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

SUMMARY: Covered in This Episode: What is a Mental Compulsion?  What is the difference between Mental Rumination and Mental Compulsions?  How to use Mindfulness for Mental Compulsions How to “Label and Abandon” intrusive thoughts and mental compulsions  How to use Awareness logs to help reduce mental rituals and mental rumination  Links To Things I Talk About: Links to Jon’s Books https://www.amazon.com/ Work with Jon https://www.sheppardpratt.org/care-finder/ocd-anxiety-center/ 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.  To learn about our Online Course for OCD, visit https://www.cbtschool.com/erp-school-lp. 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 I want you to go back and listen to that. That is where I walk you through Mental Compulsions 101. What is a mental compulsion, the types of mental compulsions, things to be looking out for. The reason I stress that you start there is there may be things you’re doing that are mental compulsions and you didn’t realize. So, you want to know those things before you go in and listen to the skills that you’re about to receive. Oh my goodness. This is just so, so exciting. I’m mind-blown with how exciting this is all for me. First of all, let’s introduce the guest for today. Today, we have the amazing Jon Hershfield. Jon has been on the episode before, even talking about mental compulsions. However, I wanted him to status off. He was so brave. He jumped in, and I wanted him to give his ideas around what is a mental compulsion, how he uses mental compulsion treatment with his clients, what skills he uses. Little thing to know here, he taught me something I myself didn’t know and have now since implemented with our patients over at my clinic of people who struggle with mental compulsions. I’ve also uploaded that and added a little bit of that concept into ERP School, which is our course for OCD, called ERP School. You can get it at CBTSchool.com.  Jon is amazing. So, you’re going to really feel solid moving into this. He gives some solid advice. Of course, he’s always so lovely and wise. And so, I am just so excited to share this with you. Let’s just get to the show because I know you’re here to learn. This is episode two of the series. Next week we will be talking with Shala Nicely and she will be dropping major truth bombs and major skills as well, as will all of the people on the series. So, I am so, so excited.  One thing to know as you move into it is there will be some things that really work for you and some that won’t. So, I’m going to say this in every episode intro. So, all of these skills are top-notch science-based skills. Each person is going to give their own specific nuanced way of managing it. So, I want you to go in knowing that you can take what you need. Some things will really be like, yes, that’s exactly what I needed to hear. Some may not. So, I want you to go in with an open mind knowing that the whole purpose of this six-part series is to give you many different approaches so that you can try on what works for you. That’s my main agenda here, is that you can feel like you’ve gotten all the ideas and then you can start to put together a plan for yourself. Let’s go over to the show. I’m so happy you’re here. ----- Kimberley: Welcome, Jon. I’m so happy to have you back. Jon: Hi, Kimberley. Thanks for having me back. Difference Between Mental Compulsions and Mental Rumination  Kimberley: Okay. So, you’re first in line and I purposely had you first in line. I know we’ve had episodes similar to this in the past, but I just wanted to really get your view on how you’re dealing with mental compulsions. First, I want to check in, do you call them “mental compulsions” or do you call it “mental rumination”? Do you want to clarify your own idea? Jon: Yeah. I say mental compulsions or mental rituals. I use the terms pretty interchangeably. It comes up at the first, usually in the assessment, if not then in the first post-assessment session, when I’m explaining how OCD works and I get to the part we say, and then there’s this thing called compulsions. And what I do is I describe compulsions as anything that you do physically or mentally to reduce distress, and this is the important part, specifically by trying to increase certainty about the content of the obsession.  Why that’s important is I think we need to get rid of this myth that sometimes shows up in the OCD community that when you do exposures or when you’re triggered, you’re just supposed to freak out and deal with it, and hopefully, it’ll go away on its own. Actually, there are many things you can do to reduce distress that aren’t compulsive, because what makes it compulsive is that it’s acting on the content of the obsession. I mean, there might be some rare exceptions where your specific obsession has to do with an unwillingness to be anxious or something like that. But for the most part, meditation, breathing exercises, grounding exercises, DBT, certain forms of distraction, exercise – these can all reduce your physical experience of distress without saying anything in particular about whether or not the thought that triggered you is true or going to come. So, once I’ve described that, then hopefully, it opens people up to realize, well, it could really be anything and most of those things are going to be mental. So then, we go through, “Well, what are the different mental ways?” We know the physical ways through washing hands and checking locks and things like that. But what are all the things you’re doing in your mind to convince yourself out of the distress, as opposed to actually working your way through the distress using a variety of distress tolerance skills, including acceptance? Kimberley: Right. Do you do the same for people with generalized anxiety or social anxiety or other anxiety disorders? Would you conceptualize it the same way? Mental Compulsions for General Anxiety Disorder vs OCD  Jon: Yeah. I think for the most part, I mean, I do meet people. Some people who I think are better understood as having generalized anxiety disorder than OCD, and identifying with that concept actually helps them approach this problem that they have of dealing with uncertainty and dealing with worry and dealing with anxiety on close to home, regular everyday issues like finance and work and health and relationships and things like that. And there’s a subsection of that people who, if you treat it like OCD, it’s really helpful. And there’s a subsection if you treat it like OCD, they think, “Oh no, I have some other psychiatric problem I have to worry about right now.” I’m a fan of treating the individual that the diagnostic terms are there to help us. Fundamentally, the treatment will be the same. What are you doing that’s sending the signal to your brain, that these ideas are threats as opposed to ideas, and how can we change that signal? Exposure & Response Prevention for Mental Compulsions  Kimberley: Right. I thank you for clarifying on that. So, after you’ve given that degree of psychoeducation, what do you personally do next? Do you want to share? Do you go more into an exposure option? Do you do more response prevention? Tell me a little bit about it, walk me through how you would do this with a client. Jon: The first thing I would usually do is ask them to educate me on what it’s really like to be them. And so, that involves some thought tracking. So, we’ll use a trigger and response log. So, I keep it very simple. What’s setting you off and what are you doing? And I’ll tell them in the beginning, don’t try too hard to get better because I want to know what your life is really like, and I’ll start to see the patterns. It seems every time you’re triggered by this, you seem to do that. And that’s where they’ll start to reveal to me things like, “Well, I just thought about it for an hour and then it went away.” And that’s how I know that they’re engaging in mental review and rumination, other things like that. Or I was triggered by the thought that I could be sick and I repeated the word “healthy” 10 times. Okay. So, they’re doing thought neutralization. Sometimes we’ll expand on that. One of the clinicians in my practice took our thought records and repurposed them as a mental behavior log. So, it’s what set you off. What did you do? What was the mental behavior that was happening at that time? And in some cases, what would’ve been more helpful? Again, I rely more on my patients to tell me what’s going on than on me to tell them “Here’s what’s going on,” so you get the best information. Logging Mental Rituals  Kimberley: Right. I love that. I love the idea of having a log. You’re really checking in for what’s going on before dropping everything down. Does that increase their distress? How do they experience that? Jon: I think a lot of people find it very helpful because first of all, it’s an act of mindfulness to write this stuff down because it’s requiring you to put it in front of you and see it, which is different than having it hit you from inside your head. And so, that’s helpful. They’re seeing it as a thought process. And I think it also helps people come to terms with a certain reality about rumination that it’s not a hundred percent compulsion in the sense that there’s an element of rumination that’s habitual. Your mind, like a puppy, is conditioned to respond automatically to certain things that it’s been reinforced to do. And so, sometimes people just ruminate because they’re alone or sitting in a particular chair. It’s the same reason why people sometimes struggle with hair-pulling disorder, trichotillomania or skin picking. It’s these environmental cues. And then the brain says, “Oh, we should do this now because this is what we do in this situation.” People give themselves a really hard time for ruminating because they’ve been told to stop, but they can’t stop because they find themselves doing it.  So, what I try to help people understand is like, “Look, you can only control what you can control. And the more that you are aware of, the more you can control. So, this is where you can bring mindfulness into it.” So, maybe for this person, there’s such a ruminator. They’re constantly analyzing, figuring things out. It’s part of their identity. They’re very philosophical. They’re not thinking of it as a compulsion, and many times they’re not thinking of it at all. It’s just happening. And then we increased their awareness, like, “Oh, okay. I got triggered. I left the building for a while. And then suddenly, I realized I was way down the rabbit hole, convinced myself that’s something terrible. So, in that moment I realized I’m supposed to stop, but so much damage has been done because I just spent a really long time analyzing and compulsing and trying to figure it out.”  So, strategies that increase our awareness of what the mind is doing are extraordinarily helpful because imagine catching it five seconds into the process and being able to say, “Oh, I’m ruminating. Okay, I don’t need to do that right now. I’m going to return my attention to what I was doing before I got distracted.” Kimberley: Right. I love the idea of this, the log for awareness, because a lot of people say, “Oh, maybe for half an hour a day.” Once they’ve logged it, they’re like, “Wow, it’s four hours a day.” I think it’s helpful to actually recognize this, like how impactful it is on their life. So, I love that you’re doing that piece. You can only control what you can control. What do you do with the stuff you can’t control? Jon: Oh, you apply heavy doses of self-criticism until you hate yourself enough to never do it again. That’s the other mental ritual that usually happens and people realize, “Oh, I’ve been ruminating,” and they’re angry at themselves. “I should know better.” So, they’re angry at themselves for something they didn’t know they were doing, which is unfair. So, I use the term, I say, “label and abandon.” That’s what you do with all mental rituals. The moment you see it, you give it a name and you drop it. You just drop it on the floor where you were, you don’t finish it up real quick. You don’t analyze too much about it and then drop it. You’re just like, “Oh, I’m holding this thing I must not hold,” and you drop it. Label and abandon. What people tend to do is criticize then label, then criticize some more and then abandon. And the real problem with that is that the self-criticism is in and of itself another mental ritual. It’s a strategy for reducing distress that’s focused on increasing certainty about the content of the obsession. The obsession, in this case, is “I’m never going to get better.” Now I know I’m going to get better because I’ve told myself that I’m being fooled and that I’ll never do that again. It’s not true. But then you wash your hands. They aren’t really clean either. So, none of our compulsions really work. Self-Compassion for Mental Compulsions  Kimberley: Doesn’t have to make sense.  Jon: Yeah. So, I think bringing self-compassion in the moment to be able to recognize it and recognize the urge to self-criticize and really just say like, “Oh, I’m not going to do that. I caught myself ruminating. Well done.” Same thing we do when we meditate. Some people think that meditation has something to do with relaxation or something to do with controlling your mind. It’s actually just a noticing exercise. Your mind wanders, you notice it. “Oh, look at that, I’m thinking.” Back to the breath. That’s a good thing that you noticed that you wandered. Not, “Oh, I wandered, I can’t focus. I’m bad at meditating.” So, it’s really just changing the frame for how people are relating to what’s going on inside.  One, eliminating self-criticism just makes life a lot easier. Two, eliminating the self-criticism and including that willingness to just label the thought pattern or the thought process and drop it right where it is. You can start to catch that earlier and earlier and earlier. So, you’re reducing compulsions. And you’ll see that the activity, the neutralizing, the figuring it out, the using your mental strength against yourself instead of in support of yourself, you could see how that’s sending the signal to the brain. “Wait, this is very important. I need to keep pushing it to the forefront.” There’s something to figure out here. This isn’t a cold case in a box, on a shelf somewhere. This is an ongoing investigation and we have to figure it out. How do we know? Because they’re still trying to figure it out. Kimberley: Right. How much do you think insight has to play here or how much of a role does it play? Jon: Insight plays a role in all forms of OCD. I mean, it plays a role in everything – insight into our relationships, insight into our career aspirations. I think one of the things I’ve noticed, and this is just anecdotal, is that the higher the distress and the poorer the distress regulation skills, often the lower the insight. Not necessarily the other way around. Some people have low insight and aren’t particularly distressed by what’s going on, but if the anxiety and the distress and the discomfort and disgust are so high that the brain goes into a brownout, I noticed that people switch from trying to get me to reassure them that their fears are untrue to trying to convince me that their fears are true. And to me, that represents an insight drop and I want to help them boost up their insight. And again, I think becoming more aware of your mental activity that is voluntary – I’m choosing to put my mind on this, I’m choosing to figure it out, it didn’t just happen. But in this moment, I’m actually trying to complete the problem, the puzzle – becoming more aware that that’s what you’re doing, that’s how you develop insight. And that actually helps with distress regulation. Kimberley: Right. Tell me, I love you’re using this word. So, for someone who struggles with distress regulation, what kind of skills would you give a client or use for yourself? Jon: So, there are many different skills a person could use. And I hesitate to say, “Look, use this skill,” because sometimes if you’re always relying on one skill and it’s not working for you, you might be resistant to using a different skill. In DBT, they have something called tip skills. So, changing in-- drastic changes in temperature, intense exercise, progressive muscle relaxation, pace breathing. These are all ways of shifting your perspective. In a more global sense, I think the most important thing is dropping out of the intellectualization of what’s happening and into the body. So, let’s say the problem, the way you know that you’re anxious is that your muscles are tense and there’s heat in your body and your heart rate is elevated. But there are lots of circumstances in your life where your muscles would be tense and your heart rate will be up and you’ll feel hot, and you might be exercising, for example.  So, that experience alone isn’t threatening. It’s that experience press plus the narrative that something bad is going to happen and it’s because I’m triggered and it’s because I can’t handle the uncertainty and all this stuff. So, it’s doing two things at once. It’s dropping out of the thought process, which is fundamentally the same thing as labeling and abandoning the mental ritual, and then dropping into the body and saying, “What’s happening now is my hands are sweaty,” and just paying attention to it. Okay, alright, sweaty hands. I can be with sweaty hands. Slowing things down and looking at things the way they are, which is not intellectual, as opposed to looking at things the way they could be, or should be, or might have been, which again is a mental ruminative process. Kimberley: Right. Do you find-- I have found recently actually with several clients that they have an obsession. They start to ruminate and then somewhere through there, it’s hard to determine what’s in control and what’s not. So, we want to preface it with that. But things get really out of control once they start to catastrophize even more. So, would you call the catastrophization a mental rumination, or would you call it an intrusive thought? How would you conceptualize that with a client? They have the obsession, they start ruminating, and then they start going to the worst-case scenario and just staying there. Jon: Yeah. There’s different ways to look at it. So, catastrophizing is predicting a negative future and assuming you can’t cope with it, and it’s a way of thinking about a situation. So, it’s investing in a false project. The real project is there’s something unknown about the future and it makes you uncomfortable and you don’t like it. How do you deal with that? That’s worth taking a look at. The false project is, my plane is going to crash and I need to figure out how to keep the plane from crashing. But that’s how the OCD mind tends to work. So, one way of thinking about catastrophizing is it’s a tone it’s a way-- if you can step back far enough and be mindful of the fact that you’re thinking, you can also be mindful of the fact that there is a way that you’re thinking. And if the way that you’re thinking is catastrophizing, you could say, “Yeah, that’s catastrophizing. I don’t need to do that right now.”  But I think to your point, it is also an act. It’s something somebody is doing. It’s like, I’m going to see this through to the end and the hopes that it doesn’t end in catastrophe, but I’m also going to steer it into catastrophe because I just can’t help myself. It’s like a hot stove in your head that you just want to touch and you’re like, “Ouch.” And in that case, I would say, yeah, that’s a mental ritual. It’s something that you’re doing.  I like the concept of non-engagement responses. So, things that you can do to respond to the thought process that aren’t engaging it directly, that are helping you launch off. Because like I said, before you label and abandon. But between the label and abandon, a lot of people feel like they need a little help. They need something to drive a wedge between them and the thought process. Simply dropping it just doesn’t feel enough, or it’s met with such distress because whenever you don’t do a compulsion, it feels irresponsible, and they can’t handle that distress. So, they need just a little boost.  What do we know about OCD? We know that the one thing you can’t do effectively is defend yourself because then you’re getting into an argument and you can’t win an argument against somebody who doesn’t care what the outcome of the argument is. The OCD just wants to argue. So, any argument, no matter how good it is, the OCD is like, “Great, now we’re arguing again.” How to Manage Mental Compulsions  Kimberley: Yeah. “I got you.” Jon: Yeah. So, what are our options? What are our non-engagement response options? One, which I think is completely undersold, is ignoring it. Just ignoring it. Again, none of these you want to only focus on because they could all become compulsive. And then you’re walking around going, “I’m ignoring it, I’m ignoring it.” And then you’re just actually avoiding it. But it’s completely okay to just choose not to take yourself seriously. You look at your email and it’s things that you want. And then in there is a junk mail that just accidentally got filtered into the inbox instead of the spam box, and mostly what you do is ignore it. You don’t even read the subject of it. You recognize that in the moment, it’s spam and you move on as if it wasn’t even there. Then there’s being mindful of it. Mindful noting. Just acknowledging it. You take that extra beat to be like, “Oh yeah, there’s that thought.” In act, they would call this diffusion. I’m having a thought that something terrible is going to happen. And then you’re dropping it. So, you’re just stepping back and be like, “Oh, I see what’s going on here. Okay, cool. But I’m not going to respond to it.” And then as we get into more ERP territory, we also have the option of agreeing with the uncertainty that maybe, maybe not. “What do I know? Okay. Maybe the plane is going to crash. I can’t be bothered with this.” But you have to do it with attitude because if you get too involved in the linguistics of it, then it’s like, well, what’s the potential that it’ll happen? And you can’t play that game, the probability game.  But it is objectively true that any statement that begins with the word “maybe” has something to it. Maybe in the middle of this call, this computer is going to explode or something like that. It would be very silly for me to worry about that, but you can’t deny that the statement is true because it’s possible. It’s maybe. So, just acknowledging that, be like, “Okay, fine. Maybe.” And then dropping it the way you would if you had some thought that you didn’t find triggering and yet was still objectively true.  And then the last one, which can be a lot of fun, can also be overdone, can also become compulsive, but if done well can make life a little bit more fun, is agreeing with the thought in an exaggerated humorous, sarcastic way. Just blowing it up. So, you’re out doing the OCD. The OCD is very creative, but you’re more creative than the OCD. Kimberley: Can you give me examples? Jon: Well, the OCD says your plane is going to crash. He said, your plane is going to crash into a school. Just be done with it, right? And that kind of shock where the bully is expecting you to defend yourself and instead, you just punched yourself in the face. He’s like, “Yeah, you’re weird. I’m not going to bother you anymore.” That’s the relationship one wants with their OCD. Kimberley: That’s true. I remember in a previous episode we had with, I think it was when you had brought out your team book about saying “Good one bro,” or “brah.” Jon: “Cool story, brah.” Yeah.  Kimberley: Cool story brah. And I’ve had many of my patients say that that was also really helpful, is there’s a degree of attitude that goes with that, right? Jon: Yeah. And because again, it’s just a glitch in the system that, of course, you’re conditioned to respond to it like it’s serious. But once you realize it is, once you get the hint that it’s OCD, you have to shift out of that, “Oh, this is very important, very serious,” and into this like, “This is junk mail.” And if you actually look at your junk mail, none of it is serious. It sounds serious. It sounds like I just inherited a billion dollars from some prince in Nigeria. That sounds very important. I Kimberley: I get that email every day pretty much.  Jon: Yeah. But I look at it and immediately I know that it’s not serious, even though the words in it sound very important.  Kimberley: Yeah. So, for somebody, I’m sitting in the mind of someone who has OCD and is listening right now, and I’m guessing, to those who are listening, you’re nodding and “Yes, this is so helpful. This is so helpful.” And then we may finish the episode and then the realization that “This is really hard” comes. How much coaching, how much encouragement? How do you walk someone through treatment who is finding this incredibly difficult? Jon: I want to live in your mind. In my mind, let that same audience member is like, “This guy sucks.” Kimberley: My mind isn’t so funny after we start the recording. So, you’re cool. Jon: Who is this clown? Again, it’s back to self-compassion. I’m sure people are tired of hearing about it, but it’s simply more objective. It is hard. And if you’re acting like it shouldn’t be hard or you’re doing something wrong as a function, it’s hard because you’re doing something wrong, you’re really confused. How could that be? You could not have known better than to end up here. Everything that brought you here was some other thought or some other feeling, and you’re just responding to your environment. The question is right now where you have some control, what are you going to do with your attention? Right now, you’re noticing, “Oh man, it’s really hard to resist mental rituals. It’s hard to catch them. It’s hard to let go of them. It’s hard to deal with the anxiety of thinking because I didn’t finish the mental ritual. Maybe I missed something and somebody’s going to get hurt or something like that because I didn’t figure it out.”  It is really hard. I don’t think we should pretend that it’s easy. We should acknowledge that it’s hard. And then we should ask, “Okay, well, I made a decision that I’m going to do this. I’m going to treat my OCD and it looks like the treatment for OCD is I’m going to confront this uncertainty and not do compulsions. So, I have to figure out what to do with the fact that it’s hard.” And then it’s back to the body. How do you know that it’s hard? “Well, I could feel the tension here and I could feel my heart rate and my breath.” So, let’s work with that. How can I relate to that experience that’s coming up in a way that’s actually helpful? The thing that I’ve been thinking about a lot lately is this idea that the brain is quick to learn that something is dangerous. Something happens and it hurts, and your brain is like, “Yeah, let’s not do that again.” And you might conclude later that that thing really wasn’t as dangerous as you thought. And so, you want to re-engage with it. And you might find that’s really hard to do, which is why exposure therapy is really hard because it’s not like a one-and-done thing. You have to practice it because the brain is very slow to learn that something is safe, especially after it’s been taught that it’s dangerous.  But that’s not a bad thing. You want a brain that does that. You don’t want a brain that’s like, “Yeah, well, I got bit by one dog, but who cares? Let’s go back in the kennel.” You want a brain that’s like, “Hold on. Are you sure about this?” That whole process of overcoming your fears, I think people, again, they’re way too hard on themselves. It should take some time and it should be slow and sluggish. You look like you’re getting better, and then you slip back a little bit, because it’s really just your brain saying, “Listen, I’m here to keep you safe, and I learned that you weren’t, and you are not following rules. So, I’m pulling you back.” That’s where that is coming from. So, that’s the hard feeling. That’s the hard feeling right there. It’s your brain really trying to get you to say, “No, go back to doing compulsions. Compulsions are keeping you safe.” You have to override that circuit and say, “I appreciate your help. But I think I know something that you don’t. So, I’m going to keep doing this.” And then you can relate to that hard feeling with like, “Good, my brain works. My brain is slow and sluggish to change, but not totally resistant. Over time, I’m going to bend it to my will and it will eventually let go, and either say this isn’t scary anymore or say like, ‘Well, it’s still scary, but I’m not going to keep you from doing it.’” Kimberley: Right. I had a client at the beginning of COVID I think, and the biggest struggle-- and this was true for a lot of people, I think, is they would notice the thought, notice they’re engaging in compulsions and drop it, to use your language, and then go, “Yay, I did that.” And then they would notice another thought in the next 12 seconds or half a second, and then they would go, “Okay, notice it and drop it.” And then they’d do it again. And by number 14, they’re like, “No, this is--” or it would either be like, “This is too hard,” or “This isn’t working.” So, I’m wondering if you could speak to-- we’ve talked about it being “too hard.” Can you speak to your ideas around “this isn’t working”? Jon: Yeah. That’s a painful thought. I think that a lot of times, people, when they say it isn’t working, I ask them to be more specific because their definition of working often involves things like, “I was expecting not to have more intrusive thoughts,” or “I was expecting for those thoughts to not make me anxious.” And when you let go of those expectations, which isn’t lowering them at all, it’s just shifting them, asking, well, what is it that you really want to do in your limited time on this earth? You’re offline for billions of years. Now you’re online for, I don’t know, 70 to 100 if you’re lucky, and then you’re offline again. So, this is the time you have. So, what do you want to do with your attention? And if it’s going to be completely focused on your mental health, well, that’s a bummer. You need to be able to yes, notice the thought, yes, notice the ritual, yes, drop them both, and then return to something.  In this crazy world we’re living in now where we’re just constantly surrounded by things to stimulate us and trigger us and make us think, we have lots of things to turn to that aren’t necessarily healthy, but they’re not all unhealthy either. So, it’s not hard to turn your attention away from something and into a YouTube video or something like that. It is more challenging to shift your attention away from something scary and then bring it to the flavor of your tea. That’s a mindfulness issue. That’s all that is. Why is one thing easier than the other? It’s because you don’t think the flavor of your tea is important. Why? Because you’re just not stimulated by the firing off of neurons in your tongue and the fact that we’re alive on earth and that we’ve evolved over a million years to be able to make and taste tea. That’s not as interesting as somebody dancing to a rap song. I get that, but it could be if you’re paying a different kind of attention. So, it’s just something to consider when you’re like, “Well, I can’t return to the present because it doesn’t engage me in there.” Something to consider, what would really engage you and what is it about the present that you find so uninteresting? Maybe you should take another look. Kimberley: Right. For me, I’m just still so shocked that gravity works. Whenever I’m really stuck, I will admit, my rumination isn’t so anxiety-based. I think it’s more when I’m angry, I get into a ruminative place. We can do that similar behavior. So, when I’m feeling that, I have to just be like, “Okay, drop away from, that’s not helpful. Be aware and then drop it.” And then for me, it’s just like, “Wow, the gravity is pulling me down. It just keeps blowing my mind.” Jon: Yeah. That’s probably a better use of your thought process than continuing to ruminate. But you bring up another point. I think this speaks more closely to your question about when people say it’s not working. I’m probably going to go to OCD jail for this, but I think to some extent, when you get knocked off track by an OCD trigger, because you made me think of it when you’re talking about anger. Like, someone says something to you and makes you angry and you’re ruminating about it. But it’s the same thing in OCD. Something happens. Something triggers you to think like, “I’m going to lose my job. I’m a terrible parent,” or something like that. You’re just triggered. This isn’t just like a little thought, you’re like, “Oh, that’s my OCD.” You can feel it in your bones. It got you. It really got you.  Now, you can put off ruminating as best you can, but you’re going to be carrying that pain in your bones for a while. It could be an hour, could be a day, could be a couple of days. Now, if it’s more than a couple of days, you have to take ownership of the fact that you are playing a big role in keeping this thing going and you need to change if you want different results. But if it’s less than a couple of days and you have OCD, sometimes all you can do is just own it. “All right, I’m just going to be ruminating a lot right now.” And I’m not saying like, hey, sit there and really try to ruminate. But it’s back to that thing before, like your brain is conditioned to take this seriously, and no matter how much you tell yourself it’s not serious, your brain is going to do what your brain is going to do. And so, can you get your work done? Try to show up for your family, try to laugh when something funny happens on TV, even while there’s this elephant sitting on your chest. And every second that you’re not distracted, your mind is like, “Why did they say that? Why did I do that? What’s going to happen next?” And really just step back from it and say like, “You know what, it’s just going to have to be like this for now.” What I see people do a lot is really undersell how much that is living with OCD. “I’m not getting better.” I had this happen actually just earlier today. Somebody was telling me, walking me through this story that was just full of OCD minds that they kept stepping on and they kept exploding and they were distressed and everything. And yet, throughout the whole process, the only problem was they were having OCD and they were upset. But they weren’t avoiding the situation. They weren’t asking for reassurance and they weren’t harming themselves in any way. They were just having a rough time because they just had their buttons pushed. It was frustrating because they wouldn’t acknowledge that that is a kind of progress that is living with this disorder, which necessarily involves having symptoms.  I don’t want people to get confused here and say like, “This is as good as it gets,” or “You should give up hope for getting better.” It’s not about that. Part of getting better is really owning that this is how you show up in the world. You have your assets and your liabilities, and sometimes the best thing to do is just accept what’s going on and work through it in a more self-compassionate way. Kimberley: Right. I really resonate with that too. I’ve had to practice that a lot lately too of accepting my humanness. Because I think there are times where you catch yourself and you’re like, “No, I should be performing way up higher.” And then you’re like, “No, let’s just accept these next few days are going to be rough.” I like that. I think that that’s actually more realistic in terms of what recovery really might look like. This is going to be a rough couple of days or a rough couple of hours or whatever it may be. Jon: Yeah. If you get punched hard enough in the stomach and knock the wind out of you, that takes a certain period of time before you catch your breath. And if you get punched in the OCD brain, it takes a certain amount of time before you catch your breath. So, hang on. It will get better. And again, this isn’t me saying, just do as many compulsions as you want. It’s just, you’re going to do some, especially rumination and taking ownership of that, “Oh man, it’s really loud in there. I’ve been ruminating a lot today. I’ll just do the best I can.” That’s going to be a better approach than like, “I’m going to sit and track every single thought and I’m going to burn it to the ground. I’m going to do it every five seconds.” Really, you’re just going to end up ruminating more that way. Kimberley: Right. And probably beating yourself up more. Jon: Exactly. Kimberley: Right. Okay. I feel like that is an amazing place for us to end. Before we do, is there anything you feel like we’ve missed that you just want people to know before we finish up? Jon: I guess what’s really important to know since we’re talking about mental compulsions is that it’s not separate from the rest of OCD and it’s not harder to treat. People have this idea that, well, if you’re a compulsive hand-washer, you can just stop washing your hands or you can just remove the sink or something like that. But if you’re a compulsive ruminator about whether or not you’re going to harm someone or you’re a good person or any of that stuff, somehow that’s harder to treat. I’ve not found this to be the case. Anecdotally, I haven’t seen any evidence that this is really the case in terms of research. You might be harder on yourself in some ways, and that might make your symptoms seem more severe, but that’s got nothing to do with how hard you are to treat or the likelihood of you getting better. Most physical rituals are really just efforts to get done what your mental rituals are not doing for you. So, many people who are doing physical rituals are also doing mental rituals and those who aren’t doing physical rituals. Again, some people wash their hands. Some people wash their minds. Many people do both. A lot of this stuff, it has to do with like, “I expect my mind to be one way, and it’s another.” And that thing that’s making it another is a contaminant, “I hate it and I want to go away and I’m going to try to get it to go away.” And that’s how this disorder works. Kimberley: Right. It’s really, really wonderful advice. I think that it’s actually really great that you covered that because I think a lot of people ask that question of, does that mean that I’m going to only have half the recovery of someone who does physical compulsions or just Googles or just seeks reassurance? So, I think it’s really important. Do you feel like someone can overcome OCD if their predominant compulsion is mental? Jon: Absolutely. They may even have assets that they are unaware of that makes them even more treatable. I mean, only one way to find out. Kimberley: Yeah. I’m so grateful to you. Thank you for coming on. This is just filling my heart so much. Thank you. Jon: Thank you. I always love speaking with you. Kimberley: Do you want to share where people can find you and all your amazing books and what you’re doing? Jon: My hub is OCDBaltimore.com. That’s the website for the Center for OCD and Anxiety at Sheppard Pratt, and also the OCD program at The Retreat at Sheppard Pratt. And I’m on Instagram at OCDBaltimore, Twitter at OCDBaltimore. I don’t know what my Facebook page is, but it’s out there somewhere. I’m not hard to find. Falling behind a little bit on my meme game, I haven’t found anything quite funny or inspiring enough. I think I’ve toured through all of my favorite movies and TV shows. And so, I’m waiting for some show that I’m into to inspire me. But someone asked me the other day, “Wait, you stopped with the memes.” Kimberley: They’re like, nothing’s funny anymore. Jon: I try not to get into that headspace. Sometimes I do think that way, but yeah, the memes find me. I don’t find them. Kimberley: I love it. And your books are all on Amazon or wherever you can buy books, I’m imagining. Jon: Yes. The OCD Workbook For Teens is my most recent one and the second edition of the Mindfulness Workbook for OCD is also a relatively recent one. Kimberley: Amazing. You’re amazing. Thank you so much. Jon: Thank you.

SUMMARY: Welcome to the first week of this 6-part series on Mental Compulsions.  This week is an introduction to mental compulsions.   Ove the next 6 weeks, we will hear from many of the leaders in our feild on how to manage mental compulsions using many different strategies and CBT techniques.  Next week, we will have Jon Hershfield to talk about how he using mindfulness to help with mental compulsions and mental rituals. In This Episode: What is a mental compulsion? Is there a different between a mental compulsion and mental rumination and mental rituals? What is a compulsion? Types of Mental Compulsions Links To Things I Talk About: How to reach Jon https://www.sheppardpratt.org/care-finder/ocd-anxiety-center/ 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 282 and the first part of a six-part series that I am overwhelmed and honored to share with you – all on mental compulsions. I have wanted to provide a free resource on mental compulsions for years, and I don’t know why, but I finally got enough energy under my wings and I pulled it off and I could not be more excited. Let me tell you why. This is a six-part series. The next six episodes will be dedicated to managing mental compulsions, mental rituals, mental rumination. I will be presenting today the first part of the training, which is what we call Mental Compulsions 101. It will talk to you about all the different types of mental compulsions, give you a little bit of starter training. And then from there, it gets exciting. We have the most incredible experts in the field, all bringing their own approach to the same topic, which is how do we manage mental compulsions? We don’t talk about mental compulsions enough. Often, it’s not addressed enough in treatment. It’s usually very, very difficult to reduce or stop mental compulsion. I thought I would bring all of the leaders, not all of them, the ones I could get and the ones that I had the time to squeeze into this six-part series, the ones that I have found the most beneficial for my training and my education for me and my stuff. I asked very similar questions, all with the main goal of getting their specific way of managing it, their little take, their little nuance, fairy tale magic because they do work magic. These people are volunteering their time to provide this amazing resource. Welcome to number one of a six-part series on mental compulsions. I hope you get every amazing tool from it. I hope it changes your life. I hope you get out your journal and you write down everything that you think will help you and you put it together and you try it and you experiment with it and you practice and you practice because these amazing humans are so good and they bring such wisdom. I’m going to stop there because I don’t want to go on too much. Of course, I will be starting. And then from there, every week for the next five weeks after this one, you will get a new take, a new set of tools, a new way of approaching it. Hopefully, it’s enough to really get you moving in managing your mental compulsion so you can go and live the life that you deserve, so that you can go and do the things you want without fear and anxiety and mental compulsions taking over your time. Let’s do this. I have not once been more excited, so let’s do this together. It is a beautiful day to do hard things and so let’s do it together. Welcome, everybody. Welcome to Mental Compulsions 101. This is where I set the scene and teach you everything you need to know to get you started on understanding mental compulsions, understanding what they are, different kinds, what to do, and then we’re going to move over and let the experts talk about how they personally manage mental compulsions. But before they shared their amazing knowledge and wisdom, I wanted to make sure you all had a good understanding of what a mental compulsion is and really get to know your own mental compulsions so you can catch little, maybe nuanced ways that maybe you’re doing mental compulsions. I’m going to do this in a slideshow format. If you’re listening to this audio, there will be a video format that you can access as well here very soon. I will let you know about that. But for right now, let’s go straight into the content. Who is Kimberley Quinlan? First of all, who am I? My name is Kimberley Quinlan. A lot of you know who I am already. If you don’t, I am a marriage and family therapist in the State of California. I am an Australian, but I live in America and I am honored to say that I am an OCD and Anxiety Specialist. I treat all of the anxiety disorders. I also treat body-focused repetitive behaviors, and we specialize in eating disorders as well. The reason I tell you all that is you probably will find that many different disorders use mental compulsions as a part of their disorder. My hope is that you all feel equally as included in this series. Now, as well as a therapist, I’m also a mental health educator. I am the owner, the very proud owner of CBTSchool.com. It is an online platform where we offer free and paid resources, educational resources for people who have anxiety disorder orders or want to just improve their mental health. I am also the host of Your Anxiety Toolkit Podcast. You may be watching this in a video format, or you may actually be listening to this because it will also be released. All of this will be offered for free on Your Anxiety Toolkit Podcast as well. I wanted to just give you all of that information before we get started so that you know that you can trust me as we move forward. Here we go. What is a Mental Compulsion? First of all, what is a mental compulsion? Well, a mental compulsion is something that we do mentally. The word “compulsion” is something we do, but in this case, we’re talking about not a physical behavior, but a mental behavior. We do it in effort to reduce or remove anxiety, uncertainty, some other form of discomfort, or maybe even disgust. It’s a behavior, it’s a response to a discomfort and you do that response in a way to remove or resist the discomfort that you’re feeling. Now, we know that in obsessive-compulsive disorder, there are a lot of physical compulsions. A lot of us know these physical compulsions because they’ve been shown in Hollywood movies. Jumping over cracks, washing our hands, moving objects – these are very common physical compulsions – checking stoves, checking doors. Most people are very understanding and acknowledge that as being a part of OCD. But what’s important to know is that a lot of people with OCD don’t do those physical compulsions at all. In fact, 100% of their compulsions are done in their head mentally. Now, this is also very true for people with generalized anxiety. It’s also very true for some people with health anxiety or an eating disorder, many disorders engage in mental compulsions. Mental Compulsion Vs Mental Ritual? For the sake of this series, we use the word “mental compulsion,” but you will hear me, as we have guests, you will hear me ask them, do you call them “mental compulsions”? Some people use the word “mental ritual.” Some people use the word “mental rumination.” There are different ways, but ultimately throughout this series, we’re going to mostly consider them one and the same. But again, just briefly, a mental compulsion is something you do inside of your mind to reduce, remove, or resist anxiety, uncertainty, or some form of discomfort that you experience. Let’s keep moving from here. What is a Compulsion Now, who does mental compulsions? I’ve probably answered that for you already. Lots of people do mental compulsions. Again, it ranges over a course of many different anxiety disorders and other disorders, including eating disorders. But again, generalized anxiety, social anxiety, phobias, health anxiety, post-traumatic stress disorder. Some of the people with that mental disorder also engage in mental compulsions. Predominantly, we talk a lot about the practice of mental compulsions for people with obsessive-compulsive disorder. The thing to remember is it’s more common than you think, and you’re probably doing more of them than you guessed. I’m hoping that this 101 training will help you to be able to identify the compulsions you’re doing so that when we go through this series, you have a really good grasp of where you could practice those skills. Now, often when people find out they’re doing mental compulsions, they can be very hard on themselves and berate and criticize themselves for doing them. I really want to make this a judgment-free and punish-free zone where you’re really gentle with yourself as you go through this series. It’s very important that you don’t use this information as a reason to beat yourself up even more. So let’s make a deal. We’re going to be as kind and non-judgmental as we can, as we move through this process. Compassion is always number one. Do we have a deal? Good. Types of Mental Compulsions Here is the big question: Are there different types of mental compulsions? Now, I’m going to proceed with caution here because there is no clear differentiation between the different compulsions. I did a bunch of research. I also wrote a book called The Self-Compassion Workbook For OCD. There is no specific way in which all of the psychological fields agree on what is different types of mental compulsions. There are some guidelines, but there’s no one list. I want to proceed with caution first by letting you know this list that we use with our patients. Now, as you listen, you may have different names for them. Your therapist may use different terminology. That’s all fine. It doesn’t mean what you have done is wrong or what we are doing is wrong. To be honest with you, this would be a 17-hour training if I were to be as thorough as listing out every single one. For the sake of clarity and simplicity, I’ve put them into 10 different types of mental compulsions. If you have ones that aren’t listed, that doesn’t mean it’s not a mental compulsion. I encourage you to just check in. If you have additional or you have a different name, that’s totally okay. Totally okay. We’re just using this again for the sake of clarity and simplicity. Here we go. 1. Mental Repeating The first mental compulsion that we want to look at is mental repeating. This is where you repeat or you make a list of individual items or categories. It can also involve words, numbers, or phrases. Often people will do this for two reasons or more, like I said, is they may repeat them for reassurance. They may be repeating to see whether they have relief. They may be repeating them to see if they feel okay. They may be repeating them to see if any additional obsessions arise, or they may be repeating them to unjinx something. Now, that’s not a clinical term, so let’s just put that out there. What I mean by this is some people will repeat things because they feel like the first time something happened, it was jinx. Like it will mean something bad will happen. It’s been associated with something bad, so they repeat it to unjinx it. We’ll talk more about neutralizing compulsions here in a second, but that’s in regards to mental repeating. You may do it for a completely different reason. Don’t worry too much as we go through this on why you do it. Just get your notepad out and your pencil out and just take note. Do I do any mental repeating compulsions? Not physical. Remember, we’re just talking about mental in this series. 2. Mental Counting This is where you either count words, count letters, count numbers, or count objects. Again, you will not do this out loud. Well, sometimes you may do it out loud in addition to mental, but we’re mostly talking about things you would do silently in your head. Again, you may do this for a multitude of reasons, but again, we want to just keep tabs. Am I doing any mental counting or mental counting rituals? 3. Neutralization Compulsions or Neutralizing Compulsions What we’re talking about here is you’re replacing an obsession with a different image or word. Let’s say you are opening your computer. As you opened the computer, you had an intrusive thought that you didn’t like. And so in effort to neutralize that thought, you would have the opposite thought. Let’s say you had a thought, a number. Let’s say you’ve had the number that you feel is a bad number. You may neutralize it by then repeating a positive number, a number that you like, or a safe number. Or you may do a behavior, you may see something being done and you have a negative thought. So then, you recall a different thought or a prayer, it could be also a prayer, to undo that bad feeling or thought or sensation. Now, when it comes to compulsive prayer, that could be done as a neutralization. In fact, I almost wanted to make prayer its own category, because a lot of people do engage in compulsive prayer, particularly those who have moral and scrupulous obsessions. Again, not to say that all prayer is a compulsion at all, but if you are finding that you’re doing prayer to undo a bad thought or a bad feeling or a bad sensation or a bad urge – when I say bad, I mean unwanted – we would consider that a neutralization or a neutralizing compulsion. 4. Hypervigilance Compulsions Now again, this is the term we use in my practice. Remember here before we proceed that hypervigilance is an obsession, meaning it can be automatic, unwanted, intrusive, but it can also be a compulsive behavior. It could be both or it could be one. But when I talk about the term “hypervigilance compulsions,” this is also true for people with post-traumatic stress disorder, is it’s a scanning of the environment. It’s a scanning, like looking around. I always say with my clients, it’s like this little set of eyes that go doot, doot, doot, doot really quick, and they’re scanning for danger, scanning for potential fear or potential problems. They also do that when we’re in a hypervigilance compulsion. We may do that with our thoughts. We’re scanning thoughts or we’re scanning sensations like, is this coming? What’s happening? Where am I feeling things? You may be scanning and doing hypervigilance in regards to feeling like, am I having a good thought or a bad thought or a good feeling or a bad feeling? And then making meaning about that. You may actually also be hypervigilant about your reaction. If let’s say you saw something that usually you would consider concerning and this time you didn’t, you might become very hypervigilant. What does that mean? I need to make sure I always have this feeling because this feeling would mean I’m a good person or only good things will happen. The last one again is emotions, which emotions and feelings can sometimes go in together. Hypervigilant compulsion is something to keep an eye out. It could be simple as you just being hypervigilant, looking king around. Often this is true for people with driving obsessions or panic disorder. They’re constantly looking for when the next anxiety attack is coming. 5. Mental Reassurance We can do physical reassurance, which is looking at Google, asking a friend like, are you sure nothing bad will happen? We can do physical, but we can also do mental reassurance, which is mentally checking to confirm an obsession is not or will not become a threat. This is true for basic like we already talked about and some checking and repeating behaviors. You may mentally stare at the doorknob to make sure it is locked. You may mentally check and check for reassurance once, twice, five times, ten times, or more. If the stove is off or that you are not having arousal is another one, or that you are not going to panic. You may be checking to get reassurance mentally that your fear is not going to happen. Again, some people’s fear is fear itself. The fear of having a panic attack is very common as well. Again, we’re looking for different ways that mentally we are on alert for potential danger or perceived danger. 6. Mental Review We’ve talked a lot about behaviors that we’re doing in alert of anxiety. Mental review is reviewing and replaying past situations, figuring out the meaning of internal experiences, such as, what is the meaning of the thought I had? What is the meaning of the feeling I had? What is the meaning of that sensation? What does that mean? What is the meaning of an image that just showed up intrusively and repetitively in my mind? What is the meaning of an urge I have? This is very true for people with harm obsessions or sexual obsessions. When they feel an urge, they may review for hours, what did that mean? What does that mean about me? Why am I having those? And so the review piece can be very painful. All of these are very painful and take many, many hours, because not only are you reviewing the past, which can be hard because it’s hard to get mental clarity of the past, but then you’re also trying to figure out what does that mean about me or the world or the future. So, just things to think about. To be honest, mental review could cover all of the categories that we’ve covered, because it’s all review in some way. But again, for the sake of clarity and simplicity, I’ve tried to break them up. You may want to break them up in different ways yourself. That is entirely okay. I just wanted to give you a little category here on its own. 7. Mental Catastrophization This is where you dissect and scrutinize past situations with potential catastrophic scenarios. Now, I made an error here because a lot of people do this about the future as well. But we’ll talk about that here in a little bit. Mental catastrophization, if you have reviewed the past and you’re going over all of the potential terrible situations. This is very true for people who review like, what did I say? Was that a silly thing to say? Was that a good thing to say? What would they think about me? Mental catastrophization is reviewing the past, but is also the future and reviewing every possible catastrophic scenario or opportunity that happened. Whether it happened or not, it doesn’t really matter when it comes to mental compulsions. Usually, when someone does a mental compulsion, they’re reviewing maybe’s, the just in case it does happen, I better review it. 8. Mental Solving Very similar, again, which is anticipating future situations with or without potential what-if scenarios. Very similar to catastrophization compulsions. This is where you’re looking into the future and going, “What if this happens? What if that happens? What if this happens? Well, what if that happens?” and going through multiple, sometimes dozens of scenarios of the worst-case scenarios on what may or may not happen. Again, it usually involves a lot of catastrophizing. But again, these are all safety behaviors. None of this means there’s anything wrong with you or that you’re bad or that you’re not strong. Remember, our brain is just trying to survive. In the moment when we are doing these, our brain actually thinks it’s coming up with solutions, but what we have to do, and all of the guests will talk about this, is recognize. Most of the time, the problem isn’t actually happening. We’re just having thoughts that it’s happening. Again, this is reviewing thoughts of potential what-if scenarios. 9. Mental Self-Punishment I talk a lot about this in my book, The Self-Compassion Workbook For OCD. Mental self-punishment is a compulsion, a mental compulsion that is not talked about enough. One is criticizing, withholding pleasure, harshly disciplining yourself for your obsessions or even the compulsions that you’ve done. Often, we do this as a compulsion, meaning we think that if we punish ourselves, that will prevent us from having the obsession or the compulsion in the future. The fact here is beating yourself up actually doesn’t reduce your chances of having thoughts and feelings and sensations and behaviors or urges. But that is why we do them. It’s to catch when you are engaging in criticizing or withholding or punishing compulsions. 10. Mental Comparison Again, not a very common use of compulsions, but this is one I like to talk about a lot. Most of my patients with OCD and with anxiety will say that they know for certain that they compare more than their friends and family members who do not have anxiety disorders. I’ve put it here just so that you can catch when you are engaging in mental comparison, which is comparing your own life with other people’s life, or comparing your own life with the idea that you thought you should have had for your life. So, an idea of how your life was supposed to be. This is a compulsive behavior because it’s done again to reduce or remove a feeling or a sensation or a discomfort of anxiety or uncertainty you have around your current situation. It’s really important to catch that as well because there’s a lot of damage that can be done from comparing a lot with other people or from a fantasy that you had about the way your life should or shouldn’t look. Again, we will talk about this in episodes, particularly with Jonathan Grayson. He talks a lot about this one. I just wanted to add that one in as well. They’re the main top 10 mental compulsions. Again, I want to stress, these are not a conclusive list that is the be-all and end-all. A lot of clinicians may not agree and they may have different ways of conceptualizing them. That is entirely okay. I’m never going to pretend to be the knower of all things. That is just one way that we conceptualize it here at our center with our staff and our clients to help patients identify ways in which they’re behaving mentally. Something to think about here, though, is you may find some of your compulsions are in more than one category. You might say, “Well, I do mental comparison, but it’s also a self-punishment,” or “I do mental checking, but it’s also a form of reassurance.” That’s okay too. Don’t worry too much about what section it should be under. Again, it’s very fluid. We want you just to be able to document. It doesn’t matter what category it is particularly. I really just wanted this 101 for you to do an inventory and see, “Oh, wow, maybe I’m doing more compulsions than I thought.” Because sometimes they’re very habitual and we are doing them before we even know we’re doing them. I just want to keep reminding you guys it’s okay if it looks a little messy and it’s okay if your list is a little different. The main question here as we conclude is: How do I stop? Well, the beauty is I have the honor of introducing to you some of the absolute, most amazing therapists and specialists in the planet. I fully wholeheartedly agree with that. While I wish I could have done 20 people, I picked six people who I felt would bring a different perspective, who have such amazing wisdom to share with you on how to manage mental compulsions. Now, why did I invite more than one person? Because I have learned as a clinician and as a human being, there is not one way to treat something. When I first started CBT School, I was under the assumption that there is only one way to do it and it’s the right way or the wrong way. From there, I have really grown and matured into recognizing that what works for one person may not work for the next person. As we go through this series, I may be asking very, very similar questions to each person. You will be so amazed and in awe of the responses and how they bring about a small degree of nuance and a little flare of passion and some creativity of each person and bring in a different theme. I’m so honored to have these amazing human beings who are so kind to offer their time, to offer this series, and help you find what works for you. As you go through, I will continue reminding you, please keep asking yourself, would this work for me? Am I willing to try this? The truth is, all of them are doable for everybody, but you might find for your particular set of compulsions specific tools work better. So trial them, see what works, be gentle, experiment. Don’t give up. It may require multiple tries to really find some little win. Please, just listen, enjoy, take as many notes as you can, because literally, the wisdom that is dropped here is mind-blowing. I’ve been treating OCD for over a decade and I actually stopped a few things after I learned this and went straight to my staff and said, “We have to make a new plan. Let’s implement this. This is an amazing skill for our clients. Let’s make sure we do it.” Even I, I’m a student of some of these amazing, amazing people. How do I stop? Stay tuned, listen, learn, take notes, and most importantly, put it into practice. Apply. That’s where the real change happens. Now, before we finish, please do note this series should not replace professional healthcare. This or any product provided by CBT School should be used for education purposes only, so please take as much as you can. If you feel that you need more support, please reach out to a therapist in your area who can help you use these tools and maybe pick a part. Maybe there’s a few things that you need additional help with, and that is okay. Thank you, guys. I am so excited to share this with you. Have a wonderful day.

SUMMARY:  This episode addresses some common questions people have about anxiety and arousal. Oftentimes, we are too afraid to talk about anxiety and arousal, so I thought I would take this opportunity to address some of the questions you may have and take some of the stigma and shame out of discussing anxiety and how it impacts arousal, orgasm, intimacy, and sexual interactions. In This Episode: How anxiety and arousal impact each other (its a cycle) Arousal Non-Concordance and how it impacts people with anxiety and OCD How to take the shame out of arousal struggles Understanding why anxiety impacts orgasms and general intimacy Links To Things I Talk About: Article I wrote about OCD and Arousal Non-Concordance https://www.madeofmillions.com/articles/whats-going-ocd-arousal Come as You are By Emily Nagoski, PhD Come as You Are Workbook By Emily Nagoski, PhD 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 281. Welcome back, everybody. How are you? It is a beautiful sunny day here in California. We’re actually in the middle of a heatwave. It is April when I’m recording this and it is crazy how hard it is, but I’m totally here for it. I’m liking it because I love summer. Talking about heat, let’s talk about anxiety and arousal today. Shall we? Did you get that little pun? I’m just kidding really. Today, we’re talking about anxiety and arousal. I don’t know why, but lately, I’m in the mood to talk about things that no one really wants to talk about or that we all want to talk about and we’re too afraid to talk about. I’m just going to go there. For some reason, I’m having this strong urge with the podcast to just talk about the things that I feel we’re not talking about enough. And several of my clients actually were asking like, “What resources do you have?” And I have a lot of books and things that I can give people. I was like, “All right, I’m going to talk about it more.” So, let’s do it together. Before we do that, let’s quickly do the review of the week. This one is from, let’s see, Jessrabon621. They said: “Amazing podcast. I absolutely love everything about this podcast. I could listen to Kimberley talk all day and her advice is absolutely amazing. I highly recommend this podcast to anyone struggling with anxiety or any other mental health professional that wants to learn more.” Thank you so much, Jess. This week’s “I did a hard thing” is from Anonymous and they say: “I learned it’s okay to fulfill my emotions and just allow my thoughts and it gave me a sense of peace. Learning self-compassion is my hard thing and I’m learning to face OCD and realize that it’s not my fault. I’m learning to manage and live my life for me like I deserve, and I refuse to let this take away my happiness.” This is just so good. I talk about heat. This is seriously on fire right here. I love it so much. The truth is self-compassion practice is probably my hard thing too. I think that me really learning how to stand up for myself, be there for myself, be tender with myself was just as hard as my eating disorder recovery and my anxiety recovery. I really appreciate Anonymous and how they’ve used self-compassion as their hard thing. Let’s get into the episode. Let me preface the episode by we’re talking about anxiety and arousal. If I could have one person on the podcast, it would be Emily Nagoski. I have been trying to get her on the podcast for a while. We will get her on eventually. However, she’s off doing amazing things. Amazing things. Netflix specials, podcasts, documentaries. She’s doing amazing things. So, hopefully, one day. But until then, I want to really highlight her as the genius behind a lot of these concepts. Emily Nagoski is a doctor, a psychology doctor. She is a sex educator. She has written two amazing books. Well, actually, three or four. But the one I’m referring to today is Come as You Are. It’s an amazing book. But I’m actually in my hand holding the Come as You Are Workbook. I strongly encourage you after you listen to this podcast episode to go and order that book. It is amazing. It’s got tons of activities. It might feel weird to have the book. You can get it on Kindle if you want to have it be hidden, but it’s so filled with amazing information. I’m going to try and give you the pieces that I really want you to take away. If you want more, by all means, go and get the workbook. The workbook is called The Come as You Are Workbook: A Practical Guide to the Science of Sex. The reason I love it is because it’s so helpful for those who have anxiety. It’s like she’s speaking directly to us. She’s like, it’s so helpful to have this context. Here’s the thing I want you to consider starting off. A lot of people who have anxiety report struggles with arousal. We’re going to talk about two different struggles that are the highlight of today. Either you have no arousal because of your anxiety, or you’re having arousal at particular times that concern you and confuse you and alarm you. You could be one or both of those camps. So let’s first talk about those who are struggling with arousal in terms of getting aroused. So the thing I want you to think about is commonly-- and this is true for any mental health issue too, it’s true for depression, anxiety disorders, eating disorders, dissociative disorders, all of them really. But the thing I want you to remember, no matter who you are and what your experience is, even if you have a really healthy experience of your own sexual arousal and you’re feeling fine about it, we all have what’s called inhibitors and exciters. Here is an example. An inhibitor is something that inhibits your arousal. An exciter is something that excites your arousal. Now you’re probably already feeling a ton of judgment here like, “I shouldn’t be aroused by this and I should be aroused by this. What if I’m aroused by this? And I shouldn’t be,” and so forth. I want us to take all the judgment out of this and just look at the content of what inhibits our arousal or excites our arousal. Because sometimes, and I’ll talk about this more, sometimes it’s for reasons that don’t make a lot of sense and that’s okay. Let’s talk about an inhibitor, something that pumps the brakes on arousal or pleasure. It could be either. There’s exciters, which are the things that really like the gas pedal. They just really bring on arousal, bring on pleasure, and so forth. We have the content. The content may be first mental or physical, and this includes your health, your physical health. For me, I know when I am struggling with POTS, arousal is just barely a thing. You’re just so wiped out and you’re so exhausted and your brain is foggy. It’s just like nothing. That would be, in my case, an inhibitor. I’m not going to talk about myself a lot here, but I was just using that as an example. You might say your anxiety or your obsession is an inhibitor. It pumps the brakes on arousal. It makes it go away. Worry is one. It could also be other physical health, like headaches or tummy aches, or as we said before, depression. It could be hormone imbalances, things like that. It’s all as important. Go and speak with your doctor. That’s super important. Make sure medically everything checks out if you’re noticing a dip or change in arousal that’s concerning you. The next one in terms of content that may either excite you or inhibit you is your relationship. If your relationship is going well, you may or may not have an increase in arousal depending on what turns you on. If your partner smells of a certain smell or stench that you don’t like, that may pump the brakes. But if they smell a certain way that you do really like and really is arousing to you, that may excite your arousal. It could also be the vibe of the relationship. A lot of people said at the beginning of COVID, there was a lot of fear. That was really, really strong on the brakes. But then all of a sudden, no one had anything to do and there was all this spare time. All of a sudden, the vibe is like, that’s what’s happening. Now, this could be true for people who are in any partnership or it could be just you on your own too. There are things that will excite you and inhibit your arousal if you’re not in a relationship as well, and that’s totally fine. This is for all relationships. There’s no specific kind. Setting is another thing that may pump the brakes or hit the gas for arousal, meaning certain places, certain rooms, certain events. Did your partner do something that turned you on? Going back to physical, it could also depend on your menstrual cycle. People have different levels of arousal depending on different stages of their menstrual cycle. I think the same is true for men, but I don’t actually have a lot of research on that, but I’m sure there are some hormonal impacts on men as well. There’s also ludic factors which are like fantasy. Whether you have a really strong imagination, that either pumps the brakes or puts the gas pedal in terms of arousal. It could be like where you’re being touched. Sometimes there’s certain areas of your body that will set off either the gas pedal or the brakes. It could be certain foreplay. Really what I’m trying to get at here isn’t breaking it down according to the workbook, but there’s so many factors that may influence your arousal. Another one is environmental and cultural and shame. If arousal and the whole concept of sex is shamed or is looked down on, or people have a certain opinion about your sexual orientation, that too can impact your gas pedal and your brakes pedal. So, I want you to explore this, not from a place of pulling it apart really aggressively and critically, but really curiously and check in for yourself, what arouses me? What presses my brakes? What presses my gas? And just start to get to know that. Again, in the workbook, there’s tons of worksheets for this, but you could also just consider this on your own. Write it down on your own, be aware over the next several days or weeks, just jot down in a journal what you’re noticing. Now, before we move on, we’ve talked about a lot of people who are struggling with arousal, and they’ve got a lot of inhibitors and brake pushing. There are the other camp who have a lot of gas pedal pushing. I speak here directly to the folks who have sexual obsessions because often if you have sexual obsessions, the fact that your sexual obsession is sexual in nature may be what sets the gas pedal off, and all of a sudden, you have arousal for reasons that you don’t understand, that don’t make sense to you, or maybe go against your values. I’ve got a quote that I took from the book and from the workbook of Emily Nagoski. Again, none of this is my personal stuff. I’m quoting her and citing her throughout this whole podcast. She says, “Bodies do not say yes or no. They say sex-related or not sex-related.” Let me say it again. “Bodies do not say yes or no. They say sex-related or not sex-related.” This is where I want you to consider, and I’ve experienced this myself, is just because something arouses you doesn’t mean it brings you pleasure. Main point. We’ve got to pull that apart. Culture has led us to believe that if you feel some groinal response to something, you must love it and want more of it. An example of this is for people with sexual obsessions, maybe they have OCD or some other anxiety disorder, and they have an intrusive thought about a baby or an animal. Bestiality is another very common obsession with OCD or could be just about a person. It could be just about a person that you see in the grocery store. When you have a thought that is sex-related, sometimes because the context of it is that it’s sex-related, your body may get aroused. Our job, particularly if you have OCD, is not to try and figure out what that means. It’s not to try and resolve like, does that mean I like it? Does that mean I’m a terrible person? What does that mean? I want you to understand the science here to help you understand your arousal, to help you understand how you can now shift your perspective towards your body and your mind and the pleasure that you experience in the area of sexuality. Again, the body doesn’t say yes or no, they say it’s either sex-related or not sex-related. Here’s the funny thing, and I’ve done this experiment with my patients before, is if you look at a lamp post or it could be anything, you could look at the pencil you’re holding and then you bring to mind a sexual experience, you may notice arousal. Again, it doesn’t mean that you’re now aroused by pencils or pens. It’s that it was labeled as sex-related, so often your brain will naturally press the accelerator. That’s often how I educate people, particularly who are having arousal that concerns it. It’s the same for a lot of people who have sexual trauma. They maybe are really concerned about the fact that they do have arousal around a memory or something. And then that concerns them, what does that mean about me? And the thing to remember too is it’s not your body saying yes or no, it’s your body saying sex-related or not sex-related. It’s important to just help remind yourself of that so that you’re not responding to the content so much and getting caught up in the compulsive behaviors. A lot of my patients in the past have reported, particularly during times when they’re stressed, their anxiety is really high, life is difficult, any of this content we went through, is they may actually have a hard time being aroused at all. Some people have reported not getting an erection and then it completely going for reasons they don’t understand. I think here we want to practice again non-Judgment. Instead, move to curiosity. There’s probably some content that impacted that, which is again, very, very, normal. this is why when I’m talking with patients – I’ve done episodes on this in the past, and we’ve in fact had sex therapists on the podcast in the past – is they’ve said, if you’ve lost arousal, it doesn’t mean you give up. It doesn’t mean you say, “Oh, well, that’s that.” What you do is you move your attention to the content that pumps the gas. When I mean content, it’s like touch, smell, the relationship, the vibe, being in touch with your body, bringing your attention to the dance that you’re doing, whether it’s with a partner or by yourself, or in whatever means that works for you. You can bring that back. There’s another amazing book called Better Sex Through Mindfulness, and it talks a lot about bringing your attention to one or two sensations. Touch, smell being two really, really great ones. Again, if your goal is to be aroused, you might find it’s very hard to be aroused because the context of that is pressure. I don’t know about you, but I don’t really find pressure arousing. Some may, and again, this is where I want this to be completely judgment-free. There’s literally no right and wrong. But pressure is usually not that arousing. Pressure is not that pleasurable in many cases, particularly when it’s forceful and it feels like you have to perform a certain way. Again, some people are at their best in performance mode, but I want to just remind you, the more pressure you put on yourself on this idea of ending it well is probably going to make some anxiety. Same with test anxiety. The more pressure you put on yourself to get an A, the more you’re likely to spin out with anxiety. It’s really no different. So, here is where I want you to catch and ask yourself, is the pressure I put on myself or is the agenda I put on myself actually pumping the brakes for me when it comes to arousal? Is me trying not to have a thought actually in the context of that, does that actually pump the brakes? Because I know you’re trying not to have the thought so that you can be intimate in that moment and engaged in pleasure. But the act of trying not to have the thought can actually pump the brakes. I hope that makes sense. I want you to get really close to understanding what’s going on for you. Everyone is different. Some things will pump the brakes, some things will pump the accelerator. A lot of the times, thought suppression pumps the brakes. A lot of the times, beating yourself up pumps the brakes. A lot of the time, the more goal, like I have to do it this way, that often pumps the brakes. So, keep an eye out for that. Engage in the exciters and get really mindful and present. A couple of things here. We’ve talked about erections, that’s for people who struggle with that. It’s also true for women or men with lubrication. Some people get really upset about the fact that there may or may not be a ton of lubrication. Again, we’ve been misled to believe that if you’re not lubricated, you mustn’t be aroused or that you mustn’t want this thing, or that there must be something wrong with you, and that is entirely true. A lot of women, when we study them, they may be really engaged and their gas pedal is going for it, but there may be no lubrication. And it doesn’t mean something is wrong. In those cases, often a sex therapist or a sex educator will encourage you to use lubrication, a lubricant. Again, some people, I’ve talked to clients and they’re so ashamed of that. But I think it’s important to recognize that that’s just because somebody taught us that, and sadly, it’s a lot to do with patriarchy and that it was pushed on women in particular that that meant they’re like a good woman if they’re really lubricated. And that’s not true. That’s just fake, false. No science. It has no basis in reality. Now we’ve talked about lubrication. We’ve talked about erection. Same for orgasm. Some people get really frustrated and disheartened that they can’t reach orgasm. If for any reason you are struggling with this, please, I urge you, go and see a sex therapist. They are the most highly trained therapists. They are so sensitive and compassionate. They can talk with you about this and you can target the specific things you want to work on. But orgasm is another one. If you put pressure on yourself to get there, that pumps the brakes often. What I want you to do, and this is your homework, is don’t focus on arousal. Focus on pleasure. Focus on the thing that-- again, it’s really about being in connection with your partner or yourself. As soon as you put a list of to-dos with it is often when things go wrong. Just focus on being present as much as you can, and in the moment being aware of, ooh, move towards the exciters, the gas pedal things. Move away from the inhibitors. Be careful there. Again, for those of you who have anxiety, that doesn’t mean thought suppress. That doesn’t mean judge your thoughts because that in and of itself is an inhibitor often. I want to leave you with that. I’m going to in the future do a whole nother episode about talking more about this idea of arousal non-concordance, which is that quote I use like “The bodies don’t say yes or no, they say sex-related or not sex-related.” I’ll do more of that in the future. But for right now, I want it to be around you exploring your relationship with arousal, understanding it, but then putting your attention on pleasure. Being aware of both, being mindful of both. Most people I know that I’ve talked to about this-- and I’m not a sex therapist. Again, I’m getting all of this directly from the workbook, but most of the clients I’ve talked to about this and we’ve used some worksheets and so forth, they’ve said, when I put all the expectations away and I just focus on this touch and this body part and this smell and this kiss or this fantasy, or being really in touch with your own body, when I just make it as simple as that and I bring it down to just engaging in what feels good – sort of use it as like a north star. You just keep following. That feels good. Okay, that feels good. That doesn’t feel so great. I’ll move towards what feels good – is moving in that direction non-judgmentally and curiously that they’ve had the time of their lives. I really just want to give you that gift. Focus on pleasure. Focus on non-judgmentally and curiously, being aware of what’s current and present in your senses. That’s all I got for you for today. I think it’s enough. Do we agree? I think it’s enough. I could talk about this all day. To be honest, and I’ve said this so many times, if I had enough time, I would go back and I would become a sex therapist. It is a huge training. Sex therapists have the most intensive, extensive training and requirements. I would love to do it. But one day, I’ll probably do it when I’m 70. And that will be awesome. I’ll be down for that, for sure. I just love this content. Now, again, I want to be really clear. I’m not a sex therapist. I still have ones to learn. I still have. Even what we’ve covered today, there’s probably nuanced things that I could probably explain better. Again, which is why I’m going to stress to you, go and check out the book. I’m just here to try and get you-- I was thinking about this. Remember, I just recently did the episode on the three-day silent retreat and I was sitting in a meditation. I remember this so clearly. I’m just going to tell you this quick story. I was thinking. For some reason, my mind was a little scattered this day and something came over with me where I was like, “Wouldn’t it be wonderful if I didn’t just treat anxiety disorders, but I treated the person and the many problems that are associated with the anxiety disorder? Isn’t that a beautiful goal? Isn’t that so? Because it’s not just the anxiety, it’s the little tiny areas in our lives that it impacts.” That’s when I, out of me, as soon as I finished the meditation, I went on to my-- I have this organization board that I use online and it was arousal, let’s talk about pee and poop, which is one episode we recently did. Let’s talk about all the things because anxiety affects it all. We can make little changes in all these areas and little changes. Slowly, you get your life back. I hope this gives you a little bit of your sexual expression back, if I could put it into words. Maybe not expression, but just your relationship with your body and pleasure. I love you. Thank you for staying with me for this. This was brave work you’re doing. You probably had cringy moments. Hopefully not. Again, none of this is weird, wrong, bad. This is all human stuff. Finish up, again, do check out the book. Her name is Emily Nagoski. I’ll leave a link in the show notes. One day we’ll get her on. But in the meantime, I’ll hopefully just give you the science that she’s so beautifully given us. Have a wonderful day. I’ll talk to you soon. See you next week. Please do leave a review. It helps me so much. If you have a few moments, I would love a review, an honest review from you. Have a good day.

In this week’s podcast episode, we are reflecting on the question, “Does anxiety make you need to pee or poop? Yes, you read that right! Today, we are talking ALL about how anxiety can cause frequent urination and the fear of peeing your pants. Have you found yourself getting anxious you might need to pee or poop in public which, in turn, makes you need to pee or poop in public? Bathroom emergencies are way more common than you think. I even share a story of how I, myself, had to handle the urgency to 🏃🏼‍♀️🏃🏿‍♂️ to the restroom. In This Episode: Why do we need to pee and poop when we are anxious? What causes the psychological need to urinate or defecate when anxious? How to stop anxiety Urination How to manage a fear of peeing your pants or pooping your pants How to use mindfulness and self-compassion when experiencing nervous pee syndrome Links To Things I Talk About: 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 280. Welcome back, everybody. I am so thrilled to have you here with me again today. Today’s format is going to be a little different. I have fused the “I did the hard thing” with the question that we’re going to address today. Usually, I sit down to the microphone and I look at my screen and I think about what I want to talk about, and I just start talking about it. To be honest, that is how this show goes. It has always been how this show has gone. But a follower on Instagram reached out to me this week and posed a really great question. So, with her permission, I will anonymously invite you to listen to the question, and then we’re going to talk about some solutions. The reason I wanted to go word for word is I think you’re probably going to get what she’s saying, because I’ve been in this position. I know most of my clients have been in this position. It’s not the funniest thing to talk about. I mean, I love talking about it, but it’s not the funniest thing for you to talk about, or often people have a lot of shame and embarrassment around this topic. So, I wanted to just, let’s just talk about it. Now, the reason I say I love to talk about it is, you know probably from previous episodes, I commonly ask my clients pretty personal questions. And often questions are like, are you prioritizing time to pee and poop? Are you holding your pee and poop? My job is to ask the questions that people are often too afraid to bring up. I often ask some personal questions about sexual arousal and things like that, again, because I have been trained to understand there’s a lot of stigma and shame, and embarrassment around these topics. And so I try to de-stigmatize them and take the shame out of them by just addressing them because they’re normal human struggles that we have. As you may imagine, today, we’re talking about anxiety and pee and poop, and how anxiety can often make us feel like we urgently need to pee or/and poop. That’s the topic of today. I’m going to read you this. It’s a two-part question. I’m going to address them separately, but all from the same situation. It said: “Kim, I hope you are well. I was reading your post yesterday about the hardest part of facing your fear.” To give you some backstory, I did a post on what the hardest things about facing fears are. I posed this question to Instagram and everyone wrote in. And using the results of what everyone wrote in, I created a post. And number seven was physical symptoms, especially bowel issues, and it really resonated with me. Why do we need to pee and poop when we are anxious? “You have said before that when you get feelings of discomfort, to just sit with it and do nothing.” That’s a common theme I talk about, is if you have discomfort, do nothing at all. You just sit with it. “But when it comes to bowel issues or needing to urinate due to anxiety, I get confused at what to do. Should I be sitting with it or going to the loo because that’s what my body needs? There are sort of two parts to my anxiety. With this, I’ll give you an example.” She said, “This weekend, I’m going to a christening and I get anxious for these types of events, like christenings, weddings, theater, anywhere where there is lots of people and they sit together in a certain way. I feel anxious about needing to go to the bathroom. It’s almost like I’m anxious of the symptom of anxiety.” Yes. Now this is exactly what it is like for so many people, and it’s a really great question. Here is my response. Naturally, it’s a normal part of the human instinct to need to pee and poop when you’re anxious. Hundreds of thousands of years ago, when we were faced with danger or some kind of threat, in order to get away from that threat, usually you needed to be able to run many, many, many miles in a very short period of time. Now, we have cars and planes to get away from danger, or we have technology to help us to get away from danger. But back we needed to run that long-distance and exert a lot of energy. And so naturally, our bodies get rid of weight and waste so that you can be prepared to run a long distance away from the threat. Often the easiest way to get rid of that waste and weight is to defecate (to go poop) and to urinate, which is to go pee, or in some cases, throw up. Some people when they’re anxious, because their brain has detected danger, whether there’s danger or not, you may do one of those three things. That’s a very, very normal approach to the fight, flight, and freeze. So, in this case, let’s say your brain has set off a false alarm and is saying there’s going to be lots of people there, and what if you need to pee and poop? So now you’re afraid of the symptom of anxiety like they’ve asked. What do you do? So here is my answer to that. When we have any symptoms of anxiety – increase in heart rate, sweating, lots of racing, thoughts, it could be tummy ache, it could be the need to urinate – yeah, we do want to practice the art of sitting with it, meaning tolerating it without reacting to it in an aversive way, meaning trying to resist it, make it go away, how can we remove this discomfort from our life? When we do that, we get into a cycle where you’re constantly trying to get rid of discomfort and that keeps you stuck. In this situation, yeah. If you have a slight urge to urinate or to go to the bathroom, if you’re able to, do try to tolerate that discomfort. However, if there’s a strong urge to go to the bathroom, there is absolutely nothing wrong with going to the bathroom. What I would say to you is it depends. The answer is it depends, and it’s a very personal one. I will tell you a story personally. I know it was probably TMI, but I remember when I was becoming an American citizen, I was overwhelmingly anxious about this situation. I was afraid of everything. I was afraid of the test. I was really emotional about becoming an American. I felt like I was denouncing my country. I was so anxious about the security process. I was so afraid that I was going to mess up and get into some legal trouble, even though I’d done everything by the book. It was really, really overwhelming. The minute I got in line, which were these thousands of people in line, I needed to go to the bathroom, like right now, it had to happen. So, in that instance, yes, I’m going to ask somebody where the bathroom is and I’m going to go to the bathroom. So, I did okay. TMI, but we’re talking about it. Everybody pees and poops, so I’m not embarrassed. Now, as soon as I got back in line, I lost my spot. I was at the back of the line again. My husband was with me. “Uh-oh, I need to go to the bathroom again.” I already know, I’ve probably dropped a lot of that weight. My brain thinks that there’s a major danger when there’s not. So, my job then is I could have easily gotten out of line again to try and get rid of that discomfort and that fear and that uncomfortableness in my stomach. But because I knew I’d already gone, my job was, I really need to get into this security building as a government building. I can’t keep getting out of line. My work then was to practice seeing if I could just hold that feeling. Now I’m not here at all saying or suggesting that you should hold for long periods of time or even to be where you’re tolerating an experience of pain. Again, it depends. The answer is, it depends. If you’ve already gone, can you hold on? If let’s say you’re holding on and you’re like, “Oh no, it’s definitely coming, I need to go,” by all means, go. That’s not a compulsion. It’s just you listening to your body. It’s you giving yourself permission to just go with the flow and again, it’s a wonderful exposure of giving your body’s permission to run the show. How to stop Anxiety Urination? I think the answer is, listen to your body, see what you can do. Again, we always want to be experimenting with tolerating discomfort for long periods or as long as you can. Bit for no reason should you hold for long periods of time and put yourself in additional pain. Now that being said, if you’re going to the bathroom, just to remove your anxiety about going to the bathroom, or you’re going to the bathroom to remove your anxiety of whether or not you will pee or poop your pants, that’s a different story. If you’re going to the bathroom to relieve anxiety, not physical, like actual urgency to go to the bathroom, well then yes, you’re giving into fear. We don’t want to let fear win, particularly when your brain is telling us there’s danger when there’s not. A perfect example, I’m becoming a citizen. I have to take a test. There’s no real danger. The worst thing that could happen is I fail the test or I don’t bring a paper or something. In this case for the ceremony, the worst thing that could happen is you would need to go to the bathroom, right? Or even if you maybe-- again, the worst thing that could happen is you would have to go. But if fear is saying, “Oh no, no, there is really bad possible, maybe possible maybes,” because fear does that, it always gives you the possible maybes – then no, we would not go to the bathroom just to relieve anxiety. If a lot of people, specifically those with panic disorder, they are very, very afraid of the sensations of anxiety. So, your job is actually, if that’s the case, to practice leaning in and having those sensations, tolerating those sensations. Or if you’re going to do exposure and response prevention, even better, you would purposely try to create the scenario so that you could simulate the anxiety and practice tolerating it that way. So, my answer, I know, isn’t direct. It is, it depends. But when it does come to fear, it’s always going to be the same – do not let fear make your choices. Do no. The next part of the question, I think, is another part of this, which I think is really important. So, they said, the second part is, “If I do need it and I have to leave the room during the ceremony, I wonder what people will think of me. I feel like I’m being a disruption. Also, if I have to move past anyone, I sit down, I feel like a nuisance. And then too, so often at the end of the seat--” so they sit at the end of the seat, excuse me, just in case. “Some of my compulsions, safety behaviors around this are needing to know where the nearest toilet is, going multiple times beforehand. Or I may do a certain number of pelvic floor squeezes whilst in the toilet.” They said, “Sorry if this is a long message, I just wanted to explain fully. I think the main thing I’m asking you is, should I be sitting with the feeling or not? If you do not see this up, the rest is just saying about the message.” There we go. I think there’s so much great opportunity here for exposure and really willingness to be uncomfortable. The first thing is, everyone pees and poops. There is no shame in needing to go to the bathroom. I have a lot of clients who, when they’re anxious, they got to go. They got to go. It’s not anxiety. They’ve got to go to the bathroom or there’s going to be an accident. Not the fear. It’s like, “No, it’s actually coming.” If that’s the case, your job is to give yourself permission to be a human with anxiety and to be gentle and compassionate toward yourself that yes, sometimes people need to leave ceremonies. If someone behind you is judging you for needing to leave, that is a full reflection on them. It means nothing about you. Human beings are allowed to come and go as they please. If they need to pee and poop, that is their right. What I would encourage you to do is, this is like a social anxiety sort of talk, and we’ve got some podcasts on social anxiety, but your job is to give other people permission to judge us and do nothing about it. Do nothing. Do nothing about their judgment, because their judgment is a full reflection of them and their beliefs, not of us. The next part is they’ve gone over a ton of safety behaviors – checking the toilet, going multiple times. I would strongly-- if it were my client and you guys do what’s right for you always, take what you need, leave the rest. But if it were my client or if it were myself, I would strongly suggest other than otherwise not doing these behaviors. We don’t want to be doing behaviors. This goes for every topic. We don’t want to be doing behaviors just in case, that just in case behaviors keep us stuck in a cycle of anxiety, that just in case behaviors validate your fear as if your fear is true and important and a fact. We don’t want to do that. We can’t do that because when we do that, we keep the fear cycling. So, I would actually encourage you to not check for bathrooms, not go to the bathroom before, unless of course you genuinely need to, not just because of fear. If for some reason you have the need, practice saying “I can have it.” If the feeling is the pressure is down in that bowel and that pelvic area, that won’t kill you either. I always think of when I’m on an airplane to Australia, you know what happens? You get on the plane, you put your bags away. You’re getting ready. And then they say, preparing for takeoff, the seatbelt light comes on, and then immediately you need to go pee. And you can’t get up. They won’t you, so you hold it. People hold it all the time. Again, we don’t want you to push you through pain, but you can hold it. Be really honest with yourself. Nothing terrible is going to happen. If it’s really urgent, of course, I mean, even on a plane, if you’re really going to pee or poop your pants, they’re going to let you stand up. They’re not going to make you sit in the chair. Try not to be doing these behaviors. Practice tolerating the discomfort of other people possibly judging you. One thing to keep in mind here too is when-- let’s say you go back to my story, I had to leave the line. I could have done a lot of mind reading, which is a cognitive distortion, which is going, “Oh, they think this and he thinks that, and she thinks that about me.” That’s all mind reading. You don’t actually know what they’re thinking. They might be thinking, what a beautiful dress you’re wearing, or they might be thinking, man, I can’t wait for this ceremony to be over. You have no idea, they might be thinking about something so different. So, it’s important that we also practice not mind reading what people think about us. There you have it. These urgencies to go are normal. Everyone pees and poops. That’s just the facts. It doesn’t matter whether you do it once a day or 20 times a day, depending on if you’re anxious. Give yourself to not be perfect. A lot of times, we also talk about when people are doing exposures or they’re having a panic attack, they’re like, “Ah, it’s not just the panic attack. I don’t want people to see me having a panic attack,” or “It’s not just the anxiety. I don’t want to have to cry in public.” The work here is you’re a human being. If you’re a human being, you won’t be perfect. If you’re holding yourself to a standard where you, number one, aren’t allowed to cry, you’re not allowed to pee, you’re not allowed to poop, you’re not allowed to disrupt other people, Well, that’s a lot of expectations you’re putting on yourself. That’s a lot of pressure that you just created in your head. No one else is expecting perfection from you. So, maybe adjust the expectations there as well. Now the last thing I will address, which isn’t specifically to the pee and the poop, is some people get a lot of gas when they’re anxious. They have a strong urgency to pass gas. This is very common for people who have irritable bowel syndrome, same with getting diarrhea or needing to pee or poo. This is very common. If you have IBS, please do speak with a doctor. Let them know that you’re struggling with this. There’s nothing to be ashamed of. They can, of course, diagnose you, make sure they maybe get you some help in those areas. Again, if you need to pass gas, no different. Humans pass gas. It’s not something to be completely ashamed of. Is it embarrassing? Yes, it is. But you do what you have to do. You just have to get through. I’ve heard so many people tell me stories of their most anxious moment being made more difficult because they had no choice, but to pass gas during that. And if that’s the case for you as well, again, I think any human who ridicules someone for needing to pass gas, which is such a human thing, I think we pass gas 17 times on average a day. Everyone, not select people, everyone, anyone who passed judgment on you for that is probably may want to step up their ability to be compassionate and empathic. Again, it’s not about you, it’s about them. So, be super, super gentle with yourself. I think I hit my limit of how many times I said pee and poop, and now we’ve added in pass gas and we’ve even used the “diarrhea” word, which I think is epic. I think I’ve checked all the boxes for today’s episode. So, I hope that it was helpful for you. I genuinely hope that it just dropped some of the anxiety and judgment you have about yourself in regards to the urgency to need to go and pee and poop. If I were to summarize it, I would say it’s very common to need to urinate, go to the bathroom or even pass gas. Lots of people have even diarrhea, very, very strong diarrhea. If that is the case for you, do what you need to do as best as you can. It’s okay if you need to go to the restroom. No problem. If you’re only going to reduce your anxiety about needing to go, I encourage you to try and challenge that some. Again, we do not want to give all of our power to fear. We actually want to ignore fear and give it none of our attention. If you can do that, you’re doing amazing hard work. I love you all so much. Thank you for holding space for me as we talk about all things, bowel-related and urination-related. Even though it’s uncomfortable, it is so important for us to be having these conversations. I hope again, it was helpful for you, and thank you for holding space for me as we talk about these things together. All right. I love you all. I hope you’re having an amazing, amazing week. I hope you’re being kind to yourself and really opening your heart to your own suffering instead of shutting it down because you’re suffering matters. It deserves to be held tenderly. It is a beautiful day to do hard things. I cannot finish an episode without saying it. I encourage you, if you’ve gotten this far in the episode, to practice the hard things as much as you can every single day. Have a wonderful day, everyone.

In todays podcast episode, together we do a self-compassion check in.  First, we address what is self-compassion and then, we check in on our needs.  Mindful Self-Compassion involves first, being aware of what we need and what needs tending to.  In this episode, we also walk through a self-compassion meditation together. In This Episode: What is Self-Compassion? What do I need? How can I give myself self-compassion right now? Self-compassion meditation. Links To Things I Talk About: https://read.amazon.com/kp/embed?asin=B08WGW9XCZ&preview=newtab&linkCode=kpe&ref_=cm_sw_r_kb_dp_XSDYJ2MCRJBYEFCPS5NF&tag=cbtschool-20 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 279. Welcome back, everybody. Today on Your Anxiety Toolkit podcast, we are talking about self-compassion. We’re doing a self-compassion check-in. It’s been a little while since we’ve checked in on how are you doing with your self-compassion practice. Now, today, we have added a little meditation for you just to supercharge your self-compassion practice. That is my agenda for today. We haven’t done a ton of check-ins lately because life just seems to get away from us. For those of you who do not know, in 2020, I wrote a book called The Self-Compassion Workbook For OCD. It was the joy of life and the biggest challenge of my life business-wise. It was such a huge agenda to have on my plate just as 2020 and COVID breakthrough, but I’m so grateful it’s out. When it was released, I had a lot of stuff out about self-compassion. And then I haven’t checked in with you guys on how you’re doing. So that’s what today is about. Now, before we get into the episode, let’s do the “I did a hard thing” for the week. We always check-in and someone submits the thing that they’ve done that is hard, because what we like to say is “It’s a beautiful day to do hard things.” And today’s is from Anonymous. They said: “I’ve recently been diagnosed with OCD and struggled my whole life with anxiety. Unfortunately, until now I was never properly diagnosed until I was 45. I have started working with a new therapist and we are focusing on ERP. At first, I couldn’t even tell her about my fears and intrusive thoughts. I have harm OCD among other various categories. Now, we are doing imaginals around some of the things I never thought I could even address, and I’m so proud of myself.” I’m proud of you too. “It is changing my life. I cannot tell you how important it is to get a proper diagnosis and never give up. You will get better. You just have to get the right help and be willing to do the hard things.” Anonymous, you are giving me the chills. Now, for those of you who don’t have access – anonymous has access to a therapist – if you don’t have access to a therapist, we do have an online course called ERP School. An ERP School is an online course that will teach you how to practice ERP at home, in your pajamas, all the skills that you need to get you started. Now, it does require you to be self-motivated. But if you are self-motivated and you are ready to learn, head on over to CBTSchool.com and you can get all the information there. All right, let’s go over to the show. It’s self-compassion check-in time. WHAT IS SELF-COMPASSION? What is Self-Compassion? It means how have you been treating yourself? Remember, self-compassion is ultimately treating yourself with the same that you would treat somebody else. So, if somebody else came to you and said, “I’m struggling with A, B, and C,” what would you say to them? How would you treat them? How would you respond to them? How would your body language change? Would your voice lower? Would your voice soften? Would you give them a hug if that was appropriate? Would you soften your eyes and let them know that everything was going to be okay, and that you had their back unconditionally? That is how you would treat yourself. So my question is, how are you doing with this? I want you to check in regularly, way more regularly than we are here today. But I want you to check in with yourself preferably every day or multiple times a day and ask yourself, how am I doing? And then we’re going to move into, and I know a lot of you remember this from previous episodes, but I want you to ask yourself the golden self-compassion question, which is, what do I need right now? What do I need? Let’s do this together. I want you to find a comfortable place. If you’re driving, please do not close your eyes. You may listen along. If you’re not driving, you may close your eyes. You may rest your shoulders. You may bring a gentle smile to your face. And I want you just to slowly bring your attention to your breath. And when I say breath, I don’t mean the physical rise and fall of your chest. I want you to bring your attention to the air that is going in and out of your body. You breathe in... The air goes into your lungs, replenishes, restores you. And then you breathe out air. And I want you to become familiar with this air as it enters your body and exits your body, replenishing you, supporting you, feeding you. And as you bring your attention to this air, I want you to gently slowly drop down into where you are and ask yourself, what is it that I need right now? If you notice being bombarded by many, many thoughts, that’s okay. Just tend to one at a time. Each one of them, each one of those thoughts gets a moment. And you are going to use your wise mind to decide which ones you’re going to tend to. As you ask yourself “What do I need right now,” you may notice your mind sharing with you, “I need rest. I need a moment. I need to laugh. I need food. I need to pee. I need water. I need to be kind to myself.” And take one at a time and take stock in acknowledging nonjudgmentally that that’s what you need. Nonjudgmentally, which means we’re not going to judge that we need it. We’re not going to treat ourselves poorly because we need it. We’re just going to acknowledge that’s what we need. Now, if you notice that your mind is coming up with other things like criticisms, a list of things to do, it might be telling you, you should be doing something different and more productive, they’re the thoughts that we maybe don’t tend to because you’re tending to those all day. Now is the time to check in for what you need. Say, “I’ll be right with you later, thoughts. Right now, it’s time to nourish me, to fill my cup so I can go and do those things later.” We breathe in air... And we breathe out air. Now we bring our attention to those needs and ask ourselves, is there anything we can tend to right now? Maybe the softening of your shoulders. Maybe to let go of the to-do list. Maybe to celebrate the wins that you’ve had today or yesterday or whenever. What do I need? Sometimes it’s to cry. Sometimes it’s to feel our feelings. Sometimes it’s to validate our own feelings and that’s our job. That’s our job. What a wonderful opportunity and a wonderful job we have, which is to be our first line of support and care, that we deserve that. Maybe you’re surprised by what’s showing up in what you need. Maybe you’re surprised that you need something and it’s something that you don’t usually need. That’s okay, too. Just be curious and open to that voice inside you. Now, if you’re struggling to identify what you need, I want you to just gently remind yourself that the wish to be compassionate towards yourself is self-compassion enough. If it doesn’t land and you don’t have this powerful experience or gentle experience, and for you, it’s actually quite gritty and edgy, that’s okay. Just the intention of being here and asking is so wonderful. I often think of my husband. If I went to him and he was struggling, and I said, “Is there anything I can do to support you?” he may not be ready to ask for my help. But just me offering it, the intention of being there to support means so much. And we can be that for ourselves. So again, take a deep breath in... And breathe out. And just give it one last time. Is there anything you can offer me in how I could support me? Which is you. Or is there anything you need? You might even offer it to your body parts if there’s particular areas struggling. Mind, what do you need? Tummy, what do you need? Foot, what do you need? Neck, what do you need? Now, as you’ve done this, I hope that you have been kind and non-judgmental, and non-critical. But if you are, I still want you to see this as a win. The check-ins can be so rich even when they’re bumpy. We’re going to slowly open our eyes... We’re going to bring our awareness to what’s around us and come grounded into the present again. And I hope that it’s the check-in you needed. I hope that you got to explore your needs, which are important, and then nothing to be embarrassed or ashamed of. It’s okay to have needs. In fact, it’s normal and natural and healthy to have needs. We all have them. Have a wonderful day, everybody. I hope you are doing well. Before we finish up, we are going to do the review of the week. This one is from Jessrabon621, and it says: “Amazing podcast! I absolutely love everything about this podcast! I could listen to Kimberley talk all day and her advice is absolutely amazing. I highly recommend this podcast for anyone struggling with anxiety or any mental health professional that wants to learn more.” Thank you so much, Jessrabon621. I love, love, love, love your reviews. Please do leave a review. I am trying to get to a thousand reviews and I will be giving away a free pair of Beats headphones to one lucky winner who leaves a review. Have a wonderful day, everybody. And I will see you all next week.

In this week’s episode of Your Anxiety Toolkit Podcast, I share what I learned from my 3-day silent meditation retreat. This 3-day silent meditation retreat was rough, I won’t lie.  I had to ride many highs and lows, so I wanted to share them with you. Links To Things I Talk About: Tara Brach Silent Meditation Retreat home schedule https://www.tarabrach.com/create-home-retreat/ Mindfulness Book https://www.amazon.com/ 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 178. Welcome back, everybody. I am so thrilled to be here with you today. I recently got back from a three-day silent retreat. I was by myself for the entire three days. It was a three-day silent retreat. I have done silent retreats in the past at Buddhist monasteries and Buddhist retreat centers. This is the first time I’ve done it on my own, and I followed the Tara Brach self-retreat website. I will leave the notes in the show notes so that you can check that out. It was amazing. I can’t lie. I had so many mind-blowing moments and I want to share with you each and every single one. I’m going to give you the cliff notes version. Otherwise, I would have you here for days on end. But I am so excited to share that with you. Before we do that, of course, you know we always do the “I did a hard thing.” This is a segment where someone can write in, submit the hard thing they’ve done. This one is by Mgwolfie1992, and they’ve said: “I have OCD and ASD. Certain shirts do not feel right. Before starting ERP, when I put on a shirt that’s uncomfortable, I immediately take it off, which was making me late for work. After starting ERP, I have slowly worked my way up to wearing and keeping that uncomfortable shirt on for 12 minutes.” Mgwolfie1992, this is just you doing the work. I’m so, so impressed. This is exactly what it’s like for everybody listening or watching today, is it is about just small baby increments and getting yourself higher and higher and a little more difficult, a little more difficult. I’m so impressed with the work that you’re doing. This is just so incredibly powerful and rewarding, and I hope that you keep going. Let’s talk about what I learned from my three-day silent retreat. Just to give you a setup, I rented through Airbnb a small little cabin in the depths of Topanga, which is very close to where I live in Los Angeles. I was following the Tara Brach home retreat that she created at the beginning of COVID. Now, when COVID hit, I so desperately wanted to do this, but I was in the middle of writing The Self-Compassion Workbook For OCD, and so I did not have time or the bandwidth to really go and really be with myself. I just had so much going on. As you probably remember, the world just felt so scary and no one knew what was happening. So I definitely wasn’t ready to do something at that time. After several years or even months at this point where I feel like I’ve really, really prioritized my mental health and my medical health, I was finally in a place where I just felt like I needed some time to really go and let go of some things. I could be doing this at home. I could do this every day and I have since I returned, but I really felt that I needed these three days to do a deep dive into really some things that I had been working through having a medical illness, a chronic illness. I have postural orthostatic tachycardia syndrome, really coming down out of the pandemic and so forth. So, I really felt like I just needed this time to really not have the kids around and just drop down in and do that really hard work. I took with me a journal. I took with me a book called Mindfulness by Joseph Goldstein. I strongly recommend that you try it. It is very heavy on Buddhist philosophy, but it is such an important book about mindfulness. And so to start off, the thing that I learned the most was I needed so desperately to go back to basics. Everything felt so complex – everything I was teaching, everything I was doing in therapy, the practices of my own. It just felt like there were so many spinning parts. When I got there, I just dropped down to like, “Kimberley, let’s go back to the basics.” So I wanted to share with you what those basics were. Number one, I went right back to the core of mindfulness, which was mostly me. The main agenda was to observe what showed up instead of being in reaction to it. Here, when life is so busy and chaotic and so many things happening at once, it’s really hard to be an observer. I think I have lost my ability to do that. And so once I got there, I promised myself and my friends that I would not be contacting them, that I would have just one part of the day where I would text people back. I would check my phone, make sure everybody was okay and my clients were okay and my staff were okay. I would respond back, but very limited. And that throughout the day, if I felt the need to pick up my phone, or I felt the need to call, or I felt the need that I needed to talk to someone, that I had to stay in that feeling. And that’s why I really chose the silent retreat. I wanted to create an environment where I couldn’t rely on anybody except myself, and that no matter what I felt I had to hang on and I had to ride it out and I wanted to really drop down a little deeper and really explore what was going on for me. Now, the thing that was most profound is the first day was excruciating. I mean, painful. I had every emotion under the sun. At one point at the evening, when I told my husband I would call after me waiting through these emotions all day, I did text and he asked how I was doing, and I said, “This is so hard. I don’t even want to be here.” I didn’t ask for his advice, but he did say via text, “Just keep going.” So, I did. Of course, I did. But what was so fascinating to me, and one thing I really learned about myself, and I’m wondering if you do the same thing, is I had gone into this silent retreat not exhausted. Usually, by the time I take a break, I am so wiped out that I’m completely like starfish on the bed, completely out of it. This was really interesting because, for the first time, I wasn’t exhausted, and on the first day, I kept having the thought, “You don’t deserve this.” I kept thinking, this is ridiculous. People are at war. There is floods in my home country. So many people have it worse than me. “You don’t deserve this, Kimberley. This is unnecessary. This is actually very silly of you to have asked to do this three-day silent retreat.” I was so shocked at those thoughts. Now, here is where the observing skill was so helpful for me. Instead of having that thought and then going, “Yeah, you’re right,” and then beating myself up or maybe even going home or feeling guilty or punishing myself, I just observed it and went, “Huh, that’s interesting. I’m having thoughts that this is selfish,” or “I’m having thoughts that this was silly.” Instead of fusing with those thoughts, I just observed them. And I also observed the feeling and going, “Uh-huh, I feel guilty,” or “I feel selfish.” But instead of saying, “I am guilty and I am selfish,” I didn’t over-identify with those emotions, which is another mindfulness skill that I wanted to go back to the basics, is how much we over-identify with the thoughts we have. If something is uncomfortable, we go, “Oh, that means it must have to go away, and this is wrong. I’m wrong and I shouldn’t be feeling this way.” Instead, I just sat in it and I had this-- I want you to just imagine me. If you’re listening to the podcast, you won’t be able to see me. But if you’re watching me on video right now, I just had my head and kept nodding and smiling, like I was almost dancing with my head and just going, “Uh-hmm, yes, brain, I hear you. Yes, mind, I can hear what you’re saying, but I’m not going to connect with that. I’m going to allow it. I’m not going to push it away, but I’m just going to observe it.” Oh my gosh, I had so many breakthroughs, one after or the other, of just catching these rules and beliefs I have and how invasive they are and how reactive I am to them. Even though I’ve practiced this for years, I just knew I needed this time to let go of all of this. Now the second thing I learned besides really dropping down into the basics and observing everything and not identifying was, in the Mindfulness book that I was reading, and I had it as my agenda to read it, is I had to practice going back to accepting impermanence. Now impermanence is a Buddhist concept that they talk about a lot. Basically, what it means is that this is temporary. As I sat and I meditated so much on this three-day retreat, not so much the second day, but the first and the third day were really good meditation days. I sat on my meditation seat and all I would do is just try to stay in the moment and notice the impermanence. So, as a satisfying feeling showed up, I would just notice that this is temporary, that it will go, and I’m not going to cling to it. As an uncomfortable thought showed up, I said to myself, “This is temporary. I’m not going to cling to it. I’m not going to push it away.” Everything that showed up, I just kept going, “This is temporary. This is temporary.” Some people would probably argue that that’s a problem. Like, why would you push away good thoughts? But I had to keep reminding myself that my attachment to good is what creates a lot of my suffering. A lot about impermanence is also looking at the fact that everything is temporary. In this beautiful rental that I had was these beautiful windows. I would sit right at the edge of the window and I would overlook this beautiful creek, all these trees, and leaves. A part of the meditation that I had practiced and I have practiced for many years is to meditate on impermanence, which is to sit and look. This time my eyes were open, and everything I see, I contemplated how temporary it is. If it was a leaf that is just newly budded, I would imagine it fully coming into bloom, falling off the tree, and then completely breaking down into the ground where it was mud muddy and sludgy and yucky. And then looking at, let’s say the wood and going, “Yes, that too will break down over time.” Looking at my hand and my face and my body and imagining me too once was very youthful and now looking slightly older and acknowledging that that too is impermanence and that I too will die. From that meditation, I cried. I sobbed actually, and I let go of a lot of beliefs and values I was hanging onto that really aren’t my values in terms of me having to stay young, that me having to stay liked by people, that I had to hold onto this idea. Instead, I was actually moving towards saying, “It’s okay. You can like me or hate me, because you liking me may actually be temporary. You may only need me for a period in your life. And then you may not need me.” And then again, observing what showed up for me and letting go of that too. It was just this massive cycle and it kept going and going. I would keep hitting these same things that I needed to let go of and learn and practice like observing and recognizing that things are temporary and that it doesn’t mean anything about me. I know this may actually be a lot, but I can’t tell you how powerful it was. It was such a beautiful experience of letting go, of catching where I’m attached to things, and then letting go of that as well. I’m not saying that because I let them go they don’t bother me anymore. I am now in a cycle and it got me going and now allowing that letting go to be more automatic. Whereas before, I used to joke with my husband and my best friend. When they’d make a suggestion to me, like maybe they would offer me some advice, I would respond a little defensively. And that’s one of the reasons I really wanted this three-day retreat, is I could feel the tension in me on how inflexible I was and how I was being stubborn and holding tight on things. I knew that’s not what my core nature is. I’m going to keep this short and I’ll give you one more thing that I learned. And this thing has probably been the most beautiful lesson I’ve ever learned. It’s been so synchronistic because so many things have really reinforced things since I’ve returned. This is the idea of independence versus interdependence. I think since I recovered from my eating disorder, I have made it my goal to be independent. I don’t want to rely on people. I don’t want to ask them for help. I want to be a strong woman. I want to be a powerful human. I want to be peaceful in myself. I want to be self-sustaining, if that makes sense. This has been such amazing growth for me. I have learned so much and really learned my own strength because I made a deal with myself that I would always be my first person. Through that, I have learned to trust myself, to rely on myself, that I’m stronger than I thought. It’s a big reason why I say it’s a beautiful day to do hard things, is because I’ve practiced that my whole life. But I was reading something from one of these, in the Tara Brach retreat, she has a lot of retreat talks and I was listening to some of these Dharma talks. One of them was that we’re interdependent. Even though we’re independent, we also need other people. And that actually through being interdependent is where we build community. It made me realize that I think I’ve swung too far in the independence. If there was a pendulum swinging, I’d swung too far in the independence and I needed to recognize how much I need other people. I need my friends, I need my husband more, I need my children more in different areas, that I need to ask for help more. It doesn’t mean I have to pay people. It doesn’t mean they owe me. It doesn’t mean I now fully swung the other direction into always being dependent. It’s that I’ve acknowledged that change happens more on the local level. Since I created this podcast and I have an Instagram profile, I think my mind had very much gone to a large scale. Like, I have to make a huge difference, that I could make a huge difference. Something came through me, a sense of knowing in terms of, yes, I can make a large difference, but I can’t forget the local difference that I can make, the connection with my neighbors, the connection with my school. Particularly since COVID, we’ve become so technological. How can I actually connect with people more on a one-to-one basis instead of a one-to-thousand? For some reason, that really spoke to me and I’ve never been more empowered and excited to serve you all because I think I needed to come out of the big crowd, thousands of people and really just start to go back to thinking one-to-one and thinking about the person instead of the crowd. I think that that will help me a lot in terms of being more connected, feeling more connected, feeling not lonely in things. They have that whole thing about you can be surrounded by people, but still feel lonely. I think that’s probably why I felt lonely in the past. They’re the main things I learn. There are so many more, but really, I just want to emphasize, if you can create a one day or even a half-day silent retreat where you sit and really be with your emotions and commit to seeing what comes up, you will be shocked at the explosion of experiences that you have inside you. It doesn’t have to be three days. You don’t have to rent someplace. You could do it in your own home, even in one room if you need it, and really drop down. When those really painful emotions come up, really sit with them and be with them and practice letting them wax and wane as much as you can. That’s what I learned. I hope that that has been inspiring to you in some way or another. For me, I’m more committed to my meditation practice than I’ve ever been. I’m more committed to my mindfulness than I’ve ever been, and I’m more connected to my business than I’ve ever been, which is really, really beautiful. All right, thank you so much. I am so grateful for you being here with me today. I just love this work I’m doing with you and I hope that it is beneficial to you. Before we finish up, let’s do the review of the week. This is from kdeemo and they said: “This podcast is a gift. I just found this podcast and I’m binging on the episodes. I learn something through each episode, and I love her practical advice and tools. I feel like part of a community-what a gift!” Thank you, kdeemo. Please, please do go and leave a review. I know you are very busy. I very much respect your time, but the best gift you can give me is just a view and honest review. It helps me to reach more people and that makes me feel so fulfilled and happy. Have a wonderful day, everybody.

Common treatment of derealization and depersonalization Kimberley Quinlan SUMMARY: Derealization & depersonalization are common experiences of anxiety. In this episode, we take a look at the definition of derealization and depersonalization. We also explore the common symptoms of derealization and depersonalization and the treatment of derealization and depersonalization. I also explore mindfulness and CBT skills to help you manage your discomfort and anxiety. In This Episode: The definition of derealization The definition of depersonalization Explore the symptoms of derealization Explore the symptoms of depersonalization Comparing derealization vs depersonalization Common treatment of derealization and depersonalization 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 227. Welcome back, everybody. I am so grateful to have this time with you. As you know, I promised this year would be the year I doubled down and get really into the nitty-gritty of some of the topics that people don’t talk enough about regarding anxiety. Today is so in line with that value Today, we are talking about what is derealization and depersonalization. These are two what I would consider symptoms of anxiety. I see it all the time in my practice. I see it reported and commented all the time on Instagram. If you follow me on Instagram, we put out tons of free information there as well. This is such an important topic. And for some reason, we aren’t talking about these two topics enough. My goal today is actually to give you a 101 on derealization and a 101 on depersonalization. We can touch upon derealization disorder and depersonalization disorder as well, but at the end, I want to give you as many tools as I can to point you in the right direction. Before we do that, let’s do the “I did a hard thing,” because we love that, right? The “I did a hard thing” is a segment where people submit the hard things they’re doing. The main reason I do this is because, number one, you’re my family. We’re all in this together. But number two, often people, many years ago when I started the podcast, people were like, when I started saying it’s a beautiful day to do hard things, which I say all the time, a lot of people were saying, “But how hard does it have to be? And how do I handle the hard things? Can you give me an example?” And so, these have been just such a wonderful way to share how other people are doing hard things. This one was submitted anonymously, and they said: “I’ve struggled with suicidal ideation for a very long time. And after years of therapy, self-discovery, and lots of hard work, I’m finally accepting that I am better off in the world than out of it.” Now I just have to take a deep breath and nearly cry because this is seriously the hard work. Sometimes when we’re talking about “I did a hard thing,” we’re talking about facing one small thing or one large thing, but I really want to honor Anonymous here and all of you who are doing this really long-term work and deep, deep work around really acknowledging how important you are and how much the world needs you in it and on it. So anonymous, I love you. You are amazing. I have such respect for the work that you’ve done and are doing, and thank you. Again. I think we don’t talk about suicidal ideation enough either. In fact, I should really do an episode on that as well. I respect you and I’m so grateful you submitted this week. Okay, here we go. I have some notes, which I rarely use notes for episodes, but I didn’t want to miss anything. I’ve got so much I want to share. I will do my best to break this down into, like I said, a 101, small bite-size helpful tools. You will hear me, as I talk, taking little deep breaths and that’s because I have to practice slowing down. Just a little off-topic, when I’m doing podcasts, I get so geeked out that my brain races, and I’m all over the place and I’m talking fast and I have to slow down, “Kimberley, pump the breaks, lady.” Let’s together take a breath... and let’s just be together. First let’s talk about derealization. The definition of derealization is that derealization is a mental state or a psychological experience, it could also be a physiological experience, where things feel unreal. Not like, “Oh, that’s totally unreal, man. Amazing.” I’m talking where they don’t feel real. When you have derealization, you might feel detached from your surroundings. You don’t feel connected to what’s going on around you, and people and objects may also seem unreal. Often people, when they have derealization or derealization disorder, feel like they’re going crazy. Actually, they feel like they’re going crazy. Not just the term that people use on the street. They actually feel like they’re losing touch with reality. When we talk about derealization disorder, we’ll talk about that here in a little bit, but we could use them interchangeably. Lots of people have derealization without having the disorder, but to have derealization disorder, you have to experience derealization. So I’m including them both there. Now the prevalence of derealization, I wanted to just give you this information because I felt it was very validating. I myself struggle with derealization and depersonalization. It was really validating for me to hear that more than half, more than 50% of people may have this disconnection from reality at least once in their lifetime. 2% of people experience it enough for it to become some kind of disorder, just like derealization disorder or even a dissociative disorder like amnesia. If you’re concerned, you can go speak with your doctor or your therapist, or a licensed therapist for an assessment if you’re concerned about it. A lot of people who I have seen have already been to the doctor, gotten cleared. Schizophrenic is often a very big concern. People often feel that they’ve been misdiagnosed. Now derealization is similar, but distinctly different from depersonalization, which we would talk about here soon. Some symptoms of derealization include feelings of being unfamiliar with your surroundings. You feel like you’ve never been there before, or you may feel like you’re living in a movie or a dream. You may feel emotionally disconnected from your loved ones or colleagues or friends. You just feel very numb. Like I said, you’re just very out of order. Things feel very strange. Your surroundings and the environment also may appear distorted, blurry, colorless, two-dimensional, or artificial. I remember the first time I ever had derealization. I was sitting across from a client and I was an intern. I was very anxious. I’ve talked about this on the podcast before. I was sitting across from them and all of a sudden, their body looked like a caricature of themselves. The caricature is where their body is really small and their head is huge. I was looking at my client, trying to be a therapist, and I’m thinking what happened. All of a sudden, their neck was very, very small and short and their head looked gigantic. It looked like a drawing, not three-dimensional, but two-dimensional. And that was so concerning to me. I freaked out. I got through the session. Thankfully, again, I had tools to use. But it was really scary. It actually brought on some panic later in that evening because it didn’t go away for a little bit of time. Now, depersonalization, the definition of depersonalization involves feeling a detachment, not from your environment like in derealization, but from your own body and your thoughts and your feelings. Think of it like it’s like you’re watching yourself from an outsider. I always say it’s like you’re flying on the wall, looking at yourself, or it’s like looking at a movie of yourself. Now, symptoms of depersonalization include feelings that you’re an outsider observer, like I just said. You’re disconnected to your body again. Others report that it feels like they’re a robot and that they don’t have control of their movements. Again, you feel like you’re watching yourself and you don’t have control of what’s going to happen next. Another symptom of depersonalization may include the sense that your body and legs and arm appear distorted. They may feel enlarged or shrunken. Some people report that their head is wrapped in cotton. That’s a different symptom. Another example I always use with my patients is often when I have depersonalization, which isn’t very often anymore, is I’d look at my hand and I couldn’t tell if it was my hand or not. I didn’t feel like it was my hand. Again, really scary, can feel really concerning in the moment. Now you may also experience some numbness, whether that’s emotional or physical. Some people say all of these symptoms are similar for derealization as well. You may feel like your memories lack emotion. Again, you’re disconnected from your own experience. So, that can be an additional symptom of depersonalization. Now for both, I’m going to talk about them together now. For both, the duration of these symptoms may last just a few minutes, they can last a few hours. Some people, particularly if you have derealization disorder or depersonalization disorder, it can be days, weeks, and months. In that severity, I would encourage you to go and speak with a mental health provider who is trained and can assess you properly. Now, to be diagnosed with derealization or to be diagnosed with depersonalization, there is no lab test. There’s no scan you can have. It requires a trained professional to review your symptoms and give you the diagnosis. You could probably, by listening to this, define for yourself whether you have the criteria to meet this classification. But if you’re wanting to be sure, I strongly encourage you to seek professional help to get that diagnosis. Now, the prevalence of the struggles almost always start in late childhood or early adulthood. The statistics, this is why I have my notes today, the average age starts around 16. 95% of cases are diagnosed before the age of 25. Not always, but that has been the common statistics that they’re showing. I think that’s really helpful to know. Now, that being said, what do you do from here? The treatment of depersonalization and derealization is often CBT (Cognitive Behavioral Therapy). Basically, what we do, and this is a lot of the work that you probably already have skills if you’ve listened to a lot of the podcast episodes – a lot of it is around practicing your mindfulness tool. The first thing I want to let you know is it doesn’t mean you’re going crazy. I totally get that. It feels like you are, but it doesn’t. The good news is, when you can’t stop appraising it as “I am going crazy,” you’ll actually start to notice it’s just a really strange feeling, but it doesn’t mean anything is wrong. I once had a teen client who told me, he said he was laughing and we were giggling together. He said, “The crazy thing is some of my friends pay a lot of money to feel this way by using drugs,” and he says, “I have it for free. I have this strange feeling, this out-of-body experience. And I don’t even have to be under the control of a drug or a substance.” He said, “When I looked at it from that perspective, I stopped appraising it as if it’s dangerous.” And that was a game-changer for him to stop appraising it as if it is a dangerous problem. For me now, when I have derealization, it usually occurs when I’m driving. I used to panic that that meant I was going to crash. But then when I just said, “Okay, I’m just having a feeling and I’m going to let it be there.” I’m not going to do anything about it. I’m not going to judge it negatively. I’m going to allow it to rise and fall on its own. And I’m going to put all of my attention on just staying present. Now your brain is going to say, “Yeah, but present is bad. Present is terrible. Bad things are going to happen. What if you’re going crazy?” And your job is actually to practice just letting those be thoughts, because that’s what they are. They’re thoughts. Just because you have them doesn’t mean they’re facts. Lots of people have derealization. The clients I’ve had who’ve had severe derealization and derealization and depersonalization disorder, they now say, “Yeah, it happens. No big deal. They just go about my day.” Now in the early stages of treatment, you’re going to hate this idea, but it works, is we actually used to purposely induce this sensation so that they could practice tolerating the discomfort without responding in unhealthy ways or in compulsive ways. We would sit them down and spin them around in a chair. We would have them stare at the wall. We would have them look at really psychedelic YouTube videos where the colors and the patterns are all wavy like seventies, like psychedelic. And we would practice inducing the feeling. From there, they would practice willingly allowing the discomfort and going about their day, being gentle with themselves, engaging in the things they value. Of course, they might feel great, and that’s okay. You can slow down a little and do what you need to do. But ultimately, when you have depersonalization and derealization, the goal is simply to do nothing at all. Crazy. When I tell my patients that, they’re like, “Oh my goodness, you’re either crazy or you’re brilliant.” By the end, usually, they say that this treatment, not me, but the treatment is brilliant, because it teaches them not to be afraid of it and not to try and live their life avoiding it. I’ve had patients report that they’ve avoided things at great length just to avoid the experience of depersonalization and derealization. And when they avoid it, it just keeps them stuck and keeps them scared and keeps it happening more. The other thing I will add is, do not check to see if you’re derealized or depersonalized, because just the act of checking for it, like a mental check, can actually bring on the symptoms. Now, that’s easier said than done. Am I right? Yes, it’s very hard. I know it’s easy to say, “Just stop doing that.” But if you’re engaging in a lot of checking behavior, sometimes it’s helpful to catch when you are and bring yourself back to the present, do whatever disengagement skills you can use to get you back into the present moment. Again, we don’t want to push the discomfort away, but we also don’t want to give too much hyper attention to these sensations and symptoms. If you’re struggling with these symptoms, go and see a mental health professional. You can quiz them, ask them if they have skills in this. Look on their website, see if they’ve got any information about it that will help you to get the help that you need. This is great. Like I said, this is what I call derealization and depersonalization 101. But there are many, many other tools that you can use to help manage this. One day I will do my best to create an online course about this that goes into detail so you have that, but for right now, I hope that this is helpful. Now, before we finish up, I’m going to do the review of the week. We have an amazing review here from Jessrabon621 and they said: “Amazing podcast. I absolutely love everything about this podcast. I could listen to Kimberley talk all day and her advice is absolutely amazing. I highly recommend this podcast to anyone struggling with anxiety or any other mental health professional that wants to learn more.” Thank you, Jessrabon621. I am so grateful that I’ve helped and I’m so happy that you’ve left a review. Thank you. I love your reviews. They help me so much. 2022 is the year that I want to get a thousand reviews. If you can help, I would be so grateful. Go in wherever you’re listening, click on the reviews, leave a review. You don’t have to write something. You can just rate it. Leave an honest review. I am so, so grateful. We will be giving a pair of Beats headphones to one lucky winner by the time we hit 1,000 reviews. So I am so grateful. Have a wonderful day, and I’ll see you next week.

SUMMARY: Overcoming Health Anxiety is possible! Today, we interview Ken Goodman and his client Maria on overcoming hpyochondria using Cognitive Behavioral Therapy. In this episode of Your Anxiety Toolkit Podcast, you will learn key concepts of health anxiety and how to overcome their health anxiety. In This Episode: What it is like to have health anxiety The key concepts of treating Hypochondria Tips for managing fears of death and cancer. A step-by-step approach to overcoming health anxiety. Links To Things I Talk About: https://www.kengoodmantherapy.com/ Quiet Mind Solutions 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 226. Welcome back, everybody. If you have health anxiety, hypochondria, health anxiety disorder, or you know of somebody who has health anxiety, you are going to love this episode. I mean, love, love, love this episode. Today, we have Ken Goodman, who’s on the show. He’s a clinician who’s here with his patient and they’re sharing a success story, a recovery story of health anxiety, and it is so good. I am so honored to have both of them on. It was so fun to actually interview other people and the way they’re doing it, and look at the steps that were taken in order to overcome health anxiety. And this is the overcoming health anxiety story of all stories. It is so, so good. I’m not going to waste your time going and telling you how good it is. I’m just going to let you listen to it because I know you’re here to get the good stuff. Before we do that, I wanted to do the “I did a hard thing” and this one is from Dave. It says: “I’ve been trying to get back into meditating regularly. I was sitting at a desk this morning, reviewing my work emails. And I told myself, before I get even further in my day, I need to meditate. I did a guided meditation, even though I felt a strong pull inside to go back to work. I kept getting caught up in my thoughts, but I just kept telling myself it doesn’t need to be a perfect meditation. I said the goal today is just to be able to sit without being busy for three minutes. Nothing more. It was hard, but I did it.” Dave, thank you so much for the submission of the “I did a hard thing” segment, because I think that meditation is so important. In fact, I keep promising myself I’m going to implement it more into this podcast. And Dave has really looked at some of the struggles people have with meditation. And look at him, go, it’s so amazing. Totally did it. So amazing. Dave, thank you so, so, so much. I love it. If you want to submit, you may submit your “I did a hard thing” by going to KimberleyQuinlan-lmft.com. If you go to the podcast page, there is a submission page right on the website. And from there, let’s just go straight to the show. I hope you enjoy it. Kimberley: Welcome. I am so excited for this episode. Welcome, Ken and welcome, Maria. Ken: Thank you for having me. Maria: Hi, Kimberley. Kimberley: So, as you guys, we’ve already chatted, but I really want to hear. This is really quite unique and we get to see the perspective of a client and the therapist. If I could do one of these every single week, I would. I think it’s so cool. So, thank you so much for coming on and sharing. We’re going to talk about health anxiety. And so, Maria, we’re going to go back and forth here, but do you want to share a little bit about your experience with health anxiety? Maria: Yes. I think I’ve had health anxiety probably for like 15, 20 years and not known about it. Looking back now, everything comes clear when you see the multiple pictures that you’ve taken of certain lumps and whatever five years ago. I’m like, “Oh my gosh, I have so many pictures that I’ve taken and so many different things.” But yeah, I’ve been struggling for a while I think, and had multiple doctor’s appointments. Until I realized that I had health anxiety, it was an everyday struggle, I think. Ken: Well, you came to me and you were mostly worried at the time about ticks and Lyme disease and skin cancer, but you told me that for the previous 15 years or so, you were worried about other things. What are those things? Maria: Well, I was mostly completely obsessed with moles on my skin and them being cancerous. And I was scared of ticks. I would not be able to walk through any grass or go hiking. I was scared that I would have to check my whole body to make sure that there were no ticks on me. I was completely scared of Lyme disease, and it just completely consumed my life really. And they were the main things. But looking back before that, I think that I always had a doctor’s appointment on the go. I would book one, and as soon as they said, “You can book online,” That was it for me. I would have one booked, and then I’d go, “Oh, what if there’s something else next week? You know what, I’m just going to book one for next week, just in case something comes up.” I am a terrible person when it comes to that because I’m taking up multiple doctor’s appointments. And I knew that. But it was trying to reassure myself, trying to control the situation, trying to control next week already before it even happened. So, yeah. MARIA’S SYMPTOMS OF HEALTH ANXIETY Kimberley: Right. What did it look like for you? What did a day look like for you pre-treatment and pre-recovery? Maria: Some days it could be fine. I remember days where nothing was bothering me. It was such a nice feeling. And then I was scared because I never knew what was going to trigger me and it could be anything at any time. And I think that was the not knowing. And then as soon as I would latch onto something, I would come to the phone, I’d start Googling over and over again, hours of Googling and then checking. And then it was just ongoing. And then my whole day, I was in my head my whole day, just what if, what if, asking questions, going back to Google, trying to find that reassurance that of course never happened. Ken: Yeah. You tell me that you would take pictures of your moles and then compare them with the cancerous moles online and do those things. Maria: Yeah. And I would book-- and interestingly enough, looking back now, I went through a phase of always having a doctor’s appointment. And then I also went through a phase of completely avoiding the doctor as well, not wanting to go because I didn’t want them to say something that I knew was going to trigger a whole host of anxiety. So, I’ve gone through multiple doctors. And then once you start the doctor’s appointments, then you’re on a roller coaster. Because you walk away from that appointment, never feeling, or for me, never feeling reassured. Or feeling reassured for maybe a few minutes, and then you leave, and then the anxiety kicks in. “Oh, I never asked them this,” or “Oh my gosh, well, what did that mean?” And then the what-ifs start again and you’re back to square one. So then, you go, “Oh, no, I didn’t try just what they said. I’m going to book another appointment and this doctor is going to be the doctor that reassures me.” MANAGING DOCTOR VISITS WITH HYPOCHONDRIA Kimberley: Right. Or sometimes a lot of clients will say to me like, “The doctor made a face. What did that face mean? They made a look and it was just for a second, but were they questioning their own diagnosis and so forth?” And I think that is really common as well. Ken: Well, the doctor will say anything and it could be something very simple like, “Okay, you’re all good. I’ll see you in six months.” And the person will leave thinking, “Why would he want me to come back in six months if nothing was wrong?” Maria: Well, that’s interesting that you would say that because I think probably at my lowest point, I was keeping notes about my thought process and what I was feeling when I was actually going to the doctors or waiting for the results. And actually, I thought it might-- if I have a few minutes to read what I actually was going through in real-time, I know it’s probably very relatable. Kimberley: I would love that. Maria: I had gone to basically a doctor’s appointment, an annual one where I knew I was going to have to have blood tests. And they’re the worst for me because the anticipation of getting the results is just almost worse than getting the results, even though-- Ken: Did you write this before we met? Maria: No. While I was seeing you, Ken. Ken: In the beginning? Maria: Yeah. When you’d asked me to write down everything and write down what I was feeling, what I was thinking, and then read it back to myself. And this is what I had written down, actually, when I was going through the doctor’s appointment and waiting or had just gotten the results. Kimberley: If you would share, that’d be so grateful. Maria: So, my blood results came back today. I felt very nervous about opening them. The doctor wrote a note at the top. “Your blood results are mostly normal. Your cholesterol is slightly high, but no need for medication. Carry on with exercise and healthy eating.” “Mostly,” what does that mean? “Mostly”? I need to look at all the numbers and make sure that everything is in the normal range. “Okay, they’re all in the normal range except for my cholesterol. But why does she write mostly? Is there something else that she’s not telling me? I need reassurance. I’m driving down to the doctor’s right now. I can’t wait the whole weekend.” I go into the doctor’s office and ask them, “Is there a doctor who’s able to explain to me my results?” The receptionist said, “No, you have to make another appointment.” I explained to her, “You don’t understand. I just need somebody to tell me that everything is normal.” Finally, this nice lady saw the anxiety on my face. She calls the doctor over to look at the labs. The receptionist shows the doctor the one lab panel, and he says, “Everything is completely normal. Nothing was flagged. Everything is completely fine.” I thank him so much for looking and walk away. As soon as I get outside, I realize I didn’t ask him to look at all the lab panels. What if she meant mostly normal on the other lab panels that I didn’t show him? When I get home, I look over each one multiple times and make sure that each one is in the exact number range. After looking over them four or five times and seeing that each one is in the number range except for my cholesterol, I still feel like I need to have her explain to me why she wrote the word “mostly.” The crazy thing is I’m not concerned about the high cholesterol. I can control that. I don’t know what she meant by the word “mostly.” I’m going to send her a message. And I’m going to ask her to clarify. I have to believe that she would tell me if something was wrong. I wish there was an off button in my head to stop me worrying about this. Ken: I remember this now. I remember. And this was in the middle. Maria was really avoiding going to the doctor and she had overdue with some physical exams. And so, we really worked hard for her to stop avoiding that. She got to the point where she felt good enough about going to the doctor. And she really, I think I remember her not having any anticipatory anxiety, handling the doctor very well, host the doctor very well, until she got the email and focused on the word “mostly.” And that sent her spiraling out of control. But the interesting thing about that whole experience was that we processed it afterwards, and that whole experience motivated her to try even harder. And then she took even bigger strides forward. And within a couple of months, she was really doing so much better. And I think it’s been over a year now since that and continues to do really well. Kimberley: Yeah. Thank you so much for sharing that. I actually was tearing up. Tears were starting to come because I was thinking, I totally get that experience. I’m so grateful you shared it because I think so many people do, right? Maria: Yeah. And there’s always and/or. You go into the doctor’s appointment, they tell you everything. And because your adrenaline is absolutely pumping, you forget everything. And then you come out and you go, “Oh my gosh, I can’t remember anything.” Then the anxiety kicks in and tells you what the anxiety is like, “Oh no, that must have been bad. That must have been--” yeah. Ken: And that boost in adrenaline that just takes over is so powerful. You can forget any common sense or any therapeutic strategies or tools that you might have learned because now you just get preoccupied with one word, the uncertainty of that word. Maria: Yeah. I would have to have a family member come in, my husband to come in and sit in the-- it got to that point where he would have to come in and sit in the appointment, so then after the appointment, I could have him retell me what was said, because I knew as soon as the adrenaline kicked in, I would not be able to remember anything. ROADBLOCKS TO HEALTH ANXIETY TREATMENT Kimberley: Right. Ken, this brings me straight to the next question, which would be like, what roadblocks do you commonly see patients hit specifically if they have health anxiety during recovery or treatment? Ken: Well, unlike other fears and phobias, the triggers for health anxiety are very unpredictable. So, if you have a fear of elevators, flying or public speaking, you know when your flight is going to be, you know when you have to speak or you know when you have to drive if you have a fear of driving. For health anxiety, you never know when you’re going to be triggered. And those triggers can be internal, like a physical sensation, because the body is very noisy. And everyone experiences physical sensations periodically and you never know when that’s going to happen. And then you never know external triggers. You never know when the doctor is going to say something that might trigger you, or you see a social media post about a GoFundMe account about someone that you know who knows someone who’s been diagnosed with ALS. So, you never know when these things are going to happen. And so, you might be doing well for a couple of weeks or even a month, and suddenly there’s a trigger and you’re right back to where you started from. And so, in that way, it feels very frustrating because you can do well and then you can start becoming extremely anxious again. Another roadblock I think might be if you need medicine, there’s a fear of trying medicine because of potential for side effects and becomes overblown and what are the long-term side effects, and even if I take it, I’m going to become very anxious. And so, people then are not taking the very thing, the medicine that could actually help them reduce their anxiety. So, that’s another roadblock. Kimberley: Yeah. I love those. And I think that they’re by far the most hurdles. And Maria, you could maybe even chime in, what did you feel your biggest roadblock to recovery was? Maria: Being okay with the unknown. Trying to be in control all the time is exhausting and trying to constantly have that reassurance and coming to terms with, “It’s okay if I can’t control everything. It’s okay if I don’t get the 100% reassurance that I need. It’s good enough,” that was hard for me. And also, not picking up the phone and Googling was the biggest. I think once I stopped that and I was okay with not looking constantly, that was a huge step forward. Ken: You really learn to live with uncertainty. And I think you start to understand that if you had to demand 100% certainty, you had to keep your anxiety disorder. In order to be 100% certain, that meant keep staying anxious. Kimberley: Yeah. Being stuck in that cycle forever. Ken: You didn’t want that anymore. You wanted to focus on living your life rather than being preoccupied with preventing death. SKILLS AND TOOLS TO OVERCOME HEALTH ANXIETY Kimberley: Right. So, Maria, I mean, that’s probably, from my experience as a clinician, one of the most important skills, the ability to tolerate and be uncertain. Were there other specific tools that you felt were really important for your recovery at the beginning and middle and end, and as you continue to live your life? Maria: Yes. I think the biggest one was me separating my anxiety from myself, if that makes sense. Seeing it as a separate-- I don’t even know, like a separate entity, not feeling like it was me. I had to look at it as something that was trying to control me, but I was fine. I needed to fight the anxiety. And separating it was hard in the beginning. But then I think once I really can help me to understand how to do that, at that point, I think I started to move forward a bit more. Kimberley: So, you externalized it. For me, I give it a name like Linda. “Hi, Linda,” or whatever name you want to give your anxiety. A lot of kids do that as well like Mr. Candyman or whatever. Maria: Yeah. It sat on my shoulder and try to get in my head. In the beginning, I would be brushing off my shoulder constantly. Literally, I must have looked crazy because I was brushing this anxiety off my shoulder every 10 minutes with another what-if. What if this? What if that? And I think I had to retrain my brain. I had to just start not believing and being distracted constantly by the “What if you do this” or “What if that?” and I’d say, “No, no.” Ken: Yeah. I’d treat a lot of health anxiety. I have a lot of health anxiety groups. And I do notice that the patients that can externalize their anxiety and personify it do way better than the people who have trouble with it. And so, whether it’s a child or a teenager or an adult, I am having them externalize their anxiety. And I go into that, not only in my groups, but in the audio program I created called the Anxiety Solution Series. It is all about how to do that. And it makes things so much easier. If now you’re not fighting with yourself, there’s no internal struggle anymore because now you’re just competing against an opponent who’s outside of you. It makes things easier. Kimberley: Right. Yeah. And sometimes when that voice is there and you believe it to be you, it can make you feel a little crazy. But when you can externalize it, it separates you from that feeling of going crazy as well. Maria: I felt so much better as soon as I did that because I felt, “Okay, I think I can fight this. This isn’t me. I’m not going crazy. This is something that I--” and I started to not believe. And it was long, but it was retraining my brain. And I would question the what-ifs and it didn’t make sense to me anymore. Or I would write it down and then I would read it back to me, myself, and I’d be like, “That’s ridiculous, what I just thought.” And the other tool which was hugely helpful was breathing, learning how to breathe properly and calm myself down. I mean-- Ken: Yeah. There’s lots of different types of breathing out there. And so, I teach a specific type of breathing, which is, I call it Three by Three Relaxation Breathing, which is also in the Anxiety Solution Series. And it really goes over into detail, a very simple way to breathe that you can do it anywhere. You can do it in a waiting room full of people, because it’s very subtle. It’s not something where you’re taking a big breath and people are looking at you. It’s very, very subtle. You can do it anywhere. MEDITATION FOR HEALTH ANXIETY Kimberley: Ken, just so that I understand, and also Maria, how does that help someone? For someone who has struggled with breathing or is afraid of meditation hor health anxiety and they’ve had a bad experience, how does the breathing specifically help, even, like you were saying, in a doctor’s appointment office? Maria: I’ve done it actually in multiple doctor’s appointments where I’ve had that feeling of, “I’ve got to get out of here now.” It’s that feeling of, “Uh, no. Right now, I need to leave.” Before, before I started, I would leave. And now I realized, no, I’m not. I’m going to sit and I’m going to breathe. And no one notices. No one can see it. You can breathe and it really does calm me down, especially in the past, I’ve had panic attacks and feeling like I can’t breathe myself. When you start to realized that you can control it and it does relax you, it really helps me a lot. I do it all the time. Kimberley: It’s like a distress tolerance tool then, would you say? Maria: It’s something that I can carry around with me all the time, because everyone needs to breathe. Kimberley: Yeah. I always say that your breath is free. It’s a free tool. You could take it anywhere. It’s perfect. Maria: Yeah. So, it’s something that I can do for myself. I can rely on my breathing. And now knowing after Ken teaching me really how to do it properly, it’s just invaluable. It really is, and empowering in a way. Now, when I feel like I can’t be somewhere, and in fact just not so long ago, I was in a doctor’s appointment, not for myself, but I sat there and it was really high up and there was lots of windows around. Of course, I don’t like being [00:22:34 inaudible]. And I felt I have to get out. “Nope, I’m not going to do it. I’m not going to do it.” I sat there, I did my breathing. I actually put my earphones in and started listening to Ken’s anxiety solutions and listened and took my mind off of it, and I was fine. I didn’t leave. And actually, I walked away feeling empowered afterwards. So, it’s huge. It’s really helpful. Ken: Yeah. You just said a couple of very important things. You made a decision not to flee, so you decided right there, “I’m not going anywhere. So, I’m going to stay here. I’m going to tolerate that discomfort, but I’m going to focus on something else. I’m going to focus on my breathing. I’m going to listen to the Anxiety Solution Series.” And then by doing that, I’m assuming your anxiety either was contained, it stayed the same, or maybe it was reduced. Yeah? Maria: Yeah, it was reduced. It stayed the same. And then it started to reduce. And naturally, by the end, I was like, “I’m fine. Nothing is going to happen.” So, it was great. And the other-- I want to say actually one more thing that really, really helped me. And it was actually a turning point, was that I was in another appointment. The doctor came in and told me I was fine. And it was actually like an appointment where they had called me back medically. So, it was a different scenario. It wasn’t me creating something in my head. But anyway, there was a lot of anticipation beforehand and he came in and he said, “You are fine. Go live your life.” And I walked away and I went home. And within maybe about 40 minutes, I said, “Maybe he was lying to me. Maybe he was just trying to make me feel good because he saw how anxious I was.” And at that point I realized, this is never going to stop, never. Unless I fight back, I will never-- I felt robbed of the relief that I should have felt. When he told me that, I wasn’t getting that relief and I was never going to have that relief unless I used-- and at that point, I actually got angry. And I remember telling Ken, I was like, “I’m so angry because I felt robbed of the relief.” And at that point, I think I then kicked up my practicing of everything tenfold. And that was a turning point for me. Ken: Yeah. That anger really helped you. And anxiety is a very, very powerful emotion, but if you can access or manufacture a different emotion, a competing emotion, and anger is just one of them, you can often mitigate the anxiety. You can push through it. And for you, it was an invaluable resource, because it was natural. You actually felt angry. For other people, they have to manufacture it and get really tough with their anxiety. But for you, you at that moment naturally felt it. And you’re right. You said it is never going to stop. And physical sensations, the body is noisy. People will have the rest of their life. You’re going to have a noisy body. So, that will never stop. It’s your reaction and your response to those physical sensations that is key. And you learn how to respond in a much more healthy way to whenever you got any sort of trigger external or internal. TREATMENT FOR HEALTH ANXIETY/HYPOCHONDRIA Kimberley: It’s really accepting that you don’t have control over anxiety. So, taking control where you have it, which is over your reactions. And I agree, I’ve had many clients who needed to hit rock bottom for a certain amount of time and see it play out and see that the compulsions didn’t work to be like, “All right, I have to do something different. This is never going to end.” And I think that that insight too can be a real motivator for treatment of like, “I can’t get the relief. It doesn’t end up lasting and I deserve that like everybody else.” So, Ken, how do you see as a clinician the differences in recovery and health anxiety treatment for different people? Do you feel like it’s the same for everybody, or do you see that there are some differences depending on the person? Ken: Well, when I treat people with health anxiety, although the content of their specific fears might be different – some might worry more about their heart, some might worry more about shaking that they experience and worry about ALS – the treatment is basically the same, which is why I can treat them in classes or groups because it’s basically the same. There are some variations. Some people are more worried about things, where other people feel more physical sensations. And I may have to tailor that a bit. So, some people have to-- their problems are more the physical sensations that they feel and they can’t tolerate those physical sensations. And other people it’s more mental. They’re just constantly worried about things. But in general, they can be treated very similarly. It’s learning how to tolerate both the uncertainty and the discomfort and the stress that they feel. Kimberley: Right. And I’ll add, I think the only thing that I notice as a difference is some people have a lot of insight about their disorder and some don’t. Some are really able to identify like, “Ah, this is totally Linda, my anxiety,” or whatever you want to name your anxiety. “This is my anxiety doing this.” Whereas some people I’ve experienced as a clinician, every single time it is cancer in their mind and they have a really hard time believing anything else. Like you said, they feel it to be true. Do you agree with that? Ken: Completely. Yeah. Some people will come to me and they know it’s probably anxiety, but they’re not sure. And some people, they are thoroughly convinced that they have that disease or that disorder. And even after months and months and months of-- and oftentimes the content changes. So, I have patients who, when I first start seeing them, they might be afraid of cancer. And then two months later, it’s their heart. And then a couple of months later after that, it’s something else. There’s always something that can come up and they’re always believing it’s something medical. And of course, they go back to, “Well, what if this time it is? What if this time it is cancer?” And that’s where they get caught in the trap. So, for them, it’s answering that question. For Maria, it’s the word “mostly” that she became fixated on to get lured in and take the bait. It’s like, what happens to a fish that takes the bait? Now they’re struggling. So, now once you take the bait, you’re struggling. Kimberley: Right. And I would say, I mean, I’ll personally explain. A lot of my listeners know this, but I’ll share it with you guys. I have a lesion on the back of my brain that I know is there. And I have an MRI every six months. And I have a lot of clients who have a medical illness and they have health anxiety, and it’s really managing, following the doctor’s protocol, but not doing anything above and beyond that because it’s so easy to be like, “Well, maybe I’ll just schedule it a little earlier because it is there and I really should be keeping an eye on it.” And that has been an interesting process for me with the medical illness to tweak the treatment there as well. Ken: Yes, absolutely. I have a patient right now and she has a legitimate heart issue that is not dangerous. They’ve had many, many tests, but all of a sudden, her heart will just start racing really fast, just out of the blue. And it happens randomly and seems like stress exacerbates the frequency of it. But it’s not just irritating for her, it was scary because every time she would experience it, she thought, “Maybe this is it. I’m having a heart attack.” But she really had to learn to tolerate that discomfort, that it was going to happen sometimes and that was okay. It happens and you just have to learn to live with it. Kimberley: Right. So, Maria, this is the question I’m most excited about asking you. Tell me now what a doctor’s appointment looks like for you. Maria: It looks a lot better. You can actually pick up the phone and book an appointment now without avoiding it. I practice everything that I’ve learned. I’m not going to lie. The anticipation, maybe a couple of days before, is still there. However, it’s really not as bad as it was before. I mean, before, I would be a complete mess before I even walked into the doctor’s office. Now, I can walk in and I’m doing my breathing and I’m not asking multiple questions. I’m now okay with trusting what the doctor has to say. Whereas before, if I didn’t like what he had to say or he didn’t say exactly the way I wanted to hear it, I’d go to another doctor. But now, I’m okay with it. And it’s still something I don’t necessarily want to do. But leaps and bounds better. Leaps and bounds really. I can go in by myself, have a doctor’s appointment, ask the regular questions and say, “Give me the answers,” and leave and be okay with it. GETTING TEST RESULTS WITH HEALTH ANXIETY Kimberley: How do you tolerate the times between the test and the test results? How do you work through that? Because sometimes it can take a week. You know what I mean? Sometimes it’s a long time. Maria: Yeah. I mean, I haven’t-- so, obviously, it’s yearly. So, I’m at that point next year where I will have to go and have all my tests again and get the results and anticipate. But I think for me, the biggest thing is distraction and trying not to focus too much beforehand and staying calm and relaxed. And that’s really it. I mean, there’s always going to be anxiety there for me, I think, going to the doctors. It’s not ever going to go away. I’m okay with that. But it’s learning how to keep it at a point where I can understand what they’re telling me and not make it into something completely different. Ken: I think you said the keywords – where you’re putting your focus. So, before, your focus was on answering those what-if questions and the catastrophic possible results. And now I think your focus is on just living your life, just going about living your life and not worrying or thinking about what the catastrophic possibilities could be. Is that accurate? Would you say it’s accurate? Maria: Yeah. Because if you start going down that road of what-if, you’re already entering that zone, which it is just, you’re never going to get the answer that you want. And it’s hard because sometimes I would sit and say to myself, “I’m going to logically think this out.” And I would pretend. I mean, I even mentioned to Ken, “No, no, I’m logically thinking this out. This is what anyone would do. I’m sat there and I’m working out in my head.” And he said, “You’ve already engaged. You’ve already engaged with the anxiety.” “Have I?” And he said, “Yeah. By working it out in your head, you’re engaging with the anxiety.” And that was a breakthrough as well because I thought to myself after, “I am.” I’m already wrapped up in my head logically thinking that I’m not engaging, but I’m completely engaging. So, that was an interesting turning point as well, I think. Kimberley: Amazing. You’ve come a long, long, long way. I’m so happy to hear that. Ken, before we wrap up, is there anything that you feel people need to know or some major points that you want to give or one key thing that they should know if they have health anxiety? Ken: Oh my gosh, there are so many. There is a tendency for people with all types of anxiety to really focus their attention on the catastrophic possibilities instead of the odds of those catastrophic possibilities happening. The odds are incredibly low. And so, if you’re focusing on the fact that it’s probably not likely that this is going to happen, then you’ll probably go through your life and be okay if you can focus your attention on living your life. But if you focus on those catastrophic possibilities that are possible, they are, then you’re going to go through life feeling very, very anxious. And if you focus on trying to prevent death, prevent suffering, then you’re not really living your life. Kimberley: That’s it right there. That’s the phrase of the episode, I think, because I think that’s the most important key part. I cannot thank you both enough for coming on. Ken: This is fun. This is great. Maria: It was fun. Kimberley: Maria, your story is so inspiring and you’re so eloquent in how you shared it. I teared up twice during this episode just because I know that feeling and I just love that you’ve done that work. So, thank you so much for sharing. Ken: Yeah. She’s really proof that someone who’s suffered for 15, 20, some odd years with anxiety can get better. They just have to be really determined and really apply the strategies and be consistent. She did a great job. Kimberley: Yeah. Massive respect for you, Maria. Maria: Oh, thank you. Kimberley: Amazing. Ken, before we finish up, do you have any-- you want to share with us where people can hear from you or get access to your good stuff? Ken: Yeah. So, quietmindsolutions.com, I have a whole bunch of information on health anxiety. I have two webinars in health anxiety on that website, as well as other webinars in other specialties I have. Also, I have the Anxiety Solution Series, which is a 12-hour audio program, which focuses on all types of anxiety, including health anxiety, as well as others. And you can listen to a few chapters for free just to see if you would like it, if you could relate to it. And there’s other programs, other articles, and videos that I produced. I have a coloring self-help book, which is basically a self-help for people with anxiety, but every chapter has a coloring illustration where you color. And the coloring illustration actually-- what’s the word I’m looking for? It’s basically a representation of what you learn in that chapter. It strengthens what you learn in that chapter. Kimberley: Cool. Ken: Yeah. And then a book called The Emetophobia Manual, which is a book for people who have fear of vomiting. Kimberley: Amazing. And we’ll have all those links in the show notes for people as well. So, go to the show notes if you’re interested in getting those links. Ken: Ken Goodman Therapy is the other website. It has similar information. Maria: I wanted to mention as well that I actually watched one of Ken’s webinars quite by accident in the beginning before I realized I had health anxiety. And after watching it, I thought, “Oh my gosh, I’ve got that.” And so, it was hugely, hugely helpful because I think that having this for so many years and not realizing, there’s a lot of people that still don’t realize that they suffer from health anxiety. For me, as soon as I could label it as something, it was a relief because now I could find the tools and the help to work on it and get that relief. Kimberley: Amazing. Okay. Well, my heart is so full. Thank you both for coming on and sharing your overcoming health anxiety story. It’s really a pleasure to hear this story. So inspiring. So, thank you. Ken: Yeah. Thank you for doing this, Kimberley. Maria: Thank you. Ken: And thanks, Maria. ----- Thank you so much for listening. Before we finish up, we’re going to do the review of the week. This is from kdeemo, and they said: “This podcast is a gift. I just found this podcast and I’m binging on the episodes. I learn something through each episode, and love her practical advice and tools. I feel like part of a community-what a gift!” Oh, I’m so, so grateful to have you kdeemo in our community. This is a beautiful, beautiful space. My hope is that it’s different to every other podcast you listen to in that we give you a little bit of tools, a little bit of tips, but a huge degree of love and support and compassion and encouragement. So, thank you so much for your review. I love getting your reviews. It helps me to really double down in my mission here to give as many practical free tools as I can. It is true, it is a gift to be able to do that. So, if you could please leave a review, I would be so, so grateful. You can click wherever you’re listening and leave a review there. Have a wonderful day.

SUMMARY:  Many people ask me, “Why do I have anxiety?” and the truth is, there is no clear-cut answer. However, in this week's episode, I give you nine possible causes of anxiety and what you can do to manage anxiety in your daily life. Some causes are in your control, and some are not.  Either way, it is important that you are super gentle with yourself as you explore some of the reasons for anxiety in your life.  In This Episode: NINE possible causes of anxiety for you in your life What you can do to manage your anxiety How to overcome anxiety by changing small behaviors Reasons you experience anxiety may include Genetics Caffeine Distorted Thoughts Behaviors Trauma Environment Stress Management Lack of Tools Isolation (lack of community) Links To Things I Talk About: Time Management for Optimum Mental Health https://www.cbtschool.com/timemanagement 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 225. Welcome back, everybody. Today, we are talking about the causes of anxiety, why you are anxious and what you can do about it. This is a topic I feel like keeps coming up with my clients like, “But why? Why is this happening?” And I totally get it. Now, a lot of the times, I encourage my patients the end goal, jump straight to the end goal is we don’t want to spend too much time trying to solve why we’re anxious. That in and of itself can become a compulsive problematic behavior. But I wanted to just address it because I don’t think I have addressed it yet in the podcast. I thought now is a good time to really just look at some of the reasons we humans are anxious. I’m an anxious person, my guess that the fact that you’re listening to Your Anxiety Toolkit means you or someone you love is an anxious person. So, let’s talk about why we’re anxious. What are the causes of anxiety and what are some of the reasons we are anxious. Now before we do that, we want to, of course, do our “I did our hard thing” segment, and this one is for Bradley. Bradley wrote: “I was at a family event and had to see a family member I haven’t seen in four years. I said a firm, no contact boundary with her since she was so toxic. And as much as I tried, I knew I could not control whether she came or not. Seeing her was very hard, but I gave myself loads of self-compassion and allowed that moment to be very difficult.” Oh, Bradley, this is so good. “I was pleasant to her, but I did not engage beyond what was necessary. I took multiple moments throughout the event to check in with myself and see what my body needed.” This is so good and this is such great modeling of how we can regulate and monitor ourselves, giving ourselves kindness as we do hard things. I love this. Thank you so much for sharing it. This is really super inspiring. I think we all need to practice this one a little better, myself included. I hope that that brings you some inspiration before we move on into the episode. Thank you again, Bradley, for submitting that. I love hearing the “I did a hard thing.” Let’s talk about why you and I, and we might be anxious. 1. Genetics Reason number one is genetics. I think that if I’m with a client and they ask me, this is usually the spiel I would give them, which is, genetically, a lot of us are set up to have anxiety. What that means is somewhere in our lineage, our parent, our grandparent, someone had anxiety and it is quite a genetic trait to have. As we go through these, I’m really wanting you, just as a side note, to think about these things, but we don’t want to use these as an opportunity to blame other people. We don’t want to blame, of course, our parents or our grandparents. It wasn’t their fault. Obviously, they probably had it passed down from somebody else as well. But as we move through some of these, I also don’t want you to displace blame onto yourself, and we can talk about that as we go. But genetics is a reason that some of us are anxious. I’ll give you a little bit of a piece of my personal experience here, is I often-- I mean, I know every anxiety tool in the book and there’s been many times where I’ve visited doctors or psychiatrists and they ask me about anxiety and I’ll say, “Yes, I have anxiety.” They’ll say, “Well have you had therapy? Have you tried medicine?” “Yeah, I’ve tried all of those things and I’m highly functioning and I have a wonderful life.” But I also have to accept that some degrees of anxiety are just genetic. I’m not going to get rid of them all. In fact, I don’t want to get rid of all anxiety. I want to use this as an opportunity to remind you that this is not meaning that it’s a list of things you now have to go and fix. Not at all. This is about just being aware of what’s going on. Hopefully, at the end, we’ll talk more about this, is you can then acknowledge what might be bringing the anxiety on, but then go straight to your toolkit. The tools are the most important part here –acceptance, not judgment, willingness, compassion, being mindful. Go straight back to your tools once you’ve listened to this podcast because that’s going to be the most important piece. 2. Caffeine The second reason you might have anxiety is because of caffeine. A lot of people report that if they have too much caffeine, they get jittery and it sets off a nervous response in the body where the brain then sends out a whole bunch of anxiety hormones and chemicals in the body. Caffeine mimics anxiety, which then means that now you have more anxiety, because when you have anxiety and you experience something like it, usually, if you go, “Oh my gosh, yeah, something must be wrong,” your body proceeds to send out more and more and more and more anxiety. Caffeine can be one, but I will also tag on additional one here, which is alcohol. A lot of my patients have reported that if they’re drinking too much alcohol, they do feel that same jitteriness the next day, which then causes their brain to think something is wrong. Therefore, again, send out more anxiety, chemicals and hormones, something to think about. 3. Distorted Thoughts Now, the third is really important. I’ve done podcast episodes on this before, and it’s distorted thoughts, catching your distorted thoughts. If you are at the supermarket and the man or woman next to you drops the cereal box all over the floor or they drop a can or a glass bottle, and it shatters everywhere, you are naturally going to have anxiety. Normal. Anyone would have anxiety. It’s a big shock to the system. But if you then have distorted thoughts about that, like that means it’s bad luck, I did something wrong, I’ve humiliated myself, they’re going to be judging me – there are so many different distorted thoughts. I’m just using this as an example. Or another example would be you are interacting with someone at the bank and you have then following the distorted thought of like, “They are judging me. They think I’m stupid. I I didn’t handle that well.” Maybe you have the thought bad things are going to happen and you’re catastrophizing. Those thoughts will create anxiety. Now again, if you go back and listen to those episodes back a few weeks ago, you will remember me saying, we cannot control our intrusive thoughts. I want to make that really clear. There are a lot of thoughts you are having right now that you have no control over. What I’m talking about at distorted thoughts are the thoughts on how you appraise a situation. Let’s say you have a thought, let’s say you have harm obsessions, and you have a thought like, “What if I wanted to hurt somebody or so forth?” That you can’t control. But if then you appraise it going, “I’m a terrible person for having that thought,” that’s the distorted thought that you can actually work on. Those distorted thoughts can cause anxiety as well. 4. Behaviors Sometimes our behaviors can create anxiety. Avoidance is one of them. You would think that avoiding your fear makes anxiety go away. Makes sense, right? But actually, it’s not true. The more you avoid things, the more you actually increase your anxiety about that thing. If you’ve avoided something for a very long time, let’s say you avoided flying. Now, even the thought of flying is going to give you anxiety. So, behaviors can cause anxiety as well. Now, this also includes compulsive behaviors. It includes reassurance-seeking behaviors. It includes rumination in your mind, mental compulsions. Behaviors can increase the degree in how your brain responds. People pleasing, this is a big one for me. If I’m people pleasing, trying to make everybody happy, no one upset, you would think, oh, that’s a good thing. You’re being a kind human being. Well, yeah, except it then creates a lot of anxiety at the idea that someone doesn’t like something you did or that they’re upset with you about something that you did. Now, you haven’t built up a tolerance to just the fact that we can’t please everybody. These are ideas on how behaviors can actually cause anxiety. 5. Trauma In the mental health field today, everybody is saying everything is trauma. It’s like, “You’ve traumatized me. I was traumatized by this.” It’s important that we-- and this is for another conversation, but I’m going to slide it in here. When we talk about trauma, where I’m actually talking about life-threatening trauma. Not to say that we call it little “t” trauma. There’s big “T” trauma, which are life-threatening events, war, assault, witnessing a death, and so forth. There’s some examples. It doesn’t include all of them, but that’s what we call capital “T” trauma. There are little “t” traumas. We all have little “T” traumas and they can cause anxiety. I’ll give you an example. When I was a kid, we went through, in 1992 I think it was, this devastating drought. I grew up on a farm. We really needed water and the whole environment was just desperate for water and we didn’t have enough water. We had to pay to have a truck bring water just so that we could have baths. It was really scary as a very young child to be afraid of not having enough water to drink. It was scary. We could call that a little “t” trauma. Still to this day, when my kids, my son just spends forever in the shower, I start to notice I get anxious when he’s in there for a long time because my brain is telling me we’re going to run out of water. That’s an example of why you may notice some anxiety show up. Now I can correct that and remind myself that I live in times where there’s no drought or that we have excess water and so forth. And that’s where I check those cognitive thoughts and errors of my thinking. But the trauma itself can cause the anxiety. Again, I want us to be really careful around the word “trauma” because I don’t want us to be using “trauma” about all the things, because that actually isn’t good for our brains either to keep telling ourselves we were traumatized. That actually can create anxiety in and of itself. 6. Environment You all have experienced this. Even though I don’t know you and your beautiful face, this you would have experienced in the last few years – the environment of COVID creates anxiety. Seeing people with the mask at the beginning of COVID, I’m guessing you would’ve had a bout of anxiety. Being around loud noises can create anxiety. Being in countries or regions where there are discord, conflict, war, they can create anxiety. Being in an abusive household, the environment of abusive household can create, of course, anxiety. Having someone around you who yells a lot and screams and throws things can create anxiety. There we’re going into the line again of trauma, but we want to consider environment. 7. Stress Management A big one for right now as well. If you have an incredible amount of stress on your plate, you will naturally have anxiety. If this is you, I’m going to encourage you to consider taking some of the stress off your plate, if possible. I know it’s hard. Some of you have double jobs and family and chronic illnesses and medical, mental illnesses. It’s hard. But anywhere you can, ask yourself, is there a way I can make this easier or simpler so that I can reduce my stress? 8. Lack of Tools Now this is a big one for me because I get really grumpy and cross. That’s an Australian term for everyone who is an Australian. When you say you’re cross, it means you’re angry or very grumpy about something. I get really cross when people who claim to be anxiety specialists give these strategies that actually make anxiety worse. Sometimes people do have generalized anxiety, but the tools they’ve been given can actually make it worse. Telling people just to use oils – oils are fine. I have nothing wrong with oils. I actually, PS, love oil. But if that’s your only skill and only tool that you have and your only agenda for recovery, that’s not going to help. It’s actually going to create more anxiety because you’re going to keep getting frustrated on why it’s not working. If your only tool is to, again, another gripe I have that makes me very cross – ah, so funny that I get so upset about it – is people who talk about thought-stopping, like just think about a big red stop sign. That is not a helpful tool. Sometimes it works for some people. But if you have a repetitive intrusive thought, that is not going to work. It’s actually going to make your anxiety worse. Lack of tools is an important one. I’m even going to say be critical, even of me when I’m giving tools. Really stop and ask yourself, does this work for me? Because I don’t know each and every one of you and all the intricacies of what’s going on for you psychologically. Always stop and ask yourself, is this helpful? I like to give you as many science-based tools as I can. I try not to just decide of a strategy that I use and just use it. But I want you to be really critical of everybody. Be very wise in your selection of who you choose to get advice from. That’s just a little piece to think about. Like I said, I always say this, take what you need and leave the rest if it’s not helpful. 9. Isolation The last one is important. It’s not last for any specific reason, but it’s isolation. If you are in isolation for too long, meaning that you’re alone, you don’t have community, you don’t have connection, your brain will naturally get anxious. Sometimes people love isolation. I myself love isolation and quiet and to be by myself. Oh, it’s so good. I just love it. I just can sit and be still. It’s good for some people, but too much isolation, prolonged periods of isolation often can cause anxiety, because we are community humans. Humans are built on community and tribe and needing each other. That goes back thousands, millions of years. For those who are struggling, they’re like, “Everything’s fine. I don’t know why, I’m in my safe house.” It’s like, “Well, when’s the last time you saw somebody?” “Oh, it was months ago.” “Okay, well, that makes sense. You haven’t had any of that.” There is some science to showing that your parasympathetic nervous system slows down when you’re in connection and even physical touch with somebody. That’s just something to think about as well. There you have it. Those are the nine reasons, 10 if we include alcohol. They’re the reasons that you might feel anxiety in your life or in your lifetime. I hope that this brings you some insight and you had a few aha moments about maybe why your anxiety is showing up again. I promised I would say at the end, this is not to say that now you have to go and fix all of those nine things. Actually, quite the opposite. We don’t fix anxiety. In fact, the more ideal option would be to practice befriending and allowing and not judging anxiety. But if this is helpful for you to maybe make some tweaks in your life, change your distorted thoughts, reduce your caffeine, manage your stress, change your environment, get some connection, get some helpful tools, that would make me so, so happy. Before we finish up, we are going to do the review of the week. This one is from Tennessee Lana. She said: “Game changer. I found this podcast four years ago and it has been monumental in my anxiety and OCD recovery. Many podcasts led to new content that I could follow and learn. I could write about this and never stop but instead I’ll leave a few adjectives that I think adequately describe this podcast. Kind, insightful, intelligent, easy, interesting, practical, helpful, uplifting, and LOVING.” Oh my goodness, Tennessee Lana, do you know the word I love the most? Practical. If I can be practical in helping you, I feel like I am winning in my career. All of those adjectives make me so overjoyed, but I love these. Actually, Tennessee Lana, I’m going to steal them from you. Copy and paste them. Maybe put them on my desktop just to remind me of the goals of the podcast. Love it. I hope you found this helpful. Have a wonderful day. Please go to leave a review if you can. Those reviews allow me to reach more people from people who trust the show, which is key. If someone can see that other people are enjoying it, that means they can trust us quickly, which is the goal. And then from there, I hope that this episode was helpful and gave you some insights. All right. I will see you next week. Have a wonderful day.

SUMMARY:  In today's podcast episode, we have Dean Stott from DLC Anxiety talking about his experience with Panic Disorder and Overcoming Panic Disorder.  In his upcoming book, Greater Than Panic, Dean talks about what it was like for him to experience agoraphobia, panic disorder, and other struggles after the death of his father.  Dean spread an inspiring story about overcoming panic and how he is Greater than Panic. In This Episode: What it was like for Dean Stott to have Panic Disorder How he overcame panic disorder using CBT and Mindfulness How Dean created DLC Anxiety, an online platform that helps millions with panic, anxiety and other mental illnesses. Tools that he found helpful to manage his Panic Disorder while also grieving the loss of his father. Links To Things I Talk About: DEANS BOOK GREATER THAN PANIC  Amazon link 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 224.    Welcome back, everybody. We have an amazing guest, a very, very sweet friend of mine. I am so excited to have on with us Dean Stott from DLC Anxiety. He is a true legend. Dean is on the episode today to tell his story about going from having a fairly severe panic disorder to then creating a mental health platform with over 1 million followers. He’s now all about creating mental health awareness sharing with people. He’s such a cool human being. And I’m so honored to have him on today.    We talk about his recovery, which you will get a lot of hope from because, like everyone who comes on the podcast, he really did the work, which is so cool. But then we also talk about the role that social media can play in mental health recovery, things to look out for, how to handle trolls, the benefits of being online, especially social media. If you have a mental illness, we go through it all. And it’s such a great episode. So, I’m so excited to have Dean on today.    Before we get into the episode, I want to give you the “I did a hard thing” for the week. This is from Nicole, from the Netherlands, and she said:   “I did a hard thing and I get very anxious when I have to call my doctor. My heart rate goes up and I get all trembly. So, I tend to avoid calling the doctor. But because I had been feeling dizzy, I had to get my blood checked. Afterwards I would have to call the doctors for the results, except I didn’t. I told myself if there was anything serious, surely they would call me. I kept this up for almost two weeks and then I suddenly thought I really should call for the result. So I pushed in the numbers to the doctor’s office, feeling all kinds of nervous. I was very tempted to just hang up. While I was waiting, I thought, why did I do this? What if I get bad news? But then I had another thought, if it’s bad news, all the more reason to hear it. So I hung on and I faced my fears. Turns out I have a vitamin D deficiency. It’s not very worrisome, but important to fix. I’m so glad I phoned the doctor, even though I REALLY DIDN’T WANT TO. Nicole from the Netherlands.” Nichole, I love this story. And the thing I love the most, and for those of you who want to submit for this, please do go. I’ll leave a link in the show notes. But Nicole, I love that you detailed what got you to do it, how you did it, what thoughts you had to shift up to get yourself to do the hard thing. You walked us through step by step and it makes my heart want to explode with joy. Thank you so much for sharing it. Amazing, amazing, amazing, amazing, amazing work. I am so, so impressed. So, thank you, Nicole. I love it.  Let’s get over to the show where we can hear all about Dean’s recovery. ----- Kimberley: Welcome, Dean. I am so happy to have more-- actually, as much as I’m happy to have you on the podcast, I’m just happy to have chats with you. Welcome. Dean: Thank you so much. Thank you for inviting me, Kim. Kimberley: Yeah. So, I feel like I know you and your story pretty well. But I would love for you to share your story with my listeners because I think you have some really great stuff to share. So, can you share whatever you’re comfortable about your recovery? Dean: Yeah, sure. So, basically, once upon a time, I was going through a panic disorder. So, dealing with four panic attacks, maybe four or five panic attacks every single day, where I get the worst period. And yeah, I went through a panic disorder, did my own research, a lot of science research, CBT research, mindfulness meditation, and curated my own plan out of recovery with the guidance of a really good support network, friends, and mentors, who’d been through an anxiety disorder and come out the other side and fully recovered from the panic disorder. I then wanted to take that feeling of the support that I was given from my older mentor, the friend that had been through it. I wanted to share that with as many people as I possibly could. So, I came up with DLC Anxiety. So, at first, I remember sitting down and I was like, “How can I get this message out to as many people as possible?” And I was thinking of local support community groups, like the Alcoholic Anonymous groups where people go and it’s a supportive network between each other. But then I was just so eager to try and get it even more on a global stage. And I saw what Instagram does and I just thought it would fit nicely in there, because I did see that there wasn’t many mental health communities when I first started. So, I thought there was definitely a nice place for it to fit there. So, yeah, I started to tell my story on Instagram. People started to relate, and it was a snowball effect from there. And now we’re over a million followers in the community, which is fantastic. Kimberley: So cool. So, I think that the whole concept here is really to look at what-- let me backtrack a little bit. So, in your recovery, did you do it all on your own? Did you have a therapist? What was that process like for you? Dean: Yeah. So, my father passed away. Like any people, any male in that situation, I bottled up the feelings that I was going through and tried to carry on with going to work and trying to get back into my daily routine. Almost putting it to the back of my mind because I wasn’t-- well, I didn’t have the techniques to cope with that and I’d never cope with loss before. So, it was from that bottling up of the grief that the panic attacks started and occurred.  So, when I first started having panic attacks, the first thing I did was go to the doctors who then referred me onto a grief counselor, but just specifically to address the grief side of things and not the anxiety, not the panic attacks. Regarding the anxiety and panic attacks, that was me curating, delving into a lot of psychoeducation, which I found very useful, learning about the system and the symptoms of anxiety. Now I’d done Psychology at university and done CBT before. So, it is like not I’d never--I knew the basic concepts of anxiety, but learning more about it and learning about the scary symptoms where you think-- firstly, when you have a panic attack, you really think that you’re going to die. It’s a really, really scary thing to go through. And yeah, to start learning about that was super important for my recovery.   Kimberley: Right. And so, let’s talk about community, why do you feel the community aspect was so important for you? Tell me about the idea of creating a mental health community for someone, let’s say, who’s suffering with panic disorder or grief or OCD or anxiety. What’s your thoughts on that?   Dean: Yeah. So, when I was going through panic disorder, I felt isolated, I felt alone, and really, I didn’t really want to bring it up to people around me because I just didn’t think they’d be able to relate to me. I thought these symptoms was just something that I was going through and something that I’d have to stick with for the rest of my life. I thought that was me, that I was going to be Dean who has these panic attacks. And I was going to have to navigate my way through my daily routine. And I think when I opened up to my mentor, a close friend of mine, who was working with me at the time – when I opened up and he shared his experience, it was the biggest weight off my shoulders, knowing that someone else had been through not the exact same story, but it experienced all these scary symptoms that felt isolated, felt alone, but more importantly overcome an anxiety disorder. And I think it was that inspiration and motivation that really helped me in my recovery.  So, yeah, having an important-- so, DLC is Dean’s Like-Minded Community. So, it’s a community full of like-minded people on anxiety recovery journeys. Some people are at the end, like myself, I don’t deal with panic attacks anymore, but some people are at the start, some people are in the middle. And they can all relate to each other no matter where they are on that journey. And then what’s beautiful about the community is where you see them sharing tips and experiences that work for them. And I know you speak about it highly as well, having an anxiety toolkit, because some tools might work for one person, but then might not work for another. But I think it’s very important to get as much information out there about all the different range of tools, so then each person can individualize their own recovery. Kimberley: Yeah. So important more now than ever, I think, given that the degree of mental illness is so high given COVID and isolation and everything. Okay. So, you have this platform. I love it. Very much, I loved being a part of your community. Why do you think that that is the most important piece, the community aspect? Can you share a little bit about what you see and hear from your community and why that’s so important? Dean: Yeah. So, again, so many DMs from people saying that they just feel connected. They feel hope, they feel inspiration, they feel motivation. Not only for me, who’s at the head or the founder of the community, but of all these people that are going through it, jumping over a million people worldwide. We know mental health. It doesn’t have a face, it doesn’t have a color, doesn’t have a social structure, it doesn’t matter what you’re working as it can affect anyone. And I think that’s why it’s really important and became an integral part of the community, was the interview series that I started doing with firstly mental health professionals from around the world. So, CBT professionals like yourself, Kim. Then we’ve had psychiatrists, psychologists, doctors. And having just as much information about anxiety and anxiety recovery, I think has been a super important part.   So, again, it’s not only having this community, it’s having the psychoeducation and real good-- I’m in a real good place now where I can guest on who I’ve joined a world-renowned within the space of anxiety. And also, we’ve had so many celebrities, musicians, actors, actresses come on and tell their own mental health stories where they struggled or where they’ve been vulnerable. And that’s really related to the community as well. Because obviously, people work at celebrities, people work at musicians and they might not know that just too, they’re going through a mental health disorder. So, yeah, having people like that come on and tell their own stories has been super, super beneficial for everyone as well.  Kimberley: Yeah. See, the cool thing is that the science, this is why I’m really fascinated in, is the science of self-compassion says that there are three components of self-compassion. One being mindfulness, the second being common humanity in that reminding yourself that you’re not alone in your struggles is the second most important part of self-compassion. The third being self-kindness. Now the reason I love this is I know for myself in the areas that I struggle, if I look at an account and I can see that a million people follow a mental health account, it gives me a sense of common humanity that there are a million people struggling with something. If you see an OCD account and it’s got 60,000 followers, you’re like, oh my God, that’s a lot of people. I must not be alone in my struggle or an eating disorder account. Or I love some of the autism accounts. I think it shows that it gives you permission to see that you’re not alone. And I love that. It’s such a beautiful piece of the work. Dean: Yeah. And especially where you just mentioned self-kindness as well. I think that’s an important subject just to speak about, is that when you’re going through an anxiety disorder, you have this inner critic that’s telling you that you’re never going to come out of it, that you’re not good enough, that maybe this is happening to you for a reason. When you come across these communities of people who are on their own journey of recovery might be a little a few more steps ahead than you, and you see that they have a positive outlook, some of them, on recovery and they are making steps. I think knowing to change that in a narrative and have that self-love and compassion is super important when it comes to anxiety disorders. Kimberley: Yeah. And that’s the benefit of social media right there. I think social media gets a really bad rep, but we have to weigh the pros and cons because there are lots of pros, right? Dean: Yeah, no, 100%. What I’d say is this is how I define it, is that if we just take Instagram and our mental health community so all the mental health accounts that are doing great, I see just like a safe haven corner of Instagram where people can go to and feel supported and connected and learn more about mental health in general. An app, like you say, can have a negative effect on people. And I think people speak about the algorithm and obviously, it’s all guessing what the algorithm’s going to do next, but I think we can actually use the algorithm in our favor.  And if you just bear with me on this, if you think about all the accounts that you’re following, so if you’re following all positive mental health accounts or self-compassion or self-care, self-love, then the algorithms are going to spew that out to you in your own feed. So, what are you doing? You’re starting to change that in a narrative like in your digital world, because you open up your app and you start to see all this self-love and positivity. So, you can definitely use the algorithm. So, I think it’s super important in taking a look at who you’re following and seeing, does that benefit your mental health? And if it doesn’t, then I don’t think you should be following them.   Kimberley: Yeah, I agree. Actually, I just was saying yesterday that I was just scrolling my-- I’m rarely on social media just to scroll. I’m usually there to do the work I do. My son was sick. I was sitting there wasting time. But the cool thing is the suggested was all cool stuff. It was really cool. I was like, “Oh, I love all these new ideas and these new looks.” And I was really appreciating what was being suggested to me, even though I know there’s some controversy around that. It was very cool. Dean: And you can imagine if somebody’s just starting or at the beginning of anxiety disorder and they’ve got this negative outlook and they’re isolated and they haven’t connected, then the algorithm may be spewing them not the right information. So, I think it’s important to really highlight the best we can our corner of Instagram, this mental health community that’s doing so great. And it’s a new wave of mental health support really and much needed, like you say, with COVID and everything that everyone’s still going through. I think over the next five, 10 years, it’s going to be more needed than ever. Kimberley: Right. Absolutely. I can’t agree more. I don’t even think we have the stats yet on what mental illness is like from COVID, mostly the isolation of COVID. So, I 100% agree. So, let’s step outside of the online world and let’s talk generally, how did you find this community? Not the online community, but as you were going through recovery, did you tell them about your struggles? Did they come to you? How would you suggest people tell somebody about their struggles? Do you have any thoughts on that?    Dean: Yeah. So, my body and my mind and everything was telling me not to open up about anxiety and not to speak to anyone and to keep it as an inner struggle, because everything with anxiety, we know it’s all internal, it’s all inwards. We’re ruminating on our thoughts, feelings, and sensations. So, it doesn’t make sense to then speak to other people. It’s not natural to do that. So, I had to go against that and I just started to open up and not feel ashamed to tell people what I was going through. I think I got to a point where it felt like I was struggling too much for me to be going through it, so I felt like I had to. So, my advice to people would be, speak to the people around you, have a support network. You may come across people who dismiss your anxiety [00:15:20 inaudible]. And it’s super important to know that just because they dismiss it doesn’t mean anything. It’s just, they may be their views. They might not have the education on mental health. So, yeah, if you get dismissed, that shouldn’t stop you from opening up, because I know that people often, especially in my community, say, “Well, I feel like I can’t tell people because if I tell my parents, for example, they just tell me to continue to get on with it that I don’t have these issues.”  So, I think that when that happens and you have parents and it’s important to put mental health boundaries in place, obviously, especially if we’re living with our parents, we can’t just move out or whatever or if we’re young. So, we have to put these boundaries in place and have a support network around us. So, if you are younger, it could be someone in your education system, it could be a support worker, or it could be the online communities like we mentioned.   Kimberley: Yeah. That’s interesting because what’s been on my mind lately, particularly in the online space, is what to do when you have been dismissed. Now that happens from parents and loved ones. But I think it does happen on social media as well, right? You will have-- the message I’ve been trying to give is, if it’s helpful, take it. And if it’s not helpful, leave it. Because a lot of people will come to my platform and say, “I’m freaking out because I just read this, which goes against what you’re saying. And I don’t know who to believe.” And they’re doing the best they can with what they’ve got. So, I think that it’s important for people, even on the online, to also dismiss bad advice online, right? Dean: Yeah, definitely. So many people get dismissed online, don’t they? But I think you gave some great advice, Kim. And that was, anybody can write anything on social media doesn’t mean that it’s true, does it? So, we need to take in what someone’s saying to us, but if it doesn’t fit our way of thinking or it doesn’t benefit us, then it’s okay to reject it. Just like if we think of anxiety and thoughts and you get these irrational thoughts. We get this irrational thought and we don’t believe it. What do we do? We don’t accept it. We can reject and replace it. And that’s what we should do with the information around us. So, if we see a negative comment towards us, it’s so easy, isn’t it? It is so natural for us to react in a negative way because that’s the way we’re built. You know what I mean? It’s our protective system there to try and protect us. But yeah, if it’s not benefiting you, then it’s okay to step away and move away from it. Kimberley: Okay. So, let’s talk about the dreaded trolls because that’s the perfect segue. So, what I would love for you and I to talk about, and if it’s okay, be as open as you can, but let’s talk about the mental impact of having a troll, because I think you could have a bully at school and you could have a bully for a boss or you could have a bully online. And I think it’s similar in how we can internalize it. So, I have had a troll for over a year now who’s pretty aggressive. And most of my people know aggressive and awful. And in the beginning, I took it completely personally, right? Completely personally. I thought everyone was just going to hate me. And it was the most-- you know the whole thing about you have to break something to put it back together the right way? Dean: Uh-hmm. Kimberley: That’s how it felt for me, because obviously, I had built my platform and what I do, my businesses on this idea that if I just do good and I’m kind all the time, no one will ever hate me. It’s impossible to hate me if I’m kind. I think it was this belief system that I had. And that got shattered into millions of pieces because there were people who really didn’t like me. And so, I think that I’m glad it broke and it got shattered because I got to put it back properly of I had to restructure that belief. But that was really, really hard. And having someone online say things, such horrible things, I really, really had a difficult time of not taking it personally. So, can you share what your experience of online trolls and that kind of thing has been? Dean: Yeah, sure. So, with the DLC Anxiety community, especially when the first lockdown happened and we had the celebrities and musicians, they all started to gain control back of their own social media accounts. So, we saw a lot of celebrities sharing mental health stuff, which is amazing because it’s shining a big light on everything to do with mental health. So, I saw an exponential growth within that period of the community. And yeah, I remembered it was on either speaking on interviews with people or just on lives. Again, your mind zones in. Doesn’t matter how many positive messages you see on your Instagram lives, for example. It’s only natural if you see one negative comment for your mind to then just zone in on that. And I remember the first time that happened to me. I was really taken back because I was putting 23, out of 24 hours into being in this community and helping the best I can, sharing a very vulnerable story to do with my father passing and then an anxiety disorder. And I thought I was being vulnerable and open and honest, and like you say, just trying to give as much love and support for people as I could. And then to see that someone else, some people were being negative towards this, it was dismay. I couldn’t believe it. It didn’t feel real. It was like, “Why are they saying negative things towards me?”  So, it was definitely a learning curve. I always remember the first time that happened. Over time, it has got better. Like you say, you managed to structure and rearrange things and you managed to not take these things personally and look from the outside, that the people that are spreading hate or being negative, they may be hurting themselves.  My take on it now, Kim, is that even if these people are spreading hate and being horrible on my community, especially towards me, is that hopefully, they may get some good out of one of the other interviews with someone else, because I know that these people, they’re in need of mental health support themselves. And for whatever reason, they haven’t been able to get it. And I always think that if they’re giving me hate, I can now take it. And hopefully, they might see something that benefits them. But it has been very hard to change my perspective on that. It was not an easy road. Kimberley: Yeah. That’s hard for me. I think on my end, I just had to keep reminding myself that, well, all the words are about me, it’s really not about me. It’s a lot about them and their struggle. The way I work through it-- and maybe you could tell me what you think as you see the troll, like how do you think about it. For me, when I see really awful, hurtful, hard comments, I first remind myself, this person had to suffer a great, great deal to be spreading this much hate. To understand that they had to-- no one who’s had a really easy life is jumping onto the internet and spending hours spreading hate on people. It’s usually that they’ve been through an immense. And that was really helpful for me, compassion-wise, of just to be like, “I actually have compassion for you. You’ve obviously been through the wringer.” And then the second piece for me, and this was the hard part and I’m curious, I really want to know your thought, was to start to trust that people will trust me, that people will see the real me, not me that that person is saying I am by me being consistent and showing up as me. And that was a hard piece because, at the beginning, I was like, “But what if they don’t trust me?” The consistency has been really helpful for me. But I think the truth is, that has also been really helpful for me to translate it into the real world.    Dean: I was just going to say, yeah, because if your inner critic, like you say, is wanting for everyone to relate to everything that you’re putting out there, all the amazing stuff that you’re putting out there, the last thing you want is somebody trying to discredit that because, you know what I mean? All we’re trying to do is help the people around us. So, yeah, it’s that inner critic and working on our inner ourselves.  When I see a troll online now, I just tend to leave them be. I think just leave them to do what they want. I think we know that our communities know what we’re about. They know how much we give to our communities, they know how much support and wealth that we give everyone on a continuous day. And like you said, you can’t stop these people, but also, just because they’re writing something, it doesn’t mean that it’s true, which I thought was beautiful for you to say.  Kimberley: Yeah. It’s tough. I mean, I think that that is a huge part of our mental wellness, is how we relate to people, right? And we’re in relationships. So, even if we’ve got a panic disorder, I was thinking about this the other day, is we’ve had a really, really rough house here in the Quinlan house this week. It’s been pretty chaotic, lots of sickness, lots of scary COVID scares, and so forth. And there was a time where I would’ve lashed out because of my own anxiety. I would’ve been really snarky to my husband because he goes to work and he doesn’t have to handle it. And I would often displace my anxiety and anger, just snotty. And that happens a lot. I hear a lot of people talking about just in daily life like, “I’m really struggling because my partner and I aren’t getting along because everyone’s anxious and so forth.” So, I think it is helpful to be in relationship with people who do have their own struggles. Like I said, it happens online, but it’s also happening at home.  Dean: Yeah. It can just happen on a day-to-day basis. A lot of people say that they can’t deal with people when they’re being negative towards them in real life. But it’s about taking a step back and knowing that the person who’s spreading that negativity towards you, that maybe they’re having a really rough time at home with their partner, that maybe they’ve got troubles with their job, money. It could be anything. Maybe they were traveling to work and they got caught up. And we’re all a product of our emotions at that time. And emotions, as we know, they come and go and it doesn’t curate who we are as a person.    So, if someone’s being angry towards you and negative towards you, it’s about taking a step back and knowing that it’s more on them again and it’s more on what their experience and the feelings and emotions and putting the correct boundaries in place. But it is really hard to do. I’m not saying that it’s easy to do. It is super, super hard, especially when someone’s coming at you with negativity. Your first line of defense is, you know what I mean, to attack normally, isn’t it? Or to take a massive step back. So, yeah, it takes a lot of practice, but it can be done. Kimberley: So, talk to me about, you’re probably the one person who would know the answer to this, can you share with us about managing mental illness with social media? How might someone have a healthy relationship with social media and the use of social media? Dean: Yeah. I have to put boundaries in myself because I say everything that I do is on Instagram, 99% of it. And if I’m not working on Instagram, I’m working on my website, which again is online. So, yeah, putting boundaries in place is super important, having rest away from social media, what we mentioned earlier about following accounts that really benefit you and have a positive impact on you and just getting rid of the negative accounts that are not making you feel good. You don’t want to go onto social media and not feel good because we all know we spend way too much time on social media. And if we’re spending that time looking at negativity, then that’s what it’s going to do. It’s going to put our mood in that sense. And we could really spiral into a state of being in a negative state just by what we consume. It’s like when people speak about the news and say, “Oh, well, I can’t watch that because it affects my mental health.” Social media is exactly the same, but probably more so, because we’re spending more time on it and it’s literally part of who we are now. Kimberley: Right. What would you say to someone who uses social media to cope with their anxiety, meaning to distract against it or to get them through their panic? Do you have any thoughts on managing it for anxiety? Dean: Yeah. It’s a very good question. So, I always go back to thinking, at the start of my panic disorder, if there were communities like ours out there, would it have been beneficial for me? And the number one answer is yes, 100%. It would’ve been an eye-opener. I would’ve felt I wasn’t alone. I would’ve felt motivated and encouraged that I can continue. But if you’re using anxiety communities as a way to not do the hard work, then I think it can be detrimental. I think anxiety recovery is about doing the hard work.  Now, a lot of people, and I’ve just done a post on this, unfortunately can’t have the access towards therapy, which we know has a massive benefit on mental health. We speak about anxiety, the latest sciences, the medication and a combination with CBT therapy has the best results. Now, that doesn’t mean for everyone, but some people may do better with medication, some people may do better with therapy. So, I think that having a community to help you and understand the psychoeducation behind it is great. But if you’re using it as a distraction to try and distract you from feeling anxious and dealing with the anxiety head-on, that’s when it can become detrimental.  I often say that there’s so much information-- and you can obviously maybe shine away on this, Kim, but what would you say to people who say that they can’t access therapy? Maybe it’s a money thing. Maybe it could be anything, couldn’t it? Do you believe that these people can still recover? Because there seems to be a narrative online that therapy is the only way forward. I think that’s an unhealthy way of looking at it because we know that anxiety recovery, there’s so many different routes out of it, and it all leads to the same angle, doesn’t it? Which is anxiety recovery. So, what would you say to the people that can’t access therapy? Would you be still giving them hope? Kimberley: Well, to be honest with you, 1000% I would give hope. I myself have had therapy for some things, but I really didn’t feel like therapy for other issues were helpful. And I felt it was better for me to actually work through a workbook, listen to a ton of podcasts. I’m a real mix. I’ve been blessed and privileged to have some amazing therapy, but some of my mental illness, I really needed to do on my own. But I did them through, like I said, a workbook, a support group, some were online courses. I mean, that’s why I created ERP School, was because people didn’t have-- that we’re turning them away to nothing. But what was really interesting about ERP School and CBT School is just recently, out of the blue, a bunch of people have reached out to me and said, “I wanted just to let you know that that got me right back on my feet.” It’s so wonderful to hear those stories, because otherwise, you’d don’t know them and you didn’t realize what an impact. So, no, I absolutely believe, I’m a real big believer in workbooks. I struggled with workaholism and that workbook for workaholism was huge for me and perfectionism. These are two really, really important things that I use that did not require therapy at all. Dean: Yeah. So, like you, Kim, I like to be guided by the science. So, I know obviously how important therapy and how life-changing it can be for some people with anxiety. But also, I think there’s still a lot of stigma around medication when it comes to anxiety, especially online. And yeah, I think we need to do a little bit more work on that because I think anxiety medication is being dismissed more so. Maybe that’s another conversation that we can have in the future. But I didn’t go through therapy with my own anxiety disorder, with the panic attacks. Mine was going online. I think you have to go to a trusted site. So, over here, you have the National Health Service, which has a ton of resources, all scientific, proven, all credible from the correct sources. And I think if you’re researching and looking at all the correct things, I think that can be really powerful for you. So, if you can’t access therapy, of course, there’s still hope. Of course, you can still recover. And that my message to everyone is I did it. So, if I can, I’m just a regular guy, you can do it too.  Kimberley: I love that. Just because I know, and thinking of the person listening here, like how did you do it? I know we haven’t got a ton of time, but could you just say, how did you muster up the courage on your own to face your fears?   Dean: That’s a great question. And I do have my book coming out, which is-- Kimberley: All right. Dean: Yeah. So, the book is called Greater Than Panic. It’s the number one question that I’ve been asked since day one of starting out the anxiety community, and that was, what is your story and how did you get from four panic attacks a day to be in the head of DLC Anxiety and be in the face of the interviews and not having panic attacks? Obviously, I’m still having anxiety. That’s a message that I think isn’t hammered home enough, whereas the goal of anxiety recovery is not never to feel anxious again. I think people often are misguided and have misinformation, especially at the start of an anxiety disorder, thinking that the goal is to never feel anxious again. The goal is to change your behavior to when you’re feeling anxious and make sure that it doesn’t have a detrimental impact on your day-to-day. I go right back to the basics. I go back to speaking about my father’s death, which was obviously a really terrible time, and it brought out a lot of emotions but also, I think it was important for me to go back and just explore it again. And I speak about my relationship with the doctor. It’s again another message that I like to hit home, is that if you’re dealing with any physical symptoms to do with emotional symptoms, to do with anxiety, your first port of call has to be the doctor, because we know that anxiety disorders can mimic other things. And so, it’s super important for a medical professional, a GP, a doctor, to run diagnostic tests to make sure that everything else is okay. And then when they tell you that it is okay, you can sit down with the doctor and you can start to plan your journey of recovery, which may be therapy, maybe self-help, maybe meditation, mindfulness, exercise, medication, so many different routes.  But yeah, my number one message is, if you’re dealing with physical symptoms and you haven’t had them checked out, you have to go to the doctor. So, I speak about my relationship with the doctor. I speak about curating my own anxiety toolkits. So, what worked for me and the research and the science behind each thing that I was trying and how it had a benefit impact for me. And I speak about exposure therapy and how that was really beneficial for me, but doing it not guided by your therapist.  Now, if you look at the science, you would say that the best effects of exposure therapy is guided with a therapist, but I didn’t personally have a therapist in my journey. But if you can have a therapist, I definitely recommend that that’s the best route to go down. But I speak about how exposure therapy worked for me and I speak about the hiccups on that road to recovery and what recovery looked like, what it meant to me. And then I speak about the anxiety community and how I wanted to spread the message and get that message across to as many people as I possibly can. And yeah, it takes me to the present day.    Kimberley: I can’t wait. That’s so exciting. So, tell me about the name of the book.   Dean: Greater Than Panic. So, that’s the message that you are greater than panic. Just because you have feelings of panic, if you’re up in panic attacks or panic disorders, it doesn’t mean that you’re broken, it doesn’t mean that you can’t be fixed. There’s nothing to fix because you’re not broken. So, you are greater than panic at all life, things, all the dreams, aspirations, careers, travel, love, money, whatever it is that you want, you can get. Doesn’t matter that you’re going through panic or have panic attacks. O if you’ve been through panic disorder, the other message is that you’re greater than panic. Kimberley: Amazing. Okay. So, I’m going to leave you. I feel like that’s the perfect way for us to end out. Is there anything else you want to share with us, any links, or how people can hear about you? Dean: Just DLC Anxiety over on Instagram and the website, www.dlcanxiety.com. I’d just like to thank you, Kim, for obviously inviting me on here. And I’d like to thank you for everything that you’re doing in the mental health space. CBT is super important to me. It’s an integral part to my recovery. And yeah, I’m just super grateful for our connection on Instagram and just everything that you’re doing. Kimberley: Thank you. I feel so blessed that we randomly got to meet. You know what, it’s such a blessing. So, thank you. I’m so grateful. Dean: Thank you. ----- Thank you so much for listening. I’m sure you got so much from that. Before we finish up, let’s do the review of the week. This is from Disc Golf Nate. They gave five stars and they said: “As Kimberly would say, this is not necessarily a substitute for in-person therapy. But it is still a very powerful tool. I’ve used this podcast in conjunction with my therapist and some books, but this podcast brings me the most peace.” Thank you so much, Disc Golf Nate. I am so honored for that amazing review. And yes, this should not substitute therapy, but my hope is it gives you some tools, some skills, some hope, some support, some joy, and compassion into your recovery. So, I’m so honored to have this time with you. I will see you all next week.