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

Today, we are going to talk about what to do when feeling hopeless. Today’s episode was actually inspired by one of our amazing Your Anxiety Toolkit podcast listeners. They wrote in and asked a question about hopelessness, and I thought it was so important and so relevant in today’s day, with the news being scary and everybody struggling and still readjusting to COVID, mental health, and mental illnesses at an all-time high. I really felt that this was important for us to talk about. So, let’s do this together. We’re going to take it step by step, and we’re going to do it with a whole lot of self-compassion. So let’s talk about what to do when feeling hopeless.  Alright folks, here is the question that was posed to me. It goes like this: “I have been really struggling with hopelessness lately. It feels like my life has no real meaning, and I feel pretty aimless. The things in my life that I want to improve need so much work to improve, such as career, relationship, family stuff. And I have large parts that are out of my control, which feels pretty discouraging despite lots of effort to improve them. I’m working to accept these feelings and trying to stay out of rumination, but it does feel hopeless a lot of the time. What are you telling folks who are in a similar position?” Now, number one, I so resonate with this question. As a clinician, a human, a mom, and someone with a chronic illness, I hear you in this question, and I don’t think you’re alone. In fact, I am a member of a pretty large online group of therapists, and I wanted to do my homework for today. So I left the question, saying, when you have clients who are experiencing hopelessness and they’re feeling stuck, what do you say? A lot of them were coming with these such humble responses of saying, “To be honest, I tell them the truth, which is I don’t know the answer. I too struggle with this.” Or they’ll say, “I often let them know that they’re not alone in this and that this is such something that collectively we’re all going through.” And I loved that they were so real and dropped into reality on the truth of this, the pain of this, and the confusion of this topic.  Now, in addition to that, there were also some amazing pieces of advice, and some of them I really agreed with. I’m going to include them here when we go through specifically some tools that you can use to help you when you’re struggling with this feeling of hopelessness or feeling like what’s the point and feeling like there’s no meaning to life.  Let’s talk about it. Number one—let me just be real with you—is I too have struggled with this. In fact, it wasn’t that long ago that I actually sought out therapy for this specific issue. I looked around my life, and I have these two beautiful children, I have two businesses and a career that I love, and I still felt hopeless. I still felt like this sense of what’s the point? What’s the meaning of all this? I’m working my butt off, trying to manage all the things. What is the real point? It felt a little like an existential crisis, to be honest.  I love that this person reached out to ask this question. I do encourage you all, if you’re struggling with this and navigating this, do go and seek therapy. I’m going to be giving you some tools on how to manage this today, but in no way do I think that my solutions are going to be exactly what you need to hear. There may be some of them that are super helpful for you, but I strongly encourage you to go and navigate them on your own.  Through exploring this, I found that there were some unmet needs that I was not paying attention to. I found that I was grieving living in a country that’s not my home country. So many parts of it were also related to my chronic illness. And so it was very personal work, and I encourage you too to do that personal work.  But, given that we’re here today, I also want to give you some strategies, skills, and direction if you too are wondering what to do when feeling hopeless. Let’s do this together. THERAPY FOR HOPELESSNESS The first thing here is I love that the person who wrote this said, “I’m working at accepting the feelings.” I think that that is probably the biggest key here, which is not accepting that they’ll be there forever but instead accepting that they’re here right now and reminding yourself that they’re temporary.  HOPELESSNESS IS A TEMPORARY EMOTION Hopelessness, like any other emotion, is a temporary emotion. It will rise and fall, rise and fall, and rise and fall. It doesn’t mean that you’ll always feel this way. What we can do is, while we’re accepting it, I often ask my patients, “As you accept it, let’s also be very curious about any resistance you have in your body as you practice accepting.”  I’ve had clients who’ve sat on the couch of my office and said, “No, no, I’m accepting it.” But every part of their body is clenched up. Every part of their face is resistant. They’re obviously accepting that it is here, but also trying to push against it, also trying not to feel it. Yes, accepting feelings is important, but are you creating a safe place for that emotion to rise and fall within you?  Here, we can check in with our bodies. Where is this discomfort in my body? Where am I holding tension around it? Is there a way I can soften around this experience of hopelessness first? And that can be so important as we’re navigating hopelessness and finding meaning in our lives.  HONOR THAT THIS IS HARD FOR YOU The next thing I’m going to encourage you to do is first honor just how hard things are for you. Often, that might be just a moment of saying, “This is really hard for me. Absolutely. This is very hard for me.”  OFFER SELF-COMPASSION WHEN YOU FEEL HOPELESS The next piece here is we want to offer as much compassion as we can. We want to nurture the fact that you’re going through an incredibly hard thing or things. You’re trying so hard. You’re exhausted. You’re feeling lost. You might even be feeling like, “I don’t even know which direction I’m going. I’m just going and getting through the day.” We want to create as much compassion as we can for that.  Now, if you are new to the work of self-compassion, there are so many resources online. We have a meditation vault with tons of different meditations for self-compassion at CBT School. They’re there for you if you’re really wanting to embark on this practice. We’ve also got tons of other episodes of Your Anxiety Toolkit on self-compassion as well.  KEEP AN EYE OUT FOR CATASTROPHIZATION The next thing I want you to think about here is keep an eye on how you’re doing things throughout the day. I’ll tell you a story. Actually, as I did this work for myself when I went into therapy, I looked at my schedule every morning, and all I could see was just a whole bunch of things I had to do. It was just like a list of things that I had to do. It felt like trash things I had to do, even though many of them were joyful things that I love doing and that I’ve signed up to do. But what I noticed was I was looking at the day as if it was just a mountain of chores instead of staying very present and mindful, doing one thing at a time, and practicing non-judgment, curiosity, and kindness as I do those things.  BREAK THINGS DOWN INTO SMALL, DOABLE STEPS What I’m going to encourage you to do is break things down into small, doable steps. When you look at your life and you think, oh my goodness, in the case of this question of relationships, career, work—when you look at all of that, it can become so overwhelming. Maybe sit down, get a notepad, and just pick one thing you want to work on right now, one thing that you can do from a place of wisdom and being effective and kind, and just focus on seeing if you can achieve and accomplish that one thing. Chances are, you might already be doing that, but there’s a piece that you’ve missed, and I can guarantee you’ve missed it—you’ve forgotten to celebrate the fact that you got a small step done.  Often, when things feel so huge, we finish something, and then we just move on to the next thing that we have to do. And that’s when things do feel like there’s no meaning, there’s no point to this life. We’re just in the motions, going with the cycles. We forget to celebrate, validate, and recognize the accomplishments that we’ve made. We forget to go, “Yeah, that’s a big deal. Good for you, you did that,” and take that time to celebrate it. Because again, as I said to you, I was looking at my life going, “Everything looks mostly pretty good. I’ve got this pretty severe chronic illness, but otherwise, things are going well.” But I realized I was just doing thing after thing after thing and after thing and not stopping to go, “Wow, good job. You’re taking care of your kids. Great job, you did something for yourself today,” or “Wow, you accomplished that one thing, and that was really hard.” We’ve got to celebrate our wins.  STOP COMPARING YOURSELF TO OTHERS The next piece of that is, often, people who get stuck in the day-to-day feeling like it’s Groundhog’s Day and there’s no real point, that’s because they’re comparing their experience to somebody else’s. They’re comparing their day-to-day with someone on social media who has made it look beautiful, they’ve got beautiful filters on, and everything looks really great. We’re making a lot of comparisons between how they’re doing and how we’re doing. I want to encourage you, please do not compare your wins and struggles to other people’s wins and struggles. That is a recipe for feeling hopeless, it’s a recipe for feeling depressed, and it’s a recipe for feeling like you’re never going to be enough. It’s so important.  THREE THEMES OF DEPRESSION The next thing I want you to do is catch yourself in the distorted thinking. Now, here is something you must take away from today—depression commonly has three themes. The first one is hopelessness—feeling like there is no hope. The second one is helplessness, feeling like no one can help you, that there’s no point, there’s no one can help you with your problem. And the last one is worthlessness, which is “I have no value.”  These three themes show up in our thinking and in our cognitions. I’ve done episodes in the past where I’d say depression is a liar. It tells lies all day. If you aren’t able to detect and correct those lies, you’re going to start believing them. Thoughts that are just depressive thoughts will start to become beliefs. Once they become beliefs, you start acting them out in many ways in your life.  What we want to do when we’re treating depression in therapy is actually slow down and be very mindful of your thoughts about the world, your thoughts about yourself, and your thoughts about your future. Look at where the distorted thoughts are and correct them.  We have a course on CBTSchool.com called Overcoming Depression, and the whole middle section of that course is teaching you how to identify cognitive distortions or errors in thinking and how to correct them. And that is a crucial part of managing depression. Because depression tells us lies all day. It tells us, “There’s no hope. You’re not doing good enough. You’re not good. There’s no hope for you. No one can help you. You’re just a piece of trash. You’re a loser. It should be easy. Why is it so hard for you?” It might even say, “Look at you, you’ve got A, B, and C, and other people have it so much worse than you. So, what’s your problem?” It just tells you all of these judgmental, horrible, mean things that are not true.  What we can do and what we do in the course, Overcoming Depression, is we identify those thoughts. We understand and acknowledge the presence of them. We maybe take a little look into what they’re trying to get to, what they’re trying to say. And then we work at coming up with alternative thoughts that feel helpful, compassionate, effective, and true. One of the tools we use in overcoming depression is we pretend that we’re in a court of law, and we have this scene where we say, “Okay, if you were to bring your depressive thoughts to a court of law, would the jury agree or disagree? Would the judge throw your case out?” Often, what happens is we have thoughts. Like, minimizing the positive is one kind of distorted thought we go through. There are many different types of distorted thoughts, but let’s say minimizing the positive. Let’s say you did something positive and you say, “No. I know I completed that, but it should have been easier,” or “I should have done it faster,” or “It shouldn’t have been that difficult.” That’s minimizing the positive. We would go, “Okay, if we were to take that to court, if we were to take that claim to court, what would the jury and what would the judge say?” The judge would not agree with that. They would say, “No, you completed the thing, and it’s okay that it’s hard. I’m tossing this out of the court. You’re wasting my time.” And so we want to be able to identify that and look at another example being a labeling distorted thought, like, “You’re a loser. You should be doing better.” In a court of law, the jury would look at the evidence and go, “No, it looks like you’re handling a lot right now. It looks like you’re handling many things. It makes sense that you feel that way, but it looks like you have many pieces of evidence to show that you’re not a loser. Let’s throw the case out. Case dismissed.” We want to make sure you’re doing that because the chances are, as you’re going through these hard things, as you’re navigating the day, you’re forgetting to check the facts. We’ve got to check the facts in depression. It’s so important. REMEMBER, YOU CAN DO HARD THINGS The next thing we have to do is remind yourself that you can do hard things. When the world feels like it’s a mountain of just chores and things in check boxes and to-do’s, we often just get overwhelmed with it, and it’s like, “I can’t do this.” I will say to you, when I actually was struggling the most with my chronic illness and I did get therapy for this, the thought we identified the most was this repetitive, consistent, nagging thought, “I can’t do this.” I probably thought “I can’t do this” about 150 times a day, minimum. Even as I was doing things, I was having the thought, “I can’t do these things.” As I was taking an MRI or helping my kids or working on my business—even as I was doing them, I was telling myself, “You can’t do this,” as I was doing them, which again shows how our thinking can really distort and make things so much worse if we don’t catch them.  We have to remind ourselves we can do hard things. We’re already doing hard things. That baby steps at a time can make small progress. There’s no race. There’s no finish line. We’re not here to beat other people or compare ourselves to other people’s timelines. This is our timeline, and we’re going to let it take as long as it needs. We’re going to be gentle. We’re just going to do one hard thing at a time.  FIND SUPPORT Another thing I want you to remember here when you’re struggling with hopelessness is to find support. When we feel hopeless, we feel alone. When we feel hopeless, we feel isolated. We feel like we’re the only one going through this. But there are so many people who are experiencing this. Sometimes it’s just saying, “This is a hard season for me.” You’d be shocked at how many other people come out and go, “Yeah, me too.”  So find support in others who are in the thick of it, who are also trying to work on hopelessness, what’s the real meaning, and so forth.  FIND PLEASURABLE ACTIVITIES And then the last piece here that I think is the foundation of this work is, make sure you’re implementing pleasurable activities in your day. When somebody has depression and hopelessness, what we often do in therapy, and we do this in Overcoming Depression, the course as well, is we look at your day, and often people with depression do not schedule pleasure. They do not input pleasurable, value-driven exercises into their day because depression often will say, “What’s the point? Don’t even bother. You used to like doing painting, but what’s the point? You’re not going to enjoy it, so don’t do it,” or “You’re not good. You’re never going to be good at it, so don’t do it.”  As we take pleasure out of our lives, it adds to this feeling of what is the meaning because the truth is, the meaning of life, who knows what it truly is? It’s different for every person. But a big piece of you finding what’s meaningful to you is acting according to your values and doing the things that feel lovely, nourishing, and yummy to you. My guess is, you’re not doing a lot of that. You’re not doing a lot of yummy, nourishing, pleasurable, fun activities.  I get it, depression isn’t going to let you have all the fun. It’s not going to let you have a 10 out of 10 fun. But even if we get a 2 out of 10 pleasure or 4 out of 10 pleasure, let’s take it. Let’s do it even just to get the 4 out of 10 pleasure, 10 being the highest level of pleasure. Try not to rid yourself of activities that used to bring you joy.  It’s also a big piece here when we find meaning. This is a really big topic in the field of therapy and psychotherapy. There is a beautiful book, which I would encourage you to read, called Man’s Search for Meaning. It’s by Viktor Frankl. It was one of the first books that were recommended in my master’s degree as I was training to become a therapist. It will bring a beautiful sense of understanding of making meaning in your life, and hopefully would be a beautiful supplement to the work that we’re doing here, and a compliment to you, finding what’s meaningful to you. Sometimes it means we have to reshuffle our lives a little bit.   When I did this work personally, I had to really go, “Okay, you’re working too much. I know it’s scary to slow down, but you’re lost. You’ve lost yourself. You’re going to have to slow down.” Or it might be, “Wow, your schedule is too full with just appointments and soccer practice and swim lessons and all the things. We’re going to have to slow down and have a little more fun. Play a little more. Sit a little more. Read a little more. Be with your family. Actually, be with them instead of just going through the motions.” We can’t get caught up in the day-to-day and not implement that pleasurable thing.  And then the last part of that is, I’m going to offer to you one sort of final idea for what to do when feeling hopeless, and it is, please try to stop fixing yourself all the time. In my experience as a clinician, the people who often do get hopeless and helpless and feel depressed are the ones who constantly tell themselves they need to be more, need to be better, that something has to change, that there’s something fundamentally wrong with them. I want to offer to you that there is nothing wrong with you, even if you’re struggling with a mental illness right now. Try to catch your constant need to fix yourself. Try to just live. Identify what your values are and see if you can get your behaviors and life to line up with those.  This striving that we have today in our pop culture of constantly having to be better, constantly having to have self-help books and being better, that is exhausting, and that is not the meaning of life. The meaning of life for me now that I’ve done the work isn’t the grand things and achievements. The meaning of life is actually quite silly and simple. In comparison, it’s sitting in the sunlight and letting the sun hit my face. It’s just hearing a laugh of my child. Nothing huge, doesn’t need to require massive wins. It might be just holding space for my emotions, honoring my needs, identifying my unmet needs, and doing what I can to meet those.  I’m not here to tell you in any way that I know what the meaning of your life is. I’m just telling you what the meaning of mine is. But I encourage you to enter this practice, to leave today, doing this as kindly, as gently, and as respectfully and compassionately as you can.  You’re going through a hard season. These are hard times. These are confusing times. I hope that with little baby steps, you changing your perspective and giving yourself the opportunity to just do one thing at a time and slow it all down will be helpful for you.  Have a wonderful day. If you’re wanting any of the resources that we have listed today, you can check the show notes, or you can also go to CBTSchool.com and learn more about our online resources there.  Have a wonderful day, everybody.

Kimberley: Welcome, everybody. This is a very exciting episode. I know I’m going to learn so much. Today, we have Caitlin Pinciotti and Shala Nicely, and we’re talking about when OCD and PTSD collide and intertwine and how that plays out. This is actually a topic I think we need to talk about more. Welcome, Caitlin, and welcome, Shala. Caitlin: Thank you. Shala: Thanks. Kimberley: Okay. Let’s first do a little introduction. Caitlin, would you like to go first introducing yourself? Caitlin: Sure thing. I’m Caitlin Pinciotti. I’m a licensed clinical psychologist and an assistant professor in the Department of Psychiatry and Behavioral Sciences at Baylor College of Medicine. I also serve as a co-chair for the IOCDF Trauma and PTSD and OCD SIG. If people are interested in that special interest group as well, that’s something that’s available and up and running now. Most of my research specifically focuses on OCD, trauma, and PTSD, and particularly the overlap of these things. That’s been sort of my focus for the last several years. I’m excited to be here and talk more about this topic. Kimberley: Thank you. You’re doing amazing work. I’ve loved being a part of just watching all of this great research that you’re doing. Shala, would you like to introduce yourself? Shala: Yes. I’m Shala Nicely. I am a licensed professional counselor, and I specialize in the treatment of OCD and related disorders. I am the author of Is Fred in the Refrigerator?: Taming OCD and Reclaiming My Life, which is my story, and then co-author with Jon Hershfield of Everyday Mindfulness for OCD: Tips, Tricks, and Skills for Living Joyfully. I also produce the Shoulders Back! newsletter. It has tips and resources for taming OCD. Kimberley: Shoulders Back! was actually the inspiration for this episode. Shala, you recently wrote an article about post-traumatic OCD or how PTSD and OCD collide. Can you tell us about your story, particularly going back to, I think you mentioned, May 2020, and what brought you to write that article? Shala: Sure, and thank you very much for having Caitlin and me on today because I really appreciate the opportunity to talk about this and to get more information out in the world about this intertwined combination of PTSD and OCD. In May of 2020, I moved to a new house, the house that I’m in now. Of course, we had just started the pandemic, and so everybody was working at home, including me. The house that I moved into was in a brand new neighborhood. While the houses on this side of me were completed, the houses behind me and on that side were not completed. I didn’t think anything of that when I moved in. But what I moved into was a situation where I was in a construction zone all the time. I was working at home, so there was no escape from it. One day I was walking behind my house, where most of the houses were in the process of being built and there were no sidewalks. As I was walking down the street, I saw, down at the end of the street, a big forklift come down the street where I was walking with my two little dogs backwards at a really high rate of speed, and the forklift driver seemed to be looking that way, and he was going that way. It happened so fast because he was going so quickly that all of a sudden I realized he was going to hit us, my dogs and me, and there was no place for us to go because we were on the road because there was nowhere else for us to be. I screamed bloody murder, and he heard me. I mean, that’s how loud I screamed, and he stopped. That was not all that pleasant. I was upset. He was not happy. But we moved on. But my brain didn’t move on.  After that incident, what I noticed was I was becoming really hypervigilant in my own house and finding the construction equipment. If I go outside, I tense up just knowing that construction equipment is there. Over time, my sleep started becoming disturbed. I started to have flashbacks and what I call flash-forwards, where I would think about all these horrible things that could happen to me that hadn’t happened to me yet but could. I’d get lost in these violent fantasies of what might happen and what I need to do to prevent that.  I realized that I seemed to be developing symptoms of PTSD. This is where being a therapist was actually quite helpful because I pulled the DSM open one night and I started going through symptoms of PTSD. I’m like, “Oh my gosh, I think I have PTSD.”  I think what happened, because having a forklift driver almost hit you, doesn’t seem like that could possibly cause PTSD. But if you look at my history, I think that created a link in my brain to an accident I was in when I was four where I did almost die, which is when my mom and I were standing on the side of a road, about to cross. We were going to go between two parked cars. My mom and I stepped between two parked cars, and there was a man driving down the road who was legally blind, and he mistook the line of parked cars where we were standing as moving traffic. He plowed into the end of all the parked cars, which of course made them accordion in, and my mom and I were in the middle of that. I was very seriously injured and probably almost died. My mom was, too. Several months in the hospital, all of that.  Of course, at that point—that was 1975—there was no PTSD, because I think— Caitlin, you can correct me—it didn’t become a diagnosis until 1980. I have had symptoms—small, low-level symptoms of PTSD probably on and off most of my life, but so low-level, not diagnosable, and not really causing any sort of problems. But I think what happened in my head was that when that forklift almost hit me, it made my brain think, “Oh my gosh, we’re in that situation again,” because the forklift was huge. It was the same scale to me as an adult as that car that I was crushed between was when I was four. I think my brain just got confused. Because I was stuck with this construction equipment all day long and I didn’t get any break from it, it just made my brain think more and more and more, “Boy, we are really in danger.” Our lives are basically threatened all the time.  That began my journey of figuring out what was going on with me and then also trying to understand why my OCD seemed to be getting worse and jumping in to help because I seemed to get all these compulsions that were designed to keep me safe from this construction equipment. It created a process where I was trying to figure out, "What is this? I’ve got both PTSD now, I’ve got OCD flaring up, how do I deal with this? What do I do?" The reason why I wanted to write the article for Shoulders Back! and why I asked Caitlin to write it with me was because there just isn’t a lot of information out there about this combination where people have PTSD or some sort of trauma, and then the OCD jumps in to help. Now you’ve got a combination of disorders where you’ve got trauma or PTSD and OCD, and they’re merging together to try to protect you. That’s what they think they’re doing. They’re trying to help you stay safe, but really, what they’re doing is they’re making your life smaller and smaller and smaller.  I wanted to write this article for Shoulders Back! to let people know about my experience so that other people going through this aren’t alone. I wanted to ask Caitlin to write it with me because I wanted an expert in this to talk about what it is, how we treat it, what hope do we have for people who are experiencing this going forward. THE DIFFERENCE BETWEEN OCD AND PTSD (AND POST-TRAUMATIC OCD)  Kimberley: Thank you for sharing that. I do encourage people; I’ll link in the show notes if they want to go and read the article as well. Caitlin, from a clinical perspective, what was going on for Shala? Can you break down the differences between OCD and PTSD and what’s happening to her? Caitlin: Sure. First, I want to start by thanking Shala again for sharing that story. I know you and I talked about this one-on-one, but I think really sharing personal stories like that obviously involves a lot of courage and vulnerability. It’s just so helpful for people to hear examples and to really resonate with, “Wow, maybe I’m not so different or so alone. I thought I was the only one who had experiences like this.” I just want to publicly thank you again for writing that blog and being willing to share these really horrible experiences that you had.  In terms of how we would look at this clinically, it’s not uncommon for people to, like Shala described, experience trauma and have these low-level symptoms for a while that don’t really emerge or don’t really reach the threshold of being diagnosable. This can happen, for example, with veterans who return home from war, and it might not be until decades later that they have some sort of significant life event or change. Maybe they’ve retired, or they’re experiencing more stress, or maybe, like Shala, they're experiencing another trauma, and it just brings everything up. This kind of delayed onset of PTSD is, for sure, not abnormal.  In this case, it sounds like, just like Shala described, that her OCD really latched onto the trauma, that she had these experiences that reinforced each other. Right now, I’ve had two experiences where being around moving vehicles has been really dangerous for me. Just like you said, I think you did such a beautiful job of saying that the OCD and PTSD colluded in a way to keep you “safe.” That’s the function of it. But of course, we know that those things go to the extreme and can make our lives very small and very distressing.  What Shala described about using these compulsions to try to prevent future trauma is something that we see a lot in people who have comorbid OCD and PTSD. We’re doing some research now on the different ways that OCD and trauma can intersect. And that’s something that keeps coming up as people say, “I engaged in these compulsions as a way to try to prevent the trauma from happening to me again or happening to someone else. Or maybe my compulsions gave me a sense of control, predictability, or certainty about something related to the trauma.” This kind of presentation of OCD sort of functioning as protection against trauma or coping with past trauma as well is really common. STATISTICS OF OCD AND PTSD Kimberley: Would you share a little bit about the statistics between OCD and PTSD and the overlap? Caitlin: Absolutely. I’m excited to share this too, because so much of this work is so recent, and I’m hopeful that it’s really going to transform the way that we see the relationships between OCD and PTSD. We know that around 60% of people who have comorbid OCD and PTSD tend to have an experience where PTSD comes first or at the same time, and the OCD comes later. This is sort of that post-traumatic OCD presentation that we’re talking about and that Shala talked about in her article.  For folks who have this presentation where the PTSD comes first and then the OCD comes along afterwards, unfortunately, we see that those folks tend to have more severe obsessions, more severe compulsions. They’re more likely to struggle with suicidality or to have comorbid agoraphobia or panic disorders. Generally speaking, we see a more severe presentation when the OCD comes after the PTSD and trauma, which is likely indicative of what we’re discussing, which is that when the OCD develops as a way to cope with trauma, it takes on a mind of its own and can be really severe because it’s serving multiple functions in that way. What we’ve been finding in our recent research—and if folks want to participate, the study will still be active for the next month; we’re going to end it at the end of the year, the OCD and Trauma Overlap Study—what we’re finding is that of the folks who’ve participated in the study, 85% of them feel like there’s some sort of overlap between their OCD and trauma. Of course, there are lots of different ways that OCD and trauma can overlap.  I published a paper previously where we found that about 45% of people with severe OCD in a residential program felt that a traumatic or stressful event was the direct cause of their OCD on setting. But beyond that, we know that OCD and trauma can intersect in terms of the content of obsessions, the function of compulsions, as we’ve been talking about here, core fears. Some folks describe this, and Shala described this to this, like cyclical relationship where when one thing gets triggered, the other thing gets triggered too.  This is really where a lot of the research is focusing on now, is how do these things intersect, how often do they intersect, and what does that really look like for people? Kimberley: Thanks. I found in my practice, for people who have had a traumatic event, as exactly what happened to Shala, and I actually would love for both of you maybe to give some other examples of how this looks for people and how it may be experienced, is let’s say the person that was involved in the traumatic event or that place that the traumatic event was recent that recently was revisited just like Shala. Some of them go to doing safety behaviors around that person, place, or event, or they might just notice an uptick in their compulsions that may have completely nothing to do with that. Shala, can you explain a little bit about how you differentiated between what are PTSD symptoms versus OCD, or do you consider them very, very similar? Can you give some insight into that? SYMPTOMS OF OCD & PTSD  Shala: Sure. I’ll give some examples of the symptoms of OCD that developed after this PTSD developed, but it’s all post-traumatic OCDs. I consider it to be different from PTSD, but it is merged with PTSD because it’s only there because the PTSD is there.  For instance, I developed a lot of checking behaviors around the doors to my house—staring, touching, not able to just look once before I go to bed, had to be positively sure the doors were locked, which, as somebody who does this for a living, who helps people stop doing these compulsions, created a decent amount of shame for me too, as I’m doing these compulsions and saying, “Why am I not taking my own advice here? Why am I getting stuck doing this?”  But my OCD thought that the construction equipment was outside; we’re inside. We need to make sure it stays outside. The only way we do that is to make sure the door stays locked, which is ridiculous. It’s not as if a forklift is going to drive through my front door. As typical with OCD, the compulsions don’t make a lot of sense, but there’s a loose link there. Another compulsion that I realized after a time was probably linked with PTSD is my people-pleasing, which I’ve always struggled with. In fact, Kimberley, you and I have done another podcast about people-pleasing, something I’ve worked really hard on over the years, but it really accelerated after this. I eventually figured out that that was a compulsion to keep people liking me so that they wouldn’t attack me. That can be an OCD compulsion all by itself, but it was functioning to help the PTSD.  Those would be two examples of compulsions that could be OCD compulsions on their own, but they would not have been there had the PTSD not been there. Kimberley: Caitlin, do you want to add anything about that from symptoms or how it might look and be experienced? Caitlin: Sure, yeah. I think it’s spot on that there’s this element of separation that we can piece apart. This feels a little bit more like OCD; this feels a little bit more like PTSD, but ultimately they’re the same thing, or it’s the same behavior.  In my work, I usually try to, where I can, piece things apart clinically so that we can figure out what we should do with this particular response that you’re having. When it comes to differentiating compulsions, OCD compulsions and PTSD safety behaviors, we can look towards both the presentation of the behavior as well as the function of it.  In terms of presentation, I mean, we all know what compulsions can look like. They can be very rigid. There can be a set of rules that they have to be completed with. They’re often characterized by a lot of doubting, like in Shala’s case, the checking that, “Well, okay, I checked, but I’m not actually sure, so let me check one more time.” Whereas in PTSD, although it’s possible for that to happen, those safety behaviors, usually, it’s a little bit easier to disengage from. Once I feel like I’ve established a sense of safety, then I feel like I can disengage from that. There doesn’t tend to be kind of that like rigidity and a set of rules or magical thinking that comes along with an OCD compulsion.  In terms of the function, and this is where it gets a little bit murky with post-traumatic OCD, broadly speaking, the function of PTSD safety behaviors is to try to prevent trauma from occurring again in the future. Whereas OCD compulsions, generally speaking, are a way to obtain certainty about something or prevent some sort of feared catastrophe related to someone’s obsession. But of course, when the OCD is functioning along with the PTSD to cope with trauma, to prevent future trauma, that gets a little bit murkier.  In my work, like I said, I try to piece apart, are there elements of this that we can try to resist from more of an ERP OCD standpoint? If there’s a set of rules or a specific way that you’re checking the door, maybe we can work on reducing some of that while still having that PTSD perspective of being a little bit more lenient about weaning off safety behaviors over time. TREATMENT FOR OCD AND PTSD Kimberley: It’s a perfect segue into us talking about the treatment here. Caitlin, could you maybe share the treatment options for these conditions, specifically post-traumatic OCD, but maybe in general, all three? Caitlin: Absolutely. The APA, a few years back, reviewed all the available literature on PTSD treatments, and they created this hierarchy of the treatments that have the most evidence base and went down from there. From their review of all the research that’s been done, there were four treatments that emerged as being the most effective for PTSD. That would be broadly cognitive behavioral therapy and cognitive therapy. But then there are two treatments that have been specifically created to target PTSD, and that would be prolonged exposure or PE, and cognitive processing therapy or CBT. These all fall under the umbrella of CBT treatments, but they’re just a little bit more specific in their approach. And then, of course, we know of ACT and EMDR and these other treatments that folks use as well. Those fall in the second tier, where there’s a lot of evidence that those work for folks as well, but that top tier has the most evidence.  These treatments can be used in combination with OCD treatments like ERP. There are different ways that folks can combine them. They can do full protocols of both. They could borrow aspects of some treatments, or they could choose to focus really on if there’s a very clear primary diagnosis to treat that one first before moving on to the secondary diagnosis. TREATMENT EXAMPLES FOR POST-TRAUMATIC OCD Kimberley: Amazing. Shala, if you’re comfortable, can you give some examples of what treatment looked like for you and what that was like for you both having OCD and PTOCD?  Shala: Yes, and I think to set the ground for why the combined treatment working on the PTSD and the OCD together can be so important, a couple of features of how all this was presenting for me was the shift in the focus of the uncertainty. With OCD, it’s all about an intolerance of uncertainty and not knowing whether these what-ifs that OCD is getting stuck on are true or going to happen. But what I noticed when I developed PTSD and then the OCD came in to help was that the focus of the uncertainty shifted to it’s not what if it’s going to happen. The only what-if is when it was going to happen because something bad happening became a given.  The uncertainty shifted to only when and where that bad thing was going to happen, which meant that I had lower insight. I’ve always had pretty good insight into my OCD, even before I got treatment. Many people with OCD too, we know what we’re doing doesn’t make any sense; we just can’t stop doing it. With this combined presentation, there was a part of me that was saying, “Yeah, I really do need to be staring at the door. This is really important to make sure I keep that construction equipment out.” That lowered insight is a feature of this combined presentation that I think makes the type of treatment that we do more important, because we want to address both of the drivers, both the PTSD and the OCD. The treatment that I did was in a staged process. First, I had to find a treatment provider, and Caitlin has a wonderful list of evidence-based treatment providers who can provide treatment for both on her website, which is great. I found somebody actually who ended up being on Caitlin’s list and worked with that person, and she wanted to start out doing prolonged exposure, which I pushed back on a little bit. Sometimes when you’re a therapist and you’re being the client, it’s hard not to get in the other person’s chair. But I pushed back on that because I said, “Well, I don’t think I need to do prolonged exposure on the original accident,” because that’s what she was suggesting we do, the accident when I was four. I said, “Because I wrote a book, Is Fred in the Refrigerator? and the very first chapter is the accident,” and I talked all about the accident. She explained, “That’s a little bit different than the way we would do it in prolonged exposure.” What’s telling, I think, is that when I worked on the audiobook version of Fred—I was doing the narration, I was in a studio, and I had an engineer and a director; they were on one side of the glass, I’m on the other side of the glass—I had a really hard time getting through that first chapter of the book because I kept breaking down. They’d have to stop everything, and I had to get myself together, and we had to start again, and that happened over and over and over again.  Even though I had relived, so to speak, this story on paper, I guess that was the problem. I was still reliving it. That’s probably the right word. Prolonged exposure is what I needed to do because I needed to be able to be in the presence of that story and have it be a story in the past and not something that I was experiencing right then.  I started with prolonged exposure. After I did that, I moved on to cognitive processing therapy because I had a lot of distorted beliefs around life and the trauma that we call “stuck points” in cognitive processing therapy that I needed to work through. There were a good 20 or so stuck-point beliefs. “If I don’t treat people perfectly nicely, they’re going to attack me somehow.” Things that could be related directly to the compulsions, but also just things like, “The world is dangerous. If I’m not vigilant all the time, something bad is going to happen to me.” I had to work on reframing all of those because I was living my life based on those beliefs, which was keeping the trauma going.  I recreated a new set of beliefs and then brought exposure in to work on doing exposures that helped me act as if those new beliefs were the right way to live. If my stuck point is I need to be hypervigilant because of the way something bad is going to happen to me, and I’m walking around like this, which was not an exaggeration of really how I was living my life when this was all happening—if I’m living like that, if I’m acting in a hypervigilant way, I am reinforcing these beliefs. I need to go do exposures where I can walk by a dump truck without all the hypervigilance to let all that tension go, walk by it, realize what I’ve learned, and walk by it again.  It was a combination of all these and making sure that I was doing these exposures, both to stop the compulsions I was doing, like the door checking, but also to start living in a different way so that I wasn’t in my approach to life, reinforcing the fact that my PTSD thought the world was dangerous.  I also incorporated some DBT (dialectical behavior therapy) because what I found with this combination was I was experiencing a lot more intense emotions than I’d really ever experienced in having OCD by itself. With OCD, it was mostly just out-of-this-world anxiety, but with the combination of PTSD and OCD, there were a lot more emotional swings of all sorts of different kinds that I needed to learn and had to deal with. Part of that too was just learning how to be in the presence of these PTSD symptoms, which are very physiological. Not like OCD symptoms aren’t, but they tend to be somewhat more extreme, almost panicky-like feelings. When you’re in the flashbacks or flash forwards, you can feel dissociated, and you’re numbing out and all of that. I'm learning to be in the presence of those symptoms without reacting negatively to them, because if I’m having some sort of feelings of hypervigilance that are coming because I’m near a piece of construction equipment and I haven’t practiced my ERP (Expsoure & Response Prevention) for a while, if I react negatively and say, “Oh my gosh, I shouldn’t be having these symptoms. I’ve done my therapy. I shouldn’t be having these feelings right now,” it’s just going to make it worse. Really, a lot of this work on the emotional side was learning how to just be with the feelings. If I have symptoms, because they happen every now and then—if I have symptoms, then I’m accepting them. I’m not making them worse by a negative reaction to the reaction my PTSD is having.  That was a lot of the tail end of the work, was learning how to be okay with the fact that sometimes you’re going to have some PTSD symptoms, and that’s okay. But overreacting to them is going to make it worse.  Kimberley: Thank you so much for sharing that. I just want to maybe clarify for those who are listening. You talked about CPT, you talked about DBT, and you also talked about prolonged exposure. In the prolonged exposure, you were exposing yourself to the dump truck? Is that correct? Shala: In the prolonged exposure, I was doing two different things. One is the story of the accident that I was in. Going back to that accident that I thought I had fully habituated to through writing my book and doing all that, I had to learn how to be in the presence of that story without reliving it while seeing it as something that happened to me, but it’s not happening to me right now. That was the imaginal part of the prolonged exposure.  This is where the overlap between the disorders and the treatment can get confusing of what is part of what. You can do the in vivo exposure part of prolonged exposure. Those can also look a lot like just ERP for OCD, where we’re going and we’re standing beside a dump truck and dropping the hypervigilant safety behaviors because we need to be able to do that to prove to our brain we can tolerate being in this environment. It isn’t a dangerous environment to stand by a jump truck. It’s not what happened when I was four. Those are the two parts that we’re looking at there—the imaginal exposure, which is the story, and then we’ve got the in vivo exposures, which are going back and being in the presence of triggers, and also from an OCD perspective without compulsive safety behaviors. Kimberley: Amazing. What I would clarify, but please any of you jump in just for the listeners, if this is all new to you, what we’re not saying is, let’s say if there was someone who was abusive to you as a child, that you would then expose yourself to them for the sake of getting better from your PTSD. I think the decisions you made on what to expose yourself were done with a therapist, Shala? They helped you make those decisions based on what was helpful and effective for you? Do either of you want to speak to what we do and what we don’t expose ourselves to in prolonged exposure? Caitlin: Yeah. I’m glad that you’re clarifying that too, because this is a big part of PE that is actually a little bit different from ERP. When somebody has experienced trauma, when they have PTSD, their internal alarm system just goes haywire. Just like in Shala’s example, anything that serves as a reminder or a trigger of the trauma, the brain just automatically interprets as this thing is dangerous; I have to get away from it.  In PE, a lot of what we’re doing is helping people to recalibrate that internal alarm system so that they can better learn or relearn safe versus actual threat. When you’re developing a hierarchy with someone in PE, you might have very explicit conversations about how safe is this exposure really, because we never want to put someone in a situation where they would be unsafe, such as, like you described, interacting with an abuser.  In ERP, we’d probably be less likely to go through the exposures and say, “This one’s actually safe; I want you to do it,” because so much of the treatment is about tolerating uncertainty about feared outcomes. But in PE, we might have these explicit conversations. “Do other people you know do this activity or go to this place in town?” There are probably construction sites that wouldn’t be safe for Shala to go to. They’d be objectively dangerous, and we’d never have her go and do things that would put her in harm’s way. Kimberley: Thank you. I just wanted to clarify on that, particularly for folks who are hearing this for the first time. I’m so grateful that we’re having this conversation again. I think it’s going to be so eye-opening for people. Caitlin, can you share any final words for the listeners? What resources would you encourage them to listen to? Is there anything that you feel we missed in our conversation today for the listeners? Caitlin: I think, generally, I like to always leave on a note of hope. Again, I’m so grateful that Shala is here and gets to describe her experience with such vulnerability because it gives hope that you can hear about someone who was at their worst, and maybe things felt hopeless in that moment. But she was able to access the help that she needed and use the tools that she had from her own training too, which helped, and really move through this.  There isn’t sort of a final point where it’s like, “Okay, cool, I’m done. The trauma is never going to bother me again.” But it doesn’t have to have that grip on your life any longer, and you don’t need to rely on OCD to keep you safe from trauma.  There are treatments out there that work. Like it was mentioned, I have a directory of OCD and PTSD treatment providers available on my website, which is www.cmpinciotti.com that folks can access if they’re looking for a therapist. If you’re a therapist listening and you believe that you belong in this directory, there’s a way to reach out to me through the website.  I’d also say too that if folks are willing and interested, participating in the research that’s happening right now really helps us to understand OCD and PTSD better so that we can better support people. If you’re interested in participating in the OCD and trauma study that I mentioned, you can email me at OCDTraumaStudy@bcm.edu. I also have another study that’s more recent that will help to answer the question of how many people with OCD have experienced trauma and what are those more commonly endorsed ways that people feel that OCD and trauma intersect for them. That one’s ultra-brief. It’s a 10-minute really quick survey, NationalOCDSurvey@bcm.edu and I’m happy to share that anonymous link with you as well/ Kimberley: Thank you. Thank you so much. Shala, can you share any final words about your experience or what you want the listeners to hear? Shala: One thing I’d like to share is a mistake that I made as part of my recovery that I would love for other people not to make. I’d like to talk a little bit about that, because I think it could be helpful. The mistake that I made in trying to be a good client, a good therapy client, is I was micro-monitoring my recovery. “How many PTSD symptoms am I having? Well, I’m still having symptoms.” I woke up in the middle of the night in a panic, or I had a bad dream, or I had a flash forward. “Why am I having this? I must not be doing things right.” And then I took it a step further and said, “It would be great if I could track the physiological markers of my PTSD so I can make sure I’m keeping them under control.” I got a piece of tracking technology that enabled me to track heart rate and heart rate variability and sleep and all this stuff. At first, it was okay, but then the technology that I was using changed their algorithm, and all of a sudden my stats weren’t good anymore, and I started freaking out. “Oh my gosh, my sleep is bad. My atrophy is going down. This is bad. What am I doing?” I was trying with the best of intentions to quantify, make sure I’m doing things right, focus on recovery. But what I was doing was focusing on the remaining symptoms that were there, and I was making them worse.  What I have learned is that eventually, things got so bad—in fact, with my sleep—that I got so frustrated with the tracking technology. I said, “I’m not wearing it anymore.” That’s one of the things that helped me realize what I was doing. When I stopped tracking my sleep, when I let go of all of this and said, “You know what? I’m going to have symptoms,” things got better.  I would encourage people not to overthink their recovery, not to be in their heads and wake up in the morning and ask, “How much PTSD am I having? How much OCD am I having? If I could just get rid of these last little symptoms, life would be great,” because that’s just going to keep everything going.  I’ll say this year, two has been a challenging one for me. I’ve been involved in three car accidents this year; none of them my fault. One of my neighbors, whom I don’t know, called the police on me, thinking I was breaking into my own house, which meant that a whole army of police officers ended up at my house at nine o’clock at night. That’s four pretty hard trauma triggers for me in 2023.  Those kinds of things are going to happen to all of us every now and then. I had a lot of symptoms. I had a lot of PTSD symptoms and a lot of OCD symptoms in the wake of those events, and that’s okay. It’s not that I want them to be there, but that’s just my brain reacting. That’s my brain trying to come to terms with what happened and how safe we are and trying to get back to a level playing field.  I think it’s really important for anybody else out there who’s suffering from one or the other, or both of these disorders to recognize we’re going to have symptoms sometimes. Just like with OCD, you’re going to have symptoms sometimes. It’s okay. It’s the pushing away. It’s the rejecting of the symptoms. It’s the shaming yourself for having the symptoms that causes the symptoms to get worse.  Really, there is an element of self-compassion for OCD here. I like having bracelets to remind me. This is the self-compassion bracelet that I’ve had for years that I wear. By the way, this is not the tracking technology. I’m not using tracking technology anymore. But remembering self-compassion and telling yourself, “I’m having symptoms right now, and this is really hard. I’m anxious; I feel a little bit hypervigilant, but this is part of recovery from PTOCD. Most people with PTOCD experience this at some point. So I’m going to give myself a break, give myself permission to feel what I’m feeling, recognize how much progress I’ve made, and, when I feel ready, do some of my therapy homework to help me move past this, but in a nonhypervigilant, nonmicro monitoring way.” As I have dropped down into acceptance of these symptoms, my symptoms have gotten a lot better. I think that’s a really important takeaway. Yes, we want to work hard in our therapy, yes, we want to do the homework, but we also want to work on accepting because, in the acceptance, we learn that having these symptoms sometimes is just a part of life, and it’s okay.  I would echo what Caitlin said in that you can have a ton of hope if you have these disorders, in that we have good treatment. Sometimes it takes a little bit longer than working on either one or the other, but that makes sense because you’re working on two. But we have good treatment, and you can get back to living a joyful life.  Always have hope and don’t give up, because sometimes it can be a long road, especially when you have a combined presentation. But you can tame both of these disorders and reclaim your life. Kimberle: You guys are so good. I’m so grateful we got to do this. I feel like it’s such an important conversation, and both of you bring such wonderful expertise and lived experience. I’m so grateful. Thank you both for coming on and talking about this with me today. I’m so grateful. Shala: Thank you for having us. Caitlin: Yes, thank you. This was wonderful. Kimberley: Thank you so much, guys. RESOURCES:  <!-- /wp:paragraph --> <!-- wp:paragraph --> The two studies CAITLIN referenced are: <!-- /wp:paragraph --> <!-- wp:list --> <!-- wp:list-item --> OCD/Trauma Overlap Study: An anonymous online survey for any adult who has ever experienced trauma, and can be accessed at https://bcmpsych.sjc1.qualtrics.com/jfe/form/SV_0j4ULJv3DxUaKtE or by emailing OCDTraumaStudy@bcm.edu <!-- /wp:list-item --> <!-- wp:list-item --> National OCD Survey: An anonymous 10-minute online survey for any U.S. adult who has ever had OCD, and can be accessed at https://bcmpsych.sjc1.qualtrics.com/jfe/form/SV_9LdbaR2yrj0oV7g or by emailing NationalOCDSurvey@bcm.edu <!-- /wp:list-item --> <!-- /wp:list -->

When things get hard, it’s really quite difficult to find a reason to keep going. Today, we have an incredible guest, Shaun Flores, talking about what keeps us going. This was a complete impromptu conversation. We had come on to record a podcast on a completely different topic. However, quickly after getting chatting, it became so apparent that this was the conversation we both desperately wanted to have. And so, we jumped in and talked about what it’s like in the moments when things are really difficult, when we’re feeling like giving up, we are hopeless, we’re not sure what the next step is. We wanted to talk about what does keep us going.  This is, again, a conversation that was very raw. We both talked about our own struggles with finding meaning, moving forward, and struggling with what keeps us going. I hope you find it as beautiful a conversation as I did. My heart was full for days after recording this, and I’m so honored that Sean came on and was so vulnerable and talked so beautifully about the process of finding a point and finding a reason to keep going. I hope you enjoy it just as much as I did. Shaun: Thank you so much for being able to have this conversation. Kimberley: Can you tell us just a little background on you and what your personal, just general mental health journey has looked like? Shaun: Yeah. My own journey of mental health has been a tumultuous one, to say the very least. For around five to six years ago, I would say I was living with really bad health anxiety to the point where I obsessed. I constantly had an STI or an STD. I’d go to the clinic backward and forward, get tested to make sure I didn’t have anything. But the results never proved to be in any way, shape, or form sufficient enough for me to be like, “Okay, cool. I don’t have anything.” I kept going back and forward.  How I knew that became the worst possible thing. I paid 300 pounds for the same-day test results. Just to give people’s perspective, 300 pounds is a lot. That’s when I was like, “There’s something wrong. I just don’t know what it is.” But in some ways, I thought I was being a diligent citizen in society, doing what I needed to do to make sure I take care of myself and to practice what was safe sex. But then that fear migrated onto this sudden overnight change where I woke up and I thought, “What if I was gay?”  overnight. I just quite literally woke up. I had a dream of a white guy in boxes, and I woke up with the most irrational thought that I had suddenly become gay. I felt my identity had come collapsing. I felt everything in my world had shaken overnight.  I threw up in the toilet that morning, and at that time I was in the modeling industry. Looking back now, I was going through disordered eating, and I’m very careful with using the word “eating disorder.” That’s why I call it “disordered eating.” I was never formally diagnosed, but I used to starve myself. I took diuretics to maintain a certain cheekbone structure. Because in the industry that I was in, I was comparing myself to a lot of the young men that were there, believing that I needed to look a certain kind of way.  When I look back at my photos now, I was very gaunt-looking. I was being positively affirmed by all the people around me. I hated how round my face was. If I woke up in the morning and my face was round, I would drink about four liters of water with cleavers tincture. I took dandelion extracts. Those are some of the things that I took to drain my lymphatic system. I went on this quest for a model face. And then eventually, I left the industry because it just wasn’t healthy for me in any way, shape, or form. I was still living with this fear that I was gay. If I went to the sauna and steam room in the gym, I would just obsess 24/7 that if I could notice the guy’s got a good-looking body, or if he’s good-looking, this meant I’m gay. It was just constant, 24/7. From the minute I slept to the minute I woke up, it was always there.  Then that fear moved on to sexual assault. I had a really big panic attack where I was terrified. I asked one of my friends, “Are you sure I haven’t done anything? Are you sure I haven’t done anything?” I kept asking her over and over. I screamed at her to leave because I was so scared. I must’ve been hearing voices, and I was terrified that I could potentially hurt her. I tried to go to sleep that night, and there were suicide images in my head, blood, and I was like, “There’s something up.” I just didn’t know what was going on. I had no scooby, nothing.  That night, I went to the hospital, and the mental health team said that they probably would suggest I get therapy. I said, “It’s cool. I’ll go and find my own therapist.” I started therapy, and the therapy made me a hundred times worse. I was doing talk therapy. We were trying to get to the root of all my thoughts. We were trying to figure out my childhood. Don’t get me wrong, there’s relevance to that. By that time, it was not what I needed.  And then last year, this is when everything was happening in regards to the breakdown that I had as well. I got to such a bad point with my mental health that I no longer wanted to be alive. I wanted time to swallow me up. I couldn’t understand the thoughts I was having. I was out in front of my friends, and I had really bad suicidal thoughts. I believed I was suicidal right off the bat. I got into an Uber, called all my friends, and just told them I’m depressed and I no longer want to be alive. I’m the kind of guy in the friendship group everyone looks up to, almost in some ways, as a leader, so people didn’t really know what to do. That’s me saying as a self-elected leader. That’s me being reflective about my friendship group. But I woke up one day, and it was a Saturday, the 4th of June, and I just said, “I can’t do this anymore.” I said, “I can’t do this.” I was prepared to probably take my life, potentially. I reached out to hundreds of people via Instagram, LinkedIn, WhatsApp, email, wherever it was, begging for help because I looked on the internet and was trying to figure out what was it that was going on with me. I was like, “Why am I having certain thoughts, but I don’t want to act on them?” And OCD popped up, so I believed I had OCD.  When I found this lady called Emma Garrick (The Anxiety Whisperer) on Saturday, the 4th of June, I just pleaded with her for a phone call. She picked up the phone, and I just burst out in tears. I said, “What’s wrong with me?” I said, “I don’t want to hurt anyone. Why am I having the thoughts I’m having?” And she said, “Shaun, you have OCD.” From there on, my life changed dramatically. We began therapy on Monday. I would cry for about two hours in a session. I couldn’t cope. I lost my job. There were so many different things that happened that year.  In that same year, obviously, I had OCD. I tore my knee ligaments in my right knee. Then I ended up in the hospital with pneumonia. Then my auntie died. Then my cousin was unfortunately murdered. Then my half-brother died. Then my auntie—it’s one of my aunties that helped to raise me when my dad died on Christmas day when I was six—her cancer spread from the pancreas to the liver.  Then fast-forward it to this year, about a couple of months ago, that same auntie, the cancer became terminal and spread from the liver to the spleen. I watched her die, and that was tough. Then I had my surgery on August the 14th. But I’m still paying my way through debt. It was an incredibly tough journey. I’m still doing the rehab for my knee, still doing the rehab for OCD.  That’s my journey. I’m still thinking about it to this day. Me and my therapist talk about this, and he has lived experience of OCD. I still don’t even know what’s kept me alive at this point, but that’s the best way to describe my story. That’s a shortened, more condensed version for people listening. Kimberley: Can I ask, what does keep you going? Shaun: What keeps me going? If I’m being very honest, I don’t know sometimes. There are days when I’ve really struggled with darkness, sadness, and a sense of hopelessness sometimes. I ride it out. I try not to give in to those suicidal thoughts that pop up. And then I remember I’ve got a community that I’ve been able to create, a community that I’m able to help and inspire other people. I think I keep going on my worst days because the people around me need someone to keep inspiring them. What I mean by that is some of the messages I’ve got on the internet, some of them have made me cry. Some of them have made me absolutely break down from some people who have opened up to me and shared their entire story. They look up to me, and I’m just like, “Wow, I can’t give up now. This isn’t the end.” I’ve had really dark moments, and I think a lot of people look at my story and perhaps look at my social media, and they think I’m healed and I’ve fully recovered. But my therapist has seen me at my worst, and they see me at my absolute best.  I think I stay here. What keeps me pushing is to help other people, to give other people a chance, and to let them know that you can live a life with OCD, anxiety. Depression I’m not sure if I fully align with. Maybe to some degree, but to let them know they can live a life in spite of that. I don’t know. Again, I keep saying this to my therapist. There’s something in me that just refuses to quit. I don’t know what it is. I can’t put it into words sometimes. I don’t know. Maybe it’s to leave the world in a better place than I found it. I really do not know.  Kimberley: I think I’m so intrigued. I’m so curious here. I think that this is such a conversation for everyone to have. I will tell you that it’s interesting, Shaun, because I’m so grateful for you, number one, that we’re having this conversation, and it’s so raw. Somebody a few months ago asked me, what’s the actual point of all this? It was her asking me to do a podcast on the point, what’s the point of all this? I wrote it down and started scripting out some ideas, and I just couldn’t do the episode because I don’t know the answer either. I don’t know what the point is. But I love this idea that we’re talking about of what keeps us going when things are so hard. Because I said you’re obviously resilient, and you’re like, “No, that’s not it.” But you are. I mean, so clearly you are. It’s one of your qualities. But I love this idea of what keeps you going.  In the day, in the moment to moment, what goes through your mind that keeps you moving towards? You’re obviously getting treatment; you’re obviously trying to reduce compulsions, stop rumination, or whatever that might be. What does that sound like in your brain that keeps you going? Shaun: Before I answer that, I think I’ve realized what my answer would be for what keeps me going. I think it’s hope because it makes me feel a bit emotional. When I was at my absolute worst, I had lost hope, lost everything. I lost my job. I end up in mountains of debt that I’m still paying off. It’s to give hope to other people that your life can get better. I would say it has to be hope.  In those day-to-day moments, one of my really close friends, Dave, has again seen me at my worst and my best. Those day-to-day moments are incredibly tough. I’ve had to learn to do things even when I don’t want to do them. I’ve had to learn to eat when I don’t always want to eat, to stick to the discipline, to stick to the process, to get out of bed, and to keep pushing that something has to change. These hard times cannot last forever. But those day-to-day moments can be incredibly tough when my themes change, when I mourn my old life with OCD in the sense that I never thought consciously about a lot of my decisions. Whereas now, I think a lot more about what I do, the impact I have on the world, and the repercussions of certain decisions that I make.  I would say a lot of my day-to-day, those moment-to-moments, is a bit more trepidation. I think that would be the best way to describe my day-to-day moments. I was just going to say, I was even saying to my friend that I can’t wait to do something as simple as saving money again. I’m trying to clear off everything to restart and just the simple things of being able to actually just save again, to be able to get into a stable job to prove to myself that I can get my life back.   Kimberley: To me, the reason that I’m so, again, grateful that we’re here talking about this is it really pulls on all of the themes that we get trained in in psychology in terms of taking one step at a time. They talk about this idea of grit, like you keep getting up even though you get knocked down. I don’t think we talk about that enough. Also, the fact that most people who have OCD or a mental health issue are also handling financial stresses and, like you said, medical conditions, grief, and all of these things. You’re living proof of these concepts and you’re here telling us about them. How does that land for you? Or do you want to maybe speak to that a little more? Shaun: I was reading a book on grits. I was listening to it, and they were talking about how some people are just grittier than other people. Some people may not be as intelligent or may not be as “naturally gifted,” but some people are grittier than other people. A lot of people who live with chronic conditions such as OCD or whatever else, you have to be gritty. That’s probably a quality you really have to have every single day without realizing it. To speak to that, even on the days when I have really struggled, as I said, I don’t know what always gets me up. There’s something inside.  I look around at the other people around me who've shown grit as well—other people around me who have worked through it. The therapist I have, he’s a really good therapist. I listen to his story, Johnny Say, and he talks about something called gentle relentlessness, the idea that you just keep being relentless very gently. You know that one step-a-day kind of mentality that, “Okay, cool, I’m having these thoughts today. I’m going to show myself some compassion, but I’m going to keep moving.” For me, when I speak to him, I tell him he inspires me massively because he’s perfected and honed his skills so much of OCD that he’s able to do the job that he does. He’s able to help other people, and that inspires me. When I look at the other people around me, I’m inspired by other people’s grit and perseverance as well. That really speaks to what I need to be able to have. I think it’s modeled a lot for me. Even in my own personal life with my mom, there’s a lot of things that we’ve gone through—my father, who died on Christmas Day when I was six—and she had to be gritty in her own way to raise a single boy in the UK when she was in a country she didn’t want to be in because of my granddad.  I think grit has been modeled for me. I think it really has been role-modeled for me in so many different ways. When people say, “Just get up and keep going,” I think it’s such a false notion that people really don’t understand the complexity of human emotions and don’t understand that, as humans, we go up and we go down. A very long time ago, I used to be that kind of human where I was like, “Just get out, man. Suck it up. Just keep going, bro. You can do this. You’ve got this.” I think going through my own stuff has made me realize sometimes we don’t always feel like we’ve got it. We have to follow the plan, not the mood sometimes. But I honestly have to say, I think grit has been role-modeled a lot for me. Kimberley: Yeah. It’s funny, as you were talking, I was thinking too. I think so often—you talked about this idea of hope—we need to know that somebody else has achieved what we want to achieve. If we have that modeled to us, even if it’s not the exact thing, that’s another thing that keeps us going. You’ve got a mentor, you’ve got a therapist. Or for those of you who don’t have a mentor or therapist, it might be listening to somebody on a podcast and being like, “Well, if they can do it, there has to be hope for me.” I think sometimes if we haven’t got those people in our lives, we maybe want to look for people to inspire and model grit and keep going for us, would you say?  Shaun: Absolutely. Funnily enough, when I was going through depression as a compulsion, my friend sent me your podcast about depression as a compulsion. The idea is that you feel this depressive feeling, you start investigating it, trying to figure out if you’re depressed, and then it becomes a compulsion. And then, after that compulsion happens, you stay in this spiral with depression or whatever it might be. That’s something else I realized—that having your podcast and listening to talking about being kind, self-criticism, and self-compassion was role modeled a lot for me because, again, growing up, I didn’t have self-compassion. It’s not something we practice in the household or the culture I’m from. But having it role-modeled for me was so big. It is huge. I cannot even put into words how important it is to have people around you who still live with something you live with, and they keep going, because it almost reminds you that it’s not time to give up.  Sadly, I’ve lost friends to suicide. I found out that someone had died in 2021 at what I thought he had died. We met at a modeling agency when I was modeling. We met at the Black Lives Matter march as well, regardless of whatever your political opinions are for anyone listening. I found that he had died. I remember I messaged some of the friends we had in common. I was like, “What happened?” And nobody knew. A couple of weeks ago, I just typed in his name. Out of nowhere, I just typed, and I was like, “What happened to him?” I found that he had taken his life when he was in university halls. I was just like, "You really don’t know what people are going through." Some people have messaged me and said what I talk about has kept them going. I’m just sitting there like, “Wow, other people have kept me going.” I think that becomes a role-modeled community almost in some ways.  Kimberley: For sure. It’s funny you mention that. I too have lost some very close people to me from suicide. I think the role model thing goes both directions in that it can also be hard sometimes when people you really love and respect have lost their lives to suicide. I think that we do return to hope, though. I think for every part of me that’s pained by the grief that I feel, hope fuels me back into, how can I help? Maybe I could save one person’s life. Actually, sometimes helping just gets me through a hard day as well. I can totally resonate. I think you’re right. There is a web of inspiration. You inspire somebody else. They inspire you. They’ve been inspired by somebody. It’s like a ladder. Shaun: Absolutely. I once heard someone say, the best way to lose yourself is in the service of others. One of the things that really got me through depression when I was at the thickest of my OCD was when I said, "How am I going to go and serve other people? How am I going to go and help other people?" When I asked my first therapist, I said, “Why are you so kind to me? Why do you believe in me?” she told me something that really sat with me. She said, “I believe you’re going to go on to help so many other people.” When I released my first story on August the 14th, and I had so many people reach out to me that I knew, people I didn’t know speaking about OCD, I was like, “This is where it begins. That in the suffering, there is hope. In the suffering, I can live. In the suffering, I can find purpose. In the suffering, I can use that to propel me out of pain.”  But you are right. This conversation has really made me think a lot about how I keep going, like how I’ve been able to just keep pushing because my friends are, again, around me. My therapist knows that there are days when I don’t want to do my therapy. I’ve gone to my physiotherapist, and I’ve said, “You have no idea what I’ve gone through.” I said, “I’m not feeling to do anything. I just want to give up right now.” I said, “I’m tired of this.” I said, “Why is life so hard on me?” Death is one thing. Physical injury is another thing. OCD is another thing. Chasing money is another thing. Everything is a constant uphill battle. It really has made me think a lot about life. It’s made me think a lot about my friends who have opened up to me about their struggles.  Very similar to you, Kimberley, I want to go on to, at some point, become a therapist and change people’s lives. When people reach out to me, I would love to be able to say to someone, if someone said, “I can’t afford a therapist,” I’d be like, “Let me try and help you and see what I can do on my part.” That kind of kindness or that kind of empathy, that kind of lived experience, that understanding—it's something I really want to give back to other people. It’s hope. Hope is everything.   Kimberley: Yeah. It’s ever-changing, too. Some days you need one thing, and the next day you need others. For me, sometimes it’s hope. Sometimes it’s, like you said, day-to-day grit. Sometimes it’s stubbornness, like I’m just straight-up stubborn. You know what I mean?  Shaun: It’s funny you say that.  Kimberley: We can draw on any quality to get us through these hard things that keep us going. My husband always says too, and now that we’re exploring it and I’m thinking about it, because you and I did not prepare for this, we are really just riffing here—my husband always says when I’ve had a really hard time, which in the moment sounds so silly and so insignificant, but it has also helped, amongst these other things, “Put on the calendar something you’re really looking forward to and remind yourself of that thing you’re going towards every day. It doesn’t even have to be huge, but something that brings you joy, even if it’s got nothing to do with the hard thing you’re going through.” I’ve also found that to be somewhat beneficial, even if it’s a dinner with friends or a concert or an afternoon off to yourself, off work. That has also been really beneficial to me. Shaun: Yeah. Taking aim at things in the future can give you things to really look forward to. In the thickest of my OCD, I had nothing to look forward to sometimes. I remember I turned down modeling jobs because of my anxiety. The only thing I could look forward to was my therapist, and that was my silver lining in many, many ways. I remember I would say to her, “I’ve been waiting for this session the whole week. I’ve needed this.” Another thing you touched on that I think made me laugh is stubbornness. There is a refusal. There’s a refusal to lay down. For example, I make jokes about this. I go to the gym sometimes, and I’ll say to the guys, “I’ve had a knee injury. Why are my legs bigger than yours?” That small little bit of fun and a little bit of gest, a bit of banter, as we would say. I’ll go to them, and I’ll be like, “I need to show these guys that my legs are still bigger than theirs and I’ve got an injury. I’m not supposed to be training legs.” Just small things like that have really given me things to look forward to. Something as silly as male ego has been-- I say this to everyone—male, female, anyone. I’m like, “How dare I get sexy? How dare I be mentally unwell but still sexy?” There is an audacity to it. There’s a temerity, a gumption, a goal. There is a stubbornness to go out there into the world and to really show people that, again, you can live with it. When I delivered my TEDx talk in 2022 at Sheffield Hallam University about masculinity, I remember a lady came up to me afterwards. This is when I was doing something called German Volume Training. It was heavy, very intense training. I put on a lot of muscle in that short space of time. She came up to me and said, “You do not look like a guy who suffered with his mental health at all.” She said, “You look like the complete opposite.” Because people have this idea that people who live with illness are—there’s this archetype in people’s heads—timid, maybe a bit unkempt. They don’t look after themselves.  It really said a lot to me that there really is no one image of how people look. Even where I live, unfortunately, there’s a lady who screams at people. She shaves her hair. She just sits down there. A very long time ago, I would look at people and judge them. One thing I’ve really learned from living with illness has been we never know what’s happened in people’s lives that has pushed them to the place of where they are.  There was also another older gentleman, and he smelt very strongly of urine and alcohol. I was on the train with him, and the train was packed. You could just see he was minding his own business. He had a bag on him, and clearly he had alcohol in it. There were two girls that were looking at him with such disgust, contempt, and disdain. It really got to me. It really irked me about the way people looked at him because, in my head, I’m like, “You don’t know what that guy’s gone through. You just have no idea what led him to become clearly an alcoholic. He probably is potentially homeless as well.” I got off that train, and I just felt my views on things had really changed, really changed in life. Dealing with people just-- I don’t know. I’ve gone off on a tangent, but it’s just really sat with me in the sense of looking forward to things—how I look forward to how my views are evolving and how my views on life are changing. Kimberley: Yeah. I’m sort of taking from what you’re saying. You bring up another way in which you keep going, which is humor, and I’ve heard a lot of people say that. A lot of people say humor gets me through the hardest times. You say you make jokes, and that, I think, is another way we can keep going. Shaun: Yeah, you are correct. When I go to the gym and I banter all the guys, I’m laughing at them, and typical male ego—that has really helped me on many, many occasions. Even people around me who we have sit down and we have a laugh. There’s times when I quite honestly say to people, my life is a Hollywood movie at this point. I need a book. I need a series of unfortunate events, a trilogy, whatever it might be at this point, because it’s almost as if it can’t be real. Humor has been a propelling agent in me helping to get better, but it’s also been an agent in everything that I do.  My first therapist, Emma, said to me, “OCD leaves you with a really messed-up sense of humor because you’ve got to learn how to laugh at the thoughts. You’ve got to learn how to not take everything seriously.” I have had some of the most ludicrous thoughts I could imagine. I told my friend, and she started cracking up at me. She started laughing. She’s like, “Do you know how ludicrous this is?” And I said to her, “I know.”  Or, for example, again, at my absolute worst, I couldn’t even watch MMA, UFC, or boxing because guys were half naked. I couldn’t be around guys who were half naked because of how my sexual orientation OCD used to really play with my head. There were so many ridiculous situations. I would walk outside and I’d have a thought, “Kill the dog,” and I’d be like, “Oh, well, this is bloody fantastic now, isn’t it?” I’ve had images of all sorts in my head. I told my friend, and he started laughing. I was like, “Bro, why are you laughing?” But it made me laugh because it took the seriousness out of what was going on. It really did.  Humor—it's been huge. It’s funny how that can even maneuver into the concept of cancel culture because there was a comedian who has OCD, and he said, “When was being clean really a bad thing?” I know, obviously, we know the way people see OCD, but he drew light on the fact that he has quite severe OCD himself. He’s using humor clearly to help him get better. But humor has been another thing. Humor, stubbornness, grit, resilience—all these things in my life experience have really helped me to still be here. I still say that as a guy who hasn’t been paid this month from work. I’m on sick leave. I’m still trying to find ways to make money. I’m still trying to train to become a therapist. I’m applying for courses. I’ve applied for a hundred jobs within the National Health Service over here in the UK. That’s just to put it into perspective. Again, as my therapist would say, a gentle relentlessness to keep pushing humor to find some of the joy and some of the sadness that happens. Kimberley: I cannot tell you how grateful I am that you have allowed us to go here today. I think this is the conversation that we needed to have today, both of us. My heart is so full. Can people hear more about where they can get in touch with you, hear more about you? You’ve talked so beautifully about the real hard times and what’s gotten you through. Where might people get ahold of you? Shaun: I say to people, you can reach out to me on Instagram, TikTok, wherever you want. I say to people, just reach out, and please feel free to message me. I don’t know whether this has happened to you, Kimberley. Some people reach out to me when they’re really struggling with their OCD, and then some people I never hear from again. Some people don’t turn up to phone calls. I think for a lot of people, there’s a big fear that if they reach out to me, I’m going to hear something that I’ve never heard. I can honestly say to people, I’ve had every thought you could imagine. I’ve had the most ludicrous thoughts. I’ve had pretty much every single theme at this point. I really want, and I really encourage people to please reach out and have a conversation with me. You can find me anywhere on social media. Kimberley: I have so enjoyed this conversation. Are there any final statements you want to make to finish this off? Shaun: If you give up now, you’ll never see what life would look like on the other side. That’s the one thing I think I have to really say. Kimberley: It’s amazing. Thank you.

If you want to know how to be uncomfortable without making it worse, you’re in the right place. Today, we’re talking all about being uncomfortable and learning how to be uncomfortable in the most skillful, compassionate, respectful, and effective way. This applies to any type of discomfort, whether it be your thoughts, your feelings, any physical sensations, or the pain that you’re feeling. Anything that you’re experiencing as discomfort, we’re here to talk about it today. Let’s do it.  Welcome back, everybody. For those of you who are new, welcome. My name is Kimberley Quinlan. I’m a marriage and family therapist in the state of California. I’m an anxiety specialist, and I love to talk about being uncomfortable. It’s true, I don’t like being uncomfortable, but I love to talk about being uncomfortable, and I love talking about skillful ways to manage that.  WHAT IS DISCOMFORT, REALLY?  Now, before we get started, let’s first talk about what we mean by being uncomfortable. There are different forms of discomfort. One may be feelings or emotions that you’re having—shame, guilt, anxiety, sadness, anger. Whatever it is that you experience as a feeling can be interpreted and experienced as uncomfortable.  Another one is sensations. Physical sensations of anxiety, physical sensations of shame, and physical sensations of physical pain. I myself have a chronic illness. Physical sensations can be a great deal of discomfort for us as human beings. We’re also talking about that as well.  We’re also talking about intrusive thoughts, because thoughts can be uncomfortable too. We can have some pretty horrific, scary, mean, and demanding thoughts, and these thoughts can create a lot of discomfort within us.  What we want to do here is we want to first acknowledge that discomfort is a normal, natural part of life. It truly is. I know on social media, and I know in life, on TV, and in movies, it’s painted that there are a certain amount of things you can do, and if you were to attain those, well, then you would have a lot less discomfort. But as someone who is a therapist who has treated the widest range of people, I’ve learned that even when they reach fame, a lot of money, or a degree of success, we can see that they have some improved wellness. They do have some decrease in discomfort, but over time, they’re still going to have uncomfortable thoughts. Sometimes having those things creates more uncomfortable thoughts. They’re still going to have physical pain, and they’re still going to have emotions that cause them pain, particularly when they’re not skillful.  What I’ve really learned as a human being as well is we can have a list of all the things that we think we need in these circumstances to be happy. But if our thoughts and our feelings and our reactions to them aren’t skillful, compassionate, wise, and respectful, we often create more suffering, and we’re right back where we started.  Now, I don’t want it to be all doom and gloom, because the truth is, I’m bringing you some solutions here today—things that you can apply right away and put into practice, hopefully, as soon as you’ve listened to this podcast. Let’s get to it.  WHAT MAKES DISCOMFORT WORSE?  First, I’m wondering whether we can first discuss what it means to make it worse because a lot of you go, “What? Make it worse? Are you telling me I’m to blame?” And that’s not what I’m doing here. But I do think that we can do some kind of inquiry, nonjudgmental inquiry into how we respond to our suffering.  LIFE IS 50/50 Think of it this way: I am a huge proponent of some Buddhist philosophy here, which is that suffering is a part of life. Discomfort is a part of life. I believe that life is 50/50. There is 50% wonderful, but you’re still going to have 50% hard. Sometimes that percentage will be different, but I think it creates a lot of acceptance when we can come to the fact that there’s going to be good seasons, but there’s also going to be some really hard seasons in our lives. It doesn’t have to be that it’s 50/50 all the time. Sometimes you might be in a really wonderful season. Maybe you’re in a really tough season right now. I’m guessing that’s the case because you’re listening to this episode. I recently went through a really tough season, which inspired me to make this episode for you. But in life, there is suffering. But what we know about that is how we respond to that suffering can actually determine whether we create more and more suffering.  WE RESIST IT One way that we make it worse is, when we are experiencing discomfort, we resist it. We try to get rid of it. We clench up around it. We try to push it away. What often happens there is, what you resist persists. That’s a common saying we use in psychotherapy. Another thing to consider here is, the more you try to push it down, the more it’s going to bubble up anyway, but in ways that make you feel completely out of control, completely lost in this experience, and maybe overwhelmed with this experience. Another thing is, the more you resist it, the more you’re feeding your brain a story that it’s important and scary, which often means that it’s going to send out more anxiety hormones when you have that situation come up again. That’s one way we make it worse.  WE JUDGE IT  Another way we make it worse is, we judge it. When we have discomfort, we judge it by going, “This is wrong. This is bad. You’re a bad person for having this discomfort. What’s wrong with you for having this discomfort? It shouldn’t be here.”  WE THROW “TANTRUMS”  I’ve done a whole episode about this, and this is something that is my toxic trait, which is I go into this emotional tantrum in my head where I’m like, “This is bad. This is wrong. It shouldn’t be happening. It shouldn’t be this way. It should be this other way. It’s not fair. I can’t believe it’s this way.” I totally can catch myself going down a rabbit hole of judging the situation, the circumstance, and myself and my discomfort, which only creates more discomfort for myself.  WE RUMINATE Another way we make things worse is rumination, which is similar to what I was just talking about. But rumination is, we try and solve things, we loop on them. Again, it could be a looping on, “Why is this happening? It shouldn’t be happening,” like I just explained. Or maybe it’s trying to figure it out. Often, we ruminate on things that actually don’t have a solution in the long run anyway.  Maybe you have chronic pain. Let’s say you do, and you’re ruminating, “What could it be? Why is it there?” I mean, the truth is, we don’t usually have a medical degree. Our rumination, it might feel productive, but we don’t actually have the details to know the answer.  Let’s say something went wrong at work and you made a big mistake, and we ruminate about what we did, how bad it was, and how humiliating it was. But in that situation, we’re trying to solve something that’s already happened that we have no control over anymore.  For people who have anxiety, maybe they’re trying to ruminate, trying to solve whether bad things will happen in the future, but we all know we can’t solve what’s going to happen in the future. That’s a dead end. That’s a dead-end road, and it again creates more suffering on our part. WE PUNISH OURSELVES  The next piece here is, we punish ourselves. We punish ourselves for having discomfort. We might withhold pleasure. We might treat ourselves poorly. We might not show up in ways that really honor our mental health and our self-care because we’ve made a mistake, we are going through a hard time, or we’re having this uncomfortable experience. These things, while in the moment they feel warranted and they feel productive and effective, they’re actually not. All they’re doing is adding to the suffering you’re already experiencing.  For those of you who say, “Yeah, no, but I deserve to suffer more,” that’s actually not true either. We have to really catch that because punishing someone with this sort of very corporal punishment kind of method—or we need to beat you up—actually, we’ve got so much research to show it doesn’t make you better. It doesn’t prevent uncomfortable things from happening. It doesn’t make it so that you don’t make a mistake. You’re a human being. We’re all struggling. We’re all doing the best we can, and we’re not going to do it perfectly.  HOW TO BE UNCOMFORTABLE, EFFECTIVELY & COMPASSIONATELY What can you do differently? Let’s now talk about how we can be uncomfortable in an effective, productive,  compassionate, and respectful way. For me, one of the first things that helps me is to really double down on my mindfulness practice. Sometimes the best thing you can do with mindfulness is to become aware that you’re engaging in these behaviors, to catch them, and to label them when you are. It might be as simple as labeling it as “I’m in resistance.” You might just say ‘resistance’ or ‘rumination.’ You’re bringing to your mind and you’re bringing to your attention that you’re engaging in something that you’ve identified as not helpful. That in and of itself can be so helpful. Now, for those of you who are new to me, I have two episodes that I’ve done on this type of situation in the past. Number one was Episode 188, where I talked about how to tolerate uncomfortable sensations specifically. The other one is Episode 113, which is where we talk about specifically how to manage intrusive thoughts. You can go on there after you’ve listened to this, but stay with me here because I’m going to give you a little step-by-step process.  MINDFULESS Number one, with mindfulness, we’re going to identify and become aware that we’re in resistance, that we’re ruminating, that we’re beating ourselves up, and we’re also going to practice non-judgment as best as we can. Think of this like a muscle in your brain. You’re going to practice strengthening that muscle. But once we are aware of it and once we’ve acknowledged that we’re judging, we’re then going to be aware of or bring our attention to where we are in resistance to allowing it to be there because that’s ultimately a part of our work.  Discomfort rises and falls so much faster when you do nothing about it. What I want to offer you is, the solution, in some way, can be quite simple, which is to do nothing about the discomfort except love it. Be careful and gentle with yourself. Do nothing at all about trying to make it go away. Do nothing at all about punishing yourself.  NON-JUDGMENT The non-judgment piece is where we allow it to be there without making a meaning about it. Here’s an example. You’ve had an intrusive thought that was really, really scary, and you wish you didn’t have it. You actually are concerned about it. It alarmed you. What you can do is, in that moment, acknowledge that thoughts are thoughts. They’re not facts. They don’t mean anything. They’re just sentences that our brains come up with. What we often do is, when we have it, we think, “What does that mean about me? Why am I having this thought? Why am I having this sensation? Why am I having this anxiety? Why am I having this anger? Why am I having this shame? Why am I anxious in this social situation? Why is this hard?” NOT OVER-IDENTIFYING What we want to come back to is not making meaning of it, not over-identifying with it and just acknowledging that this is a normal part of human life. This is a normal part of being a human. We all have intrusive thoughts. We all have strong emotions, some more than others. But if you’re someone who has strong emotions more than you maybe think others are, there’s a couple of things I want you to remember. Number one, we actually don’t know how other people are doing, so you can’t actually say that they’re not having these emotions. Maybe they are.  Often, people will say to me, “You always seem so calm.” I’m like, “Oh, you have no idea.” Like, yeah, I am calm in many situations, but it doesn’t mean I don’t have anxiety about certain things or big, big, big emotions about certain things. You just don’t see it. You don’t see it on the camera; you don’t see it in the podcast. You don’t see it in my daily life. It’s at home in my mind when I’m experiencing it as I’m regulating. But we want to work at not over-identifying with “What does it mean about me” and that “I’m bad for having these experiences.” One thing you must take away, and I say it quite often, is there is no thought, feeling, sensation, urge, or image that makes you bad. The meditation vault, which we just launched, is an online vault, a collection of meditations for people with sticky thoughts, intrusive thoughts, anxiety, and so forth. They’re very, very specific in almost every single one. I work at getting them to not overidentify with the experience they’re having.  Oh, you’re having an intrusive thought. Let’s not make meaning of what that means about you.  Oh, you’re having shame. Your shame is telling you that you’re bad. Let’s not agree with it. Let’s acknowledge that it is a thought and a feeling, but it’s not a fact about you.  You’ve made a mistake; you failed. Okay, we can acknowledge that, but that doesn’t make you a failure. We want to catch over-identifying with what our discomfort is experiencing and how we’re experiencing that discomfort. The over-identification, the labeling, and the making meaning often is what contribute to us feeling double the discomfort.  MAKE SPACE FOR THE DISCOMFORT The next thing you want to do is make space for the discomfort. My clients roll their eyes because they know I’m going to say it. I’m going to say, “Why can’t we make some space for this emotion,” or “Would you be willing to make some space for this emotion as it rises and falls?” If we make space for it to be here while we go about our day, while you interact with your child or your loved one, or your client, or your employer or your employee—if we can just make space for it to be there, nonjudgmentally, it tends to be less loud.  BE WILLING TO BE UNCOMFORTABLE The whole point of the work that I do here with my patients and with you is to nurture a sense of you having any emotion, any feeling, or any discomfort in a safe way, in a way where you make space for it. I often will say, we want to work towards you being able to have any thought, feeling, sensation, urge, or image so that you know that there’s nothing you can’t handle. If you’re really willing to feel it all, if you’re really willing and have practiced giving yourself permission to feel all the discomfort, there’s very little that can be painful for you. There’s very little that can stump you. There’s very little that can hold you back.  Often, when people ask me, “How do you do what you do? You spend all day with clients who are suffering, and you’re in the suffering with them. And then you get online and do these videos, or you do social media. How do you do all that?” The only reason, there’s nothing special about me, truly. The only thing about me is I’m willing to feel a lot of discomfort. I really am. The more I practice having it, the more I feel empowered that I can handle anything.  Confidence to do things isn’t something you just learn and have; you get it by feeling feelings. Having them willingly and making space for them—truly, this is the work. If there’s really anything I’ve learned, it’s that—we have to be better at making space and feeling our feelings and having the discomfort and saying, “Great, this is a wonderful opportunity for me to practice being uncomfortable.” If something gets thrown out of whack this week for you, I urge you to say, “Okay, good. This is another great opportunity for me to practice being uncomfortable. Where do I notice my resistance to being uncomfortable? Where do I notice the judgment? Where do I notice that I overidentify with it? Where do I notice that I’m punishing myself for it?” Okay, good. Now that we know, we’re aware, and we’re non-judgmental, let’s use this as an opportunity to be able to feel any experience that comes up. Things get a whole lot less scary if you’ve already practiced feeling your feelings.  FEEL YOUR FEELINGS I actually did a whole podcast on that as well. It’s Episode 65, where I talk about how your feelings are meant for feelings. That’s another resource if you want to jump into that kind of topic as well. But then once you’ve done all that—we’ve done this zooming in and now we zoom out—then you move on with your day. You don’t just sit there and feel your feelings and sit on the couch and stare at the floor going, “I’m feeling my feelings. I’m feeling my feelings. Here they are.” That’s fine if that’s what you feel right about. But ideally, you would take the feelings with you and go mow the lawn or do the things you love or do the things that you need to get done today, your chores or whatever that might be.  But take this practice with you, because if you can get good at feeling discomfort, then you can marry that skill. It’s a skill. It’s not something that you were born with; it’s something that you can learn to do. But once you get good at that, then you can marry it with, “Now I’m going to go live my life while I use that skill.” And then you 10x your life, truly, 10x your ability. You’re still going to be uncomfortable. You’re still going to have hard days. You’re still going to have some discomfort, but your experience of it will not be one of, “Oh no, geez, I hope it goes away. I hope it’s not strong today. I hope it doesn’t stay all day because it really messes me up.” It won’t be like that. You’ll be like, “It doesn’t matter. I know it’s here, and I’m going to be here with it, and I’m going to make space for it. I’m going to be kind. I’m going to be non-judgmental about it. But it can come. I’ve done it as much.” One thing I did learn, and I’ll use this as an example, is I used to have the most excruciating sleep anxiety. I used to worry about not sleeping. Because if I didn’t sleep, I’d have massive anxiety. The next day, I’d be teary. I just couldn’t function well. As I got pregnant and went to have my first child, I was so worried about how my mental health would go.  Don’t get me wrong; not having sleep did impact my mental health for sure. But getting less sleep and having to get up and take care of a baby, and then having to get up and go to work once I’m done with maternity leave, and learning that I can actually get through a day, using my skills, seeing my patients, and managing my emotions, a lot of my sleep anxiety went away because all I could think of was that I’ve done worse. I’ve literally gone a night where I slept for 25 minutes and I still was able to cope. Even if I can’t fall asleep tonight, I know I can handle it. That empowerment is gold. That change in perspective. That attitude shift about discomfort is a game changer.  Now, of course, you know what I’m going to say. This has to be done with an immense degree of compassion. This has to be done in small, baby steps. I’m not here to tell you to throw yourself into 10 out of 10 discomfort, but if you have to, I still trust and believe wholeheartedly that you can still handle it. I always say to my patients, no one has ever died from discomfort itself. It won’t kill you. It’s just going to be really hard. We can practice holding ourselves kindly as best as we can as we ride that wave. That’s the work.  A RECAP: BRING ON THE DISCOMFORT To recap, what makes it worse? Discomfort and uncomfortability get worse when we do anything to try and make it go away. We won’t resist it with this urgency to get it go away. But the solution is acceptance, willingness, non-judgment, compassion, making space for it, and then engaging with your life. Again, I’ll say it again. The solution is accepting the discomfort. Willingness is the willingness to be uncomfortable. The non-judgment of being uncomfortable. It’s neither good nor bad; it’s neutral. It is still uncomfortable, but it doesn’t mean you are bad or it’s bad. We’re going to be self-compassionate as we feel this uncomfortable feeling. And then we’re going to keep making space and moving back into our lives, doing maybe baby steps at a time. Even if you do this for 10 seconds, I applaud you. Let’s celebrate you. If you do it for 30 seconds and you’re able to do that multiple times a day, you are on the right track. If you can be uncomfortable for three minutes at a time, you’re basically winning at life. I want to encourage you, this is huge.  Sometimes, when things are really hard at the Quinlan household and I want to scream, yell, or totally do something that I know I will regret, stopping and saying, “Okay, this is discomfort. Can you stay with it? Can you make space for this for three minutes or 30 seconds,” has given me an opportunity to not say things I don’t mean, to not react in ways that will end up causing me more suffering that keep me in line with my values. This ability to be uncomfortable has saved me from making some big mistakes in my life. Not all of them. I’ve still made mistakes, of course, but relationally, huge mistakes I could have made had I not slowed down and made a little space for the fact that I’m angry. “Okay, I’m going to make space for this anger,” or that I’m hurt, or that I’m really anxious. There’s been times where I’ve wanted to run away from my anxiety, but my ability to, for 30 seconds at a time or 10 minutes at a time, make space for the anxiety, not judge it, allow it, and bring it on has meant that I've been able to face some really scary things, and that’s what I want for you. That’s how you’re uncomfortable. Is it easy? No way is not easy. Is it doable? Absolutely. I want to remind you, this is a practice in which you can grow. Before you know it, there will be these moments of empowerment that will shock you, and you can’t believe that you’ve made these changes out of nowhere. I fully and wholeheartedly believe that. I’ve heard it from so many patients and so many students. A lot of you have also shared how helpful it’s been. That is why I say it’s a beautiful day to do hard things, because when we do hard things in a very skilled way, they actually make us feel really empowered, and we have a sense of “I can handle things now.” All right. It’s a beautiful day to do hard things. Again, please go to CBT School if you’re interested in any of our online courses. They talk about all these kinds of things. We have courses for OCD, anxiety, depression, BFRBs, meditation, mindfulness, time management—the whole deal. My hope is that this type of message can be taken in any area of your life, and hopefully, it makes it so much better.  Have a great day. 

In today’s episode of Your Anxiety Toolkit podcast, you will learn how to meditate to reduce anxiety. You’ll also learn which meditation is best for anxiety and how to find a meditation practice that suits your lifestyle and your recovery needs. With the pressure of today’s society and the news being so scary, people are rapidly turning to meditation as a powerful tool to calm their minds and ease their anxiety. My name is Kimberley Quinlan. I am a licensed therapist and anxiety specialist, and my hope today is to teach you how you can use meditation to help manage and reduce your anxiety. What Is Meditation?  Now, what is meditation? Meditation is a training in awareness, and the goal is to help you get a healthy awareness and understanding of what is going on in your mind. So often, our minds are like a puppy. They are just going all over the place, jumping, skipping, yelling, screaming, and going in all different directions. If we aren’t skilled, and if we aren’t intentional with that, we can be off with that, off down the track in negative thinking, scary thinking, and depressive thinking.  The Benefits Of Meditation For Anxiety Relief There are many benefits of meditation for anxiety relief. Meditation helps train your brain. Now, there are so many benefits to meditation for anxiety relief, and I want to share with you some of those benefits. The first one is, it rewires your brain. It reduces the activity in the amygdala, which is the part of the brain that is responsible for the fear response. Meditation can also lower stress hormones such as cortisol. It can increase the production of those feel-good neurotransmitters like serotonin and dopamine. This is really important, particularly if you struggle with depression.  It can also shift the brain chemistry and lead to improved mood, reduced anxiety, and an overall sense of well-being. We could also argue that this would be helpful for anybody, even if they don’t have anxiety.  We also know that meditation cultivates mindfulness, which we talk a lot about here on Your Anxiety Toolkit, which is the practice of being fully present and nonjudgmental in the moment. Meditation increases self-compassion and acceptance, which I think we all agree can help us with our mental health, and it helps reduce negative thinking patterns and also reduces self-criticism.  Common Problems People Have With Meditation Now, there are a couple of problems here, though, with meditation. Often, when people come to me, they'll say, “I don’t know about this whole meditation thing. It sounds a bit like a cult or a bit like a scam or a fad, a psychology fad.” Often, that’s because people have a misled idea about what meditation is and how it works.  One of the main problems that I hear is that people expect that meditation will, poof, make their anxiety go right away. As they’re practicing meditation—and it is a meditation practice—as they’re starting to practice this meditation, they’re getting frustrated because they’re thinking, “This isn’t working. It’s not making my anxiety go away.”  We want to first challenge the idea that meditation is not a quick fix. It’s not something that’s going to, poof, make your anxiety go away, but there are so many benefits that I will talk to you about here in just a second.  Another problem that people have with meditation is they get frustrated with the practice. They have these expectations that they should be able to do it. Well, simply because it’s often sitting or very stationary, they assume, “I must be really good at this. It’s such a basic task.” But the truth is, it’s not. We have to remove those expectations that we will be excellent at it, that it should be easy, or that discomfort won’t arise.  Another problem people have is that they do experience anxiety while they’re meditating, and they’ll say, “I’m here to get away from my anxiety, but when I’m meditating, everything is still, and I actually feel more anxious.” We’ll talk about that here in just a second.  People also don’t like meditation because they have been told that the solution to anxiety is to make it go away. And so, what would this mindfulness meditation practice really do if we’re actually just sitting there thinking? What a waste of time, actually putting more focus on the actual problem of anxiety. Again, not true, but these are the common problems people have.  The last one is, people say, “I don’t have time for meditation.” I always laugh because I do know that the Dalai Lama said, “For those who don’t have time to meditate, they’re the ones who need to meditate twice as long.” That always made me laugh because there’s been many times where I’ve said, “Oh, I don’t have time today,” and I laughed thinking, okay, even more important that these are the days that I focus on meditation.  Which Meditation Is Best For Anxiety? Let’s talk about which meditation is best for anxiety, because I know you’re here to talk about how meditation can help with your anxiety. Now, there are many types of meditation. No one really agrees what the best one is, and no one really even agrees on the specific types because there are so many and so many modifications. But here are some options—we will also talk about later how to apply these to your anxiety disorder—that you may want to consider.  VIPASSANA MEDITATION The first one is mindfulness, or what we call Vipassana meditation. Now, this is a meditation that really helps you become skillful in how you respond to your intrusive thoughts, your feelings, and your sensations. BODY SCAN MEDITATION Another type of meditation is body scan meditation. This is very body- and somatic-centered in that we’re focusing on different parts of the body, often with some kind of relaxation technique to slowly move down the body and move us into a place of relaxation.  Now, there are pros and cons to this meditation. Some people find it very relaxing, especially when we’re looking at getting sleep. Others find that, again, their expectations are very high, and then they get quite frustrated when they’re unable to get relaxed, because the truth is, when we’re anxious, when that amygdala is firing in our brain, it is really hard to relax. Sometimes meditation in and of itself is not going to fix that. But a body scan meditation is a really effective one, particularly if you’re trying to slow down the nervous system. Maybe look at trying to get some sleep, a nap, or some rest.  VISUALIZATION MEDITATION Another type of meditation is visualization meditation. This is where you actually visualize something happening to you. Maybe you’re walking along a path or along a beach. You’re in a relaxed setting. Let’s say you’re an athlete. It might be visualizing you doing the activity, the exercise, or the skill that you’re practicing—a layup for basketball, running a marathon, or so forth. The visualization can help with empowerment. It can help promote creativity. It can help create a sense of mastery over something that you haven’t yet mastered.  WALKING MEDITATION Another type of meditation is walking meditation. This is a great one, particularly if you’re someone who is very sedentary during your work. I am one of those people. I sit a lot during my day. Walking meditation is similar to mindfulness meditation in that you’re very aware of the present moment, what it feels like for your feet to touch the ground, for the balls of your feet to touch the ground compared to the heel of your feet, what it feels like for the wind to blow on your face, or what it feels like for the weight balance, going from left foot to right foot, and so forth. SELF-INQUIRY MEDITATION Another type of meditation practice is self-inquiry meditation. This often involves inquiry or curiosity to who I am in this moment. It might be, who am I as I hear these sounds? Who am I when I have these thoughts? There are some pros and cons to this for those with anxiety. Sometimes, when we have anxiety, we already spend a lot of time doing a lot of self-inquiry or self-rumination about who we are. What’s our identity? Are we good? Are we bad? This type of meditation can be beneficial for some, but for many people with anxiety, they may find it not helpful at all unless they’re with someone who can very much direct them and keep them on track with the active inquiry instead of going into rumination. MANTRA MEDITATION Another type of meditation is mantra meditation. This is where you repeat a mantra, a phrase, or a sound over and over again. It’s about the training of the mind and the training of discipline for one specific sound, tone, or word. It can be very helpful, again, if there’s a particular intention you’re trying to go towards. But again, for those folks with anxiety, this can be very frustrating because, again, there’s sort of this attachment and expectation and clinging to a certain outcome. For those of us who have anxiety, that can actually create a lot of distress in our bodies. Not to say that any of these are bad or good; it’s just dependent on your specific set of situations. LOVING KINDNESS MEDITATION One that I always love and talk about all the time is loving-kindness meditation. This is an act of compassion where you send yourself others and all sentient beings loving kindness and care. It is a way of generating, practicing, and nurturing self-compassion. It is a beautiful way to be in connection with people out in the world that maybe we don’t have a connection with, particularly if we’re lonely or feeling isolated and alone. Loving-kindness meditation can be so beneficial to people with anxiety or depression, OCD, health anxiety, and so forth if they’re feeling so alone and they’re really very hard on themselves. Loving kindness is absolutely a beautiful meditation for people with anxiety.  ZAZEN MEDITATION Another type of meditation is zazen meditation, which is a specific zen meditation where the goal is to be focused on a direct experience of this present moment. The main goal is non-attachment. The goal is to allow everything to be just as it is. It’s a very disciplined practice, but can be very beneficial to people who have anxiety.  BREATHE MEDITATION The last two: number one, breath meditation where you focus on the breath and you have that as your focal point. This is very beneficial for people with anxiety. The only thing I would say is, for those who have somatic obsessions of a specific type of OCD, if your somatic obsession is already focused on the breath, we actually then wouldn’t practice this because it would actually add to their hyper-awareness. But overall, breath meditation is a very beneficial practice for people with anxiety.  SOUND MEDITATION And the last one is a sound meditation. This is where your focal point is on sound. Very beneficial for those with somatic obsession and very beneficial for people who really like the vibration of sound and really love music, and music is something that grounds them, lifts them up, motivates them, and so forth.  There are different types of meditations and some pros and cons, but there are some specific things I want you to know and remember as you start a meditation practice and while meditating, because so many people have come to me to say, “I don’t like meditating. It doesn’t help me. Therefore, I’m not going to do it.” I feel that that is such a shame because meditation can be such a powerful mental health practice. It can be such powerful training for the brain.  I often say to my clients, when you start to notice some tightness in your knee or some shoulder pain, you don’t just ignore it. You think, okay, I have an opportunity to strengthen that muscle around the knee or stretch out that shoulder. We usually move in and do some work, exercises, and practices to create an environment where that pain can go away. I think of meditation as being exactly that. It’s like physical therapy for the brain, and it can help. Like I talked about, there are so many benefits to meditation, but it does require that we do it specifically in a way that doesn’t make more anxiety. Now I have a really exciting thing I want to mention to you before I get into all the things I want you to remember as you move into your meditation practice. Because so many people have come to me and said that they’ve listened to meditations online, they’ve gone to meditation trainings, and they actually found it to be not helpful for their anxiety, for their intrusive thoughts, or for their depression.  I have created an online meditation vault specifically for those who have anxiety and repetitive intrusive thoughts. My goal with this meditation vault is to make it very informative for the person who struggles with high expectations and rapid, repetitive intrusive thoughts, and I try to bring that concept into the meditations so they’re specific for people with anxiety.  There are over 28 meditations. There are specific meditations for people with OCD, health anxiety, social anxiety, panic, generalized anxiety, and depression. There are meditations on sleep, meditations on compassion, meditations on mindfulness, and meditations on strong emotions like guilt and shame. I did my best to pack them all into one specific place so that you have a wide range of guided meditations specifically for whatever it is that you need. There’s even a meditation for people who don’t want to meditate. I felt that that was really, really important.  You can click the link in the show notes below if you’re interested. You can also go to CBTSchool.com to get information about the vault. It is very low-cost. I want it to be low-cost so everyone can access it, and I’m so excited for you guys to check that out. How To Meditate To Reduce Anxiety If you are wondering how to meditate to reduce anxiety, there are things you need to remember as you practice meditation.  Do not expect anxiety to magically disappear. Number one, if that were to happen, it probably wouldn’t be for very long anyway.  I want you to imagine this practice as the slow and steady growth of a muscle. If you were going to train at the gym, you wouldn’t go straight in and pick up a hundred pounds right away. You would start low; 10, 15, maybe 10 to 12 and a half, then to 15, and you would slowly work your way up. You wouldn’t have these expectations that your body would be able to pick up a hundred pounds at a time without pain afterwards. You would go in knowing that the cost of this is going to be that I may get pain if I overdo it, and I want you to think about that with your meditation practice as well. Not that you’ll have pain, but that it’s healthy to take baby steps and do it slowly and steadily. Another thing I want you to think about is, again, to think of this as an opportunity to change the way your brain responds to anxiety. Think of this as an opportunity to change how you respond to discomfort, how you act in your daily life, and how you can change your habits to benefit your mental health. How Long Does It Take For Meditation To Reduce Anxiety And Stress? Often, people will ask: how long does it take for meditation to reduce anxiety and stress? The answer here is very simple, which is, let’s not put pressure on that to be the outcome. I know you came here to learn that exact answer, but the thing to remember here is, the more we resist anxiety, the more we want it to go away, the more we try and avoid it, the more we’re feeding to our brain that it’s dangerous and scary, and it will make our brain send out more stress hormones. We want to use meditation as an opportunity to train our brains that we are no longer going to run away from anxiety and stress. Instead, we’re going to open up a space for anxiety and stress and have it be a safe place. Have our bodies and our minds be a safe place for anxiety to rise and fall. It’s important that we understand that this, again, is an opportunity for you to change your specific emotional reaction to having anxiety and stress. Now that being said, I will still answer the question, which is, I think within time, you will probably see a very significant improvement. Most research shows that a short meditation practice of four to six weeks will significantly reduce people’s stress and significantly improve people’s relationship with their anxiety. I often say to my patients, give it 30 days. Go in with a solid commitment to practicing as often as you can for 30 days. Track your anxiety; maybe even put it on a scale from 1 to 10. If you’re able to do it in this way, where you’re not trying to get rid of anxiety but instead trying to make it a place where you can have anxiety and not respond with judgment, criticism, and resistance, you’ll probably find that you’ll have significantly reduced levels of anxiety and stress after 30 days.  Now, again, I want to emphasize that there is significant research to show that meditation for stress is very beneficial. In fact, we’ve found that practicing meditation again downregulates your stress response. It reduces your nervous system’s activity and reactivity to stressful events in your life and can greatly benefit your overall well-being. Definitely, if you’re someone who’s struggling with a very stressful time, and I think we all are given that the news is so, so painful right now, I think it’s a beautiful opportunity for us to start a meditation practice.  Another thing I want you to remember here is that by practicing meditation, you widen your window of tolerance. Now, what does this mean? I’ve talked about it on the podcast before. If your window of tolerance is very narrow, it means, as soon as you have any kind of strong emotion, strong experience, sensation, or pain in your body because you haven’t practiced being able to tolerate that, you are very much more likely to rely on unhelpful safety behaviors to cope with that distress.  In discomfort, as I mentioned, we actually widen our window of tolerance. The wider we can have this window of tolerance, the more likely we are to be regulated when we have a lot of emotions. We can be steady and really intentional in how we respond. We are more likely to act according to our values than according to our fears. So we want to practice widening that window of tolerance. There is so much benefit to doing that.  Another thing to remember, and I’ve mentioned this already, but I think it’s really important as we finish up, is to not put pressure on yourself to get this right. I will often say to clients, and I say it all the time in the meditation vault over and over again, expect anxiety to show up over and over again. Expect your mind to go off track and go off and think about the grocery list. Your job is to bring it back to the present moment.  Don’t be upset with your brain for going off track. That’s its job. Its job is to be highly functioning and thinking about all the things. But the training and the benefit is that discipline to bring you back to the focal point that you’re on right now, depending on the type of meditation that you’re doing.  I hope that you can practice letting meditation be messy, because it is. Even very, very skilled monks who practice meditation for hours a day still report that there are days when meditation is messy. There are days when your brain will be all over the place like that puppy dog, but with practice, you will start to see an improvement in your ability to be disciplined and intentional with where you put your attention, which again, as I mentioned, reduces the chances of you engaging in safety behaviors that aren’t helpful, reduces the chances of you engaging in compulsions, and reduces your chances of going back down into those negative thought processes. There are so many benefits. The last thing I want you to remember is, as you begin this practice, be curious. Be open. Instead of being judgmental and rigid about what you think will happen, be curious about what might come from inquiring and moving into this practice.  Meditation has changed my life. It has calmed me in the darkest hour. It has been there for me when I needed support, and I hadn’t had anybody else to lean on. Meditation, as I mentioned, is a practice where you teach yourself to be a safe place for you to experience any emotion at all, and you know that it’s there; you can take it with you wherever you’re at. It costs nothing to practice meditation in the moment, and I hope that it’s something that will bring you as much joy and as much wellness as it has for me.  Have a wonderful day, everybody. As always, it is a beautiful day to do hard things. Again, if you’re interested in the mindfulness meditation vault, you can click the link in the show notes. Have a wonderful day.

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

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

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

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

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