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

In This Episode: Amy Mariaskin, PhD shares her new book, Thriving in relationships when you have ocd What is Family accommodation and how does it apply to ocd Ocd family accommodation vs family support,  What is OCD reassurance and how it can creep into one’s relationship Relationship ocd, also known as rOCD Relationship issues with ocd and how to manage them Sexual orientation OCD, Gender related OCD, and Harm OCD and the impact this has on relationships Attachment styles in ocd and how to understand them to help you navigate communication.  Links To Things I Talk About: Thriving in Relationships When You Have OCD: How to Keep Obsessions and Compulsions from Sabotaging Love, Friendship, and Family Connections Amy’s Instagram https://www.instagram.com/ocdnashville/?hl=en ERP School: https://www.cbtschool.com/erp-school-lp Episode Sponsor:This episode of Your Anxiety Toolkit is brought to you by CBTschool.com.  CBTschool.com is a psychoeducation platform that provides courses and other online resources for people with anxiety, OCD, and Body-Focused Repetitive Behaviors.  Go to cbtschool.com to learn more. Spread the love! Everyone needs tools for anxiety...If you like Your Anxiety Toolkit Podcast, visit YOUR ANXIETY TOOLKIT PODCAST to subscribe free and you'll never miss an episode. And if you really like Your Anxiety Toolkit, I'd appreciate you telling a friend (maybe even two). EPISODE TRANSCRIPTION This Your Anxiety Toolkit - Episode 312.  Welcome back, everybody. This is going to be a really important episode for you to listen to. Today, we have the amazing Dr. Amy Mariaskin, who is what I consider to be a very dear friend, someone I very much respect. She has written a book about relationships and OCD, and we talk all about it. We go deep into some of the core skills and discussions she has in her upcoming book. And this is just going to be an episode I really feel like you could take away and put some skills together right away. I’m so thrilled. So, thank you, Amy, for coming on this show.  But before we do that, I would like to do the review of the week, and I really hope you listen carefully to this. Not because it’s reviewing the podcast, but because I actually think the person who wrote this, who put in this review, is following some key points that I want you to consider. And this is what I encourage a lot of people to do. So, let’s go.  This is from Detroitreview and they said: “Thank you, I just started listening today after having a few weeks of anxiety and irregular thoughts that I never experienced. I randomly chose your podcast and am thankful for your experience, knowledge and personal and situations. As a 46-year-old father of two boys and loving wife, your podcast gives me a sense of calming. I’m taking notes on each cast.” Guys, I encourage you to do this. This is a free resource. It is jam packed full of skills. I encourage you to take notes. So, I love that you’re doing that Detroitreview. “While I started with the most recent, I have listened to #301/302/303.” And then they went on to say: “And they’ve already given me strategies that I’m using. I decided to start from your first podcast in 2016.” And that is what I encourage you all to do, mainly because those first 11 episodes are core content. I want you to take the content I talk with my patients about all the time. He went on to say, “I have been so impressed. I’ve listened to 1-2 daily. I’m up to 10 and 11. There’s so many things to listen to and I’m so grateful for you. The meditations are amazing. Keep up the great work.” Thank you so much for that review, Detroitreview. That is exactly my intention. This is a free resource, you guys. I want you to take advantage of the skills and tools so that you can have a toolkit for yourself. And so, I’m so thrilled for that review. It just makes me feel like, yes, that’s exactly what I want you guys to take from this podcast. Okay, before we get over to the show, let’s talk about the “I did a hard thing” segment. This one is from Kelly, and they said: “I recently faced one of my biggest fears – general anesthesia.” Holy moly, Kelly, I feel you on so many levels with this. “I started struggling with some gallbladder issues and was told I needed to have it removed. I was terrified, and I didn’t think I could go through with it. Thoughts were racing out of control. I sought help with therapy and your podcast. Thoughts are thoughts and not facts was huge for me. It was calm the day of the surgery, and I did it. Thank you.” That is amazing. You guys, listen, thoughts are thoughts. Just because you have them doesn’t mean they’re facts. I love that they’re bringing in that key concept as well.  Alright, let’s go over to the show. This is the amazing Dr. Amy Mariaskin. She’s an OCD therapist. She’s an advocate. She’s an author of an upcoming book. You must go and check it out. I’ll leave the link in the show notes. I am so, so honored to have you on the show, Amy. Let’s get over to the episode. Kimberley: Welcome, Amy Mariaskin. I am so excited for this episode today. Can you do a little introduction of who you are and all the good things about you? Amy: Yes. Thank you so much. I’m excited to be here. I’m Dr. Amy Mariaskin. I’m a licensed clinical psychologist and owner and director of the Nashville OCD and Anxiety Treatment Center in Brentwood, Tennessee. I’ve been working with OCD and anxiety for over 15 years now, and I just absolutely love it. Kimberley: And you wrote a book? Amy: And I wrote a book. I know I need to get better about that. I was like, “Oh, do I say it now or do I say it later?” Kimberley: You say it all the way. Amy: All the time. I wrote a book. It was fun and not fun and everything in between. And I think we’ll be talking quite a bit about it. It’s called Thriving in Relationships When You Have OCD. Kimberley: Right. Now, when you told me that you were going to write this book, I was so excited because I feel like at the crux of everything we do, a lot of the time, the reason people with OCD want to get better or the thing that propels them is how much their OCD impacts relationships. Not always, but I feel like that’s such a huge piece of the work. So, I am so grateful for you for writing this book, and it is an amazing book. I’ve read it myself. You did a beautiful job. And I want to cover some of the main pieces that you cover in your book today and go from there. So, first of all, congratulations. I know writing a book is not easy. Amy: Thank you. Yeah, it’s been a dream for a long time. So, I’m excited about the accomplishment and I’m ready to figure out the next topic. When Ocd Is The Third Wheel Kimberley: Yeah. I love it. I love it. Okay. So, Chapter 1, I think it’s funny. I’ll have to tell you how, when I was reading your book, I was lucky enough to get an early manuscript. I remember sitting, it was with my kids at track and they were running. And I opened the book and the first chapter said, “The Third Wheel: Understanding OCD’s Role in Relationships.” And I was like, “That’s exactly it.” So, I was excited right off the bat. Tell me, what do you mean by the third wheel? Tell me a little bit about that. Amy: Yeah. First, I should also thank you for writing the wonderful foreword for the book. So, if anybody is a fan of Kimberley, yet another reason that you might be interested in this book. Well, let me think. So, yeah, the third wheel analogy, it felt very apt because when I work with couples, I often imagine, and sometimes I’ll have couples imagine that the OCD is like this other presence in the room sitting there with us. Not physically, but in all the things that are important for relationships, all the ways that we develop intimacy, and that we even structure our time or the activities we choose to do together that OCD can wiggle right in there and can be this like third presence. And the thing is, it’s really easy, I think, for somebody without OCD if they don’t have good education or they don’t understand it, to get that third wheel confused with the person with OCD itself. So, like, “Well, you never want to go out,” as opposed to saying, “We both want to go out.” And here’s this other guy, OCD, really bossy, really pushy, really oppressive, who’s also coming along with us. And even when you do the things that you love, OCD can come along.  So, it felt to me like this sense of something in the relationship that makes it both unbalanced and is this separate component and that both people, in coming together, have to find creative ways to connect around it or eventually connect and evict it more and more. And so, that’s why I chose that metaphor. Kimberley: Yeah, I love that. And it’s funny because I remember when I was an intern and I was seeing a family or perhaps the wife who had OCD, what was interesting is I’m sitting in my chair and I noticed that the family members always sat across from her as if it was like her versus them, like who’s on which side of the team. And a big part of it was like, all you guys need to be over on that side of the room. You’re the team. I’ll be over here with OCD and we’ll work this out. But I think that that, even metaphorically, is such an important part of how OCD can turn everyone against each other. Is that how you’ve experienced it? Amy: Yeah, I think at times there are a lot of conversations about how everybody has a common goal to figure out how to live with one another, develop intimacy, connections, be they friendships, parenting relationships, romantic relationships, even work relationships, and things like that, how to form those and how to come together around common goals. And sometimes OCD can be, again, confused as a goal that one person in the relationship has. And the truth is, everybody’s suffering in a way, and that everybody can be a part of that process of, again, reducing symptoms or evicting it, things like that.  I do the thing as well when I have people in my office to just look at where are they sitting or when OCD comes up, what is the body language? Are both people really like arms crossed? Is the person with OCD hanging their head in shame, which we know could be such a powerful emotion and such an inhibitor of connection and vulnerability. So, I look for some of those and I remind them, “Head up, we’re all talking to OCD right now, and we’re all working with that, and we’re all on the same team.”  Family Accommodation & Ocd Kimberley: Such an important message. Thank you for that. I think that’s beautiful. So, let’s say the third wheel, I always think of like you go on a date and the third wheel shows up. And we know that definitely happens with OCD. You addressed a lot in your book about family accommodation. Can you share what that means and how that can impact a relationship? Amy: Yeah, absolutely. Accommodation is this thing where we’re extending this metaphor. You’re on a date, you’re with somebody, and the third wheel rolls on up. It’s, “Hey, my buddy from college is here, what’s up?” Essentially, accommodation is like, “Hey, why don’t you have a seat right here? Here’s the menu, here’s a place mat.” It is anything that the person in the relationship without OCD is doing to make OCD have a comfortable place at the table. So, that’s the metaphorical way. That’s abstract, but bringing it down to practically what it looks like, it means doing things generally in the service of what feels comfortable in the moment for the person with OCD. We’re going on a trip and I have concerns about contamination and I really want you to check all the hotels, do all this research to make sure that none of these places have ever had bedbugs or things like that. Then when we get there, we’re dirty from traveling, so I’m going to need you to take a shower. And so, the person, the spouse is taking showers and doing research and perhaps taking over responsibilities from the person with the OCD in order to provide that short-term relief. But it ends up, again, making a place for OCD in the relationship. And it reduces that motivation for the person with OCD to change.  Family Accommodation is tricky. There are a lot of ways that it can happen. I think reassurance-seeking is certainly one that I think we’ll talk about, but providing excessive reassurance about things to the person with OCD in a way to keep them comfortable but keep them caught up in compulsions. And I think it’s important to note that a lot of times, partners will hear about accommodation. And just as much as we think being apprised of accommodation and looking out for it is important, it’s also, I think, really important that partners understand that that’s nuanced and that they don’t take it to like, “Well, I’m not going to do that for you. That might be accommodation,” or, “I’m not going to reassure you about anything,” or “Is that your OCD?” I guess I say that to say that it’s a little tricky, but it’s really anything that is preventing the person with OCD from experiencing discomfort and thereby strengthening the cycle. Kimberley: Right. No, I’m grateful that you bring that up actually, because probably the one that I get asked the most from parents, and this not in every relationship, but with parents, is like, okay, my child is having a really hard time getting homework done, their OCD is impacting them. So, if I don’t help accommodate them, if I don’t do some compulsions for them, read for them or so forth, they won’t do their homework. And then there’s an additional consequence. So, they’ll say like, “I feel like that’s too risky. I could actually be letting my kid fall behind, so I can’t stop doing this accommodation.” What are your thoughts on that? Again, how would you approach that type of situation? I mean, there’s many examples. Amy: Sure. I think with a situation like that, first, I would validate the parents’ love and desire for their child to do as well as possible. Most accommodation is coming from a place of love and not a deliberate enabling or anything like that. Of course not. So, I really provide a lot of validation there. And then I help them reframe it as, “One way to be loving and supportive in the long run is to really cheer your child on in taking over, taking on more and more ownership of that.” So, does that mean, “I know that I’ve been reading. Right now, I’ve been reading for you, and that makes it easier to do your homework. We also know that you have OCD and we know that your brain tells you, you’ve got to reread and reread and reread. So, can we be on the same team together, fight that rereading? I’m not going to read it for you because I love you, because I know you can do this. Boy, is it going to be hard at first and I’m going to be there to cheer you on and motivate you.” I sit with kids, I’m always about gamifying it. “Do we want to just race through this? We don’t have to be perfect.” Again, it depends on the symptoms, if it’s perfectionism or what’s getting in the way.  And then what I say is, if a parent says, “Well, then they’re really just not going to get their schoolwork done,” sometimes then I’ll say, “Well, if it gets to the point where it is interfering with things like that, then it may be that they need a little bit more support.” Because it’s like, with kids, your job is school and with the adults, your job can be a job or it can be care taking. It can be a lot of different things. But if one of those major domains of living is affected, then it may just mean that you need more support. So, we might up the number of sessions per week or refer out to another program or things like that.  But those kinds of things would be the same things I would say in any kind of relationship where there’s an accommodator, which is, wow, you love your friend or partner or coworker so much that you’re willing to do this stuff for them so that they’re not suffering or so that they can demonstrate their potential as in the case of the kid with homework. But here’s why that’s not the loving response in the long run. Ocd Family Accommodation Vs Ocd Support  Kimberley: Right. You’re right. I mean, you mentioned like, then we have the complete other end of the spectrum where people are going, “No, I’m cutting you off completely.” And I think too, I think it’s important, as you said. Some accommodation happens in every relationship. I don’t particularly like cleaning hair out of the sink drain. That’s not my favorite. So, I’m going to ask my husband to do it, knowing that I take the trash out or whatever. We trade-off. So, how might people identify accommodation through the lens of OCD compared to loving exchanges of acts of service?  Amy: Right. Oh, I love that question, because essentially, what we call compromise in relationships could be called accommodation – accommodation by a gentler name. And I think part of that has to do with, what’s the motivation there? You do such a wonderful job in your podcasts and online and everything of talking about how doing the hard things are important, and how if you’re not doing the hard things and you’re avoiding difficult things that can really shrink your world over time and put anxiety or OCD in the driver’s seat. So, if the motivation, if a child or a spouse or a friend is asking-- well, if you are asking a child or a friend or a spouse, if you’re saying, “Hey, can you do this for me,” or “I’d feel a lot more comfortable if you did this,” thinking about, is it a compulsion or a preference to me? There are so many different ways that we can look into that, but is it in the service of just like, I could, but I prefer not to? Or is it, I feel like if I do that, I’m going to be too anxious or I’m going to do too many compulsions, or something bad is going to happen? So, I think if the motivation there is more avoidance due to anxiety as opposed to just preferences, I think that’s helpful.  Sometimes I’ll say to people when they’ll say to me like, “Well--” and I think division of labor in the house is such a good example. When people say, “Well, I don’t ever take the trash out,” I will often ask, “Well, what happens when your roommates are out of town?” Let’s say they’re living in a roommate situation. And if they say, “Well, it just piles up and I can’t deal with it,” then I say, “Aha, this might be a place that we need to work on and chip away.” And again, reducing accommodations doesn’t mean like all of a sudden, I’m a garbage master and I’m the only one doing it. It might mean that I’m doing some exposures to get up to the point where I can have that role in the household.  So, I love that question of like, well, what if you had to do it? What would that be like? And if it’s really hard, then hey, let’s help break down some of those barriers and reduce accommodation. OCD Reassurance Kimberley: Yeah. I usually tell clients like, “Okay, let’s just do it so that we know you can, and then you can move on to the next exposure.” Tell us about reassurance. You talked about it a little bit. And in your book, actually, the thing I highlighted, because I read it in Kindle, that I love the most is your reassurance tracking. Tell us a little about that.  Amy: Yes. Because again, I love that you’re highlighting this because reassurance is something that is okay. Reassurance happens in all relationships. Again, we might call it by different names. It might just be checking in. It might be clarification. It might be getting information from one another. So, I developed a worksheet that’s also available with the book that allows for people to track when they’re asking for reassurance from loved ones, and to answer a series of questions that aren’t going to give you a 100% certain answer of whether or not it’s compulsive, but are going to give you some clues. So, on the worksheet, it says, people write down the situation. So, for example, I was asking my friend if she was mad at me. That might be the situation. And then there’s a column that says, what were your emotions?  Again, if we’re seeing anxiety, guilt, shame, some of those words might be a clue that our OCD is at play, but not always. And then people track, did you ask only once? Because we also know if it’s truly the type of reassurance, “Oh, I just need to know. I’m having a vulnerable moment. I just need to know, is this okay with you? Are you upset?” Then asking once and accepting the answer is generally how it goes. So, if you’re asking more than once, if you answer no to that, it’s a clue that it could be compulsive reassurance. And then also, was the source credible?  I feel like I talk about this example a lot, but I just love it so much, which is that I worked with a little girl who was really worried about getting strep throat. She would ask everybody for reassurance about her tonsils. I mean, anybody and everyone. At one point, she took a picture and she was just old enough that she got social media. She put it on her Instagram and she was like, “Do you guys think I have a strep throat?” That was the caption. That was the little caption, which is like, she was laughing about it afterwards, but that’s not a credible source. I mean, she wasn’t even friends with all the docs in town or anything, or ear, nose, and throat specialist. So, was the source credible?  Now, often if it’s social reassurance, it is a credible source. If I ask you, if I say, “Kimberley, was I too long-winded,” you’re going to be able to tell me. So, you would be a credible source. If I leave this room right now after doing this podcast and I ask somebody, “Do you think I was long-winded? Do you think I was?” and they’re like, “Well, we weren’t there,” that’s that answer. That’s that question about credibility.  And then the last one is, did you accept the answer? Anxiety and OCD have this way of undermining. Well, pretty much everything, but undermining any answer we get and countering with it. ‘What if,’ or ‘Are you sure?’ ‘But I think...’ So, if it’s starting with a ‘but,’ a ‘maybe,’ a ‘what-if,’ then again, it may not be that helpful reassurance-seeking. Relationship Ocd (Rocd) Vs Relationship Issues With Ocd Kimberley: Yeah, I love that. And thank you for adding that because I just love that template so much. That is just like gold. I love it so much. Alright. So, as you move into Chapter 4, I believe it is, you talk about specific subtypes of OCD that are commonly impacted in relationships. Can you share just briefly what your thoughts are around that? Amy: Yeah. I love this question too because as I’ve been talking about the book, a lot of people are like, “Oh, great, a book about ROCD, or relationship OCD.” And my answer to that, or my response to that is, “Yes, and...” Just a step back, any subtype of OCD can affect and often does affect relationships. Why? Because OCD goes after what’s important to us. And for many of us, our connectedness with one another is just so important. That being said, there are subtypes of OCD that are relational in nature. And so, I do have a chapter that is more devoted to these types, and one of which is relationship OCD. This is a passion of mine. I’ve done now a few iterations of an ROCD treatment group at my clinic, and I have other plans to expand that group and do some cool programming around that.  But relationship OCD, it’s basically when OCD symptoms are about the relationship itself or about the person with whom you’re in relationship. So, it could be about-- we think about it a lot of times with romantic relationships, but it could be any relationship. To use a different one, it could be, am I a loving enough parent? Do I love my kids enough? How do I know? Do other parents have these thoughts? So, it could be about the relationship or it can be about the individual. Like, my spouse doesn’t like the same music that I do, and are we ever going to get past this? And so, something that might be seen as, yes, it’s an actual difference, but then there’s all this story making around the difference and how the difference is going to be the demise of the relationship. Those are the two flavors of ROCD, relationship and partner-focused.  I also want to pause here and say that oftentimes when people talk about ROCD, I feel like there’s this pull to say, “Well, if you know you have ROCD, if relationship issues come up in your relationship, it’s probably your ROCD.” And that’s just like another backdoor to the certainty that we all want. I think all relationships have some crunchy bits and some edges that chafe. And so, I want the people with ROCD to feel empowered to also develop the relationships that they want and then notice that maybe the ROCD turns up the volume on some of their concerns, if that makes sense.  Kimberley: It’s hard, isn’t it? Because so many times a patient will say, “But I don’t know if I really love-- is he the one?” And we’re like, “Well, we’ll never know.” There’s no way to objectively define that. And then someone, a friend is like, “Well, if you don’t know, it must be a problem.” It’s so hard for those people because people without OCD also don’t know all the time either, so it’s a common concern. Sexual Orientation Ocd & Gender Related Ocd Amy: Right. No, that’s a great point. So, I have some stuff about relationship OCD in there and then the identity subtypes of OCD as well. So, sexual orientation OCD and gender-related OCD. I put those in there because oftentimes our identity is the foundation from which we interact with others and create relationships and things like that. So, I talk a little bit about sexual orientation OCD, not just even in dating, but in finding a community and friendship and things like that. SOOCD can rear up and lead to lots of social comparisons or it can just really try to sabotage certain relationships, and with gender-related OCD as well, be it somebody who is cisgender and wondering if they are transgender or vice versa. I’ve worked with people in the transgender community who have OCD and have these unwanted thoughts about like, “Well, what if this is not who I am? What if I’ve been doing this for attention?” And then, therefore, are wanting to compulsively disengage from their community because of the feeling of like, “Well, I don’t feel authentic enough.” So, that’s a way in which that can root in relationally. Kimberley: Right. So, we’ve got relationship OCD and identity. What are the other ones?  Harm Ocd & Its Impact On Relationships Amy: Yeah. And then the last one that I highlighted in here in that section is harm OCD. And I put that in there because harm OCD, which again is a huge category, which I would say under that are anything that’s violent. That could be sexual as well. So, sexual violence toward others or sexual intrusive-- obviously, all intrusive thoughts, but intrusive thoughts about being sexual with children. I would roll all that into the harm OCD category. And this one is just, it’s always so striking to me the ways in which OCD can take something that’s really important. Like, I want to be a good person, I want to be a kind person and then undermine it. So, the amount of people I’ve worked with harm OCD who are experiencing isolation and really the self-imposed isolation, the irony of which is “I’m isolating myself because I don’t want to harm others,” but then they’re withholding themselves as this fantastic person to be out in the world. And so, that’s what I always say, is you’re doing more harm isolating, but sort of. Get out there. You have so much to offer and in fact, your OCD has attacked this area because it’s important for you generally to have relations with others. Kimberley: Yeah, I love that. So, I love how you’ve given us a way, and as you said, it can impact any relationship outside of those subtypes as well. What I’d love to do is give you the mic and tell us just now, in general, give us your best relationship ideas, advice, tips, tools, whatever you want to call them, for the person with OCD and the loved ones of people with OCD. Amy: Yeah. Thank you. I feel like that’s a dangerous thing to be giving me the mic. Kimberley: It’s all yours. Go for it. What’s the main thing you want people to know? Amy: I think I want for people to be able to-- number one, there’s no right or wrong way to have a relationship provided that everything is consensual and respectful. And so, taking a step back-- and actually Russ Harris just put out this. I don’t know if you saw this, but this incredible list of relational values words. So, there’s an activity where-- or I don’t know if it’s new, it’s new to me. That’s clarifying what are your relational values and what are they with different relationships? Is it playfulness? Is it intimacy? And so, figuring out what you want and having your spouse do the same. In our relationship OCD group, most recently, we had people and their significant others, I shouldn’t say spouse, do this and figuring out ways to connect around those things. I think it comes down to connection and to supporting each person, like supporting each other’s goals.  I think I’m bringing this up in part because I think sometimes there are these narratives out there about like, we have to have all the same interests or opposites attract. And again, to that, I say yes, and... For some people, they want people with really similar interests and for others, they want somebody who’s going to be different. But I think what we can do is support each other and try to see the world through your loved one’s eyes and try to celebrate when they’re celebrating.  I think part of this is like, I’m married to somebody who’s a huge thrill seeker. He’s paragliding. He just got his private pilot’s license. He does things that are not in my nature. If he’s gone out and he’s done some sort of paragliding trip in a different country, and he’ll come back and he’ll say, “I found a lift here and there were thermals,” in my head, I’m like, “You didn’t die. You didn’t die. Yeah, you didn’t die.” And I have to stop my own anxious story about it or my own interpretation of “I wouldn’t like that” and just be there with him in that moment of sharing his joy. It’s finding joy in others’ joy. It’s being there with other people’s emotions about whatever they are. Because I think with anxiety and OCD, it can always be this upper-level analytical process of like, “Oof, I don’t like that. Is that okay?” or things like that. I know a lot of the Gottman’s research will talk as well about how very important it is to just support one another, be cheerleaders, et cetera.  Attachment Style & Ocd  I think too, knowing your attachment style. And this is a whole topic that we could spend forever on, but knowing if you’re somebody who-- when you get close to others, do you feel more resistance in getting closer or do you feel worries about like, “Ugh, I don’t want to lose myself by merging with someone else”? Or do you have more resistance around, “I’m worried they’ll abandon me, I’m worried they won’t love me enough?” And that’s a very, very, very rudimentary look at two of the concepts of attachment, that more avoidant attachment where it’s, “I’m worried I’ll be subsumed by the other person and I value independence,” or more anxious attachment, which is, “I’m worried they won’t love me enough or I’ll be abandoned.” Knowing that and knowing when those thoughts come up, take a pause, take a step back and check in with yourself and your body and the facts and things like that, instead of reacting in that moment. When anxiety is there, it wants us to just react to every alarming or provocative thought that we have. So, yeah, those are some things. I know that I had them scrolling through because I know I had more in the book from the Gottman. They’re top of mind. Kimberley: I think back to when I was first married, I was so young. So, if someone had explained to me attachment styles, it would’ve made the first five years so much easier. You know what I mean? My husband would go away. He’s actually away right now. He would go away because he loves to fly fish. And for me, I would feel anxiety because he would leave and I would interpret, because I’m anxious, and I was like, “No, this isn’t hard for me to be alone.” It would quickly turn to anger towards him for having a hobby. I’m totally fine to say this too. I’m feeling anxious here by myself. He’s off doing something fun for him. So then I got angry that he’s doing fun things and leaving me to have my anxiety. He would come home not to a happy wife. He would come home to wife with her hands on her hips. You know what I mean? And I think that that is so common for people with anxiety. When you’re feeling anxious, you feel like they’re doing it to you like, “Why are you doing this to me?” And then that can create a whole narrative that can interfere in relationship. So, that’s just a personal example of how, if I had have known my anxious attachment early in our marriage, I think that would’ve saved us a lot of fights. Amy: Yeah. Oh, I love that example. And I feel like for me, as somebody who tends toward the other side, I tend to feel more worried about being stifled by relationships. I want to be fully seen and encouraged. And so, sometimes, in particular with friendships, if I’ve had people who are like, “I’ve felt exactly the same way,” or “I had the same experience,” or “We should do this all together. Let’s get matching jackets,” I’m like, “I am an individual.” I get really threatened because my feeling is-- my brain’s automatic interpretation is they don’t see you because they think that you are just-- they assume like we’re all the same, whereas they’re just like, “We want to affiliate.” So, I’ve had to do some work there as well, even with friendships, to know like it’s not-- people aren’t trying to kidnap my identity and merge it with theirs. They’re actually just being loving.  Kimberley: Right. But it feels threatening. Yeah, absolutely. I think the last question I have for you is, it goes back to that accommodation reassurance piece, particularly related to these dynamics. And maybe this is just my experience, I’d actually love to hear yours. What I do find is, when the person with OCD is coming from an anxious place, like often overanalyzing things, hyper-attending hyperawareness of things, their need for reassurance or their need for everyone to follow what OCD tells the family to do, I have found that the partner, because it’s so overwhelming for them, tends to flip to the other end of the spectrum where they don’t worry about anything or they’re like, “It’s fine.” Or maybe even they’re frustrated of like, “It’s fine, it’s fine.” Have you noticed that as a trend in dynamics of a relationship? Amy: Yeah. Sometimes almost like there’s a dismissiveness. Yes, I have noticed that and I think that there are so many reasons why that can happen. And I think for the partner and their experience, getting at what that is and what’s motivating that is so interesting because, to the person with anxiety or OCD, it can feel really invalidating, or it can feel very comforting. But I think a lot of the times, it can feel invalidating and the partner might be doing it because they might be having their own feelings come up about, “I don’t know what to say.” I’ve tried to use facts and sometimes facts can bounce right off of OCD if you’re not in the mindset to accept them. OCD is skeptical about everything. So, I’ve tried everything and I’m really now at this place of like, “I am so tired.” And it’ll come out. “I’m so tired of hearing you talk about this.” And that’s when, as a clinician, I see time out. I think you’re both really tired of this cycle that OCD has you both in.  So, yeah, I will see that. And I think sometimes when that’s the pattern as opposed to a lot of overly accommodating, I think when that’s the pattern, the element for me in working with couples to inject back in there is the validation of, “This is really hard.” And also for them to take a step back and realize, well, not everything is going to be OCD either. Sometimes if there is reassurance-- I mean, again, the irony is sometimes this pattern can lead to more reassurance because then it’s like, “Well, you just dismissed me. You said that there’s nothing wrong in our relationship that you did it in a manner that felt dismissive. And so, now I’m going to ask again.”  So, yeah, deconstructing that pattern. Does the partner feel angry? If so, you’re angry at this pattern, not your partner. Does the partner feel helpless, hopeless? Did they feel scared? Are they grasping at straws? So, yeah, that would be how I would look at that when I see it come up. Kimberley: Oh, thank you. I’m so grateful that you shared all that because I think they are all great questions that need to be addressed within the relationship. Thank you. So good. Okay, tell us about your book. I want to be respectful of your time. Tell us about your amazing book, which I think every family that has members should read. Tell us about it. Amy: It’s called Thriving in Relationships When You Have OCD: How to Keep Obsessions and Compulsions from Sabotaging Love, Friendship, and Family Connections. It’s available for pre-order as of the recording of this, which is in October, but I think this is going to come out later. It will be hot off the presses December 1st from New Harbinger Publications, available on Amazon, available through New Harbinger, I think available on other websites. People keep sending me links and I’m like, “Wow, that’s really cool.”  So, yeah, I tried to cover all different kinds of relationships. We talk about family relationships, parenting, romantic relationships, sex and intimacy and those kinds of relationships, friendships, work, and really just a relational lens to what can be a very isolating and security disorder. And I don’t want anyone to feel like they have to go at it alone. Kimberley: Thank you. Again, hats off to you. Much respect. You did a beautiful job writing the book. It’s an honor. I was so honored to write the foreword. And I think, again, it’s like a handbook I think everybody needs to have on the onset of being diagnosed. Here’s the book to make sure you can protect your relationship and nurture the relationship outside of OCD. So, thank you. Amy: Well, thank you for having me.

In This Episode: What if people notice I am anxious? How to handle the fear that people ill judge you  Tools to manage anxiety Episode Sponsor: This episode of Your Anxiety Toolkit is brought to you by CBTschool.com.  CBTschool.com is a psychoeducation platform that provides courses and other online resources for people with anxiety, OCD, and Body-Focused Repetitive Behaviors.  Go to cbtschool.com to learn more. Spread the love! Everyone needs tools for anxiety...If you like Your Anxiety Toolkit Podcast, visit YOUR ANXIETY TOOLKIT PODCAST to subscribe free and you'll never miss an episode. And if you really like Your Anxiety Toolkit, I'd appreciate you telling a friend (maybe even two). EPISODE TRANSCRIPTION This is Your Anxiety Toolkit - Episode 311.  Welcome back, everybody. I am so happy to have you with me today. Today, we’re talking about what to do if people notice how anxious you are. This is something that I’ve even thought about myself. When you’re having anxiety, it’s like, “Are people noticing how anxious I am?” And when you worry about that or you think about that, sometimes it can actually create more anxiety for you. Quite a few of you have asked this question to me in the past, specifically around when doing exposures. As you go to do your exposures, then you have this secondary thought of like, “Oh my goodness, are people actually seeing how anxious I am?” So, I wanted to do a podcast just about this topic.  Before we get into the episode, let’s quickly run through the “I did a hard thing” for the week. This one is from Anonymous and they said: “My son just started preschool this month. For context, my OCD and anxiety has me housebound for the last two years, and never in a million years did I think I was going to be able to handle this. I still feel discomfort and struggle with intrusive thoughts, but the sparkle in his eye when I pick him up makes it all worth it. This has reinforced the importance of pushing through even when it’s hard.” Anonymous, this is so good. Look at you go. And I think we can all resonate with being so overwhelmed with anxiety, but we make decisions based on our values, not our fear. And then we get to see people sparkle in people’s eyes or our own eyes. And I’m so excited to have you share that with me. So, thank you so much. All right, quickly, review of the week. This is from Sybil Cross and they said: “Compassionate and competent care. My ERP therapist recommended this podcast to me and I love it! It is both educational and supportive. It helps me learn more about my OCD and feel comforted, all while retaining its therapeutic value. Thank you for all your hard work and love, Kimberley!” It is my pleasure. Thank you, Sybil, for sharing that amazing review. Please do go and leave a review. I know I say it every week, but you do not understand how helpful it is to me. I am really doubling down in 2022 and next year on really making sure this podcast reaches as many people and makes a massive impact. So, your reviews mean so much to me.  All right, let’s get over to the show. Have you ever been out and about doing your thing socially and then all of a sudden, you have anxiety and then you start to worry, what if people start to notice that I’m anxious? If this is you, you’re going to want to listen up because today we’re going to go through what to do if people do notice or what to do if you’re afraid of people noticing that you have anxiety.  So, thank you so much for joining me again today. I love spending time with you, talking about all things anxiety. Let’s talk about what to do if people do notice that you have anxiety. So, the first thing to ask yourself, and I love asking questions because I think it really helps us to really understand the actual problem, but what I’m going to ask you is, what’s your actual fear? If you’re afraid of someone noticing that you are anxious, what are you actually saying there? Are you afraid that maybe they’re going to judge you for having anxiety? Or are you afraid that there may be some consequence for having anxiety? Sometimes people are afraid in certain work environments or school environments. Or is it that you’re afraid that if they notice you have anxiety, that then you’ll then have even more anxiety and then that creates a perpetual cycle? Let’s take a look at these outcomes depending on which one you struggle with.  So, let’s talk about first the fear that they might judge you. Now, if this is you, there is a pretty good chance you may have social anxiety. Social anxiety is a specific anxiety disorder around the fear of being judged by others socially or feeling humiliation or embarrassment around others socially. And often what we understand about social anxiety is it’s actually not so much an anxiety disorder. Well, yes, you will feel a lot of anxiety, but we actually understand it to also be a shame disorder. Often people go out and then enter the social environment and they’re afraid that if someone notices an adequacy or a floor, that they’ll be judged and that will create a lot of shame for them. Remember, fear and shame is often associated together. They often go together. And shame is really about us having a thought that there’s something wrong with us, that we are inherently bad.  So, if your fear is that you’re going to be noticed and they’ll catch you, and then you’re going to feel shame, what you’ll want to do here is work at being able to navigate your shame. Stay here and we’ll talk about that a little bit later. It could be also that you’re afraid of humiliation or embarrassment. Some people don’t want to be judged because then they know they’ll get stuck in a cycle of regret. “Why did I do that? Should I have done that? What could I have done different?” which looks a lot like mental rumination, which we know is a mental compulsion, a common behavior we do to try and reduce or remove anxiety.  So, we can talk a little bit more in a second about how to manage that. First, let’s talk about another concern people have, which is that you’re afraid that if you get noticed for having anxiety, that you might have more. The thing to remember here, and you probably know this from me already, is the more you try to make fear go away, the more likely you are to have a strong wave of fear. So, remember, what you resist persists. So, if you’re saying, “What if someone notices that I’m anxious and then that makes me more anxious,” if you’re paying a lot of tension to their facial expression, trying to figure out what they’re thinking about you, chances are, you will have more anxiety because of how much attention you’ve put on their opinion of you. The last piece here is, will there be consequences? So, let’s really talk about that. Some people are concerned that if they are visibly anxious, let’s say you’re giving a presentation at work or school or you’re meeting your boss for your yearly meeting or your teacher for a check-in and so forth, that there will be consequences if you’re visibly jittery, nervous, stuttering, shaky. Some people are afraid that they’ll get noticed for sweating. And sometimes there can be consequences. Maybe a part of your job or your schooling is to be able to perform. And if you’re engaging in avoidant behaviors, yes, there may be some consequences that go along with that.  But what I’m going to encourage you to do to manage this is talk to your boss, talk to your teacher, talk to your coach, whoever it may be that you’re concerned will employ these consequences. Ask them what we can do and what they can do and how you can get supported as you manage your anxiety. Hopefully, it’s an environment that supports mental health struggles and supports mental health in general. And usually, I have found, if you go to your boss or your teacher or your dean or your parent or your coach or whoever it may be, and you let them know that you’re struggling, they may have some really helpful tools or they may actually be able to help you to manage that in that environment. So, 100%, while I know bringing it to their attention is actually your fear, that can often very much help.  Now, if you’re in a situation where you don’t feel comfortable going to them and sharing that-- it could even be with a friend, or a partner, a boyfriend, girlfriend, someone you’re interested in. If you’re really afraid of that and you don’t want to share, that is entirely okay. But what it does mean is, and this is where we get to the tools, you’re going to have to give yourself permission to have anxiety.  So, number one, the main thing I’m going to tell you if you have this fear in any certain way is, if you are going into this circumstance or this event saying you shouldn’t have anxiety, you’re going to have more anxiety. We know that to be true. So, what do you do instead? You can practice allowing your anxiety to be there and actually saying, “This is a good thing.” And I know it doesn’t feel good, it doesn’t feel fun, but what you’re saying is, “Here is an opportunity for me to have the anxiety and show up anyway.” Number two, here is an opportunity for me to have the anxiety and show up and really see who are the true friends, who are the unconditional friends, who can be caring and compassionate in this environment, and can I face this fear, and baby steps, make small wins, and have small achievements where you’re able to increase your willingness to have the anxiety, increase your tolerance of discomfort and sensations that you don’t like.  The next thing I want you to do is, number three, the most important, you will be shocked how important and how helpful it can be if you practice self-compassion. If you are using the tool of self-criticism to manage this, chances are, you’re going to make your anxiety a whole bunch worse. So, instead, try validating yourself. “It makes complete sense that this is hard for me. It makes complete sense that this would create anxiety for me.” Maybe you would say, “Anyone else in this situation would have anxiety.” And I know your brain is going to say, “No, no. Jack, John, and Jennifer could do this without anxiety.” The thing to remember is, they might be a few steps ahead of you and you can get there too. Our brains are neuroplastic. We can actually get there too with practice, small wins and self-compassion. The self-criticism is only going to make you more anxious. Really, I think you probably already know this, but I think it’s important for you to understand, self-criticism only makes it worse, and we want you to do great, and we know you can do great.  Number four is, be an observer to what’s going on. So, let’s say you’re about to do this event or this social experience with somebody, or you’re about to have a conversation, and you’re shaking or you’re sweating or you’re stuttering, or whatever it may be. Your job is to be an observer of your thoughts about that.  Now, here is an example. I am often with anxious people. It’s a normal part of my day. I’m an anxiety specialist, but I go into a lot of exposures with my patients. We go to Costco, we go to the supermarket, we go to the outdoor park, and my patients practice exposing themselves to the exact thing they’re afraid of. And what you’ll find here is the average human that they interact with are incredibly forgiving. Humans want to like you. They don’t want to not like you. They want to be in connection with you. They don’t want to be out of connection with you. And when you’re struggling, if that is the case, 99% of the time, they have enough empathy and compassion to help you along. And so, a part of this work is you increasing your ability to see the good of the human race.  Now, I know you may have had a few experiences where people weren’t so kind, but the good people are out there. It’s just a matter of practicing. And when I go on exposures with my patients, they’re actually pleasantly surprised. We might go to the supermarket and we might say, “Okay, I want you to go and ask 10 people for the time, or I want you to look 15 people in the eye and say good morning to them. Or I want you to ask five people a question, where is the local bank, or can you tell me where such and such street is?” And 99% of the time, they walk away going, “Wow, people are actually kinder than I thought.” There are people who don’t want to talk to them, and that’s usually because they’re anxious too. And so, it’s important for us to understand and have an understanding of the human race here, and give ourselves permission to show up imperfectly when we’re around other people. Now, another thing I want you to think about here is, how can I practice on purpose facing this fear. I know what you’re thinking. You’re like, “Let me just shut this down. Where’s the pause button?” But I really want you to understand that there are hundreds of opportunities in your day where you can practice showing up anxious on purpose and how many of those can you put in a day. Put them in your calendar, plan for them, leave work, or leave for school a little early so you could get an extra couple of practice runs in with this.  If someone had, let’s say, a fear of being shaky, I actually encourage them to be shaky. Sometimes we even induce shakiness for them. We might have them have a cup of coffee before they do the exposure so that they’re on purpose feeling this feeling and they’ve got a lot of practice doing it. And then the last thing I want you to remember is, once you’ve done all these steps and you’ve done the hard thing, because I always say it’s a beautiful day to do hard things, I want you to then practice what we call response prevention. Response prevention is, now that you’ve done the hard thing, you’re to practice not engaging in rumination and self-criticism, the things that actually you used to do, which only make you feel worse and actually reinforce the fear. You’re going to practice not doing those things and instead engage back into the world and just practice moving on, practice engaging in what you are showing up to do, practice engaging in the things that you love and that you value. Instead of sitting there looping about how it went and what they thought and what they think about you and how did they perceive you and you should have said this and you shouldn’t have said that, your job is actually to catch the urge to engage in that rumination and then bring yourself back to the present. Now, if you can do those things, you are leaps and bounds ahead of where you would be if you weren’t engaging in those things. And we know that small steps lead to medium size steps, which lead to massive steps forward.  Now, what is the one thing I want you to take away? Because I really love giving you a takeaway here. Number one, the more you try and avoid the fear, the more you’re probably going to have it. And then the last thing here I’m going to say is, go gentle. Go easy. Catch how you’re engaging in self-criticism. The truth is, we have a lot of research to show that people aren’t thinking about you nearly as much as you think they are. Most of the time, they’re thinking about them. They’re thinking about what they’re going to have for lunch and their meeting that they have coming up and, “Whoops, I forgot to get milk at the grocery store.” They’re not hyper-attending to every little mistake that you make as much as you think they are. And if they are in fact judging you that heavily, that is a strong relation and reaction of what’s going on in their mind. It actually shows us a lot. It’s a reflection of what they value and what they’re judging about themselves. And so, really other people’s judgment is often just a reflection of their judgment about themselves and the way that they think. And our work is actually to focus on actually being the person you want to be or who do you want to be? How do you want to show up? What are your values? What kind of person do you want to be?  So, I hope that’s been helpful. At the end of the day, you will be judged. This is something I have had to learn the hard way. I have had to learn that not everyone is going to like me, and that is okay. I am a messy human being. I am not perfect. I was never supposed to be perfect. And my job is to give myself some grace and some compassion for the fact that I’m just a human, messy person, just like you’re a human, messy person. And that’s true for every human. Okay?  Have a wonderful day. Do remember it’s a beautiful day to do hard things and I look forward to talking to you again next week.

SUMMARY:  What if you don’t identify with the concept of an obsession being a FEAR? It’s a repetitive thought or feeling, but you’re not scared of a specific outcome.  What is the UNCERTAINTY when it comes to these obsessions?  Guilt Obsessions:  WHAT IS OCD GUILT?  OCD Guilt over past mistakes “I shouldn't have done that”  “That was a mistake”  OCD Guilt as a simple intrusive thought- no known mistake “Is it bad that I did that”  “Did I make a mistake?”  “What could be the consequences”   REGRET obsessions.  I’ve heard a lot about how guilt is a common intrusive feeling in OCD but not much about regret.  “I wish I didn't do that”  “I wish I had done it another way”  Guilt and Regret accompanied with sadness??  How to stop OCD guilt?  How to treat OCD guilt and regret Links To Things I Talk About: Feeling guilty doesn't mean you have done something wrong https://kimberleyquinlan-lmft.com/ep-161-feeling-guilty-doesnt-mean-you-have-done-something-wrong/ How to let go of the past https://kimberleyquinlan-lmft.com/ep-70-how-to-let-go-of-the-past/ I screwed up. Now what?  https://kimberleyquinlan-lmft.com/ep-293-i-screwed-up-what-now/ ERP School: https://www.cbtschool.com/erp-school-lp Episode Sponsor: This episode of Your Anxiety Toolkit is brought to you by CBTschool.com.  CBTschool.com is a psychoeducation platform that provides courses and other online resources for people with anxiety, OCD, and Body-Focused Repetitive Behaviors.  Go to cbtschool.com to learn more. Spread the love! Everyone needs tools for anxiety...If you like Your Anxiety Toolkit Podcast, visit YOUR ANXIETY TOOLKIT PODCAST to subscribe free and you'll never miss an episode. And if you really like Your Anxiety Toolkit, I'd appreciate you telling a friend (maybe even two). EPISODE TRANSCRIPTION This is Your Anxiety Toolkit - Episode 310 Welcome back, everybody. We are at Episode 310. I just recorded it as 210 and I’m still in shock that we have hit 310 episodes. I recorded it and I was like, “Hang on a second. That doesn’t sound right.” And it wasn’t, and that still shocks me to this day.  All right. Today, we are talking about a very important topic, which is guilt and regret. And I’ve called this episode Guilt and Regret: The Most Misunderstood Obsession, and I believe that to be true because a whole bunch of you are walking around wondering whether you have OCD or not because a lot of what you hear is that OCD is all about anxiety and uncertainty. But what about the folks who don’t have a lot of anxiety and a lot of uncertainty, but they’re having obsessive guilt and obsessive regret in the form of OCD guilt and OCD regret? So, I wanted to talk about that today.  Before we do so, let’s quickly do the “I did a hard thing” segment. For those of you who are new, this is where listeners and followers share the hard thing that they’ve done. Why do I do this? Because so often, you guys forget that just because your hard thing is hard for you doesn’t mean there’s anything wrong with that. I want you to see that hard things are hard things and we should celebrate them and we should share them, and this is a platform I want to do that with. So, this one is from Mars, and Mars said: “After many weeks and years of hard work, I finally managed to reach an important stage of my career, and I ended up with two job offers.” Amazing. “Both were great really for different reasons, and I couldn’t choose. I went back and forth and tortured myself four months trying to get certainty about which one is the right choice. I’d never been so anxious in my life. Finally, today, I sent the final email, even though I wasn’t certain about the choice, it was the hardest thing I’ve ever done, but I finally feel like I can move forward with my life again.”  Mars, number one, congratulations. Sounds like you’ve worked really hard. And number two, you’re also doing this hard thing where you’re allowing the discomfort into your day, into your life, and you’re moving forward anyway. Thank you for sharing that. That is such an amazing accomplishment. Interesting, isn’t it, how you’ve shared here too like it was around the certainty, but it sounds like that was similar to what we’re talking about today, and let’s talk about that. So, let’s start from scratch. Start from the beginning. So, often people will come into therapy and say, “I didn’t seek treatment for the longest time, because all I’m hearing is OCD is the uncertainty disorder, and I don’t feel a ton of uncertainty in the way that I’ve heard other people do with OCD.” What do I do if I don’t identify with this concept of the obsession being around fear and uncertainty? What about if you have a repetitive thought or a feeling, but you’re not scared of the specific outcome? And this is so important, guys, because we do hyper-focus on uncertainty and I really do believe that uncertainty is the root of lots of OCD obsessions and a lot of our suffering if we don’t accept that uncertainty. But what about those who have obsessive guilt and obsessive regret? So, let’s talk about it. Guilt OCD - Guilt Obsessions Let’s first talk about guilt obsessions. So, what is guilt obsessions, or what is OCD guilt? Ultimately, it’s a thought or an action that occurs. That’s the trigger. So, you had a thought or you did some behavior, and then you are having this onset of guilt. Remember, an obsession is an intrusive thought, feeling, sensation, urge, or image. And so, in this case, we’re talking about intrusive feelings. And so, what’s happening here is you’ve had a thought or you’ve done something and then you feel this very, very real feeling of guilt, very real feeling of guilt. Most of my patients who struggle with OCD guilt or obsessive guilt will say, “I genuinely feel like I’ve done the equivalent of killing a person. That’s how much guilt I feel.” Even though you might be very clearly able to identify like, I didn’t kill a person, or it doesn’t make total sense on why I’m feeling this high level of guilt, that’s so disproportionate. and that can be really confusing. And so, they’re really confused as to what’s going on.  So, they might show up in-- the guilt may be accompanied by intrusive thoughts like, “I shouldn’t have done that. That was a huge mistake. I wish I didn’t do that. How can I avoid that in the future?” And then you can easily see why we then move into compulsions, like avoidance, rumination, tons of reassurance seeking. In therapy, a lot of people go to therapy, not even OCD therapy because they don’t even know they have OCD yet, and they spend all this time doing EMDR and biofeedback and hypnosis and all of this deep therapy work, exploring the deep meaning of the guilt, only then to realize like, “Wait a second, this is OCD. I’m doing all these compulsions and I’m even doing them in session.” Now, as I mentioned, OCD could be as simple as an intrusive thought of you’re walking down the street and you just get the onset of guilt after some kind of trigger where there’s no known mistake. Or it could be that you did something that didn’t completely line up with your values, but again, then you have disproportionate degrees of guilt. Disproportionate.  If it’s just a simple intrusive thought that has no known trigger or no known mistake, maybe your thoughts are related like, “Is it bad that I did that? Did I make a mistake? Was that right? Did that line up with my values? What could be the consequence of this?” And it can be incredibly painful.  Regret OCD- Regret Obsessions So, now let’s move over to regret obsessions and compulsion. So, with regret obsessions or regret ocd, they usually are presented more as, “I wish I didn’t do that. I wish I hadn’t done it that way. I wish I had done it in a different way.” It’s often accompanied with a deep feeling of sadness, like regret this deep feeling. Again, it can be an intrusive thought, but it often is just an intrusive feeling. This deep sense of, “I wish I didn’t do that.” Sometimes it’s accompanied with dread. “Oh, I hope I never do that, have this emotion, or do that thing again.” It can be incredibly painful. And again, people can get stuck in really the wrong kind of therapy, ruminating, ruminating, trying to solve what it was.  Sometimes I’ve had patients even come to me and say, “Oh, I saw you because you do self-compassion and I want to be able to forgive myself,” and they’re doing compulsive forgiveness. I believe in forgiveness. I’m not saying there’s anything compulsive about forgiveness in the day-to-day. But if they’re doing it to get rid of an obsessive degree of regret, an OCD degree of regret, and that involves obsessions and compulsions, well then, that forgiveness practice can become impulsive.  OCD Guilt Over Past Mistakes I always laugh because I’m doing this breathing training, this meditation training right now. And some of them, the trainers who obviously are not OCD informed will say, “Breathe in your discomfort and breathe it out and let go of it and release it.” And I think that’s a beautiful practice. But for a person with OCD, that can become compulsive. And so, it’s important when you have OCD to catch these little nuances and these little behaviors and activities that can end up becoming a problem.  So, let’s talk about how to stop this obsessive guilt or this OCD guilt, and let’s think about this a little bit in terms of how you might master this sensation and this feeling that you’re having. So, a couple of things before we move on is I have done quite a few episodes on guilt or letting go of things in the past in other episodes. So, I wanted to let you know, you can also go over, I did one episode about feeling guilty. It’s Episode 161. I did another episode, which was highly requested, Episode 70, which is called How to Let Go of the Past. And I did another episode, which was actually me talking about my own sense of getting through something that I felt regret and guilt for, which was Episode 293 and it was called I Screwed Up, Now What? So, we’d actually have tons of sources here on the podcast about that, and I wanted to share those in case you wanted to really delve a little deeper. But let’s talk about how to stop this OCD guilt.  How To Treat OCD Guilt And Regret All right? So, as you know, trying to stop an emotion usually doesn’t work. So, we don’t want to try that. That’s not going to work. Same with regret. How to treat OCD regret, I don’t encourage it. What we want to do instead is we want to be able to acknowledge it and observe it and do nothing about it. Now, I am a big believer in this. Truly I am. Whether you have OCD or not, when it comes to guilt, when it comes to regret, when it comes to shame, I’m going to encourage this very mindful approach.  Number one, are you able to catch it in its tracks? That is number one. That is a tactical skill, is awareness, to be able to catch, “Oh, I am stuck in this guilt bubble or this regret bubble or this shame bubble.” Just like you would when you’re stuck in OCD. You’re able to catch, “Oh, I’m engaging in a pattern of behaviors that looks a lot like OCD.” Same goes for this situation. So, I’m observing and being aware of it. And then number two, catching where I’m wrestling with it. What safety behaviors do you have in relation to this feeling? Again, when it comes to OCD, it doesn’t matter what the obsession is, it doesn’t matter whether it’s associated to uncertainty or not, it doesn’t matter if it’s real or feels real or not. What we want to do is take a look at the safety behaviors we’re engaging in and first ask ourselves, are these helpful and effective?  So, if you have guilt or regret, and your way of coping with that is to beat yourself up in hope that you never do it again, how effective is that? Is that working for you? Is it actually preventing you from doing things in the future that may trigger off regret and guilt? No. Are you avoiding certain things so that you don’t have to have this guilt and regret in the future? Do a quick assessment on those safety behaviors and ask yourself, does this help me in the grand scheme of things, knowing that OCD may pull guilt and regret on me for the most minor thing again tomorrow? Is it effective for me to try to make my life really small and avoid things because of an emotion that I may have to experience?  Remember, the emotion will not hurt you. You’ll allow it to rise and fall. It is painful. I’m not going to lie, it is painful, but it won’t destroy you, especially if you have a relationship with guilt and regret and with this discomfort where you’re not resisting it. Remember, what you resist persists.  So, you want to take a look at, do a functional analysis, do a review on how effective is my safety behaviors. Are you engaging in reassurance-seeking compulsions saying, “Do you think I did something wrong?” Going to your partner, “Do you think I did something wrong?” Maybe you’re confessing. “I feel guilty that I did this thing. I want to tell you what I did so that I can let it off my conscience.” Now again, within a normal degree, we do this to some degree. I always laugh. Several years ago, my son, who was four at the time, came home and blurted out to my husband that mom had run through a red light, just out of the blue. He’d figured out that red lights were bad and you can’t drive through them and he’s like, “Mom went through a red light,” the minute he saw him. Of course, he was like, “No, you didn’t.” And I had to admit to it. But after that, I felt this urge to admit to things so that I could absorb myself of that guilt and regret that I had. And we all do it. I want to normalize that. I don’t want to pathologize those kinds of behavior. But if you’re doing that repetitively and it’s interfering with your relationships and it’s creating more and more stress for you, and you do it once and you don’t completely feel absolved and you feel like you need to confess again, this is a safety behavior that isn’t effective and that’s causing long term problems and is feeding the cycle of OCD. We want to break that, guys. We want to break that. So, what I want you to look at here is, again, awareness. Are you able to acknowledge what’s going on? Are you able to identify the compulsions that are problematic? And then are you able to let it be there? Let it be there. Do nothing about it. Now, if you’re a real badass, which I know that you are, you will then, if you’re really ready, you might even do something fun and pleasurable while you feel guilt. Now that is doubling down. While you feel the obsessive guilt, while you feel the obsessive regret, you’re actually going to go have some fun and enjoy yourself. So important. This is a super important piece of the work that we do.  How To Stop Relationship OCD Guilt Now, for those of you who have relationship guilt or relationship OCD guilt in relation to your OCD, this is so important. It’s so important that you catch the safety behaviors that you’re doing and then you reengage with your loved one, because often what we do is we either do a whole bunch of compulsions or we shut down completely. We stop hanging out with them, we stop opening our heart with them, we stop engaging in intimacy with them. And that can become a big problem. For those of you who have real-event OCD and guilt associated with real-event OCD, the same thing is applicable, which is we want to go through those steps, and then we want to practice opening up our life being fully engaged in our life, in the things that you value, whether the real event happened or not. I often get emails and DMs from people saying, “I feel like my real event is worse than other people’s real event, and so therefore I should suffer, or I should figure this out.” And I want to say, “That’s a very tactical trick that OCD plays on you to get you back into doing compulsions.”  And so, I want you to be aware specifically to harm obsessions, relationship obsessions, real event obsessions, sexual obsessions. This is such an important piece because that’s often where it shows up. But again, it doesn’t have to be fear and uncertainty related. Sometimes the guilt and the regret can be the actual obsession that people experience. Okay?  So, as always, we want to throw a massive dose of self-compassion onto this. Self-compassion in and of itself is an exposure for many people. and often people with specifically this OCD guilt and OCD regret when they practice self-compassion, it is like the ultimate exposure. The ultimate exposure. And I really want to encourage you guys to surround yourself with kindness, encourage yourself with kindness, motivate yourself with kindness, nurture yourself with kindness when you’re struggling and you’re experiencing a high level of discomfort. It doesn’t have to be fear. It can be around these other emotions that you experience, and shame. Shame often comes along with this. So, we want to make sure that we are doing everything we can to engage in self-compassion as much as we can. Okay? All right. That’s it for now. Let’s quickly do the review of the week. This is from Triphonik and he or she said: “Love this podcast. Kimberley’s podcast is so inspirational, relatable, and helpful. I have been dealing with OCD since my early 20s. I went through extensive therapy, medications, and lots of prayer! I got to the point where my OCD was not taking over my life anymore & hardly noticeable. I’m now 43 & I’ve recently gone through some lapses with it after these years. It really shook me to the core. Following Kimberley’s anxiety toolkit podcast was helpful in getting me back on track with the tools I’ve learned from my past along with some new ones! Her spirit and her level of sincerity with the knowledge and experience she has helped me so much! I’m so incredibly grateful to have found this podcast. Thank you, Kimberley!” Thank you so much, Triphonik. Your reviews mean the world to me. Really, they do. And I’m just so happy to be on this journey with you.  All right, folks, I’m going to see you next week and I’ll talk to you soon.

SUMMARY: Not having a subtype makes it hard to get diagnosed with OCD  Not fitting into a subtype can make you doubt having OCD.  When you don’t see other examples, you can feel like an outsider in the OCD community.  All the subtypes seem to have their “people.”   The doubt can make you feel that it really is about the content, not OCD.  What if I don't fit into a typical OCD Subtype Examples:  What if I picked the wrong name for my baby?  Obsessions about the weather and whether you will enjoy the weather?  This nail color makes me feel strange.  What if I don't remember this the way it was?  What if my partner cheats on me? What if my child suffers?  What if my taxes were not correct?  How will I know when it is time to stop therapy?  General Anxiety Vs Ocd? Dimensional Obsessive COmpulsive Scale (Jon Abramowitz)  Concerns about germs and contamination Concerns about being responsible for the harm. Injury, Bad luck  Unacceptable thoughts  Concerns about symmetry, completeness, and the need for things to be “Just right.”  Does ERP work for these obsessions?  Does the process of treatment work any differently than it would with a “subtype”?   Ideal Treatments for OCD ERP  ACT SC MINDFULNESS Links To Things I Talk About: ERP School (An online course for OCD) https://www.cbtschool.com/erp-school-lp Dimensional Obsessive COmpulsive Scale (Jon Abramowitz) http://www.jabramowitz.com/uploads/1/0/4/8/10489300/docs.pdf Episode Sponsor: This episode of Your Anxiety Toolkit is brought to you by CBTschool.com.  CBTschool.com is a psychoeducation platform that provides courses and other online resources for people with anxiety, OCD, and Body-Focused Repetitive Behaviors.  Go to cbtschool.com to learn more. Spread the love! Everyone needs tools for anxiety...If you like Your Anxiety Toolkit Podcast, visit YOUR ANXIETY TOOLKIT PODCAST to subscribe free and you'll never miss an episode. And if you really like Your Anxiety Toolkit, I'd appreciate you telling a friend (maybe even two). EPISODE TRANSCRIPTION What If I Don’t Fit Into The Typical Ocd Subtypes? Welcome back, everybody. Thank you so much for joining me. I know your time is so valuable, and so I am so honored to spend this time with you to talk to you about today common question that I get asked. Well, actually, no, it’s not a common question, but it has been a question that I have been asked over the years by clients and followers, and listeners. And I was proposed with this idea as something that we really need to address. And so, here I am. And my goal is to always address the things that maybe aren’t getting addressed if possible. And so, today we are going to talk about, what if I don’t fit into the typical OCD subtype? So, what if my obsessions don’t line up with the typical classifications and categories that we have for OCD? Ocd Subtypes So, for those of you who maybe are new to this idea, we have OCD as a general diagnosis. And then under that umbrella of the diagnosis, we have-- over the years, the clinical and OCD community have created subtypes of OCD to help us, number one, categorize different groups of obsessions so that we can then direct the treatment to being very specific. We also do that to build a sense of community so that you feel less alone. Let’s say you have a harm obsession that can be very stigmatizing and feel very, very overwhelming, and you can have a lot of guilt and judgment about that for yourself. So, knowing you’re in a category, in a group with other people can actually soften the blow of the stigma and the judgment around that obsession. Same goes for sexual obsessions, pedophilia obsessions, and so forth. Again, as a clinician, as I’m training my therapist, these subtypes are actually helpful so that we can help the newer therapists have a treatment plan specific to that person’s obsession. However, what about the group of people who don’t line up perfectly in those groups? And so, in today’s episode, we’re going to talk about what to do if that is you, what to do if you’re a therapist and you’re dealing with this, some skills that you might use, and maybe a few shifts and reframes here, I’ll use some clinical research that may help you shift the way you look at this problem. And maybe we can even stop calling it a problem. We could actually not address it as a problem and actually move through that together. Okay?  Before we do that, let’s get straight to the “I did a hard thing.” I haven’t even read this hard thing you guys, so I’m as excited as can be. This one is from Hannah, and this is what Hannah had to say: “Earlier this year, I suffered a debilitating OCD episode that focused on harm OCD,” so, there we are, we have a subtype already explained, “Specifically the fear of sleepwalking or going crazy and harming my family. At the time, I had no idea I had OCD as I had always been told I was just an anxious person. So, this well and truly threw me to the point that I couldn’t get off the couch, take my daughter to and from school or be alone. I wanted to admit myself into a mental health facility for fear that I was a real danger to my family and my daughter in particular. Long story short, after weekly ERP with a therapist and starting an SSRI, I did a very hard thing by being at home alone with my daughter for a whole weekend while my husband went away for work. I don’t think I’d be able to do it and I had been feeling anxious for months prior to knowing it was coming. But I did it and I actually ended up enjoying our time together despite some fairly consistent rumination.” Hannah, oh my gosh, this is so good. You are such a walking billboard for how effective ERP and medication can be. I love that you did this. This is so good. And so, congratulations. I am so honored that you shared that with us. And look at you go. Look at you go. All right. Again, quickly, let’s do the review of the week. This one is from Austin-mang, and they said: “I finally did it and signed up for therapy. My session is this Friday. I’ve been doing my best to prepare and was uncertain about what to expect my first session. This show helped me to know exactly what to expect and gave me some great mindset tools going in. Thank you!” Austin-mang, it sounds like you did a hard thing too. This is so wonderful. So, thank you guys for sharing your hard thing, and thank you so much for leaving a review. It does help me immensely build trust for those who are new to the show.  All right, let’s get to it.  A Common Question: “I Dont Fit Into A Typical Ocd Subtype?” So, let’s backtrack to the main concern here, which is what if I don’t fit into a typical OCD subtype. Now, this is a hard thing for people, because not falling into that subtype can make it hard to be diagnosed. I was just thinking about this yesterday. Ten years ago or longer when I first started treating OCD – it’s been nearly 15 years now – if you typed into Google “What if I harm my baby,” maybe one or two articles would come up, but you would find an article about OCD and then you would slowly, if you’re able, get to treatment. Remember, our mission here is to reduce the amount of time it takes someone with OCD to get diagnosed and treated. Right now, it’s seven to 14 years, which is absolutely horrendous, but we’re getting better. We’re getting better.  So, if you typed in “What if I harm my baby” or “What if I sinned,” you would probably come to an article that may lead you to, you may have OCD. What if I get sick and die? If you typed your what-if thought into Google, you’d probably find an article somewhere. But there are a group of people who if they typed their fear in, OCD would never come up. It would never show up on a Google search. If you told your doctor, they might not be able to identify this as OCD, because as far as we’ve come with educating, these subtypes have actually helped us educate doctors, nurses, teachers, and caregivers so that they can be more likely to pick up on children’s and young adult’s OCD. As much as we’ve done this, if you don’t have those specific subtypes, it can make it very difficult to get diagnosed. The next piece here is a lot of people, and this is what I really hear a lot in my community online, on Instagram – if you follow me on Instagram, it’s @YourAnxietyToolkit – is some people will say, “Because I don’t fit into this subtype, I have a lot of doubt that I have OCD at all.” We know OCD is a doubting disorder, but often people with OCD even doubt, even if they fit into a subtype, they doubt that they have OCD. But if you don’t fit into one of these categories that we’ve put, these loose categories that we’ve put, that can make it even harder to really double down with your treatment and feel confident in your provider and feel confident in your diagnosis and so forth.  There is a lot of times when people don’t talk about their specific obsession, when it doesn’t fall into that subtype in fear that someone would say, “You don’t have OCD. You don’t follow any of the subtypes.” And I’m sure maybe even some uneducated clinicians have shared that with their clients like, “No, you don’t meet criteria because you don’t meet a subtype.” And hopefully today we can actually get rid of that and hopefully resolve that issue. And what really comes and becomes apparent is, as we were talking before, let’s go to the “I did a hard thing.” They said they had harm OCD. And as I said before, it can feel really validating to know you have your community like, “Oh, I have perinatal OCD.” So, you have your little-- you can find a group of people who have the same obsessions, and that can be really validating. It can be very, very comforting to feel like you have that community. But for those who don’t feel like they fall into a subtype, they may actually feel quite isolated and alone, like unseen. And that doubt can really make it really difficult.  And what I thought was really interesting is somebody said to me, the doubt can make you feel that it really is about the content, not the OCD. So, remember, we’re always talking about like, it’s not about the content. The content doesn’t matter. And in this case, they were saying, no, it really does feel like the content matters because if your content is within a category, well then you get that community, you get that reassurance. Not compulsive reassurance, but you get a little reassurance like, “This is OCD, you’re on the right track, keep going.” So, I have such compassion. If you are somebody or your client is somebody who has an obsession that doesn’t fall into these categories, let’s really make sure we validate them. Let’s really make sure we slow down to understand what that is like for them. Examples Of Ocd That Do Not Fit Into Traditional Subtypes Let’s talk about some examples of what this might look like. So, examples of what it might look like if you don’t fit into a typical OCD subtype might be: What if I picked the wrong name for my baby? Some people could go, “Oh, that’s just a normal concern. Let’s come up with a solution.” You know what I mean? That would be probably, “Let’s work at making the right choice.” And I have had clients in the past who’ve gone as far as changing their baby’s name multiple times. I’ve seen this case multiple times, trying to just figure out the solution. But you can see here, it’s not a general fear. It’s something that is repetitive and they can’t seem to get rid of that uncertainty. And even if they do change it, the uncertainty still returns and it’s very urgent. Again, we can really see that’s OCD. Clear and clean OCD. It’s got the obsession, it’s got an urgent compulsion that is repetitive, that causes distress. It doesn’t line up with their values. So typically OCD. Some people have obsessions about the weather and whether they’ll enjoy the weather. And you might immediately think, well, again, that doesn’t sound like OCD. But again, let’s look, it doesn’t matter about the content, it matters on the process. Is this person ruminating about this a lot? Are they stuck on trying to find the correct answer or the answer that resolves their uncertainty? Is there an incredible amount of distress? Are they trying to solve this with urgency? If that is the case, we have a very clean and clear case of OCD.  I’ve had clients who’ve spent a lot of time obsessing and compulsing over the nail color that they picked or whether nail-- simple things like things they’ve chosen for their body – tattoos and so forth. And again, we could say that’s a generalized anxiety or that’s a common concern, but if it’s done repetitively and urgently and it’s causing them an extreme amount of distress, and it’s often targeted around uncertainty or anxiety or disgust, clean and clear OCD.  Some clients I’ve had have said, “What if I don’t remember something the way that it actually was? What if I can’t remember it the exact way that it was? What if I lose a part of the memory?” Now, this might show up around, let’s say the loss of a loved one. What if I don’t remember them? And we might say that is a total normal stage of grief, except this person is trying to solve this memory issue repetitively, urgently over and over again, struggling in massive amounts of distress. The uncertainty of this is really destroying them. And again, clean and clear case of meeting criteria for OCD, but they don’t seem to make these into these categories. They don’t seem to slide into a category.  I’ve had patients have obsessions about whether their partner cheats on them, and we could say, “Oh, well, they were probably--” in some cases, they have been cheated on before and we go, “That makes complete sense that they would worry about that. That’s not OCD.” But we look at the presentation and it goes far beyond generalized anxiety. It goes far beyond daily normal anxiety concerns for that situation. Again, it could become massive amounts of reassurance-seeking, rumination, avoidance, compulsions, self-criticism, self-punishment. And we can see that the way these compulsions are playing out meet criteria for OCD. And you might even say there, “Well, that’s kind of relationship OCD.” But that fits into the category. And we could argue that maybe you’re right, but I really wanted to highlight how often. Let’s say, if the partner had cheated on them and they’re having this obsession, usually, people would not put it in the category of relationship OCD because the partner had cheated on them or because a family member had cheated on their partner and they were somewhat traumatized by that event. We can sometimes miss cases because it doesn’t fall into a category.  I’ve had people and clients who’ve worried obsessively and compulsively about their thought, what if my child suffers? What if my child goes through hard times? And again, we would go, “Oh, that makes complete sense. Every parent feels that. Every parent worries about that.” But then again, it crosses a line into massive amounts of rumination, massive amounts of checking, massive amounts of reactivity. It might not even be that it’s the typical compulsions. It might be just a great deal of reactivity done because the uncertainty of this is so overwhelming.  I’ve had patients have obsessions about their taxes. What if they weren’t done correctly? They go back and they check them and then they go back and have a second opinion, and then they-- and again, we could say, “Well, isn’t that kind of like a bit of a moral obsession?” But when we ask the patient, they might say, “No, it’s not about that. It’s just about the fact that it’s uncertain.” Again, doesn’t fit into a typical subtype. One other example I have is a lot of patients I’ve had have had the obsession, how will I know when it’s time to stop therapy? Now that’s a common rational concern. That’s actually a really good question to ask. Well, how will I know? But again, the obsession is excessive and causing them great distress. They spend a lot of time trying to figure it out. They can’t figure it out. There is no solution. The uncertainty is so overwhelming and overbearing and painful, they end up doing a lot of compulsions.  And so, there we have all of these examples, and I’m sure you probably have more of where your obsession doesn’t fit into a typical subtype but is so clearly OCD.  So, here is what I want to offer you. In this case, I’m going to give you the answer up front, and then we’re going to work through it together. The truth is, the subtypes really don’t matter. The only reason they matter is they help with treatment and they help with validation in helping people to feel not alone. But we must remember that nowhere in the criteria for OCD does it say you have to have a subtype. The only criteria you need to have is to have an obsession, a repetitive thought, feeling, sensation, urge, or image. And that obsession has to create a lot of distress in your life and can impact your functioning. Not always, but it can. And then must contain compulsions. And the compulsions are either covert or overt, meaning they’re behavioral, they’re physical, or they’re mental. They must cause a lot of distress in your life. They must take a certain amount of time. And if you meet that criteria, that’s all we really need for you to move forward with your recovery, and I want to encourage you to move forward as fast as you can. Try not to get caught up. Remember the subtypes. Just think about me being a therapist who trains staff. I have ERP School, which is our online course. That is for people who don’t have face-to-face therapy, who don’t have access to therapy, who want to learn how to structure ERP for themselves. I talk a lot about subtypes there, but only because it’s an education tool to help people get direction for their treatment. But if you don’t meet that criteria, that means nothing about whether you can recover or not. So, that’s the main point, and now we’re going to talk about how we can do this. Now, first, before we do this, I actually want to introduce to you something that is a science-based measurement tool we use for OCD that may be very validating to you folks if you don’t have a specific subtype that you fall into that category. Dimensional Obsessive Compulsive Scale (Jon Abramowitz)  Now, Jon Abramowitz and his team has created what he calls the Dimensional Obsessive-Compulsive Scale. If you Google it, it should come up. I will do my best to link it in the show notes. And this ultimately doesn’t have anything about subtypes. It really just has four categories of concerns that people with OCD have. And what I found so wonderful about that is if we throw out all the subtypes and we just look at the symptoms, we look at the process that someone with OCD goes through, you’ll probably find you fall into one of these categories. If you don’t, still don’t worry because-- but I think that this is-- I love the way that they’ve really put this together because it simplifies everything. It makes it a whole lot less confusing. So, let’s go through them together.  Number one, category 1 is concerns about germs and contamination, and they go through to explain that. If you download it, you’ll get more information about this.  Category 2 - concerns about being responsible for the harm, injury, or bad luck. And so, for that one, that includes harm OCD, it includes religious obsessions, self-harm OCD, moral obsessions. A lot of those subtypes can fall into these little categories, but I like that these are really basic.  The third is simple, unacceptable thoughts. And in these cases of people with OCD that don’t fit into the subtypes, we could easily just say, “You fall into the unacceptable thoughts category, that these thoughts are unacceptable to you. The uncertainty is unacceptable to you.”  And then the fourth category is concerns about symmetry, completeness, and the needs for things to be just right. And what I think is so helpful about that is so often these cases where they don’t fall into these more typical subtypes, I find often they do fall into somewhere around this idea of the need for things to be completed or just right or resolved. Hopefully, this Dimensional Obsessive-Compulsive Scale helps catch a net underneath all of these subtypes that can validate you, that you still fall under the category of having OCD, that you can still move forward with your treatment. You go full fledged into your ERP and move forward ultimately.  Ocd Vs General Anxiety Disorder (Gad)  Now, that being said, we also need to look at the overlap, or maybe we should actually say the spectrum of where generalized anxiety can meet OCD. Some of these, as we said, some of these obsessions fall under maybe that’s more generalized anxiety, but we know that you could have generalized anxiety fears. But if they’re presenting with obsessions and compulsions, we’re actually going to treat it like OCD. And some people – I’ve actually really loved the OCD community – are now arguing that general anxiety and OCD are the same thing, just on a spectrum, from not so severe to very, very severe. And they’re doing that. People with generalized anxiety are doing obsessions, having obsessions, and doing compulsions. The biggest one being mental rumination and avoidance.  So, let’s round this out by talking about what to do now. So, if this is you, here is what I want you to remember. At the end of the day, and this is what I say to my clients, at the end of the day, it doesn’t matter what we call this. We could call your set of symptoms bibbidi-bobbidi-boo, and we would still use the same tools to get you effective results because what do we know? It doesn’t matter. Whatever the content is, what do we know is the problem that you’re struggling to manage the uncertainty that you’re having, that you’re having a great deal of distress and discomfort, and we need tools to be able to manage and ride that out.  So, again, if we call it this specific subtype, we call it OCD, we call it generalized anxiety, we call it bibbidi-bobbidi-boo, at the end of the day, they all require us to stop trying to suppress the thought because we know suppressing the thoughts make it worse. And then we can practice exposing ourselves to the situations where those thoughts come up without doing those compulsions. So, if you’ve taken ERP School or you’re interested in taking ERP School, we go thoroughly through what ERP is, which is exposure and response prevention. What it is, is that we expose you to the thought and fear and the obsession that you’re having. And then we practice, slowly but surely, reducing – this is called response prevention – reducing the compulsive behaviors that you do that reinforce that fear and obsession. That’s ERP. It’s actually pretty structured. We walk you through it in ERP School, but if you have an ERP therapist, they’re going to walk you through identifying your obsession, even if it doesn’t meet those categories, identifying what is your fear, and then practicing, exposing you to the life that you want to live, whether that fear shows up or not, and then practicing reducing those compulsions. The process of treatment is the same, disregarding the subtype, whether you have a subtype that you fall into or not. It is effective either way.  Ideal Treatments For Ocd And so, what I’m going to encourage you to do, and I’m just going to think of this as me finishing out the podcast, but giving you some direction, is if you meet criteria for OCD, and that involves doubting your disorder-- I remember once John Hirschfeld when I was training to become an OCD therapist. He said to me, if he had his way, he would add to the criteria for OCD that you must doubt your disorder because it’s so common for people with OCD to doubt whether they have the disorder. So, here we want to do is we want to have a plan where ERP is the meat and cheese of your treatment. And what you can do then is supplement treatment with either acceptance and commitment therapy, self-compassion, mindfulness. Sometimes people use DBT. There are new supplements coming to treatment all the time, which is wonderful, but the meat and cheese is to make sure you’re doubling down on that exposure and then the reduction of those compulsions. Okay?  My message to you is you can still 100% recover from this disorder. Look at the “I did a hard thing” today and look at the review even, talking about the benefits of practicing ERP. So, that’s what I want you to focus on.  If you don’t have access to an ERP therapist, we have a course available to you. It’s $197, which is actually less than one session with any of my staff or most ERP therapists. That is about seven hours long and will walk you through this process. So, if you’re interested, head over to CBTSchool.com. The course is called ERP School and hopefully, it will give you the tools and the education you need to feel like you can get the ball going here, even if you don’t fit these typical subtypes.  Okay, that’s all I have to say about that. I hope that this has been absolutely jam-packed with helpful skills for you to learn. I hope it absolutely validated your concern if, in fact, this is a concern that you have, and it is my honor to be on this journey with you.  So, as I always say at the end of almost every episode, it is a beautiful day to do hard things. Thank you so much again for supporting me. I just adore sending out these free resources for you and hopefully filling up your cup if your cup is feeling very empty. Please also, one thing I should have said, be gentle guys. OCD and anxiety in general can be a mean beast in our minds. And one of the best antidotes to that can be kindness, gentle self-care, loving, nurturing presence. And so, I hope that’s what I am for you and I hope that is what you are for you as well.  Have a wonderful day, everybody.

In This Episode: Andrew GottWorth shares his story of having Obsessive Compulsive Disorder (OCD) and how ERP allowed him to function again.  addresses the benefits of ERP and how ERP is for Everyone  How Exposure & response prevention can help people with OCD and for those with everyday stress and anxiety  Links To Things I Talk About: Andrew’s Instagram @justrught ERP School: https://www.cbtschool.com/erp-school-lp Episode Sponsor: This episode of Your Anxiety Toolkit is brought to you by CBTschool.com.  CBTschool.com is a psychoeducation platform that provides courses and other online resources for people with anxiety, OCD, and Body-Focused Repetitive Behaviors.  Go to cbtschool.com to learn more.  Spread the love! Everyone needs tools for anxiety... If you like Your Anxiety Toolkit Podcast, visit YOUR ANXIETY TOOLKIT PODCAST to subscribe free and you'll never miss an episode. And if you really like Your Anxiety Toolkit, I'd appreciate you telling a friend (maybe even two). EPISODE TRANSCRIPTION  This is Your Anxiety Toolkit - Episode 308.  Welcome, everybody. I am really pumped for this episode. We have the amazing Andrew Gottworth on for an interview where he just shared so many nuggets of wisdom and hope and motivation. I think you’re going to love it. But the main point we’re making today is that ERP is for everyone. Everyone can benefit from facing their fears. Everyone can benefit by reducing their compulsive behaviors. Even if you don’t technically call them compulsions, you too can benefit by this practice. Andrew reached out to me and he was really passionate about this. And of course, I was so on board that we jumped on a call right away and we got it in, and I’m so excited to share it with you. Thank you, Andrew, for sharing all your amazing wisdom.  Before we head into the show, let’s quickly do the “I did a hard thing” for the week. This one is from Christina, and they went on to say: “Thought of you today, and you’re saying, ‘It’s a beautiful day to do hard things,’ as I went down a water slide, terrified, as I’m well out of my comfort zone.” This is such great. They’re saying that’s on their holiday, the first time they’ve taken a holiday in quite a while. “It’s difficult, but I’m doing it. I’m trying to lean into the discomfort.” This is so good. I love when people share their “I did a hard thing,” mainly, as I say before, because it doesn’t have to be what’s hard for everybody. It can be what’s hard for you. Isn’t it interesting, Christina is sharing a water slide is so terrifying? Christina, PS, I’m totally with you on that. But some of the people find it thrill-seeking. And then I’m sure the things that Christina does, she might not have anxiety, but other people who love to thrill seek find incredibly terrifying. So, please don’t miss that point, guys. It is such an important thing that we don’t compare. If it’s terrifying, it’s terrifying, and you deserve a massive yay. You did a hard thing for it. So, thank you, Christina.  Again, quickly, let me just quickly do the review of the week, and then we can set back and relax and listen to Andrew’s amazing wisdom. This one is from Anonymous. Actually, this one is from Sydneytenney, and they said: “Incredible resource! What an incredible resource this podcast is! Thank you for sharing all of this information so freely… you’re truly making a difference in so many lives, including mine! (I am also reading through your book and I LOVE it. You nailed it in marrying OCD with self-compassion - what a gift!!!)” So, for those of you who don’t know, I wrote a book called The Self-Compassion Workbook for OCD. If you have OCD and you want a compassionate approach to ERP by all means, head over to Amazon or wherever you buy books and you can have the resource right there.  All right, let’s get over to the show. Kimberley: Okay. Welcome, Andrew Gottworth. Thank you so much for being here. Andrew: Yeah. So, happy to be here. Really excited to chat with you for a bit. Kimberley: Yeah. How fun. I’m so happy you reached out and you had a message that I felt was so important to talk about. Actually, you had lots of ideas that I was so excited to talk about. Andrew: I might bring some of them up because I think, anyway, it’s related to our big topic.  Erp Is For Everyone Kimberley: Yeah. But the thing that I love so much was this idea that ERP (Exposure and Response Prevention) is for everyone. And so, tell me, before we get into that, a little bit about your story and where you are right up until today and why that story is important to you. Andrew: Yeah. So, there’s a lot, as you work in the OCD field that it takes so long between first experiencing to getting a diagnosis. And so, with the knowledge I have now, I probably started in early childhood, elementary school. I remember racing intrusive thoughts in elementary school and being stuck on things and all that. But definitely, middle school, high school got worse and worse. So, fast forward to freshman year of college, it was really building up. I was really having a lot of issues. I didn’t know what it was and really didn’t know what it was for nine, 10 years later. But I was having a really hard time in college. I was depressed. I thought I was suicidal. Learning later, it’s probably suicidal ideation, OCD just putting thoughts of death and jumping up a building and jumping in a lake and getting run over and all that. But I didn’t want to talk about it then, I think. Andrew’s Story About Having Obsessive Compulsive Disorder A bit about me, I come from Kentucky. I count Louisville, Kentucky as the Midwest. We have a bit of an identity crisis, whether we’re South Midwest, East Coast, whatever. But still there, there’s a culture that mental health is for “crazy people.” Of course, we don’t believe that. So, my tiptoe around it was saying, “I’m having trouble focusing in class. Maybe I have ADHD.” And that’s what I went in for. For some reason, that was more palatable for me to talk about that rather than talk about these thoughts of death and all that. And so, I did an intake assessment and thankfully I was somewhat honest and scored high enough on the depression scale that they were like, “Hey, you have a problem.” And so, ended up talking more. So, back in 2009, freshman year of college, I got diagnosed with depression and generalized anxiety disorder, but completely missed the OCD. I think they didn’t know about it. I didn’t know about it. I didn’t have the language to talk about it at the time because I didn’t have hand washing or tapping and counting and these other things that I would maybe see on TV and stuff, which – yeah, I see you nodding – yes, I know that’s a common story.  So, I entered therapy in 2009, and I’ve been in therapy and non-medication ever since. But I had problems. I still had problems. I would make progress for a bit. And then I just feel like I was stuck. So, I ended up being in three mental hospitals. One, when I was doing AmeriCorps up in Milwaukee, Wisconsin, and had a great experience there. Two, three days up there at Rogers, which I’m very grateful for. And then stabilized moving forward. So, I ended up-- I dropped outta college. I dropped out of AmeriCorps. I then went back to college and again went to a mental hospital in Bowling Green, Kentucky. I was at Western Kentucky University, stabilize, keep going. Learning lessons along the way, learning cognitive distortions and learning talk therapy, and all these.  So, let’s keep fast-forwarding. Another mental hospital in Atlanta, Georgia. There’s a long-term outpatient stay, Skyline Trail. I’m thankful for all of these places along the way. And I wish somewhere along the way, I knew about OCD and knew about ERP, our big topic for the day.  So, finally, gosh, I can’t quite remember. I think 2018, a few years ago, still having problems. I had gone from full-time at work to part-time at work. I was just miserable. I would get into my cubicle and just constantly think, I’m not going to make it. I got to go home. I got to find an excuse to get out of here early. I just need to stay sick or I got to go home, or something came up. And so, every day I’d have an excuse until I finally was like, “I’m going to get found out that I’m not working full-time. I’m going to jump the gun, I’ll voluntarily go down in part-time.”  So, that worked for a bit until OCD kept going. And then I quit. I quit again. And at that point, I was like, “I’ve failed. I’ve quit so many things – college, AmeriCorps.” I was a summer camp counselor and I left early. “Now this job. I need something.” So, I went again to find more help. And finally, thankfully, someone did an intake assessment, came back, and said, “Well, one problem is you have OCD.” I was like, “What? No, I don’t have that. I don’t wash my hands. I’m not a messy person. I’m not organized.” Gosh, I’m so thankful for her.  Kimberley: Yeah, I want to kiss this person.  Andrew: Yeah. But here’s the duality of it. She diagnosed me with it. I am forever grateful. And she didn’t do ERP. She didn’t know it. So unbelievably thankful that I got that diagnosis. It changed my life. And then I spent several weeks, maybe a few months just doing talk therapy again. And I just knew something didn’t feel right. But I had this new magical thing, a diagnosis. And so, my OCD latched onto OCD and researched the heck out of it. And so, I was researching, researching, researching, and really starting to find some things like, “Oh, this isn’t working for me. I’ve been doing the same type of therapy for a decade and I’m not making progress.” Unbelievably thankful for the Louisville OCD Clinic. So, at this point in this story-- thanks for listening to the whole saga.  Kimberley: No, I’ve got goosebumps. Andrew: I’m unemployed, I have my diagnosis, but I’m not making any progress. So, I go, “Throw this in as well. Not really that important.” But I go to an intensive outpatient program in Louisville before the OCD clinic. And I remember this conversation of the group therapy leader saying, “I need you to commit to this.” And I said, “But I don’t think this is helping me either,” because the conversation was about relationships, my relationship was great. It was about work, I wasn’t working. It was about parents, my parents were great. They were supporting me financially. They’re super helpful and loving and kind. It’s like, “None of this is external.” I kept saying, “This is internal. I have something going on inside of me.” And she said, “Well, I want you to commit to it.” I said, “I’m sorry, I found a local OCD clinic. I’m going to try them out.”  So, I did IOP, I did 10 straight days, and it is a magical, marvelous memory of mine. I mean, as you know, the weirdest stuff, oh gosh. Some of the highlights that are quite humorous, I had a thing around blood and veins. And so, we built our hierarchy, and maybe we’ll talk about this in a bit, what ERP is. So, built the hierarchy, I’m afraid of cutting my veins and bleeding out. So, let’s start with a knife on the table. And then the next day, the knife in the hand. And then the next day, the knife near my veins. And then we talked about a blood draw. And then the next day, we watched a video of a nurse talking about it. Not even the actual blood draw, but her talking about it. So, of course, my SUDs are up really high. And the nurse says in the video, “Okay, you need to find the juiciest, bumpiest vein, and that’s where you put it in.” And my therapist, pause the video. She said, “Perfect. Andrew, I want you to go around to every person in the office and ask to feel the juiciest, bumpiest veins.” Oh my gosh. Can you imagine?  Kimberley: The imagery and the wording together is so triggering, isn’t it? Andrew: Right. She’s amazing. So, she was hitting on two things for me. One, the blood and veins, and two, inconveniencing people. I hated the inconveniencing people or have awkward moments. Well, hey, it’s doing all three of these things. So, I went around. And of course, it’s an OCD clinic, so nobody’s against it. They’re like, “Sure, here you go. This one looks big. Here, let me pump it up for you.” And I’m like, “No, I don’t like this.” Kimberley: Well, it’s such a shift from what you had been doing.  Andrew: It’s totally different. I’ll speak to the rest because that’s really the big part. But ERP over the next few years gave me my life back. I started working again. I worked full-time. Went part-time, then full-time. Got into a leadership position. And then for a few other reasons, my wife and I decided to make a big jump abroad. And so, moved to Berlin. And I have a full-time job here and a part-time disc golf coach trainer. And now I’m an OCD advocate and excited to work with you on that level and just looking at where my life was four or five years ago versus now. And thanks to our big-ticket item today, ERP. Kimberley: Right. Oh, my heart is so exploding for you. Andrew: Oh, thank you.  Kimberley: My goodness. I mean, it’s not a wonderful story. It’s actually an incredibly painful story. Andrew: You can laugh at it. I told it humorously. How Andrew Applied Erp For His Ocd Kimberley: No. But that’s what I’m saying. That’s what’s so interesting about this, is that it’s such a painful story, but how you tell it-- would I be right in saying like a degree of celebration to it? Tell me a little bit about-- you’re obviously an ERP fan. Tell me a little bit about what that was like. Were you in immediately, or were you skeptical? Had you read enough articles to feel like you were trusting it? What was that like for you? Because you’d been put through the wringer. Andrew: Yeah. There’s a lot to talk about, but there are a couple of key moments when you mention it. So, one, we’re going through the Y-BOCS scale, the Yale-Brown Obsessive Compulsive Scale, something like that. So, she asks me one of the questions like, how often do you feel like a compulsion to do something and you don’t do the compulsion? “Oh, never. I’ve never stopped. But you can do that?” It was just this moment of, “What do you mean?” If it’s hot, I’m going to make it colder. If it’s cold, I’m going to make it warmer. If I’m uncomfortable, I’m going to fidget. I’m a problem solver. Both my parents were math teachers. I was an all-A student and talk about perfectionism and “just right” OCD maybe in this context as well. But also, I love puzzles. I love solving things. And that was me. I was a problem solver. It never occurred to me to not solve the problem. And so, that was a huge aha moment for me. And I see it now and I talk about it now to other people.  Am I Doing Erp “Just Right”? But another part of ERP with the just right is, am I doing ERP right? Am I doing it right? Am I doing ERP right? And of course, my therapist goes, “I don’t know. Who knows? Maybe, maybe not.” So, depending on where you want to go with this, we can talk about that more. So, I think in general, I hated that at the time. I was like, “I know there is a right way to do it. There is. I know there is.” But now, I even told someone yesterday in our Instagram OCD circles, someone was posting about it, and I said exactly that, that I hated this suggestion at first that maybe you’re doing it wrong, maybe you’re not.  I will say, as we talk about ERP for everyone, someone who maybe is going to listen to this or hears us talking on Instagram and wants to do it on their own, this idea of exposing yourself to something uncomfortable and preventing the response – I don’t know if this is wrong, but I will say for me, it was not helpful. In my first few weeks, I would do something like-- I was a little claustrophobic, so I maybe sit in the middle seat of a car. It’s good I’m doing the exposure. I’m preventing the response by staying there. I didn’t get out. But in my head, I’m doing, “Just get through this. Just get through this. I hate this. It’s going to be over soon. You’ll get through it and then you’ll be better. Come on, just get through it. Oh, I hate this. Ugh. Ugh.” And then you get to the end and you go, “Okay, I made it through.” And of course, that didn’t really prevent the response. That reinforced my dread of it. And so, I would say that’s definitely a lesson as we get into that.  Kimberley: And I think that brings me to-- you bring up a couple of amazing points and I think amazing roadblocks that we have to know about ERP. So, often I have clients who’ll say early in treatment, “You’d be so proud I did the exposure.” And I’d be like, “And the RP, did that get included?” So, let’s talk about that. So, for you, you wanted to talk about like ERP is for everyone. So, where did that start for you? Where did that idea come from? Andrew: I would say it’s been slow going over the years where-- I don’t know how to say this exactly, but thinking like, there must be higher than 2% of people that have OCD because I think you have it and I think you have it and I think you have it, and noticing a lot of these things. And so, maybe they’re not clinical level OCD and maybe it’s just anxiety or I think, as I emailed you, just stress. But it’s this-- I just wonder how many friends and family and Instagram connections have never had that aha moment that I did in my first week of IOP of, “Oh, I cannot try to solve this.” And so, I see people that I really care about and I joked with my wife, I said, “Why is it that all of our best friends are anxious people?” And I think that comes with this care and attention and that I’ve suffered and I don’t want anyone else to suffer. And so, I see that anxiety in others. But getting back to what I see in them, maybe someone is socially anxious so they’re avoiding a party or they’re leaving early, or-- I mean, I did these two, avoided, left early, made sure I was in either a very large group where nobody really noticed me or I was in a one-on-one where I had more control. I don’t know. So, seeing that in some other friends, leaving early, I just want to say to them, you can stay. It’s worked for me. It really has. This staying, exposing yourself to the awkwardness of staying or maybe it’s a little too loud or it’s too warm. And then let that stress peak fall and see, well, how do you feel after 30 minutes? How do you feel after an hour? I want to scream that to my friends because it’s helped me so much. I mean, you heard how awful and miserable it was for so long and how much better. I’m not cured, I think. I’m still listening to your six-part rumination series because I think that’s really what I’m working on now.  So, I think those physical things, I’ve made tremendous improvement on blood and veins and all that. But that’s also not why I quit work. I didn’t quit working. I didn’t quit AmeriCorps because there’s so much blood everywhere. No, it’s nonprofits, it’s cubicles. But it was this dread that built this dread of the day, this dread of responding to an email. Am I going to respond right? Oh no, I’m going to get a phone call. Am I going to do that? Am I going to mess this up? And because I didn’t have that response prevention piece, all I had was the exposure piece, then it’s-- I can’t remember who said it, but like, ERP without the RP is just torture. You’re just exposing yourself to all these miserable things.  Kimberley: You’re white-knuckling.  Andrew: Yeah. And it’s-- I love research. I am a scientist by heart. I’m a Physics major and Environmental Studies master’s. I love research and all this. And so, I’ve looked into neuroplasticity, but I also am not an expert. Correct me if I’m wrong, but from what I hear, you’re just reinforcing that neural pathway. So, I’m going into work and I dread it. I’m saying, “I hate this. I can’t wait to go home. I hate this.” So, that’s reinforcing that for the next day. And tomorrow I go in and that dreads bigger, and the next day the dreads bigger.  And so, seeing that in other colleagues who are having a miserable time at work is just getting worse and worse and worse. But I also can see that there are parts they enjoy. They enjoy problem-solving, they enjoy helping students, they enjoy the camaraderie. And so, I want to help them with, well, let’s see how we can do ERP with the things you don’t like and so you’re not building this dread day after day and you can do the things you value. Seems like you value us coworkers, seems like you value helping the students, seems like you value solving this problem, and that’s meaningful. But I’m watching you get more and more deteriorated at work. And that’s hard to do that in others.  ERP Is For Everyone Kimberley: Yeah. I resonate so much from a personal level and I’ll share why, is I have these two young children who-- thankfully, I have a Mental Health degree and I have license, and I’m watching how anxiety is forming them. They’re being formed by society and me and my husband and so forth, but I can see how anxiety is forming them. And there’s so many times-- I’ve used the example before of both my kids separately were absolutely petrified of dogs. And they don’t have OCD, but we used a hierarchy of exposure and now they can play with the neighbor’s dogs. We can have dogs sitting. And it was such an important thing of like, I could have missed that and just said, “You’re fine. Let’s never be around dogs.” And so, it’s so interesting to watch these teeny tiny little humans being formed by like, “Oh, I’m not a dog person.” You are a dog person. You’re just afraid of dogs. It’s two different things. Andrew: Yeah. So, it’s funny that my next-door neighbor, when I was young, had a big dog. And when we’re moving into the house for the very first time, very young, I don’t know, four or something, it ran into the house, knocked me over, afraid of dogs for years. So, same thing. Worked my way up, had a friend with a cute little pup, and then got to a scarier one. And also, funnily to me, my next-door neighbor, two in a row, were German, and they scared me, the scary dog, German. And then the next one was the “Stay off my lawn, don’t let your soccer ball come over.” So, for years, I had this like, “I’m not going to root for Germany in sports. I don’t like Germany.” And then here I am living in Germany now. Kimberley: Like an association. Andrew: Yeah. So, I think fear association, anxiety association. And then I’m also playing around with this idea, maybe do a series on Instagram or maybe another talk with someone about, is it anxiety or is it society? And so, talking about things that were made to feel shame about. So, I don’t know if you can see on our webcam that I have my nails painted. I would never have done this in Kentucky. So, growing up in this, I remember vividly in elementary school, I sat with my legs crossed and someone said, “That’s how a girl sits. You have to sit with your foot up on your leg.” So, I did for the rest of my life. And then I wore a shirt with colorful fish on it, and they said, “Oh, you can’t wear that, guys don’t wear that.” So, I didn’t. I stopped wearing that and all these things, whether it’s about our body shape or femininity or things we enjoy that are maybe dorky or geeky. I just started playing Dungeons and Dragons. We have a campaign next week. And I remember kids getting bullied for that.  I don’t know if you agree, but I see this under the umbrella of ERP. So, you’re exposing yourself to this potential situation where there’s shame or embarrassment, or you might get picked on. Someone might still see these on the train and go, “What are you doing with painted nails?” And I’m going to choose to do that anyway. I still get a little squirmy sometimes, but I want to. I want to do that and I want that for my friends and family too. And I see it in, like you said, in little kids. A lot of my cousins have young kids and just overhearing boys can’t wear pink, or you can’t be that when you grow up, or just these associations where I think you can, I think you can do that. Kimberley: I love this so much because I think you’re so right in why ERP is for everyone. It’s funny, I’ll tell you a story and then I don’t want to talk about me anymore, but-- Andrew: No, I want to hear it. That’s fine. Kimberley: I had this really interesting thing happen the other day. Now I am an ERP therapist. My motto is, “It’s a beautiful day to do hard things.” I talk and breathe this all day, and I have recovered from an eating disorder. But this is how I think it’s so interesting how ERP can be layered too, is I consider myself fully recovered. I am in such good shape and I get triggered and I can recover pretty quick. But the other day, I didn’t realize this was a compulsion that I am still maybe doing. I went to a spa, it was a gift that was given to me, and it says you don’t have to wear your bathing suit right into the thing. So, I’m like, “Cool, that’s fine. I’m comfortable with my body.” But I caught myself running from the bathroom down into the pool, like pretty quickly running until I was like, that still learned behavior, it’s still learned avoidance from something I don’t even suffer from anymore. And I think that, to speak to what you’re saying, if we’re really aware we can-- and I don’t have OCD, I’m open about that. If all humans were really aware, they could catch avoidant behaviors we’re doing all the time that reinforces fear, which is why exposure and response prevention is for everybody. Some people be like, “Oh, no, no. I don’t even have anxiety.” But it’s funny what you can catch in yourself that how you’re running actually literally running.  Andrew: Literally running. Yeah. Kimberley: Away. So, that’s why I think you’ve mentioned how social anxiety shows up and how exposure and response prevention is important for that. And daily fears, societal expectations, that’s why I think that’s so cool. It’s such a cool concept. Andrew: Yeah. And so, help me since I do consider you the expert here, but I’ve heard clinically that ERP can be used for OCD but also eating disorder, at least our clinic in Louisville serves OCD, eating disorder, and PTSD. And so, I see the similarities there of the anxiety cycle, the OCD cycle for each of those. So, then let’s say that’s what ERP is proposed for. But then we also have generalized anxiety and I think we’re seeing that. I’ve heard Jenna Overbaugh talk about that as well. It’s this scale between anxiety to high anxiety to subclinical OCD, to clinical OCD, and that ERP is good for all of that. So, we have those, and then we get into stress and avoidant behavior. So, I have this stressful meeting coming up, I’ll find a way to skip it. Or I have this stressful family event, I’ll find a way to avoid it. And then you get into the societal stuff, you get into these. And so, I see it more and more that yes, it is for everyone. Kimberley: Yeah. No, I mean, clinically, I will say we understand it’s helpful for phobias, health anxiety, social anxiety, generalized anxiety. Under the umbrella of OCD are all these other disorders and, as you said, spectrums of those disorders that it can be beneficial for. And I do think-- I hear actually a lot of other clinicians who aren’t OCD specialists and so forth talking about imposter syndrome or even like how cancel culture has impacted us and how everybody’s self-censoring and avoiding and procrastinating. And I keep thinking like ERP for everybody. And that’s why I think like, again, even if you’re not struggling with a mental illness, imposter syndrome is an avoidant. Often people go, procrastination is an avoidant behavior, a safety behavior or self-censoring is a safety behavior, or not standing up for you to a boss is an opportunity for exposure as long as of course they’re in an environment that’s safe for them. So, I agree with you. I think that it is so widespread an opportunity, and I think it’s also-- this is my opinion, but I’m actually more interested in your opinion, is I think ERP is also a mindset. Andrew: Yeah. Kimberley: Like how you live your life. Are you a face-your-fear kind of person? Can you become that person? That’s what I think, even in you, and actually, this is a question, did your identity shift? Did you think you were a person who couldn’t handle stresses and now you think you are? Or what was the identity shift that you experienced once you started ERP? Andrew: Yeah. That’s a good question. I’ve had a few identity shifts over the years. So, I mentioned-- and not to be conceited, although here I am self-censoring because I don’t want to come across as conceited anyway. So, I was an all-A student in high school, and then OCD and depression hit hard. And so, throughout college, freshman year I got my first B, sophomore year I got my first C, junior year I got my first D. And so, I felt like I was crawling towards graduation. And this identity of myself as Club President, all-A student, I had to come to terms with giving up who I thought I could be. I thought I could be-- people would joke, “You’ll be the mayor of this town someday, Andrew.” And I watched this slip away and I had to change that identity. And not to say that you can’t ever get that back with recovery, but what I will say is through recovery, I don’t have that desire to anymore. I don’t have that desire to be a hundred percent. I’m a big fan of giving 80%. And mayor is too much responsibility. I don’t know, maybe someday. So, that changed.  And then definitely, through that down downturn, I thought, I can’t handle this. I can’t handle anxiety, I can’t handle stress. People are going to find out that this image I’ve built of myself is someone who can’t handle that. So, then comes the dip coming back up, ERP, starting to learn I can maybe but also-- I love to bounce all over the place, but I think I want to return a bit to that idea that you don’t have to fix it. You don’t have to solve the problem. I think that was me. And that’s not realizing that I was making it harder on myself, that every moment of the day I was trying to optimize, fix, problem-solve.  If you allow me another detour, I got on early to make sure the video chat was working, sound was okay. And I noticed in my walk over to my computer, all the things my brain wanted me to do. I call my brain “Dolores” after Dolores Umbridge, which is very mean to me. My wife and I, Dolores can F off. But I checked my email to make sure I had the date right. Oops, no, the checking behavior. Check the time, making sure, because we’re nine hours apart right now. “Oh, did I get the time difference right?” I thought about bringing over an extra set of lights so you could see me better. I wanted to make sure I didn’t eat right before we talked, so I didn’t burp on camera, made sure I had my water, and it was just all these-- and if I wasn’t about to meet with an OCD expert, I wouldn’t have even noticed these. I wouldn’t have even noticed all of these checking, fidgeting, optimizing, best practicing. But it’s exhausting.  And so, I’m going to maybe flip the script and ask you, how do you think other people that are not diagnosed with OCD, that are just dealing with anxiety and stress can notice these situations in their life? How do they notice when, “Oh, I’m doing an avoidant behavior,” or “I’m fixing something to fix my anxiety that gives me temporary relief”? Because I didn’t notice them for 10 years. Kimberley: Yeah. Well, I think the question speaks to me as a therapist, but also me as a human. I catch every day how generalized anxiety wants to take me and grab me away. And so, I think a huge piece of it is knowledge, of course. It’s knowledge that that-- but it’s a lot to do with awareness. It’s so much to do with awareness. I’ll give you an example, and I’ve spoken about this before. As soon as I’m anxious, everything I do speeds up. I start walking faster, I start typing faster, I start talking faster. And there’s no amount of exposure that will, I think, prevent me from going into that immediate behavior. So, my focus is staying-- every day, I have my mindfulness book right next to me. It’s like this thick, and I look at it and I go, “Okay, be aware as you go into the day.” And then I can work at catching as I start to speed up and speed type.  So, I think for the person who doesn’t have OCD, it is, first, like you said, education. They need to be aware, how is this impacting my life. I think it’s being aware of and catching it. And then the cool part, and this is the part I love the most about being a therapist, is I get to ask them, what do you want to do? Because you don’t have to change it. I’m not doing any harm by typing fast. In fact, some might say I’m getting more done, but I don’t like the way it makes me feel. And so, I get to ask myself a question, do I want to change this behavior? Is it serving me anymore? And everyone gets to ask them that solves that question. Andrew: So, I think you bring up a good point though that I’m curious if you’ve heard this as well. So, you said you’re typing fast and you’re feeling anxious and you don’t like how that feels. I would say for me, and I can think of certain people in my life and also generally, they don’t realize those are connected. I didn’t realize that was connected. In college, I’m wanting to drop out, I drop out of AmeriCorps, I drop out of summer camp. I’m very, very anxious and miserable and I don’t know why. And looking back, I see it was this constant trying to fix things and being on alert. And I got to anticipate what this is going to be or else is going to go bad. I need to prevent this or else I’m going to have an anxious conversation. I need to only wear shorts in the winter because I might get hot. Oh no, what if I get hot? And it was constantly being in this scanning fear mindset of trying to avoid, trying to prevent, trying to-- thinking I was doing all these good things. And I saw myself as a best-practice problem solver. It’s still something I’m trying to now separate between Dolores and Andrew. Andrew still loves best practices. But if I spend two hours looking for a best practice when I could have done it in five minutes, then maybe that was a waste. And I didn’t realize that was giving me that anxiety.  So, yeah, I guess going back to I think of family, I think of coworkers, I think of friends that I have a suspicion, I’m not a therapist, I can’t diagnose and I’m not going to go up, I think you have this. But seeing that they’re coming to me and saying, “I’m exhausted. I just have so much going on,” I think in their head, it’s “I have a lot of work.” Kimberley: External problems. Andrew: Yeah. I may be seeing-- yeah, but there’s all this tension. You’re holding it in your shoulders, you’re holding it here, you’re typing fast and not realizing that, oh, these are connected.  Kimberley: And that’s that awareness piece. It’s an awareness piece so much. And it is true. I mean, I think that’s the benefit of therapy. Therapists are trained to ask questions so that you can become aware of things that you weren’t previously aware of. I go to therapy and sometimes even my therapist will be like, “I got a question for you.” And I’m like, “Ah, I missed that.” So, I think that that’s the beauty of this.  Andrew: I had a fun conversation. I gave a mental health talk at my school and talked about anxiety in the classroom, and thanks to IOCDF for some resources there, there’s a student that wanted to do a follow-up. And I thought this was very interesting and I loved the conversation, but three or four times he was like, “Well, can I read some self-help books, and then if those don’t work, go to therapy?” “No, I think go to therapy right away. Big fan of therapists. I’m not a therapist. You need to talk to a therapist.” “Okay. But what if I did some podcasts and then if that didn’t work, then I go to therapy?” “Nope. Therapy is great. Go to therapy now.” “Should I wait till my life gets more stressful?” “Nope. Go now.” Kimberley: Yeah, because it’s that reflection and questioning. Everyone who knows me knows I love questions. They’re my favorite. So, I think you’re on it. So, this is so good. I also want to be respectful of your time. So, quick rounded out, why is ERP for everybody, in your opinion? Andrew: How do we put this with a nice bow on it?  Kimberley: It doesn’t have to be perfect. Let’s make it purposely imperfect. Andrew: Let’s make it perfectly imperfect. So, we talked before about the clinical levels – OCD, eating disorder, PTSD, generalized anxiety disorder. If you have any of those, take it from me personally, take it from you, take it from the thousands of people that said, “Hey, actually, ERP is an evidence-based gold standard. We know it works, we’ve seen it work. It’s helped us. Let it help you because we care about you and we want you to do it.” And then moving down stress from work, from life. You have a big trip coming up. There’s a fun scale, home’s rocky, something stress inventory. I find it very interesting that some of them are positive, outstanding personal achievement like, “Oh, that’s a stressful thing?” “Yeah, It can be.” And so, noticing the stressful things in your life and saying, “Well, because of these stressful things are the things I’m avoiding, things I’m getting anxious about, can I learn to sit with that?” And I think that mindfulness piece is so important.  So, whether you’re clinical, whether you’re subclinical, whether you have stress in your life, whether you’re just avoiding something uncomfortable, slightly uncomfortable, is that keeping you from something you want to do? Is that keeping you-- of course, we-- I don’t know if people roll their eyes at people like us, “Follow your values, talk about your values.” Do you value spending time with your friends, but you’re avoiding the social gathering? Sounds like ERP could help you out with that. Or you’re avoiding this, you want to get a certification, but you don’t think you’ll get it and you don’t want to spend the time? Sounds like ERP could help with that. We’re in the sports field. My wife and I rock climbing, bouldering, disc golf. You value the sport, but you’re embarrassed to do poorly around your friends? Sounds ERP can help with that. You value this thing. I think we have a solution. I’ve become almost evangelical about it. Look at this thing, it works so well. It’s done so much for me. Kimberley: Love it. Okay, tell me where-- I’m going to leave it at that. Tell me where people can hear about you and get in touch with you and hear more about your work. Andrew: Mainly through Instagram at the moment. I have a perfectly imperfect Instagram name that you might have to put down. It’s JustRught but with right spelled wrong. So, it’s R-U-G-H-T. Kimberley: That is perfect. Andrew: Yeah. Which also perfectly was a complete accident. It was just fat thumbs typing out my new account and I said, “You know what, Andrew, leave it. This works. This works just fine.” Kimberley: Oh, it is so good. It is so good. Andrew: Yeah. So, I’m also happy I mentioned to you earlier that my wife and I have started this cool collab where I take some of her art and some of the lessons I’ve learned in my 12-plus years of therapy and we mix them together and try to put some lessons out there. But I’m currently an OCD advocate as well. You can find me on IOCDF’s website or just reach out. But really excited to be doing this work with you. I really respect and admire your work and to get a little gushing embarrassed. When I found out that I got accepted from grassroots advocate to regular advocate, I said, “Guys, Kimberley Quinlan is at the same level as me.” I was so excited. Kimberley: You’re so many levels above me. Just look at your story. That’s the work. Andrew: The imposter syndrome, we talked about that earlier. <!-- /wp:paragraph --> <!-- wp:paragraph --> Kimberley: Yeah, for sure. No, I am just overwhelmed with joy to hear your story, and thank you. How cool. Again, the reason I love the interviews is I pretty much have goosebumps the entire time. It just is so wonderful to hear the ups and the downs and the reality and the lessons. It’s so beautiful. So, thank you so much. <!-- /wp:paragraph --> <!-- wp:paragraph --> Andrew: I will add in, if you allow me a little more time, that it’s not magic. We’re not saying, “Oh, go do ERP for two days and you’ll be great.” It’s hard work. It’s a good day to do hard things. I think if it was easy, we wouldn’t be talking about it so much. We wouldn’t talk about the nuance. So, I think go into it knowing it is work, but it is absolutely worth it. It’s given me my life back, it’s saved my relationships, it’s helped me move overseas, given me this opportunity, and I’m just so thankful for it. <!-- /wp:paragraph --> <!-- wp:paragraph --> Kimberley: Yeah. Oh, mic drop. <!-- /wp:paragraph --> <!-- wp:paragraph --> Andrew: Yeah. <!-- /wp:paragraph --> <!-- wp:paragraph --> Kimberley: Thank you again. <!-- /wp:paragraph -->

SUMMARY:  In This Episode: What to do what your chronic illness causes anxiety  The Difference between POTS and anxiety.  How to manage POTS related anxiety  What is an “Adrenaline Surge”?  The Treatment for POTS and Anxiety  POTS AWARENESS MONTH Links To Things I Talk About http://www.dysautonomiainternational.org/page.php?ID=30 Overcoming Anxiety and Panic https://www.cbtschool.com/overcominganxiety ERP School: https://www.cbtschool.com/erp-school-lp Episode Sponsor: This episode of Your Anxiety Toolkit is brought to you by CBTschool.com.  CBTschool.com is a psychoeducation platform that provides courses and other online resources for people with anxiety, OCD, and Body-Focused Repetitive Behaviors.  Go to cbtschool.com to learn more.  Spread the love! Everyone needs tools for anxiety... If you like Your Anxiety Toolkit Podcast, visit YOUR ANXIETY TOOLKIT PODCAST to subscribe free and you'll never miss an episode. And if you really like Your Anxiety Toolkit, I'd appreciate you telling a friend (maybe even two). EPISODE TRANSCRIPTION This is Your Anxiety Toolkit - Episode 307.  Welcome back, everybody. I am so thrilled to be here with you today. As most of you may know, it is OCD Awareness Month or Awareness Week. It’s just passed, and that’s something I’m so passionate about advocating for. But in addition to that, it’s also Postural Orthostatic Tachycardic Syndrome Awareness Month. For those of you who don’t know, I suffer from postural orthostatic tachycardic syndrome. We call it POTS for short. I’ve had multiple people ask me to do an episode about when chronic illnesses cause anxiety, and I thought this is probably the best week to do it. Not only is it awareness week or awareness month for POTS, but I actually have had a little blip in my own recovery in my POTS. So, I wanted to share with you my story and share with you how I’m handling the anxiety and health anxiety and stress and grief of that, and also just address some tools that have worked for me and that I’m hoping will work for you as well. If you have a chronic illness or even if you don’t, I think that these are really core skills that we need to practice just in regards of managing daily stress as well.  You know what, before we do that, let’s go and do the “I did a hard thing” because this one is actually really touching and I would really like to feature. This was actually an email we received. I love getting your emails. If you guys are not on our newsletter list, please do go and sign up for our newsletter. We do give you access to the whole series. I created a whole website for the six-part mental compulsion series. It will be private just for people who sign up for the newsletter, and it’s got some amazing additional resources, PDFs, links that you really should check out. So, if you want to sign up for that, head on over to CBTSchool.com and you can sign up for our newsletter.  This person said: “I took a big leap of leaving my family and moving to China on my own.” Now, I totally resonate with this because I am in America on my own, even though I have my family. Leaving your home country is a big deal. It’s a huge deal. They go on to say, “The only thing, I haven’t been home to see my family in over three years, and I’ve been struggling so much. We hadn’t had a holiday in over two years, and I had been stuck in our complex for months. It was really, really hard. We finally were allowed out of our city, so we decided to go to Yunnan Province.” Hopefully, I pronounce that okay. “I was so worried that my OCD would come in hard and stop me from enjoying this amazing holiday we had planned for. I was strong and I did the hard things, thanks to you. I did a six-day hike at the start of the Himalayas, and I’m like, ‘Holy moly, that is amazing.’ I got engaged on Tiger Leaping Gorge. I ran down a bear and wolf-infested forest, and I slept in a tiny house next to pigs and cows.” What an adventure. “Kimberley, thank you. You have given me strength I needed. You are my inspiration.” This is what I mean by why I love the “I did a hard thing” because sometimes the hard thing is getting out of bed. Sometimes the hard thing is facing a fear that you know is in your daily life. But sometimes your fear is like living a life according to your values and doing some pretty huge, openhearted things. And so, I absolutely love this “I did a hard thing.” Thank you so much, Leanne, for submitting this because there was something about it that just made me giggle like, holy moly, you really packed in some adventure into a short period of time, and well-deserved after being in a complex for so many months and years. Thank you so much for leaving that here in my inbox.  Real quick, let’s do the review of the week so that we can head on over. This one is from Young Math Mama and they said: “BEST podcast for a daily mindset reset. This podcast was recommended to me by my therapist, and it is one of my favorite ‘homework assignments’ to help me have a good mindset and feel inspired to try my best. I’ve learned so much great information from Kimberley, but the most important thing, in my opinion, is that I feel motivated to improve one small thing every time I listen. I’m taking better care of myself, which helps me take better care of my family.” Literally, Young Math Mama, that is the absolute goal of this. I consider myself part therapist and part coach. I do a lot of coaching in my work and hopefully, I inspire you and motivate you all as well. Thank you so much, Young Math Mama, for submitting, and also Leanna.  Update On My Pots/Chronic Illness Okay, so let me give you a little background here. I haven’t shared this with you because I actually didn’t feel it was appropriate at the time for me to share, but I will share it now. As you guys know, I did a whole podcast about health anxiety, and this whole shocking episode where I had to get my teeth removed, one of my teeth got pulled out. Interestingly, since I had that infection in my tooth and I had it removed, almost all of my POTS symptoms went away. And the reason I didn’t want to share that, which is strange in hindsight why I wouldn’t want to share that, is number one, I wasn’t convinced it was long-term. Number two, I was really concerned that saying that would be really disheartening to some people who are still really struggling. Number three, I was a little worried. I had a bit of a placebo effect if I’m not going to lie. The doctor said it could actually help my POTS and then when it did, I was a little bit like, “Oh, is this the placebo?” I was just waiting for the shoe to drop, which is really not good practice. I wish actually now in hindsight I didn’t do that, but that is the way it played out.  I have actually had an almost full remission. I do have some bad days. I do have some bad blood pressure days. But I was able to stand for the first time in many years. What I mean by “stand” is the day that I actually realized that I was in recovery from that. In the mornings, I always fill up my kids’ drink bottles and we have one of those filters in the fridge. And usually, it takes probably like 45 seconds, maybe a minute to fill up a drink bottle. But because I can’t stand up for very long or I get really dizzy and I can faint, it usually takes me two goes to fill up a drink bottle. I would fill it up for maybe 20 seconds, then I would go sit down just for a minute or two. I could feel myself get less dizzy and then I would go to do it again.  You Must Find Rhythms I have found a rhythm in my life, that’s how debilitating it is. But I had found these rhythms and routines in my life to where I could still fill up my kids’ drink bottles and no one needed to know that I was dizzy. I had found routines to mask it and I’d found routines so I could get through the day. And then I started to notice, oh my God, I’m halfway through filling up the drink bottle and I don’t need to sit down. I could actually fill this whole drink bottle without feeling really dizzy and nauseous, which to you might seem like an easy part of the day, but to me, that’s just a luxury I didn’t have for two years. So, I’ve been so thrilled and so overjoyed and actually really protective of my body because I’m like, “Oh my gosh, I’m in recovery. I’m really doing so well.”  And then really why the “I did a hard thing” segment resonated with me is because when I came back from Australia, I was so happy and just my heart was so full and we hit the ground running. We really hit the ground running. My daughter started middle school, my son started second grade. They’re in two different schools now. My husband had gone back to another job. We’d just had some house remodeling done. The house was a disaster. We’d had a couple of other stressful events happen. About three weeks ago, I had gotten some really scary news about a loved one. I remember sitting on the couch and just being overwhelmed with anxiety. A massive cortisol, adrenaline surge just went through my body because I was really worried the lasted several days and then I didn’t sleep very well for a few days and then I stopped exercising as much as I was and probably didn’t drink enough water, which is all these things are really important if you have POTS. And I had also not kept up with how much salt I need to eat. I need to eat the most disgusting degrees of salt. It’s a common treatment for POTS. Most people are encouraged not to eat a lot of salt. People with POTS usually have to eat an immense amount of salt.  My Pots Relapse Unfortunately, I just started to have all of my symptoms returned. All of them I can manage, but the one that I’m struggling with the most is what they call an “adrenaline surge.” It’s common for people who have POTS. It just feels like you’re having a panic attack, but you’re not having a panic attack. You’re not worried about anything. I think that all of the stress and me loosening my recovery treatment is what caused it. But all of a sudden, I remember I woke up at three in the morning and I thought I was having a panic attack, but it was, now I understand, an adrenaline surge. It was just like someone had injected me with adrenaline and cortisol. At that time, I was like, “This makes sense. We’ve just had a couple of some scary things happen and life is pretty stressful. I’m obviously having a panic attack.” So, first I want to teach you or show you or demonstrate to you that even though I had woken up in the middle of the night with a panic attack, I used every single one of my tools. I was like, “All right, brain, thank you for waking me up and bringing this to my attention in the middle of the night. There is nothing I can do about it right now. I’m just going to let you be there and we’re going to lay here until you’re ready to leave. You don’t have to leave if you don’t want to.” It took about two hours, three hours, which is pretty long and strange. I was like, “This is a bit strange.”  When Your Chronic Illness Causes Anxiety & Panic But then the next night, again, all day feeling anxious, on edge, but also using all my tools. Like, “It’s cool, anxiety can come along, no big deal, I’m cool with it” kind of thing. And then next night, wake up in the middle of the night at 11 o’clock because I go to bed pretty early. 11:00 PM, massive panic, adrenaline surge. Oh my gosh. Okay, now what? I get up and I’m like, “Something is up. I’m obviously struggling.” I do what an average person would do, would be like look around and be like, “What’s going on with me? Is there something really anxiety-provoking that’s going on? Should I be worrying about something? Is this a sign?” And then I was like, “No, no, no, I’m going to use my tools.” This happened for several days until I realized this actually could be just generalized anxiety because I do struggle sometimes with generalized anxiety, but I actually think this is a part of my POTS. So, I did some research and spoke to a doctor and yes, it is in fact a part of my POTS symptoms and it’s one that I didn’t have before.  But the reason I’m sharing this with you today is, this is actually so common for people with chronic illnesses. If you have a chronic illness, there are these weird things that happen to your body and then it’s so easy just to chalk it up as like, “Oh, I’m having a panic attack,” or “I’m having anxiety.” And then you start panicking and having anxiety. If you’re not careful, you’ll start to do hypervigilant behaviors and avoidant behaviors and mental compulsions, and then it’s a full-blown anxiety disorder.  Pots And Anxiety: The Dreaded Adrenaline Surge If there’s one thing I have learned from having a chronic illness is to be so skilled with physical sensations that show up in my body because it can seem so similar to anxiety – dizziness, lightheadedness, agitation, feeling like you’re going to faint. These are all symptoms of POTS, but they’re also symptoms of anxiety. POTS and Anxiety can feel almost exactly the same. So, I’ve had to become very, very skilled. And I use the word “skilled” because this is not an innate thing I know. I had to practice what I preach and I had to be very objective, not subjective about what’s going on, and go, “Okay, you’re having dizziness. It could mean that you’re going to faint, but it also could mean you’re anxious.” So, let’s actually be really skilled in how we respond to this. Or you’re having a panic attack. In this case, you’re having a massive adrenaline surge is what they call it in the POTS world. You’re having this adrenaline surge, it could be a panic attack and it could be your POTS. Let’s work at being very logical and wise in our response to it. Let’s not be responding to it as if it’s a catastrophe or that there’s actually danger.  This has been so key for me. What I have found, and this is literally as we speak this week and I can say to you as we speak right now, I actually am having a massive adrenaline surge as we speak. It is so easy to interpret it as something is wrong, there must be danger, we’ve got to get out of here. But I’m working at just allowing it to be there and going, “Thank you, brain, for setting off this alarm. I understand. I’m going to allow it to be there.” The reason I’m sharing this with you and the reason I actually had scheduled to do this recording tomorrow, but today’s the perfect day to do it because I’m actually in quite a lot of suffering right now. It’s pretty painful. It’s pretty uncomfortable. I’m at like an eight 8 of 10 anxiety level, maybe even a 9 depending on where I’m at. I’m just actually going to go about my day. As I speak to you, I’m actually in a pretty big degree of suffering and I just want to be completely real with you. The reason, again, that I wanted to record this today is I was getting ready for work and I started to notice, I was putting all these black clothes on because I don’t feel so great. And I was like, “Wait a second, this is how invasive this can be in that I’m actually choosing black clothes. Not that there’s anything wrong with black clothes, but I’m choosing it because my body feels so uncomfortable. What could I do right now to fully embrace joy, fully just embrace the fact that it’s here?”  Choosing Your Values I have this bright, yellow dress that’s like a full circle dress. If you did a spin, it would go into a full circle and I love this skirt. I was like, you know what? I’m going to wear my yellow skirt today. Today is a perfect day to wear my yellow skirt, even though my body is having a massive reaction. My body is obviously in some kind of response to something, chronic illness-wise, and my body wants me to panic. My body wants me to be hypervigilant. My body and my brain want me to tighten up my whole body. But I’m going to put on this yellow skirt and I’m going to sit down with my friends, you guys, and I’m going to talk about this thing that I have to handle.  As I’m sharing about this, I’m just going to pause here for a second because it brings me to tears. I’m in a lot of pain emotionally. But in that pain, if you could see me right now, I actually have a huge smile on my face because I am so grateful that I gave myself the opportunity to practice these skills because they are actually reducing how much suffering I could have. I remember when I first had these symptoms that I did go into hypervigilance and panic because I was like, “Something is seriously wrong. Something is really wrong. We have to fix it. We’ve got to go to the emergency room.” And now I have these skills to where I’m not actually increasing my suffering by doing all of those compulsive behaviors. And that is key when you have a chronic illness.  Treatment For Pots And Anxiety (and other chronic illnesses) All the research I have done shows that having a chronic illness requires medical attention and therapy. Cognitive behavioral therapy, I did a whole bunch of research in prep for this, a whole bunch of research. If you have POTS, they recommend cognitive behavioral therapy. That’s because along with having a chronic illness comes anxiety and depression and other emotions. Along with having other chronic illnesses comes anxiety and depression, diabetes, Crohn’s disease, celiac disease. It could be even just having a chronic illness of having a disorder. A mental health disorder also creates a lot of anxiety in your life. This is key. I’m just so grateful that I have the ability to practice these skills and the ability to just sit in the mud. I am just sitting in the mud today. That’s what I’m doing. I’m so grateful that I have those skills and I really want to teach you guys those skills by modeling to you today. So, let’s break it down.  When you have anxiety, whether it’s in association to a chronic illness or it’s just regular anxiety, what I’m going to encourage you to do is do nothing at all. It’s actually quite easy when you think about it, but it’s actually really hard at the same time, is to do nothing at all different. Today, I am going about my day. I am going to allow my heart rate to go through my chest and beat so hard. I’m going to allow that lightheaded, blood pressure issue that I’m having to be there. I’m going to allow the dizziness to be there. I’m going to allow the raising thoughts to be there. I’m going to still show up in my yellow skirt. If I spin in a circle, it would be a full spinning circle. It would be so beautiful. And I’m going to keep my heart open. If you could see me right now, I’m not hunched up. My hands are soft, my cheeks are soft, my heart is open, my shoulders are dropped. I’m just here for it. I’m allowing it. Is it hard? Yes, it is painful as. Is it exhausting? Yes. Every night this week I’ve been going to bed at seven o’clock and just resting my body because I’m working really, really hard. And my body is exhausted because it’s pumping adrenaline all day long. These are some ideas I want you to implement into your life if you can. And a lot of it, one thing, of course, I didn’t discuss because it’s just such a part of my practices, I’m also really gentle with myself. Like, “Yeah, Kim, this is rough.” I use the word “suffering.” You even heard me use it. “This is a lot of suffering for you right now, hun. You deserve to go to bed a little early and it’s okay if you don’t show up perfect and you might drop some balls. Yeah, that’s okay.” That’s the main point.  Pots Awareness Month  What I will say at the end here is please-- you’re probably hearing some of this and going, “Oh my gosh, maybe I have POTS.” I really want to make sure you know the difference. Given that it’s POTS Awareness Month, postural orthostatic tachycardic syndrome is not an anxiety disorder. It is a disorder of the autonomic nervous system. It does mean that when you stand up, there is changes in your heart rate and in your blood pressure that cause you to faint. Lots of people with POTS can’t stand up at all. So, I’m so grateful for the fact that I can stand up, even though it takes me two goes to fill up a drink bottle. I can stand up better than a lot of people who have postural orthostatic tachycardic syndrome. I can walk. I can exercise. I’ve been building up my exercise routine according to the POTS exercise program.  Difference Between Anxiety And Pots  It’s important for you to understand that just having these anxiety symptoms doesn’t mean you have POTS. If you are fainting and you are actually having a really difficult time with nausea and multiple different autonomic nervous system issues, well then definitely go see your doctor and share with them your symptoms. If they think that you are a candidate for maybe getting tested for POTS, the type of test you would need is called a tilt table test. It is usually administered by a cardiologist or a cardiologist nurse. It’s a horrible test, and if you have POTS, it will be very painful and very difficult. But basically, it’s where they put you on a table and then the table tilts up really fast, and then you’re connected to all these cardio nodes, I guess, all over your body and they’re got a blood pressure machine and some people even faint during the test. They raise you and then they drop you down flat and then they raise you and they drop you down flat and they’re monitoring whether there’s shifts in your heart rate and blood pressure. And that is the test that will get you diagnosed for POTS based on whether you meet criteria. It’s a very unpleasant test if you have POTS because it does induce fainting for a lot of people or a severe amount of nausea for a lot of people. But if you are concerned, you can reach out to your doctor and see if you meet the criteria to get that test.  That’s it. I wanted to share with you what it’s like to have POTS and to share my ups and downs with having POTS. Also, one thing I will say, if you don’t mind and you want to stay with me just for a few more minutes, is having a chronic illness is also a very anxious experience. You never know whether you’re going to have a good day or a bad day. You never know what your symptoms are going to be. For me, I’ve actually been very blessed and the treatments have helped me a lot. For some people they don’t, but for some people, they can’t guarantee they can show up for work tomorrow. They can’t guarantee they can take their kids to the park. They just don’t know. It depends on the day and it depends on their body. So, there’s so much uncertainty with what your body will do and how your body will react. That in and of itself creates a lot of anxiety and uncertainty and it can be very, very depressing.  For those of you who have severe POTS, they can’t play with their kids. They can’t stand up long enough to run in the park. It can be very, very debilitating. So, if you have a chronic illness and you have anxiety and depression, that doesn’t mean there’s something wrong with you. It actually means it’s a normal natural part of having a chronic illness. I wanted to really make sure I advocated for that because some people think if you have a medical problem, it’s just a medical problem. But often medical problems create mental health problems and we have to look at the whole human. Even though I’m an OCD and Anxiety Specialist, I’m still going to admit to you guys, it still creates anxiety for me. I handle it pretty well, but some days I don’t. Some days I’m very sad about it and have a lot of grief and a lot of anger and a lot of frustration around it and sometimes even jealousy. Just jealous. I wish I could A, B, and C. I’ll tell you one story. There’s a person on social media and they constantly do their posts while they’re standing at a computer desk. Even just looking at her stand at a computer desk, she’s got one of those standing desks, I have so much envy because I’m like, “I could never ever do that.” Never ever do that unless somebody-- I don’t know. I didn’t even know how I would do it, but-- yeah, a lot of emotions show up.  All right. So, that’s it for today. I wanted to share with you a whole little update on what happens when your chronic illness causes anxiety. I wanted to highlight that it’s Postural Orthostatic Tachycardic Syndrome Week or Awareness Week. Actually, I think it’s Awareness Month. I hopefully inspired you to lean into your fear and not give it all the power because you’re actually stronger than your anxiety.  All right. Thank you so much for listening. I know it may have been a bit of a rambling episode, but hopefully, you took a few pieces away from it. I really, really appreciate you checking in. Please do go and leave a review. It is the best gift you can give me because it does allow me to then get trust of other people who are new coming to the podcast, and then we can help some more people.  Take care and I will talk to you soon.

In This Episode: The difference between Reassurance seeking vs. holding in emotions Why Reassurance seeking OCD is problematic and keeps you stuch What tools you can use to help you manage emotions with OCD Links To Things I Talk About: ERP School: https://www.cbtschool.com/erp-school-lp https://kimberleyquinlan-lmft.com/32-reduce-reassurance-seeking-behaviorscompulsions/ Newsletter https://www.cbtschool.com/newsletter Chatter Book:https://www.amazon.com/Chatter-Voice-Head-Matters-Harness/dp/0525575235 Episode Sponsor:This episode of Your Anxiety Toolkit is brought to you by CBTschool.com.  CBTschool.com is a psychoeducation platform that provides courses and other online resources for people with anxiety, OCD, and Body-Focused Repetitive Behaviors.  Go to cbtschool.com to learn more. Spread the love! Everyone needs tools for anxiety...If you like Your Anxiety Toolkit Podcast, visit YOUR ANXIETY TOOLKIT PODCAST to subscribe free and you'll never miss an episode. And if you really like Your Anxiety Toolkit, I'd appreciate you telling a friend (maybe even two). EPISODE TRANSCRIPTION This is Your Anxiety Toolkit - Episode 306. Welcome back, everybody. We are well and truly into OCD Awareness Week, and I have been so excited to be a part of some amazing awareness projects, being an advocate for the International OCD Foundation, doing a lot of social media on self-compassion this week. It’s been such a treat. This week, I actually wanted to discuss a concept that I-- actually, I say this often these days, but I get asked this question a lot in some various forms by my clients, so I wanted to address this question that I got with you. This is actually a question from one of the people in ERP School, which is our online course for OCD. If you click the link here in the bio or you can go to CBTSchool.com, we have a course called ERP School where we teach, or I teach step by steps that I take with my patients on how to set up an ERP plan so that you can slowly face your fear and reduce your compulsions and take your life back from OCD. Reassurance Vs Holding In Emotions One of the members asked a question, and there’s a whole portal in there where you can ask questions to me directly, and they asked: “I have a question to you regarding reassurance seeking.” They said, “I’ve been trying to stop doing my compulsions and my go-to is reassurance seeking.” “What is the difference between Reassurance vs holding in emotions?” Reassurance Seeking OCD Reassurance seeking is a type of compulsion where you usually go to Google or you go to a loved one or another person and you ask for reassurance on your fear or your uncertainty. They go on to say, “One thing I do understand about is why it’s bad and how it keeps the cycle going.” So, they do understand that reassurance seeking OCD is a problem. They do understand how it keeps the OCD cycle going. We talk a lot in ERP School about this OCD cycle. It’s a huge component of the treatment. We have to first understand the cycle so that we can then know how to stop the cycle. And they go on to say, “I know that I have to learn to rely on myself to manage my anxiety and seeking reassurance makes me dependent on others for my relief, which can increase my anxiety when they’re not around. But I’ve always been told by friends and family that talking about things that are bothering you is healthy because that way you get it out as opposed to bottling it in. When I don’t seek reassurance, I worry that I’m bottling it in and that the only way to feel better is to let it out by talking to others. How do I join these two seemingly healthy ideas?” This is such a core component of all the work that we do. And so, I really want to go deep into this with you here in just a sec. Now, before we move on, if you aren’t quite sure about reassurance seeking yet, you can go back and listen to a previous podcast we did, Number 32, which is called How to Reduce Reassurance Seeking Behaviors. It’s an amazing podcast episode that really goes deep into what is a reassurance compulsion. You can click that there. But let’s talk more about this specific question. Before we do that, let’s quickly do the review of the week. This is from Isha.Isha and they said: “An invaluable resource. I have read many books on anxiety and OCD, and yet I am continuously surprised to learn new things with this podcast. It is thought-provoking and brings forward new, helpful, and interesting content.” She went on to say: “Kimberly, your 6 Part series on Mental Compulsions has truly been life-changing for me. Despite reading dozens of books on OCD and Anxiety, including yours, I was astounded to realize how many mental compulsions I actually have. The approaches to dealing with them, suggested by a few of the guests (thank you, Hershfield, Nicely, and Reid), have been nothing short of miraculous for me. Thank you for your hard work here! It is deeply appreciated!” Again, you guys, if you go to CBT School and you sign up for our newsletter, you will be given a gift from me, which is a link where I have put all of those six-part mental compulsion audio files together and we’ve thrown in a whole bunch of PDFs that will help you really strategize your own way of managing mental compulsions. So, go sign up for the newsletter. If you go to CBTSchool.com, you’ll be able to get access to it there. And then one more thing before we move on, let’s quickly do the “I did a hard thing” segment. It sounds like this person who asked the question is doing hard things too, but this one was so fun, I wanted to share it with you. Anonymous says: “Having OCD has made wedding planning and the wedding process in general challenging for me. But this weekend, I made it to my bridal shower and I had the best time, even despite my OCD being along for the ride. I actually took the day as an opportunity to face the disorder head-on. I left feeling empowered as F***.” Amazing, Anonymous. I’m so happy and congratulations on your bridal shower. I hope you had the most incredible time. All right, so let’s look at this question. Let’s break it down. Okay. So, yes, this person has already shared they understand that reassurance-seeking keeps us in the OCD cycle, keeps the fear going strong, and only makes more problems. It makes problems for the person with OCD, but it also impacts the relationship. In fact, I would go as far as to say, those who engage in reassurance-seeking behaviors tend to have a bigger impact on their family members because they’re constantly going to their family members saying, “Would this happen? Could it happen? Do you think it could happen? What would happen?” And that person, because they’re not trained as a clinician, they don’t know how to respond. They haven’t been trained. Usually, they try many different ideas and it actually ends up making the person with OCD even more confused. And then that can create conflict in the relationship. We know this. We know that reassurance-seeking can be very, very problematic and we want to slowly reduce it. It sounds like this person is doing amazing work, but they’ve got this dilemma in saying, “But I thought I was supposed to let things out.” Let’s take a look here. Managing emotions with OCD When you have an obsession, naturally, your instincts are, “How can I make this fear go away or this discomfort or feeling go away?” You’re going to want to do a compulsion. The goal of ERP is to reduce those compulsions. So, now what are you doing? So, you’re reducing the compulsion, you’re not trying to get reassurance, and now you’re handling a large degree of anxiety and stress. Yeah, that’s true. You will have to rise and fall in discomfort. Absolutely. We know that that’s a part of the work. Willingly, ride the wave of discomfort. So, what I want to say to you here is you have some choices. You could ride that wave on your own. Let it go high, let it go low, let it go up and down, do what it wants, and you can practice actually allowing that discomfort and really building a resilience to that as you go. Similar to what Anonymous said in “I did a hard thing” is they left feeling empowered. When we do it on our own, we can actually feel incredibly empowered. Now, that is one option. That doesn’t mean to say that when things are really hard, naturally, we do want connection. That’s what human beings want. So, sometimes we do want to go to our loved one and say, “I’m having a hard time.” But there’s a really big difference between going to a loved one and saying, “I’m having a hard time. Will this bad thing happen? Or do you think it will happen?” and saying to your partner, “I’m going through some stuff right now, would you sit with me?” One is very compulsive and one is not. But this is where OCD can be very, very tricky. Sometimes, just having a partner there forms reassurance. If your fear is like, “Well, what if I’m going to go harm someone?” keeping them in the room, even though you’re not talking, that can still serve as a reassurance because you’re like, “Okay, they’re here. They’ll stop me if I’m going to do something bad and I snap.” So, we want to keep an eye out for how reassurance seeking doesn’t have to be just verbal, it can be physical, it could be us just looking at them to see their face and go, “Okay, they look fine, they don’t look stressed. Okay, that gives me the reassurance that nothing bad is happening.” Catch the little nuances that can happen here because as we know, OCD can be very, very sneaky. Again, we can use the option and it is healthy to go to your partner and say, “Hey, I’m really dealing with something. This is really hard. I’m riding a wave of discomfort.” But you’re doing that without getting any reassurance, without seeking any reassurance, without them reducing or removing your uncertainty or anxiety. So, you can do that. There are ways to do it. But the main thing to remember here is, are you doing this with urgency? Because that’s usually a very good sign that you’re doing something compulsive. Are you doing it in attempt to reduce or remove your discomfort? If you’re able to be in conversation with them and discuss and seek support from them without seeking it in an urgent way or trying to reduce or remove your discomfort, well then that’s fine. But here is what I want you to consider just to start, is I am all for support. In fact, it is a human need to have support. But what I’m going to offer you is an idea, which is, when it comes to OCD, if you’re going to them for support because of this discomfort, there is a chance you’re still treating the fear like it’s important, and you will suffer. I get that. You’re going to have a lot of emotions. But if you have the emotions and you’re like, “Oh my God, I feel so bad, I just have these thoughts, or having this anxiety,” and you’re giving that too much attention by saying, “I need your support, I’m really, really suffering,” sometimes that in and of itself can actually reinforce the anxiety. I guess you’re still probably thinking, well, what’s the balance? And there is no perfect answer. I’m sorry, I can’t give you a yes or a no. What I can say is, when it comes to OCD or anxiety, I personally am always going to encourage that you do it yourself as much as you can because that’s where you actually learn how much you can actually tolerate. Remember here, anxiety is always going to be sneaky and say in the back of your mind, “Kimberley, just in case, just so you know, my anxiety is high, but I can really turn it up and freak you out, so you better be careful. Do your best to avoid me.” That’s what anxiety says in some way or form. So, if we still treat ourselves as if we’re really fragile, we can actually reinforce that belief in that thought or intrusive thought. So, I personally am always for myself going to say, “Okay, fear is here, how can I ride this one out 100% by myself?” and this is the key point to remember. Ask yourself in that moment, because you’re probably having some pretty strong reactions right now. Ask yourself in this moment if you are having a strong reaction, “What is my strong reaction to that?” Is it “it’s not fair”? Is it “that’s uncool, that’s too much to handle”? That just shows you where our work is and here is the key point. What is it that you want them to provide you? Is it warmth? Is it compassion? Is it relief from the shame you feel? Is it to know that they won’t leave you or they’re not judging you? What is it that they’re, this one particular person in that moment, what is it that they can provide you? And now, can you provide it for yourself? Or, is this thing you’re looking for even really that helpful? So if you’re like, “Oh my gosh, I just need a safe place to land right now,” I beg for you to practice being the safe place to land. Not your partner, not your family, not your friends. You be that for you. You deserve to be the safe place to land. If there’s a sneaky part of this where you’re like, “No, I just want them to tell me that I’m good and not a terrible human being,” well, that is in fact still reassurance. Yes, we’re all allowed to get that reassurance, but you have to ask yourself, is that reassurance a healthy reassurance or is it something keeping you stuck in the cycle? You get to choose. I’m not saying what’s right or wrong here because each person is different. If I’m with a patient, we will look at this and go, “Okay, let’s talk about why you want your partner to provide you support. What is it that the partner support provides you?” And we pull apart whether that support is in fact benefiting their long-term resilience and success in treatment or actually slowing them down. There’s nothing wrong with getting support at all, but is this an opportunity where you can show up and be your best person? Be the first person that’s standing there going, “I got you.” Mindfulness & Self Compassion For Reassurance Seeking Now here is the other piece of this, which is they’re talking about bottling it in. Let’s say you decide, “Kimberley, I’m on with this idea and I am going to commit to 30 days or seven days or one day or 10 minutes where I’m actually going to be the support for myself. I am going to practice my self-compassion skills, my mindfulness skills, my radical acceptance skills, and I’m going to be it for myself.” That doesn’t mean you’re technically bottling it in. Bottling it in is when you have the emotion and you shut it down and you refuse to let it pass through you and you hold it in and you pretend it’s not there and you’re faking your way through it. If sometimes you need to do that, that’s still fine. But this question is around saying that’s a problem. Now here’s what I’m going to say. There’s really no scientific evidence to say that bottling things in is particularly bad, because how do we know what’s bottled in really? We can’t really measure what’s being bottled in, but we do know that if you don’t talk to people and you aren’t processing stuff that, yeah, it can create some problems. So, this again is, how can we be healthy in our expression and effective in our expression of what’s going on for us? Can you journal? For me, this might sound a little weird, but I am a little weird, is when I really have something I’ve got to get off my chest, I record an audio, I take a walk. I leave my kids and my husband and I take a walk and I record an audio of me just venting it out because, the truth is – this was particularly true during covid – me venting it out to my partner when he’s got his own stuff he’s working on, he’s also going through some things as well. It’s not helpful for me to dump it on him, so I would audio it into myself and listen back and listen for things that I could maybe work on.  So, there are ways. Another way is to practice just feeling your feelings. That’s probably the most important thing I want to mention here and which is why I wanted to really report it, is feel your feelings instead of bottling them in. Now, we recently did an episode about this and how this idea of sitting with your emotions. Go back and listen to that because that’s important. When we talk about feeling your feelings, it doesn’t mean lashing out and having them all over the place and being really unskilled in how you manage them, and it also doesn’t mean having your feelings and staring at the wall and just being like, “Oh my God, I’m just so overwhelmed with this feeling, but I’m sitting with it.” It’s saying, while you go and engage with your life, you allow and embrace whatever emotions to come up. That’s not bottling it in. You saying them out loud is not what’s preventing you from bottling it in. They’re two completely different concepts. Let’s finish up by really talking about what is a healthy way to ride a wave of discomfort instead of having reassurance-seeking compulsions play out. You could journal, you could feel your feelings while you engage with your life, and use skills that you have, mindfulness skills, skills from this podcast. Go all the way back to the beginning. We’ve got tons of good stuff at the beginning of the podcast episodes where you can actually mindfully experience your emotions while also engaging in life. You could do those. You could also go and ask for support and say, “Hey, it’s a really hard time. I just did a really hard exposure. My anxiety is really high. I don’t want you to try and reduce or remove my anxiety, but your presence here is really wonderful. Thank you.” You could be the one who shows up for you radically so hard. You could be like, “Hey Kimberley, what do I need? What do you need right now? How can I show up for you? Do you need my fear support? Do you need my nurturing support? Do you need my champion support? What do you need? And I’m here for you, sister.” That’s what I really want you to practice. You could also find an OCD therapist who’s trained in ERP and say, “Hey, I’m working through some things. Can we talk about it in a way that doesn’t provide me reassurance?” Because you trust that they understand how to not provide reassurance. And that can be a really helpful way. But there’s one thing I want you to remember here at the very end. The reason I’m saying it at the very end is I think this is probably one of the most groundbreaking things that I learned just this year, and this has changed my marriage. I’m not going to lie, it’s changed my marriage, which is this: At the beginning of this year, I read a book called Chatter. I will link it in the show notes. The book is-- let me pull it up really quick. The Voice in Our Head, Why It Matters, and How to Harness It by Ethan Kross. It is an amazing book. One of the things that blew my mind was the research that venting actually increases a person’s distress and does not benefit them. What? That is the opposite of what I have been trained in my career. I was trained that venting is a really healthy thing. I know some of you may be like, “Well, duh, I’ve had issues with this in my past.” But the truth is, it really showed the data on why venting actually makes us feel worse. It actually has a negative impact and there’s no benefit to venting. So, I’m going to leave you to think about that because for me, when I read that, I can be-- I’m not going to lie, one of my not-so-great traits is I can be a little bit of a ventor. A ventor? Is that a thing? I can be a person who vents and unfortunately, my husband is the one who has to hear me process stuff. I’m a real process kind of person. What I realized when I learned this is, holy moly, I’ve been thinking that this is important and this keeps us connected, but the truth is, it doesn’t. It doesn’t impact me positively. It doesn’t impact him positively, even though he is the most kind, supportive man in the history of the world. This is actually not a good behavior and I got to stop it. So, what I did is I called my best friend and I called my husband and I said, “From now on, I’m going to be much more mindful around venting. There will be times when I’m really struggling where I’m actually going to choose not to share about it in that moment. You might see that I’m spiraling on something.” I’m going to say, listen, now is not the time because I now understand the science that venting is not in fact beneficial. It just makes me feel worse and works me up more. So, I use all my tools and I double down and I ride the wave and I journal and I audio in and I ride the wave on my own. So, here are some ideas you take and choose what you want, but that’s the main concepts I want you to consider. And there’s your answer, is this whole idea of holding it in is not the only option. You can, in a healthy way, ride your emotions and your wave of anxiety and you can do it in a way that actually is very effective that doesn’t require anybody else. However, if you require somebody, no problem. That’s wonderful. I hope that you have the most amazing, supportive people in your life and it’s all good. So, that is it. I hope that is helpful for you guys. We did go around and around into all of the little cracks and crevices of this topic. If you’ve got any questions, you can always let me know. Please do leave a review because I hope this is helpful for you. I will see you next week. Next week, I’m actually doing a little bit of a personal episode, talking about a few shifts that I’ve had with my own chronic illness and how it’s impacted my own anxiety. All fun and games. Not really. No fun and games is what I should say. All right, my loves, have a wonderful day. Please do remember it is a beautiful day to do really freaking hard things. You’re not alone because I’m doing the hard things and your friends are doing the hard things and all the people listening here, thousands and thousands of people are doing the hard things too. Have a wonderful day, everybody.

In This Episode: We talk about how the ton of your voice really matters when it comes to self-compassion practices USING SELF-COMPASSION TO INCREASE MOTIVATION USING SELF-COMPASSION TO BETTER APPRAISE EVENTS How you can improve your self-compassion practices to include a warm nurturing voice. How you can practice a kind coach voice in your daily life. Links To Things I Talk About: Self-Compassion Workbook for OCD: https://www.amazon.com/dp/168403776X/ref=cm_sw_em_r_mt_dp_2JG8H4VWFSBMBJVQ4AD8 ERP School: https://www.cbtschool.com/erp-school-lp Episode Sponsor: This episode of Your Anxiety Toolkit is brought to you by CBTschool.com.  CBTschool.com is a psychoeducation platform that provides courses and other online resources for people with anxiety, OCD, and Body-Focused Repetitive Behaviors.  Go to cbtschool.com to learn more. Spread the love! Everyone needs tools for anxiety...If you like Your Anxiety Toolkit Podcast, visit YOUR ANXIETY TOOLKIT PODCAST to subscribe free and you'll never miss an episode. And if you really like Your Anxiety Toolkit, I'd appreciate you telling a friend (maybe even two). EPISODE TRANSCRIPTION This is Your Anxiety Toolkit – Episode 305. You guys, 305. That sounds like a lot of episodes to me. Oh my goodness. So exciting. All right. I am really feeling so connected to the message that I have with you today. It has been an ongoing lesson I have learned in my life. It has been something that I have had to fine-tune in my own self-compassion practice. And I know I’ve spoken about this before, but I wanted to come on and do a quick reminder of why the tone of your voice matters more than anything. When I say the tone of your voice, I mean like how you speak to yourself, and that would also include how you speak to other people. That both. Both are very, very important. I’m sure you know this from experience of talking to other people. When your tone is a little off, it tends to create some problems. Am I right? I definitely have some stories to tell you on that one. But there have been so many times over the summer and going now into the fall where I have had to really keep reminding my patients and myself. And I’m going to tell you a couple of stories here about my family where this has gotten so, so important. Why the tone of your voice matters more than anything? Because tone sets a scene for how things land. Here is an example. If I said to you-- let’s use last week’s example, we did a podcast on what does it actually mean to sit with your emotions. Now, as I talked about how frustrated I was about how-- sometimes we use this term and we don’t explain what it actually means. If the tone of my voice, as I said that, was like, “Oh my gosh, it’s so important that you use it in the right way,” I was saying those actual words. But if I’m using a tone that’s like, “You have to use it this way because you can’t use it this way!” that’s going to create inside a massive degree of anxiety and defensiveness and rejection from you guys. We can all agree. In fact, if you have read any of Dan Siegel’s work, he’s an amazing researcher, an amazing author – he talks about how the word “no” and how we say the word “no” can actually create a massive emotional approach or a response in people than if you were to say “yes” very kindly. Just a one-word difference. What I want to talk about here with you is tone and why tone needs to be a major part of your recovery. Let me tell you a story. The other day, for those of you who don’t know, I have this beautiful, young daughter who just started middle school. Yeah, get ready for the ups and the downs. It’s been a total ride since she started. But my husband was actually at the end of the day reflecting to me in a very compassionate way and he was saying, “Isn’t it interesting how you can say to her, ‘Get your bags, let’s go,’ and that can land so different than ‘Get your bags, let’s go!’” Same words, different tone. Five words, same five words, but those five words and the tone that we use can shift their experience and the way we feel as we express it. We were talking about-- and he was actually giving me a little bit. I’m not going to lie, he was giving me a little bit of feedback that my tone could be a little calmer. In the morning, things are stressful. I know I have some work to do. I’m not going to lie. I was like, “Okay. Yeah, you’re so right.” Coincidentally, I was already going to record this podcast, because so much of how we talk to ourselves is about motivating. I’m motivating her to “Get your bags, let’s go, come on. We’re going to move to the next step. We’re going to be late for school.” And it’s about how do we motivate ourselves. I’ve got some examples for you here and I want you to think about them and how they apply to you. These are personal examples, but I’m pretty certain you may or may not resonate with most of them. So, here we go. Using Self-Compassion To Increase Motivation The first one is how we motivate ourselves to get things done. So, what was shocking to me while I was in Australia, because things were much more calm and my workload was much less, is there were certain tasks I had to keep doing. Even though I was on vacation visiting with my family, I still saw my clients and I still had to respond to emails and so forth. But it was so interesting that when I sit to my desk, which I’m sitting at right now, I often use a tone, which is like, “You’ve got to write your email, get going!” Not that mean, but you hear what I’m saying. Maybe I’m going to be a little overdramatic in this today just for the sake of getting the message across. But like, “You’ve got to get your email done before you see your clients!” Whereas when I was in Australia, I had more space and I was like, “Okay, hun, you’ve got to get your emails done before you get and see your clients.” Same words, but the tone was so different. And so much of the motivating we deal with ourselves has a tone that is aggressive and unkind and bossy and anxiety-provoking and creates a defensive anxiety-driven experience. We all know when we are having anxiety, we actually then tend to build into that cycle even more. So, I want you to think about, how do you motivate yourself? You might even want to pause this and sit down and be like, “What specifically do I say and where’s the tone that gets me in trouble?” What’s the tone that brings on emotions that create more suffering for us? Another one, and this is true for a lot of my patients, this is where I pick up in them, is they know they have homework for therapy. And for those of you who are in therapy, usually, if you’re doing any kind of CBT, you get homework, so you have to get it done. And how you talk to yourself about that homework can determine whether you’re suffering or not. You could say, “I should get my homework done before I see my therapist!” or you could go, “Okay, I’m going to get my homework done before I see my therapist. When might I get that done?” Same topic, same motivation, same intention. The tone makes such a difference. Again, we’re talking about motivation. Using Self-Compassion To Better Appraise Events What about your appraisal of events? You could say, “That was really hard.” You’ve honored that you just did an exposure, let’s say, or you did your homework or you got your emails done, and then you go, “Wow, that was really hard.” That’s a lot different if you were really in a wrestle, “That was really hard! Urgh!” Because when we’re in that tone, we’re in, again, a resentful, angry tone. Not that there’s anything wrong with that. Again, there’s an important place for every tone. You’re allowed to be angry. You’re allowed to be frustrated. You’re allowed to be sad. You’re allowed to be resentful and all those things. I just want you to question your tone and be curious about your tone and ask, is it helpful? Is it effective for you? An example of this is, we’re talking about motivation, if you’re in the last mile of a marathon, you might need to take on a tone that’s very coaching, very like, “Come on, you could do it!” And you’re like, “Ah, just get it done!” I have a dear friend who is suffering with a lot of grief. She lost her father. When she’s playing her sports, she says, “I swear I can’t stop the whole time, and I use my anger to belt out the ball.” So, there is a great example. If it’s effective for you, go ahead and do it. But I want you to really question and be curious about your tone and really ask if it’s working for you. And then you have this great opportunity to start to play around with tones that work for you. Same goes for when we talk about it’s a beautiful day to hard things. A client of mine once mentioned to me that this really, really made her mad. She hated this term. She was like, “This is very annoying. I don’t want to do hard things. I know I can do them, but I don’t want to do them.” Again, you can absolutely use any tone you want, but check in on the tone you’re using. Does it motivate you? Does it give you a sense of inspiration? Does it move you towards the behavior you’re using? Is it kind? Absolutely the most important. Does it feel safe to use that tone? These are just questions to think about. One of the biggest ones is you made a mistake. You could say to yourself, “Okay, Kimberley, you made a mistake,” or you could say, “Kimberley, you made a mistake!” Same words, massive in different tone. Hugely different in the tone, same words. I keep saying same words. The tone is so much different and can really impact how much you suffer. For me, the one that actually-- I got it last, but the one that actually blew my mind the most is the saying, “Keep going.” I could say to myself, “Keep going. Keep going, Kimberley. Keep going. You’ve got this. Keep going. Keep going.” And that’s this idea of just one more, you can do one more. But if I were to be saying, “Keep going! Just keep going!” Same words, totally different effect. So, there’s some examples. You probably have dozens more, or the ones that are really, really different, but I really want, if you can implement, just checking in on your tone each day. You might find that you go leaps and bounds in your self-compassion practice. In fact, I found that the ones who mastered this idea, or not even mastered, just work towards having a kinder tone, tend to be people who end up embracing self-compassion and really reaping the benefits from it. Because again, this is why I’m saying, this is why the tone of your voice matters more than anything. It propels us towards healthier motivation. It propels us towards a bigger, wider self-compassion practice. It propels us away from having emotions that are brought on by this really mean tone, like more fear, shame, guilt, embarrassment, humiliation, irritability. When we use that tone, that really creates a really negative vibe for us. So, that is what I want you to take away. So, so important. All right. Before we finish up, let’s quickly go over the “I did a hard thing” one. This is from Sienna and they said: “In high school, I developed an eating disorder, and in college, I was diagnosed with anorexia nervosa. I’m currently one year out of college and weight restored, but eating is so difficult for me. I’m now in therapy for OCD, which my therapist and I realize, intersects with my eating disorder. It is very challenging for me to eat anything. I think I might be unhealthy and then continue to eating healthy foods that make me feel good. As a part of my ERP, I was assigned to drink kombucha once a day at lunch, and then continue eating healthy for the remainder of the day and to eat pizza once per week. These things scare me because of the pizza with my friends after a pool party, when I normally would have avoided the situation. I am so happy I was a part of my friend group in a way I previously couldn’t be and that I was able to face some of my fears.” Sienna, this is so good. Oh, I love it. You’re doing such hard things. And I love how you’ve identified the specifics, like eating unhealthy, but then going back to your other. I think that is such a great-- you’ve identified what the trigger is. That is so, so important, and it’s such an important part of exposure therapy. We talk about this a lot in ERP School, which is our signature course for OCD, which is, as you plan your exposures, you really want to be clear on the obsessions that you’re going to be targeting. Because once you’ve identified a good obsession and what you want to target, then you can create some really great exposures and some really specific exposures for it. So, so good. All right. Let’s finish up with the review of the week. It’s from Love Heart 2 and they went on to say: “Kimberley knows her stuff. I discovered Kimberley’s podcast a few months ago, and I really love listening to her Aussie-American accent as I am an Aussie in the US myself.” How fun, Love Heart 2. That makes me feel so close with you. “So it feels like a little piece of home. Secondly, she’s very informed on OCD, which I have had for a long time and anxiety. When you get down on yourself as a result of a mental illness, you need someone like Kimberley in your ear, reminding you that you can do hard work and that you are worth it.” Oh my goodness. Thank you so much for that review, Love Heart 2. If you haven’t left a review, please do so. It allows me to reach more people. When they see my podcast, it allows them to feel like they can trust what we’re saying. And that’s so important to me. The more people who feel that they can trust me, the more I can help them, and hopefully, I can bring just a little bit of joy into their day. So, thank you so much, Love Heart 2, and thank you so much, Sienna, for contributing to the “I did a hard thing” segment. All right, my loves, I’m going to sign off. Please do remember that the tone of your voice matters. It really, really does. Have a wonderful day.

SUMMARY:  Today we have Natasha Daniels, an OCD specialist, talking all about how to help children and teens with OCD and phobias.  In this conversation, we talk all about how to motivate our children and teens to manage their OCD, phobias, and anxiety using Cognitive Behavioral Therapy (CBT), Exposure and Response Prevention (ERP), and other treatments such as self-compassion, mindfulness, and ACT. We also address what OCD treatment for children entails and what changes need to be made in OCD treatment for teens. In this episode, Natasha and Kimberley share their experiences of parenting children with phobias and OCD.   In This Episode: What does sitting with emotions mean?  How to sit with difficult feelings  How to sit with your sadness  How to sit with uncomfortable feelings,  Sit with the feelings  Links To Things I Talk About: ERP School: https://www.cbtschool.com/erp-school-lp Episode Sponsor: This episode of Your Anxiety Toolkit is brought to you by CBTschool.com.  CBTschool.com is a psychoeducation platform that provides courses and other online resources for people with anxiety, OCD, and Body-Focused Repetitive Behaviors.  Go to cbtschool.com to learn more. Spread the love! Everyone needs tools for anxiety...If you like Your Anxiety Toolkit Podcast, visit YOUR ANXIETY TOOLKIT PODCAST to subscribe free and you'll never miss an episode. And if you really like Your Anxiety Toolkit, I'd appreciate you telling a friend (maybe even two). EPISODE TRANSCRIPTION This is Your Anxiety Toolkit - Episode 304.  Welcome back, everybody. It’s a delight to have you here with me today.  Oh, I’ve got so much I want to talk to you about and this is actually coming from an emotion of frustration, this episode, which every time I check in and I begin a podcast, I try to come from a place of fun. And am I feeling calm? And am I feeling completely connected to you, the listener? But today, just for fun, I’m coming to you from a place of frustration. And the frustration, promise, this is not going to be a vent episode – it’s actually a frustration in that I caught an error that I’ve made, and I think a lot of clinicians are making. And it’s not an error in that it’s bad or wrong or problematic. It’s just that I caught something in my own practice, and I was like, “Oh, hold up, we have to talk about this.” So, saddle in, get your cup of tea, settle in, because we’re going to have to have a conversation about wording. It might be really nuanced and I want you to take what’s helpful and leave the rest. I want you to think about it with an open, curious mind, and decide what’s best for you.  So, before we get into the show, as always, let’s start with the “I did a hard thing.” Let’s do it. This one is actually from someone that says-- the handle name is GottaCatchEmAll, and they said: “Thank you so much for your recent series on mental compulsions. Your podcast is truly a godsend and I’ve been listening nonstop ever since my friend shared it with me last month.” Now, for those of you who don’t know, the mental compulsion series was a six-part series that we created here on the podcast. It had so many amazing clinicians on. If you want access to that series, you can go back and listen to previous podcasts. Or, if you sign up for our newsletter, you’ll go to CBTSchool.com/newsletter. I will actually send you an amazing webpage, just one link where all the episodes are there, all the PDFs are there. It’s so pretty. I have to say it is so pretty, and it’s like a one-stop shop for that series. So, go over to the newsletter, CBTSchool.com/newsletter. Sign up for the newsletter. You’ll get an email from me every week. But on the front end, you will receive that link. I’m so proud of it. I love it. So, I digress, sorry. They went on to say: “I suffer from a plethora of different anxieties, OCD, scrupulosity, hoarding, body dysmorphia, perfectionism. So, basically a bunch of normal human things, right? Exactly. The other day, I told my therapist that dealing with all of these issues felt like playing a game of whack-a-mole in my head, except that instead of the typical game, the mole would pop up and then a zebra and a giraffe, and so on, in a quick succession throughout the course of the day. While sobbing, I told my therapist that I didn’t want to have a zoo in my head and I didn’t know how to treat so many issues simultaneously. Imagine my surprise when I heard a recent episode called Whack-a-mole Obsessions, it was a relief to discover that I wasn’t alone and weird or broken as I thought. I realized, instead of trying to resist or whack the zoo in my head, I could approach my anxieties and compulsions like they were different Pokemons that I could catch and train and carry around with me while I live the rest of my best life. Thank you, Kimberley, for putting on such an incredible content and for helping me and so many others navigate this difficult thing.” That is so good. Look at you working through that whack-a-mole ongoing struggle with different thoughts, different disorders, and so forth. I think so many of us resonate with this and you are definitely doing hard things. So, so, so cool.  All right. Real quick, before we get to the frustration that we’re all hanging out for, let’s just quickly do the review of the week. This one is a shorty from Inventedcharm, and they said: “It is a mental pick me up. I love listening when I need a mental pick me up. Kimberley’s voice is soothing, and she offers great tools for self-compassion and interviews other experts in the field of mental health.” So, thank you, Inventedcharm, and thank you, GottaCatchEmAll. Okay. So, here we go. I’m going to tell you a story of why I’m landing here on this episode with you today. So, once I got back from Australia, a lot of you know I spent five and a half weeks in Australia over the summer with my children. It was so beautiful. I can’t tell you how full my heart was when I returned. I was energized. I was the happiest I’ve ever been. And you know where this is going. Yeah, we do. I crashed big time. I just went through so much sadness. I missed my family. I was angry. I had so much grief. I was feeling, actually, if I’m going to be completely honest, quite a lot of resent towards even my husband, who I love and is such a wonderful human. But I was observing resent show up because I was like, “I don’t understand. I just want to be with my family and why can’t I have all the things I want?” So, all these emotions started showing up.  WHAT DOES IT MEAN TO SIT WITH EMOTIONS?  My therapist – of course, I talked with a therapist – was saying, “Everything, Kimberley, that you’re saying makes complete sense. Why don’t you practice sitting with your emotions?” And of course, I was like, “Yeah, that makes sense. I have given that advice myself.” And so, off I went right onto the roller coaster, or we could say the whack-a-mole to talk about the “I did the hard thing” segment, the whack-a-mole of emotions with the agenda of not numbing them like I often do. Sometimes when I work, I engage in these numbing behaviors where I just numb all of everything out by working. It’s something that I’ve overused as a coping skill, is when I work. So, I’m not doing that anymore. I’m not using any other problematic safety behaviors. I caught all these problems. So, it’s like, “I think really all you’ve got left to do is just sit with your emotions.” So, I went, “Okay, let’s do it. There’s no solution. There’s nothing I can do about this. Let’s just sit with it.” And I started to play with this idea of, okay, let’s talk about what does it mean to sit with your emotions. Now, this is where, again, I’m going to identify, I’ve given this advice and I’m going to say, I don’t think I’m going to give that advice anymore. Or if I do give it, and for any reason you don’t catch me doing this, you can always bring it to my attention, but I’m going to do my best, is I’m going to add another sentence to the whole “sit with your emotions” concept, because let’s say often you guys have heard me say, “Sit with anxiety, sit with your anxiety.” And that’s helpful because we know that doing compulsions with anxiety is a problem. If you resist or avoid or try and remove your anxiety, it’s going to create more problems. But where that gets in the way is it doesn’t mean you just sit there and do nothing but stare at the wall and just let the anxiety beat you into a pummel. No. I think that the mistake I’ll make, and I’m going to be completely transparent, I think the mistake I make is I’m assuming you guys know what I mean by that, and I’m assuming that you know, I mean, don’t just sit there and stare at the wall.  There were a couple of days where I was so overwhelmed with emotion that I did just sit there and be like, “Okay, I’m allowing this. I have to allow it. I’m sitting here. I’m allowing it. Oh man, this is hard,” until I was like, “Wait a second. This is not helpful. Just sitting here and letting it pummel me, that’s not the whole picture. There has to be tools and skills associated with it.” That’s where I’m talking about in regards to anxiety. It’s a great concept, but what do we actually mean when we say, “Sit with your emotions”? We mean, allow it, particularly when we’re talking about fear. We’re saying, don’t interfere with it. Don’t engage with it. Don’t wrestle with it. Don’t stir it up. And we’re also saying, don’t run away from it. We don’t thought suppress. So important.  So, I totally believe that sitting with emotions is an important concept, but we must, and I am sorry if I haven’t mentioned this and I haven’t gone a full explanation, we then must engage back into life. We must engage back into the things that we value. We must engage, even if we don’t like it. Sometimes you have to do the dishes. Sometimes you have to get out of bed. And sometimes we have to allow emotions, embrace emotions, bring on emotions in order to get up and do those things. But that’s just anxiety.  HOW TO SIT WITH DIFFICULT EMOTIONS?  Now, let’s talk about which emotions should you sit with and which ones shouldn’t you? Now, number one, there is no bad emotion. There’s no such thing as a bad emotion, a negative emotion, a problematic emotion. They’re all just neutral. And that’s huge to know. But as I was sitting in the chair of the client instead of being the therapist, and I was really going, “Okay, I’m not going to engage in these behaviors. I’m going to instead just allow them and sit with them,” I realized sometimes asking yourself to sit with an emotion, particularly ones like guilt and shame, that too isn’t completely helpful. We need to put an extra sentence on the end of that as well. So, we can say, “Sit with your emotion of shame, but also be aware of the stories it’s telling you, not taking it as a fact.” Because as I was noticing, so much shame showed up for myself in this specific situation. I was thinking, wait, if I told my client to sit with shame, but I hadn’t taught them the skill of diffusing from shame or observing the story of shame, they’re going to have shame and be like, “Oh yeah, it’s true. I am bad. I’m just going to sit with the fact that I’m bad.” So, no, no, no, no, no. That’s not what we mean, again, by sitting with emotions. We’re not saying we’re going to sit with them and accept them as fact.  Let’s talk about sitting with sadness and grief because, boy oh boy, did I have sadness and grief. And it would come in waves that punch me in the face. I’d be like-- and again, I want to validate grief. Doesn’t matter, it’s not just losing a human body. Nobody passed away. That’s definitely grief. But I was handling grief and loss of like, “Oh, I missed my family. I wish I was there. I wish I lived there. I wish I could just snap my fingers and be there. I wish the world was different. I wish COVID didn’t happen.” All these things. So, I just was getting these waves of sadness. And it was important as I was “sitting with sadness.” That’s okay. We want to do that. We want to allow it. We don’t want to interfere with it. We don’t want to run away from it. We want to embrace it. But we don’t want to thicken it with hopelessness as we sit there. We don’t want to thicken it with like, “Yeah, bad things are going to keep happening and there’s not hope.” That will only create more problems.  HOW TO SIT WITH SADNESS?  So, when we say “sit with your emotions,” particularly the one of sadness, we actually want to sit in sadness again with non-judgment, with curiosity, with awareness of other things. And when I did that, when I sat with my emotions and was curious and open, I noticed like LA’s got a beautiful, beautiful scene. The vibe is really cool. I love my house. I really do love my house. I love the fact that my house is surrounded by trees. I love my family. And I allowed me to be open to sadness and other parts of my life here. So, again, I’m bringing this up of just like in that moment of doing the action, I was thinking, oh my goodness, we need to make sure we expand our description of what it means to sit with your emotions.  If you need more step by step, in my book, The Self-Compassion Workbook for OCD, if you have OCD, I actually have a full chapter on managing strong emotions. And in that book, I actually did, I believe, a good degree of explanation. But I wanted to get on here and set the-- what do you say? Set you straight? That’s not right. Set the story straight. I don’t really know what that saying is, forgive me. But I wanted to be really clear and actually correct if I’ve ever said this term, “sit with your emotions.” It’s not a bad term. I actually almost called this episode “Why I’ll never say sit with your emotions again.” But the truth is, I won’t. I can’t hold that as true. So, I changed it to “What does it really mean to sit with your emotions,” and how can we add additional context to that statement so that it doesn’t mean you’re just indulging the emotion and all of the trash that some emotions can leave behind. And what I mean by trash, I’m not judging, it is like, with sadness comes hopelessness sometimes. So, we want to be careful not to engage with that and infuse too much with that. With shame comes a story that you’re bad, that you’re wrong, that you don’t have any worth. We don’t want to indulge or engage in that while we allow and experience the emotion of shame.  HOW TO SIT WITH ANGER?  Anger was another one. I went through these crazy waves of anger and talking with a therapist like, “Okay, you’re having your anger.” Of course, don’t lash out or say me unkind things, or catch yourself if you’re starting to feel highly dysregulated. And then just sit with your emotions. And I thought, wow, again, there’s that saying. But if I’m angry and I’m sitting with it, I could easily percolate on some pretty hateful thoughts. I could be sitting with and ruminating with that emotion. And that is not what we mean when we say “sit with your emotions.” So, I really wanted to just drop into this. If I were to sum up this whole episode, the thing I want you to think about the most is, there is no right way to manage an emotion and there is no right or wrong emotion. There is no-- and I talk with my patients all the time about this. There is no playbook on how this is supposed to go. The metaphor I often use is, it’s like any sport. Some of you may know, I’m learning tennis. I actually pretty suck at it, but that’s a whole nother story. The whole thing I’m learning is, and the reason that I suck, and I don’t say that in a judgmental way, I actually think it’s hilarious, is it’s all about being super flexible. So, I’m standing and my knees are bent and I’m holding my racket and I’m going left to right, left to right on my feet, and I’m getting ready for this constantly changing direction of a ball. And I have to stay really flexible. So, if the ball goes all the way to the right, I have to move my legs so I can move to the right. And then if next time it goes to the left, I have to be ready to make that maneuver.  HOW TO SIT WITH OTHER DIFFICULT EMOTIONS Same goes with emotions. Your emotions are going to flip flop and go from left to right and north to west, and it’s going to give you a run for your money. And we have to be able to adjust the strategy depending on what’s coming to us. And that’s true of emotions. In simple, we’re always going to observe it, allow it, acknowledge it. In some points, we have to be curious instead of being closed and judgmental. These are skills you can use with all of them. But as I’ve gone through some of the more difficult emotions today, sometimes we have to catch the themes that percolate and loop us into it when “sitting with emotions.” So, that’s the main thing I want to talk to you. Again, I’ll tell you, as I-- I was actually driving to the dentist and I called a very dear friend of mine, and I just said, “I actually just had a major epiphany. We can’t keep saying ‘sit with your emotions’ as clinicians. We have to make sure we add context to what that looks like, and it means not just sitting still and doing nothing, except focusing on the emotion.” So, if this resonates with you, I hope it does. It was such an important thing I wanted to talk with you about again. Does it mean it’s wrong? Absolutely not. If you’re a clinician or you hear this, or you’ve probably even heard it from me – if you’ve heard it, it doesn’t mean they’ve done anything wrong. I just want you to understand what it actually means when they say that and to add those extra sentences at the end and give context to like-- again, don’t interfere with them. Don’t run away from them. Allow them. Also, don’t calculate and ruminate on them either.  Sending you so much love. As always, this is really hard work. So, please do remember, it is a beautiful day to do these hard things. And I will add, for any of you who are writing out waves of emotion right now, I salute you. I have such deep respect for you because it’s no easy feat to choose an emotion, to choose to tolerate it and interrupt behaviors that are problematic and allow emotions to rise and fall. That is some pretty impressive work you’re doing. And I just want to give you a massive shout out because it’s not fun. It’s hard. It’s not easy. It’s skillful work. It takes some stamina to do it, and it’s exhausting. And so, if you’re doing even 10% of this work, I applaud you.  All right, my friends, I will see you next week. Have a wonderful, wonderful week. Again, please do go to CBTSchool.com/newsletter if you want access to that mental compulsions worksheet. And I’ll be seeing you in a week.

SUMMARY:  In this episode, I addressed a question that was asked of me by a loyal follower.  They asked, “What do I do if the present moment totally sucks? Like, what if I have a migraine , nausea , chills , pain?  Any suggestions ?!” This is such a great question and one we probably have all asked ourselves or our therapist at some point.   Links To Things I Talk About: ERP School: https://www.cbtschool.com/erp-school-lp Episode Sponsor:This episode of Your Anxiety Toolkit is brought to you by CBTschool.com.  CBTschool.com is a psychoeducation platform that provides courses and other online resources for people with anxiety, OCD, and Body-Focused Repetitive Behaviors.  Go to cbtschool.com to learn more. Spread the love! Everyone needs tools for anxiety...If you like Your Anxiety Toolkit Podcast, visit YOUR ANXIETY TOOLKIT PODCAST to subscribe free and you'll never miss an episode. And if you really like Your Anxiety Toolkit, I'd appreciate you telling a friend (maybe even two). EPISODE TRANSCRIPTION This is Your Anxiety Toolkit - Episode 303. Welcome back, everybody. Thank you from the bottom of my heart for being here with me. Thank you for listening. Thank you for supporting me. I know how valuable your time is, and I know there are so many people that you could spend your time with, especially out on the podcast field. So, I am so, so grateful to have you here with me. Really, really, really I am. I hope that you find these episodes incredibly helpful. My hope is to give you bite-size tools so that you can get on with your life and live your best life. I hope this podcast is everything that you wanted to learn.  This week’s episode, I am totally, totally amped for. The reason being is, it was actually a response to a previous podcast where we talked about being present. Somebody had written back because they subscribe to my newsletter. If you haven’t subscribed to my newsletter, please do so. I will leave a link in the show notes, or you can go over to CBTSchool.com and sign up there. They had responded and said, “But Kimberley, what do I do if the present moment totally sucks?” And they went on to say, “I have a migraine or nausea or chills or pains.” And they said, “What are your suggestions?” I figured, this is probably the question you all have for me. I come on, I share with you tools. And then you guys are probably always going to have a question and this is a really common one.  WHAT TO DO IF THE PRESENT MOMENT TOTALLY SUCKS Today, I want to talk about what to do when the present moment totally sucks. Before we do that, let’s first do the “I did a hard thing” segment. This one is from Rachel and they said: “My thoughts get the best of me. I recently started teaching and I needed to stay long after the students go home. And I decided it just needs to be a busy time to distract me. I use your book to help me with any meditations and I just let my thoughts come and go. It was scary the first time, but now I’m used to it.” Thank you so much, Rachel. I’m so grateful my book can be of assistance. I think you’re doing some really, really hard work there. So, congratulations on that.  And then last of all, before we get into the bulk of the episode, let’s first share a review of the week and this is from Meldevs and they said: “I am so thankful to have found this podcast! Kimberley is such a compassionate, warm, honest, and insightful person for those struggling with anxiety disorders as I do. I have learned more listening to her than I have in my years of therapy. The way that she presents each and every podcast episode so that I feel challenged and understood. Thank you, thank you, thank you for being there for people struggling with anxiety!” Thank you, Meldevs. That is such a beautiful review, really. That brings me so much joy and I really, really appreciate all your reviews on the podcast, because it helps me to reach more and more people. Meldevs and Rachel, thank you so much for being a part of my community. Let’s get into the episode.  What do we do when the present moment totally sucks? Let’s break it down.  When we talk about being present, one of the biggest mistakes we make, and I talk with my patients about this all the time, is we assume that being present means everything feels great. I think we have in our mind that being present is when we are most mindful, when we are most at peace, when we’re most compassionate. And I’ll tell you honestly, that has not been my experience. Oh no. HOW TO BE PRESENT WHEN ANXIOUS Being present, the art of being present, the practice of being present in your most mindful sense has never meant being comfortable in my experience, especially as my experience with it as a clinician, especially as my experience of having my own mental illnesses and my own medical illnesses. No, it’s not that. Most of the time, when we need to be present are the times when things totally suck, when we’re in a great deal of distress. Because otherwise, if you’re not in distress, usually, you don’t have to be as present because often you naturally are.  So, let’s just remember that our brains, when we are uncomfortable, is wired to focus on that discomfort. That’s how we’ve survived all these years. And it’s going to focus on the pain because it is trying to send a message to you to get the pain to go away. But when we have something where the pain won’t go away, have it be migraine, like you said, nausea, chills, discomfort could be also anxiety or intrusive thoughts because we all know we can’t stop those. When we experience those, yes, naturally, you’re going to want to run away from it. But as a part of this team and as part of this community, you guys know and hopefully, I’ve taught you that running away from discomfort only makes it worse. Resisting the pain we feel and the suffering we feel only makes it worse and increases our suffering. So, what do we do? Friends, we settle in. I’ll give you a personal example of when I actually recently had COVID.  Some people bless your hearts. And also, I’m really still very mad at these people, but still, bless your hearts. I wish this was the case for everybody. But some people have very few symptoms when it comes to having COVID. I am not one of those people. When I have COVID and when I got COVID, I get bone pain. It is like the deepest pain in my bones. It goes right to the center of my bones and it is so painful. My daughter and my husband both had COVID as well. My daughter came in. And I, when I’m in this state where my bones hurt this bad, I’ve had it several times in my life. She said, “Mama, you’re tensing up. Your face is all squished.” I was holding my muscles tight. And thank goodness, because I was in so much pain that I actually needed somebody outside of my body to tell me this was happening because I just was so entrenched in the pain I was feeling that she said, “Mama, you’re all tense.” Thank goodness I’ve taught her that tensing up around pain actually makes it worse. Her and I have had many conversations around this.  STEP ONE: VALIDATE And so, I naturally was able to go, “Oh, okay, Kimberley, let’s pause.” Number one, validate. “Hun, you’re in a lot of pain.” You could even say, “This present moment totally sucks.” Or you could say, “Wow, I’m observing that you’re really uncomfortable right now.” So, if that’s you and your present moment really sucks, I’m strongly encouraging you first validating. The alternative would be you go, “It shouldn’t be this way.” But the truth is, it is this way. So, don’t go down the road of fighting it.  STEP TWO: STOP RESISTING THE PRESENT MOMENT The second piece is then check for where you are resisting the present moment and how much it sucks. Now I’m going to keep saying the word “sucks” really passionately because it does sometimes really suck, like really suck. And so, when it really sucks, it’s almost like the more it sucks, the more we have to soften around how much it sucks. If you have a migraine, the worse it is, the more you need to soften your brow and close your eyes and soften the environment that you’re in. The more you feel nausea, the more you feel your stomach nodding up. And some of you may feel that just by me mentioning it. The more you feel that, the more you need to soften around that physically by relaxing your muscles and softening your thoughts around it. Meaning now is not the time to beat yourself up for it. Now is not the time. Some people are going, “Yeah, but it’s my fault. I have nausea because I drank too much,” or “I ate too much,” or whatever it may be. Now is not the time to go through that. Now, the facts are, the present moment totally sucks. And so, let’s be gentle around it because our resistance makes it worse.  If you were like me and you have the chills and you’ve got literal, like feels like every bone in your body is broken, now is not the time to fight that and tense your muscles. Now is the time to soften. If you’re having a full-blown panic attack, first acknowledge, “Okay, I’m noticing I’m having a panic attack.” And then soften around it physically and cognitively in your thoughts. Don’t resist it.  Now, that being said, let me bring a very important concept to the table. And this actually just came up this morning. So, as many of you know, I have my online business, which is CBTSchool.com, and then I also have a private practice where we see clients. Because I can’t see all the clients that come to me, I have 10 amazing therapists who work for me and who I have trained and who I supervise every single week. We have a meeting every Monday, and we talk about cases. One of my staff was telling me today that one of her patients took what she said literally, which actually is pretty common. She was explaining to her patients that when you have anxiety and panic or discomfort, you sit in the discomfort or sit with the discomfort, or be with the discomfort. And this patient and client took it literally, which is fair. We have to be really descriptive and give lots of steps and explanations. And so, while they were feeling this discomfort, they literally sat in a chair and just stared and suffered. So, if I’ve ever said, sit with your discomfort, please don’t take it literally. And so, what I want to remember here and what I remind you of, I should say, is once we’ve acknowledged and we stop the resistance to it, we must then reengage in something we value. So, let’s use me as an example. I had COVID. I literally felt like every bone in my body was broken. That doesn’t mean I’m going to get up and go for a run. It doesn’t mean I’m going to get up and see patients because I’m actually in pain. I wasn’t able to. But what I can do is instead of putting my attention on how much it’s painful, I’m going to put my attention onto something else. And it could be as little or as minute as the sound of the leaves rustling outside, the sound of music, the, the smell of the cough medicine I had taken, the taste of the cough medicine I had taken, the touch of the blanket. So, you just get really in touch with that. And then you catch how your mind then keeps offering you thoughts that make you want to reengage back with the pain.  Now, again, I’ll give you another example. Most of you know, I have a chronic illness. I have postural orthostatic tachycardic syndrome. I am dizzy almost all the time. It’s under control now. I don’t faint nearly as much as I used to. But dizziness is actually a very normal part of my existence, particularly when I’m standing up. And so, my job is to allow it and then to catch when my brain starts to say, “It shouldn’t be this way. This isn’t fair. It’s not good. This is bad. It could be better. Your life could be better.” My brain offers me those thoughts and I choose not to entertain them. Now, I’m not perfect at this, and this is something I’ve been practicing for a long time, so please be gentle with yourself. My job and your job, when the present moment totally sucks, is to be an observer to our brain. And of course, as I said, at the beginning, it’s going to present to us all the problems and why this shouldn’t be the problem. And you just say, “Thank you for showing up. I totally get what you’re saying, brain. Thank you for being there for me, but I’m going to keep directing my attention to whatever it is in front of me.”  If you have anxiety and you’re having panic, you’re having high levels of anxiety, I’m going to say to you, ask yourself the question, what can I do or what would I be doing if anxiety wasn’t here right now? And go do those things. Don’t just sit in the discomfort. Only go engage back with life. Do the most that you can with your life WHILE you have anxiety. Now, let’s also address one other main issue. In no way am I saying to dump toxic positivity on yourself here. In no way am I saying things like, “Oh, you should be happy. The leaves are so beautiful.” Again, like I was saying to you, no, absolutely not. That is not what we’re talking about.  If you feel sad about this, if you feel down about it, if you feel a little discouraged or irritable, that’s okay. We can also be mindful and acknowledge, “Yeah, I’m feeling really frustrated with how I feel so terrible.” We’re not here when we’re mindful. We’re not here to say it shouldn’t be this way and just be happy about it. No, like I said to you, in my experience being present, my most mindful is actually when things totally suck. And I don’t try and change it that often. In fact, I just try to allow it, bring it in and then add other valuable things into my life.  Can it be positive? Absolutely, if you want it to be. But if the suffering you’re experiencing is depression or hopelessness or grief or panic, we don’t need to throw a bunch of positivity on there unless it’s really helpful to you. All I’m here trying to do is get you to not fight how painful it is because that usually makes it more painful. And also, we don’t want to thicken the pot of it by going, “You’re right. It does suck. It’s not fair,” and all those things. That can actually often-- we have research to show that that rumination actually makes our suffering worse. I know I said that was the last thing, but I have one more important thing to say, which is, please, please practice nonjudgment. If you’re going to be mindful, you have to practice nonjudgment. You can’t have mindfulness without nonjudgment. I have a whole episode on that. The whole point here with nonjudgment is, when we say this moment totally sucks, it’s actually a judgment. And I don’t want to take that from you. I don’t want to take that from you. It’s okay. You’re allowed to acknowledge it. But we also want to catch that how sometimes when we’re judgmental, this is good and this is bad, we actually train our brains to send out more anxiety hormones when we have that experience the next time, especially when we tell ourselves it sucks and it shouldn’t be there. So, keep that in mind.  Anytime I’m going through something difficult, and this is very true of my work that I did around dizziness, with my POTS, is I had to take all the judgment out of it to reduce my suffering around my dizziness. Because the more I judged it, the more I felt completely hopeless and depressed about the situation. The more I felt like, oh, I just don’t have an answer, there is no answer.  Again, I didn’t say, “Wow, I love dizziness. It’s so positive and wonderful.” I just said, it’s a sensation. I’m going to be gentle. I’m going to acknowledge it and allow it and lean into it, but not give it too much attention. And it’s neither good nor bad. And that was a conscious, intentional decision. Again, be careful that it doesn’t become toxic in that you’re pushing too much positivity on yourself, but again, it’s a balance. So, there it is. That is what I would encourage you to do when the present moment totally sucks. And as I said, the present moment, especially when you’re suffering, it will totally suck sometimes. But that doesn’t mean you’re going in the wrong direction. It doesn’t mean it’s going to stay that way forever. There’s another piece to catch.  I am just in love with you guys. I really am. What an amazing, amazing community. Please, if you want to be part of my community, you can go over to Instagram @YourAnxietyToolkit. You can listen to this podcast and go right back to the beginning and listen to the beginning ones. You can go over to Facebook. We actually have a private Facebook group called CBT School Campus. You’re welcome to come and join us there. Thank you. Just love you, love you, love you.  Have a wonderful day and I’ll talk to you next week.