying to push it away actually keeps that thing going, which is why it can be so easy and so tricky to get stuck in these pretty severe OCD spirals by doing that. Kimberley: Right. If we were talking about mindfulness, and let's go back to that, are attention and awareness both parts of mindfulness? Give me how you would conceptualize that. Max: That's exactly right there, and that's what I was talking about where mindfulness is such a beautiful, helpful practice and term. But oftentimes when we say just mindfulness, people don't understand that there are really relevant parts of mindfulness that are actually applicable skills that we can practice getting really good and solid without shining that beam of light and focusing flexibly on aspects of our experience. We can get good at letting go of that focused attention and just being with what pops up in our awareness, which are very relevant practices when we have OCD or anxiety. But if we just say mindfulness as a whole, paying attention to the present moment, we could miss these really important nuances and actionable skills that are different parts of mindfulness. Kimberley: Let's go deeper into that. Let's say you have OCD or you have panic disorder, or you have a phobia, and your brain-- I was talking with my son who has anxiety and he was saying, "I keep having the thought. No matter how many happy thoughts I have, it just keeps thinking of the scary thought." That's just a really simple example. How might you use attention versus awareness or attention and awareness for folks who are managing these really sticky thoughts, like you said, or these really repetitive, intrusive thoughts? Max: It's such a good question. OCD, I always talk about how clever and tricky it is. In order to get through OCD, we need to be even more clever, more tricky than OCD. One of the ways OCD gets people to fall into its trap is by confusing them. It gets people to try to control things that they cannot control, which is what pops up in their awareness, but it also blinds people and gets them that they can't see that there are things that are in their control. That will be really helpful, powerful tools, and OCD gums up the works a little bit.  MINDFULNESS & ATTENTION TRAINING To be more specific, there's an aspect of mindfulness that we can think of as attentional training or attentional flexibility. What that is, it's strengthening up the brain's muscles to be able to take control of that flashlight, of that beam of focused attention. OCD, what it's going to do, it steals it from you and shines it on the really scary stuff, like with your son, "Oh, here's a thought that you really don't like," or "Here's a really uncomfortable sensation." All of a sudden, that beam of light is shining there. What attention training does, it really teaches people to be able to first notice, "Oh, my beam of light is on something really scary. Okay, this is a thing. This is a moment to practice now." But then more importantly, to be able to then take power back and be able to shine that flashlight in flexible ways that are in line with people's values and goals versus are in line with OCD's agenda. But attention training, it's not only getting really good and powerful at shining that beam of light on what you want to shine, but it's also the practice of letting go of control over the stuff that's in our awareness. We're going to practice and allow those scary thoughts and feelings. I treat them like a car alarm going off where it might be annoying, might be uncomfortable, but I'm not going to focus on them. I'm not going to pay attention to it, because otherwise there's going to be front and center.  It's both. It's awareness, it's being able to flexibly shift between different aspects of our experience, and it's also allowing things to go, and you're like that broader floodlight of awareness. I always find it really helpful to practice the skill of attention training on non-OCD, non-anxiety neutral stimuli. It's not too triggering. And then we can start applying that to anxiety. If it's okay with you, Kim, I would love to walk you through some quirky little easy exercises that just help you maybe understand what I'm talking about and hopefully your listeners as well. Kimberley: I was just going to say, let's do it.  Max: Let's do it. Let's dive in.  Kimberley: Let's roleplay this.  ATTENTION TRAINING EXERCISE Max: Okay. I want you to roleplay with me and if your listeners would like to roleplay as well, more than happy to follow along too. Again, these exercises, I don't see them as like coping skills. I see them as like creating an understanding of what we can control, what we can't control, and being able to just feel what that's like in our bodies and know that this is something that we can do.  For the first one, what I want you to do is put your thumb and index finger together, like you're making an okay sign. Put a little bit of pressure between your thumb and index finger, but not a whole lot of pressure. Just take a couple of seconds and see if you can put your brain into your thumb and your index finger and just notice what that feels like. Notice the sensations. Let me know when you feel like you've got a good sense of the feeling. Kimberley: Yep, I got it.  Max: What I want you to try to do is shine that beam of attention. Really focus in on the pressure only from your index finger and see if you cannot think about not engage in the pressure from your thumb, allowing that to be there. See if you can really find and identify what your index finger feels like. let me know when you've got that. Again, not thinking about your thumb, just focusing on your index finger. Kimberley: Yeah, that was hard, but I got it. Max: It is hard, right? Because what we're doing is honing in that beam of light that we're paying attention to. What I want you to do now is switch. Let your index finger, let that feeling go, and switch to your thumb. Again, only focusing on the pressure from your thumb and allowing your index finger, allowing that pressure to be there without thinking about it or controlling it. Just letting it exist, and then focusing on the pressure from your thumb. Kimberley: Yeah, I got it.  Max: We could do this for five, ten minutes. I won't make you do it right now, but you can see there and there's like a bump. There's a shift where you go from one to the other. It's great. It's not about getting into details, it's about noticing, "Oh, I can pay attention flexibly. I can focus on my index finger, allow the thumb feeling to be, and then I can switch to the opposite side." That's one way that people can start understanding what I'm talking about, where we can flexibly pay attention while allowing other stuff to exist in the background. Kimberley: Let me bring up my own personal experience here because, like I said, I'm here to learn. As I was pushing, I actually had some pain in my thumb. As I was trying to imagine the top finger, that index finger, that was really hard because I have a little bit of ligament pain in my thumb. I had to work really hard to think about it. What was actually getting in the way was the thoughts of, "I won't be able to do this because of the pain." What are your thoughts on people who are fighting that? Max: It's such an important piece of this because oftentimes what prevents people from practicing are these thoughts and beliefs that pop up. The belief of, "I have no control over rumination," or "I cannot pay attention." I'm saying this, and where we're stepping back and noticing these are thoughts, these are stories as well. Part of the practice is, can I see them as events of the mind? Can I see them as stories? Allow them to be in the background, just like we're maybe allowing the sensation of your index finger to be in the background while maintaining focus on that one part of your experience, your thumb. Again, we want to treat pain, thoughts, feelings, sensations as best as we can, allowing them, seeing them as mental events versus as distinct parts of who you are as a person while maintaining as best as you can that focused beam of attention on what you choose to. Kimberley: Right. This is really cool. Just so I understand this, but please don't be afraid to tell me I've got it completely wrong. As I was doing it, I was noticing the top of my index finger, doing my best, and in my awareness was the thoughts I had and the pain that I had. My attention was on the top, but there was some background awareness of all the other noise. Is that what you're saying? Max: That's exactly what I'm saying. The trick with OCD or anxiety is, can we allow the stuff in the background? Because a lot of people get annoyed or frustrated. And then as soon as you do that, that focus goes from your index finger to the stuff that you don't want versus if we can let go of control. Another way to think about it too is if you're looking out of a window. Focused attention would be, you are immensely engaging in this beautiful oak tree in your front yard. I don't have an oak tree, but hopefully, somebody does. Imagine you're really focusing on this oak tree, and that is what you're paying attention to.  Now, there might be other things that come and go. There might be birds flying and bushes in the background. There might be houses and a bunny rabbit running by. You could choose to then shift your beam of light from the tree to one of those things, but you don't have to. You can keep paying attention to the tree and allowing all this other stuff to exist. That would be what we're talking about and that's the practice you could do with your fingers. And then with that same metaphor, broader just overall awareness would be looking out the window, but not intentionally focused on anything. Just letting your eyes wander to whatever is present. "Oh, I notice the tree and I notice a cloud and I notice a bird. Oh, I noticed a thought that I've been looking out this window for a very long time." We're not questioning, we're not ruminating, we're not judging, we're just simply being there with what's present. That's that broader awareness piece to this.  Kimberley: Okay. I love it. For those who have probably heard me talk about this, but not using this language, or are completely new and this is the first time I've ever logged in and listened to us, how may they apply this to specific intrusive thoughts that they're having? Can you walk us through a real example of this? You could use my son if you want, or an actual case of yours or whatever. Max: Yeah, for sure. If we think about it in this way, also, it's like a little bit of a different approach than maybe how some people think about exposure and response prevention. Because in this way of doing things, there's a really hard emphasis on the response prevention piece, which in this case would be not ruminating, not engaging in the mental compulsions. It's doing the exposure, which is triggering the scary thoughts and the feelings, and then accessing awareness mode, like being with what's present.  An example of that, let's just say somebody has an intrusive thought, a really scary fear that they might hurt somebody. They might be a serial killer or they might do something really bad. Let's say we want to do an exposure with that thought and we choose a triggering thought of, "I am a murderer." Normally, when they have that thought, they do all this stuff. Their focused attention is on that thought, and they're trying to convince themselves they're not a murderer. They're trying to maybe look for evidence. "Did I kill somebody? I did not." They're engaging in this thought, doing all this sort of stuff that OCD wants them to.  One way that we might use this difference in attention awareness, doing exposure would be to first evoke the scary thought. Maybe really telling themselves for a couple of seconds like, "I am a murderer. I am a murderer, sitting with the fear and the dread and all the stuff that comes up." But then instead of focusing on it, then letting go of any engagement. We could just sit there and actually do nothing at all. We just watch and observe. Like you're looking out that window and that thought "I'm a murderer" might pop up, it might go away. Another thought might pop up. But we want to take this stance of, "None of my business." We're going to sit here, we're going to observe, and we're not going to mentally engage in the thoughts. It's really accessing this more of like awareness mode. We can actually do something like that.  If you want to, Kim, we don't have to use an intrusive thought, but we can, again, practice with a neutral thought together and then apply what I'm talking about. Usually, what people realize is that what happens to their intrusive thoughts is what happens to 99.9% of all the thoughts they get in a day where it comes and then it just goes away when it's ready. If you think about it, we have thousands and thousands of thoughts per day. Mostly that's what happens because we're not focusing our beam of light on it, because we're not doing all this work that inadvertently keeps it around. It's exposure not only to sit with the feelings, but to practice the skill of letting go, of focusing on it, of letting go of any mental compulsive behaviors towards it. ATTENTION TRAINING VS DISTRACTON Kimberley: Right. I know this is going to be a question for people, so I'm going to ask it. How does attention training differ from distraction? Quite often, I will get really quite distressed messages from people saying, "But wait, if I'm being mindful on the tree, isn't that me distracting against my thoughts?" Can you talk about, again, differentiating this practice with distraction or avoidance? Max: Yep, absolutely. I like to think about it as an attitude that people take where we're willing to have whatever our brain pops up at us. With distraction, we're unwilling. We don't want it, we don't like it, we're turning away from it. But that's actually like, it's okay too. We call it distraction, we can call it engagement. It's okay to live your life to do stuff, but we have to first get really clear on, can I allow whatever my brain pops up to be there without then keeping that beam of attention on it? Because all mental rituals, all sorts of stuff that we do starts with focused attention. Summons, rituals are pure retention, but a lot of them like analyzing, reassurance, attention is a major part of them. If you can notice when our OCD took that beam of light and shined it, then we could practice taking the light off, allowing it to exist, allowing it to be there, but without engaging. If you want, Kim, I'm happy to maybe do another experiential exercise, not to throw too many at you today.  Kimberley: No, bring it on. Max: So maybe you and your listeners can understand that piece to it.  Kimberley: Yes, please.  ATTENTION TRAINING EXERCISE #2  Max: Okay. Lets start with attention training exercise #2. What we're going to do is we're going to practice engaging in what we might think of as a rumination, analytical way of thinking. Again, rumination, mental compulsions, they are a behavior. They're a mental action that we're taking that we could turn on, but we can also turn off. We want to be able to turn off mental compulsions throughout the rumination, but allow any thoughts and feelings to exist without doing anything about them. I know it sounds heavy, so let me show you what I mean by that.  Kimberley: Good.  Max: What I want you to do is think about a vacation or a trip that you either have coming up, or it might be like a dream vacation that you really want to take, and just take a second and let me know when you got something in mind. Kimberley: I got it. Max: You got it. That was quick. That was a good thing. What I want you to do is start mentally planning out the itinerary for this vacation, thinking about what you're going to do, all the steps you're going to take, just like doing it in your mind. And then I'll tell you when to stop. Okay. Stop. Now what I want you to do is let go of that engaging analytic way of thinking and just sit here for a couple of seconds. We're not going to do really anything. If the idea of the vacation pops up in your mind, I want you to allow it to pop up. But don't think about it, don't focus on it. Allow it to be there or not to be there. Just don't do what you were just doing where you're actually actively thinking about it. Are you ready?  Kimberley: Mm-hmm. Max: Okay. Again, we're just going to sit and we're going to observe. Whatever comes up, comes up. We're going to let it hover and float in your overall awareness without focusing on it.  Waves washing on the beach or just letting your thoughts and feelings come and go. We're not engaging, we're not thinking about them. We're just observing.  What I want you to do one last time, I want you to start thinking again, planning, going through the itinerary, thinking all the cool stuff you're going to do. As you're doing it, notice what that feels like psychologically to go from not doing to doing. And then start thinking about it, and I'll let you know when to stop again. All right. We can let go of the vacation. Again, just for five, ten seconds sitting. If the thought pops up, allow it to pop up, but don't engage in it. Don't manipulate it or actively walk through the itinerary again. Just notice what that's like.  Okay, Kim. I'd love to hear your experience walking through, turning it on the analytical way of thinking, and then turning it off and playing around with it a little bit. Kimberley: Okay. Number one, I immediately was able to go into planning. I think because I do this, this is actually one of the things I do at bedtime. I've planned my 91st birthday, my 92nd birthday party. That's what I love to do, so it was very easy for me to go into that. When I went back to more awareness of just what I noticed, I was actually able to do it really easily except of the thought like, "Oh, I hope I don't have the thought. I hope I'm doing this right." Max: That's such a beautiful way, and the mind is going to do stuff like that. We're going to start thinking about thinking, and I'm curious how you respond to that thought. What you did next? Kimberley: I was just like, "Maybe I will, maybe I won't. What else?" And then I was like, "Well, there's Max and there's my microphone." That was the work. Max: Yes. That's exactly what I'm talking about. We're not like, "Don't think about this vacation." Because if we did that, what do you think that would do to you if you're just sitting there in that moment of awareness and be like, "This is not a good thought to have, I can't think about this upcoming vacation"? Kimberley: Well, I had more of them and I had distress about them. Max: Yeah, exactly. That's what I mean by we're not distracting, we're allowing, but we're also not analytically thinking about it. Now that we're talking about this, I think this is a really important piece on where mindfulness can get maybe especially confusing or even contradictory for people. Again, to preface this, I'm a huge mindfulness advocate and fan, but one of the issues about mindfulness for OCD, in particular, is that mindfulness is really in a lot of ways teaching it, it's about coming back to the present moment. I'm going to focus on my breath. I'm going to refocus to my body. I'm going to ground myself. Again, overall very healthy things to do, we should practice that.  But the problem about that is if applied directly to OCD mental compulsions—and again, just to be really clear by mental compulsions, I'm talking about anything that people do to try to feel better, cope with, resolve a scary, intrusive thought. Kim, your six-part series, let's say, on mental compulsions that you did is one of the best OCD contents I've ever seen. I think everybody should go back and listen to that, whether you have OCD or not. So, all this mental stuff that we do in response to a scary thought. Mindfulness can be really helpful in noticing when we get caught up and again, like flexibly shifting. But at the end of the day, sufferers of OCD really need to understand that you don't need to focus onto the present moment to stop doing mental compulsions. Because it's analytical, it's a behavior, it's a way of thinking. Just like you did, we can simply turn it on and then we can turn it off.  Now, I don't mean to say it's as easy as just don't do it. Obviously, it's not the case. This is complex stuff. There's so many psychological factors that lead people to ruminate and to do compulsions, but it's a simple idea. People need a foundation to understand that mental compulsions are a behavior that we have a lot more agency over than your OCD wants you to think. I like to think about when you look at more traditional, like contamination OCD, people might wash their hands a lot. It's the same thing where there's the behavior of washing your hands that you could do or you cannot do.  Now there's entire treatment protocols helping people chip away at that to not wash their hands, so it's not just like, "Don't wash your hands." But people understand that the goal of this treatment is to, "I'm washing my hands too much and now I'm not washing my hands." If you apply the same mindful logic to rumination, it would be like, "Oh, we're going to wash your hands, but you cannot wash your hands. You're just going to have to use wet wipes forever." It's like, oh, I'll get maybe a step in the right direction. But people need to know that the goal here is to not wash your hands. Just like with more Pure O rumination type of OCD, the goal is to learn how to not ruminate. Learn how to step out of that. Kimberley: Yeah. I think you had said somewhere along the way that it's a training. It's a training that we do. What's interesting for me, I'll use this as solely example, is I am in the process of training myself to do what I call deep work, because I have two businesses, things are chaotic, and I can get messages all the time. When I sit down to do something, I'm being pinged on my phone and called on my computer and email bells, so I'm training myself to focus on doing the thing I'm doing and not give my attention to the dinging of the phone and so forth as a training. I'm trying to train myself to be able to go longer, longer, longer periods and hold my attention, which at the beginning, my attention, I could really only do like 15 minutes of that and it felt like my brain was going to explode. Would you say that this is a similar practice in that we're slowly training our brain to be able to hold attention and awareness at the same time and increase it over time?  Max: Yeah, absolutely. I think everything with OCD and anxiety is a process. First, it takes awareness, and that's where mindfulness can be so helpful, where the practice of mindfulness is about being more aware. "I'm aware, I'm ruminating. I'm aware of that. I'm doing some sort of compulsion." That itself could take a very long time. I think it's all about baby steps.  Now, I will say though, Kim, some people, when I explain them these differences and they're able to really feel what it's like to be ruminating, what it's like not—some people click and they can do it really fast. They're like, "Oh my gosh. I had no idea that this is something I was doing." Some people, it takes a very long time and there's a spectrum. I think everybody always needs to go at their own pace and some people are just going to need to work at it harder. Some people, it's going to come really easy and natural. There's no right or wrong way to do it. These are principles that live in the ERP lifestyle. We want to start taking little baby steps as much as we can. Kimberley: Right. For those listening and for me too, where it clicked for them, what was the shift for them specifically? Max: The shift was understanding that while it felt like rumination—again, a lot of this is like, think about OCD, there's this big unsolvable problem and they're trying to solve it. They're analyzing it, they're paying attention to it, they're focusing on it, they're thinking about it, for them to really feel that, "This is something that I am doing. I know there's reasons why I'm doing it, there's beliefs I have about the utility of ruminating, including beliefs that I can't control this, when really, we can't control it. Beliefs about how helpful it is." There's a lot of reasons why people do that, but to recognize, "Oh my gosh, this is a thing that's a lot more in my control than I thought." When they experience that stepping back and allowing their brain to throw out whatever it does without having to engage with it, game changer.  Also, in terms of classic mindfulness, think about mindfulness of breath. The instructions generally are, we're going to focus on, say the breath, the rise and fall of my belly. My attention goes, I'm going to come back to it. I think if we do that with a very specific intention, it could be so relevant and so helpful for OCD. That intention is seeing your brain as a little puppy dog. When you have OCD, that puppy dog is full of energy. OCD is like this mean bully that's thrown a tennis ball and getting that puppy dog to go.  What mindfulness of breath can teach you, if we're aware of this, we go into it like, "This is what I'm going to work on. This is how my OCD is getting me—it's getting me to follow these lines of thought." When you're there sitting on your breath to be able to notice where your thought goes, be able to look at it, "None of my business. Come back to my breath." To me, Kim, that is actually exposure and response prevention. You expose yourself to discomfort of not following the thought, which is really hard. For people with OCD, without OCD, that's hard to do, but like you said, that is absolutely a skill that people can get better at. STOPPING COMPULSIONS WITH ATTENTION TRAINING  Kimberley: Yeah, and it's response prevention. It's the core of that. Okay, I love this. I love this. Now, as we wrap up, is there anything that you feel we haven't covered here that will bring us home and dial this in for those who are hearing this for the first time or have struggled with this in the past?  Max: I think we did a pretty good job. I mean, it's very nuanced stuff. I like to see this for people that feel like their OCD is well enough managed, but there's still work to go. This is like icing on the cake. Let's really look at the nitty-gritty of how this works. Or if people are feeling really stuck and they're not knowing why, hopefully, this can shine a light on some of these less talked about principles that are really important.  But I guess the one final thing, going all the way back to Amishi Jha and her neurological research on mindfulness, really fascinating studies out of her lab show that 50% of the time, 50% of her waking day, people are not aware. They're not aware of what's going on, which means 50% of this podcast, people aren't going to be paying attention to. We can't take offense to that because it's 50% of any podcast. When you have that coupled with OCD's tendency to steal that beam of focused attention on scary stuff, it can be so devastating and so stuck for people. Hopefully, some of the stuff can give a sense of what we do about that and how we can start making moves against anxiety and OCD. Kimberley: Yeah, and compassion every step of the way. Max: Oh my gosh. I think everything needs to be done, peppered with compassion. Or maybe peppered is too level like in the context of full radical compassion. That's such an important part of all of this work. Kimberley: Yeah, because it's true. I mean, even myself who has a pretty good mindfulness practice, I was even surprised how much of mine was like, "Am I doing this right? What if I don't do it right? Will this work? How will it help me?" All of the things. I think that everyone's background noise, like you said, is very normal. I so appreciate you bringing this to the conversation, because again, I talk about mindfulness a lot. One other thing is, I will say when, let's say, someone has a somatic obsession or they have panic, and so they're having a lot of physical sensations. When you say "Come to the present," they're like, "But the present sucks. I don't want to be here in the present." What are your thoughts on that?  Max: Somatic OCD and panic, I think out of any themes or content when it comes to awareness and attention, those are the most relevant. If you think about somatic OCD, where people come obsessed about different parts of their perceptual experience, it's all about people trying to not be aware of things that they can't control, and then therefore they're aware of it all the time. I think this is especially spot on for those. It's helpful for all forms of anxiety, but that in particular, that's going to be-- we tend to not do exposures by hyper-focusing on what they're afraid of because that's compulsive. That's we're focusing on controlling more. This process should be effortless. When we're ruminating, when we're compulsing or paying attention, that's like you're on the treadmill. You're doing work, and just hopefully, people experience some of these exercises, all we're doing is getting off the treadmill. We want to be doing less, if anything. OCD is making you work for it. It's making you do stuff. We want to identify that and do a whole lot less. And then you'll forget about it usually until you don't. It's like, "Oh crap, here it is again." And then, "Okay, cool. I just practiced. Let me do it again," until it loses power more fully. Kimberley: Yeah. I so appreciate you. Tell us what people can hear about you. Max: I run a practice in Redondo Beach. We're called Beachfront Anxiety Specialists. We have our website. Again, my name's Max Maisel, and people can feel free to Google us and reach out at any time. Kimberley: Amazing. Thank you. We'll have all of your links in the show notes. I'm really, truly grateful. Thank you for coming on and talking about this. It is so nuanced, but so important. As I say to my patients, I could say it 10 times and sometimes you need to hear a similar thing in a different way for it to click. I'm so grateful. Hopefully, this has been really revolutionary for other people to hear it from a different perspective. I'm so grateful for your time.  Max: Thank you. It's such a privilege to be here with you and your listeners and I really appreciate you having me on today. Kimberley: Thank you.

Welcome back, everybody. This is a last-minute episode. I usually am really on schedule with my plan for the podcast and what I want to do, but I have recently got back from vacation and I have been summoned to jury duty.  For my own self-care, the idea of going to this master plan that I created for all of the other episodes that I do a lot of planning and a lot of prep and really think it through today, I was like, "I deeply need this episode to land on my own heart." This is as much for me as it is for you, and it is a community effort, which also was very helpful for me.  As you may know, I'm a huge proponent of self-compassion, which isn't just having bubble baths and lighting a candle. It's actually stopping and asking, "What do you need in this moment?" And I really dropped in and I was like, "I need this to be really simple, really easy, and I need this to be also something that will land." Let's do it.  Today, we're talking about the 14 things you should say to a loved one with anxiety. I asked everyone on Instagram to weigh in on what they need to hear, and the response was so beautiful, it actually brought me to tears.  I am going to share with you the 14 things that you should say to a loved one with anxiety, and I'm also going to talk about, it's not just what we say. I was thinking about this the other day. When we're anxious, the advice we get can make us feel very soothed and validated, or it can feel really condescending. Saying "stop worrying" can be really condescending. It can make us enraged. But if someone so gently says, "Listen, don't worry, I got you." You know what I mean? The tone makes a huge difference.  For those of you who are family members or loved ones who are listening to this, to really get some nuggets on what they can do to support their loved one, remember that the tone and the intent are really 80% of the work. That is so, so important. Here we go. Let's go through them.  I AM HERE FOR YOU. The first thing you should say to a loved one with anxiety is, "I am here for you." The beauty of this is it's not saying, "How can I make your discomfort go away?" It's not saying, "What should we do to fix this and make you stop talking about it and stop having pain about it?" It's just saying, "I'm here, I'm staying in my lane and I'm going to be there to support you." It's beautiful.  HOW CAN I SUPPORT YOU? The second thing you could say to a loved one with anxiety is, and this is actually my all-time favorite, this is probably the thing I say the most to my loved ones when they're anxious or going through a difficult time, "How can I support you?" It's not saying, "What can I do?" It's not saying, again, "How can I fix you?" or "Let's get rid of it." It's just saying, "What is it that you need? Because the truth is, I don't know what you need and I'm not going to pretend I do because what may have worked for you last week mightn't work this week." That's really important to remember. How can I support you? YOU ARE NOT BAD FOR EXPERIENCING THIS. The third thing you could say to a loved one with anxiety is, "You are not bad for experiencing this." So often when we are going through a hard time, we're having strong emotions. We then have secondary shame and blame and guilt for having it. We feel guilty, we feel weak, we feel silly, we feel selfish, we feel juvenile for struggling—often based on what we were told in childhood or in our early days about having emotions. We can really start to feel bad for having it. Or for you folks with OCD or intrusive thoughts, you might feel bad because of the content of your obsessions.  Now let's pause here for a second and be very clear. We also have to recognize that we don't want to be providing reassurance for our loved ones with OCD and intrusive thoughts because, while giving them reassurance might make them feel better for the short term and might make you feel like you're really a great support person, it probably is reinforcing and feeding the disorder and making it worse.  So in no way here am I telling you to tell your loved ones like, "You're not bad. You're not going to do the thing that you think you're going to do," or "That fear is not going to come true." We don't want to go down that road because that's going to become compulsive and high in accommodation. Those two things can really, really make your OCD and intrusive thoughts much, much, much worse. But we can validate them that having a single emotion like anxiety, shame, anger, sadness does not make them a bad person. So, so important. THINGS WILL GET BETTER... THIS WILL NOT LAST FOREVER. The fourth thing you should say to a loved one with anxiety is, "Things will get better," and another thing that the folks on Instagram said is, "This will not last forever." This was something that was said many, many times. I pulled together the main common themes here. But what I loved about this is they were bringing in the temporary nature of anxiety, which is a mindfulness concept, which is, this is a temporary experience that this anxiety will not last forever. Again, pay attention to the tone here. Telling them "This won't last long" or "This won't last forever" in a way that devalues their experience or disqualifies their experience, or invalidates their experience isn't what we're saying here. What they're saying is, they're really leading them towards a skill of recognizing that yes, this is hard, we're not denying it. Yes, this is hard, but things will get better or that this won't last forever.  The thing I love about "Things will get better" is, so often when we have anxiety, and we recently did an episode about this—when you have invasive anxiety all the time, you can start to feel depressed about the future. You can start to feel helpless and hopeless about the future. Offering to them "This will get better with steps and together we'll do this and we'll support you and we'll take baby steps," that can really help reduce that depressive piece of what they're experiencing.   YOU HAVE GOTTEN THROUGH THIS BEFORE. The fifth thing you should say to a loved one with anxiety is, "You have gotten through this before." Now, that reminds them of their strength and courage. Even if they've never done this scary thing before, chances are, they've done other scary things before or other really difficult things in their life. Often I'll say to patients when they're new to treatment, "Tell me about a time where you did something you actually didn't think you could do." It's usually things like, "I ran a marathon," or "I rode a bike up this really steep hill and I couldn't do it forever. And then one weekend I built up and I could," or "I never thought I would pass this one exam and I'd failed it multiple times and I finally did." It helps us to really see that you are a courageous, resilient person, that you've gotten through hard things before.  Again, we're not saying it in a sense of urgency like, "Get up and do the hard things because you've done them before." We are really dropping into their experience. We're really honoring their experience. We're not rushing them too much.  I have learned as a parent of a kid who hates needles, this is the biggest lesson for me because I'm an exposure therapist. I'm like, "Let's go, let's face our fear." I've learned to trust my child. When we go in to get vaccinations or immunizations, my child says, "Mama, I'm going to do it, but you have to let me do this at my pace." I was like, "Wow, you're quite the little wise one." It was so profound to me that I was pushing them too fast, going, "Let's just get it over with. Once you're done, you'll feel so much better." They really needed to slow it down and be like, "I'm going to do it. It's just going to be at my own pace." I digress.  I AM PROUD OF HOW HARD YOU ARE TRYING. The sixth thing you should say to a loved one with anxiety, and you don't have to say all of these by the way, but number six is, "I am proud of how hard you are trying." I loved this because it, number one, validates that they're going through a hard thing. It also encourages and recognizes that they are trying their best.  Often we make the mistake of saying, "You could be doing a little better." The truth is, yeah, you will be doing better in the future, but you're doing the best you can right now with what you have, so do really say, "I'm proud of how hard you are trying." One thing I've also learned, and I learned this from another clinician once, is this clinician taught me. She says, "I never tell my patients how proud I am of them." She says, "I always say, you must be so proud of how hard you are trying." She said that because that gives them ownership of being proud. It gives them permission to be proud. I have learned in many clinical settings with patients to say that. Not all the time, sometimes I just straight up say, "I'm so proud of you." I don't think there's anything wrong with that. But you might even want to play around with this nuanced change in this sentence of, "I'm so proud of how hard you are trying and you must be so proud of how hard you are trying." So powerful the use of words here.  LET'S LISTEN TO STORIES OF OTHER PEOPLE WHO HAVE GOTTEN THROUGH THIS. The seventh thing you need to say to a loved one who has anxiety is, "Let's listen to stories of other people who have gotten through this." The person who wrote this in, I loved it because they actually gave some context of them saying, "In a moment where I don't think I can do the scary thing, sometimes hearing other stories of people who have done this work is exactly what I need to remind myself that I can do this hard thing." This is how they did it, and I have the same skills that they do. I'm the same human that they are. They're no better or worse than me.  If you go back, there's tons of stories and OCD stories that you can look at on Your Anxiety Toolkit podcast or OCD stories or other podcasts, or even IOCDF live streams of other people's stories that can be inspiring to you. I WILL DO THE DISHES TONIGHT. The eighth thing you should say to a loved one with anxiety is, I loved this one, "I will do the dishes tonight." I loved this one. They actually put a smiley face emoji after it because really what they're saying is, "You need a break and I'm going to be the break you need." It's not to say, again, that we're going to accommodate you and we're going to do all your jobs and chores for you. All they're saying is, "I can see anxiety's taking a lot of space for you. As you work through that—not to do compulsions, but as you work through that and navigate that using your mindfulness and your ERP and your willingness and your act and all of the skills you have—as you do that, I'm going to take a little bit of the slack and I'm going to do the dishes tonight." I just loved this. I would never have thought to include that. I thought that was really, really cute.  YOU ARE ALLOWED TO TAKE THIS TIME AND THIS SPACE. The ninth thing you should say to a loved one with anxiety is, "You are allowed to take this time and this space." I thought that was really a beautiful way. Quite a few people said something similar like, "You're allowed to struggle at this time. It's okay that you're having this discomfort. I'm going to give you some space to just feel your feelings. Be uncomfortable if that's what you're doing. Bring on the loving kindness and the compassion, and I'm actually going to give you space to do that. You're allowed to take this time. You're allowed to take up this space with these emotions." As somebody who, myself, struggles with that, I feel like I should tie my emotions up and put them in a pretty bow. I really felt this one really landed on me. It was exactly what I needed to hear as well. Thank you, guys.  YOU DO NOT NEED TO SOLVE EVERYTHING RIGHT NOW. YOU CAN PACE YOURSELF THROUGH THIS. The tenth thing you should say to a loved one with anxiety is, "You do not need to solve everything right now. You can pace yourself through this." There's two amazing things I love about this, which is number one, reminding us that we can be uncertain, that we can be patient, that we can let this one sort of lay it down, sit down. We don't have to tend to it right now, we can just let it be there. We're going to go about our time. Absolutely. And that you can pace yourself in that.  Often I get asked questions like, "I just want to get it all done right now. I just want to get all my exposures done and I want to face all my fears and I want to have all the emotions and get them over and done with." You can pace yourself through this. I think that's so important to remember.  WHAT'S IMPORTANT TO YOU RIGHT NOW? The eleventh thing that you should say to a loved one with anxiety is—this is actually not something you'd say, it's actually something you would ask. They'd say, "I need them to ask me, what's important to you right now." I think this is beautiful because instead of supporting them, you're really just directing them towards their north star of their values. "If you're anxious, let me just be a prompt for you of, what's important to you right now." So cool. It's really helping them, especially you guys know when we're anxious, we can't think straight. It's so hard to concentrate, it's all blurry and things are confusing. Sometimes being given a prompt to help direct us back to those values is so, so important. I BELIEVE YOU. The twelfth thing that you should say to a loved one with anxiety is, "I believe you." Really what we're saying here is, "I believe that this is really hard for you. You're not trying to attention seek. I believe that you're struggling." This was a big one, especially for those people who have a chronic illness. As someone with a chronic illness, so many people kept saying, "Are you sure it's not in your head? Are you sure it's not anxiety? Maybe you're seeking attention." For people to say, "I believe you, I believe what you're experiencing. I believe that this is really hard for you," I think that that is so powerful and probably the deepest level of seeing someone authentically and vulnerably. All right, we're getting close to the end here guys. You have held in strong.  YOU ARE STRONGER THAN YOU THINK AND YOU HAVE GOT THIS. The thirteenth thing you should say to a loved one with anxiety is, "You are stronger than you think and you have got this." So good. Again, similar to what we've talked about in the past, but it's reminding them of their strengths, reminding them of their courage, reminding them of their resilience.  Sometimes when we're anxious, we doubt ourselves, we doubt our ability to do the hard thing. They're saying, "You've got this. Let's go. Come on, you've got this." But again, not in a way that's demeaning or condescending, or invalidating. It's a cheerleading voice.  I KNOW YOU CAN RESIST THESE COMPULSIONS. The fourteenth thing you should say to a loved one with anxiety, but I do have a bonus one of course, is," I know you can resist these compulsions." This is for the folks who have OCD and who do struggle with doing these compulsions. Or if you have an eating disorder, it might be, "I know you can resist restriction or binging or purging," or whatever the behavior is. Maybe if you have an addiction, "I know you can resist these urges." Same with hair pulling and skin picking. It's really reinforcing to them that, "I know you can do this. I know you can resist this urge or compulsion, whatever it may be."  Again, it gives us a north star to remind ourselves what are we actually here to do. Because when we're anxious, our default is like, "How can I get away from this as fast as possible?" Sometimes we do need a direction change of like, "No, the goal is to reduce these safety behaviors." BONUS: IT'S A BEAUTIFUL DAY TO DO HARD THINGS. These are so beautiful. I'm going to add mine in at the end and you guys know what I'm going to say. We almost need a drum roll, but we don't need a drum roll because I'm going to say that the 15th thing that I always say to any loved one, including myself with anxiety, is, "It's a beautiful day to do hard things. It's a beautiful day to do freaking hard things. It's a beautiful day to do the hardest thing." I say that because it reminds me to look at the beauty of it, to look at the reward of it, and to remind myself that yes, we can do hard things.  My friends, thank you for allowing this to be a nice, soft landing for me today. I know I have to rearrange all the schedule and my podcast editor and my executive assistant is going to have to help me with all of the mix-up and mess around. But I'm grateful for the opportunity just to slow down with you this week.  Take a deep breath.  Drop into what do I need. I hope you're doing that for yourself. I will see you next week back on schedule and I cannot wait to talk with you there.  Have a wonderful day everybody, and talk to you soon.

Today, we're talking about when anxiety causes depression and vice versa. This is a topic that I get asked about all the time. It can be really confusing and a lot of time, it's one of those things that we talk about in terms of like, is it the chicken or the egg? I want to get to the bottom of that today.  When anxiety causes depression, it can feel like your world is spinning and racing from one thought to another. You may feel a complete loss of interest in the things that you're doing. You may have racing thoughts, depressive thoughts, or thoughts of doom. This can be really, really overwhelming. Today, I want to talk about when anxiety causes depression and how you might target that, and also when depression causes anxiety. Let's get into it. We're going to go through a couple of things today. Number one is we're going to go through why does anxiety cause depression, how does depression cause anxiety, how common is depression and anxiety, particularly when they're together, and what to do when depression and anxiety mix. Now, stick around till the end because I'm also going to address how OCD causes depression and how social anxiety causes depression, and what to do when anxiety and depression impact your sleep, and in this case, cause insomnia. I'm so excited to do this. Let's get started.  WHAT CAUSES ANXIETY AND DEPRESSION What causes anxiety and depression? Let's look at that first.  What we understand is that anxiety and depression—we don't entirely know just yet to be exact, but what we know so far is that there is a combination between genetics, biology, environment, and also psychological factors. That's a big piece of what we're going to be talking about today.  Now, if you want to know specifically the causes of anxiety, and that's really what you're wanting, you can actually go over to Episode 225 of Your Anxiety Toolkit. We have a whole episode there on what causes anxiety and what you can do to overcome anxiety. That might be a more in-depth understanding of that.  But just in general, we do know that genetics play a huge component. However, we do know, talking about the psychological factors, that often people who do have depression, that depression does cause an increase in anxiety. A lot of people who have an anxiety disorder do notice that they feel themes of depression like hopelessness, helplessness, and worthlessness.  WHY DOES ANXIETY CAUSE DEPRESSION? Now, let's first look at, why does anxiety cause depression? The thing to remember here is, anxiety alone doesn't cause depression in all cases. There are lots of people who do have an anxiety disorder who don't experience depression. However, we do know that for those who have a lot of anxiety, maybe untreated anxiety or anxiety that is very complex and they're in the early stages of recovery or learning the tools and mastering those tools, it is common for people with anxiety or uncertainty to start to feel doom and gloom about their life. Often it comes in the form of feeling like, "Is this going to be here forever?" A lot of people will say, "What's the point really of life if I'm going to be experiencing this level of suffering with my anxiety every single day?" And that's very, very valid.  When you're suffering to the degree that some of you are with very chronic anxiety disorders, very severe degrees of anxiety disorders, it makes complete sense that you would start to feel like, "What is the point? How do I get through this? No one can help me. Am I someone who can be helped?" These are very common concerns. I myself have struggled with this as well, particularly when your anxiety feels so out of control and you don't feel like you have mastery over it yet. I think that that is a very, very normal experience for people who have that degree of anxiety.  This also includes other anxiety disorders like phobias, panic disorder, PTSD, and eating disorders. I know when I had my eating disorder, I felt so stuck, "How am I ever going to climb out of this deep hole that I'm in?" And that in and of itself made me feel depressed. I had what we call secondary depression. My primary condition was an eating disorder, and then I had a secondary depression because of how heavy and how overwhelming my primary condition was.  If that's something that you resonate with, I first want to acknowledge and recognize that this is very normal, very common, but also very treatable, particularly if you have a mental health professional who can help you. But again, I want to go back and say, just because you have anxiety or intrusive thoughts, doesn't mean that you will be anxious and depressed for the rest of your life. With mastery and tools and recovery and practice and patience and compassion, you can actually slowly peel those layers of depression and anxiety away.  WHY DOES DEPRESSION CAUSE ANXIETY? So then we move over now and look at, why does depression cause anxiety? If your primary diagnosis or your primary disorder is depression, meaning that's the first disorder you had and you didn't have an anxiety disorder before that, or that's the disorder that is the largest and the one that takes up the most space in your life. When we are depressed, often people will have anxiety about how much that depression is going to impact them in their life. Similar to the last points we made about anxiety. A lot of my patients and a lot of you folks have written in or messaged me or in my comments on Instagram talking about the overwhelming fear of relapse and the overwhelming fear of going back to those dark days when depression was so strong and you couldn't get out of bed, and it was almost traumatizing how painful and how much suffering you are experiencing. It is, again, very normal to have a large degree of anticipatory anxiety about how that may impact you.  Now, in addition, depression in and of itself will say some pretty mean things. Actually, let me rephrase that—will always lie to you about who you are, your worth, your future, your place in the world. When you hear those things on repeat, of course, you're going to have anxiety about, will that come true? Is that possible? Oh my goodness, that's not what I want for my life. This is not how my life was supposed to go. The messages and the narrative of depression in and of itself can create an immense degree of anxiety.  HOW COMMON IS DEPRESSION AND ANXIETY? Now, let's take a look now, as promised, to look at how common anxiety and depression are. I'm actually going to read you some statistics here that I got from some really reputable journal articles, and I will link them in the show notes.  One research said that generalized anxiety disorder affects 6.8 million adults in the United States. That's 3.1% of the population, and that's just in the United States. That's not talking about the world. Yet, only 43.2% of them are receiving treatment. That's from the National Institute of Mental Health. Now, what's interesting about that, as I remember sharing before, is being untreated increases your chances of having both. Because as you can imagine, if you're having a disorder and it's not improving, you're going to feel more depressed about it and you're going to feel more anxious about that.  Statistics also show that women are twice as likely to be affected as men with generalized anxiety. Generalized anxiety disorder often co-occurs with major depression. They are almost always going to go together. Now, we also know that depression is a very common illness worldwide, with an estimated 3.8% of the population affected. That's 5% for adults and 5.7% for adults older than 60 years. That's very interesting as well to see how our age can impact these disorders, and that comes directly from the Institute of Health Metrics and Evaluation. We have some really important information here to show that there is a huge overlap between the two. And then it gets murky because then, again, as I mentioned in the intro, is it the chicken or the egg? Which one do we treat? Which one do we look at? Which one came first? Which is the primary? Which is the secondary?  WHAT TO DO WHEN DEPRESSION AND ANXIETY MIX? Let's talk first about what to do when depression and anxiety mix, because that's why you're here. It's important and what's cool is to recognize that we have a treatment that can target both. As you all know, I'm a Cognitive Behavioral Therapist and we have a lot of research to show that cognitive behavioral therapy or CBT can help with both. Thank goodness, it's not that you have to go to one particular treatment for one, and then you have to learn a whole other treatment for another. We actually have this one treatment that you can use to address both in different ways.  Now, CBT is going to be looking at your cognition, your thoughts, which we know with anxiety and depression, there are a lot of irrational, faulty thoughts. It also looks at your behaviors and how those behaviors may actually be contributing to your anxiety and your depression. Not to say that it's your fault. I want to be really clear here. We are not saying that this is all your fault and you've got bad thoughts and you've got bad behaviors. That's why you have both and you're going to be stuck in both until you change that. Absolutely not. We're not here to blame. What we're here to do is be curious about our thoughts and about our behaviors, and then look and do experiments on what helps and what doesn't. I'll give you an example of a really basic CBT skill that I used recently, and that was that somebody I knew was talking about how difficult it is to go to bed. They get really depressed going to bed. It makes them have a lot of thoughts about how they didn't get done what they wanted to do. They would procrastinate going to bed, but before they know it, it would be 3:00 AM in the morning or even later. They still haven't yet journeyed through their night routine to go to bed.  We talked about what would be effective for you, what behavior change would be effective for you to move into the direction that you want. With CBT, we are not looking at 17 different changes at once. We might make one simple change at a time and then look at your thoughts about that. This is a really important way for us to be curious and do experiments and look at what's effective and what's not effective and make small little tweaks to your behaviors.  Now, some examples of this, we go through this extensively in our online course called Overcoming Depression. We also go through this extensively in our online course called Overcoming Anxiety and Panic, where we thoroughly go through your thoughts and then do an inventory of your behaviors. I give tons of examples of little ways that you can change behaviors, moving in ways that will reduce the repetition of these disorders. Let's talk a little bit about that.  One really important piece for depression when we're talking about behavioral therapy is activity scheduling. The less routine you have, the more likely you are to be depressed. Often people with depression tend to lose their routine or they have lost their routine, which can actually contribute to depression. What we might do is we might look at our day and implement or add just one or two things to create some routine. Once you've got those things down, maybe you have a morning routine in the morning where you take a walk at eight o'clock, and that's it for now. Let's just try on that. And then by lunchtime, we might add in some kind of pleasurable activity. Because we know with depression, as I mentioned at the beginning, depression can take away our pleasure or interest in hobbies. We might introduce those back, even though I know that you're not going to experience as much pleasure as maybe you used to. But we're going to experiment and be curious about bringing back things into your life like paint-by-number, crochet, or whatever it might be.  I personally just took up crocheting when I was in Australia. My mom insisted that I learn how to crochet and it's quite impressive to me how something so simple can be such a mindful activity. Even though I only do it for 5, 10, 15 minutes a day, that in and of itself can be an incredible shift to our mental health. Again, I want to make clear, none of these alone will snap you out of depression. It's a series of small baby changes in a direction that is right for you and is in line with your values. Now, another thing you can do when depression and anxiety mix is to consult with your doctor about antidepressant medications for anxiety & depression or what we call SSRIs. We know that research shows that a combination of CBT and medication is a really effective way to come out of that hole of depression and anxiety. If that's something you are interested in or willing to consider, please do go to a medical professional or a psychiatrist and talk with them about your particular needs. It can be incredibly helpful. I know for me, during different stages of my life, SSRIs have been so, so helpful. That's something that you could also consider. The next thing you can do when depression and anxiety mix is to consider exercise. We actually have research to show that exercise is as effective as medications or SSRIs, which blows my mind. Actually, I think it's so wonderful that we have this research. In my opinion, add it slowly to your calendar. I'm not here to say this means you have to go out and do an hour class at the gym. It could be as simple as taking a walk around the block.  Actually, recently, as many of you follow me on Instagram, I am trying to get back to exercising more as I still continue to recover from my chronic illness, POTS. I don't go and do huge workouts. For me, it's first starting in baby steps, 5, 10 minutes. Or can I do a plank for 30 seconds? And that's it to start. I want to again encourage you to take baby steps here and implement just little things at a time. And then ask yourself, how does this feel? Did this help? Did this hinder? How does it feel in my body? And then if you need to, talk to a mental health professional about what would be the best step for you next. Now we also know that exercise aids relaxation, it aids over well-being. It's incredibly helpful, again, for your mental health. That's something you can consider and consult with a doctor as well.  Now another thing you can consider is relaxation techniques. Now here, we're not talking about doing breathing just to get rid of anxiety. We know that that doesn't typically work, but there are ways in which you can learn to breathe as an act of self-compassion, of slowing down and acknowledging where you are and slowing down your behaviors, and checking in with yourself. This does include some mindfulness or you can even consider taking up one or two minutes of meditation a day. These techniques can be very helpful for both depression and anxiety.  Again, I keep teasing this, but I keep having technical issues. We will eventually have a meditation vault for you guys that will have meditations for anxiety and depression specifically and anxiety with intrusive thoughts. I've tried my best to continue to add. We've got probably over 30 meditations already. That will be available to you soon as well, so do keep an eye out for that. HOW OCD CAUSES DEPRESSION?  Now, let's talk as promised about how OCD causes depression, because I know a lot of you out there have OCD. If you don't have OCD, stick with this because I'm also going to go through here about insomnia. We do know that statistically, OCD affects 2.5 million adults. That's 1.2% of the population. That's just what we know of. That's not actually the real stats because there are so many people who haven't reported it because of stigma and shame and so forth. We know here that women are three times more likely to be affected than men. That's actually not my experience. I think I have a 50/50 in my clientele. But that's what the statistics show.  Again, as you can imagine, if you have OCD and you're completely flooded with intrusive thoughts, you're doing compulsions for hours, you're stuck in a mental loop, I think the research shows 80% of people also have depression, up to 85%. Now, that is significant in the overlap and it just shows how much OCD can take you down and really target your worth and your sense of identity and your self-esteem and how much shame and guilt and blame goes along with those. When you're experiencing that, of course, you're going to experience some depression or themes of depression, as I said before, hopelessness, helplessness, and worthlessness.  If this is the case for you, what we often recommend, again, especially if the primary condition is OCD and then you have depression because of that, we really want to target getting you better from OCD as soon as we can. A lot of the time, when depression is caused by the anxiety disorder, the major treatment goal needs to be getting that primary condition under control. Often once we get that primary condition under control, the depression does lift. Now, again, it's different if you're someone who's always had depression or had it throughout your life. We still want to go back and look at cognitive behavioral therapy or mindfulness-based cognitive behavioral therapy. We also want to look at maybe including a massive self-compassion practice because that is absolutely key for all of these conditions, no matter what, whether they're coexisting or not. But you can also include other modalities like acceptance and commitment therapy. You could also do other modalities such as dialectical behavioral therapy. That's particularly helpful if you're engaging in impulsive behavior or self-harm. You're having a tremendous degree of suicidal ideation, or sometimes in some cases, suicide attempts. These are other options you can add to your cognitive behavioral therapy if you require it. Because remember, we have to look at you as a person, not just you as a diagnosis. We have to really be certain that we look at all the symptoms, you have a thorough assessment, we're clear on what's the primary and secondary condition, and then we can create a treatment plan for you that targets those specific symptoms.  If you have OCD and you don't have access to a mental health professional, we do have ERP School, which is an online class for OCD, it's on demand. You can watch it as many times as you want. You can go to CBTSchool.com to get any of these courses. But that is there for you. I made it specifically for people who either don't have access to mental health services, can't afford them, or have had it in the past and they just want to hear it be said in a different way. Maybe you really like my way of training and teaching and you want to hear it and how I apply it with my patients. All of the courses that I have recorded are exactly how I would treat my clients and how I would walk them through the process. They're there for you if you would like.   HOW SOCIAL ANXIETY CAUSES DEPRESSION? Now let's move on to how social anxiety causes depression. Now, this is true for everything, and forgive me because I should have mentioned this before. One of the most common safety behaviors that come out with social anxiety is avoidance, isolation. But I should have mentioned before, that is very true of any anxiety disorder. It's very true of OCD, it's very true of post-traumatic stress disorder. When we isolate and we avoid, we do tend to feel more depressed because we have less connection in our life, we have less interaction, which can be a really great way for us to stay present. When we're in a room by ourselves with our thoughts, that can always create more anxiety and more depression. That's very common for social anxiety.  The other thing to remember about social anxiety too is the voice of social anxiety is also very, very mean, just like OCD and generalized anxiety and depression. Thoughts we have when we have social anxiety are often like, "You look like an idiot. You look awkward. What's wrong with you? Why did you say that? You shouldn't have said that. They're going to think you're stupid." As you can imagine, those thoughts in and of themselves will create more anxiety, and that secondary depression, that layer of like, "I give up. I can't do this. This is too hard. What's even the point of trying?"  WHAT TO DO WHEN ANXIETY AND DEPRESSION CAUSE INSOMNIA Last of all, we want to talk about what to do when anxiety and depression, or one or the other, cause insomnia. Now, it's important to recognize here that one of the core symptoms of depression is insomnia or getting too much sleep. It can go either way, but there are some people who have depression and one of their symptoms is they cannot fall asleep. They lay in bed for hours just round and round and round ruminating. That is true for any of the anxiety disorders as well.  When you have anxiety and you have depression, you go to bed, you turn the lights off, and you are left with your thoughts. If your thoughts are mean, if your thoughts are catastrophic, if your thoughts are very much in the theme of hyper-responsibility or perfectionism, it's a very high chance that you're going to get stuck being completely overwhelmed with those thoughts and then have a hard time falling asleep. What happens there, as this is the theme of today, is it becomes a cycle. The less sleep you get, the more anxious you might feel. Or the more that you have anxiety, the more you might be afraid you won't fall asleep, and that anxiety in and of itself keeps you up and you're caught in a cycle.  What I want to offer to you here, as we look at all of these conditions, let's wrap this up for you, is number one, if you have anxiety and/or depression, you are so not alone. I would say the majority of my patients have both. No matter what anxiety disorder, they have little inklings or massive degrees of depression. That does not mean there's anything wrong with you and it doesn't mean you cannot move into recovery. It also doesn't mean that this is your fault.  I really want to emphasize here that with compassion and baby steps and PATIENCE, we can slowly come out of this place and get you back out. I strongly encourage you to reach out and have a team around you who can support you, even if you haven't got access to a mental health professional, your medical doctor, or any friends you may have, family. Maybe it's using resources like online courses or workbooks. We have, for people with OCD, The Self-Compassion Workbook for OCD. They're amazing workbooks for depression. One I strongly encourage you to consider is a book by David Burns called Feeling Good. It's an amazing resource using cognitive therapy for depression. These are things that you can bring in and gather as a part of your resources so that you can slowly find your way out. Hopefully, the clouds will separate and you can see the sky again.  I truly want to recognize here that this is really hard. We're talking about two very influential conditions that bully us and can make us feel hopeless. I want to recognize that and validate you and send you a large degree of love because this is hard work.  As I always say, it is a beautiful day to do hard things. I say that because if we can look for the beauty, that in and of itself is a small step to moving out of these conditions. Look for the beauty in your day, and see doing the hard things as a beautiful thing because, with each hard thing you do, you're taking one step closer to your recovery. You just focus on one hard thing at a time, and then you focus on the next hard thing and you celebrate your wins, and you of course act as kindly and as compassionately as you can. Thank you so much for being here. I hope that was helpful. We went all the way through what to do when anxiety causes depression and vice versa. I hope you took so much from today's video and podcasts. For those of you who are listening on podcast, do know that we will be introducing a lot of these on video on YouTube as well. If you want to see my face, I will be over on YouTube as well.  I'm so honored that you have spent your time with me. I know how valuable your time is. I do hope that you have a wonderful day. Please do remember it is a beautiful day to do hard things and I am here cheering you on every step of the way.