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

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

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

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

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

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

Welcome back, everybody. Today we are talking about Acceptance Scripts with Dr Jon Grayson.  So happy to be here with you as we tie together our series on imaginals and scripts. Today, we have the amazing Dr. Jon Grayson and he is going to talk about acceptance scripts and the real importance of making sure we use acceptance when we’re talking about scripts and imaginals. I’m so excited to share this episode with you. I think it really does, again, tie together the two other guests that we’ve had on the show in this series.  For those of you who are listening to this and haven’t listened to the other two episodes of the series, go back two weeks. We’ve got the first one with Krista Reed and she’s talking about scripts and the way she uses them. Then we have Shala Nicely and she talks about her own specific way of using scripts. Again, the reason that I didn’t just have one person and leave it at that is I do think for each person, we have to find specific ways in which we do these skills and tools so we can make it specific to your obsessions and your intrusive thoughts. One explanation or one version or variety of this is probably not enough. I want to really deep dive in this series so that you feel, number one, you have a good understanding of what an imaginal and a script is. Number two, you know how to use them, you know the little nuanced pieces of information that you need to help make sure OCD and your OCD-related disorder doesn’t make it a compulsion because it can. I really wanted to get some groundwork so that you feel confident using imaginal and scripts in your own treatment and your own recovery. Again, for those of you who are a little lost and feel like you need a better understanding of OCD, of how OCD works, how it keeps you stuck, the cycle of OCD and you want to make your own individual OCD and ERP plan, you can go to CBTSchool.com. We have a full seven-hour course that will walk you through exactly how I do it with my patients, and you can do that at your own pace. It’s an on-demand course. It is not therapy, but it will help you if you don’t have access to therapy or if you’re really just wanting to understand and do a deep dive and understand what ERP is and how you can use it. That is there for you. But if you are someone who is just wanting to get to the good stuff, let’s go over to the episode with Dr. Jon Grayson. Thank you, Dr. Jon Grayson, for coming on the show again. Always a pleasure to have such amazing people who really know their stuff. I’ll enjoy this episode with you. Let’s go. Kimberley: Welcome, Dr. Jon Grayson. I’m so happy to have you back. Jon: It is always fun to be with you. Kimberley: Okay. It’s funny that you are number three, because I probably need you to be number one. Almost all of the scripting I ever learned was from your book. I think that even Shala Nicely came on and spoke about how a lot of what she does is through your book as well. Let’s just talk about the way in which you walk people through an imaginal or a script. Now do you call it imaginal or script? Do you think they’re synonymous? Do you have a different way of explaining it? Jon: I think jargon-wise, they’re synonymous. I think by definition-- I feel weird saying that by definition because we made it up. I came up with the name “script” because originally, imaginal exposure suggested I’m just dealing with all the horrors and person’s just going to think about it. I changed the name to “script” because I was including both. What are you being exposed to? What might happen and why would you take this risk? Because I feel like the script is not only to get used to the material, but we remind the person, why am I doing this? What am I getting out of taking this horrible risk? Why would I want to live with that?  WHAT IS AN ACCEPTANCE SCRIPTS/IMAGINALS?  Integral to the Acceptance Script is the whole idea of learning acceptance. Because too often, I think the biggest problem I see in most therapists is they just jump into doing exposure without making sure the person has done level 1 acceptance, which is “I want to live with uncertainty,” because to say “I want to live with uncertainty” is to say, “I am willing to cope if the worst things happen.” It’s not just this general idea, it’s like going to the extreme. “I’m willing to live, even if this happens. I’m willing to drive a car knowing that I might get paralyzed and disfigured in a car crash.” I think that’s acceptance because if you’re telling me you’re never going to crash in a car and you know that’s true, I guess that’s a nice comforting thought that you might be in for a shock. We’re willing to take that risk. I think across the board, it’s always willing to live with the worst possible.  Scripts try to encapsulate that. They’re trying to help bring the person not only to confront their fear but remind them of all the ways they want to cope with it. It is not a reassurance thing because let’s face it, the worst thing happening, saying “I’ll cope with the worst” is not really reassuring in a sense because it’s something you really don’t want to happen. But I guess the goal is, first of all, if it happens, you will do something that’s coping or not.  I think non-acceptance-- God bless you. I’m glad we’re live so people can see you were sneezing. I just didn’t go into a religious ecstasy. I think we see non-acceptance insidiously all over the place without realizing it. In the beginning of the pandemic, so many people were going like, “Well, this can’t last all summer. I can’t deal with that.” That is a statement of avoidance and non-acceptance. I was listening to that and in the back of my mind, it’s like, “Let’s see. Everything they’ve told us makes it seem like this is going on for two years because they’re not finding a vaccine.” Seriously, you can’t take it. You’re not going to do it. What are you going to do? In retrospect, everybody would have to admit, “Well, yeah, it was not fun, it was awful, but I lived through it.” Acceptance would’ve been, “Well, how am I going to try to make the best of this?” Making the best of it isn’t wonderful, which I guess brings us to the first point about acceptance because I think in the Western world, we make everything glossy and pretty and beautiful. Acceptance is just this wonderful land of zen happiness. It’s like I’m accepting everything is so good and, in reality, the best way to describe acceptance is that it sucks in the short run. In the short run, acceptance means “I’m going to be willing to embrace what seems to me the second-best life. This is what I want, I can have it, I will embrace this.”  WHY DO WE NEED TO PRACTICE ACCEPTANCE?  The prime reason to do acceptance is you don’t have a choice. The other world doesn’t exist. In the beginning of the pandemic, Kathy and I were doing our pandemic walk, my wife Kathy. We were doing our pandemic walk. I remember because you’re terrified of everybody and you’re walking looking around. Kathy says to me, “God, this would be such a great day if all this wasn’t happening.” I said to her, “You’re wrong, Kathy,” which for all the listeners should immediately cue them into the idea that being married to a psychologist is not necessarily fun. I said to her, “It is a beautiful day. We’re with each other. Here we are. We’re holding hands, taking a walk. It’s really pretty. We’re going to be spending the whole day together.” The truth is, it is a great day AND it’s horrible that all of this is happening. I think acceptance is always AND. We always talk about letting stuff be there as if it’s very passively like, “Oh, I can just let it be there and not bother me.” No, it’s really horrible. Let me tell this really horrible story, which I can’t remember if I’ve told on here, but it’s a more graphic description of what acceptance looks like, if I may. A young girl was brought to me, 17, was really in terrible shape. I mean, she had been hospitalized, she had suicide attempts. So anxious, she couldn’t tolerate being in a counsel’s office for more than one hour when she first came in. Her meds were a mess. Over the next three months, we got her meds in line and she really worked incredibly hard considering where she was. And then in December, they asked, could she be in my support group? I said, “Well, it’s not really for kids.” They talked me into things, “We think she’s mature.” First of all, whenever she spoke up in the group, whatever she said would be brilliantly insightful that would just knock everybody out. She did not look old, but nobody could believe she was only 17.  As the year went on, we were tapering off sessions. The last time I saw her in June, her parents, her and her brother were driving out to the desert outside of LA looking for a vacation getaway place. On their way there, a drunk driver in her third DUI rammed the car and killed my patient Ruby and her 14-year-old brother. I don’t have to tell you how devastated the parents were. I could talk a lot of stories that are amazing about them because I saw them starting about three weeks after their loss. At which point they said, “We want to be more than the parents of dead kids, but we can’t imagine anything else.” I said, “Well, I can tell you what treatment will be like, but it just seems like words.” They agreed it’ll be just words, but it’s just nice to hear there’s something. They coped amazingly well. But the only good thing about coping, in this case, is it’s better than not coping. Maybe that’s true a lot of the time. After a year and a half, they did buy the place where they were going to that they were looking for that day. They bought it because it made them feel closer to the kids. They didn’t push that away at all. After a year and a half, they were at the place. It was one night where there was a meteor shower. They go, “Oh, we’re going to go out and watch the meteor shower.” They go out at midnight, lay down on their backs and both immediately burst into tears because this 17-year-old, 14-year-old were actually the kind of kids they would’ve happily gone out there with their parents and enjoyed the whole time. I said to the dad, “Was it a pretty meteor shower?” He said, “Yeah.”  “Are you sorry you saw it?” “No.” I said the truth, “It was a beautiful meteor shower AND it’s horrible that your kids were murdered.” It’s a dark sense of humor and said, “Well, I thought we’d have at least a few moments. I said, “Yeah, that wasn’t happening.” That’s acceptance. They were living in the present. They could enjoy things and there was a hole in their heart. The alternative to that is comparing life to every second of life to how much better it would be. Whenever I compare life to a fantasy, I ruin the present. I have nothing.  I think the reason for acceptance is to make the best of whatever we can have. I think one of the wonderful things sometimes is that a lot of what we avoid is not something so devastating. It’s maybe more in our head what we’re trying to avoid. But a low probability event is not a no probability event. If that’s what I’m scared of, low odds are comforting because I want no odds. Am I answering your question? Kimberley: You are. I think it’s a really great opportunity for us to segue. You’ve talked about the first step being to familiarize yourself with uncertainty before doing scripts and acceptance. You’ve beautifully explained this idea. For the listeners, you can also go back. Dr. Grayson has been on the show before. You can listen to it. We’ve talked a lot about that, which is so beautiful and I think very much compliments what you’re saying. Let’s talk about the script that you’re speaking of. Once you’ve done that work of acceptance, how would you-- Jon: I may have to call you Ms. Quinlan since you referred to me as Dr. Grayson.  Kimberley: No, call me Kimberley.  HOW CAN WE ACCEPT UNCERTAINTY USING SCRIPTS/IMAGINALS?  Credit: https://www.instagram.com/p/CmZUliJKhQB/ Jon: When considering how to accept uncertainty, that first step, are you willing to learn to live with uncertainty? That step is variable of talking in therapy for the first session. I’ve had some people take three months before they agree like, it’s not like I really have a choice, and that’s really what we’re getting. What are you losing to that? I can’t remember if I just said this before, but one of the biggest things that I end up teaching therapists who have been around the field for years is do not start exposure until the person has actually agreed that they’re willing to learn to do this because obviously, they can just accept uncertainty. Then we’re done with session 1. It takes one session to three months. The loose measure is to accept uncertainty to say if the worst happens, I will try to live with it and I will try to cope with it. If somebody says to me, “If that happens, I’ll kill myself.” No, no. That’s an avoidance. In this scenario, you are condemned to life. You’re going to have to figure out how to cope no matter how awful.  In scripting, the idea of a script is not only to provide the imaginal exposure, which is like this terrible thing might happen. Because a lot of times, people go, if you say X might happen, “I don’t want to think about it.” As I said to you in the beginning of the show, I can get any parent into an immediate statement of denial by saying, “What if your kids die,” the response of almost every parent is, “I don’t want to deal with that. I don’t want to think it through.” But if you’re being tortured by the thought, that normal level of denial, which I don’t think is the ideal way to handle it, but you already can’t do it because you keep going into, “What about no, what about no, what about, no?”  How to write an Acceptance Script The very first step of how to write an  acceptance script is essentially asking the question, “why would I take this risk?” Because within that statement is part of your answer of why I’m going to pursue acceptance. It is not the same as acceptance, but it’s why I’m being motivated to go after this.  Kimberley: What would that look like? How would you word that? Jon: As to why would I take this risk?  Kimberley: Uh-hmm. Jon: I’m trying to think of how horrible to go.  Kimberley: Let’s pick an example because I think examples are helpful. Let’s say someone has relationship OCD and they’re afraid they’re making the wrong choice in their partner. Jon: You picked one, I think, that’s not necessarily the most horribly devastating consequences on one hand compared to like, am I an old child molester?  Kimberley: You go there. Jon: I have a really wonderful acceptance thing I do with that, so we will go there. But with the ROCD, I want to know, am I making this terrible mistake with my spouse? What we’re asking them to accept is never knowing. Kimberley: You’d just say that in the script?  Jon: No, because we’ll talk to them and we’ll talk about why like, why am I willing to never know for sure? Because some of it is like they’re looking into a relationship with the thermometer and taking the measure every minute. What’s the temperature now? What’s the temperature now? There’s this fantasy that I should have no questions. I mean, depending on how deep they’re in, I should find no one else attractive, but every moment should be great and I should have no complaints. Well, that is a fantasy marriage.  Kathy and I took a trip to France and it was an incredible trip. Of course, when you say going to Paris, everybody’s eyes glaze over. We ate at a patisserie every morning, but let’s face it, it’s just a damn croissant. One place had the best café au lait. We were there for two days, but it was great. We saw the Catacombs where we had to wait in line for three hours in the hot sun. Went to a really fine restaurant, but we’re not super foodies, so we’re not necessarily going to like it. The experience can’t just depend on, “This was great food,” or “This is terrible, we just spent a lot of money for what.” We go in knowing that. It was a great vacation. A great vacation. It’s not like every second is great. Three hours in a hot sun, five-hour bus ride to go see the site, but it was still a great vacation. I think a relationship is like that, so I can’t look at that now.  I think for the person with ROCD, we’re going to say they are not perfect. Like any relationship, we want a hundred things and we’re only getting 70 of them. It should be more than 20, but we’re only getting 70. Are you making a mistake? Now, most people with ROCD can say they don’t want to leave right now or sometimes they want to leave because of the anxiety. It’s like, then you have to stay. I don’t want you talking about all your fears and confessing because if you are wrong, you’re just making this person feel bad for no reason.  My thought is, you can leave this relationship when you know for two weeks solid you want to leave with no question. No question. You know it is, sure, as you know you’re sitting there because they generally accept that. We have to point out what are the realities of a relationship. Everyone on their wedding day thinks they’re going to be married forever, but that’s wrong 50% of the time. Whomever we marry, my spouse being an exception, 40 years later, they don’t look as good as you did the day you married them. Technically, you were accepting second best in looks 40 years later. Kimberley: Did you know the rate of divorce is higher in therapists? Jon: Wow. So, Kathy and I are really against the odds. This is a little scary to you probably. We started dating in 1970 and this year, it’ll be our 50th anniversary.  Kimberley: Wow. Congratulations. Jon: Having met at the age of two and started dating then, we don’t really have much significant history before that. You will get angry and there are going to be things they don’t want to do. Yes, you’re going to have to learn to live not knowing that. That’s going to be part of the script, that you don’t get to know. What if you’re making a mistake? Even if you fell wildly happily in love now and you had no question, really nice feeling. If the relationship seems good, no reason to question it. Now of course, if you have ROCD, you’re checking all these reasons. It’s like you’re not ready to leave yet. Yes, when you’re answering your questions, it’s maybe. Even if I feel wonderfully in love with you, it might be that next year or after 20 years ago, I discover you’ve been having a seven-year illicit affair. I discover, “Oh hey, guess what? You’re leaving me.” There are all kinds of things that could go wrong. Or I’ll ask the person in this relationship, if this relationship was good and you felt constant passion affair and next year your spouse suddenly gets a dread disease that’s going to make them really messed up and crippled and sick for the next years, I guess you’re leaving them. Of course, everybody goes like, “No.” But the bottom line is, that’s good, but that’s not going to be what you signed up for.  How do we make the best of it? I did this one thing with one couple that worked like magic. I’m saying that worked like magic because I’d do it with everyone across the board, but usually, it doesn’t work like this. This was the low probability. Oh my god, this was the killer intervention as opposed to, this is a start for most people. It was such a cute couple, but I’d given him the thing. “This weekend, when you’re spending time with her, I want you to notice whenever you’re having fun, and although part of you wants to compare it to what it should be, I want you to consciously just notice whatever it is, like if it’s 5%.” Because a lot of times, you’re comparing your current feeling to what it should be. There could be good things happening and you don’t even notice because it’s like, “I was just thinking about this, I was just thinking about this.” He had that assignment to notice it, whatever. He came back and he was like, “We had a great weekend. I still don’t know if I love her or not, but if it could be like this forever, I’m good.” Now, that was a rarity, but that was the beginning of acceptance for most people, just noticing, oh, I’m not miserable every second. I agree a two-minute 20% joy isn’t like, oh wow, that makes it all worth it. But it’s stuff that you don’t notice all along. We’re trying to notice the good and the other stuff. Acceptance is not a decision; trying to learn it is. But when I talk about that couple who lost two kids, when I say it was more than a year for them to get to acceptance and what acceptance means for them is they didn’t compare every moment to what it would be like if their kids were still alive. In fact, I didn’t know this at the time when I told them that everything goes well after a year. You’ll still have a hole in your heart, but you’ll stop comparing every moment to if they were still alive. They just listened. But the dad wrote a book about mourning and he also did a one-man show called Grief, which I wish I could show everyone. But in one of those places, he said that when I told them that, in his mind, he was saying, “F you! I am never going to stop wishing my kids were alive.” And then he wrote that two years later, he’s come to realize it doesn’t do him or his kids any good to wish they were alive.” He’s in acceptance. He still misses them greatly. He can still cry at them, but he’s no longer making that comparison. I’m mentioning it because that takes time. No one expects a couple, three weeks after their kids are murdered, to be in acceptance. The same with anything I have to accept.  The person with OCD, they have this goal, but getting to that great state where “I’m living with this and it’s okay, I embrace this life” is hard. Luckily, most of the time what they have to accept isn’t devastating in the sense that nobody dies of AIDS. Am I with the wrong person forever? Well, maybe it’s the second-best life, but that’s the life I’m asking you to live for now, because all of us have no choice. Kimberley: Right. Let’s break it down.  Jon: I’m sorry. Kimberley: No, you’re great.  Jon: Okay. You’re good at being back on target. Kimberley: I’m a real visual person too. I don’t know if you know that about me, like if I need to see it visually-- Jon: By the way, that’s fantastic because to say something and show it visually just makes it easier for everyone else around you that you’re talking to. I appreciate what you’re going to do. Kimberley: Okay. Walk me through the visual here. The first step is what?  Jon: Why would you take this risk? Kimberley: Okay, what’s the second? THE SECOND STEP OF ACCEPTANCE SCRIPTS Jon: The second step of acceptance scripts is, if I do X, here’s a list of the things I’m actually scared might happen. I say actually scared because I want to go, what’s their fear? I can always go beyond even more horrible things, but I need to know what is their actual worst fear. Kimberley: Right. Let’s say for two if it was relationship OCD, it would be, “I find out I’m in a terrible relationship and I’m stuck with them.” Or if they were having harm obsessions, it would be, “I harm and kill my wife or my grandparent or so forth.” You would write that down. Jon: Yeah. “Here’s what might happen.” Kimberley: Okay. What’s step number three? Jon: If this happens, how would I try to cope with this in a positive way? Kimberley: That’s key, isn’t it? How would I cope in a positive way? Jon: Right. And that will often be second best. Kimberley: Which is acceptance. Jon: Well, it’s the road to acceptance. Remember, acceptance is not just this logical thing; it’s this emotional thing. I have clients and they appreciate it. It’s like, if we were just doing a therapy test, like say all the right stuff, they could ace therapy right away. They know how to say everything, they can do it. But feeling it takes time and behavior. I not only have to know it; I have to do the work of getting there. I have to go through all this pain. Now, I say, I think going through ERP is as painful as doing rituals. One is just an end of rituals versus endless rituals. I hate to keep going back to this couple, but what I said initially, the only good thing about coping is it was better than not coping. I had told them how well they were coping somewhere in the middle. Again, the dad said, “Wow, I hate to see the other poor bastards,” which was cute. I said, “Yes, but you’ve been in support groups, you’ve seen them.” He suddenly realized, “Whoa, we are coping even though this really sucks.” Kimberley: In this script—and maybe I’m wrong here, please tell me—I always think of the research around athletes and when they have an injury, there’s research to show that while they’re in the hospital bed with their new hip replacement and whatnot, the sports psychologists are coaching them through visual, imaginal, imagery of them doing the layup again and dunking the ball or turning the corner of the sprinting track or whatever. They’re doing that imagery work to help them play out how they would cope, how they would handle the pain, how they would return. Is that what this process is in step 3?  Jon: No. Well, that guy or a woman who’s imagining that, does their injury permit that possibility? Kimberley: Tell me more. Jon: Are they so injured that they will never be able to do a layup? Kimberley: No. In this example-- Jon: Or maybe somebody could say the odds are against them, so here’s what you can try to do, and here’s what to expect of how horrible it is to try.” But they might have to say, “You might not get there.” In a marriage, I don’t care how good the marriage is, I cannot say it will definitely work out. I can’t say you will definitely work out your problems. If I’m married for 20 great years, and then we have these three years at hell and I find out that you’ve been cheating on me the last two years, did I make a mistake? Or should I have left you four years ago, how would I know four years ago and should I have not tried, and all these questions that don’t have an answer. All I know is where I am now.  THE THIRD STEP OF ACCEPTANCE SCRIPTS  I like to say success is not making the right decision. It’s coping with the consequences of whatever decision you have made. I feel regret is cheating because regret is, again, I’m going into denial as soon as I have a regret. I should have done X. X would’ve been different. I don’t know if it would’ve been better. This failed. X being better is one possibility, but there are a whole lot of other ones where maybe it wouldn’t have been as good. All I can ever do is, what is next? That person in the relationship with ROCD, what do I need to do next? What have I learned? Somebody with ROCD did get divorced and gets into a relationship where they have the ROCD, but it’s such a better relationship. It’s not like you should have gotten out sooner because you know what, maybe if you didn’t go into that other relationship, maybe you wouldn’t have been ready for this one. Maybe you needed to go through your ROCD and go through all the crap to have this good one. Dumping that person sooner and getting into another relationship might have been better, or maybe you would’ve picked worse. We don’t get to know. All we know is what is from this moment on.  Part of the exposure is, okay, X might happen. What are the possibilities of coping? Again, I think I said, in my scenarios, the person can’t do suicide. They’re condemned to life and say, why I kill myself? That’s just a way of not thinking in the present. I want you to be stuck thinking about how you would try to cope with this. A lot of times, people have been so distant from it that it just seems like a screaming wall. It is like getting a phone call that somebody you love died. The whole world stops, and that’s where people stop thinking. But in the real world, something happens after you get that information.  Part of the exposure is to go through what happened next, what are some possibilities? I always say to somebody, “I don’t know if I can cope with the worst things that could happen to me, but I know that there are brave people who have. I don’t know if I can be like them, but they’re a model that I hope I will do that.” What if you don’t cope? Well, then I’ll be in deep trouble. My current plan is, the best I can do is I hope I will cope. I don’t want to be paralyzed and disfigured in a car crash. I hope I would cope. I don’t have to know that I’d cope because I’m going to wait till I get there to try to find out. But I might try to imagine it.  We’re going to imagine what would you actually do. In this relationship, how will I live never knowing? I’m taking the ROCD, how will I live? What if this is wrong? It might be wrong. What’s decent right now? What do you like? Because again, no person is perfect. How do I get into the state of that? Do I ever send people to marital counseling? If I see actual problems, I will, but I am not sending them to marital counseling to get rid of the ROCD. I’m sending them to get rid of actual problems. With or without those problems, they still have ROCD. I’m just eliminating, okay, here’s some definite reasons to get out. But once they’re resolved, then you’re still stuck with the ROCD. THE FORTH STEP OF ACCEPTANCE SCRIPTS  Kimberley: Is there a fourth step of acceptance scripts?  Jon: Kind of. It’s embedded in it, which is part of why I would take this risk, is what’s resulting from not taking this risk? What are the graphic horrible things that keep happening to you because you keep avoiding, including the torture you feel, the hours loss, humiliation from doing things? How are you actually hurting the people you think you love? Because a lot of times in ROCD, they can say they care about the person. I’ll always ask somebody, do you love your kids or love your spouse?” They’ll say, “Yeah.” “Will you do anything for them?” They’ll say yes. I’ll say, “I’m sorry, you’re a liar.” How do you hurt your family and loved ones with your ROCD? Not being present, yelling at them because they didn’t do something, and all the other ways that one might, asking for reassurance endlessly being in pain in the neck. I will point out, you have a choice in your relationship. I’m going beyond ROCD. But you get to pick between, are you going to serve your fear or your love? You keep choosing fear over love.  Part of acceptance does have to do with what my values are. Who is the person I want to be? Here’s another reason I need to do acceptance, because here’s life without acceptance. Most people who we see, we can say, the idea of trying to not accept and do avoid, I think you’ve done an amazing experiment of checking out that method. I think the results are clear, it sucks, so it’s time to try this other method. It’s like, why am I doing acceptance? Because I think, again, in our society we just make acceptance sounds so wonderful. But that’s just an idea. Why would acceptance actually be worth it? I have to think about why would it actually be worth it. I have to be motivated to do it. And then I’m stuck with this in-between thing that a lot of the time I’m doing a separate, recognizing I am not there yet, which by the way, there’s this great book that this wonderful person wrote on self-compassion, because I need self-compassion during treatment because I’m not where I want to be. It’s like I’m doing this really hard work and it’s not there yet. The best I get to say is, I’m working hard, I see some improvement, but yes, I’m not there yet and mourning.  Learning to live the second-best life takes time. I keep saying second-best life. I don’t actually mean it in some sense, but that is the feeling that when I’m working towards acceptance, that it is. I think in some cases, it’s not really a second-best life. I think a lot of times, if I overcome a fear, it’s like, this is great. Other times it is. I’ve had some people with a moral OCD about something they’ve done in the past and they’re going through all these contortions to try to convince themself that it’s not really bad even though they actually think it’s bad, but maybe here’s why it’s not bad. Part of the acceptance is, oh yeah, that was a bad shitty thing. You feel guilty about that. What is forgiving yourself mean? Shockingly, almost nobody knows what forgiving yourself means. How are you going to get to that point? But I have to accept, yeah, that was bad. That hurt people or whatever it is by whatever standards. Again, depending on who we’re talking about, it’s like, “Oh, I guess we have to have you accept being as bad as everyone else.” In some other cases, no, that was really bad. WHAT HAPPENS IF I REFUSE TO ACCEPT?  Kimberley: It’s great. The last part of the question is, what happens when I refuse to accept? What is the result of not taking this risk or even not accepting this, which is you have additional pain, right? The pain just keeps going and going and going. Jon: Right. That’s right. End of pain. Endless pain. Kimberley: Yeah. If they’ve used these somewhat prompts and people can go to your book and work through a lot of them, I know on your website there are a lot of worksheets as well. Once they’re writing these prompts, is there anything else you feel is important for them to know about this process or to be aware of or be prepared for in this process? Jon: I am pausing. The next revision of the book might be your inspiration. Well, because I know that it is way, way, way, way easier said than done. The core treatment for all OCD is the same. However, I have a completely different set of things I say depending on the presentation, because they each have their own set of things that the individual has to be focused on working to accept and live with. Although I think in my book I attempt. When I talk about each presentation, I do try to go over those and I’ve seen that for many people as helpful. But I also see for many people who’ve read the book, and even though they’ve read it, it ends up different for them to actually have to discuss it out loud. Sometimes it’s because they haven’t been able to think about it without realizing they avoid thinking about it. Sometimes because I think not all the connections are obvious, which I know is a really vague statement. I think I can go on, but I have to wait for you to ask a question.  Kimberley: Okay. We’re running out of time, so I want to make sure I’m respecting your time. Jon: Don’t respect my time, by the way. I set aside way extra time. This is on you if we end. Kimberley: Once you do those questions, you would then walk them through the four steps that you went through with scripting as well.  Jon: Yes, and some other horrible things because the horrible show, that should have been illegal. Actually, it’s not on anymore. I think you can still find that on YouTube. Toddlers & Tiaras and the crazy mothers who make their little girls try to be in beauty pageants. You know what, if you look at the pictures of the kids, it’s like, oh my God, they’re sexualizing this eight-year-old. But when you say that word, that means you can see what they have done. You recognize the sexual aspect. You know what, if I go and take this picture apart, this horrifies people when I say it. It’s like, if you look at their legs, it’s like, yeah, they have good legs. Now, nobody wants to say that, and it’s like, “Oh.” That’s our first response. But if I have POCD, I see that, “Oh my god, what’s wrong with me?” It’s an acceptance that we can see something and recognize a piece of it.  I think the most difficult POCD is the people who “I don’t want to be attracted to a 15-year-old.” I can say, if I show you this picture and tell you they’re 18, oh, that’s okay. If I show you the same picture and tell you they’re 15, no, that’s okay. It’s like somehow magically, I find that the picture, the attractive is the picture is right or wrong if I tell you the age, which of course makes no sense. The picture is attractive or not independent of that. It’s accepting, yes, I might find a whole lot of things. Again, what we think makes us accept or not do we act on it.  <!-- /wp:paragraph --> <!-- wp:paragraph --> Kimberley: It’s interesting because as you know, we just got a new puppy. It’s taking over all of the Quinlan family and our lives. I had a moment where our puppy loves his belly to be scratched and right there is his genitals. I can see the projection of my mind of like, “What if you just touched that? Or what if you pulled that back?” The imagery, I could see myself doing it. Thankfully I have all these skills where I’m able to go, “Oh, there’s a thought.” I did feel that hot, sticky anxiety flow going through. <!-- /wp:paragraph --> <!-- wp:paragraph --> Jon: If you don’t change diapers regularly, I’m sorry, it’s a weird experience and I don’t care who you are, you’re going to think about that. If you’re changing a little person and there you are, you’re pumping their genitals because you got to clean it up and wipe it, you know what you’re doing and the healthy thing is like, “Okay, weird thoughts. This is normal.” If I have OCD, it’s like, “Why would I even think that?” Well, it’s normal. <!-- /wp:paragraph --> <!-- wp:paragraph --> Kimberley: It’s funny because I was noticing myself going through some of these imaginal scripting steps myself. Instead of going, “No, no, no, no, no, you wouldn’t, you wouldn’t, you couldn’t. That’s terrible.” It was like, “All right.” This is the last question I want because you’ve given some great examples. As I was having this thought, I noticed the choice—I used the word “choice” on purpose—to get really edgy with it and try not to have it. My body language is all tight and I was gritting my teeth, or I was like, “Kimberley, just let it flow. Let the thoughts come.” As you’re doing this with your patients, is there any piece of you where you are bringing their attention to whether their shoulders are all tight and their jaw is all tight and their hands are all tight, or does that not matter? <!-- /wp:paragraph --> <!-- wp:paragraph --> Jon: Nothing not matters, maybe, but that’s not always true. I thought you’d enjoy that. I think it depends on how much that’s part of their conscious fear response. I mean, I think if they’re doing their dog and it’s like, “Oh my God, am I excited by this,” the answer I would be working on is, “I’m not really sure. Maybe I am in some deep way. I’m not going to play with the genitals now and that’s the best I get to know.” <!-- /wp:paragraph --> <!-- wp:paragraph --> Kimberley: Yeah. Agreed. I love this. Thank you. Again, I want you to say, where are the resources that people can go to get your concrete workbooks and your worksheets? <!-- /wp:paragraph --> <!-- wp:paragraph --> Jon: I love how you make me have so many more books and worksheets. All the paperwork that appears in my book appears for free for anybody on the site FreedomFromOCD.com. In the Kindle and audio version, they couldn’t have those, so I was obsessed to have the Kindle version so I made that available. My book has most of my repertoire except about 20 minutes. Those are the main places. I hate to do this, but most of the time, when it comes to OCD books, I will say to people, there are a bunch of books that I would recommend, I think, that are roughly equal. But I think the one that most agrees with me happens to be mine, so I mention a few of the other good books. There is only one other book seriously that I tell people to get because I think it’s different, and that is your book, which is amazing because generally, I hate books that label themselves “self-compassion” because it’s just a version of be nice to yourself in a lot of words. I feel your book gives these not easy-to-do steps that make it work. Although as I said to you last time, it is just you used too many exclamation points. <!-- /wp:paragraph --> <!-- wp:paragraph --> Kimberley: I will forever decline your opinion on my exclamation points and my emojis. If you ever text with me, you’ll know that I over emoji and I over exclamation points. <!-- /wp:paragraph --> <!-- wp:paragraph --> Jon: I’m okay with that in text.  <!-- /wp:paragraph --> <!-- wp:paragraph --> Kimberley: Thank you for that wonderful compliment. I do agree, yes, I have been blamed for the exclamation mark issue before, but I stand up and I stand with it. <!-- /wp:paragraph --> <!-- wp:paragraph --> Jon: I like to warn people because I want them to know, oh no, don’t worry. This isn’t as you would put it all flowers and unicorns. It’s a great book with too many exclamation points. <!-- /wp:paragraph --> <!-- wp:paragraph --> Kimberley: No, it’s funny because my mom helped me edit it while I was in a 14-day quarantine in a Sydney hotel for COVID. She would go through and she would add exclamation marks. She was adding e emojis and hearts and smiley faces and I was like, “Oh, we are going crazy here.” <!-- /wp:paragraph --> <!-- wp:paragraph --> Jon: Now I know where you got it from. <!-- /wp:paragraph --> <!-- wp:paragraph --> Kimberley: We’re all love. Thank you for that. It’s a very huge compliment. Thank you so much for being here and talking about this. Again, I love having you on talking just a little deeper into the topic and a bit more abstract, which I think is helpful too. Is there anything else you want to conclude on here? <!-- /wp:paragraph --> <!-- wp:paragraph --> Jon: I would love to have some really cool, all-summarizing conclusion. The truth is, I can just talk endlessly. I’m just going to thank you for having me on and I am always willing to come talk with you. <!-- /wp:paragraph --> <!-- wp:paragraph --> Kimberley: I would say, the point that I love that you made today, which I will add for you, is the word AND. The word AND is so important in this conversation. <!-- /wp:paragraph --> <!-- wp:paragraph --> Jon: That’s a great summary because I think so many of our ideas, it’s not like they’re new, they get refined with time. In a way, something we’ve been saying all along and suddenly there’s this very slightly different way of saying it, but it summarizes it in a way that makes it more understandable, and AND I think does that for a lot of understanding mindfulness and acceptance. <!-- /wp:paragraph --> <!-- wp:paragraph --> Kimberley: Yeah. Thank you so much.Jon: You take care. <!-- /wp:paragraph -->

Today we are talking all about ERP Scripting with Shala Nicely. Welcome back, everybody. We are on Week 2 of the Imaginals and Script Series. This week, we have the amazing Shala Nicely on the show. She’s been on before. She’s one of my closest friends and I’m so honored to have her on.  For those of you who are listening to this and haven’t listened to any of the previous episodes, I do encourage you to go back to last week’s episode because that is where we introduce the incredible Krista Reed and she talks about how to use scripts and imaginals. I give a more detailed intro to what we’re here talking about if this is new for you. This will be a little bit of a steep learning curve if you’re new to exposure and response prevention. Let me just quickly explain. I myself, I’m an ERP-trained therapist, I am an OCD Specialist, and a part of the treatment of OCD and OCD-related disorders involve exposing yourself to your fear and then practicing response prevention, which is reducing any of the safety behaviors or compulsions you do in effort to reduce or remove whatever discomfort or uncertainty that you feel. Now, often when we go to expose ourselves to certain things, we can’t because they’re not something we can face on a daily basis or they’re often very creative things in our mind. This is where imaginals and scripts can come in and can be incredibly helpful.  If you want a more detailed understanding of the steps that we take regarding ERP, you can go to CBTSchool.com, which is where we have all our online courses. There is a course called ERP School that will really do a lot of the back work in you really understanding today’s session. You don’t have to have taken the course to get the benefits of today’s session because a lot of you I know already have had ERP or are in ERP as we speak, or your clinicians learning about ERP and I love that you’re here. Honestly, it brings me so much joy. But that is there for you if you’re completely lost on what’s going on today, and that will help fill you in on the gold standard treatment for OCD and the evidence-based treatment for OCD and OCD-related disorders.  That being said, let’s get on with the good stuff. We have the amazing Shala Nicely. I am so honored again to have you on. You are going to love how applicable and useful her skills and tools are. Let’s just get straight over to Shala.  Kimberley: Welcome, Shala. I am so happy to have you back. I know we have a pretty direct agenda today to talk about imaginals versus scripting in your way in which you do it. I’d love to hear a little bit about, first, do you call it imaginals or do you call it scripting? Can you give me an example or a definition of what you consider them to be? SHALA’S STORY OF ERP SCRIPTING  Shala: Sure. Well, thank you very much for having me on. Love to be here as always. I’ll go back to how I learned about exposure when I first became a therapist. I learned about exposure being two different things. It was either in vivo exposure, so in life. Meaning, you go out and do the thing that your OCD is afraid of that you want to do, or it was imaginals where you imagine doing the thing that you want to do that your OCD is afraid to do. Research shows us that the in vivo is more effective, but sometimes imaginals is necessary because you can’t go do the thing for whatever reason. But I don’t think about it like that anymore. That’s how I learned it, but it’s not how I practice it.  To help describe what I do, I’ll take you back to when I had untreated OCD or when I was just learning how to do ERP for myself because I think that would help it make sense what I do. When I was doing ERP, I would obviously go out and do all the things that I wanted to do and my OCD didn’t want me to do. What I found was that I could do those things, but my OCD was still in my head, getting me to have a conversation about what we were doing in my mind. I might go pick up a discarded Coke can on the side of the road because it’s “contaminated,” and I would then go either put it in the trash, which would be another exposure because that would be not recycling. There are layers of exposures here. But my OCD could be in my head going, “Well, I don’t think that one is contaminated. It doesn’t look all that contaminated because it’s pretty clean and this looks like a clean area so I’m sure it’s not contaminated. What do you think, Shala?”  “Oh, I agree with you.” “Well, we threw it away, but I bet you, these people, they’re going to get wherever we threw it. They’re actually going to sort it out and it’s going to get recycled anyway.” There was this carnival in my head of information about what was going on.  I determined what I was doing because I was doing the exposure, but I wasn’t really getting all that much better. I was getting somewhat better but not all that much better. What I realized I was doing is that I’m having these conversations in my head, which are compulsive. In my recovery journey, what I was doing was I was going to a lot of trainings, I was reading a ton of books, and I talk about this in Is Fred in the Refrigerator?, my memoir, because this was a pretty pivotal moment for me when I read Dr. Jonathan Grayson’s book, Freedom from Obsessive Compulsive Disorder. I know you’re having him on this series as well. I read his book and he talks so much in there about writing scripts to deal with the OCD—writing scripts about what might happen, the worst-case scenario, living with uncertainty, and all that kind of stuff. That really resonated with me and I thought, “Aha, this is what I need to be doing. I need to be doing ERP scripting instead of having that conversation in my head with the OCD. Because when I’m doing exposure and I’m having a conversation with OCD in my head, I’m doing exposure and partial response prevention. I am preventing the physical response, but I’m not at all preventing the mental response, and this was slowing down my recovery.” The way I like to think of imaginals—you think about imagine like imagination—is that the way I do imaginal exposures, which I just call ERP scripting, is that I’m dealing with OCD’s imagination. People with OCD are exceptionally creative. If you’re listening to this and you think, “Well, not me,” for proof, all you have to do is look at what your OCD comes up with and look how creative it is. You guys share the same brain, therefore, you are creative too. All that creativity. When you have untreated OCD, it goes into coming up with these monstrous scenarios of how you’re harming others or harming yourself. You’re not ever going to be able to handle this anxiety or uncertainty or icky feeling or whatever, and it builds these scary stories that get us stuck.  WHAT IS ERP SCRIPTING?  What I’m trying to do with imaginal exposure or scripting is I’m trying to deal with OCD’s imagination because in the example I gave, I was picking up the Coke can and my OCD was using its imagination to try to reassure me all the ways this Coke can was going to be okay or all the ways this Coke can was going to eventually get recycled. I needed to deal with that. Really, the way I do ERP Scripting for myself and for my clients is I’m helping people deal with OCD’s imagination in a non-compulsive way. For me, it is not a choice of in vivo or imaginal; it is in vivo with imaginal, almost always, because most people that I see anyway are doing what I did. They are doing physical compulsions or avoidance and they’re up in their head having a conversation with their OCD about it. I’m almost always doing in vivo and imaginals together because I’m having people approach the thing that they want to do that OCD doesn’t want them to do, and I’m having them do scripts. The Coke can may or may not be contaminated. The fact that it’s sitting here and it looks pretty clean may or may not mean that it’s got invisible germs on it. I don’t know. The Coke can may or may not get recycled, it may or may not end up in recycling, but somehow contaminate the whole recycling thing that has to throw all that other recycling away because it touched it. I’m trying to use my imagination to make it even worse for the OCD so that we’re really facing these fears.  That’s how I conceptualize imaginal exposure. It’s not an AND/OR it’s an AND for me. Some people don’t need it and if they don’t need it, fine. But I find it’s very helpful to make sure that people are doing full response prevention in that they’re permitting both the physical and the mental compulsive response. DOES EVERYONE NEED ERP SCRIPTING?  Kimberley: Does everyone need ERP scripting? When you say some people don’t need it, what would the presentation of those people be? Shala: That for whatever reason, they are good at not having the conversation with OCD in their heads. This is the minority of people anyway that I work with. Most people are pretty good at having compulsive conversations with OCD because the longer you have untreated OCD, the more you end up taking your physical compulsions and pulling them inward and making the mental compulsion so that you can survive. If you can’t really do all that physical checking at your office because people are going to see you, you do mental checking. That’s certainly what I did. People become good at doing this stuff in their head and it becomes second nature. It can be going on. I talk about this a lot in Fred, I could do compulsions while I was doing anything else because I could do them in my head. Most people are doing that and most people have been doing that for long enough by the time they see somebody like me that if I just say, “Well, stop doing that,” I mean I’m never going to see them again. They’re not going to come back because they can’t stop doing that. That’s the whole reason they called me.  I’m giving them something else to do instead. It’s a competing response to the mental compulsions because they don’t know how to stop that. They’re not aware of what they’re doing, they don’t know how to stop the process, so I’m giving them something to do instead of that until they build the mental muscles to be able to recognize OCD trying to get them to have a conversation and just not answer that question in their head. But it takes a long time to develop that skill. It took me a long time anyway.  Some people, for whatever reason though, are good at that. If they don’t need to do the scripting, great. I think that’s wonderful. They don’t have to do it. The strongest response you can ever have to OCD is to ignore it completely, both physically and mentally. If you can truly ignore it in your head, you don’t even need to do the scripting. It’s a stronger response to just do what you want to do that upsets OCD and just go on with your day. HOW TO DO ERP SCRIPTING?  Kimberley: Amazing. So How do you do ERP Scripting? If you’re not one of those people and OCD loves to come up with creative ideas of all the things, what would be your approach? You talked about imaginals versus scripting. Can you play out and show us how you do it? Shala: I mean, I guess imaginals in the traditional way that it is defined versus scripting. The way I would do it is we would design the client and I would design whatever their first exposure is going to be. Let’s say that it would be touching doorknobs. They’re going to be in their location and I’m going to be in my location. They’re going to be wherever we’ve decided they’re going to touch the doorknobs. Maybe it’s to the outside of their house, for instance. I’m there on video with them and we have them touch the doorknob.  And then I asked them, “Well, what is OCD saying about that?”  “Well, OCD says that I need to go wash my hands.”  I will say, “Well, are you going to go do that?”  “No.”  I’m like, “Well, let’s tell OCD that.”  “Okay, OCD, I’m not going to wash my hands.”  “Now what’s OCD saying?”  “Well, OCD is saying that I’m contaminated.”  “Well, let’s say I may or may not be contaminated.”  So far, we’ve got, “I’m not washing my hands and I may or may not be contaminated.” Okay, now I’ll ask them their anxiety level. When they say, “Gosh, I’m at a four,” I’ll say, “Is that good?” They’ll often say, “No, I wish it were zero.” I’ll be like, “I’m sorry, what? What did you say? You want your anxiety to be zero? I must have misheard that. Is four good?” Finally, they understand, “Oh, well, four is not good because we could be higher.”  “What would be better than four?”  “Anything above a four.”  I’m working with them on that. We might start to throw some things in the script. I want to be anxious because this is how I beat my OCD, so bring it on.  I’ll ask again, “What’s your OCD saying?”  “Well, it’s saying that I’m going to get some terrible disease.”  “Well, you may not get a terrible disease.” I’m questioning back and forth the client as we’re working on this, until we’ve got enough of a dialogue about what’s going on in their head that we can then create a script. A script might look something like, “Well, I may or may not be contaminated. I may or may not get a dread disease, but I’m not washing my hands and I’m going to do this because I want my life back. It makes me anxious and I may or may not get a dread disease.” And then we’ll focus in on what’s bothering OCD most. Maybe it’s, at the beginning, the dread disease. “Well, I may or may not get a drug disease. I may or may not get a dread disease. I may or may not get a dread disease. I may or may not get a dread disease.” We might sing it, we say it over and over and over and over and over again, and look for what the reaction from the OCD is. If the OCD is still upset, then we still go after that. If it starts moving, “Well, what’s OCD saying now?” “Well, OCD is saying now that if I get a dread disease, then I won’t be able to do this thing that I have coming up that I really want to do.” “Well, okay, I may or may not get a dread disease and I may or may not miss this important event as a result.” We add that in.  We do that and do that and do that and do that for whatever the period is that we’ve decided is going to be our exposure period. And then we stop and then we talk about it. What did we learn? What was that like and what did you learn? Really focusing on how we did more than we thought we could do. We withstood more anxiety than we thought we could withstand. What did we learn about what the OCD is doing? I’m not so concerned about what the anxiety is doing. I mean, I want it to go up. That’s my concern. I’m not all that concerned about whether it comes down or not. I do want it to go up. We talk about what we learned about the anxiety that gosh, you can push it up enough and you can handle a lot more than you thought you did. That would be our exposure.  And then we would plan homework and then they would do that daily, hopefully. I have forms on my website that people can then send me their daily experience doing these exposures and I send them feedback on it, and that’s what we’re working on. We’re working on doing the thing that OCD doesn’t want you to do that you want to do, and then working on getting better and better at addressing all of the mental gymnastics in your head.  Now, if somebody touches the doorknob and they’re like, “Okay, I can do this,” and then their anxiety comes up and comes back down and they can do it without saying anything, great, go touch doorknobs. You don’t need to do scripting. Often, I don’t know if somebody needs to do that until we start working on it. If they don’t need to do the scripting, great. We don’t do the scripting. Makes things easier. But often people do need to. That’s generally how I do it. Obviously, lots of variations on that based on what the client is experiencing.  Kimberley: This is all thing, you’re not writing it down. Again, when you go back to our original training, for me, it was a worksheet and you print it out, you’d fill out the prompts. Are you doing any of this written or is this a counter to the mental compulsions in your head? Shala: None of this is written. The only time I would write it out is after that first session. When you’re really anxious, your prefrontal cortex isn’t working all that well, so you may have trouble remembering what we did, remembering the specific things that we said, or pulling it up for yourself. When you’re doing your exposure, you’re so anxious. I might type out some of what we said, the main things, send it to the clients, and have that. But really to me, scripting is an interactive exercise and I want my clients to be listening to what the OCD is saying for the sole purpose of knowing what we’re going to say. Because when we start doing exposure, what we’re often trying to do is keep pace with the OCD because it’s got a little imagination engine running and it’s going to go crazy with all the things that it’s going to come up with. We’re trying to stay on that level and make sure we’re meeting all its imagination with our own imagination. As we get better and better at this, then I’m teaching people how to one-up the OCD and how to get better than the OCD as it goes along. But it’s a dynamic process. I don’t have people read scripts because the script that we wrote was for what was going on whenever we wrote the script. Different things might be going on this time. What we’re trying to do is listen to the OCD in a different way. I don’t want people listening to it in a compulsive way. I want people listening to it in a, “I’ve got to understand my foe here and what my foe is upset about so I can use it against it.” That’s what we’re doing. There might be key things, little pieces we write down, but I’m not having people write and read it over and over. Now, there’s nothing wrong with that. It’s just not what I do. Everybody has a different way to approach this. This is just my way.  Kimberley: Right. I was thinking as you were talking, in ERP School, I talk about the game of one-up and I actually do that game with clients before I do any scripting or imaginals or exposures too. They tell me what their fear is, I try and make it worse. And then I ask them to make it even worse, then I make it even worse, because I’m trying to model to them like, we’re going here. We’re going to go all the way and even beyond. If we can get ahead of OCD and get even more creative, that’s better.  Let’s play it back and forward. You talked about touching a doorknob and all of the catastrophic things that can happen there. What about if someone were to say their thoughts are about harming somebody and they have this feeling of like, I’ve been trained, society has trained me not to have thoughts about harming people or sexual thoughts and so forth? There’s this societal OCD stigmatizing like we don’t think those things. We should be practicing not thinking those things. What would you give as advice to somebody in that situation?  Shala: I would talk a lot about the science about our thoughts, that the more that you try to push a thought away, the more it’s going to be there. Because every time you push a thought away, your brain puts a post-it note on it that says, “Ooh, she pushed this thought away. This must be dangerous. Therefore, I need to bring it up again to make sure we solve it.” Because humans’ competitive advantage—we don’t have fur, we don’t have fangs, we don’t have claws, we don’t run very fast—our competitive advantage is problem-solving. The way we stay alive is for cave people looking out onto savannah and we can see that there are berries here, there, and yawn. But that one berry patch over there, gosh, you saw something waving in the grass by it and you’re like, “I’m going to notice that and I’m going to remember that because that was different, but I also don’t want to go over there.” Your brain is going to remember that like, “Hmm, there was something about that berry patch over there. Grass waving could be a tiger. We need to remember that. Remember that thing, we’re not going to go over there.” We’re interacting with thoughts in that way because that’s what kept us alive.  When we get an intrusive thought nowadays and we go, “Ooh, that was a bad thought. I don’t know. I should stay away from that,” our brain is like, “Oh, post a note on that one. That one is like the scary tiger thought. We’re going to bring that up again just to make sure.” Every time we try to push a thought away, we’re going to make it come back. We talk a lot about that. We talk a lot about society’s norms are whatever they are, but a lot of society’s norms are great in principle, not that awesome in practice. We don’t have any control over what we think about. The TV is filled with sex and gore, and violence. Of course, you’re thinking those things. You can’t get away from those images. I think society has very paradoxically conflicting rules about this stuff. Don’t think about it but also watch our TV show about it.  I would talk about that to try to help people recognize that these standards and rules that we put on ourselves as humans are often unrealistic and shame-inducing and to help people recognize that everybody has these thoughts. We have 40, 60, 80,000 thoughts a day. I got that number at some conference somewhere years ago. We don’t have control over those. I would really help them understand the process of what’s going on in their brain to destigmatize it by helping them understand really thoughts are chemical, neuronal, whatever impulses in our brain. We don’t have a lot of control over that and we need to deal with them in a way that our brain understands and recognizes. We need to have those thoughts be present and have a different reaction to those thoughts so your brain eventually takes the post-it note off of them and just lets them cycle through like all the other thoughts because it recognizes it’s not dangerous.  HOW FAR CAN YOU GO IN ER SCRIPTING?  Kimberley: Right. I agree. But how far can you go in ERP Scripting? Let’s push a little harder then. This just happened recently actually. I was doing a session with a client and he was having some sexual pedophilia OCD obsessions playing up, “I’ll do this to this person,” as you were doing like I may or may not statements and so forth. And then we played with the idea of doing one up. I actually went to use some very graphic words and his face dropped. It wasn’t a drop of shock in terms of like, “Oh my gosh, Kimberley used that naughty word.” It was more of like, “Oh, you are in my brain, you know what I’m thinking.” And then I had to slow down and ask him, “Are there any thoughts you actually aren’t admitting to having?” Because I could see he was going at 80% of where OCD took him, but he was really holding back with the really graphic, very sexual words—words that societally we may actually encourage our children and our men and women not to say. Do you encourage them to be using the graphic language that their OCD is coming up with? Shala: Absolutely. I’m personally a big swearer.  That’s another thing I talk about in-- Kimberley: Potty mouth. Shala: I’ll ask clients, “What’s your favorite swear word? Let’s throw swear words in here.” I want to use the language that their OCD is using. If I can tell that’s the language their OCD is using, well, let’s use that language. Let’s not be afraid of it.  The other thing I do before I start ERP with anyone is I go through what I consider the three risks of ERP so they understand that what happens during our experience together is normal. I explain that it’s likely we’re going to make their anxiety worse in the weeks following exposure because we’re taking away the compulsions bit by bit, and the compulsions are artificially holding back the anxiety. I explained that their OCD is not going to roll over because they’re doing ERP therapy now. Nobody’s OCD is going to go, “Oh gosh, Shala is in ERP. I think I’ll just leave her alone now.” No, the OCD is going to ratchet it up. You’re not doing what you’re supposed to do, you’re not doing your compulsions, so let’s make things scarier. Let’s make things more compelling. Let me be louder. Your OCD can get quite a bit worse once you start doing ERP because it’s trying to get you back in line. When somebody is in an exposure session and their OCD is actually going places, they never even expected them to go, and I’ll say that’s what we’re talking about, “That’s just the OCD getting worse, that’s what we wanted. This is what we knew was going to happen.” We’re going to use that against the OCD to help normalize it. Then I also explain to people that people with OCD don’t like negative emotions more than your average bear, and we tend to press all the negative emotions down under the anxiety. When you start letting the anxiety out and not doing compulsions, then you can also get a lot more emotions than you’re used to experiencing so that people recognize if they cry during the exposures, if it’s a lot scarier than they thought, if they have regret or guilt or other feelings, that’s just a normal part of it. I explain all that. When things inevitably go places where the client isn’t anticipating they’re going to go like in a first exposure, then they feel this is just part of the process. I think it makes it so that it’s easier to go those graphic places because you’re like, “Yeah, we expected OCD to go the graphic place because it’s mad at you.” Kimberley: It normalizes it, doesn’t it?  Shala: Yeah. Then we go to the graphic place too. I tell clients that specifically because this is a game and I really want them to understand this is what your opponent is likely to do so that they feel empowered so we can go there too and trying some to take the shame out of it. When you said the graphic word and your client had a look on their face and it was because how did you even know that was in my head, because you were validating that it’s okay to have this thought because you knew it was going to be there. I think that’s a really important part of exposure too. HOW LONG DO YOU USE ERP SCRIPTING FOR?  Kimberley: So, how long do you do ERP Scripting for? Let’s say they’re doing this in your session or they’re at home doing their assigned homework. Let’s say they do it for a certain amount of time and then they have to get back to work or they’re going to do something. But those voices, the OCD comes back with a vengeance. What would you have them do after that period of time? Would they continue with this action or is there a transition action or activity you would have them do? Shala: That’s a great question. It depends a lot on really the stage of therapy that somebody is in and what is available to them based on what they’re going to be doing. Oftentimes, what I will ask people to do is to try to do the exposure for long enough that you’ve done enough response prevention that you can then leave the exposure environment and not be up in your head compulsively ruminating. Because if you were doing exposure for 20 minutes, you’ve done a great job, but then you leave that exposure and you are at a high enough anxiety level where it feels compelling. Now you have to fix the problem in your head even though you just did this great exposure. Then we’re just going to undo the work you just did. I try to help people plan as much as they can to not get themselves in a situation where they’re going to end up compulsively ruminating or doing other compulsions after they finish. But obviously, we can’t be perfect. Life happens.  I think some of the ways you can deal with that, if you know it’s going to happen, sometimes they’ll ask people to make recordings on their phone and they just put in their earpieces or their earbuds or whatever and they can just listen to a script while they’re doing whatever they’re doing. Nobody has to know what they’re doing because so many people walk around with EarPods in their ears all the time anyway. That’s one way to deal with it.  Another way to deal with it is to try to do the murmuring out in your head as best as you can. That’s really hard because they’re likely to just get mixed up with compulsive thoughts. You can try to focus your attention as much as you possibly can on what you’re doing. That’s going to be the strongest response. It’s hard for people though when they get started to do that. But if you can do that, I think that’s fine, and I think just being compassionate with yourself. “Okay, so I am now sitting here doing some rituals in my head. I’m doing the best I can.” If you’re not in a situation where you can fully implement response prevention in your head because you’re in a meeting and you got to do other stuff and you’ve got this compulsive stuff running in the background, just do the best you can. And then when you’re at a place where you can do some scripting, some more exposure to get yourself back on top of the OCD, then do that. But be really compassionate.  I try to stress this to all my clients. We are not trying to do ERP perfectly because if you try to do it perfectly, you’re doing ERP in an OCD way, which isn’t going to work. Just be kind to yourself and recognize this is hard and nobody is going to do it perfectly. If you end up in a situation where you end up doing some compulsions afterwards, well, that’s good information for us. We’ll try to do it differently or better next time, but don’t beat yourself up.   Kimberley: It’s funny you brought that up because I was just about to ask you that question. Often clients will do their scripting or their imaginal and then they have an obsession, “What if I keep doing compulsions and it’s not good to do compulsions?” Would you do scripting for that? Shala: Oh yeah. I may or may not do more compulsions than I used to be doing. I may or may not get really worse doing this. I may or may not have double the OCD that I had when I started seeing trauma. This may or may not become so bad that they have to create a hospital just to help me all by myself. We try to just create stuff to deal with that. But also, I’m injecting one up in the OCD, I’m injecting some humor, how outlandish can we make these things? I try to have “fun” with it. Now I say “fun” in quotes because I know it’s not necessarily fun when you’re trying to do this, but we’re trying to make this content that OCD is turning into a scary story. We’re trying to make it into a weapon to use against the OCD and to make this into a game as much as we can. Kimberley: I love it. I’m so grateful for you coming on. Is there anything that you want the listeners to know as a final piece for this work that you’re doing? Shala: Sure. I think that there are so many different ways to do exposure therapy. This is the way that I do it. It’s not the only way, it’s not necessarily the right way; it’s just the way I do it and it’s changed over the years. If we were to record this podcast in five years or 10 years, I probably will be doing something slightly different. If your therapist is doing something differently or you’re doing something differently, it’s totally fine. I think that finding ERP in a way that works for you, like finding how it works for you and what works best for you is the most important thing. It’s not going to be the same for everybody. Everybody has a slightly different approach and that’s okay.  One thing that people with OCD can get stuck on, and I know this because I have OCD too, is we can be black and white and say there’s one right way. Well, she does it this way and he does it that way and this is wrong and this is right. No, if you’re doing ERP, there are all sorts of ways to do it, so don’t let your OCD get into the, “Well, I don’t think you’re doing this right because you’re not doing this, that, or the other.” Just work with your therapist to find out what works best for you. If what I’ve described works well for you, great. And if it doesn’t, you don’t have to do it. These are just ideas. Being really kind and being really open to figuring out what works best for you and being very kind to yourself I think is most important. Kimberley: Amazing. Tell us where people can get more information about you. Tell us about your book. I know you’ve been on the podcast before, but tell us where they can get hold of you. Shala: Sure. They can get a hold of me on my website, ShalaNicely.com. I have a newsletter I send out once a month that they can sign up for called Shoulders Back! Tips & Resources for Taming OCD. In it, I feature blogs that I write or podcast episodes, other things that I’m doing. It’s all free where I’m talking about tips and resources for taming OCD. I have two books: Everyday Mindfulness for OCD that I co-wrote with Jon Hershfield and Is Fred in the Refrigerator? Taming OCD and Reclaiming My Life, which is my memoir. It is written somewhat like a suspense novel because as all of you know who have OCD, living with untreated OCD is a bit like living in a suspense novel. My OCD is actually a character in the book. It is the villain, so to speak. The whole book is about me trying to understand exactly what is this villain I’m working against. Then once I figure out what it is, well, how am I going to beat it? And then how am I going to live with it long term? Because it’s not like you’re going to kill the villain in this book. The OCD is going to be there. How do I learn to live in a world of uncertainty and be happy anyway, which is something that I stole from Jon Grayson years ago. I stole a lot from him. That’s what the book is about. Kimberley: It’s a beautiful book and it’s so inspiring. It’s a handbook as much as it is a memoir, so I’m so grateful that you wrote it. It’s such a great resource for people with OCD and for family members I think who don’t really get what it’s like to be in the head of someone with OCD. A lot of my client’s family members said how it was actually the first time it clicked for them of like, “Oh, I get it now. That’s what they’re going through.” I just wanted to share that. Thank you so much for being on the show. I’m so grateful to have you on again. Shala: Thank you so much for having me. It was fun.

Welcome back, everybody. Thank you for joining me again this week. I’m actually really excited to dive into another topic that I really felt was important that we address. For those of you who are new, this actually might be a very steep learning curve because we are specifically talking about a treatment skill or a tool that we commonly use in CBT (Cognitive Behavioral Therapy) and even more specifically, Exposure and Response Prevention. And that is the use of imaginals or what we otherwise call scripts. Some people also use flooding.  We are going to talk about this because there are a couple of reasons. Number one, for those of you who don’t know, I have an online course called ERP School. In ERP School, it’s for people with OCD, and we talk about how to really get an ERP plan for yourself. It’s not therapy; it’s a course that I created for those who don’t have access to therapy or are not yet ready to dive into therapy, where they can really learn how to understand the cycle of OCD, how to get themselves out of it, and gives you a bunch of skills that you can go and try. Very commonly, we have questions about how to use imaginals and scripts, when to use them, how often to use them, when to stop using them, when they become compulsive and so forth.  In addition to that, as many of you may not know, I have nine highly skilled licensed therapists who work for me in the state of California and Arizona, where we treat face-to-face clients. We’re actually in Los Angeles. We treat patients with anxiety disorders. I also notice that during my supervision when I’m with my staff, they have questions about how to use imaginals and scripts with the specific clients. Instead of just teaching them and teaching my students, I thought this was another wonderful opportunity to help teach you as well how to use imaginals and why some people misuse imaginals or how they misuse it. I think even in the OCD community, there has been a little bit of a bad rap on using scripts and imaginals, and I have found using scripts and imaginals to be one of the most helpful tools for clients and give them really great success with their anxiety and uncertainty and their intrusive thoughts.  Here we are today, it is again a start of another very short series. This is just a three-week series, talking about different ways we can approach imaginals and scripts and how you can use it to help manage your intrusive thoughts, and how you can use it to reduce your compulsions.  It is going to be three weeks, as I said. Today, we are starting off with the amazing Krista Reed. She’s been on the show before and she was actually the one who inspired this after we did the last episode together. She said, “I would love to talk more about imaginals and scripts.” I was like, “Actually, I would too, and I actually would love to get some different perspectives.” Today, we’re talking with Krista Reed. Next week, we have the amazing Shala Nicely. You guys already know about Shala Nicely. I’m so happy to have her very individual approach, which I use all the time as well. And then finally, we have Dr. Jon Grayson coming in, talking about acceptance with imaginals and scripts. He does a lot of work with imaginals and scripts using acceptance, and I wanted to make sure we rounded it out with his perspective.  One thing I want you to think about as we move into this series or three-part episode of the podcast is these are approaches that you should try and experiment with and take what you need. I have found that some scripts work really well with some clients and others don’t work so well with other clients. I have found that some scripts do really well with one specific obsession, and that doesn’t do a lot of impact on another obsession that they may have. I want you just to be curious and open and be ready to learn and take what works for you because I think all of these approaches are incredibly powerful.  Again, in ERP School, we have specific training on how to do three different types of scripts. One is an uncertainty script, one is a worst-case scenario script, and the last is an acceptance script. If you’re really wanting to learn a very structured way of doing these, head on over to CBTSchool.com and you can sign up for ERP School there. But I hope this gets you familiar with it and helps really answer any questions that you may have.  Alright, let’s get over to the show. Here is Krista Reed. Kimberley: Welcome back, Krista Reed. I am so happy to have you back on the show. Krista: Thank you. I am elated to be able to chat with you again. This is going to be great. Kimberley: Yeah. The cool thing is you are the inspiration for this series. Krista: Which is so flattering. Thank you.  IMAGINAL OR SCRIPT? Kimberley: After our last episode, Krista and I were having a whole conversation and you were saying how much you love this topic. I was like, “Light bulb, this is what we need to do,” because I think the beautiful piece of this is there are different ways in which you can do imaginals, and I wanted to have some people come on and just share how they’re doing it. You can compare and contrast and see what works for you. That being said, number one, do you call it an imaginal, do you call it a script, do you think they’re the same thing, or do you consider them different? Krista: I do consider them differently because when I think about script, I mean, just the word script is it’s writing, it’s handwriting in my opinion. I mean, scripture is spoken. That’s something a little bit different, but scripting is writing. When I think of an imaginal, that is your imagination. I know that I already shared with you how much I love imaginals because in reality, humans communicate through stories. When we can, using our own imagination, create a story to combat something as challenging as OCD, what a powerful concept. That’s exactly why I just simply love imaginals. Kimberley: I can feel it and I do too. There’s such an important piece of ERP or OCD recovery or anxiety recovery where it fills in some gaps, right? Krista: Yes, because imaginals, the whole point, as we know, it’s to imagine the feared object or situation. It could evoke distress, anxiety, disgust. Yet, by us telling those stories, we’re poking the bear of OCD. We’re getting to some of that nitty gritty. Of course, as we know that, not every obsession we can have a real-life or an in vivo exposure. We just simply can’t because of the laws of science, or let’s be real, it might be illegal. But imaginals are also nice for some people that the real-life exposure maybe is too intense and they need a little bit of a warmup or a buy-in to be able to do the in vivo exposure. Imaginal, man, I freaking love them. They’re great.  Kimberley: They’re the bomb.  Krista: They really are.  HOW TO DO IMAGINALS FOR OCD Kimberley: You inspired this. You had said, “I love to walk your listeners through how to do them effectively. I think I remember you saying, but correct me if I’m wrong, that you had seen some people do them very incorrectly. That you were very passionate because of the fact that some people weren’t being trained well in this. Is that true or did I get that wrong? Krista: No, you absolutely got it right. Correct and incorrect, I think maybe that is opinion. I’ll say that in my way, I don’t do it that way. That’s a preference. But this is an inception. We’re not putting stories into our clients’ minds. The OCD is putting these stories into our clients’ minds. If you already have a written-out idea of a script, of like fill in the blanks, you are working on some kind of inception, in my opinion. You are saying that this is how your story is supposed to be. That’s so silly. I’m not going to tell you how your story is supposed to be. I don’t know how your imagination works. When we think of just imagination, there’s so many different levels of imagination.  Let’s say for instance, if I have somebody who comes into my office who is by trade a creative writer, that imaginal is probably going to be very descriptive, have a lot of heavy adjectives. Just the way it’s going to be put together is going to be probably like an art in itself because this is what that person does. If you have somebody who comes in and creativity is not something that is part of a personality trait, and then I have a written fill-in-the-blank thing for them, it’s not going to be authentic for their experience. They’re going to potentially want to do what I, the therapist, might want them to do. It’s not for me to decide how creative or how deep that person is to go. They need to recognize within themselves, is this the most challenging? Is this the best way that you could actually describe that situation? If that answer is yes, it’s my job as a therapist to just say okay. Kimberley: How would one know if it’s the most descriptive they could be? Is it by just listening to what OCD has to say and letting OCD write the story, but not in a compulsive way? Share with me your thoughts.  Krista: I think that that’s almost like a double-edged sword because that of itself can almost go meta. How do I know that my story is intense enough? Well, on the surface we can say, “Is it a hard thing to say.” They might say yes, and then we can work through. But if I’m really assessing like, “Is it hard enough, is it hard enough,” and almost begging for them to provide some type of self-reassurance, they might get stuck in that cycle of, is this good enough? Is this good enough? Can it be even more challenging?  Another thing I love about imaginals is the limit doesn’t exist, because the limit is just however far your imagination can take you. Let’s say that I have a session with a client today and they’re creating an imaginal. I’m just going to give a totally random obsession. Maybe their obsession is, “I am afraid that I’m going to murder my husband in his sleep,” harm OCD type stuff, pretty common stuff that we do with imaginals. They do the imaginal and they’re able in session to work through it. It sounds like it was good. In the session, what they provided was satisfactory to treatment. And then they come back and say, “I got bored with the story,” which a lot of people think that that’s a bad thing. That’s actually a good thing because that’s letting you know that you’re not in OCD’s control of that feared response and you’re actually doing the work. However, they might still have the obsession. I was like, “Okay, so you were able to work through this habituate or get bored of that. Now, let’s create another imaginal with this obsession.” Because it’s all imagination, the stories, you can create as many as you possibly can or as you possibly want to.  I’m actually going to give you a quote. He’s a current professor right now at Harvard. He is a professor of Cognitive and Educational Studies. If you look this guy up, his name is Dr. Howard Gardner—his work is brilliant. He has this fantastic quote that I think is just a bomb when it comes to imaginal stuff. His quote is: “Stories constitute the single most powerful weapon in a leader’s arsenal.” Think about that. What a powerful statement that is. Isn’t that just fantastic? Because we can hear that as the stories OCD tells us as being hard. Okay, cool story, bro, that is your weapon OCD, but guess what? I’m smarter than you and I brought a way bigger gun and this gun isn’t imaginal and I’m going to go ahead and one up you. If I come back that next week in my therapist’s office and I’m able to get bored with that, I can make a bigger gun. Kimberley: I love that. It’s true, isn’t it? I often will say, “That’s a good story. Let me show you what I’ve got.” It is so powerful. Oh my gosh. Let’s actually do it. Can you walk us through how you would do an imaginal? Krista: This is actually something that I created on my own taken from just multiple trainings and ERP learning about imaginals, because one of the things that I was realizing that a lot of clients were really struggling with is almost over-preparing just to do the imaginal. Sometimes they would write out the imaginal and then we would work through that. But what I was finding is sometimes clients were almost too fixated on words, reading it right, being perfect, that they were almost missing out on the fact that these are supposed to be movies in our mind. Kimberley: Yeah. They intellectualize it. Krista: Exactly. I created a super simple format. I mean, we really don’t have a lot of setup here. It’s basically along the lines of the Five Ws. What is your obsession and what is your compulsion? Who is going to be in your story? Who is involved? Where is your story taking place? When is your story taking place? And when is already one of those that’s already set because I tell people we can’t do anything in the past; the past has already existed. You really need to be as present as possible. But the thing is that you can also think. For instance, if my obsession is I’m going to murder my husband in his sleep tonight, part of that might be tonight, but part of that might also be, what is going to be my consequence? What is that bad thing that’s going to happen? Because maybe the bad thing isn’t necessarily right now. Maybe that bad thing is going to be I’m not going to have a relationship with my children and what if they have grandchildren? Or what if I’m going to go to hell? That might not necessarily exist in the here and now, but you’re able to incorporate that in the story. When is an interesting thing, but again, never in the past, needs to start in the present, and then move forward.  And then also, I ask how. How is where I want people to be as descriptive as possible. For instance, if I say, and this is going to sound gritty, you’re fearful that you’re going to murder your husband tonight. Be specific. How are you going to murder your husband? Because that’s one of the things that OCD might want us to do. Maybe it is just hard enough to say, “I’m going to murder my husband.” But again, we’re packing an arsenal here. Do you want to just say that? Because I can almost guarantee you OCD is already telling you multiple different ways that it might happen. Which one of those seems like it might be the hardest? Well, the hardest one for me is smothering my husband with a pillow. Okay, that’s going to be it. That’s literally my setup. That’s literally my setup, is I say that. Actually, I have one more thing that I have to include. I have all that as a setup and then I say, “Okay, at the very end, you are going to say this line, and it’s, ‘All of this happened because I did not do the compulsion.’” If I were going along with the story of I murdered my husband, I suffocated him with a pillow, and in my mind, the worst thing to happen is I don’t have a relationship with my kids and grandchildren, and the compulsion might be to pray—I’ll just throw that out—the last line might be, “And now, I don’t have a relationship with my children or grandchildren all because I decided to not pray when the thought of murdering my husband came up in my mind.” That is the entire setup.  And then I have my clients get their phones out and push record. They don’t have to do a video, just an audio is perfectly fine. I know some therapists that’ll do it just once, but I actually do it over and over again. Sometimes it could be a five-minute recording, it could be a 20-minute recording, it could be a 40-minute recording. The reason for that being is if we stop just after one, we might be creating accommodation for that client, because I want my clients to be in that experience. That first time they tell that story after that very brief setup, they’re still piecing together the story. Honestly, it’s really not until about the third or fourth time that they’ve repeated that exact same story that they’re really in it. I am just there and every time they finish—I’ll know they finish because they say, “And this happened all because da da da da da”—I say, “Okay, what’s your number?” That means what’s your SUDS? And they tell me they’re SUDS. I might make a little bit, very, very minimal recommendations. For instance, if they say, “I murdered my husband,” I say, “Okay, so this time I want you to tell me how you murdered your husband.” Again, they say the exact same story, closing their eyes all over again, this time adding in the little bit that I asked for. We do that over and over and over again until we reach 50% habituation. Then they stop recording. That is what they use throughout the week as their homework, and you can add it in so many different ways.  Again, keeping along with this obsession of “I’m afraid I’m going to kill my husband tonight,” I want you to listen to that with, as you probably have heard this as well, just one AirPod in, earbud, whatever, keep your other ear outside to the world. This is its way to talk back to OCD. Just something along the lines of that. I want you to the “while you’re getting ready for bed.” Because if the fear exists at night and your compulsions exist at night, I want you to listen to that story before you go to bed. It’s already on your mind. You’re already in it, you’re already poking the bear of OCD. It’s like, “Okay, OCD, you’re going to tell me I’m going to kill my husband tonight? Well, I’m going to hear a story about me killing my husband tonight.” Guess what? The bad thing’s going to happen over and over and over again.  It’s such a powerful, powerful, powerful thing. Because it’s recorded, you can literally listen to it in your car. You can listen to it on a plane. You can listen to it in a waiting room. I mean, there’s no limit.  Kimberley: It’s funny because, for those of you who are on social media, there was this really big trend not long ago where they’re like what they think I’m listening to versus what I’m actually listening to, and they have this audio of like, “And then she stabbed her with the knife.” It’s exactly that. Everyone thinks you’re just listening to Britney Spears, but you’re listening to your exposure and it’s so effective. It’s so, so effective. I love this. Okay, let’s do it again because I want this to be as powerful as possible. You did a harm exposure. In other episodes, we’ve done a relationship one, we’ve done a pedophile one. Let’s pick another one. Do you have any ideas?  Krista: What about scrupulosity? Kimberley: I was just going to say, what about scrupulosity? Krista: That one is such a common one for imaginals. We hear it very frequently, “I’m going to go to hell,” or even thinking about different other religions like, “Maybe I’m not going to be reincarnated into something that has meaning,” or “It’s going to be a bad thing. Maybe I’m insulting my ancestors,” or just whatever that might be. Let’s say the obsession is—I already mentioned praying—maybe if I don’t read the Bible correctly, I’m going to go to hell. I don’t know. Something along the lines of that. If that’s their obsession, chances are, there’s probably somebody that maybe they have a time where they’re reading the Bible or maybe that we have to add in an in vivo where they’re going to be reading or something like that. A setup could potentially be, what is your obsession? “I’m afraid that any time I read my Bible, I’m not reading it correctly and I’m going to go to hell.” What is your compulsion? “Well, my compulsion is I read it over and over and over again and I reassure myself that I understand it, I’m reading it correctly.” Who’s going to be in your story? This one you might hear just, “Oh, it’s just me.” Really, OCD doesn’t necessarily care too much if anybody else is in this story. Where are you? “I’m in my living room. It’s nighttime. That’s when I read my Bible.” When is this taking place? “Oh, we can do it tonight.” Let’s say it’s tonight.  Interestingly enough, when you have stuff that’s going to go to hell, that means, well, how are you getting to hell to begin with? Because that’s not just something that can happen. Sometimes in these imaginals, the person has to die in order to get there, or they have to create some type of fantastical way of them getting to hell.  I actually had a situation, this was several years ago, where the person was like, “Well, death doesn’t scare me, but going to hell scares me,” because, in some cultures and some religions, it’s believed that there are demons living amongst us and so forth. “It’s really scary to think about, what if a demon approaches me and takes me immediately to hell and I don’t get to say goodbye to my family, my family doesn’t know.” Just even like that thought. We were able to incorporate something very similar to that.  Just to make up an imaginal on the spot, it could be, I’m reading my Bible. I’m in my living room, I’m reading my Bible, and the thought pops up in my brain of, did you read that last verse correctly? I decide to just move on and not worry about reading my Bible correctly. Well then, all of a sudden, I get a knock at the door and there’s these strange men that I’ve never seen in my life, and they tell me that they’re all demons, and that because I didn’t review the Bible correctly, I’m going to go to hell. I would go on and on and probably describe a little bit more about my family not missing me, I don’t get to see my kids grow up, I don’t get to experience life, the travel, and the stuff that’s really important to me, incorporate some of those values. I don’t get to live my value-based life. And then at the very end, I was summoned and taken to hell by demons, all because I had the thought of reading my bible correctly and I decided not to.” Kimberley: I love it, and I love what I will point out. I think you use the same model as me. We use a lot of “I” statements like “I did this and I did that, and then this happened and then I died,” and so forth. The other thing that we do is always have it in present tense. Instead of going, “And then this happens, and then that happens,” you’re saying as if it’s happening. Krista: Yeah. Because you want it to feel real to the person. In all honesty, and I wonder what your experience has been, I find some of the most difficult people to do imaginals with our children. Even though you would think, “Oh, they’re so imaginative anyways,” one of the biggest things I really have to remind kids is, I want you to be literally imagining yourself in that moment. Again, I see this with kids more than adults, but I think it just depends on context and perspective. We’ll say, “Well, I know that I’m in my living room,” or “I know that I’m in your office, so this isn’t actually happening to me in this moment.” You almost have to really work them up and figure out, what’s the barrier here? What are you resisting? Kimberley: That’s a good question. I would say 10 to 20% of clients of mine will report, “I don’t feel anything.” I’ll do a Q and A at the end of this series with common questions, but I’m curious to know what your response is to a client who reads like, “I kill my baby,” or “I hurt my mom,” or “I go to hell,” or “I cheat on my husband,” or whatever it is, but it doesn’t land. What are your thoughts on what to do then? Krista: A couple of things pop up. One, it makes me wonder what mental compulsions they’re doing. And then it also makes me wonder, are we going in the right direction with the story? Because again, like I mentioned before, if a client comes back and they’ve habituated to one thing, but they’re still having the obsession, well, guess what? We’re just telling stories. Because the OCD narrative is typically not just laser-focused—I mean, it can be laser-focused, but usually, it has branches—you can pick and choose. I’m going to go ahead and guarantee, that person who is terrified of killing their husband ensure they’re not going to see their grandchildren and children. I’m going to go ahead and waiver that there’s probably other things that they’re afraid of missing.  Kimberley: Yes. That’s what I find too, is maybe we haven’t gotten to the actual consequence that bothers them. I know when I’ve written these for myself, we tend to fall into normal traps of subtypes, like the fear that you’ll harm somebody or so forth. But often clients will reveal like, “I’m actually not so afraid that I’ll harm somebody. I’m really afraid of what my colleagues and family would think of me if I did.” So, we have to include that. Or “I’m afraid of having to make the call to my mom if I did the one thing.” I think that that’s a really important piece to it, is to really double down on the consequence. Do you agree? Krista: Oh, I agree a hundred percent. You got to figure out what is that core fear. What are you really, really trying to avoid? With harming somebody, is it the consequences that might happen afterwards? Is it the feeling of potentially snapping or losing control? Or is it just knowing that you just flat out, took the life of somebody and that that was something that you were capable of? I mean, there’s so many different themes, looking at what does that feared self like, what does that look like, and maybe we didn’t hit it last time. Kimberley: Right. Krista: I know this is going to sound silly and I tell my clients this every once in a while, is I’m not a mind reader. What I’m asking you, is that the most challenging you can go and you’re telling me yes, I’m going to trust you. I tell them, if you are not pushing yourself in therapy to where you can grow, I’m still going to go to bed home and sleep tonight just fine. But I want you to also go home and go to bed and sleep just fine. But if you are not pushing yourself, because we know sleep gets affected super bad, not just sleep, but other areas, you’re probably going to struggle and you might even come back next week with a little bit more guilt or even some shame. I don’t want anybody to have that. I want people to win. I want people to do well in this. I know this stuff is scary, but I’m going to quote somebody. You might know her. Her name is Kimberley Quinlan. She says, “It’s a beautiful day to do hard things.” I like to quote her in my practice every once in a while.  Kimberley: I love her. Yes, I agree with this. The way you explained it is so beautiful and it’s logical the way you’re explaining it too. It makes sense. I have one more question for you. Recently, I was doing some imaginals with a client and they were very embarrassed about the content of their thoughts. Ashamed and guilty, and horrified by their thoughts. I could see that they were having a hard time, so I gave them a little inch and I went first. I was like, “Alright, I’m going to make an assumption about what yours is just to break the ice.” They were like, “Oh yeah, that’s exactly what it is.” There was a relief on their face in that I had covered the bases. We did all of the imaginal and we recorded it and it was all set. And then at the end I said, “Is there anything that we didn’t include?” They reported, “Yeah, my OCD actually uses much more graphic words than what you use.” I think what was so interesting to me in that moment was, okay, I did them the favor by starting the conversation, but I think they felt that that’s as far as we could go. How far do you go? Krista: As far as we need.  Kimberley: Tell me what that means. Krista: Like I mentioned before, the limit does not exist and I mean, the limit does not exist. This is going to sound so silly. I want you to be like a young Stephen King before he wrote his first novel and push it. Push it and then go there. Guess what? If that novel just doesn’t quite hit it, write another one, and then another one, and let’s see how far you can go. Because OCD is essentially a disorder of the imagination, and you get to take back your imagination by creating the stories that OCD is telling us and twisting it. I mean, what an amazing and powerful thing to be able to do. I’m sure you’re the same in that you know that there’s a lot of specialists that don’t believe in imaginals, don’t like imaginals, especially when it comes to issues with pedophilia OCD. I think we also need to not remind our clients because that would be reassurance, but to tell these specialists, we’re not putting anything into our client’s heads that aren’t there to begin with. Just like you said, if your client is thinking like real sick, nasty core, whatever, guess what? We’re going to be going there. Are you cutting off the heads of babies in your head? Well, we’re going to be talking about stories where you’re cutting off the heads of babies. If that’s what’s going on, we’re going to go there. Kimberley: What’s really interesting, and this was the example, is we were talking about genitals and sexual organs and so forth. We’re using the politically correct term for them in the imaginal. Great. Such a great exposure. Vagina and penis, great. Until again, they were like, “But my OCD uses much more graphic words for them.” I’m like, “Well, we need to include those words.” Would you agree your imaginals don’t need to be PC? Krista: I hope my clients watch this, and matter of fact, I’m going to send this to them, just to be like, no, no. Krista’s imaginals with her clients. Well, not my imaginals. Imaginals that are with my clients. Woah, sometimes I’m saying bye to my client. I’m like, “I think I need a shower.” Kimberley: Again, when people say they don’t like imaginals or they think that it’s not a good practice, I feel like, like you said, if OCD is going to come up with it, it gives an opportunity to empower them, to get ahead of the game, to go there before it gets there so that you can go, “Okay, I can handle it.” I would often say to my clients, “Let’s go as far as we can go, as far as you can go, so that you know that there’s nothing it can come up with that you can’t handle.” Krista: I think that where it gets even more complex is when we’re hitting some of the taboo stuff. Not only pedophilia, but something like right now that I’m seeing a lot more of in my office is stuff relating to cancel culture. This fear that what if I don’t use somebody’s pronouns correctly? What if I accidentally say an inappropriate racial slur? I will ask in session and I’ll be super real. It’s hard for me to hear this stuff because this goes outside of my values. Of course, it goes outside of their values. OCD knows that. That’s why it’s messing with them. I’ll say, “Okay, so what is the racial slur?” My clients are always like, “You really want me to say it?” I said, “We’re going to say it in the imaginal.” I realized how hard that is to stomach for therapists. But in my brain, the narrative that OCD is pushing, whether it is what society views as OCD or taboo OCD, it doesn’t matter. We still have to get it out. It is still hard for that client. If that’s hard for that client to think of an imaginal or a racial slur, it is almost the exact same amount of distress for somebody maybe with an imaginal that I’m afraid I’m getting food poisoning.  We, as clinicians, just because we’re very caring and loving people, sometimes we can unintentionally put a hierarchy of distress upon our clients like, okay, I can do this imaginal because this falls with my values, but I don’t know if I can do this imaginal because pedophilia is something that’s hard for me to do and I don’t want to put my client through that. Well, guess what? Your client is already being put through that, whether you like it or not. It’s called OCD. Kimberley: Right. Suppressing it makes it come on stronger anyway. Love that. I think that the beauty of that is there is a respectful value-based way of doing this work, but still getting ahead of OCD. Is that what you’re saying? Krista: Absolutely. OCD tries to mess with us and think, what if you could be this person? Well, like I mentioned before, if a story is like a weapon, well, I’m going to tell a story to attack OCD because it’s already doing it to me. Kimberley: Yeah. Tell us where people can hear more from you, get your resources because this is such great stuff. Krista: Thank you. I’d say probably the best way to find me and my silly videos would be on my Instagram @anxiouslybalance. Kimberley: Amazing. And your private practice? Krista: My private practice, it’s A Peaceful Balance in Wichita, Kansas. The website is apbwichita.com. Kimberley: Thank you so much. I’m very grateful for you for inspiring this whole series and for also being here as a big piece of the puzzle. Krista: Thank you. I’m grateful for you that you don’t mind me just like this. I’m grateful for you for letting me talk even though clearly, I’m not very good at it right now. You’re amazing. Kimberley: No, you’re amazing. Thank you. Really, these are hard topics. Just the fact that you can talk about it with such respect and grace and compassion and education and experience is gold.  Krista: Thank you. At the end of the day, I really truly want people to get better. I know you truly want people to get better. Isn’t that just the goal? Kimberley: Yeah. It’s beautiful. Krista: Thank you. 

Welcome back, everybody. Today, we are going to have a discussion, and yes, I understand that I am here recording on my own in my room by myself, so it’s not really a discussion. But I wanted to give you an inside look into a discussion I had, and include you hopefully, on Instagram about a post I made about being busy.  Now, let me tell you a little bit of the backstory here. What we’re really looking at here is, is being busy a compulsion or an effective behavior? Here’s the backstory. I am an anxious person. Nice to meet you. Everybody knows it, I’m an anxious person. That’s what my natural default is. I have all the tools and practice using all the tools and continue to work on this as a process in my life. Not an end goal, but just a process that I’m always on, and I do feel like I handle it really, really well. In the grand scheme of things, of course, everyone makes mistakes and recovery is an up-and-down climb. We all know that. But one thing I have found over and over and over and over again is my inclination to rely on busyness to manage my anxiety.  The reason I tell you this over and over is it’s a default to me. When I’m struggling with anything, I tend to busy myself. Even when I had the beginning of an eating disorder, that quickly became a compulsive exercise activity because trying to manage my eating disorder created a lot of anxiety, and one way I could avoid that anxiety and check the eating disorder box was to exercise, move my body. Even though I fully recovered from that, and even though I consider myself to be doing really well mentally overall, I still catch myself relying on work and busyness as a compulsion, as a safety behavior to reduce or remove or avoid my anxiety.  I made a post on this and it had overwhelming positive responses. Meaning, I agree, there was a lot of like, “Oh, I feel called out or hashtag truth.” A lot of people were resonating with this idea that being busy can be a very sneaky compulsion that we do to run away from fear or uncertainty or discomfort or sadness and so forth. But then some of my followers, my wonderful followers came in hot—when I say “hot,” like really well—with this beautiful perspective on this topic and I really feel like it was valid and important for us to discuss here today. Let’s talk about that, because I love a good discussion and I love seeing it from both sides. I love getting into the nitty gritty and determining what is what. Let’s talk about me just because it’s easy for me to use an example. Let’s say I have a thought or a feeling of anxiety. Something is bothering me. I’m having anticipatory anxiety or uncertainty about something. My brain wants to solve it, but because I have all these mindfulness tools and CBT tools, I know there’s no point in me trying to solve it. I know there’s no point in me ruminating on it. I’m not going to change it or figure it out. I have that awareness, so I go, “Okay, now I’m going to get back to life,” which is a really wonderful tool. But what I find that I do is I don’t just get back to life. I, with a sense of urgency, will start typing, cleaning, folding laundry, whatever it is, even reading. I will notice this shift in me to do it fast, to do it urgently, to try and get the discomfort to be masked, to be reduced.  And then, of course, I want to share with you, what I then do is when I catch that is I go, “Okay.” I feel the rev inside me and then I ease up on it. I pump the brakes and I try to return back to that activity without that urgency, without that resistance to the anxiety, or without that hustle mentality. But it is a default that I go to that often I don’t catch until later on down the track. It’s usually until I start to feel a little dizzy, I feel a little lost, a little bit overwhelmed. And then I’m like, “Oh, okay, I’m overusing busyness to manage my anxiety.” The perspective that I loved was people saying, and one in particular said, “I want us to be really careful around that message because I think that some people can hear this idea that being busy is a compulsion and then start to question their own normal busyness throughout the day.” I’ll use the exact terms because I thought it was so beautifully said. They said, “You have to be pretty careful with how you explain this to some people with OCD because we’re told to lean into our values or live a ‘value-based’ life, and that does require us to be busy,” and I wholeheartedly agree.  I think that’s where I’m coming from. I want to offer to you guys that I want you to just check in and see if you’re using busyness, this urgent, rushing movement, or frantic experience in your body to avoid discomfort. And if so, that’s good to know. Let’s not judge that. Let’s not beat you up. Let’s not be unkind. Let’s just acknowledge that that is a normal response to having anxiety. In fact, it’s a big part of what’s kept us alive for all these years. That’s true. And we can return back. Once we catch that we’re doing those behaviors, we can return back to staying effective in our skills. But I don’t want you guys to worry that you are overusing busyness.  I think that the discussion I had online was to say, isn’t this a wonderful opportunity for us to see how anxiety or OCD or any anxiety disorder can make a really healthy behavior into a compulsive behavior? You might flip between the two, it mightn’t be all or nothing. An example of that might be prayer. Prayer is a beautiful practice for those who are spiritual. However, we can sometimes overuse prayer in a compulsive manner in this urgent, frantic, trying to get anxiety to go away manner, and then it’s being misused.  There may be sometimes you use prayer in this beautiful non-compulsive way and there’ll be other times when you’re absolutely using it as a safety behavior. Same goes for cleaning, same goes for thinking through your problems. There will be times when thinking through problems and solutions is a very effective behavior. However, there will be other times if you’re doing it with a sense of urgency to make the discomfort go away or you’re doing it to try and figure out something that you know you won’t figure out because there’s really no solution to it—that’s something for us to keep an eye out for. There are so many ways in which this can get blurred. Asking for help and reassurance. It’s not a problem to go to your loved ones and say, “I have this really huge presentation at work, would you let me rehearse it to you and you can give me feedback?” That’s an effective behavior. However, if we are doing that repetitively and we are doing it coming from this desperate place of urgency to get certainty and removal of discomfort, that’s how we may determine whether the behavior is a safety behavior that we want to start to reduce. I want to just offer this to you. If we’re being honest, this episode isn’t really about just the busyness. It’s being able to, again, for yourself, determine are the behaviors you’re doing being done because they line up with your values? Are they being done with a degree of willingness to also bring anxiety with you? I think that’s a huge piece of the work that I have to catch, which is, okay, I’m rushing, I’m hustling, I’m engaging in busyness just for the sake of trying to get rid of that discomfort. Can I pause and return back to that behavior? Because it might be a behavior or an activity I need to get done. But can I do it with an increased sense of willingness to bring anxiety along for the ride? Can I do it with a sense where I’m not trying to train my brain that anxiety is bad? Can I just say, “Yeah, it’s cool. Anxiety is here, let’s bring it along”?  I want to, again, reinforce to you guys, it’s okay that you haven’t figured this out because it’s probably ever-changing. There will be times when you are engaging in compulsive busyness and there’ll be other many times in which you’re not. What I would encourage you to do is not to spend too much time trying to figure out which is which, because that can become a compulsion as well. A lot of this is just accepting that nothing is perfect and just moving one step at a time moving forward as you can kindly and compassionately.  The only other thing I want to address here is this idea of a good distraction and a bad distraction. I think that this has been an argument or a complex discussion in the anxiety field for a long time. When I first was trained as an anxiety specialist, there were all these articles that talked about bad distraction, that distraction is bad and we shouldn’t do it, and we should just have our anxiety and let it be there and then focus on it and so forth. I actually don’t agree with that. In fact, I would go as far as to say, a real mindful practice would be taking the judgment out of destruction in general and saying that distraction is neither good nor bad. What distraction is, is up to you to decide whether it’s helping you and is helpful behavior that brings you closer to your recovery goals or not. I don’t want you to spend too much time trying to figure it out either, again, because I think it gets us caught in this mental loop of, am I doing recovery right? Am I doing my treatment right? Am I using the skills perfectly?  I think when we get to that point, we’re too far in the weeds and we have to pause and let it be imperfect and let it be uncertain and do our best not to try and solve that one, because often how would we know? There isn’t actually an answer to what’s bad and what’s good. I wouldn’t encourage you to place good and bad labels on those kinds of things because that usually will just keep you in a loop of anxiety anyway.  That’s just a few ideas on this idea of being overly busy being a compulsion. I really want to make sure I say one more time. I think there is absolutely an opportunity for us to consider that busyness is also neither good nor bad. It just is, and that you for yourself can determine whether it’s helpful for you to stay busy or not. What I will say—and I will use this as an example, I think I actually did a podcast episode on this—not long ago, my parents were voyaging across the Drake Passage, which is a very dangerous body of water that takes you from South America to Antarctica. It’s usually very, very calm or it can be incredibly dangerous to pass the Drake Passage. For the 18 hours that they were passing that, I engaged in a lot of busyness. I would say it wasn’t compulsive either. It was, I knew they were doing something scary. I knew that it would be probably fine, but it was still uncertain. I knew that there was nothing I would do to make my anxiety go down during that 18 hours. I knew I probably wouldn’t get a good sleep because I love them dearly and I want them to have a safe trip. I just said to myself, “I’m going to mindfully go from one activity to another. Because I don’t want to engage in a bunch of mental rumination, I’m just going to gently stay busy.” I think that’s fine. I think that that is effective. In fact, I was very proud of how I handled that. I was able to resist the urge to text them at two in the morning and be like, “Take a photo of the waves. I want to see that you’re okay.” You know what I mean?  I want to just offer to you that to check in whether your busyness is compulsive, be gentle with yourself either way to discuss with your mental health provider on what is a great way for you to engage in this kind of behaviors and for you to come up with your own protocol on how to determine when you’ve crossed over from being busy into compulsive busyness. That’s it. I think that from there, you can be gentle with yourself and practice being uncertain about what’s right and wrong.  I hope that was helpful. I’m very much just chatting to you. I didn’t do a whole ton of prep for this. I just wanted to include you in the conversation on “Is being overly busy a compulsion?” I wanted to give you some ideas and things to look out for and I hope that it helps you move forward towards the recovery that you’re looking for. Have a wonderful, wonderful day. If you guys want additional resources from me, you can head over to CBTSchool.com. We have all kinds of online options there for you. If you’re looking for one-on-one therapy, if you live in the state of California or Arizona, you can go to www.kimberleyquinlan-lmft.com and I look forward to chatting with you next week.

Hello and welcome back, everybody. We have an amazing guest today. This is actually somebody I have followed, sort of half known for a long time through a very, very close friend, Shala Nicely, who’s been on the show quite a few times, and she connected me with Dr. Ashley Smith. Today, we are talking about happiness and what makes a “good life” regardless of anxiety or of challenges you may be going through.  Dr. Ashley Smith is a Licensed Clinical Psychologist. She’s the co-founder of Peak Mind, which is The Center for Psychological Strength. She’s a speaker, author, and entrepreneur. She has her own TED Talk, which I think really shows how epic and skilled she is.  Today, we talk about how to be happy. What is happiness? How do you get there? Is it even attainable? What is the definition of happiness? Do we actually want it or is it the goal or is it not the goal? I think that this is an episode I needed to hear so much. In fact, since hearing this episode as we recorded it, I basically changed quite a few things. I will be honest with you, I didn’t actually change things related to me, but I changed things in relation to how I parented my children. I realized midway through this episode that I was pushing them into the hamster wheel of life. Ashley really helped me to acknowledge and understand that it’s not about success, it’s not about winning things, it’s not about achievement so much, while they are very important. She talks about these specific things that science and research have shown to actually improve happiness.  I’m going to leave it at that. I’m going to go right over to the show. Thank you, Dr. Ashley Smith, for coming on. For those who want to know more about her, click the links in the show notes, and I cannot wait to listen back to this with you all. Have a great day, everybody.  Kimberley: Welcome, Dr. Ashley Smith. I’m so happy to have you here. Dr. Ashley: I am excited to be here today. I’ve wanted to be on your podcast for years, so thank you for this. Kimberley: Same. Actually, we have joint friends and it’s so good when you meet people through people that you trust. I have actually followed you for a very long time. I’m very excited to have you on, particularly talking about what we’re talking about. It’s a topic we probably should visit more regularly here on the show. We had discussed the idea of happiness and what makes a good life. Can you give me a brief understanding of what that means or what your idea about that is? Dr. Ashley: Yeah. Oh, this is a topic that I love to talk about. When I think about it, I have a little bit of a soapbox, which is that I think our approach to mental health is broken. I say that as someone who is a mental health practitioner, and I really love my job and I love working with people and helping. But what I mean by that is our traditional approach has been, “Let’s reduce symptoms. Let’s correct the stuff that’s ‘wrong’ with someone.” When it comes to anxiety or depression, it’s how do we reduce that? And that’s great. Those are really important skills, but we’ve got this whole other side that I think we need to be focusing on. And that is the question of how do we get more of the good stuff. More happiness, more well-being. How do we create lives that are worth living? That’s not the same as how do we get rid or reduce anxiety and depression. In the field of psychology, there’s this branch of it called Positive Psychology. I stumbled on that 20 years ago as a grad student and thought, “This is amazing. People are actually studying happiness. There’s a science to this.” I looked at happiness and optimism and social anxiety and depression and how those were all connected. Fast forward, 15 years or so, I really hit a point with my professional life and my personal life where I was recognizing, “Wait a minute, I need more. I need more as an individual. The clients I work with need more. How do we get more of this good stuff?” This is the longest preamble to say, I did a deep dive into the science of happiness and learned a lot over the years, and I want to be really clear about a couple of things. When we talk about happiness, a lot of people think pleasure. “I want good experiences, I want to enjoy this.” That’s a part of it, this positive emotion that we all call happiness or joy. But that’s only a piece of it. There’s actually this whole backfiring process that can happen when we chase that. If I’m just chasing the next pleasant event, what that actually does is set me up to not have a happy life. Think about it. I mean, I love chocolate, and if I eat that unchecked because it brings me pleasure, at some point, it’s going to take a toll on my health. What does that actually do to my well-being and happiness?  What was really interesting getting into this area was, it’s not just this transient state of pleasure or enjoyment, but they’re the other factors that contribute to a good life. It’s things like relationships. It’s things like meaning and purpose. It’s engagement. It’s achievement even. It’s these things that are not always pleasant in the moment, but that really contribute to this sense of satisfaction with life or contentment with life. I think it’s really important that we need to be looking at what are the ingredients that really make a good life.  WHAT IS CONSIDERED A GOOD LIFE?  Kimberley: I love this, and I love a good recipe too. I like following recipes and ingredients. It’s funny, I’m actually in the process of getting good at cooking and I’m realizing for the first time in my life that following instructions and ingredients is actually a really important thing, because I’m not that person. First of all, what is a good life? When I looked at that, I actually put it in quote marks. What is a good life? What do you think? You explained it; it’s not chasing pleasure. We know that doesn’t work, otherwise, you just buy a bunch of stuff you don’t want and behave in ways that aren’t helpful. Not to also villainize pleasure, it’s a great thing, but what would you describe as a good life? Dr. Ashley: On the one hand, it’s the million-dollar question. Philosophers and scientists and religious leaders and all kinds of people have been trying to answer that question for eons. I don’t know that I have it nailed down. I think I’m humble enough to say I have my own ideas about it. To me, what makes a good life, it’s really when the way we spend our time lines up with what’s important to us, when we’re living in accordance with our values to use some psych buzzwords, but when we’re doing the things that really matter. I think also part of a good life is having daily rhythms and lifestyle habits that support us as biological creatures. I want to contrast that with the demands of modern life, which are that we should be productive 24/7, that we should be multitasking. People sacrifice sleep and movement and leisure time and stillness. I think all of that compromises us. It impacts us on a neurological level. Our brains are part of our system. If we’re not taking care of our system, they’re not going to function optimally. That gets in the way of a good life.  When we’re sacrificing relationships, when I look at all of the research, when I look at my own experience, a huge component of a good life is having quality relationships. Not quantity, quality. Trusting ones that are full of belonging and acceptance that are two-way support streets, those are really important. I think a lot of times, modern life compromises that. We get pulled in all of these other directions. Kimberley: Yeah. Oh my gosh, there’s so many things. I also think that anxiety and depression pull us away from those things too. You are anxious or you’re depressed and so, therefore, you don’t go to the party or the family event or the church service. That’s an interesting idea. I love this. Tell us about this idea of meaning. How do we find meaning? I’ll just share with you a little bit of my own personal experience. I remember when I was actually going through a very difficult time with my chronic illness and I know I was depressed at the time. It was the first time in my life where I started to have thoughts like, “What’s the point?” Not that I was saying I was suicidal, but I was more like, “I just don’t understand why am I doing all this.” I think that that’s common. What are your thoughts on this idea of the meaning behind in life? Dr. Ashley: That’s a fantastic question. I have a vision impairment, so I’m legally blind. It’s a really rare thing and it’s unpredictable. I don’t know how much sight I will lose. Ultimately, the doctors can’t tell me there’s no treatment options. It’s just I go along and every so often, there’s a shift and I see less. For me, I hit that same point you were talking about back in 2014 when I had to stop driving. I was anxious and I would say depressed and really wallowing in this, “What does this mean for my life? I can’t be independent. People aren’t going to associate with me personally or professionally when they see this flaw.” It was a dark point. For me, that’s when I went back to the science of happiness when I finally got tired of being stuck and I realized my anxiety skills and my depression skills. They’re helpful and I practice what I preach, but it wasn’t enough. And that’s really what propelled me back into this science of happiness where I figured, you know what, someone has to have done this.  I did come across this theory of well-being called the PERMA factors. These are like the ingredients that we need. I’m getting back to that because the M in this is meaning. With this, the PERMA factors, P is positive emotion. That’s the pleasure, the joy, the happiness. Cool. I know some strategies for boosting that. E is engagement. Are you really involved and engaged in what you’re doing? Are you present? Are you hitting that state of flow? R is the relationships, A (skipping ahead) is achievement, but M is this meaning, and it’s a hard one to figure out.  I remember then, this started what I was calling my blind quest for happiness where I started to think about, what do I need to do? How do I experiment? How do I live a happy life despite these cards I’ve been dealt? We don’t get to choose them. You’ve got a chronic illness, I have a vision impairment, listeners have anxiety and depression, and we get these cards. I think of it like if life is a poker game, we don’t get to choose the cards we’re dealt, but by golly, we get to choose how to play them, and that’s important. I think a lot of times people can turn adversity into meaning. For me, I’m now at a point where it’s not that I don’t care about my vision, it’s just I really accepted it. It is what it is, it’s going to do what it’s going to do, and I’m focusing on the things I can control. That has given me a sense of meaning. I want to help other people live better lives. I want to help other people crack the code of how our brains work against us and how do we play our cards well. If we go to all of this, “meaning” is really just finding something that’s bigger than you are, finding something to pursue or contribute to that’s bigger than you. I think when we look at anxiety and depression, the nature of those experiences is that they make us very self-involved. I mean, people with anxiety and depression, in my experience, have giant hearts, tons of empathy, but it locks our thinking into our experience and what’s going on in these unhelpful thoughts.  When we can connect with something bigger than us, it gets us outside of that.  If I go back to grad school, writing my dissertation was decidedly not a fun experience. Would I do it again? Yes. Because it was worth it on this path to my reason for being—helping people live better lives. Sometimes I think when we have this meaning, this purpose, this greater good, it helps us endure the things that I want to say suck. Kimberley: You can say suck. Dr. Ashley: Yeah. That’s where it’s not just about how do I get rid of anxiety or depression. Sometimes we can’t. Chronic health conditions, anxiety is chronic. My vision is chronic. I’m not getting rid of this, but how do I live a good life despite that? I think there are a ton of examples throughout history and currently of people doing amazing things despite some hardship.  Kimberley: Yeah. I love this idea. It’s funny, you talk about being outside yourself. When I’m having a bad day, I usually go, there’s like a 10 minutes’ drive from us that looks over Los Angeles. If let’s say I’m having a day where I’m in my head only looking at my problems, and then I see LA, I’m like, “Oh honey, there is a whole world out there that you haven’t thought about.” I’m not saying that in a critical way, just like it gives me perspective. Dr. Ashley: I think that’s so important, to realize there’s so much more. When it does shrink our problems, all of a sudden, it’s manageable. Kimberley: Right. Let’s talk about just one more question about meaning. I’m guessing more about people finding what’s your why and so forth. What would you encourage for people who are very unhappy, have been chasing this idea of reducing anxiety, reducing depression, chasing pleasure, and feeling very stuck between those? Let’s say I really have no idea what my meaning is. What would be your advice to start that process?  Dr. Ashley: Experimentation. I think experimenting is a lifestyle that I wish everyone would adopt, because what happens is we want to think. We are thinkers. That’s what our minds were designed to do. That’s awesome and sometimes it’s really helpful, but I don’t think we’re going to think our way into passion or meaning or a good life. I think we have to start trying things. What will happen, if you notice, is your mind is going to have a lot of commentary. It’s going to say, “That’s dumb. That’s not going to work. Who are you to try that? You can’t do that.” It’s all just noise that if we look at what is it doing, it’s keeping you stuck. With the experimentation, I’m just a big fan of go try it. Whether you think it’s going to work or not, you don’t know. We want to trust our experience, not what our mind tells us. Trust your actual experience.  For me, I remember getting my first self-help book. It was actually called Go Find Your Passion and Purpose. Because I was at this crossroads, I had been doing anxiety work for a long time, had plateaued, and was feeling a little bored, and that coincided with the stopping driving. My whole personal world was just in disarray and I was like, “I’m going to go hike part of the Appalachian Trail while I can. While I do that, I’m going to find my purpose in life.” I did not find it, but it was an experiment. I go and I get this experience and I can say, “Okay, I’m not going to be someone who does a six-month hike. I made it four days. Awesome.” But go and experiment with things. I never thought that I would really want to write and I started a blog, and that has turned out to be such a positive experience. Prior to that, my writing experience had been very academic where it was a chore. Now, this is something I really enjoy, or talking to people.  I would say experiment and continue to seek out those new experiences. One, seeking out new experiences helps on the anxiety side because you’re continually putting yourself into uncertain and new, so your confidence level is going to grow, your tolerance for not knowing grows, and your tolerance for awkward grows. That’s my plug for go try new things, period. Somewhere along the way, you’re going to find something that sparks an interest or that sparks this sense of, “Yeah, this is me.” Notice that. I know you talk a lot about mindfulness, we need to notice what was my actual experience, not what did my head tell me. What did I actually feel? And keep experimenting until you find something. I think that’s really the key. Kimberley: I love that you said your tolerance for awkwardness. I think that is a big piece of the work because it is a big piece. We talk about tolerating discomfort, tolerating uncertainty, but I think that’s a very key point, especially when it comes to relationships, which I know is one of the factors. Tolerate the awkwardness is key. Dr. Ashley: Yeah. I think it’s huge. I’ve been seeking out new experiences since 2017. This is going to be my New Year’s resolution. It was such a transformational experience over the course of the year that I’ve just continued it, and I’m trying to get everybody to join me because it’s such an expansive practice. I think it’s great for anxiety and depression, it’s great for humans, it’s been great for me on this quest for a good life. But with this, it means I have put myself into some awkward situations on purpose. Sometimes I know going into it, sometimes I don’t.  I went to this one, it was called Nia. I practice yoga. That’s cool. That’s very much in my comfort zone. This was yoga adjacent, but it was also an interpretive dance with sound effects. You had to make eye contact with people and dance in these weird ways. I distinctly remember having this conversation with myself when I showed up, “What did you just get yourself into?” And then it was immediately, “Okay, you have two choices here. You can grit your teeth and hate the next hour, or you can embrace the awkward and dance at a three. Because she said, you can dance at a one, itty bitty, at a two or at a three and really go for it.” That for me was my, “All right, let’s just do this.” I embrace the awkward, and that was a turning point. That was amazing. And then now, when I think about good life, I feel like so many doors are opened because I’m not afraid of, “This is going to be awkward.” It’s going to be and you’re going to be okay or it’s going to make a hilarious story. I said, “Go for it.” Kimberley: You’re here to tell the story. I love it. You didn’t die from awkwardness. Dr. Ashley: No. Kimberley: Can you tell me about the P? Can you go through them and just give us a little bit more information? Because I think that’s really important. Dr. Ashley: Yeah. I love this theory because you can think about it as like, how are my PERMA factors doing? When you’re low, raise them. You know that those are the ingredients for a good life. The P is positive emotion. That is, we do need to spend time in positive emotional states. The more time we’re in the positive emotional states, the better compared to the negative ones like anxiety or sadness, or anger. Now that said, we know if we try to only pursue pleasure, it’s going to backfire. If I’m trying to avoid anxiety, I’m actually going to get more anxiety. But this is where behavioral activation comes in. Do things that are theoretically enjoyable and see if it puts you in a positive state. Again, theoretically enjoyable, because if you’re in the throes of depression, nothing feels enjoyable, do it anyways. And then notice, did it bring on a pleasurable emotional state? Cool. We want to do those things.  E is engagement. This is when people talk about finding flow or being in the zone. These are the activities that you’re fully engaged in it. Self-consciousness goes away. You lose track of time because you’re just in it. We know that the more consistently we are able to put ourselves in states of flow, the higher our well-being tends to be. Athletes will talk about this a lot. When they’re on the field, they’re in the zone. Musicians, artists. But there are other ways to do this. This is a place for me personally, I didn’t know. I was like, “Well, okay, great. I need E, I need engagement. What puts me in a state of flow?” It took experimentation and noticing. For me, writing does it. Web design, I’m not techy, but when I start to do design projects, I get in that state of flow. It has to be this perfect apex, this perfect joining of skill and pleasure, like enjoyment. If it’s too easy, you will not go into a state of flow. That’s just the P. If it’s too hard, we go into a state of stress or anxiety, so that’s not flow. We have to be right on the cusp of our skillset. It’s hard work, but we’re into it. That’s the E. R is relationships. We need quality relationships where we are being open, where we are being vulnerable, we’re really connecting with other people. That is huge. I mean, if we look at what’s the best predictor of life satisfaction, it’s quality relationships. This also is doing things for other people. Altruism, ugh, I love this side note. The act of kindness thing hits on three different factors. It feels good to do something good for other people. If you want a mood boost, go do an act of kindness. That reliably boosts our mood. It also improves relationships and it can tap into that meaning. I love that as just a practice.  The M we talked about, that’s meaning. And then the A, that’s achievement for achievement’s sake. As humans, it feels good to conquer goals. It feels good to accomplish things. And that contributes to our well-being independently of the positive feelings that we get from it, or the meaning in the relationships or the engagement. I’m also a really big fan of set goals and then crush them. It can be silly little things like, I’m going to hold my breath for two minutes. Okay, cool. That’s a silly little thing, but then it feels good to do it. Or it could be something huge like crossing those bucket list things off your list. Kimberley: You know what’s funny around achievement? I’ve got a couple of questions, but first I want to tell you your stories. Last year, I was struggling to do a couple of things that were really important to me for my medical health. I found an app called Streaks. Have you heard of Streaks? It’s a $5 app. But when you do the action, and for me it was taking my medicine, it does this little spiral and then it’s like, “You’ve done this for three days in a row.” And then tomorrow you click it and then it says, “You’ve done it for four days in a row.” You would think that the benefits of taking my medicine would be enough. But for me, it’s actually knowing I get that little positive reinforcement of like, “Look at me, I’ve taken my medicine for 47 days in a row, or now are like 300 days in a row.” I don’t think I deserve a medal for being able to take my medicine. But for me, that little bit of reward center on the achievement was a huge shift for me. And then it became, how many days did you practice your Spanish in a row? Even like, how many days did you do your Kegels? I’ve got all of the streaks happening and it’s really incredible how that little achievement piece does boost your mood. Dr. Ashley: Yeah. But what I love about this is you’re also talking about how to hack the system. We’re talking about our brains and this is the stuff that just lights me up, because oftentimes our minds will say, “Well, you should just take your medication. You should just do these things.” Well, that’s not how it works. There’s a million reasons why we don’t do the things we know we should do. But can we figure out how to hack the system? Yeah. Our brains love streaks. They love streaks.  it taps our reward centers, like you’re saying, and so let’s use the tools that work. That got you if your goal is to take your medication consistently. Using our brain’s glitchy wiring to our own advantage is something that’s huge. That did it. And then it does feel good. And then you get some momentum going and then you create a habit around that and it’s fantastic. Kimberley: Yeah. What about those who are overachieving to the point that it’s bringing their happiness down? What would we do there?  Dr. Ashley: Yeah. I think that’s a great question and it’s something that comes up a lot, especially when we look at anxiety and perfectionism. At least the way I think about it is coming back to what’s driving this. Is this being driven by fear? Is this being driven by values? For me, I almost think of it as—I’m going to try to make sense with it—is it the -ing or the -ed? Meaning, the doING (I-N-G) or the -ed as in I did this past tense. What I mean by this is, I notice for me when I’m approaching something, say a big goal, like I want to write a book this year. If I can approach that from a place of, “I am doing this because this is important to me, I feel driven to get this message out into the world,” the -ing, the process of doing it, that feels like it’s going to boost my wellbeing when I start to get pulled into the thoughts of the outcome. I’m going to write this book and how many people are going to read it and is it going to sell? I’m really looking at all of this, and underneath that is fear. What if it doesn’t sell? What if people judge it? What if they think it’s stupid? Then I’m focusing on the outcome, kind of when it’s done. That I think is actually going to detract from my well-being because it’s not coming from a valued place; it’s coming from this feared place.  A lot of times with overachieving, we’re chasing this other people’s expectations or we’re chasing this promise of happiness. When you do this, then you’ll be happy. It’s not going to work like that. It may be for a moment and then the bar just changes again. Now you’ve got another target. We have to come back to this, I think the process or the journey. Are you doing this because it matters to you, or are you doing this because some sort of fear is compelling you?  Kimberley: Right. I’m just asking questions based on the questions I would’ve had when I was struggling the most. I remember hearing something that blew my mind and I actually want your honest opinion about it. I remember I used to chase happiness, like you talked about, even though I was doing all these things. I was doing all these things, but there was that anxious drive behind it. I remember hearing somebody saying life is 50/50. Even though you’re doing all these things, you’re still going to have 50% great and 50% hard. For me, that was actually very relieving. I think I was caught in and I think a lot of people experienced this like, “Okay, I’m at 50%, how can I get to 55? How can I get to 56?” What are your thoughts on also accepting that you won’t be happy all the time, or what are your thoughts on balancing this goal for happiness or this lifelong playfulness around happiness?  Dr. Ashley: I agree with you completely. I think we have this cultural myth that we should be happy all the time. If you’re not happy, there must be something wrong. You’re doing something wrong. It sets up even this idea that being happy all the time is possible. It isn’t. If we look at, again, happiness, what people mean by that is a pleasurable or enjoyable state, an emotion that we like. Humans are wired. Two-thirds of our emotions would be under that negative category. Just by the way we’re wired, we’re more likely to have negative emotions, and they’re just messengers. They’re just designed to give us information about a situation. Some of them are going to be dangerous, so we’re going to feel anxious. Or we’re going to lose something we care about, so we’re going to be sad. We’re going to mess up, so we’re going to feel guilty. It’s unrealistic to expect to not have those emotions. I think that is a hundred percent something that we need to work on, just accepting happiness all the time is not possible and pursuing it is like playing a rigged game.  The other thing, you know how on the anxiety side we talk about facing fears because then you habituate or you get used to them. But that habituation process happens on the pleasurable side too. This is why when we chase happiness, we end up on this hedonic treadmill where it’s, “Oh, I’m going to go buy this thing. And then I’m going to feel really happy,” and you are. And then you’re going to habituate. Your body goes back to baseline so that happiness fades. If you’re looking to an external source, you’re going to get caught up in this always chasing something bigger and better, not sustainable.  I like to look at happiness as the side effect of living a good life. Do the things that we know matter. Take care of your health and wellbeing. Sleep, eat well, move your body, practice mindfulness, the PERMA factors that we talked about, and live in line with your values. If you’re doing those things, happiness is the side effect of that. Kimberley: To make that the goal, not happiness the goal.  Dr. Ashley: Yeah.  Kimberley: I think that’s very, very true. Again, for me, it was a massive relief. I remember this weight falling off of like, “Oh,” because I think social media makes it so easy to assume that everyone is just happy, happy, happy content, to feel all the things. It was delightful to be like, “Oh no, everyone’s got a 50/50.” Dr. Ashley: Exactly. When we know that’s normal, then all of a sudden, you can accept it. Like, I’m anxious for now, I’m sad for now. To do that, it does keep us from piling on extra. I have this saying that I love, “Just because life gives you a cactus doesn’t mean you have to sit on it.” A lot of times, we sit on it because we’re ruminating or I don’t want to feel this way and we’re fighting it. And that’s just amplifying it and making it a lot harder. When we can say, “Oh, this is where I’m at today. I’m still going to choose to do the things that I know are good for me, that are part of me, living a good life by my standards or my terms,” that’s going to be the side effect, is I’m going to end up with more happiness down the road, but not chasing it in that moment. Kimberley: I love this. Thank you for coming on and talking about this. I think this has been enlightening and so joyful to have these conversations. I feel a little lighter, even myself, after chatting with you, so thank you. Tell me how people can hear from you, get in touch with you, learn about your work. Dr. Ashley: Yeah, absolutely. I have a blog that I publish every week, so if you’re interested in that, you can subscribe at PeakMindPsychology.com/subscribe, o you can just check out all of the blog posts. That’s probably the best way to follow me and follow my work. I also have a TEDx Talk that came out pretty recently and you can watch that as well. It’s called Is Your Brain Deceiving You, and talk a little bit about learning to play my cards well. Kimberley: I love the TED Talk. Congratulations on that. It was so cool.  Dr. Ashley: Thank you.  Kimberley: Thank you again for coming on. This has been just delightful. Really it has. Dr. Ashley: I appreciate you having me.