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

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.

Welcome back, everybody. It is so good to have you here talking about hyper-responsibility & hyperresponsibility OCD. A lot of you may not even know what that means and maybe have never heard it, or maybe you’ve heard the term but aren’t quite sure what it entails. And some of you are very well acquainted with the term hyper-responsibility. I thought, given that it’s a theme that’s laced through so many anxiety disorders through depression that we should address it. I think that’s a really great starting point. WHAT IS HYPER-RESPONSIBILITY OCD? Let’s talk about first what is hyper-responsibility. Hyper-responsibility is an inflated sense of responsibility. It is feeling responsible for things that are entirely out of your control, such as accidents, how other people feel about you, how other people behave, events happening in your life. It’s ultimately this overwhelming feeling that the world rests on your shoulders, that it’s up to you and it’s your job to keep yourself and everybody else safe. Even as we look at this definition of what hyper-responsibility is, I’m actually feeling and noticing in my body this heaviness, this weight that you’re carrying, and it is an incredible weight to carry. It is an incredibly stressful role to play. If you’re someone who experiences hyper-responsibility, you often will have additional exhaustion because of this.  WHAT IS THE DIFFERENCE BETWEEN HYPER-RESPONSIBILITY AND RESPONSIBILITY OCD? One thing I want to clear up as we move forward is first really differentiating the difference between hyper-responsibility and responsibility OCD. When we say “hyper-responsibility,” we’re talking about a heightened sense of responsibility. Actually, let me back up a little bit. We do have responsibility. I am an adult. I’m responsible for my body, I’m responsible for two young children, a dog. Responsibility is one thing. You need to keep them safe, you need to take care of them, you need to show up in respectful ways. But hyper-responsibility is so much more than that. It’s taking an incredible leap of responsibility and feeling responsible for all the teeny tiny things, like I said before, that are out of your control.  Now, once we’ve determined what responsibility is, then we can also look at responsibility OCD. Now specifically for those who have responsibility OCD is where this sense of hyper-responsibility has crossed over into meeting criteria for having the obsession of hyper-responsibility that’s repetitive, intrusive, unwanted, and you’re also engaging in a significant degree of compulsions that, again, meet criteria for OCD. They could be mental compulsions, physical compulsions, avoidant compulsions, reassurance-seeking compulsions, and so forth.  The way I like to think of it is on a spectrum. We have responsibility on one side, then in the middle, we have hyper-responsibility, and then it goes all the way over to responsibility OCD. Some people will differentiate them differently in terms of they will say, hyper-responsibility is the same thing as responsibility OCD. But I’m not here to really diagnose people, and I’m not here to tell people that they have OCD if they don’t quite resonate with that. I’ll use me as an example. I 100% struggle with hyper-responsibility in certain areas of my life. But the presentation of that hyper-responsibility, I don’t feel, and I’m sure my therapist doesn’t feel, meets criteria for me to get the diagnosis of OCD. That’s why I want to make sure this is very loose so that you can decide for yourself where you fit on that spectrum.  HYPER RESPONSIBILITY SYMPTOMS OR RESPONSIBILITY OCD SYMPTOMS A little bit more about hyper-responsibility symptoms or even responsibility OCD symptoms. Examples will include: when something goes wrong, you’re probably likely to blame yourself and feel guilty for the fact that something went wrong. Even disregarding whether it was your fault or not, you’ll feel a sense that this was your mistake, that you should have prevented it.  Another hyper-responsibility symptom is you might believe that it is up to you to control the outcomes of your life. It is up to you to control the outcomes of other people’s lives—your dependence, your partner, your family members, and so forth, the people at your work, the projects at your work, or at school.  Another symptom of hyper-responsibility and responsibility OCD is this act of always trying to “fix” the problem. Even when you’ve recognized that there is no solution, you feel this need to just keep chipping away and finding the solution to prevent the bad thing from happening or being responsible for the bad thing. You may spend hours trying to prevent accidents or bad things from happening. What I mean by spending hours is it takes up a significant degree of your time, and it’s usually quite distressing. It’s a heavy feeling.  There is a difference between responsibility and hyper-responsibility. An example might be my husband found that one of our decks was rickety and shaking, and he felt it was his responsibility to fix that. He did it in a very measured way, in a very rational way, and it was coming from a place of his genuine value and his genuine view that it’s his responsibility to fix that. However, hyper-responsibility would be fixing it, but then also checking every part of it to make sure that it was safe, spending a lot of time going over all the possible scenarios on how it may not be safe, how it could have been safer, what it would mean if something bad happened, replaying. I actually shouldn’t use the word “replay.” It’s almost like future forecasting what would happen and who would be at fault if something bad did happen.  Again, if we even went further into more responsibility OCD, it might involve repetitively doing these over and over again to get a sense of relief from this hyper-responsibility or to absolutely get security and certainty that nothing bad will ever happen. Often in this case, if I was using this example, maybe they would do the avoidant compulsion of saying, no one’s allowed on the deck, even though it might be a safe, secure deck. That’s just one example. It’s probably not the best example, but I’m trying to use it in contrast to the many ways in which this can play out, especially for those who don’t have hyper-responsibility.  A thing to remember is, people who don’t have hyper-responsibility may look at the person with hyper-responsibility with a quite perplexed look on their face because to them, they can’t understand why the person feels so heavy loaded with responsibility. And that can be very frustrating, particularly as it shows up in relationships.  Now, an inflated responsibility may also present as people-pleasing, which is really an attempt to control how people feel about you. It may also present as giving a lot of money or time to charities or groups of people who are less privileged and so forth. Again, let’s get really nuanced. It doesn’t mean if you donate money that you have hyper-responsibility. A lot of these actions people may do from a place of value. But again, we always want to look at the intention of why they’re doing it, and are they doing it to reduce or remove this feeling that they’re having?  Another symptom of an inflated responsibility is over-researching unlikely threats or possible scenarios. You’re really doing it to try and prevent something bad from happening. Is it possible that someone could fall off a deck? Sometimes I’ll explain it to you, for me personally, often it’s related to the law. For me, it will show up in, “Oh, I’m a boss. I’m someone who has employees. What are all the possible scenarios that legally could impact me? Let me do a lot of research around that.” Until I catch it, and I’m like, “Kimberley, you’re engaging in a ton of reassurance here. Let’s not try to solve problems until they’re actually here and actually a problem.” Another example of an inflated responsibility is keeping physical or mental lists like, did you do this? Did you do that? Did you do this? That’s really an attempt to make sure nothing bad has happened.  One other thing is—I remember doing this a lot when I had a baby—checking the baby over and over. I felt that it was my responsibility to keep this baby alive, and yes, it was my responsibility to keep my baby alive. But I had somehow taken it upon myself that if something happened, I would be fully at fault. That it wouldn’t have been my husband’s fault, who’s laying right next to me, who is a fully engaged and loving dad. I had taken it on myself that 100% of the responsibility of her wellness and his wellness, my children are mine, and if something happened, 100% of the fault would be on me.  I have such compassion for the moms out there who experience this responsibility weight on their shoulders. I think number one, it’s societal. Number two, I think it’s normal, again. But number three, it’s so terrifying because often, not just for moms, for everybody here, the thing that we are worried about are often people we deeply love too. The things that we hold in high value. That’s again why it can be so incredibly painful.  Now, while these behaviors don’t necessarily, again, mean you have hyper-responsibility or OCD. Again, I want you to think of it like it’s on a spectrum. It is important to know that lots of people with OCD experience hyper-responsibility in many areas of their lives, and that hyper-responsibility shows up in many different subtypes of OCD, many themes of OCD. If you have OCD, you can really put that in your back pocket and keep an eye out and really increase your awareness of how hyper-responsibility is showing up and making it harder for you to overcome your obsessions and compulsions.  We can all agree as we move forward that hyper-responsibility deeply, deeply impacts somebody’s mental health and their overall well-being. My hope is now to give you some tools, some things that I’ve found helpful for me to manage that—things that I’ve had to practice over and over again.  WHAT CAUSES RESPONSIBILITY OCD & HYPER RESPONSIBILITY? Now, before I do that, let’s quickly check in on, often people will ask what causes responsibility OCD or hyper-responsibility. There are a couple of things to think about here. When I’m talking with patients who have OCD, I don’t spend a lot of time digging deep into childhood stuff and bringing up old events and so forth. For some people, that can be incredibly helpful. I tend to find it often does become compulsive and we spend a lot of time there instead of actually targeting the behaviors that are problematic. But for the sake of today, of just giving you some education, we do know that hyper-responsibility CAN, not always, but CAN come from childhood experiences and family dynamics. Often a child may feel it’s their job to take care of other people. Maybe they’ve been taught that. Maybe they’re the eldest sibling and they were given a lot of responsibility. Maybe their parents were very, very strict, and that for them, they felt that they had to maintain that perfect demeanor and perfect school report and so forth. We do know that childhood experiences, that environment that we were raised in can impact someone’s experience of hyper-responsibility.  We also know that brain disorders like OCD, other anxiety disorders, or even depression, or trauma—trauma is not a brain disorder—these mental health disorders can also exacerbate the theme of hyper-responsibility in people.  We also know that external pressures, societal expectations, the way our culture raises us can also add to a sense of hyper-responsibility. I know for me, as I’ve thought about this a lot recently, which was a part of the reason why I wanted to do this episode, I am a therapist; it’s an incredible weight of responsibility to be a therapist. I’m surrounded by laws and ethics and licensing boards and all of these rules. I find that the environment of my work can very much nurture my already inclination to have hyper-responsibility. I do think too the environment we are even in as an adult can keep this going.  And then the last thing I want to look at, which we’ll talk about here in a second, is simply irrational beliefs and rules we keep for ourselves can very much “cause” (I don’t like to use that word) and exacerbate hyper-responsibility.  STRATEGIES FOR MANAGING HYPER-RESPONSIBILITY Now that we have this and we can get a feel for why someone may experience this, now let’s talk about some strategies for managing hyper-responsibility. Because that’s why you’re here and that’s what I really love to do the most. Let’s talk about it. First, when I’m managing my own hyper-responsibility or I’m talking with patients about it, the first thing I do is get really clear on what is your responsibility and what is not. I often will do an exercise with my patients and say, “Okay, you are a human being. I want you to write me a job description of what you need to do to be a human being, to exist as a human being.” Let’s say I owned a supermarket and I hired someone to work at the register, the job description would say exactly what is your responsibility. It would say, “You need to turn up at this time, you need to leave at this time. When you come, you need to log in, you need to clock in, you need to put your uniform on. Here’s the things that you need to do that are your responsibility.” And then that employee has a very clear understanding of what their role entails.  Now, for you as a human, and everybody’s job description looks a little different, I want to first get clear on what is your responsibility. For me, I’ll use an example, I’m a mom, so I do have to be responsible for the well-being of my two children. But let’s get a little clearer on what that means. Does that mean I have to just keep them fed and dressed? Or does that mean for me and my values that I keep them fed and dressed and have a degree of emotional support, but to what degree? This is why I want you to get really clear on what it is for you and your values.  And then once we do that, you can actually sit with a trusted person—either a family member, a therapist, a mental health provider, or a loved one—and start to question how much responsibility you’re taking on. Of the things on your list, what are the things that are actually not in your control? Not in your control. Because if you have an anxious brain, remember your brain is going to tell you all of the worst-case scenarios. That’s your brain’s job. If you have an anxiety disorder, you’re probably got a hyperactive brain that lists them off like a Rolodex, da da, da, really, really fast. All the worst-case scenarios.  People with hyper-responsibility often use that Rolodex of information and just start adding that to their job description. “Oh, well, if there’s a possible chance that they could run out and whatever it may be, well then I have to protect for that,” even though it hasn’t happened and it’s highly unlikely. You can start to see, once you are looking at this list of rules you have for yourself, where you’ve pushed from just having a responsibility to having hyper-responsibility.  Another example might be in relationships. I’ll use again me as an example. My husband and I are going to be 20 years married this year. For years, I took on as my responsibility that I was supposed to keep him happy. Over and over again, I found that I was unable to do this because I’m a human being and I’m faulty and I’m going to make him mad and annoyed sometimes. But I’d taken this responsibility that it was my job to maintain his happiness. And that’s not actually the job description of being a human being. Once I started to go through this with my therapist at the time, I’m starting to see, I’m trying to control things that are out of my control.  The second thing I want you to think about is once you are clear on what is your responsibility, you have this great roadmap now. Now you have to think about staying in your lane. I may have talked about this on the podcast before, but I talk about this a lot with my patients. Once you’ve determined what is in your control, what is in line with your values, not just what anxiety’s telling you, but what you believe is a healthy limit for you, then you can work at keeping yourself within those parameters and practicing not engaging in picking up responsibility outside of your lane again.  We always use the metaphor of like, I’m in my car, I can control what kind of car I drive, what speed I go, that’s my responsibility. But let’s say my child is in the lane, metaphorical lane next to me, and they’re speeding like crazy, and they’re driving all over. My kids haven’t got a driver’s license, just stay with me for the metaphor. But let’s say my kid or my partner is in their car and they’re smoking and they’re checking their phone and they’re swaying all over and they’re doing all these things. I have to then determine, if I’m going to respond to that, what is my capacity in my lane. Let’s say it was my husband. I have to basically accept that he’s a full-grown adult who is responsible for himself, which sucks. Believe me, I know. This drove me crazy that I had to let him be in his own lane and I had to stay in my lane.  I remember having fights with my therapist, not actual fights, but conversations. I’m like, “If we were using this metaphor, he could die. He could get himself into trouble.” She would say, “Yes, and you’re going to have to decide what’s best for you. There’s no right for every one person. We’re not going to treat everyone the same, but you have to take responsibility for how much you engage in trying to control the people around you, and you also have to be willing to allow this to be out of your control sometimes.” You can imagine me sitting in the chair. This was way before COVID. I’m sitting back on the couch and my arms are crossed and I’m all mad because I’m just coming to terms with this idea that I can’t be responsible for everything, that I’m exhausted from trying, that I’m creating a lot of relationship drama because of my attempt to take control and be hyper responsible. I had to give it up. But the giving up of it, the staying in my lane required that I had to feel some really uncomfortable feelings. Let’s just take a breath for that because it was tough and it is tough. I’m sure if you are experiencing hyper-responsibility, you too are riding strong waves of guilt, regret, shame, anger, resent because of this hyper-responsibility.  If this is you, what you can also do is really double down with your mindfulness practice. The biggest, most important piece of this is increasing your awareness of where it shows up in your life, in what corner, and how it creeps into little parts of your life, and noticing when it does and why it is. In that moment, maybe the question might be, what is it that I’m unwilling to feel? What am I unwilling to tolerate in this moment, and how might I increase my willingness to feel these feelings of guilt or regret or shame, or anxiety, massive degrees of uncertainty? Can I allow them without engaging in these behaviors that just keep this hyper-responsibility going? It’s a huge test of awareness. And then we double down with kindness, and I’ll tell you why. Because when you have hyper-responsibility, you’re probably going to be plagued with guilt. You feel guilty for all the things happening with someone. We feel anxious because we didn’t get it right. We couldn’t keep the things straight and perfect and it’s really, really heavy.  In order for us to negotiate with ourselves through those emotions in a non-compulsive way, we have to have a self-compassion practice where we give ourselves permission to get it wrong sometimes. We give ourselves permission to make mistakes sometimes. We allow things to fall apart. That’s the hard part, I think. It feels so wrong to not be fixing things all the time. It can feel so irresponsible to not be preventing things and we have to be willing to navigate and ride through that compassionately. Now, if you’re someone who really struggles with guilt, I’ve got two podcast episodes that you really need to go and listen to. Number one was Episode 161, which is all about this idea that feeling guilty does not mean you have done something wrong. A lot of people with anxiety, hyper-responsibility, and OCD think and feel that if they feel guilt, it must be evidence that they did something wrong. We have a whole episode, Episode 161 again, where you can go and listen and learn about how our brains make mistakes on this one.  In addition, if you are someone who has OCD and you really struggle with regret and guilt, we also have another Episode 310. It wasn’t that far gone, that I talked about how regret and guilt are also obsessions. Meaning we have intrusive thoughts, we have intrusive feelings, and sometimes the intrusive feeling is guilt and regret. Please do use that resource as well.  And then the last thing I would want you to think about here is, for those of you who are in the background listening, but secretly thinking, “But I have screwed up. I have made mistakes. I’ve made so many mistakes and I need to make sure that never happens again,” number one, let me slow down for a sec—I want to first acknowledge that you are a human and you will make mistakes just like I am a human and we will continue to mess up over and over again. Let’s just get that out in the open. Let’s just come to a place where we can acknowledge and humble ourselves with the fact that yes, we are going to make mistakes. A part of you in this moment when you’re saying, “But I’ve made mistakes, I’ve really screwed up,” is that you will not accept that that is a part of being a human. That is the tax on being a human, my friend. You’re going to have to come to a place of acceptance of that.  Often people say, “That sucks. I don’t want that,” and I’m going to keep saying, “But you will.” They’ll say, “But I don’t want to,” and I’ll say, “But you will.” We could go all day on that one. But if you are someone who actually did screw up, it then again becomes a concept or a practice of when you screw up, how do you handle it? Do you screw up and beat yourself up for days and days and months and months and years or years? Or do you screw up and learn from it and acknowledge your humanness and learn what the mistakes are, and then do your best to pivot within the rules in which you set in what we said was your lane? Because often what happens is we do all this work, we address our job description as being a human and what’s just within your line of values and what’s your regular human responsibility. And then when something goes wrong, they hypercorrect and they go back to these rules that include a lot of control, a lot of preventing, a lot of ruminating, a lot of making sure, and you’ve gone back to being in all of everybody’s lanes. If you’re struggling with this, you can go to Episode 293. I did an episode called “I Screwed Up, Now What?” I really think that that was an episode where I had made a massive mistake and I was navigating through it in real-time and sharing what I thought was helpful.  RESPONSIBILITY OCD TREATMENT If you’re wanting to learn more about responsibility OCD treatment, I’m going to strongly encourage you to look for an exposure and response prevention therapist who will be able to identify your specific subtypes and help apply an ERP plan for you. Now, if you cannot access professional help, you can also go to CBTSchool.com. We have ERP School, which is our online course teaching you how you can practice ERP. The course is not specifically about hyper-responsibility, but it will allow you to do an inventory of your specific set of obsessions, your specific set of compulsions, and put a plan together so that you can start to target these behaviors on your own. You can very much get up and running on your own if you do not have access to professional mental health. The whole point of me having those courses isn’t to replace therapy. It’s there to help you get started if you haven’t got any way to get started. Often people go there because they want to know more and they want to understand the cycle of OCD, and that’s why we made it. My lovely friends, that is hyper-responsibility. We’re talking about when you feel responsible for anything and everything and everyone. If that is you, let me leave you with this parting message: Please slow down and first recognize the weight that you’re carrying. Sometimes we have to do an inventory of the costs of this hyper-responsibility because it’s so easy just to keep going and keep carrying the load and pushing harder and solving more and preventing more. But I want you to slow down for you as an act of compassion and take stock of how heavy this is on you, how exhausting this is on you, and then start to move towards acknowledging that you don’t have to live this way, you don’t deserve to live this way. That there is another way to exist in the world compassionately and effectively without taking on that responsibility. If you need support, of course, reach out and get support because you don’t have to do it alone. There are ways to crawl out of this hyper-responsibility and get you back into that lane that’s healthy for you.  I’m sending you so much love. I hope you’re having a wonderful summer for those of you who are in the northern hemisphere. I have just gotten back from the southern hemisphere and I loved getting some sun. I’m so happy just to be here with you and keep working through this stuff with you and addressing these really cool, important topics.  Have a wonderful day. Do not forget, it is a beautiful day to do hard things. Take care.

Kimberley: Welcome. This conversation is actually so near and close to my heart. I am so honored to have Jessie Birnbaum and Sandy Robinson here talking about Managing the anxiety of chronic illness and disability. Welcome and thank you both for being here. Sandy: Thank you for having us. Kimberley: For those of you who are listening on audio, we are three here today. We’re going to be talking back and forth. I’ll do my best to let you know who’s talking, but if anything, you can look at the transcripts of the show if you’re wondering who’s saying what. But I am so happy to have you guys here. You’re obviously doing some amazing work bringing awareness to those who have an anxiety disorder, specifically health anxiety OCD, panic disorder. These are all very common disorders to have alongside a chronic illness and disability. Jessie, will you go first in just telling us a little bit about your experience of managing these things?  Jessie: Yeah, of course. I’ve had OCD since I was a little kid but wasn’t diagnosed until around age 14, so it took a little while to get that diagnosis. And then was totally fine, didn’t have any physical limitations, played a lot of sports. And then in 2020, which seems like it would coincide with the pandemic (I don’t think it did), I started getting really physically sick. I started out with these severe headaches and has continued on and morphed into new symptoms, and has been identified as a general chronic illness. I’m still searching for an overall diagnosis, but I’ve seen a lot of different ways in which my OCD has made my chronic illness worse. And then my chronic illness has made my OCD worse, which is really why Sandy and I are so passionate about this topic. Kimberley: Thank you. Sandy, can you share a little about your experience? Sandy: Yeah. Just briefly, I was born really prematurely at about 14 weeks early, which was a lot. And then I was born chronically ill with a bowel condition and I also have a physical disability called [02:31 inaudible] palsy. And then I wasn’t diagnosed with OCD until I was 24, but looking back now, knowing what I do about OCD, I think I would say my OCD probably started around age three or something. So, quite young as well. Kimberley: You guys are talking about illnesses or medical conditions that create a lot of uncertainty in your life, which is so much of the work of managing OCD. Let’s start with you Jessie again. How do you manage the uncertainty of not having a diagnosis or trying to figure that out? Has that been a difficult process for you, or how have you managed that? Jessie: It has been such a difficult process because that’s what OCD latches onto, the uncertainty of things. That’s been really challenging with not having a specific diagnosis. I can’t say, “Oh, I have Crohn’s disease or Lyme disease,” or something that gives it a name and validates the experience. I feel like I have a lot of intrusive thoughts and my OCD will latch onto not having that diagnosis. So, I’ll have a lot of intrusive thoughts that maybe I’m making it up because if the blood work is coming back normal, then what is it? I’ll have to often fight off those intrusive thoughts and really practice mindfulness and do a lot of ERP surrounding that to really validate my experience and not let those get in the way. Kimberley: Sandy—I can only imagine, for both of you, that is the case as well—how has your anxiety impacted your ability to manage the medical side of your symptoms? Sandy: I think that’s an interesting question because I think both my OCD and my medical symptoms are linked. I think when I get really stressed and have prolonged periods of stress, my bowel condition especially gets a lot worse, so that’s tricky. But I think as I’ve gone through ERP, and I’m now in OCD recovery, that a lot of the skills I’ve learned from being chronically ill and disabled my whole life, like planning, being a good self-advocate at the doctors or at the hospital and that flexibility, I think those tools really helped me to cope with the challenges of having additional anxiety on top of those medical challenges. Kimberley: Right. Of course, and I believe this to be from my own experience of having a chronic illness, the condition itself creates anxiety even for people who don’t have an anxiety disorder. How have you managed that additional anxiety that you’re experiencing? Is there a specific tool or skill that you want to share with people? And then I’ll let Jessie chime in as well. Sandy: Yeah. I think the biggest thing is, it was realizing that my journey is my journey and it might be a little slower than other people’s because of all the complicating factors, but it’s still a good journey. It’s my journey, so I can’t really wish myself into someone else’s shoes. I’m in my own shoes. I guess the biggest thing is realizing like my OCD isn’t special because I have these complicating factors, even though I myself am special. My OCD is just run-of-the-mill OCD and can still be treated by ERP despite those medical issues as well. Kimberley: Right. How about you Jessie? What’s your experience of that?  Jessie: I’d like to add to what Sandy had said too about the skills from ERP really helping. One of the things I feel like I’ve gone through is there’s so much waiting in chronic illness. You’re waiting for the doctors to get back to you, you’re waiting for test results, you’re waiting for the phone schedulers to answer the phone. I feel like I’ve memorized the music for the waiting of all the different doctors. But there’s a lot of waiting, and that’s really frustrating because the waiting is uncertain. You’re just waiting to get an answer, which typically in my case and probably Sandy’s and yours as well, then just adds more uncertainty anyways.  But I remember one of the tools that’s really helped me is staying in the present, which I’m not great at. But I remember I had to get an MRI where you literally can’t move. There’s only the present. You’re there with your thoughts, your arms are in, you can’t move at all. It was really long. It was like 45 minutes long. I remember just thinking the colors. What do I see? I see blue, I see red. I thought I had to think of things because then my eyes were closed and I was thinking of different shapes of like, “Oh, in the room before, I saw there was a cylinder shape and there was a cube.” That’s really helped me to stay in the present, especially with those really long waiting periods Kimberley: For sure. The dreaded MRI machine, I can totally resonate with what you’re saying. It’s all mindfulness. It’s either mindfulness or you go down a spiral, right? Jessie: Exactly. Kimberley: You guys are talking about skills. Because I think there’s the anxiety of having this chronic illness or a disability or a medical condition. What about how you manage the emotions of it and what kind of emotions show up for you in living with these difficult things that you experience? Sandy, do you want to share a little about the emotional side of having a chronic illness or a disability? Sandy: Yeah. I think the first thing that shows up for me emotion-wise, or did at least when I started to process the idea that I have a disability and I have these chronic illnesses and it’s going to be a lifelong thing, was I was in my undergraduate university and I really hadn’t thought much about what it’s like to-- I had thought about having a disability, but I hadn’t thought about the fact that I needed to process that this is a lifelong thing and it’s going to be challenging my whole life. I think when I started to process that, the grief really showed up because I had to grieve this life that I thought I should have of being able-bodied or medically healthy or mentally well, I guess. I had to really grieve that. But I think that grief shows up sometimes unexpectedly for me too because sometimes I feel like I moved past this thing that happened. But then because it’s an ongoing process to navigate chronic illness and disability, the grief shows up again at unexpected times.  I think the other thing too I’ve navigated was a lot of shame around the idea that I should be “normal.” But of course, I can’t really control how I was born and the difficulties I’ve had. I think something that really helps me there is bringing in the self-compassion. I do think that compassion really is an antidote to shame because when you bring something out to the forefront and say, “This is something that I’ve experienced, it was challenging,” but I can still move forward, I think that really helps or at least it helps me.  Kimberley: Yeah, I agree. Jessie, what are your experiences? Jessie: I would say the first two words I thought of were frustration and loneliness. I think there’s a lot of frustration in two different ways. The first way being like, why is this happening? First, I had OCD, and then now I have this other thing that I have to deal with. As Sandy was saying before, there’s a lot of self-advocacy that has to happen when you’re chronically ill, or at least that I’ve experienced, where you have to stand up for yourself, you have to finagle your way into doctor’s appointments to get the treatment that you deserve. But there’s also the frustration that both OCD and my chronic illness, I guess, are invisible. I look totally fine. I look like someone else walking down the street who might be completely healthy. I often feel frustrated that as a 23-year-old, a person who is a young adult, I’m having to constantly go to these doctor’s appointments and advocate for myself and practice ERP, which is not always the most fun thing to do. It’s frustrating to constantly have to explain it because you don’t see it. And then that goes together with the loneliness of being a young adult and being pretty much the only person in the doctor’s offices and waiting rooms who isn’t an older adult or who isn’t elderly. And then they get confused and then I get confused. My OCD will then attack that like, “Everyone else is older. What are you doing here?” I would definitely say loneliness, and I just forgot the other thing. Loneliness and frustration.  Kimberley: I resonate with what you’re saying. I agree with everything both of you are saying. For me too, I had to really get used to feeling judged. I had to get good at feeling judged, even though I didn’t even know if they were judging me. But that feeling that I was being judged, maybe it’s more magical thinking and so forth. But that someone will say like I have to explain to someone why I can’t do something. As I’m explaining it, I have a whole story of what they’re thinking about me, and that was a really difficult part to get through at the beginning of like, “You’re going to have to let them have their opinions about you. Who knows what they’re thinking?” That was a really hard piece for me as well. I love that you both brought in the frustration and the loneliness because I think that’s there. I love that we also bring in the grief, and I agree, Sandy. Jessie, do you agree in terms of that grief wave just comes at the most random times?  Jessie: Absolutely. Kimberley: It can be so, so painful. Let’s keep moving forward. Let’s go back to talking about how this interlocking web of how anxiety causes the chronic illness to get worse sometimes, the chronic illness causes anxiety to get worse sometimes. Sandy, have you found any way that you’ve been able to have a better awareness of what’s happening? How do you work to pull them apart or do you not worry about pulling them apart?  Sandy: Oh, that’s an interesting question. I think I have a few strategies. I do try to write everything down. I make notes upon notes upon notes of, this day I had these symptoms. I do automate a lot of tasks in the fact that I have a medication reminder on my phone, so it reminds me to take my pills instead of just having to remember it off the top of my head. Something that really helps is trying to remember that things that work for other people might actually also work for me too, because it’s like, yeah sure, maybe me as a person, I’m unique and my medical situation is interesting or different or whatever. But a lot of good advice for other people, especially for mental health works for me too, like getting outside. Even if I feel really not great and I’m really tired or in a lot of pain, just like getting outside. Anytime I have my shoes on and I’m just outside even for five minutes, I count that as a win. Drinking a lot of water, for me, helps us too. Of course, I’m wary of saying all this because a lot of people might just say, “Oh well, Jessie and Sandy, they just need to do more yoga and that’ll just cure them.” Of course, it’s not that simple. It’s not a cure at all. But at the same time, I try to remember that at least for me, I have common medical issues that a lot of different people have so I can pull on literature and different things that I’ve worked for other people with my conditions. Maybe other people haven’t had this exact constellation that I do, but I can still pull on the support and resources from other people too. Kimberley: How about you, Jessie? Jessie: If I could add there, I’m not as good as differentiating. I can tell, like I know when things are starting to get compulsive, which I actually appreciate that I had had so much ERP training before I got sick because I really know what’s a compulsion, what’s an obsession and I can tease that out. But a lot of my treatment has also been really understanding, like maybe I don’t need to know if this is my chronic illness or if this is my OCD because then that gets compulsive. I’ve had to sit in that uncertainty of maybe it is one, maybe it is the other, but I’m not going to figure it out. Kimberley: You read my mind because as you were both talking, I was thinking the most difficult part for many people that I see in my practice is trying to figure out and balance between advocating going to the doctor when you need, but also not doing it from a place of being compulsive because health anxiety and OCD can have you into the doctor surgery every second day or every second hour. How are you guys navigating that of advocating, but at the same time, keeping an eye on that compulsivity that can show up? Sandy, do you want to go first?  Sandy: Yeah. I honestly haven’t figured out the perfect formula between trying to figure out like, is this anxiety around the potential that I might be getting sick again and compulsively trying to get things checked out, and the idea that I might have something actually medically going wrong that needs to be addressed. I find it still challenging to tease those things apart. But I think something that does help is trying to remind myself like, not what is normal, because I don’t think normal really exists but what is in the service of my recovery. I can’t have recovery from my disability or my chronic illnesses, but I can’t have OCD recovery. I’m always still trying to think to myself, how can I move forward in a way that both aligns with my values and allows me to move forwards towards my recovery? Kimberley: How about you, Jessie? Jessie: It’s so hard to follow that, Sandy. I love that. I would say, I think it’s tough because a symptom that I have is like, I was never really a big compulsive Googler. But I know in OCD world, it’s like, “Don’t go to Google for medical issues. Google is not your friend.” But for my chronic illness recovery or chronic illness journey, Google’s been important. I’ve had to do a lot of research on what is it that I possibly have. And that really helps me advocate my case to the doctors because I’ve had some great doctors, but they’re not spending hours reading medical journals and trying to figure it out to the extent that I care about it because it’s my situation and I want to figure stuff out. Googling has actually helped me a lot in that regard and joining different Facebook groups and actually hearing from other people what their experiences have been.  I know Sandy and I started a special interest group, which hopefully we’ll talk about a little later, but someone in the group had mentioned that something that really helps them is the community of their doctors and their therapists working together of, oh, I’m going to wait two days if I have this symptom and if it’s still a symptom that’s really bothering me and my therapist thinks it should be checked out, then I’m going to go to the doctor. Having those people who are experts guiding you and helping you with making sure, no, this isn’t compulsive, this is a real medical thing that needs to be checked out—I thought that was really smart and seemed to work for her, so I’d imagine it would work for other people as well. Sandy: I guess if I can add-- Kimberley: I have a question about that. Yes, please. Sandy: Oh, sorry. If I can add one more thing, it would just be that, while there’s so many experts on OCD and ERP and your chronic medical issues or your disability or whatever it is for you, you are the only frontline expert in your own experience of your mind and your body and you are the only one who knows what it’s like to exactly be in that, I guess, space. While I 100% think therapy is important, evidence-based treatments are important, I do also think like remembering when you think like, “Oh, this is really hard,” or “I can’t cope,” actually, you can cope, you’re capable and you know yourself best. I think that’s challenging because I know sometimes in ERP, for people who maybe don’t have other complicated medical challenges, they would say, “Don’t Google.” But I think, as just Jessie has explained, sometimes because we have other chronic stuff going on, we do need to do things to help ourself holistically too. Kimberley: I love that. I’ll speak from my own experience and if you guys want to weigh in, please do. I had to always do a little intention check before I went down into Google like, okay, am I doing this because anxiety wants me to do it, or am I doing it because this will actually move me towards being more informed, or will this actually allow me to ask better questions to the doctor and so forth? It is a tricky line because Google is the algorithm and the websites are set to sometimes freak you out. There’s always that piece at the bottom that says, “It could be this, this, or this,” or “It could be cancer.” That always used to freak me out because that was something that the doctors were concerned about as well. This might be beyond just Googling, but in terms of many areas, how did you make the decision on whether it was compulsive or not? Jessie? Jessie: It’s tough too because then you’re down the rabbit hole. You’ve already been Googling it and it’s like, “Or this,” and I’m like, “Well, I have to figure out what that is.” Sometimes it does get a little compulsive and then the self-compassion, and also realizing it like, okay, now it’s getting compulsive and I’m going to stop and go about my day. But another thing that I’ve struggled with is the relationship with doctors. Sandy and I have talked about this before with wanting to be the “perfect” patient. I worry that I’m messaging them too much or I’ll often now avoid messaging them because then I don’t want to be too annoying of a patient. I can’t be the perfect patient if I’m messaging them all the time. It really is, like you said, the intention. Am I messaging them because I want to move forward with this and I want an answer, or am I messaging them because there’s a reason to message them and I need their medical advice? There’s just so much gray in it. Again, not necessarily having that specific answer, it can be very tricky. Kimberley: It truly can. How about you, Sandy? Sandy: I think the biggest thing for me, and I’m still trying to figure out the right balance for this, is weighing how urgent is this medical symptom. Am I-- I don’t know, I don’t want to say something that would put someone into a tailspin, but do I have a medical symptom going on right now that needs urgent attention? If so, maybe I should go to my doctors or the ER. Or is the urgency more mental health related, feeling like an OCD need to get that reassurance or need to know, and just separating the urgency of the medical issue that’s going on right this second versus the urgency in my head.  Kimberley: Amazing. You guys have created a special interest group and I’d like to know a little more about that. I know you have more wisdom to tell and I want to get into that here a little bit more. But before you do, share with us how important that part of creating this special interest group is, how has that benefited, what’s your goals with that? Tell us a little bit about it, whoever wants to go first. Jessie: Sandy and I actually met in an online OCD support group, and I found those online groups to be really helpful for my OCD recovery and mostly with feeling less shame and stigma. Met some amazing people clearly. And then I remember Sandy had mentioned in one of the different groups that she had a chronic illness. When I was going through my chronic illness journey, I felt really alone. As I was saying before, the loneliness is one of the biggest emotions that I had to deal with. I looked online, and now online support groups are my thing. Let’s just Google chronic illness support groups. I thought it would be as easy as OCD support groups, and it wasn’t. It was very challenging and it was really hard to find one.  I found one that was state-based. For my state, it was me and three women. I think one was in their eighties, the other two were in their nineties, and they were very sweet. But we were at very different lifestyle changes. We were going through very different experiences. I remember I reached out to Sandy and I said, “Do you have any chronic illness support groups that you’ve been attending?” Even in that group with the elderly women, there were so many things that they were saying that helped them with their chronic illness and my OCD would totally have latched onto all of it. I was like, “I can’t do that with my OCD.” There’s so much overlap that it just seemed like there needed to be this dual chronic illness and OCD. Sandy had said she had the same issue, like it was really hard to find these groups.  I think we’re really lucky that the International OCD Foundation was such a good partner for us and they were so kind in helping us get this special interest group started. I’m interested to hear what Sandy says, but it’s been so helpful for me to see that there are other people who deal with a lot of these challenges. Of course, I wouldn’t want anyone else to have these experiences, but being able to talk about it, being able to share has just been so helpful. I was really quite amazed to see the outreach we had and how many people struggled with this and that there really weren’t any resources. It’s been pretty amazing for me and I’m really lucky that we’ve been able to have this experience. Kimberley: Amazing. Sandy? Sandy: Similar to Jessie, I had found some resources for OCD support groups both locally to me in Ontario and online, and that was great. The sense of community really helped my OCD recovery. But then when it came to the chronic illness disability part, there was just a gap. As Jessie said, we started this special interest group and I think it’s called—Jessie, correct me if I’m wrong—Chronic Illness/Disability Plus OCD is our official title. Basically, it’s for anyone who has a chronic illness or disability and OCD, or is a clinician who’s interested in learning more. Our goals really are to create a community, but also create resources for the wider OCD community to help people who are struggling with chronic illness or disability and OCD or clinicians.  The sense of community has been great. I think for my own recovery OCD-wise, it’s been really motivating to be able to help found and facilitate this group because it’s showed me that I really don’t have to be in this perfect state of recovery to have something valuable to contribute. I just have to show up in an imperfect way and do my best and that is enough in itself, and that the fact that I don’t have to get an A+ in recovery because that’s not even a thing you can get. I just have to keep trying every single day and try to live my values. I think this SIG’s been a great opportunity to embody those values as well of community and advocacy. It’s just been great. Kimberley: Oh, I love it so much and it is such an important piece. I actually find the more I felt like I was in community, that in and of itself managed my anxiety. It was very interesting how just being like, “Oh, I’m not alone.” For some reason, my anxiety hated this idea that I was alone in this struggle. I totally just love that you’re getting this group and I’ll make sure that all of the links are in the show notes so people can actually access you guys and get connected.  I have one extra question before I want to round this out. How do you guys manage the—I’m going to use the word “ridiculous”— “ridiculous” advice you get from people who haven’t been what you’ve been going through? Because I’ve found it actually in some cases to be quite even hilarious, the suggestions I get offered. Again, I know patients and clients have had a really difficult time because they might have been suggested an option, and then their anxiety attaches to like, “Well, you should do that,” and so forth. Sandy, do you want to go first in sharing your experience with “ridiculous” advice? Sandy: I guess to give a brief example, a practitioner who I’ve worked with for quite a while, who I think is great and a wonderful person and wonderful practitioner, had in the last couple months suggested that maybe I should just try essential oils to manage my bowel condition. What actually was needed was hospitalization and surgery. It’s that kind of advice from both well-meaning practitioners or just people in my life that can be not what you need to hear and maybe not as supportive as they’re hoping it would be. I guess for me, I manage it mostly by saying, “Thank you, that’s a great idea,” even when it’s not really a great idea. I just say to myself or maybe to a support person later, “That was not the best advice.” Just debriefing it with someone I think is really helpful, someone that I trust.  Jessie: Kimberley, I love this. I think, Sandy, our next SIG, we should ask this and hear all the ridiculous advice that people have been given because it’s true. There’s so many things that are so ridiculous. I’m going to shout out my mom here who I love more than anything in the world, but even my mom who lives with me some of the time and sees what I go through, one time she called me (she’s going to kill me) and she said, “I heard there’s a half-moon at 10:30 AM your time and if you stand outside, it will heal some of your rear rash.” I was like, “What? That’s absurd.” She was like, “I know, I think it’s absurd too, but you need to do this for me.” With that, you see she just wants me to get better. As Sandy was saying, people really want to help and this is a way they think they can help. I’ve also been told like, “Oh, if you mash up garlic and then you put--” it was like this weird recipe, then you want to had it. Just ridiculous things. But people are really well-meaning and they want to help. Unfortunately, those often don’t really help. But now I can laugh about it and now text my mom and be like, “You’ll never guess what so-and-so said,” or text Sandy and we could have a good laugh about it. But that’s what’s nice about community. You’re like, “Wait, should I do this essential oil thing?” And then you realize from others, “No, that’s probably not the best route to go.” Kimberley: For me, with anxiety, self-doubt is a big piece of the puzzle. Self-doubt is one of the loudest voices. When someone would suggest that, I would have a voice that would say, “It’s not going to hurt you to try.” And then I would feel this immense degree of self-doubt like, “Should I? Should I not? What do you think?” “You could try. You should try.” I’m like, “But I literally don’t have time to go and stand in the sun and do the thing,” or in your example. I would get in my head back and forth on decision-making like, “Should I or shouldn’t I?” “It wouldn’t hurt.” “It sounds ridiculous, but maybe I should.” And that was such a compulsive piece of it that would get me stuck for quite a while. It’s often when it would be from a medical professional because it really would make you question yourself, so I fully resonate with that. Sometimes I wish I could do a hilarious Instagram post on all of the amazing advice I’ve been given throughout the time of having POTS. Some of it’s been ridiculous.  Let me ask you finally, what advice would you give somebody who has an anxiety disorder and is at first in the beginning stages of not having these symptoms and not knowing what they are? Jessie, will you go first? Jessie: Yeah. I would say a big thing, as we’ve been talking about, is finding that community whether that be reaching out to us with the SIG or whether that be finding a Facebook group or online group or whatever it may be, because it has helped me so much to reach out and be in a community with others who really understand. There’s nothing like people who truly get it. And then I would say to validate like, this is really tough. Having OCD is tough. Having a chronic illness or disability is tough, and having both is very, very tough. Validate those symptoms too because I think there’s a lot of people that will say, “Oh, you have an anxiety disorder, you’re probably making that up,” and that comes up a lot. Just validating that and really trying to find other people who are going through it because I think that’s just irreplaceable. Kimberley: Sandy? Sandy: I think the biggest thing to echo Jessie would be try to find community. I think for me, for my OCD recovery journey, Instagram has particularly been great because there’s so many wonderful OCD advocates or clinicians on Instagram. It’s really a hub for the OCD community. I would say check out Instagram and once you follow a couple of people from the OCD community, the algorithm will show you more so it’s nice that way. I think the other thing is that being disabled or having a chronic illness can really chip away your confidence. Just reminding yourself that you’re doing the best you can in a really hard situation, and it may be a long-term situation, but just because your life is different than other people doesn’t mean that it’s not going to be a great life. Kimberley: I’m actually going to shift because I wanted to round it out then, but I actually have another question. Recently, we had Dr. Ashley Smith on talking about how to be happy during adversity. I’m curious, I’ll go with you, Sandy, first because you just said, how do you create a wonderful, joyful life while managing not only an anxiety disorder, but also chronic illness or disability? What have you found to be helpful in that concoction per se? Sandy: I listened to that episode with Dr. Smith and that was a wonderful episode. If people haven’t listened to it, I recommend it. I listened to it twice because I just wanted to go back and pick out the really interesting parts. But I think for me, the combination of finding things that are both meaningful from a values and an acceptance and commitment therapy (ACT) perspective, meaningfulness, finding those things that matter to me, but also finding the things that challenge me. If I’m having a really bad pain day or fatigue day, the things that challenge me might just be getting out of bed, or maybe I’m really depressed and that’s why I can’t get out of bed. Either or, your experience is valid, and just validating your own experience and bringing in that self-compassion and saying, what is something that can challenge me today and bring me a little closer to recovery? Even if it’s going to be a long journey, what’s this one small thing I can do, and break it down for yourself. Kimberley: Amazing. I love that. What about you, Jessie?  Jessie: I would say I’ve been able to find new hobbies. I’m still the same person. I’m still doing other things that I found meaningful and this doesn’t. Well, it is a big part of my life. It’s not my entire life. I’m still working and hanging out with friends and doing things that regularly bring me happiness. But just a small example, I said before, I used to play sports and love being really active and that gets a little harder now. But something I found that I really love is paint by numbers because they’re so easy. They’re fun, they’re easy, you don’t have to be super artistic, which is great for me. I’m able to just sit down and do the paint by numbers. Even recently I had friends over and it was like a rainy day and we all did a craft. Even though it was a really high-pain day for me, I was in a flare of medical symptoms, I was still able to engage with things that I find meaningful and live my life. Kimberley: I love that. Thank you. That’s so important, isn’t it? To round your life out around the disability or the chronic illness or your anxiety. I love that. We talked about those early stages of diagnosis, any other thing that you feel we absolutely have to mention before we finish up? Sandy? Sandy: I guess to quote someone you’ve had on the podcast before, Rev. Katie, I find her content amazing and she’s just a lovely person. But she always says, you are a special person, but your OCD is not special. Your OCD isn’t fundamentally different or it’s never going to get better. You got to remember that you are the special person and your OCD doesn’t want you to recognize that you are the thing that’s special, not it. Just be able to separate yourself from your anxiety disorder or your chronic illness or your disability, saying, “I’m still me and I’m still awesome, and these things are just one part of me.” Kimberley: So true. I’m such a massive Katie fan. That’s excellent advice. Jessie? Jessie: To go the other route, I think you said right with people who are first going through this. I would say we recently did a survey of our SIG, so people who have chronic illness and OCD. We haven’t done all the data yet, but the thing that really stood out was we asked the question like, have you ever felt invalidated by a medical professional or mental health professional, and every single person said yes and then explained. Some people had a lot to say too. I think I’ve really learned in this process that you have to be a self-advocate. It’s very challenging to be an advocate when you’re going through a mental disorder, a physical disability, and/or both. It’s required. Really standing up for yourself because it’s going to be a tough journey and there’s so much light in the journey too. There’s so many positive things and so much “happiness” from the episode before, but there’s also a lot of difficulties that can come from being in the medical world as well as the mental health world and really trying to navigate both of them and putting them together. Really try to advocate for yourself or find someone who could help you advocate for yourself and your case because I think that’ll be really helpful. Kimberley: So true. You guys are so amazing. Jessie, why don’t you go first, tell us where people can get resources or get in touch with you or the SIG, and then Sandy if you would follow. Jessie: We have an Instagram account where we’ll post-- we’re experiencing with Canva. We’re really working on Canva and getting some graphics out there about the different things that come up when you have both of these conditions. And then that’s where we post our updates for the special interest group. Sandy, correct me if I’m wrong. @chronically.courageous is our Instagram handle. And then in there, the link is in our bio to sign up for the special interest group. You get put on our email list and then you’ll get all the emails we send with the Zoom links and everything. And then you could also go to the International OCD Foundation’s website and look at the special interest groups there and you’d find ours there. Sandy: The other thing is we meet twice a month. We meet quite frequently and we’d love to have you. So, please check out our Instagram or get at our email list and we would love you to join. Kimberley: You guys, you make me so happy. Thank you for coming on the show. I’m so grateful we’re having this conversation. I feel like it’s way overdue, but thank you for doing the work that you’re doing. Thank you so much. Jessie: Thank you. Sandy: Thanks for having us.

Kimberley: My tummy already hurts from laughing too much. I’m so excited to have you guys on. Today, we are talking about thriving in relationships with OCD and we have Rev. Katie O’Dunne and Ethan Smith. I’d love for you both to do a quick intro. Katie, will you go first? Katie: Yeah, absolutely. My name is Reverend Katie O’Dunne. I always like to tell folks that I always have Reverend in my title because I want individuals to know that ordained ministers and chaplains can in fact have OCD. But I am super informal and really just go by Katie. I am an individual who works at the intersection between faith and OCD, helping folks navigate what’s religious scrupulosity versus what is true authentic faith. I’m also an OCD advocate on my own journey, helping individuals try to figure out what it looks like for them to move towards their values when things are really, really tough. Outside of being a chaplain and faith in OCD specialist and advocate, I’m also an ultramarathon runner, tackling 50 ultramarathons in 50 states for OCD. As we get into stuff with Ethan today, Ethan is my biggest cheerleader throughout all of those races. I’m sure we’ll talk all about that too, running towards our values together. Ethan: My name is Ethan Smith. Katie is my fiancé. I’m a national advocate for the International OCD Foundation, a filmmaker by trade, and a staunch advocate of all things OCD-related disorders. Definitely, my most important role is loving Katie and being her biggest cheerleader. Katie: Since you said that, one of my things too, I am the fiancé of Ethan Smith. Sorry. Ethan: Please note that this is an afterthought. It’s totally fine. Kimberley: No, she knew you were coming in with it. She knew. Ethan: Yeah, I was coming in hot. Yup, all good. WHAT IS IT LIKE BEING IN A  RELATIONSHIP WITH SOMEONE WITH OCD? Kimberley: Thank you both for being on. I think that you are going to offer an opportunity for people to, number one, thriving in Relationships with OCD, but you may also bring some insight on how we can help educate our partners even if they don’t have OCD and how they may be able to manage and navigate having a partner with OCD. I’m so excited to have you guys here. Thank you for being on. Can you first share, is it easier or harder to be in a relationship with someone with OCD? For you having OCD? Ethan: I’ll let Katie start and then I’ll end. Katie: Yes. No, I think it’s both. I think there are pros and cons where I think for so long being in relationships with individuals who didn’t have OCD, I desperately wanted someone to understand the things that I was going through, the things that I was experiencing, the intensity of my intrusive thoughts. I was in so many relationships where individuals felt like, well, you can just stop thinking about this, or you can just stop engaging in compulsions. That’s not how it works. It has been so helpful to have a partner through my journey who understands what I’m going through that can really say, “I actually get it and I’m here with you in the midst of that.” But I always like to be honest that that can also be really, really challenging where there are sometimes points, at least for me, having OCD with a partner with OCD, where if we are having a tough point at the same time, that can be really tough. It can also be really tough on a different level when I see Ethan struggling, not reassuring him even more so because I know how painful it is and I want so badly to take that away. There are times that that can feed into my own journey with OCD when I see him struggling, that my OCD latches onto his content, vice versa. There’s this amazing supportive aspect, but then there’s also this piece I think that we have to really be mindful of OCD feeding off of each other.  Ethan: I was just making notes as you were-- no, go ahead.  Kimberley: No, go ahead, Ethan. I’m curious to know your thoughts. Ethan: Katie made all great points, and I agree. I mean, on the surface, it makes a lot of sense and it seems like it’s fantastic that we both can understand each other and support each other in really meaningful and value-driven ways. I always like to say that we met because of OCD, but it by no means defines our relationship or is at the heart of our relationship. It’s not why we work. It’s not what holds us together. I think Katie brings up two good points. First of all, when I would speak and advocate with parents and significant others and things like that, and they would say, “I’m having a really hard time not reassuring and not enabling,” I’d be like, “Just don’t, you’re making them sicker. Just say what you got to say and be tough about it.” Then I got in a serious relationship with Katie and she was suffering and hurting, and I was like, “Oh my God, I can’t say hard things to her.” I became that person. I suddenly understood how hard it is to not engage OCD and to say things that aren’t going to make her comfortable. I struggle with that. I struggle with standing my ground after a certain amount of time and wanting to desperately give in and just make her feel better. I just want her to feel better.  For me personally, I lived alone for 10 years prior to meeting Katie, and those 10 years followed my successful treatment and recovery from OCD. For me, my mother was my safe person. I learned during treatment and therapy that you don’t talk about your OCD around your parents anymore. You just don’t. That’s not a conversation you have. I found myself, other than within therapy, not ever talking about my OCD. I mean, advocacy, yes, but my own thoughts, I never talked about it.  Starting to start a relationship with Katie, I suddenly had someone that understood, which was wonderful, but it also opened up an opportunity for OCD to seek reassurance. I’m an indirect reassurance seeker. I don’t ask for it as a question; I simply state what’s on my mind, and just putting it out there is reassuring enough for me. For instance, like, “Oh, this food tastes funny.” Whether she says it does or it doesn’t, I really don’t care. I just want her to know that I think that it does, and it could be bad. I think this is bad. I’m not saying, “Do you think it’s bad?” I’m like, “I think it’s bad. I think there’s something wrong with this.” I’ve had to really work and catch myself vocalizing my OCD symptoms because having a partner that understands has given my OCD permission to vocalize and want to talk about it. That honestly has been the biggest challenge for me in this relationship. NAVIGATING OCD REASSURANCE SEEKING IN RELATIONSHIPS Kimberley: So interesting how OCD can work its way in, isn’t it? And it is true. I mean, I think about in my own marriage, at the end of the day, you do want to share with someone like, “This was hard for me today.” You know what I mean? That makes it very complicated in that if you’re unable to do that. That’s really interesting. Let’s jump straight to that reassurance seeking piece. How do you guys navigate, or do you guys create rules for the relationship? How are you thriving in Relationships with OCD related to reassurance seeking or any compulsion for that matter? Katie: A couple different things. I think part of it for us, and we by no means do this perfectly, I’d have to have conversations about it even-- yes, Ethan, you might do it perfectly, but even in the last week, we’ve had conversations about this where what Ethan responds well to is very different from what I respond well to. I think that is really important to note, especially when there’s two partners with OCD, that it’s not one size fits all. It’s not because I understand OCD that I know exactly how to respond to him. It’s still a conversation. For me, I respond really well if I’m seeking reassurance or I’m struggling to a lot of compassion where he doesn’t respond to the content, but tells me, “I know that this is really hard. This sounds a lot like OCD right now, but let’s sit with it together. I know that it sucks, but we can be in the midst of this. We aren’t going to talk about it anymore, but I love you. We’re going to watch a show. We’re going to do whatever it is we’re going to do, we’re going to be in it together.” I respond really well to that.  Ethan, on the other hand, does not respond quite as well to that and actually responds better to me being like, “Hey, stop talking about that. We are not going to talk about this right now. I have heard this from you so many times today. No, no, no, no.” He responds in a harsher tone. That’s really hard for me because that is not naturally what comes out of me, nor what is helpful for me. Sometimes the compassion that I offer to Ethan becomes inherently reassuring and is just not something that’s helpful for him, so we have to have these conversations. Vice versa, sometimes when I’m really struggling, he’ll forget the compassion piece works for me and is like, “Hey, Katie, no. Stop doing that.” I’m like, “Seriously? This is really hard.” Being able to have those conversations.  Kimberley: How do those conversations look, Ethan? Can you share whatever you’re comfortable sharing? Ethan: Yeah. Katie hit over the head, first of all. We are definitely products of our therapists when we’re struggling. For those of you that may or may not know, Katia Moritz, she is hardcore, like here’s what it is, and I’m a product of that. There’s like, “Nope, we’re not going to do it. We’re not going to have it. OCD is black and white, don’t compulse, period. End of story.” Katie is like, “Let’s take a moment.” My natural instinct on how I respond to her is very different to what she needs and vice versa. We’ve learned that. I would say that the rule in our household is we’re a no-content household. I’m not saying we succeed at that all the time, but the general rule is we’re not a content household. We don’t want a no content. You can say that you’re struggling. You can say that you’re having a hard day. You can say that OCD is really loud today. Those are all okay things. But I don’t want to hear, and Katie doesn’t want to hear the details because that inevitably is reassuring and compulsy and all of those things. That’s our general rule. I’ll talk for me, and I don’t know, Katie, I’ll ask you ahead of time if it’s okay to share an example of our conversation, but my stuff, like I said, it’s covert reassurance seeking and she does it too. We’re both very covert. We’re like well-therapized and we know how to-- Katie: It’s really funny because I can tell when he’s sneaky OCD reassurance-seeking. Nobody else in my life has ever been able to tell when I’m secretly seeking reassurance. It’s actually frustrating because he can call me on it because he’s really good at it too. There’s some level of accountability with that. Ethan: For sure. For me, I’ll get stuck on something and I’ll just start verbalizing it. That’s really the biggest thing I think, unless Katie has some other insight, and she may. But for me, verbalization of my thoughts, not specifically asking for a specific answer and simply saying, “Oh, my chest feels weird. I’m sure I’m dying. My heart is about to give out.” How are you going to respond to that? What are you going to say right now? And that’s my system. She’ll be like, “Okay, yup. You may.” To be honest, I’ll call Katie out, she really struggles with giving me-- she’s like, “Ethan, I’m sure you’re fine.” I’m like, “Why did you say that?” She does. She really struggles with-- Katie: It’s interesting because I work with folks with OCD all the time and I don’t reassure them, but it’s so interesting because it feels so different with my partner knowing how much he’s struggling and I just want to be like, “You know what this is, it’s fine.” But yeah, working on that Kimberley: If he’s struggling, then you said sometimes you will struggle, it makes sense that in that moment you’re like, “You’re fine, you’re fine.” You don’t want them to have a struggle because you know it might even impact you, I’m guessing. Katie: Well, yeah. It’s funny, all of Ethan’s stuff is around bad things happening to him. All of my stuff is around bad things happening to other people. If Ethan’s worried something bad’s going to happen to him, I’m like, “No. I can’t handle that. I don’t want to worry that you’re going to die. Let’s not put that on the table.” Ethan: We discovered it was true love when my OCD was worried about her. She’s like, “Baby, it’s about me. It’s not about you.” It’s true love. No question. Katie: He had never had obsessions about someone else before. I was so excited. He was like, “Am I going to kill you in your sleep? Is that going to happen?” I was like, “Oh my gosh, you do love me. So sweet.” Ethan: But to answer your question, conversely, when Katie is struggling, she gets loopy and she directly asks for reassurance. I can definitely get frustrated at it at a certain point. I always feel like one time is appropriate. “Do you have a question or concern? Do you think blah, blah, blah?” “No, I don’t think so. I think that’s totally appropriate.” And then the second time, “Yeah, but do you...” I was like, okay, now we’re starting to move into OCD land and I stay compassionate up to a certain point and then I’ll get frustrated because it will be so obvious to me. As she said, myself is so obvious to her. I just want to be like, “Katie, can you see this makes no sense at all?” But when she’s really struggling, not just the superficial high-level or low-level OCD hierarchy stuff, when she’s really, really deeply struggling, it’s challenging. I really struggle with not giving her the reassurance that her OCD craves because I can’t stand to see her suffer. Sometimes I wish that I didn’t know as much about OCD as I do because I actively know that I’m helping OCD, but giving her that instant relief in the moment, it just pains me.  We’ve definitely changed our relationship style as we’ve gotten to know each other and been able to say things like, “I know this doesn’t feel good. I don’t want to say these things to you, but I really, really don’t want to help OCD and hurt you. I really, really want to help you get better in this moment and hurt OCD and just put it to bed, so I’m not going to answer that.” We’ve had to have those communicative conversations to be able to address it when it does cross the line.  I will say we’re pretty well., we do pretty good, but that’s not to say that there aren’t times where we can both get in a rabbit hole. To Katie’s point and to your point, it gets sticky sometimes. I literally never checked an oven in my entire life till I moved in with Katie. And then now she’ll mention it or I’ll be closing up the lights and I’ll be like, I’ve never looked and thought about it. But Katie talks about it and that’s one of her things, and like, “It latched on. I’ll take it,” and like, “No, no, no. Ethan. Everything’s going to burn down.” Yes, moving on. Katie: Likewise, I’ve never checked my pills multiple times to make sure that I didn’t take too many or worried that there was glass inside of my glass from hitting it. I mean, there’s things that were Ethan’s that I now think about. It’s really interesting because I think we actively work to not give into those things, but that’s definitely a process to you where they were things that I never would’ve gotten stuck on before. We have these conversations too of being able to call each other out. Well, actually, comedy is a really big thing in our house too, so we also like to call it out in a way of like, “Hey, you’re stealing my themes. Stop it. That’s mine. Come on, let me have that stomach bug thing.” Kimberley: Isn’t that so interesting, though? We constantly get asked what causes OCD, and we never can really answer the question. We say it’s a combo of nature and nurture and you guys are touching on the nurture piece in that, yes, we are genetically predisposed to it, but that other people’s anxiety around things can create anxiety for us. I actually feel the same way. There are so many things my husband is anxious about, or my kids. Now I’m hyper-vigilant about it. That’s so interesting that you guys are seeing that in real life.  HOW TO SUPPORT A LOVED ONE WITH OCD  Ethan: Yeah, for sure. And then Katie brought up a great point, which is, I think the most challenging times, and they don’t happen often, is when we’re both struggling simultaneously. How do you support each other in that moment? First of all, what’s very funny is we like to joke we both have OCD and we’re both only children. It’s one of those households. Literally, we’ll cook a frozen pizza and we’ll sit there and size up the half to figure out which one’s bigger and then be like, “Are you sure you want that one? I want that.” It’s a thing.  When we’re both struggling, it’s like, “No, you need to listen to me.” “No, no, no, no. You need to listen. It’s my thing. It’s my thing.” It’s been few and far between where we’ve both really been significantly struggling simultaneously, but we’ve managed it. We learn how to be able to struggle and listen and support. It’s no different than advocating when you’re not feeling your best. You can still be compassionate and sympathetic and offer advice that is rooted in modalities of treatment and still be struggling at the same time. We may not get the empathy that we want because maybe we’re just not in a place or we’re pouring from an empty cup or whatever, but fortunately, those times aren’t that frequent. But when they do happen, we’ve navigated and managed really well, I think.   Katie: And even just-- oh, sorry.  Kimberley: No, please, Katie. Go ahead.  Katie: I was going to say, even with that, having conversations around it, I think, has been really helpful. We’ve had moments of being really honest. Particularly earlier this year, I had some tough stuff that happened and I was in a place of grief and then also OCD was coming into that. Ethan, it lined up at some points with some difficult points that you had. There were some times that you were honest about saying, “I am just not in a place to respond to this right now in this moment in a healthy way.” I think that’s actually one of the best things that we can do too. Of course, OCD sometimes gets frustrated at that, “Hey, why can’t you talk about it right now?” But I think having those honest conversations as a couple too so that we can both offer care to ourselves and to one another in the midst of those times that we’re struggling is really, really important. SETTING BOUNDARIES IN RELATIONSHIPS WITH OCD Kimberley: You answered actually exactly what I was going to say. There are times when we can’t be there for our partner. When that is the case, do you guys then go to your own therapist or to a loved one? Not to get reassurance or do compulsions, but just have a sense of containment and safety. Or are you more working towards just working through that on your own? How do you guys navigate thriving in Relationships with OCD when your partner is tapped out?   Katie: We both have our own therapist and that’s really, really helpful. We both actually have conversations together with the other person’s therapist. Ethan will meet with his therapist and we’ve had times when he’s struggling where I’ll come in for a half session to talk about, hey, what’s the best way to respond to him and vice versa. I’ll meet with my therapist separately, but we might bring him in for 20 or 30 minutes for him to learn, hey, what’s the best way to respond to Katie right now? We both have those separate spaces to go and talk about both what we’re navigating and what we need, but also how to respond to our partner and then collaborate with one another’s therapist. I mean, that has been so helpful for me because there have been points where I don’t know how to respond to what Ethan’s navigating. To hear directly from his provider as opposed to feeling like I have to take on that role is so crucial. And then, Ethan, you meeting with my therapist earlier this year, oh my goodness, was so helpful because she had given me all this insight that I just wasn’t in a place to be able to share because I was struggling. For you to hear that directly from her and what she thought that I needed I think was a huge step forward for us. Ethan: Yeah. It’s nuanced. It’s not a one size fits all. Yes, it’s all ERP or ACT or DBT or whatever. But it’s all specific to what we’re all going through. I will say it’s funny because as we’re talking, I’m like, “I didn’t ask Katie if these things I could say or not.” Katie: I’m afraid to say that. You can literally say anything. I pretty much talk all the time about all this. Ethan: For sure. I think one of the things that really, really helped our relationship in terms of navigating this is, when I first met Katie and we started dating, she wasn’t seeing a therapist actively. It was challenging because as someone that is well-versed in OCD, we would constantly talk about things and she would divulge a lot of information to me. I started to feel like I didn’t want to take on an advocate or therapist’s role with her. I wanted to be her boyfriend. I was really struggling because I really wanted to support her and I really wanted to be. That was never a question, it was not supporting her. But for the same reason that we tell parents like, “Don’t police your kids, be their parents,” and hear how that can backfire, it was really challenging to navigate being a significant other and also supporting her, but not becoming that person that her OCD goes to.  I think her finally landing on a therapist that was right for her and good for her where she can get that objectivity that she needs and I can too learn what she needs from me as a partner, not that there was anything wrong with our relationship, but really allowed our relationship to grow and really allowed us to focus on what we should be focusing on, which is each other and who we are to each other and what’s important to our lives and our family. Our therapists can handle our OCD. That doesn’t mean that OCD doesn’t get involved. It does. But for the most part, that was really where our relationship really got to level up. We both were able to turn to our therapists, but also include each other in treatment so we can have open and honest conversations about what’s going on.  DO I TELL MY PARTNER ABOUT MY OCD OBSESSIONS? The other thing I’ll say is, we have no secrets. We literally have no secrets. As a first timer to a long-term relationship, because my OCD Obsessions wouldn’t let me have a long-term relationship any longer than four or five months, as a first-timer in the three-year club on May 9th, I really feel like that is such a crucial piece to our relationship. We watch reality shows and it’s like, “You went through my phone,” and it’s like, “Well, I don’t care. She knows my passwords. I have nothing to hide.”  I always say that individuals with OCD would make the worst thieves. Could you imagine? I put myself in a position of robbing a house. There’s no way I wouldn’t worry that one piece of DNA was not left in that house. I find hair on my pillow all the time. There’s no possible way I could ever burglarize anyone and not think I would be caught. We’re not transparent because we know that that will alleviate our OCD. We’re transparent because I think honesty is really important in a relationship and so is communication. We always advocate that having therapy and having access to treatment shouldn’t be an exception at all. That should be the standard. It should be accessible, should be affordable, should be effective. Absolutely, no question there. But with that being said, Katie and I were both fortunate enough to have really good treatment and I think our relationship reflects that. Not to say that we’re perfect all the time, but I think we’re too highly therapized individuals that began our relationship with honesty and communication and have continued that through and through. I think that has enabled us to not only grow as a couple but also helped us manage our own OCD and the OCD of each other and how we interrelate. HOW TO ENCOURAGE SOMEONE WITH OCD  Kimberley: Right. I think that is so true. As you’re talking, I’m thinking of people who are at the very beginning stages. They didn’t have any idea about OCD and they’ve been giving reassurance, they’ve been asking for reassurance, and there’s tantrums because the person isn’t giving the right reassurance. What would you encourage couples to do if they’re newly to treatment, newly to their diagnosis, and their goal is to be thriving in Relationships with OCD? Katie: There’s so many different things, and I know this is different for every person, but even if they’re new to that process, getting their partner involved in therapy, meeting with their therapist, having them learn about OCD, again, Ethan talked about, not from a space of the partner becoming the therapist, but having an understanding of what the person is going through so that they’re not reassuring, so that they’re not accommodating. But I say this to folks all the time, again, so that you’re not also being so hard and so rigid so that you can still be the person’s partner in the midst of that. I think being able to understand what their triggers are, what their symptoms are, what’s coming up, so that you can say, “Hey, I’m your partner. I love you. I can’t answer that, but I’m here.”  I think figuring out what that looks like with the provider, but also with the partner is just so beyond important to have an effective relationship, one, so that you’re not just closing it off so that you can’t talk about it, but two, so that, as Ethan said, you don’t become the therapist because that’s not healthy either. I think we have in our relationship almost tried both extremes at different points of, “Hey, we’re not going to talk about it at all,” or “Oh, we’re going to talk about everything and we’re going to totally support each other through every aspect.” I think with each person, it’s finding that balance of how we can be a couple with open and honest communication, but we’re actually still each other’s partners and not each other’s therapists. Kimberley: Yeah. Do you have any thoughts, Ethan? Ethan: I was just thinking. I mean, she nailed it. I don’t know that I have anything to add to that, whether you both have OCD or one of you has OCD. I was actually thinking earlier on in the relationship, and about divulging your OCD and when it’s appropriate. We get so many questions from so many people about, when I’m dating, when am I supposed to let them know? When am I supposed to talk about it? I have very aggressive feelings about OCD and dating, and as amazing as somebody may look and be like, “Oh my God, I would love to be in a relationship with a partner that has OCD because then I don’t have to explain anything.” I did not date to specifically find somebody with OCD. When I met Katie, we were friends long before we were together.  Katie: We always say that, like he was my best friend that I happened to meet through the OCD community, that we fell in love during COVID because he was my best friend, and because we had so much that connected us beyond OCD. I know you said this earlier, Ethan, but we get the question all the time, “Oh, if I just had a partner with OCD...” and that is not. If all we had in common was our OCD, this would not work out because it actually can make it even more challenging. But it’s what’s beyond that. I always think we shouldn’t be in a relationship or not in a relationship based on our diagnosis. It’s about who the person is and how we can support them for who they are. Ethan: Yeah, for sure. You actually raised a good point. I was going to talk about, and we can maybe come back to it, when to talk about your OCD to your partner, when it’s appropriate, when you feel it’s appropriate, this difference between wanting to confess about your own OCD and feeling like they need to know right now that I have OCD so I’m not dishonest with them and I don’t hit them with the big secret down the road. We can talk about that. But you raised-- wow, it was a really interesting point that I totally forgot. Katie, what did you just say? Go ahead. Katie: No, I was just talking about not being in a relationship because of the OCD and really having--  Ethan: I remember. Katie: Okay, go ahead. You got it.   HOW TO HELP YOUR LOVED ONE UNDERSTAND WHAT IT'S LIKE TO HAVE OCD Ethan: Yeah. I’d be curious to Kim’s thoughts. But I think with OCD individuals, whether it’s a significant other or family and friends, and I’ve been talking about this a lot lately, we’ve talked about, okay, how do I get someone to understand what OCD is? How do I help them understand what I’m going through? We did a town hall on family dynamics last week for the IOCDF and we’ve had multiple conversations about this. I’d be curious to Kim’s thoughts. I think there’s a difference between having a partner or a family member, whatever, being able to support you in an effective, healthy, communicative way, and fully understanding what you’re going through. I think those are two different things. I don’t think that an individual needs to know and feel exactly what you’re experiencing going through to be able to understand and support you. I think as individuals with OCD, we have this inherent need for our partners or people that we care about to know exactly how we feel and exactly what we’re going through. “You need to know my pain to understand me.” I think that is a big misnomer.  I think honestly, that’s a potential impossible trap for a relationship when you’re dating someone or with someone that doesn’t have OCD. The likelihood of that individual, while you can give them examples, the likelihood of them actually truly understanding your own OCD experience is unlikely. Just like if Katie had had cancer and went through treatment, I’ll never know what that’s like. But that doesn’t mean that I can’t be sympathetic and empathetic and support her and learn about the disease state and be able to be a really, really wonderful partner to her. I think for individuals that are in relationships with individuals that don’t have OCD, if you resonate with this, being able to release this idea of like, they need to know exactly what I’ve gone through. Really the real thing they need to know is, how can I be a supportive partner? How can I support you in a meaningful, healthy, value-driven way so we can have the best possible relationship? I don’t know if I ever said that, but Kim, I’d be open to your thoughts.  Kimberley: No, I agree. Because the facts are, they won’t get it. No matter how much you want them to get it, they will get it, but they won’t have experienced something similar to you. But I think like anything, there’s a degree of common humanity in that they can relate without completely having to go through it. They can relate in that I too know what it’s like to be uncertain or I too know what it’s like to have high levels of anxiety. Or even if they don’t, I too can understand your need for certainty in this moment or whatever it may be.  I think the other thing to know too is often when someone needs to be understood and they insist on it, that’s usually a shame response. There’s a degree of shame that by being understood, that may actually resolve some of that shame. If that’s the case, they can take that shame to therapy and work through that and get some skills to manage that, because shame does come with mental illness. Often I find some of the biggest fights between couples were triggered by a shame emotion. They felt shame or they felt embarrassed or humiliated, or they felt less than in some way, or the boxing gloves are on. How do you handle, in this case, conflict around-- I don’t know whether you have any conflict, but has conflict came up around this and how do you handle it? SHAME + GUILT IN RELATIONSHIPS WITH OCD Katie: One piece with the last component, and then I’ll shift into this. I think as you were talking, the shame piece resonates with me so much. I’m definitely someone that even through the OCD experience, guilt and shame are much heavier for me than anxiety or fear or anything else, that feeling really challenging. I think that the biggest piece that helped to combat that actually had to do with my relationship with Ethan, not specifically because he knew every ounce of my themes or what I was going through, but simply because of the empathy that he showed me. I talk often about how because of shame in my OCD journey, one of the reasons I struggled to get better for a long time was I didn’t feel like I deserved it. I didn’t feel like I was good enough because of my intrusive thoughts. I didn’t like myself very much. I hated myself actually. Ethan, by loving me, gave me (I’m going to get emotional) permission to love myself for the first time. It wasn’t because he specifically knew the ins and outs of my themes, but simply because he offered empathy and loved me as a human being, and showed me that I could do that for myself. That was a huge step forward for me. I think every partner can do that.  I used to talk with my students when I was in education about empathy, and I would always say you don’t have to experience the exact same thing that your friend experienced to say, “Oh, I can put myself in your shoes.” To your point, Kim, I know what sadness feels like. I know what this feels like. I know what that feels like. I think just showing empathy to your partner, but also showing them that they truly do deserve love in the midst of whatever they’re experiencing with their OCD can be such a healing component. I just wanted to say that, and now I’ve forgotten the other part of your question.  Ethan: Well, wait, before she asks it, can I piggyback?  Kimberley: Yeah.  Ethan: I’m going to just offer to Katie. Katie’s shared that story before and it’s really special. Always, I was just being me and seeing something beautiful in her and wanting it to shine. But something that I don’t think I’ve ever talked about ever is what she did for me in that same context. I always saw myself as a really shiny car, and if you saw me surface, I was really desirable. I knew my first impressions were really solid. But if you got in me and started driving, I got a little less shiny as the deeper you went. It was really hard to get close to Katie and let her in. Katie and I haven’t talked about this in a while, but when we started getting intimate, I would never take my shirt off with the light on. I would hold my shirt over my stomach because I was embarrassed about my body. She’s an athlete. I’m not an athlete. When we would walk and I would get out of breath, the level of embarrassment and shame, I would feel like, how could this person love me? Now I’m going to get emotional, but it took me a long time to be able to-- this morning, I was downstairs making breakfast without a shirt. I didn’t think about it. She taught me that the parts of myself that I thought were the ugliest could actually be loved. I had never experienced that beyond my parents. But even beyond that, I don’t know that they had seen pieces of my OCD, pieces of me as a human being, as an individual. Katie taught me about unconditional pure love and that even what I deemed the most disgusting, grossest parts of myself, even seeing those.  My biggest fear with Katie was her seeing me. I don’t panic often, like have major panic freakouts, but there are a few things that I do. My biggest fear was her seeing me. I kept saying, “Just wait. Wait till you see this, Ethan.” It comes out every now and again. “You won’t love that person.” Early on, I had a thing that I panicked and she was nothing but love and didn’t change anything. For weeks, I was like, “How can you still love me?”  It doesn’t necessarily relate to your question, but I wanted to share that because I think that for so many that really see themselves as broken or cracked, I think it’s real easy to look really good on the surface. But I think that being willing to be vulnerable and honest and truthful-- and Katie’s the first woman I’ve ever done that with, where I was literally willing to go there despite what my OCD told me, despite what my head told me and my brain told me. I just think that’s also created a really solid foundation for our relationship. I just wanted to share that. Kimberley: That full vulnerability is like the exposure of all exposures. To actually really let your partner see you in your perceived ugliness, not that there’s ever any ugliness, but that perceived, that’s the exposure of all exposures in my mind. You have to really use your skills and be willing to ride that wave, and that can be really painful. I love that you guys shared that. Thank you for sharing that, because I think that that’s true for even any relationship. That is truly thriving in Relationships with OCD! Katie: Absolutely. SEEING BEYOND OCD  Ethan: Yeah, for sure. OCD can definitely get sticky even with that. It’ll start to question, well, does she still love me because of that? She says she does, but does she really-- even my brain now goes, “She can’t possibly love my body. That doesn’t make sense. That doesn’t make sense.” So funny thing about Katie, we were early on in our dating, we were struggling. She’s laying on me. She’s like, “You’re the most comfortable boyfriend I’ve ever had.” I was like, “Yeah.” And then I started thinking like all she’d ever dated before me were triathletes, like washboard dudes. I was like, “Huh, thank you?” She’s like, “No, no, it’s a good thing. It’s a good thing.” I’m like, “Okay. Yeah.” It’s very funny, but I also loved it. Katie: I do the same thing with you. I mean, all the time, everything’s still. Three years in, we’re getting married in September, stuff will come up and it’s like, “Wait, you saw this, this part of myself that I think is really ugly. You still love me?” Like, what? It gives me permission every time to love myself. Ethan: That’s such an interesting relationship dichotomy between the two of us. I don’t mean to venture away from your question, Kim, but it’s so interesting. I don’t see any of the things that she sees in herself. She could freak out for a week and I would still see her as this perfect individual who I couldn’t love more. She feels the same about me. It’s so weird because we see each other in the same light, but we don’t see ourselves in that light. It is amazing and I feel a little selfish here to have a partner to be able to remind me of how I should see myself. I hope that I give Katie that same reminder and reassurance, but it really is amazing to be able to see that within our partner because I’ll do something and I’ll be like, “Wow.” She’s like, “Yeah, that didn’t change anything for me.” I’m like, “Really?” Because that’s how I feel like, “Oh, okay.” Because that’s how I feel when you do. “Okay, we’re on the same page.” Kimberley: Let’s just delete the last question because I want to follow this. I love this so much. It actually makes me a bit teary too, so we might as well just cry together. What would you say to do for those who don’t understand OCD and maybe perceive it as “ugliness”? I’m sure there are those listening who are thinking, “I wish my partner could see beyond my anxiety and how I cope.” What advice would you give to them?  Katie: Ethan, you go first. Ethan: It’s a hard question. It’s a hard question to answer. It’s thundering and you get it twice since we’re in the same house. I think one thing I was going to say before, and maybe this will get tight, and this doesn’t answer your question directly, Kim, but I’m hoping we can get to it, is when somebody asks me like, “I have OCD and I want to date and get in a relationship, well, how do I do that?” I have very strong feelings about that particular question because I don’t want to dive into acceptance and commitment therapy and this whole concept of being able to do both things simultaneously, which is very value driven and we’re going to feel the feels and have the ick and we don’t have to wait for the perfect moment. But I’ve always believed that if your OCD at that time is so severe that it’s going to heavily impact your relationship, and the reason that you have to tell the person that you’re interested in all about your OCD is because you have expectations of that person to reassure and enable, and you’re going to need that from that person, I would always say, you might not want to get in a relationship right now. That may not be the best timing for you to get in a relationship.  I always would want somebody to ask themselves like, if you’re in therapy and you’re in treatment or wherever you are in your process and you know that you shouldn’t be seeking things from somebody and reassurance, enabling and so forth and so on, then that’s a different conversation. But I think at first, being honest and true to ourselves about why we’re divulging, why we want them to know about our OCD, and what we’re going to get out of this relationship—doing that from the beginning, I think, then trickles over into your question, Kim, about like, what if they don’t understand? What if they don’t get it? Because going into a relationship with this idea of, “Well, they need to know so they can keep my OCD comfortable,” is very different than my OCD doesn’t necessarily play a prominent role in my life, or maybe it does, but I’m in treatment and I need them to know and then they may not understand. I think that that’s like a different path and trajectory. Katie? Yeah, go ahead.  Katie: I think that’s such an important component. It’s interesting. I heard a very different side of the question. I was thinking about maybe someone who is already in, whether it’s a romantic relationship or-- Ethan: No, that was the question. I didn’t know what to say yet, so I was being like, “Well...” Yeah, no, that was the question. You heard that right. YOU ARE WORTHY & LOVABLE WITH OCD Katie: It was really important too. This might sound really simplistic, but I think it’s so important. Just based on, oh my goodness, my experiences with feeling for such a long time, I was defined by my OCD or defined by my intrusive thoughts, or, oh, how could anybody love me in the midst of all of this? I want everybody to hear that regardless of how your OCD is making you feel right now, or how you’re feeling, you are not defined by your OCD. You are not defined by your intrusive thoughts. You are not defined by your disorder. You are an amazing human being that is worthy of love in all of its forms, and you’re worthy of love from yourself. You’re also worthy of love from a partner. I think sometimes there’s this feeling of, well, I don’t deserve love because of my OCD, or I don’t deserve someone to be nice to me or to treat me well. I’ve also seen folks fall into that trap. I’ve been in relationships that weren’t particularly healthy because I felt like I didn’t deserve someone to be kind to me because of my OCD, or like, oh, well, I’m just too much of a pain because of my obsessions or my compulsions, so of course, I don’t deserve anything good in this sense.  I want you to hear that wherever you are in your journey, you do deserve love and respect in all of its forms, and that the people that are around you, that truly love you, yes, there are moments that are hard just like they are for me and Ethan, where sometimes there might be frustrations. But those people that truly love you authentically, I really believe will be with you in the midst of all of those highs and lows, and continue to offer you love and respect and help you to offer yourself that same love and respect that you so deeply deserve. Kimberley: I love that. I think that that speaks to relationships in general in that they’re bumpy and they’re hard. I think sometimes OCD and anxiety can make us think they’re supposed to be perfect too, and we forget that it’s hard work. Relationships are work and it takes a lot of diligence and value-based actions. I think that that is a huge piece of what you’re bringing to the table. I want to be respectful of your time. Closing out, is there anything that you feel like you want the listeners to hear in regards to relationships and yourself in a relationship? Do you want to go first, Ethan? Ethan: Sure. Yeah, I agree. Let Katie close out. She’s amazing. I just want to echo, honestly, the last thing that Katie said was perfect, and I wholeheartedly agree. What would I want to bring into a relationship? I want to bring in my OCD or myself, what is going to be my contribution to a relationship, a romantic relationship. I definitely would want to bring me into it. I want to bring Ethan and not Ethan’s OCD. That doesn’t mean that Ethan’s OCD won’t tag along for the ride, but I definitely don’t want Katie to be initially dating my OCD. I wanted her to date Ethan.  I think what Katie said about that directly relates in the sense that love yourself, value yourself, realize your worth, know your worth. It’s so hard with OCD, the shame and the stigma and just feeling like your brain is broken and you don’t deserve these things, and you don’t deserve love. What’s wrong? It’s so hard. I mean, I say it humbly. When I say go into a relationship with these things, I know it’s not that simple. But I think that if you can find that place where you know what you have to offer as a human being and you know who you are and what you have to give, and it doesn’t have to be specific. You don’t have to figure yourself out of your life out, simply just who your heart is and what you have to give like, I don’t know who I am entirely; I just know that I have a lot of love to give and I want to give it to as many people as possible—own that and don’t be afraid to leave crappy relationships that are good, that because it’s feels safe or comfortable, it’s the devil you know in terms of how it relates to your OCD. You’re not broken. You’re not bad. You shouldn’t feel shame. OCD is a disorder. It’s a disease, and you deserve, as Katie said, a meaningful, beautiful love relationship with whomever you want that with. You deserve that for yourself. Stay true to who you are. Stay true to your values. If that’s where you are now, or if it isn’t where you are now, be willing to take a risk to be able to find that big, as Katie says, beautiful life that you deserve. It’s out there and it’s there.  To Kim’s point, I’m sorry, this is a very long last statement, so I apologize. But to Kim’s point, relationships are hard and life is hard. I really believed when I got better from OCD that in six months, I was going to meet my soulmate, make a million dollars, and everything would be perfect. Life did not happen like that at all. It’s 15 years later. But at a certain point, I was like, “I’m never meeting my person. OCD is not even in the way right now, and I’m never meeting my person. I’m never going to fall in love. I’m never going to get married.” Now we’re four months away from my wedding to being married to the most amazing human being. I truly believe that that exists for everyone out there in this community. Living a life that is doing things that I never would imagine in a million years. Please know that it’s there and it’s out there. If you put in the work, whether it happens the next day, the next year, or the next decade, it’s possible and it’s beautiful. Embrace it and run towards it.  Kimberley: Beautiful. Katie? Katie: I feel like there isn’t much I can add to that. I’m going to get teary listening to that. I think I’ll just close similar to what I was sharing before for anyone listening, whether it is someone with OCD or a partner or a family member, whomever that is, that you deserve love and compassion from yourself and from every single person around you. You are not defined by your OCD. It is okay, especially if you’re a partner, if you don’t respond perfectly around OCD all the time, because you know what, we are in the midst of a perfectly imperfect journey, especially when it comes to romantic relationships. But if you continue to lead with love, with empathy, and with compassion, and with trusting who you are, not who the OCD says you are, I truly believe that you’ll be able to continue to move towards your personal values, but also towards your relationship values, and that you so deeply deserve that. Kimberley: Oh, I feel like I got a big hug right now. Thank you, guys, for being here. I’m so grateful for you both taking the time to talk with me about this. Most of the time when someone comes to see me and we talk about like, why would you ever face your fear? Why would you ever do these scary hard things? They always say, “Because I’ve got this person I love,” or “I want this relationship to work,” or “I want to be there for my child.” I do think that is what Thriving in Relationships with OCD is all about. Thank you so much for coming on the show.  Katie: Thank you for having us.Ethan: Thank you for having us.

Welcome back, everybody.  Alright, alright, alright. You may already notice the sound of my voice has shifted, the tone has shifted, and that is on purpose. Actually, I’ve never thought of this, but it’s true. I often show up when I’m ready to do a podcast. I sit in front of my microphone, I’m in front of my desk, I take a deep breath and I just talk to you from a place of centeredness and calm, gathering as much wisdom as I can. That is a part of what I’m bringing today. But my other hope is I want to shift the tone a little bit because that’s what you have to do when you’re addressing this particular topic, which is motivation during depression. We’re talking about how to get things done during depression. That’s what we’re here for today. Thank you for being here. My name is Kimberley Quinlan. I’m a marriage and family therapist. I’m an OCD and anxiety specialist, and a lot of what I do is manage depression. That is because nearly 85% of cases of an anxiety disorder also have depression. That’s because anxiety is hard and it creates these feelings of depression inside us.  Today, I wanted to talk about how to cultivate motivation during depression because so often when we’re talking about either just managing depression or managing another mental health condition, you’re usually required to do a lot of homework, use a lot of skills, and also go about daily functioning. That is really hard when you’re experiencing depression.  DEPRESSION MOTIVATION CYCLE One thing I wanted to talk about first is just to get you guys familiar with what we call the depression motivation cycle. This is something that I talk to my clients about. I wouldn’t say it’s a science-based theory, but definitely, I think a lot of us will resonate with this. What I mean by the depression motivation cycle is when you have depression, you experience symptoms of depression, which I’ll share here in just a few minutes. But you experience these symptoms that cause you to then have lower motivation. But when you have lower motivation, you tend to not get to your daily functioning activities and you tend to maybe avoid some of the hard things in your life, which then causes more depression. And then once you have more depression, that often ends up leading you back into the cycle of having even less motivation because you’re feeling so hopeless, and the cycle continues and continues and widens and widens and spreads throughout your life. My hope today is that we can work towards breaking that cycle. I’m not going to overpromise that we will break it today because I’m always going to be as honest and realistic as I can with you guys. I don’t want to oversell that this is going to be a simple snap of the fingers, I have the solution for you. No, there’s a slow, gradual breaking of this cycle.  Number one, do I believe you can do this work? Absolutely. I want to heavy-load you with confidence at the front end, but also very much validating that it’s a process, it’s a practice. I want you to be as gentle with yourself as you can as we talk about this today.  Let’s take a breath, but let’s also stay in our mindset.  COMMON DEPRESSION SYMPTOMS & HOW TO GET MOTIVATED In understanding motivation during depression, we must consider, like I just said, common depression symptoms. We must understand them. One of the common depressive symptoms is hopelessness. Hopelessness is feeling like there is no hope for you. You might be having a lot of depressive thoughts such as, “What’s the point? There’s no hope. It’s not getting better.” These are symptoms of hopelessness. In addition to hopelessness, or maybe instead of hopelessness, if you have depression, you may experience the depression symptom of helplessness. Helplessness is where you feel like no one can help you. That your problem is different or separate to other people’s or too big than everybody else’s, and that there’s no one out there that can help you. That’s important to notice because one of the lies depression tells us is you are the only one that has this particular type of depression and you are the only one that can’t be helped, and that that means something about you. There’s some innate flaw about you that makes your life hopeless. It’s all lies. I just want you to know that. Another common depression symptom is worthlessness—feeling like you’re not enough, you’re not worthy. You don’t deserve to be here, to be loved, to be in connection with. Maybe you feel like you don’t deserve kind, wonderful, loving things or even pleasure. Worthlessness isn’t a very common piece of depression. As you can imagine, just hearing these words that I’m saying, it’s a horrible feeling. It’s a very deep, dark, gray place to be, and it’s not your fault.  Another common depression symptom is sleepless nights. You’re unable to sleep or oversleeping, sleeping day and night, hitting the alarm over and over again, turning it off, going back to bed, not getting to your daily functioning. Another huge one is exhaustion. People with depression will often go from many, many medical tests because they’re so exhausted and they think it must be a medical condition. You definitely should seek medical care and have an assessment always. But often it’s not a medical condition; it’s a common symptom of depression.  In depression, no motivation to do anything is common. In depression, no motivation to eat, to exercise, to engage in daily activities is also very, very common. Often daily functioning will be depleted completely if it’s a severe case of depression.  My hope today, first of all, to acknowledge this for you and validate this for you and hopefully bring a ton of hope, is to also talk about concepts that can help boost your motivation during depression because it’s not your fault. But there are ways we can slowly climb out of this deep, dark hole that we often can get into when we have depression. BOOSTING MOTIVATION WHEN DEPRESSED  Okay, let’s do it. We’re going to talk about how you can increase your motivation during depression. The first thing I want to encourage you to do is to embody this idea of becoming a kind coach. Now, for those of you who have read The Self-Compassion Workbook for OCD—that’s a book I wrote in 2021—it talks a lot about the kind coach. Maybe you’re already familiar with it. Or recently in Episode 343, we did a whole episode about talking back to anxiety, and that was all about using the kind coach voice to help get you through these difficult times. We also talked that you could also use that skill with depression.  What I mean by the kind coach is that when things are hard, when you are suffering, you tend to yourself in a way that is kind and you coach yourself forward. Often what we do is we criticize ourselves forward. Meaning we say, “Get up, you lazy thing, and just get your teeth brushed,” or “You’re such a loser if you don’t brush your teeth,” and we use self-criticism to motivate. I’m here to tell you, the science shows us that self-criticism, while it does get people to do things for the short term, it actually for the long term makes people more depressed. It reduces motivation, it increases procrastination, it lowers a person’s self-esteem and their sense of wellbeing. We want to take the pedal off of using self-criticism and move our pedal and accelerator towards talking to ourselves and coaching ourselves in a way that is kind.  What I’m not saying is that’s saying, “You’re the best, you’re wonderful.” That’s fine. If you want to try that, you can. But the kind coach from my perspective doesn’t usually talk like that. It’s usually encouraging like, “Just do one thing at a time. You can do it. One more minute,” and really focusing in on what are your strengths and how can we highlight those, and also what are your challenges and how can we not use those against you. We all have challenges. Let’s say you’re someone who has a challenge with time management. Maybe in that area, we really lean on, “What strengths do I have that I can rely on when it comes to time management,” instead of just saying, “You suck at time management, there’s no point.” I want you to practice being a kind coach. If you want more information about that, go back to listening to Episode 343.  Another way to boost motivation when depressed is what we call activity scheduling. Now this is a science-based skill that we use when we are practicing cognitive behavioral therapy, which is an evidence-based treatment for depression. Now for those of you who have taken Overcoming Depression, which is our online course for depression, if you’re interested, you can go to CBTSchool.com and you can enroll in that course. It’s an on-demand course where you can learn exactly the same skills that I would give my clients, but you’ll be using them on your own. It’s a self-led course and you have unlimited access to all of those strategies and skills. But we talk a lot about this behavioral skill of activity scheduling.  What I mean by that is, one of the biggest things that takes motivation away is a lack of routine, a lack of structure in our day. What we do when we first start treating someone with depression, or we’re starting to target depression, is we break the day up into sections. It might be two sections in the morning and two sections in the afternoon and one in the evening, and we’ll say, “Okay, you just have to do one thing in each of those sections.” You get to pick. It could be as simple as brushing your teeth, but you’ll put it in your schedule and you’re going to give yourself permission that that’s the only thing you have to do in that section if you’re unable to do that at the present.  Let’s say that you’re more in a high functioning area and you’re already doing a lot, but you’re also engaging in a lot of depressive rumination. We might actually keep your schedule the same, but schedule in times during your schedule to check in, use some skills, maybe do some journaling, maybe using some mindfulness activities and so forth. But we can actually use the scheduling to reduce problematic behaviors.  DEPRESSION MOTIVATION TIPS  Now, one of my go-to depression meditation tips for everybody is to set realistic goals and expectations for yourself. One of the things I notice about people with depression, and I’m also including myself here because I too have struggled with depression during different seasons of my life, is that we really want to achieve a lot with our lives. We have this idea of what life should look like. We have this idea of how great it can be, which is such a wonderful quality. But the flip side of that wonderful quality is that we have such rigid expectations for ourselves, and when we don’t meet them, we beat ourselves up.  Often what we can do is we can check in with these expectations and these unrealistic goals. We can check and say, “Okay, is this helping me be motivated?” Almost always, it’s no. Let’s say I’m sitting across from a patient in my office, I might say to them, “What would be a goal that you actually feel like you can achieve this week or today or this month?” When they set the bar a little lower, all of a sudden, a tiny inkling of motivation comes into them. From that place, they start to move forward. Whereas if they set these really high goals, they can’t access motivation. It’s so huge, it just feels hopeless. Again, it feels helpless. They feel worthless, those themes of depression. The motivation doesn’t light up inside them and they don’t do any of it. They don’t take even a baby step. If that’s you, I don’t want you to feel called out; I want you to feel understood. I want you to feel validated. I’m hoping that you can give yourself permission to set a goal that’s realistic, and it’s just for now. I know what you’re thinking. You’re thinking, “Well, geez, I’m never going to amount to anything if I set this low bar.” But the truth is, we start small and then we increase it over time.  Another thing to consider when addressing motivation during depression using your activity scheduling is incorporate self-care and healthy habits and whatever that means for you. If you’re someone who has depression and you’re not eating because of it, you’re going to have a low energy. When you have low energy, you don’t have any motivation to do anything. Incorporating scheduled meals, even if they’re not even that healthy to start with. It could be just whatever you can tolerate for the time being. But getting that nutrition into your body may be also what helps with motivation.  If you’re someone who is so depressed, unable to be out in nature and exercise, which we know based on science helps with depression, maybe you could schedule three minutes where you look out the window if that’s all you can do, or take a hike with a friend, or maybe just sit outside on a chair. Whatever it may be. I really don’t want to put expectations on you guys. I think it’s very personal, so you’ll have to think for yourself, “What is one thing I could do today that would really cultivate self-care?” A really important thing when you’re depressed is, it’s so important. I really want to emphasize this: Finding a support group, a team of support—a loved one, a family member, a friend, a therapist—support groups, actual structured groups is so important to help with that cycle of depression too. Remember we talked about that cycle of depression and motivation? Sometimes just feeling like you’re not alone in and of itself can create a little motivation, or feeling like you’re not alone can reduce that depression just a little bit, which can then help with that motivation piece.  One other thing to consider here, and I myself do this with my best friend, is I use her not only as support, but as an accountability buddy. I’ll tell you, actually, something I’ve struggled with recently is, as many of you know, we’ve gotten a puppy and out the window went my exercise plan. My exercise plan is so important for me in managing my medical condition, but it went out the window. I messaged her and I said, “Listen, I don’t want you to feel any responsibility about this, but I am just telling you, this is what I’m committing to. You don’t have to do anything. I’m just telling you so that you’re my accountability buddy. Every day that I do the thing I said I’m going to do, I’m going to send you a thumbs up emoji.” I said, “You don’t even have to do anything. I just need you to be there so I can be my sounding board.” There have been other seasons in my life where I’ve had things that I needed to get done, and I would say to her, “Can you be my accountability? Do you have the capacity?” She’s like, “Yes, of course. What do you need?” I’ll say, “I need you to text me on Monday, Wednesday, and Friday to remind me to do such and such.” That’s fine too. Again, that doesn’t make you a loser. It doesn’t mean that you’re weak. It doesn’t mean anything. It just means we’re using effective skills to get you back on the bandwagon.  Now, that being said, there are some key components of getting motivated during depression and these key components, also what I would call a mindset, is leaning towards your values, getting really clear about what is it that you want out of your life. Again, let’s go realistic, but let’s look at the long term. Sometimes when we are depressed, the whole future looks like it’s hopeless. What we want to do is kindly get in touch with your why. Like what can you bring to the table? Why are you here? What do you want? What can you bring to the table for others or for yourself? I want to slow down here a little. I get that you might have no answers to that right now, and that’s okay. It might be as simple as just going, “Okay, what’s one value of mine that I want to lean on during this difficult time?” Values can help us make decisions about what’s best for us.  Another mindset shift that I want you to move towards is, don’t live your life according to what depression is telling you to do. Make choices based on the direction of your life you’re wanting to go. If you used to love swimming, try swimming again. If you used to love drawing, try doing more drawing, even if you’re depressed. Because what we know is that those hobbies, personal interests, more creative expression using your body, can actually create spaces for you where you’re opening your mind up to other things, not just putting your attention on your depression. A lot of my patients have said that they don’t want to go out and be with people or go on a hike or something, but once they’re there, they deeply feel the benefit of it. Sometimes it’s a matter of putting our attention on how you’ll feel once you get that thing done. Try to find things that bring you some joy or some fulfillment. But again, for this first part, don’t put too much pressure on that either because you mightn’t feel a lot of that to start with. But over time and with repetition, you will. Another really important piece, and you’re already hopefully doing it right now, is to lean on the people who are sources of inspiration for you. Hopefully, if it’s me, I’m honored. For me, it’s often like poetry, people who’ve been through it. I love Jeff Foster. He is a poet who has had depression and suicidal ideation and he’s just talks about it in such a beautiful, mindful way. I find it to be a very safe landing place when you’re feeling really down. And then the last thing to consider when addressing motivation for depression is, actually, after you’ve done any activity that you had to muster up a lot of energy to do, you celebrate. If you miss the celebrating part, you miss an opportunity to generate more motivation to keep going. If you do something hard and you go, “Whatever, it’s no big deal. I should have been able to do it yesterday,” you’re missing an opportunity. What I want you to do is throw a mini party in your mind. Or if that’s impossible, just text someone and say, “I did a hard thing today and it was...” and tell them what it was, so that you are celebrating, you are rewarding, you are congratulating yourself for taking steps towards these small victories. It’s so important.  And then the last thing I’m going to offer to you, which is a catchall for all of this is, don’t do it alone. If you have access, like I said before, to a therapist, a support group, it doesn’t even have to be a paid one; it could be a Facebook group. But being in a community, being in a group of people who get what it’s like for you can be a game changer. If you do have access to professional help, absolutely go and get help because they often will bring your attention to things you weren’t noticing, thought patterns that you didn’t realize that you had, and that can be so incredibly beneficial.  Now, with all of that said, I want to also emphasize this idea of, again, my voice hopefully is a little different and I’m trying to cheer you on. Let’s go. You could totally do this. Baby steps. What I want to remind you of is, surround yourself with people who lift you up, who have a high vibe if you can. If you haven’t got access to those people in real life, lean on singers and celebrities and even social media platforms that are encouraging, that are inspirational. A lot of my clients have said that Pinterest has been even helpful for them in that they go onto Pinterest and they google inspiring quotes. That could actually be something so simple that gets them up to brush their teeth. I hope that’s helpful. If you are interested in looking into Overcoming Depression, our online course, talking a lot about different skills you can use, go to CBTSchool.com or reach out to a therapist in your area. I really hope that this has sparked a little teeny tiny light inside you, and if so, I will be so happy.  Do not forget, it is a beautiful day to do the freaking hard things. Do not forget it. Write it on a piece of paper and read it off as many times as you need to remind yourself it’s okay that it’s hard, it’s not a bad thing that it’s hard, and that you can do those hard things. Sending you love. Have success. I’m sending you every ounce of love that I have. Talk to you soon.

Welcome back, everybody. Today we are talking about a topic that I commonly get asked as a clinician, I commonly get asked as an advocate for anxiety online and so forth, which is how to let go of intrusive thoughts. I think that this is such an interesting question because words matter. For those of you who know me, you’re going to know that words really do matter when it comes to managing anxiety and we have to get it “right.” When I say “right,” what I’m really saying is our mindset about anxiety and intrusive thoughts and any emotion really that is uncomfortable, we have to approach it with a degree of skill, effectiveness, and wisdom. My hope is to help you move in that direction. I know you’re already in that direction, but hopefully, this episode will be really powerful. I’m going to give you a metaphor that I hope really, really helps you. It really helps me. I’ve talked about it on the podcast before, but I feel like it’s important so I have to talk about it again.  When we talk about this idea of how to let go of intrusive thoughts, we have to ask, what do we mean by that? Often when people first start seeing me as a clinician or they start seeing my therapist—we have a private practice in Calabasas, California—we commonly will get, “Okay, just I’m here. I’m ready to do the work. Teach me how to let go of intrusive thoughts.” A lot of the beginning stages of treatment is educating on how letting go, meaning not having them anymore or quickly avoiding them or distracting against that, could actually be what’s making your anxiety worse. For those of you who’ve taken ERP School, which is our online course for OCD. If you’re interested, you can go to CBTSchool.com to learn more about that course. That’s where you can learn how to manage your own OCD. It’s an on-demand course. But we talk a lot about understanding that trying to push thoughts away or suppress thoughts, not having them actually reinforces the problem. I also want to mention, it makes total sense that your goal is to be able to have the thoughts and have no discomfort related. Like I just want to have the thoughts and I don’t want them to bother me, and I just want them to create no suffering at all. I get that. That is a very normal desire to have. But what we want to do here is, when we’re talking about how to “let go” of intrusive thoughts, what we are really talking about is how we can be skillful in how we respond to them, because we know, based on science, that we can’t control our intrusive thoughts. Often there are mechanisms in the brain that’s making it very difficult for you to pump the brakes on thoughts, which is why you’re struggling with so many of them, and they’re happening so repetitively. We know this.  When I first learned about mindfulness, one of the most important metaphors that just shook me to the core—it really changed the way that I learned to deal with thoughts, feelings, sensations, emotions, urges, and all the things—was to think of my thoughts like water in a stream, and that my mind is this stream of water. As you’re thinking like these beautiful green banks, and there’s the river in the stream, and it’s flowing in one direction. What happens for us when we’re experiencing our mind is we hit a rock in the stream. When we hit that rock, we want to imagine that that rock is a metaphor for an intrusive thought. Here you are, you’re the water. You’re just rolling over all of the banks and commandeering back and forth, and then all of a sudden you hit this very sharp, jagged rock. Of course, your reaction is to get jolted and go, “Oh my goodness, what is this? Why is this here? I’m just trying to get from A to B.” Often what we do is when we hit the rock, we make a huge splash. The splash goes everywhere. We’re like, “Wait, what happened?” When we do this, we actually create a lot of pandemonium for ourselves.  Now, that’s what we do. But if we were to think about a stream, what does the stream water normally do when it hits a rock? It hits the rock, it notices the shape of the rock, and then it gently goes around them. It doesn’t stop to go, “Is this a good rock or a bad rock? How do I feel about this rock? What does this rock mean about me? Why is there a rock here? There shouldn’t be a rock here.” The water just notices the rock, observes that the rock’s here. It doesn’t make a huge splash. It doesn’t try to go under it. It doesn’t try to stay on the left side of the bank and avoid it. It just notices the rock and it goes around it and it moves on.  Mindfulness is just that. Mindfulness is observing what shows up from a place of non-judgment, from a place of non-attachment. What I mean by that is that the water’s not attached to what this rock means about them. It doesn’t assign value to the rock. It doesn’t say the river is bad now because we have a jagged rock, or it doesn’t say the river is good because it’s a small rock. It just says “rock” and it goes around it. Mindfulness is also very present. It notices it. It doesn’t stop there and go, “Okay, I’m going to spend a lot of time solving this and I’ll get to the end of the river in my own jolly time.” It is often being moved by gravity, so it just keeps moving. It doesn’t slow down too much for that rock.  That’s the way I want you to now practice approaching your intrusive thoughts or your emotions, if you’re having other emotions, like strong waves of guilt or shame or sadness and whatever it may be. You’re going to notice the obstacle or the object. Be non-judgmental, not get caught up in a story about what it means about you that there is a rock in your stream of water, and you’re going to go around it. I was going to say quickly, but that’s not actually the right word. You’re going to go around it from a place of not gripping. Not gripping to that rock and so forth.  Now, here is where the metaphor continues. For those of you who are listening, my guess is, in your stream, in your mind metaphorically, you hit one rock, you go around it, but very, very quickly comes another rock. And then you might practice that and go, “Okay, all right, I did one. I’m going to notice this rock as well. I’m not going to assign value to it. I’m just going to notice it, be aware of it, be non-judgmental of it, and do my best to go around it without making too big of a splash.” You do it the second time. But then what happens? Another rock comes.  Often what my patients say to me, or like I said to you at the beginning, followers on Instagram or you listeners of the podcast will say, “I get what you’re saying.” One of the most common questions we get in ERP School in the portal where people ask questions is, “I get what you’re saying, but what happens if they just keep coming and coming and they just don’t stop?” That’s where I would say, again, the stream doesn’t get involved in a conversation about what this mean. It just hits the rock and goes around the rock and moves to the next one and the next one and the next one, and it takes one rock at a time.  What we often do—and I’m the worst at this, I have to admit—is once we’ve hit 4, 5, 6 rocks, we then shift our gaze not on the present moment, but we look down the stream and we go, “Oh my goodness, I see nothing but rocks. This is going to be a bad day. All I could see is my future is going to contain a lot of rocks. I can see them on the horizon, I give up,” which is okay. I want to first really validate you, that is a normal human emotion, a normal human instinct to be like, “I give up, there’s too many rocks.” But our job isn’t to be looking into the future, trying to solve the many rocks that we are going to face. Because as soon as we do that, we lose our skills, we lose our cool, we lose our motivation, we lose our resilience. Just the same as if we looked up the stream where we’ve been and we go, “Oh my gosh, what a terrible day. Look how many rocks I hit today. It was nothing but rocks.” We could get in trouble that way as well. Mindfulness is only paying attention to one rock metaphorically at a time. Staying as present as you can.  HOW TO GET RID OF INTRUSIVE THOUGHTS?  Often people will say to me, “Well, how do I get rid of rocks? Isn’t there a way to get rid of rocks?” I love this. What they’re really asking, just in case you lost the metaphor, is they’re asking, how do I get rid of intrusive thoughts? How do I get rid of them? Here is where I think the metaphor is really clever, because when you think of a stream and you think of the rocks in a stream, like the actual stream—our family spends a lot of time rafting; my husband is an amazing raft, I guess you would say, and my kids love it too—what I always think that’s so interesting is when you’re in rapids or ripples, the rocks actually aren’t jagged anymore. Often when rocks have been hit by water enough times, the jaggedness of them gets washed away and the rocks become actually quite smooth. I think it’s such an amazing metaphor here for the work that we do, which is when we are mindful, when we are non-judgmental, when we are present, when we don’t attach it to what it means about us, the thoughts become less powerful, less painful, less jagged, less sharp, less of an ouch. That’s true in science with actual streams on water and for us in our minds too.  HOW LONG CAN INTRUSIVE THOUGHTS LAST?  Now, it’s not uncommon for people to be curious about how long intrusive thoughts can last. Because often when we have them, before we’ve learned these skills and before we’ve learned mindfulness, we have them. And then because we are so averse to them and we’re so afraid of them and they’re so painful, it can feel like they last for a very, very long time, and that’s true. They can be so repetitive that it feels like you just don’t get a break.  But what I have found to be true, as a clinician who’s watched hundreds of clients practice this, is when you start to apply mindfulness, they can be quite fleeting, these intrusive thoughts. They can pass quite quickly. I want to be really honest with you. What I’m not saying is that they will stop returning. Again, I want to really keep reinforcing because that’s not our goal. Our goal isn’t to say, how can we get rid of them as fast as we can, or how can we get them to not be here. I’m not saying that, but I can vouch for this in that when you do practice treating intrusive thoughts like a rock in a stream, they do tend to be less prolonged. Not always. I want to keep saying not always. There will be days where you’ll have lots and lots, there’ll be days when you won’t. Again, we’re going to practice not attributing value or judgment to that. But I have found this to be very true, that when we are really present and we’re kind and we are non-judgmental, it can actually reduce the suffering so, so much HOW TO LET GO OF OCD INTRUSIVE THOUGHTS and PTSD INTRUSIVE THOUGHTS?  That’s the metaphor I want you to think about here in regards to how to let go of OCD intrusive thoughts. But I would even go as far as saying, this is the same metaphor I would use when talking with patients who have trauma, and they’re wanting to know how to let go of their PTSD intrusive thoughts because some people with PTSD have intrusive thoughts. I would even go as far as saying that, as I’ve said in the beginning, you can use this skill with any adversity.  HOW TO LET GO OF INTRUSIVE THOUGHTS RELATED TO DEPRESSION?  You could use this skill with sadness, you could use this skill with shame, guilt, fear in general. It could be discomfort or some physical sensation of pain that you’re having. We can also let go of these intrusive thoughts related to depression. Noticing a depressive negative thought, seeing it like a rock in the stream, trying to practice non-judgment around that, and moving around it with a sense of kindness and compassion and radical support. That’s what I would love for you to practice.  I’ve had patients in the past say that they changed the computer screen to a stream just to remind them of that. Or they’ve left a little sticky note on the side of their desk saying thoughts are like a rock in a stream or a rock in a river. There are other ways you could imagine this metaphor as well, but this is the one that I really, really resonate with. If you want to get creative, you can maybe come up with some other forms. But I find it to be so incredible how nature can really teach us about how to be mindful and manage really, really hard things.  That’s it, guys. That’s what I wanted to share with you. I hope it was helpful. I know this is not easy, by the way. The whole reason I say it’s a beautiful day to do hard things is because this is not easy. This is like hardcore work and I want you to give yourself a lot of claps and hugs and celebrations and high fives for even trying this sometimes in the day. I really do believe that one rock at a time, even though it mightn’t seem very significant, it accumulates. If you have hit tens or twenties or thirties or hundreds of these rocks, you are on your way. You are doing the work, you are walking the walk, and I really want to celebrate you and honor you for that.  All right, folks. I hope that was helpful. I am sending you so much love. Keep doing the work. I will see you in a week. Well, you’ll hear me in a week. I hope you’re having a wonderful summer if you’re in the northern hemisphere. I hope you’re having a wonderful winter if you’re in the southern hemisphere, and I will talk to you soon.

TALKING BACK TO ANXIETY Welcome back, everybody. Today we’re talking about talking back to anxiety, and we’re really talking about the power of positive self-talk.  Now I know when it comes to this idea of talking back to anxiety, it can get somewhat controversial. In fact, even talking about this idea of positive self-talk can be controversial, and I will be the first to say there is nothing worse than when you’re struggling with something that’s really painful. People say, “Oh, just be positive.” That is not what we’re talking about here today. In fact, I have a personal twist on how I like to consider a positive self-talk. You probably have heard me talk about it before, but I felt like it was time for me to revisit these concepts that I find so incredibly powerful when it comes to talking back to anxiety, or being positive, staying positive, engaging in some form of positive self-talk. WHAT DOES TALKING BACK TO ANXIETY LOOK LIKE?  Let’s talk about it. When we consider what we mean, when we say “talking back to anxiety,” what do I really mean by that? First of all, I want to get to one of the controversies. What I’m not saying is that when you have anxiety, you tell it to go away or stop, because we know that when we do that, when we try and suppress anxiety or we try to suppress our intrusive thoughts, it usually means we have more of them. Let’s just get that scientific fact out in the eye. We know that is true. But when we are talking about talking back to anxiety, when I’m talking about it, what I mean is, when you experience anxiety, whether that be in the form of sensations or in thoughts or feelings or images, how do you respond? How do you converse with your anxiety?  I always make a metaphor with my clients, and I’ve done it here on the podcast before, that I always think of anxiety as this little short Lorax-looking guy that sits on my shoulder. For you, it might look different. But he sits on my shoulder and he’s in a beach chair and he is really lazy and he is wearing sunglasses, and he just wants to mess with me as much as he can, but in the most effective, lazy way. And how does he do that? He does it by knowing exactly what bothers me and throwing that at me first. He’s not going to throw some random thing at me. He’s going to go straight for the thing that he knows I value, because that’s where my anxiety is going to show up the most. And then when he shows up, it’s up to me then to be skilled in how I respond. One of the ways we respond is how we talk back to it. The first thing I’m going to ask you is, when your anxiety tells you of the thing that you value, talks to you about the thing that scares you, that hits you right in the gut, how do you respond? Do you yell at him and say, “Get off my lawn, you horrible thing.” None of this is bad, I just want you to get to know. How do you respond? You say, “No, no, no, please go away. I don’t want you. I’ll do whatever you say. I’ll do whatever compulsion you tell me to do. I’ll avoid whatever you tell me to avoid if you just quiet down.”  Some of this, instead of doing that, instead of yelling at anxiety, we yell at ourselves. We say, “What is wrong with you? Why are you always anxious? You’re a loser. You’re bad. What’s wrong with you? Something is seriously broken about you. Why have you got to have anxiety all the time?” You engage in a ton of self-criticism and self-punishment. The ones I just gave you are some negative self-talk examples like, “What’s wrong with you? You’re a loser. You’re such an idiot for having this anxiety. You’re stupid.” I want to remind you that you’re not. This is not about your intelligence; it’s not about who you are, what you are. Your anxiety has nothing to do with any of that. Some of us are just genetically prone to having more anxiety. But we use this negative self-talk. We use this criticism, this self-judgment to try and beat out the anxiety, as if we could beat it out of ourselves. But the facts are, this negative self-talk doesn’t motivate us to change because we were never in control at the start. We can’t control our anxiety and whether it shows up, so that doesn’t work. What we do know that does work is positive self-talk. It is one of the most successful ways of motivating ourselves.  When anxiety does show up, I want you to explore how you might respond differently to whatever discomfort or whatever form of suffering you’re experiencing. It doesn’t even have to be anxiety. It might be pain, it might be stress, it might be sadness, any emotion. We can actually use these skills with any of these emotions.  WHAT POSITIVE SELF-TALK IS NOT  Let’s talk about what I mean by this. What does positive self-talk look like in my definition, not what you may have seen online. Number one, in my definition, positive self-talk—let’s talk about what it actually isn’t—it’s not just positive affirmations. While that’s great, and if that works for you, by all means, keep it. But for me, it never ever lands. I could say the world is safe and good things will happen, and I’m a good person. I could say that all day long and it would not land. It would do nothing for my anxiety. Literally, it just doesn’t. I’ve tried it and it really doesn’t work for me.  Positive self-talk is also not just telling yourself to be happy or relaxed. That is a huge issue. Because if you’re having anxiety and you’re just telling yourself how you “should feel,” you’re only going to feel judged. You’re only going to feel less in control. You’re only going to feel more hopeless about the situation.  HOW TO BECOME YOUR OWN KIND COACH  We’ve talked about what it’s not, and I’m sure there’s other examples that I’ll probably think of here in a minute, but that’s what it’s not. But what it is, is talking to yourself in a voice that I call the kind coach. For those of you who have read The Self-Compassion Workbook for OCD, I talk about this a lot in that workbook, but I also teach this in the course Overcoming Anxiety and Panic, which is learning how to speak to anxiety in a way that motivates us, that leads us more towards our values and our beliefs, that disarms the anxiety. Instead of fighting it, it tends to the fact that you are experiencing something really, really, really uncomfortable. These are key components of overcoming anxiety and panic. In the course, we also go through cognitive changes, behavioral changes, a lot of tools, a lot of mindfulness, a lot of self-compassion. If you’re really wanting to do a deep dive, you can go and check out that course. Go to CBTSchool.com. The course specifically is called Overcoming Anxiety and Panic. But for today, let’s just talk about being a kind coach.  A kind coach. If you were actually thinking about a coach that you’ve had in the past, or an ideal coach, if you were training for something, a marathon, let’s say, or a competition or something, a kind coach wouldn’t berate you for struggling, because we know, as we’ve already talked about, that beating yourself up and criticizing, it might propel you into some change, but it also creates more anxiety. We are here to try not to make more anxiety just for the sake of making more of it. We know that self-criticism isn’t beneficial. We know that telling someone of their faults and their weaknesses, that only makes us feel worse. It usually sends us into a shame response. When we go into a shame response, the normal human response is to slump over, to get really tired, to feel very unmotivated, to be stuck in this slow-moving body where everything feels heavy. That doesn’t help us. That makes it worse.  The kind coach knows your challenges, but it also knows your strengths, and it uses your strengths to motivate and propel you towards the thing that you want. Let’s say you’re having anxiety. The kind coach would talk back to anxiety by saying, “I see you’re here. It’s cool. It’s okay that you’re here. I was planning on recording this podcast today at 11 o’clock, and I know you want to tell me about all the terrible things that might happen today, but I agreed that I was going to do this, and it’s really important to me that I do. You could come along, and I’m going to let you be there while I record this podcast.”  Now, you might hear that none of this is me saying, “I’m going to record this podcast and I’m going to be happy and I’m not going to have any problems with it, and I’m going to finish it. I’m going to feel ecstatic and free and overjoyed.” That’s not what I’m talking about. That’s one example of positive self-talk, but that’s not what I am talking about today, and that’s not what I’m encouraging you to do. I’m encouraging you to learn to be the kind coach for yourself. Meaning you are the one who shows up for you when anxiety shows up. Often when we’re anxious, we step out of that role and we actually go to someone else to try and make us feel better. We go to someone else to reassure us. We go to someone else to soothe us. While there’s nothing wrong with that, we miss an opportunity to be there for ourselves, to be the one who soothes us, to be the one who says, “Hey, I see that you’re going through something hard. I see that this is uncomfortable for you.” TALKING BACK TO ANXIETY: POSITIVE SELF-TALK EXAMPLES  Now, to get a little deeper here, if we were really going to talk about positive self-talk examples, we would also include the kind coach reminding us that we can do hard things. When I think of positive self-talk, I don’t think of, “You’re the best, you’re great. Everyone loves you. You’re perfect.” I think of positive self-talk as being it believes in us, it believes in our ability to really settle into hard, uncomfortable things.  In the world of social media, and a lot of you guys know I’m on Instagram a lot, I constantly see people saying, “The five quick tips for anxiety,” or “Heal your panic attack fast.” They’re selling you on quick fixes and making it easy. I don’t believe that that’s helpful. I think positive self-talk for anxiety shouldn’t be about saying it’s easy and quick to get over. It should be about saying, “You can do this. You can tolerate this. You can ride this wave of discomfort out. I believe you can because you’ve done it before,” or “I believe you can because humans are incredibly resilient. Even if you haven’t done it before, it’s a skill we will learn together.” That’s how a kind coach talks.  Let’s say you’ve always avoided something and it creates so much anxiety for you. Basically, your brain is saying, “I’ll never be able to do that one thing.” My kind coach, if I really listened, would say, “I know you haven’t been able to do it in the past, but I have seen you in so many other areas overcome different things that you’ve never done, but then you were able to do it with practice and repetition and kindness and support. I do believe this is another opportunity for you to do that.” That’s what my kind coach would say, and this is something you can start to practice for yourself.  If this is really hard for you, another way of doing it is saying, “What would a loved one say to me in this example?” And then you just practice saying it to yourself. But this is a grand gesture of self-compassion. It’s a grand gesture of encouragement, motivation, positivity that isn’t toxic, because we know that positivity can sometimes be so toxic and dismiss what we’re going through. This is not that. Now, when we talk about talking back to anxiety, we may also have to practice this idea of talking back to depression too. What I’m going to encourage you to do here is use exactly the same tools.  TALKING BACK TO DEPRESSION Let’s talk about it. If you have depression, your brain is telling you these lies like, “You’re terrible. Nothing good is going to happen. There’s no point. You’re useless.” Talking back with positivity like you are the best, again, is not going to land. Saying, “You’re wonderful, you’re really great. Great things are going to happen,” some people find that really beneficial. If that’s you, by all means, keep using it. It’s incredibly powerful. But for a lot of us folks, that won’t land. I find it really much more beneficial to talk back to anxiety and depression with this kind coach voice, someone who coaches us through the depression while it’s there, because it’s going to be there. It is here. There’s no point in telling ourselves just to be happy because it is here. I find it to be so incredibly helpful.  TALKING BACK TO OCD Now, in addition, there is also some controversy around talking back to OCD. A lot of people say, “Doesn’t that become compulsive? Doesn’t that get in the way of the actual foundation of ERP?” Well, what I will say is, once again, it depends on how you’re doing it. If you’re talking back to OCD, which we know is a disorder of uncertainty and doubt, if you’re talking back by going bad things won’t happen, “No, you’re fine. Nothing bad is going to happen,” well then yes, you will be engaging in compulsive self-reassurance or reassurance in general.  But what I’m talking about here when it comes to talking back to anxiety, specifically related to OCD, is the kind coach will say, “I believe you can handle hard things. Just a few more minutes, let’s ride this wave of discomfort out. Can you tolerate another 10 minutes of uncertainty?” Instead of saying it as a question, it might say, “Let’s do it. Let’s try for another two minutes not engaging in that compulsion.” You’re talking to anxiety, you’re talking to depression, you’re talking to OCD, but you’re not doing it in a way that dismisses how hard it is. You’re not doing it in a way that overlooks the actual reality. Meaning you’re not saying, “Just be happy,” or “Just ignore it,” or “Just think about something else.” You’re not doing it in a way that creates compulsive behaviors that keep you stuck.  The kind coach encourages you to keep trying. It validates that you’ve had a hard time and that this is hard. It reminds you of your strengths, whatever that is. Maybe it tells you you’re resilient or you’ve done it before. It might gently remind you to use your humor if humor is something that you’re really good at doing. It might remind you of any strength you have. It won’t use your challenges against you. It’s radically, absolutely, unconditionally there for you, even on the low days. It encourages you to just go a little further, try a little bit more, but not in our “get down and give me 20 pushups” way like our mean coach would. It’s saying it in a way that feels doable and motivating and kind.  That’s what I want you to practice. This, guys, is a skill that you have to practice. Meaning you won’t do it for a couple of hours and then feel on top of the world. Again, this is not about ridding you of your reality of true discomfort. It’s something we practice every day during the easy times and the hard times. This is how we talk back to anxiety. This is the power of positive self-talk when used correctly.  That’s it. That’s what I want you to practice. What I would do with me, because I’m a little bit of a track it kind of girl, is I would encourage you to track it. To track when you were engaging in the kind coach, what did the kind coach say? I would also track when other people act as the kind coach, maybe a loved one, a family member or a boss, a colleague, a friend—really track what it is that they said to you that helped you propel yourself towards behaviors that are positive in your life and use those to help you really strengthen your own kind coach voice. You may also want to track when you get caught up in self-criticism. Because that too, sometimes when you’re tracking it, it helps us be more aware of it. When we’re more aware, we can catch it sooner and intervene sooner.  That’s what I would encourage you to do. If you don’t like tracking, that’s fine. I don’t want to push you in a direction that doesn’t work for you. As you always know, I just want you to take what’s helpful here and leave what’s not. But this is a skill I really hope that you do engage in and start to practice.  If you’re interested in any of the courses I’ve mentioned today, please go to CBTSchool.com. You can also go to my private practice website, which is KimberleyQuinlan-LMFT.com. I am a therapist with nine therapists who work for me, helping people with OCD and anxiety. We are in Calabasas. I would love to connect further with you there.  Have a wonderful day, everybody, and remind yourself that it is a beautiful day to do hard things.  

Welcome back, everybody. Today we’re talking about sleep anxiety relief. We’re talking about how to get a good night’s rest. Oh, the beauty of a good night’s sleep. I can’t even tell you and I can’t even explain for me personally how much sleep impacts my mental health and my mental health impacts my sleep. Hence why we’re doing this episode today.  For those of you who are new, my name is Kimberley Quinlan. I’m a marriage and family therapist in the State of California. I have a private practice. I am the developer of an online program called CBTSchool.com. I’m an author and I am the host of this podcast.  A few weeks ago, a psychiatrist reached out and said, “I have been listening to you for years, not realizing that I work literally down the street from you.” It made me realize that I never introduced myself on the podcast. I just talk and talk and talk and I actually don’t tell people where I am and what I do and what I offer. So that was a really big lesson.  Let’s talk about sleep anxiety relief. I’m going to tell you a bit of a story first. For years, my daughter has been telling us that she can’t sleep, that she has terrible sleep. She lays awake, staring at the roof. She said she always feels tired during the day and that she “can’t get to sleep” when she tries. We have taken her to the pediatrician and we’ve talked to her about it and checked in, “Are you worrying about anything in particular?” She says, “No, I just worry about getting enough sleep.” Again, she’s saying, “When will I go back to sleep? Will I go back to sleep? Will I wake up at night?” She says she struggles to get comfortable as she settles into bed.  We took the plunge and took her to a sleep specialist and we were expecting either a sleep disorder diagnosis or a sleep anxiety diagnosis. He did this thorough assessment and asked her all these questions and he was incredible. At the end, he said, “I’m going to tell you, it sounds like you’re getting good sleep. You sound like you sleep very normally for a kid your age and we address some issues that may be happening.” But he said, “A lot of this is about managing anxiety about sleep,” because he tracked like, “You’re getting enough. We will track it during the night. Everything looked good. This is actually about you managing your mind around sleep.” Now I understand that may not be your experience, but this blew me off my feet. I was expecting serious bad news. I have this conversation with my patients so often and it made me feel like, let’s talk about sleep anxiety relief.  SLEEP ANXIETY SYMPTOMS  Now, before we talk about sleep anxiety relief, let’s talk about sleep anxiety symptoms because some people who don’t experience this or aren’t sure if they’re experiencing this, I wanted to make sure you feel like you’re in the right place. For those who have sleep anxiety, they experience a lot of anxiety around going to bed or when going to bed. They may report racing thoughts in bed, inability to concentrate when they’re preparing to go to sleep or they’re laying in bed. They might experience a lot of irritability, whether that’s emotional or physical sensations in the body. A lot of jitteriness. There may be also an experience of nervousness or restlessness. They may have feelings of being overwhelmed. Some people report this impending danger or doom as they approach the bed or as they approach bedtime. They may experience a lot of anticipatory anxiety about it.  There are also some physical sensations or effects of anxiety before bed and that might include some tummy troubles. Kids in particular will report before bed, “My tummy hurts,” and often their tummy hurts is a sign of anxiety. This is true for adults too. They may have an increase in heart rate, which may make them feel like something bad is about to happen. They may have rapid breathing. They may experience sweating. They may experience tense muscles. They may experience trembling, even nausea. These are symptoms that could be your regular day-to-day anxiety, or it could be that you’re specifically managing anxiety related to sleep.  IS THERE A CURE FOR SLEEP ANXIETY?  When talking about sleep anxiety relief, often people talk about this idea of a sleep anxiety cure. Now, I’m not going to give you any specific “cure” today because I don’t know your exact case and you would need to be assessed by a doctor. I encourage you to go and see your doctor if you’re struggling with sleep because it is so important. If you need, go and get a referral for a sleep specialist or do some research. There are some amazing books on sleep as well.  Now, do I consider that we can overcome sleep anxiety? Yes, 100%. I do believe you can get to a place where you have healthy sleep. Again, I’m always very cautious about talking about the word “cure,” but if we were to really address sleep anxiety relief in terms of what you need to practice, I’m going to first always do a ton of psychoeducation with my patients and with you today about sleep hygiene.  WHAT IS SLEEP HYGIENE?  Think of sleep hygiene as like, how clean your bedtime routine is. Clean, meaning has it got a lot of stuff that dirty up your sleep routine, or does it free up and clean up your sleep hygiene, sleep routine? I’m not talking here in terms of contamination. I don’t want to get that confused. It’s about making your bedtime routine something that is with ease, and even if there’s anxiety, it’s a routine that you follow and you are pretty consistent with it so that you can start to get better sleep.  Now, how do we do that? First of all, I strongly recommend you first decide when you want to be asleep by or when you want to be in bed preparing to wind down. Pick an actual time. A lot of people miss this step. They just go, “Oh, I’m going to light candles and I’m going to read and hopefully, I’ll fall asleep when I want to.” That’s fine and that’s good. We will talk about that here in a second. But I’m going to strongly encourage you, pick a time you want to be in bed. And then from there, we work backwards. From one hour minimum, from the time you want to be in bed starting to wind down, you must turn off your tech. I know you want to turn off your podcast right now because you don’t want to turn off your tech that early, but I’m going to stress to you that your phone and your device are causing havoc on your bedtime routine unless you are using it for meditation, soothing music, something that actually deeply calms you. But I’m going to say a minimum of one hour, preferably two, you turn off your tech before that time that you picked. Let’s say you picked 10 PM. That’s the time I pick. All phones, technology should be off by 9:00 PM, even 8:30 or 8:00 is better.  What you do during that hour is that’s when you start to do the wind-down routine or program. Now this doesn’t have to be compulsive, it doesn’t have to be exact to the minute, but what we’re talking about here is now starting to implement things that bring you to a place of comfort. I understand if you’re having a lot of anxiety, you might still feel it in every single part of the sleep routine. That’s okay, but you’re engaging in behaviors that don’t make your anxiety worse. You might be reading. However, if reading is something that makes you hyper-aroused in an anxiety way, maybe it’s not reading. Maybe it’s meditation, maybe it’s listening to an audiobook, not something that’s going to, again, rev you up and get you going. Something boring, something simple, something a little more monotone. It could be listening to sounds. There are so many free YouTube videos with just sounds of the waterfall or rain or birds or waves. If you have a specific sound that you like, I’m sure you can find it. These are all great options.  You may also want to engage in a wind-down routine. This is my personal routine, you don’t have to follow it, but without too much being pedantic, I have a routine. I go downstairs. I brush my teeth. I floss my teeth. I wash my face. I then go plug in my devices. I go to bed. I get my Kindle out. I actually am fine with the Kindle as long as you’re not reading something too overwhelming because the lighting is different on a Kindle compared to an iPad that shoots light right into your eyes. I might take a glass of water. I make my bed actually before I go to bed. Meaning it’s pretty messy usually, so it’s something I like to feel like the covers are all neat on me. I then allow a wind-down. That’s just me. My husband doesn’t do any of that. He just brushes his teeth, goes to bed, and starts reading. Not that different, but for me, I have more steps. You can do whatever you think is helpful, but sleep hygiene has to be a piece and you have to work backwards by removing the technology.  Some people say, “What about if I use my phone for my alarm?” That’s fine, I do too. However, if it’s in your room or it’s next to you, that’s fine as long as you can practice some restraint of not picking it up and going on social media because you can lose hours by just picking up your phone and opening up the Instagram app. You can lose hours.  One thing I’m going to encourage you to do here is consider we have a course called Time Management for Optimum Mental Health and we talk all about scheduling. I’ll give you a little bit of information that I share during the Time Management course. I personally calendar a lot of my life and I have found that that has been very beneficial for my sleep. The reason being is because I have to wake up at 6:15 to get my kids to school. I used to get to bed whenever I could and then I realized I was massively sleep deprived. When I looked at the calendar and I thought, okay, if I have to be up at 6:15 and if I need a certain amount of sleep (I do better on eight hours), I have to be in bed asleep by 10:15. What am I doing? Going to bed at 10:30, I’m already setting myself up for failure.  When you’re scheduling, you actually look at your wake-up time and you even plan backwards for that on when you need to be in bed. And then you plan backwards from that on when you need to work on your sleep wind-down program. Again, you don’t have to be pedantic, you don’t have to be too hyper-controlled on this. But doing it a couple of times is life-changing in realizing, at the way I’m going, I’m never going to get enough sleep. SLEEP ANXIETY REMEDIES Now, in terms of talking about sleep anxiety help or sleep anxiety relief, there are some additional sleep anxiety remedies you may say that may help you. Let me add here, there’s not a ton of research. I try to only bring research-based stuff to you. But a lot of people say things like oils or candles or deep breathing. I mean, we have research on deep breathing. It can be very beneficial. But you can bring in anything that soothes you, certain sense people love. I have a sister and family members who love those satin pillows. That really helps them. Just get a feeling for textures and sensations that also help you to wind down in the evening.  SLEEP ANXIETY TREATMENT Now, if you’re doing these things and you’re still really struggling with sleep anxiety and getting to sleep and insomnia, I would encourage you to look into some kind of sleep anxiety treatment. We do have science-based treatments to manage sleep anxiety or even chronic insomnia. One of those things is mindfulness training. In mindfulness training, what we are doing here is we’re training you to be able to get a hold of your attention. Because as you know, anxiety, if you really let anxiety lead the way, it’s going to ping-pong you to all the worst-case scenarios. It’s like what I said about my daughter. Will I fall asleep? Will I wake up? How long will it take? What if I don’t?  A lot of people also report anxiety around, “I don’t like the feeling of falling asleep. I feel like I’m losing control or feel going to sleep is scary. I don’t know what’s going to happen.” If you’re someone who’s very hypervigilant, being asleep can actually be very triggering for you.  Mindfulness trains us to stay present and not engage in all of that drama that our brain creates around all the possible worst-case scenarios. It also allows us to practice non-judgment about the anxiety and about the sensations that we’re experiencing, so we can just be present with them and practice. When I say practice, I mean over and over and over again because this is not easy. Practice being willing to be uncomfortable but keep our mind attending to the present instead of the worst-case scenarios.  Another piece of this when we’re talking about sleep anxiety treatment is general stress management. Now, if you have an anxiety disorder during the day that also starts to leak into the evenings, particularly if you’re someone who has more anxiety in the evenings, you will need to use a lot of cognitive behavioral therapy to manage that anxiety. Or if you have a lot of stress in your life, maybe your work or your school or your relationships are very stressful in this season, CBT (cognitive behavioral therapy) can be helpful in first looking at your cognition—that’s the cognitive part of CBT—and then also looking at your behaviors. Now, the cool thing is a lot of the behavior stuff, you and I have already talked about in that sleep hygiene piece. We know that the behavior of being on your phone is not helpful. In addition with sleep hygiene, getting a lot of exercise less than two hours before bed isn’t really great for sleep either because your body’s metabolism is all sped up from that. Those are some behavior changes. Not watching scary movies or very activating movies or books—reading those books is very important behavior changes, or having difficult conversations.  For me, I have had to learn that if I work after about 7:00 PM, I can’t fall asleep. I need about three to four hours to wind down from work before I can fall asleep. Now that’s not always possible and I understand there’s a lot of privilege that goes with these ideas sometimes, but you just can do the best that you can, and if you can change things, go ahead and try. But those are some behavioral changes you can additionally do.  Now, if you are somebody who struggles with severe insomnia, in addition to sleep anxiety, because sometimes sleep anxiety goes alongside actual insomnia where biologically you don’t sleep much or you can’t sleep much, there is a specific type of cognitive behavioral therapy that is being scientifically proven to help called CBT-I. That is a specific form of CBT that is directed towards managing sleep anxiety and insomnia. It is really cool, it’s very effective. It’s very hard to get treatment, but if you do some Google searches, you might be able to find a CBT-I specialist in your area. GIVE ME SOME MORE SLEEP ANXIETY TIPS.. In general now, because I’m trying to move us through this and not give you a full-on lecture, let’s just talk about some general sleep anxiety tips. As you’re approaching bed, the first skill I want you to practice is not tending to the noise that your brain creates about how bad this is going to go. For me, my mindfulness mantra is “not happening now.” I’ve done a whole episode on that in the past, not happening now. Meaning I’m not tending to something that has not yet happened. Until it happens, it does me no benefit by trying to focus on it right now. My brain is going to keep saying, “But what if you don’t? What if it’s bad? What if you’re really tired tomorrow? How is it going to go? What if you wake up? What if you have a panic attack at night and so forth?” I’m just going to say over and over, “You know what, it’s not happening now. I’m tending to what is happening.” Another sleep anxiety tip I really want you to practice is compassion. Be really gentle with yourself, particularly as you start to practice these behavioral changes, and clean up your sleep hygiene. It takes time. The other thing with compassion is also be kind to yourself when you’re tired because a lot of us are exhausted. You have an anxiety disorder. Maybe it’s making it even harder for you to fall asleep. Then you’re tired, so now you’ve got two problems. Be as gentle and kind as you can. Again, when it comes to self-compassion, check in with yourself. Am I doing and engaging in behaviors that are kind towards me and my long-term goal? I’ll tell you what I used to do. When I had young toddlers, by two o’clock I’d be exhausted because I hadn’t gotten enough sleep, so I’d have a coffee or a tea. But the tea and the coffee then prolonged how much I could get to bed, and it was made later and later. Again, reducing coffee, tea, some energy drinks is another important piece of sleep hygiene and behavioral changes that will benefit you if you struggle with sleep anxiety or insomnia.  We have mindfulness, we have compassion. These are really important sleep anxiety tools or tips. Another piece here is, as I’ve said before, engage in things that soothe you. If you’re doing exposures, if you’re doing ERP, try not to do them before bed unless you’ve been instructed by your therapist. Sometimes that’s not helpful. Now, that being said, if you have really severe anxiety around sleep, you may need to do exposures around bedtime as the exposure. That is an actual part of CBT-I. Sometimes they even have you set alarms to wake up at 2:14 in the morning and 4:45 in the morning so that you have to practice these skills over and over. That is okay and that is, again, where this can be very paradoxical, but that will be up to you to decide what’s best for you.  WHAT ABOUT SLEEP ANXIETY MEDICATION?  Another thing to remember is that there is sleep anxiety medicine. You can talk with your doctor about medicines that can help with sleep, help staying asleep, help you regulate what time. Some people take medication a few half an hour before they go to bed so that it helps ease them into sleep. Please do speak with a psychiatrist or a medical doctor about that because I’m not a doctor, so I’m not going to be giving you medical advice about that.  Now, before I wrap up, there’s a couple of specific groups of people I also don’t want to miss here. First, I want to address sleep anxiety in association with depression. Sometimes a symptom of depression is insomnia. If that is the case, you could use some of these skills and I encourage you to, but we don’t want to miss the fact that if depression is what’s causing your insomnia or your sleep anxiety, please seek out a CBT therapist because it’s very important that you address that depression. One of the side effects of having depression can be sleepless nights, so I don’t want to miss that.  Another thing is, a lot of folks with OCD experience obsessions about sleep. Again, as I was mentioning before, it may mean that you do have to do some exposure around sleep and that would be advised to you because the best treatment for OCD is exposure and response prevention. We actually wrote an entire article about this on the website. If you want to go to KimberleyQuinlan-LMFT.com and then type in OCD and insomnia, it will be there. We did a whole article on that just a couple of weeks ago.  >>>OCD AND INSOMNIA ARTICLE IS HERE