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

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

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

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

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

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

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

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

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

In This Episode: What is the difference between a Panic Attack and an Anxiety attack? What is the prevalence of Panic Disorder? Are anxiety attacks dangerous? Are Panic Attacks dangerous? How does anxiety affect the body? What anxiety does to your body when expereincing a panic attack? What is the best treatment for panic disorder Links To Things I Talk About: Overcoming Anxiety and Panic Online Course Natasha's Parenting Survival Online Program www.ATparentingsurvivalschool.com Natasha's instagram @atparentingsurvival 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). This is Your Anxiety Toolkit - Episode 302. Welcome back, everybody. Today, we are talking about a question I get asked very commonly: Are panic attacks dangerous? Now I get this question a lot from clients who are just starting treatment. However, I will say I do get this question a lot on social media. People like doing the last-minute panic DM. What's happened usually is they've experienced a panic attack or an anxiety attack, and then they have the thought, what if this panic attack is dangerous? What if this panic attack creates some illness in my body or is unhealthy for my body or unhealthy for my baby, if they're pregnant. And so, from there, now they're having anxiety about their anxiety and, as you guys know, then anxiety just takes off from there. So, I wanted to address this with you first. I've got a series of questions that I want to go through here with you. I will be looking a little bit at my notes because I wanted to make sure I got everything today. Before we do that, let's first do the "I did a hard thing" segment. This is a segment where you guys write into me and tell me the hard things that you've been doing – facing your fears, staring your fear in the face, or maybe it's something not related to fear. It's just something that you've been going through. So, go ahead and submit those to me anytime you would like. Let's go over. This one is amazing. It says: "Honestly, Kimberley, you have changed my life in the last two weeks. I was in such a low place and coming across your podcast gave me so much power. I even faced my fear of heights last weekend and I went bungee jumping." Love it. "That was frightening. And as I was falling, I screamed F-U-C-K," but they said it in real life, excuse the language. "And I just thought, if I can do this, which is honestly terrifying, I can stop my mental rituals that are just so hard and scary." This message is so good and it's exactly the epitome of the work that we do and you do, which is when we face our fear, we realize how strong we actually are. And then we go on to face our fears again, which helps us to feel even more strong and courageous, which makes us do even harder things. And from there, our life turns away from getting smaller and smaller to getting bigger and bigger. So, I love this. All right, let's get to the show. So, we really want to pull apart, are panic attacks dangerous? But what's interesting about this is, often when we talk about panic attacks, people start to talk about what's called an anxiety attack. So, let's first just pause and really talk about what is what. So, what is the difference between a panic attack and an anxiety attack? Let's just go through that first so that we all know we're talking about the same thing. What Is The Difference Between A Panic Attack And An Anxiety Attack? A panic attack or panic disorder is a disorder that is in the DSM, which is the Diagnostic Statistical Manual of Mental Disorders. That's what we use to diagnose people. It usually involves a sudden onset of panic. It can last for minutes, sometimes longer than that or hours. For some people who are really struggling, it usually involves shaking or trembling or it may be heat flashing, hot flashes through your body. Some people experience a sense of detachment from their body. They may experience dizziness, sweating, heart pounding, maybe depersonalization and derealization, which we have episodes on if you want to go back and listen, trembling, sweating, weakness, feeling of extreme terror. Some people have numbness in their hands and feet, again, which is why they then question, is this dangerous? You can imagine, if you're having any of these symptoms, it's terrifying. It's terrifying. But once we really get educated about what that is, then we can actually work with it. Now, as I said, when it comes to having panic disorder, you need to have had at least one of those panic attacks. And then that's usually followed by one month or more of the person then fearing having another panic attack. And that can actually lead to some people having panic disorder with agoraphobia. Some have it with agoraphobia, which is where you feel like you can't leave the house, and some do not. So then the other part of this question is, what about an anxiety attack? Now, here's the thing to remember. I asked quite a few clinicians, what do you think the difference between these is? And I actually got a ton of different answers, which I know isn't super helpful for you guys, but some just basically said, "I don't consider them any different at all." Others said, yes, there is a difference in that an anxiety attack isn't usually a disorder of its own, and it's usually in relation to an actual threat. So, let's say, panic disorder is very sudden, it's often irrational, but not always. And so, it's coming on very strong out of nowhere. However, an anxiety attack often gradually builds. It can last for several months. It can cause restlessness, sleep issues, fatigue, muscle, tension, and irritability. That though can all show up with panic disorder as well, but the main key thing that a lot of clinicians, and I've done some research online, is some people believe that it's about what the trigger is. So, with an anxiety attack, if the trigger is an actual threat, like there is a dog running towards you and it's going to bite you, or there is an actual threat in your society, a gun or weather issues, extreme weather, that that would be a trigger that would cause an anxiety attack and that's how you would separate them. Now, for the sake of today, I'm going to use them interchangeably. Whether it's from a current stressor in your life that is actually a danger or whether it's panic disorder in that it's just sudden and out of the blue or related to a specific fear or phobia you have, I'm going to talk about them as if they're the same, given that their symptoms are often the same. And really, what I want to look at today is about whether these symptoms are dangerous or not. What Is The Prevalence Of Panic Disorder? Before we move on, let me quickly give you a little prevalence here, because I just wanted to normalize if you're having panic, and I'm going to read directly here. The National Institute of Mental Health reports that approximately 2.7% of the adult population in the United States experience panic disorder each year. That's pretty big. They went on to say, approximately 44.8% of those individuals experience a panic disorder that is classified as severe. Now, I think that's actually really interesting because anyone who's had a panic attack is going to say it's severe because a panic attack is 10 out of 10. So, I think that that's actually-- I'm surprised. I would be surprised if it's actually not way more than that. But what I'm guessing they're also talking about here is the degree in which it impacts their functioning. Because a panic attack in and of itself, and we'll talk about this here in a second, isn't a problem. What can get in the way is it starts to make your life very, very small and can impact your functioning, your ability to have conversations, interact with people, go to work, go to school, sleep, eat, and so forth. So, really important that you get those points. Are Anxiety Attacks And Panic Attacks Dangerous? But then we want to move over to: Are these anxiety and panic attacks dangerous? So, let's talk about that. Let's look at those symptoms – chest pain, hot flashes, dizziness, pounding heart. Often when we experience those symptoms, we would make the assumption that something is terribly wrong with our body and we better get to the hospital pretty quick. Chest pain – what do you see often on advertisements and so forth? You can imagine, when you have those sensations, it makes complete sense that your brain is going to set off the alarm. I do encourage you all, if you've had these symptoms, go and see a doctor, explain to them what happened and have them do a check on you so that you are really clear that what you're experiencing is a panic disorder or a panic attack or an anxiety attack. We all know the common TV show where they get rushed to the hospital and they're having a heart attack. And then the doctor, in a comedic way, says, "You're having a panic attack. It's common." It is true. Statistics show it. I think this is correct that the most admissions into an ER is panic attacks. Isn't that so fascinating? So, it makes sense that people are afraid. But once you've had that clearance and I do encourage you to get clearance and just speak with your doctor always about that stuff, and if they've defined like you're having a panic attack, then your job is actually, when you have those sensations, to not respond to them as if they are threats. If you respond to them as if they're threats, you're going to create more panic. We've got a whole ton of other episodes out about panic, so I'm not going to talk about too much there. But what I want to talk about is, are they dangerous? And the same goes for anxiety attacks. What I'm going to tell you once and once only is, no, they're not dangerous. Our body can withstand all of these symptoms many, many times. Lots of people who've been through very difficult times or had panic disorder can go on to live wonderful, healthy lives. But here is where I want to maybe address the elephant in the room. If you don't follow me already, there is a chance you found this podcast because you saw the title and you were like, "Oh yes, I want to know if they're dangerous." And once you listen, you may actually feel compelled to come back and listen to this episode again and again to reassure yourself that they're not. If that is the case, I'm going to strongly encourage you not to keep listening after you've listened to the first time. Let me give you some information about that. When I see a patient for the first time, I do a lot of psychoeducation. I share with them, these are common sensations, this is normal if you've got panic. If you have these sensations, we're going to treat them like we would treat panic symptoms. I would educate them if they're concerned about the dangerousness. But then I would say to them, after today, we're actually not going to keep revisiting these questions because what will happen is, the more you tend to these questions, the more you actually be fueling your panic disorder. Anytime you respond in a way that's urgent and need to reduce your anxiety or your uncertainty, the chances are, you're making the anxiety worse. So, I want to give you permission to go and see your doctor. I want you to get permission to share all of the details that you're experiencing. Then I want you to give yourself permission to have your panic attacks without trying to solve whether they're dangerous or not. Not tending to all of this, because the truth is, number one, nobody knows, number two, even I don't know for certain, for every different person, and number three, the more you try and solve it, the more that you're putting too much attention on this question that can actually keep you stuck in the cycle. How Does Anxiety Affect The Body? Once we look at that, and that's probably as far as I would go with my patients as well in terms of addressing that, often people have questions like, well, then what's the impact of anxiety on my body? How does anxiety affect my body? How does panic impact my body? And again, I want to tread very gently because you deserve to have some psychoeducation about that, but we also want to be careful that we don't spend too much time, again, tending to fears about what anxiety is doing to our body. Remember here, a lot of anxiety disorders is ultimately the fear of fear itself. Even though the content might be on something specific, it's usually our resistance to having fear and experiencing fear and doing so without response or reaction. So, does it impact the body? Yes and no. Meaning it does tend to make us increase sleep struggles. It makes it difficult to eat. There are many impacts that it can have on the body. But again, catch – the question, how does it impact my body – if that's actually you saying, is this dangerous? Think of it this way. When we ask questions and we pose questions to our mind, the words we choose and the emphasis we ask them can actually create more anxiety. If we say, "That's so dangerous, we shouldn't be doing that," it's true of anything. When you label anything as good and bad, you actually increase your resistance and your wrestle with it. If you say something is bad, you're going to have anxiety about it next time. And so, what we want to look at here is, yes, it does impact our body in terms of it's exhausting and it creates struggles without regular functioning. So then what I would encourage you to do, instead of tending to back and forward on, is this anxiety good or bad for my body, what does it do to my body, does this anxiety impact my body in a healthy way – instead, put your attention on, what will help me overcome this anxiety in the long term? Anytime we ask for the short term, we're always going to do something that's a safety behavior or a compulsion, an avoidant behavior, a reassurance-seeking behavior. So, just keep asking yourself, what will help me in the long term overcome this fear? And often that involves not ruminating about whether it will be dangerous or not because when we ruminate, we get stuck. And when we get stuck, it makes the fears look bigger. Isn't it interesting, and I'm going to call myself out here, in that in my attempt to address the question, are panic attacks dangerous, my advice or my encouragement to you is to practice not trying to solve that question, i not giving attention to that question. Yes, you can get basic psychoeducation or you can go to your doctor and get a checkup, but anything beyond there, you're always, and hear me if you can, if you can take one thing away from today's episode, is really remember that anxiety is about willingness to tolerate discomfort and it's about your willingness to be uncertain, especially if you have disorders like panic disorder, OCD, phobia, social anxiety, generalized anxiety. It's almost always going to be, can I be uncertain? How can I be more uncertain? How can I practice riding the waves of uncertainty? And that's very much the case with this specific question. So, I hope that is helpful. Again, catch your urgency to listen to this over and over and do your best to acknowledge the thought that you're having, treat it like a thought and not a fact, and then move on into the things that actually bring you value into your life because that is what recovery looks like. Thank you so much for being here with me today. I am honored to have this special time with you. I hope that was helpful. Do please remember, it is a beautiful day to do hard things because this work is hard, but it is done in effort to really serve and nurture the future you. Even though it's hard right now, we're really tending to the wellness of the future you when we take on these really difficult concepts Have a wonderful day, everybody, and I will see you next week.

This is Your Anxiety Toolkit - Episode 301. Managing OCD Relapse (with Jazzmin Johnson) Welcome back, everybody. I am covered in goosebumps. I literally, as we speak, just finished the recording of this episode. I wanted to come on and do the intro right away just because I'm so moved by this week's guest. This week, we had Jazzmin Johnson. She's a mental health advocate and she came on to talk about something she felt really, really passionate about, which is relapse, particularly related to relapse with anxiety disorders, even more particular and specific is with OCD. And she brought to the conversation the same struggles that I have seen my patients have over and over with relapse and how hard we can be on ourselves when we relapse and how difficult it can be to pull ourselves out of relapse. It's a topic that I haven't touched on nearly enough. And so, I'm just so grateful for her to come on and share her story and the steps she took to overcome any kind of relapse that she was experiencing, and identifying the difference between a lapse and a relapse I thought was really profound. I'm just so excited to share this episode with you. I actually had scheduled it to be out much later and I'm like, "No, no, no, we just have to get this out. This is so, so important." So, I'm so thrilled. I'm not even going to do an "I did a hard thing" because this whole episode is Jazzmin explaining to us how to do hard things. So, I'm again impressed with how she's handled it. So, let's get straight to the show. I love you guys. I hope you can squeeze every ounce of goodness out of this episode. I think the main real message we took away is it's a beautiful day to do hard things. So, enjoy the show. Kimberley: Welcome, everybody. I am so excited to have a special guest on the show that I've actually been wanting. We've been talking back and forth. I'm so excited to have Jazzmin Johnson on today. Thank you for being here, Jazzmin. Jazzmin: Thank you so much. I'm absolutely honored and really, really excited to chat. Can OCD Relapse? Kimberley: Yeah. So, let's dive in. We are going to talk about relapse, which is a topic I think you brought to my attention. I have not covered barely at all. So, let's dive into that. But before we do that, can you give us a little background and fill us in up to where we're at with relapse? Can OCD Relapse? Jazzmin: Yeah, absolutely. So, my name is Jazzmin. I'm 28 years old. I was diagnosed with OCD when I was just freshly 23. So, it's been a while. Looking back on my life, I've had OCD for a very long time, long before I was 23. So, definitely fun to look back on your life and the moments and say, "Oh, that was an interesting behavior and no one really caught that." My story is I always love to tell it, but it started off with a really simple night of not sleeping, something that we think we've all experienced. And up until that point, I had assumed I was this rock-solid girl who was tough and I skateboarded on the weekends and just knew that nothing could touch me. And I remember having a hard night of sleep one night and my heart was beating really fast and I just felt really panicky. It was such a bizarre feeling for me. I remember at the time reaching out to my sister who also struggles with anxiety and OCD as well, and I just said, "Hey, have you ever dealt with this weird heart palpitation thing at night and you can't relax?" And she just sent me a text in all caps and was like, "Yes, that's anxiety." And I think it was just this bonding moment where we were just like, "Oh, okay, I guess I'm like you like. Let's do this." But with that I think came a lot of fear too, because as someone who was assuming I was this rock-solid gal, who was tough and never stressed about anything, to have that identity switch that happened when I was told that I might have anxiety. As all of us know, listen to this, anxiety is a terrible feeling and it's even harder when it really sticks around for a long time. I remember feeling like my body was buzzing all the time and I remember trying to explain it to my boyfriend and he was just like, "That's really strange." And I'm like, "You don't understand. My whole body feels like it's vibrating all the time and I just couldn't sleep at night." And so, I ended up reaching out to my mom and she helped me find a therapist, which I'm really grateful that my family is really pro helping people with mental health disorders. So, they knew exactly how to help me. So, I popped in with a therapist and was just like, "I don't have anxiety. Why am I having anxiety? What's going on?" And she just asked me if there were things that made me anxious. And I just remember telling her, "No, there's no reason. My life is really good. I really enjoy where I'm at and I love my job and I love my boyfriend and I love my life. So, why am I feeling this way?" And she just said, "Well, have you talked to anybody about it?" And I remember telling her, "Yeah, my mom and my sister, and they've told me the things that make them anxious." And so, now when I think about those things, I plan to be anxious in those scenarios too. And I just told her I was having a hard time figuring out what was causing this anxiety. And she just said-- I will remember these words forever because they started everything for me. But she said, "Maybe you just need to find yourself in all of this." And so, I went home and was just like, "What does that even mean, how do you find yourself?" I was so lost. And at the time, I was thinking, okay, I'm 23 years old. What do I need to do? Do I need to eat, pray, love, and go to Italy and dump my boyfriend? And then that's when that thought popped in my head. And I thought, what if I need to leave my boyfriend in order to not feel anxious anymore? And of course, that terrified me at the time. I'd been with my boyfriend for five years. We were high school sweethearts. I knew in my bones I would marry him one day. And the idea that the only way out of how I was feeling was to lose something that I really valued was just life-shattering. And so, I just spent so much time thinking to myself, no, that can't be it. But OCD is the doubting disorder and I just hated this idea that what if that was the key to it all and it was something I didn't want to do. And so, I fought it and I probably struggled with that thought for another three or four months. I spent every day thinking about it the first time I woke up in the morning. And it got to a point where my body and my brain was trying really hard to convince me to leave because it wanted this relief from this anxiety. So, I was almost trying to convince myself and arguing with my mind on why I need to leave. And it would jump from maybe I didn't like the way he looked or he has a mustache this week and I don't like mustaches, so maybe I need to leave. Or his jokes are really bad. I can't be with someone whose jokes are bad. I mean, it's almost comical to the point where the things that my brain was trying to do to get me out of this scenario that felt like anxiety was ruling at all. I remember going to therapy every week, and my therapist just said, "You've been talking about this for a long time and it sounds like you might be struggling with some obsessive thinking, and it might be OCD." And that crushed me because at the time, I thought of OCD as flicking light, switches on and off, and I did not know what it was and that it could look different. So, I just got really scared and she just said, "Nope, we're going to work through this. You're going to be fine." And so, we did my first exposure in that appointment and it was absolutely horrible and it was so hard, but we sat down and we mapped out what my life would look like for the next five years if I chose to leave. My life looked great. I was like, "I would move. I would go to LA and become a fashion designer," whatever I was into at the time. And she was like, "You'd probably be okay. So, why is this so scary to you?" And I just told her, "I just don't like this feeling of losing agency over my choices and feeling like anxiety was making those choices for me." And that really made me spiral into a bit of a depression and just really struggled with feeling like I could do anything really. My therapist and I, we talked and I was prescribed antidepressant, which I owe my life to because that antidepressant gave me the strength to stand up against OCD for the first time in my life. And so, I started and I started just diving into the OCD community and listening to stories online, reading about it. Not just reading about people that were struggling, but people that had made it out or had worked through it and were doing really well. I just loved listening to specifically Stuart Ralph's The OCD Stories podcast and your podcast really. I just loved hearing people's stories about OCD, because I would listen to it on my way to and from work on my hour-long commute. And I would always smile when I was listening to these people's poor traumatic stories, just because I could hear how different our obsessions were, yet we were all doing the same thing. There were so many similarities that I heard and I just felt such a sense of community and belonging. And so, I just really dove into that and was like, "Hey, let's talk about this. Now, why isn't anyone talking about relationship, anxiety, and relationship OCD?" I reached out to Stuart Ralph and he let me post a little blurb on his website about what I was going through and that started my advocacy journey. And so, now I just float through life and deal with what it throws at me. And of course, I struggle at times. OCD will always stick around, but I try really hard to always have all of my social media channels open for people that just want to talk. And I find that's just such a good space to have for people when they just need someone to understand. So, that's a brief, little rundown of my life with OCD so far. Kimberley: I had goosebumps for quite a bit of that. It's just like it gives me the chills in the best way and that you've gotten through so many bumps and windy corners and stuff. Then we come to here now. So, you've got this progression, this windy story and you arrive. And obviously, you're doing pretty well. Tell me about this idea of relapse and what that means to you. How to Deal with OCD Relapse Jazzmin: Yeah. So, I look at lapses and relapses, in my opinion, a little differently. So, of course, in my journey, I had a few lapses. There were things that life happens and stress trauma happens. A few instances, I was really unfortunate to be in a space at my work where someone chose to take their life. And I was not at work, but I walked in about two minutes after it happened, because it happened at my work. I didn't see anything, but just the feelings of the people around me just was really traumatic. And so, my OCD latched onto that for a while and that sense of safety that I felt and the fear of being in another instance or something else that would be traumatic. And of course, there's been other moments in my life where really wild, crazy things have happened. And my OCD does always find something to latch onto for a short while. But usually, I'm able to notice a behavior and feel like, "Oh, that feels familiar. Uh-oh, I think I might be stuck again," and then I can usually spot it. But this last spring, I had a bit of a relapse and I call it a relapse more than a lapse because it looped back into my old themes that I had worked through a lot. And it lasted for a really long time. And I really had a hard time finding that kind of pathway out. I couldn't really find where on the cycle, the OCD cycle I was to where I could see where to get out. And so, at the time, I looked at relapses as failure and I think that's one thing I really wanted to talk about. But I imagined that since I had come so far in my recovery, that when OCD shows its face again, I would know that it was OCD. I would see it and I'd be ready and I'd have my warrior gear on and I'd fight it and I'd carry on with my life. I think this last spring, just with the chaos that happened in my life, I learned that that's not always the case. And sometimes it takes a little bit longer. But also, I think it always unlocks new layers to your recovery journey and healing that I think I needed to learn. So, I'm really grateful that it happened, which is so funny. I wish I could tell myself that four months ago and I was really in the thick of it, but yeah, I'm really grateful that I had that experience. OCD Relapse Story…or is that not the right wording? Kimberley: Why do you think-- because I really resonate with what you're saying and I think I've had, even in the last couple of weeks, some clients who've come back to treatment after doing really well with ERP and therapy. Can you tell us your OCD relapse story? Why do you think we consider it a failure to relapse? Where did that come from, do you think? Jazzmin: I think for me, I hear a lot about in the OCD community of just this idea of being fighters and warriors and we're going into this battle. And once you've won the battle once, you feel not untouchable, but you just have that upper hand. And I think with every new theme that it throws at you, which it always will, it's something new and it might take longer to recognize that, oh, this is the same thing. But for me, it felt like I was just losing a game, losing a battle, and that I knew how to fight. And I always would use this metaphor with my therapist that I felt like I had my toolkit with all of the things I had learned over the years, all of the exposures I can do and scripts and stuff I can write, but it felt like it was in a toolbox that was locked. Like I had to find the key before I could get to that toolbox. And when you're feeling so terrible, you're frantically searching to find that specific key. And I just found myself fumbling. And so, I think that idea of failure comes from just knowing better too. I felt like I knew better. I know what OCD looks like. I know this cycle like the back of my hand, yet, somehow it sneaks into my life again. I don't realize it until either it's too late and I've been doing compulsions for months maybe. And that is always a real letdown just in your personal self-esteem, and your idea of where you were in recovery can sometimes shift. And that's scary because you think you're through it or you're better than that or that you know better. And then to find out maybe you were wrong, it's really hard to sit with. Kimberley: Yeah. It's an interesting reframe, isn't it? We think of being a fighter and getting through it as if you won the battle and the battle is over. It can be a massive dent to your self-esteem would you say? Or tell me a little bit about, did it shift your perspective of yourself being a fighter for a while or were you able to be like, "No, no, this is the work"? How was that feel? Jazzmin: I think it's a little different for me because at the time, I really considered myself an advocate. And I felt as an advocate, I guide other people and I help them through these things. And I remember a really specific moment with my husband after we had just met my baby niece for the first time. And the entire time we were visiting her, I was having intrusive thoughts probably every second and it was jumping themes. It was harm and then pedophilia and then harm again and harming myself. And I remember getting in the car with him as we left and just crying. And he just was like, "What's going on? Talk to me." And I just told him, "I'm so tired. I know what this is. I had those thoughts. I knew they were OCD. I knew the moment they showed their face, because why would I ever want to do that to my beautiful baby niece?" And yet, they still made me anxious. And I had made the story to myself that if an intrusive thought made me anxious, I'd already lost. So, my reaction to it was the first thing I could control. And when you get thrown a new theme, it knocks you down because you've never seen it before and it's scary. I just remember crying to him and just explaining, "I am so frustrated with myself because I know what this is. I know what I'm doing and I can almost step outside of myself and see the cycle. I can draw it on a piece of paper. In fact, I did that often, and yet I couldn't stop." It was just a lot of disappointment in myself. I think as an advocate, you feel like you should know better and I helped people through this. In fact, there were times when I was in that relapse that people reached out to me for help. And I strapped on my booth and helped them and walked, talked them through it all and found them therapists and then was like, "Why can't I do that for myself? Why am I so good at helping others and not giving myself the tools that I know are sitting right in front of me?" Kimberley: Yeah. I thought it was really interesting. You said like you were mad at yourself, or maybe I didn't use that word correctly, for having anxiety about your thoughts. Oh my God, when did the expectations get so high? What are your thoughts about that? Jazzmin: I have no idea. It's so funny too, because when I look back on the themes that I've always had, it's always been around feeling anxiety. I have a fear of feeling anxiety. And that first thing I had was, maybe this will get rid of my anxiety. So, all of my obsessions were what's the key to get rid of it. In fact, I often have an intrusive thought to this day that maybe my anxiety disorder is caused by the fact that I have hair and I need to shave my head to not feeling anxious anymore. And I have the best hair. I love my haircut. I have the best hair stylist, so I'm just like, "No, I don't want to shave my head." Kimberley: You don't want to go all Britney Spears on yourself. Jazzmin: No. But it's so funny to me how that works and the way-- yeah, I lost my train of thought there because we were laughing about Britney Spears, but-- Kimberley: But no, I think going back to what I was saying is I think you're right. I think that we judge ourselves based on whether we're anxious about something, like, "Oh, I shouldn't be anxious about that." But that's just our brain doing its thing. Jazzmin: I was holding a newborn baby that I was related to for the first time in my whole life. Of course, I'm going to be terrified. I'm going to throw her against the wall. That's a normal thing to feel really anxious about. But I think also when you're in recovery, there's a certain acceptance you have with anxiety. You learn that anxiety is going to be a part of my life and I'm going to accept it. And I'd always thought that I had done that. And then I remember doing ERP School this last spring. And you mentioned something about, I believe it's willingness versus willfulness. Is that what it is? Kimberley: Yeah. Jazzmin: And I remember feeling angry with you when you mentioned that because I knew you were right. And I was like, "No," because that was that missing piece that I had yet to figure out. I was always like, "Yeah, I get that I'll have to feel anxious sometimes in my life. But I'm only feeling anxious and allowing myself to feel anxious because I hope that that will be the key to get rid of it." So, it was just, that was always the way out. And for the first time, I had to realize that while I was allowing anxiety to happen, I wasn't really welcoming it in a way. And so, that was what unlocked that little portion in my head. Kimberley: Okay. So, I just have a question. The therapist/educator in me is like, tell me more – you obviously took ERP School – what is it about? And I'm so happy that that was helpful. But I want to know, because you're not alone. I love knowing when things make people mad because it means there's a roadblock there. There's a common human roadblock that we all get to. So, what about that made you mad? I'm so curious. Jazzmin: Yeah. I think in all honesty, it was a little bit of resistance because it was like, I knew that that was that next step and I really didn't want to do that. Everything that I've ever done was to get rid of my anxiety. Even my OCD, all of my research, and all of the exposures that I worked on was only to get rid of that anxiety. And at the beginning of every video, you talked about, you said, "Hey, if that's your goal, let's reframe that." And I was just like, "How do I do that? How does someone want to feel anxious?" I just really struggled with understanding how-- it's such a terrible feeling. I hate it so much. How am I supposed to be happy to experience that? And I wasn't sure how to connect those two. I also was always looking for someone to just tell me how, like to give me steps and just say, "Hey, this is how you become willing to be anxious, or the willfulness, this is how you do it." I remember talking to my therapist about it and I just said, "Kimberley was talking about this, and can you just tell me how to do that?" I was like, "How do I lean in? Is that something I should just tell myself? Is it something I need to write down?" And she just said, "I think it's not something I can tell you. I think it's a little more abstract than that." And I just said, "Okay. So, you can't give me a step-by-step on how to get out of this," because that's how I am. And she just said, "No, I think it's a feeling." It scared me more than it made me angry. And I think that's why it made me angry because I knew that that was what I needed to do. So, that anger really comes from fear of just knowing what's next and what I need to do. And it's something I think I've put off for a very long time. Kimberley: Yeah. Listen, this week alone, I've had multiple of these conversations with my clients. I think it's such a common roadblock for everybody. Like how often people who have recovered said, "When I stopped trying to not be anxious is when I actually got relief from my anxiety." And it's like what you resist, persist, is always this sort of thing. Jazzmin: Absolutely. Kimberley: I love that you told me that. Number one, I'm terrible. I always giggle when people say that my stuff made them mad because I'm like, "What happened?" But I think it's such an important point, right? It's such an important piece of the work. So, how would you encourage people to manage relapse or lapse? Jazzmin: Yeah, I think I was really lucky to have my sister by my side through this relapse, especially if someone who understands OCD. And encouragement was a huge thing in having a support system because I had my husband, I had my sister, I have grown a community on Instagram of people that know I have OCD and I don't shy away from putting on my Instagram like, "I'm relapsing right now. Give me a minute. Let me figure this out." And my comments are always flooded with like, "You got this. We believe in you. Hang in there if you need anything." And so, I think that was a huge part of that healing for me, was just the support. But I also think there's a huge part about self-compassion that fits into this, about allowing yourself the opportunity to stumble. And I think it gives us its humanity. We're going to fall and we're going to trip and that's going to happen. And also, life is not perfectly straight and boring where nothing bad ever happens. That's what makes life exciting. So, I think there's a big self-compassion piece to it all of just allowing yourself to be wherever you are. Kimberley: Is the self-compassion piece the work you'd, like you'd said, sometimes when we relapse? And I've had these conversations. It's like, "Oh, there's a layer of your therapy that you hadn't done, or that this is a good thing for your long-term recovery." Was the self-compassion work you had previously done or did you have to take on the self-compassion once you realized you had relapsed? Jazzmin: Self-compassion was not at all a part of my previous healing and it was something that I was really missing. I bought your book too, The Self-Compassion Workbook. I wrote through when I was on an airplane ride once. And again, it also made me frustrated because I remember you had me write like how I felt about me if my OCD was flaring up or what I thought to myself about the fact that these intrusive thoughts were present. And all of the things that I wrote were really nasty about myself like, "Why are you thinking that? Even if I know everyone has intrusive thoughts, people don't have those ones or they don't make them feel the way that mine make me feel. So, I'm not strong enough or I'm not doing well enough or I'm not as well as I thought I was." And so, self-compassion was that layer of my healing that I don't think I had reached yet but I think I really needed because again, I think I have that tough girl mentality and I want to be strong for everybody. And when it comes to doing that for myself, I fall short. So, I think it was really helpful to just learn, to give myself grace and to watch the way that I was speaking to myself when I was struggling and allowing myself to struggle, allowing myself to feel bad because that's life. Kimberley: Yeah. I love that you had support. I love that you had those people cheering you on, like clapping their hands, "You can do this." What would you encourage people to do if they didn't have that support? And in the same question, were you able to start to have that voice? Where you were like, "I can do it" and have that kind of coaching voice as well? Or was that not a part of your experience? Jazzmin: So, I think if anyone doesn't have that support, the first thing I would encourage them to do was to find the community online because that's how I mostly got that sport in the beginning, was just finding people that were struggling in a similar way. But also, I think a huge part of that self-compassion in your voice is to be that voice for yourself and to be an advocate for yourself in those moments. And so, yeah, I think there's a part of just doing it for yourself in a way. And there was a second part of that question you asked. Kimberley: No, no, you answered it beautifully, because I think that is a piece of it too, is I have found for myself and I could be-- you may not feel this at all or the listeners may not feel this at all, but a huge part of my self-compassion journey was instead of going to other people to cheer me on, I had to learn to do it myself. Not to say you don't deserve to go and get it. It's not a problem if they cheer you on, that's not a problem at all, but that was a huge piece of it. And I try to practice that with my patients as well, like can you cheer yourself on just a little, can you reframe that you're strong while you suffer kind of thing. I think there's so many reframes that we can make. Jazzmin: Yeah, absolutely. And I think back to the things that I did to encourage myself and I remembered one thing that I did is, I would have a full day of negative thoughts and negative intrusive thoughts and really struggling. And then maybe for two minutes out of that day, I would feel this overcome of like, "Hey, I got this. Wait a minute, I can do this." And I'd always snap a selfie when I was feeling that. And so, over the course of this relapse, I have tons of these selfies and some of them I'm crying in and some of them I'm in the coffee shop or I'm in my car. And when I was really feeling down, I'd look back on that and I'd be like, "Hey, that's the version of me that's cheering me on right now." And I would look back on those photos all the time and be like, "Hey, yesterday at 2:04 PM, I felt okay for a minute." And even if it was just a minute, I'm going to trust that girl right there, because that's who I am. Kimberley: Wow. That's so cool. I love that. I've never heard that before. What an amazing way to capture you in that moment. I love that so much. Jazzmin: I think I put it in my phone, in my folders as reminders of hope. And I would look at those pictures whenever I needed it because I think seeing proof that you were there at one point too, it's like, that was me and I could be there again. Kimberley: I love that so much. I actually think that that's a piece of the tool belt or the toolkit that we need to have more of, like how can you remind yourself that you're in the game and you're doing the game. I love that so much. I remember many months ago, I did a podcast with Laura. I can link it in the show notes. She talked about, she did a collage of photos of her doing her exposures, even though she's crying or even though-- and I just think that's it, right? Just to remind ourselves that we've been there and we've gotten through it is so huge. This goes back to the very beginning, but how do you-- is there a difference in how you respond depending on whether it's a lapse, your version of a lapse or a relapse? For you, is the response and the tools you use the same or is it different? Jazzmin: I think for me the tools are about the same. I would almost say I use less tools in my lapses and that's always what causes them. So, I relax into this anxiety that I'm feeling and I let my guard down maybe a little bit and I start doing something. But generally, the way that I spot myself out of those cycles is to-- I quite literally will map out. I'm like, "What thought just made me anxious, and then what was my initial-- what did I feel like I needed to do to make myself feel better?" And then once I could take that step back, I could see what was going on. And I think my relapse was a little bit different because it reached that core fear of mine about feeling anxious forever or feeling like I wasn't going to get rid of it. And so, I think it was a little harder to find that exit of that loop because it was something that I was so deeply engraved in my being that I've had for so long that I don't think I ever really looked at. I always treated the surface of my obsessions and never really realized what is the core of this. It's feeling anxious. It's just this fear of anxiety. Kimberley: Yeah. And how are you doing now? Can you give me a realistic description on how to recover with OCD Relapse? How to recover from OCD relapse Jazzmin: Yeah. I would say I'm doing really good right now. I'm actually 16 weeks pregnant. We found out we were pregnant back in May. And so, pregnancy is one big exposure because as someone who doesn't like not knowing the future and is not great with uncomfortable sensations, that is pretty much all this pregnancy has been. But I remember explaining to a friend like sometimes when you're pregnant, at least for me, I'll just have these waves of sadness. Nothing is making me sad. I'm actually having the best day ever, and I'll just have to go cry really hard for 10 or 20 minutes. And I was thinking to myself, this is something a couple years ago that would really scare me. I'd be really fearful of these feelings. And I have just come so far in my journey with anxiety and OCD that when I feel that way, I just surrender to it and I say, "Hey, babe, I'm going to go upstairs. Give me 10 minutes." And I'll just go hang out in the bathroom and let it out and wipe my tears away and just allow that I'm going to feel that way sometimes and it's okay and I think so. So, right now, I'm doing really well and navigating, of course, pregnancy as much as I can as it's super new. And of course, I have a lot of fears about being a mother and when those intrusive thoughts will show their face again, when I'm holding my baby, which I'm sure they will. But I'm really leaning into this idea that the version of me that will make it through that will be born in that moment. So, there's nothing I can really do right now to make that intrusive thought not stick as much when it happens. All I can do is just trust that when it happens, if it happens in that moment, I'll gain whatever resilience I need to work through it. And there's a lot of self-trust that comes into that. And really trusting that I've got this and who knows, maybe I'll stumble and I am fully allowing myself the opportunity to do that. So, I think that's just been a big part of this journey for me, is allowing the unknown to just exist. Kimberley: I love what you're just saying. In fact, I have had clients who've actually written invitations to OCD like, "I welcome you to my baby's birth," or "I welcome you to my wedding," and so forth. And so, I think that this is beautiful in sort of an insurance policy for relapses to say, "I'm inviting you to this big event," which is what you're doing. Jazzmin: Yeah. It's like, "Let's join me. I know you're a part of my life and I want to see what are you going to throw at me. Let's do this." Almost like, "Let's do this together. It's not a fight and I don't want you to go away, but I'm curious to see what you're going to bring to the table and I'm looking forward to seeing how I handle it, learning whatever I need to learn in that moment." Kimberley: See, you have a lot of willingness. Jazzmin: Now I do. Kimberley: You have got it. I'm so grateful to have you on and to share your story. This is so good. So good. Tell me-- let's just wrap it up with like, okay, someone is in the depth of their relapse, they're the lowest of the low. What words of wisdom do you have for them? Jazzmin: Feel it. I think that's what I would say. I think when you're in those lows, you're always looking for that way out. And of course, naturally, you want a way out. There's no way you want to be there forever. But I think just really leaning into this idea that the only way out is through and just really feel what you're feeling and don't be scared of it, because I think fear really holds us back from a lot of healing. Kimberley: So beautiful. Thank you so much for coming on. Jazzmin: Thank you so much. It's so much fun. And I just want to say, I want to sing your praises for a minute. Your podcast and just you as a person are so kind, and I really found that just your content and just your presence was so comforting in the time of really darkness for me. And I think sometimes when you're going through OCD, you have a lot of people that have that fight mentality and they're like, "You got this. Just go at it, run at it." And you just showed a level of gentleness in approaching that. And that was what really helped me find that self-compassionate voice. So, I just want to thank you from the bottom of my heart for the things that you do and what you do on here. It's incredible. Kimberley: Oh, thank you. I'm covered in goosebumps. I can't tell you-- I say this every time, is when you're here talking to a microphone and no one's there, sometimes you don't really know who you're touching and I just love hearing that. Thank you, because it really means so much to me that I could be there without even knowing that I'm being there. So, it brings me just so-- Jazzmin: Sometimes you just need to know. You need someone to tell you like, "Hey, what you're going through is hard and it's okay that it's hard." And I think that's something you've always done for people, that we can do hard things. Kimberley: We can. It's a beautiful day, right? Jazzmin: Uh-hmm. Kimberley: Thank you, Jazzmin. You have been such an inspiration. If people want to follow you, where can they get ahold of you? Jazzmin: So, my Instagram is where I'm the most vocal. It's Jazzmin Lauren. My name is weird. J-A-Z-Z-M-I-N. I have a jazz musician as a father. And I would say I'm not super vocal on big advocacy stuff on my social media. My goal is just to share my life as someone with OCD. So, my DMs are always open though. If you ever want to reach out and just say hi, or if you want help finding a therapist, I know how to do that and I'm always willing to help. So, yeah, you can find me there. Kimberley: You're amazing. Thank you so much. Jazzmin: Thank you.