Stay ConnectedKimberley Quinlan, an anxiety specialist for over 15 years, delivers Science-Based Solutions for Anxiety, Panic, Depression, OCD, Social Anxiety, Health Anxiety, & other difficult emotions.
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Obsessive-Compulsive Disorder (OCD) is a challenging condition, but the good news is that it's highly treatable. The key to effective management and recovery lies in understanding the condition, embracing the right treatment approaches, and adopting a supportive mindset. This article distills essential guidance and expert insights, aiming to empower those affected by OCD with knowledge and strategies for their treatment journey. YOU ARE BRAVE FOR STARTING OCD TREATMENT Taking the first step towards seeking help for OCD is a significant and brave decision. Acknowledging the courage it takes to confront one's fears and commit to treatment is crucial. Remember, showing up for therapy or seeking help is a commendable act of bravery. YOU CAN GET BETTER WITH OCD TREATMENT OCD treatment, particularly through methods like Exposure and Response Prevention (ERP) and Cognitive Behavioral Therapy (CBT), has shown considerable success. These evidence-based approaches are supported by extensive research, indicating significant potential for individuals to reclaim their lives from OCD's grasp. The path may not lead to a complete eradication of symptoms, but substantial improvement and regained control over one's life are highly achievable. OCD TREATMENT IS NOT TALK THERAPY OCD therapy extends beyond the realms of conventional talk therapy, involving specific exercises, homework, and practical worksheets designed to confront and manage OCD symptoms directly. These tools are integral to the treatment process, allowing individuals to actively engage with their treatment both within and outside therapy sessions. THERE IS NO SUCH THING AS "BAD" THOUGHTS A pivotal aspect of OCD treatment involves changing how individuals perceive their thoughts and their control over them. It's essential to recognize that thoughts, regardless of their nature, do not define a person. Attempting to control or suppress thoughts often exacerbates them, which is why therapy focuses on techniques that allow individuals to accept their thoughts without judgment and reduce their impact. YOU CAN NOT CONTROL YOUR THOUGHTS, BUT YOU CAN CONTROL YOUR BEHAVIORS You will have intrusive thoughts and feelings. This is a part of being human, and it is not in your control. However, you can learn to pivot and change your reactions to these intrusive thoughts, feelings, sensations, urges, and images. YOU HAVE MANY OCD TREATMENT OPTIONS While medication can be a valuable part of OCD treatment, particularly when combined with therapy, it's not mandatory. Decisions regarding medication should be made based on personal circumstances, preferences, and professional advice, acknowledging that progress is still possible without it. In addition to ERP and CBT, other therapies such as Acceptance and Commitment Therapy (ACT), mindfulness, and self-compassion practices have emerged as beneficial complements to OCD treatment. These approaches can offer additional strategies to cope with symptoms and improve overall well-being. The accessibility of OCD treatment has expanded significantly with the advent of online therapy and self-led courses. These digital resources provide valuable support, particularly for those unable to access traditional therapy, enabling individuals to engage with treatment tools and strategies remotely. For those without access to a therapist, self-led OCD courses and resources can offer guidance and structure. Engaging with these materials can empower individuals to take active steps towards managing their OCD, underscoring the importance of self-directed learning in the recovery process. TREATMENT WILL NEVER INVOLVE YOU DOING THINGS YOU DO NOT WANT TO DO I am usually very clear with my patients. Here are some key points I share I will never ask you to do something I do not want you to do I will never ask you to do something that I myself would not do I will never ask you to do something that goes against your values. RECOVERY IS NOT LINEAR Recovery from OCD is not a linear process; it involves ups and downs, successes and setbacks. Embracing discomfort and challenges as part of the journey is essential. Adopting a mindset that views discomfort as an opportunity for growth can greatly enhance one's resilience and progress in treatment. There will be good days and hard days. This is normal for OCD recovery. There will be days when you feel like you are making no progress, but you are. Keep going at it and be as gentle as you can SETTING CLEAR TREATMENT GOALS Clarifying treatment goals is crucial for a focused and effective therapy experience. Whether it's reducing compulsions, living according to one's values, or tackling specific fears, clear goals provide direction and motivation throughout the treatment process. BE HONEST WITH YOUR THERAPIST The success of OCD treatment is significantly influenced by the honesty and openness of the individual undergoing therapy. Without reservation, sharing one's thoughts, fears, and experiences allows for more tailored and effective therapeutic interventions. IT IS A BEAUTIFUL DAY TO DO HARD THINGS. No question. You can do hard things! OCD is a complex but treatable condition. By understanding the essentials of effective treatment, including the importance of evidence-based therapies, the role of mindset, and the value of self-directed learning, individuals can embark on a journey towards recovery with confidence. Remember, every step taken towards confronting OCD is a step towards reclaiming control over one's life and living according to one's values and aspirations. TRANSCRIPT There is so much bad advice out there about OCD treatment. So today, I wanted to share with you the 11 things I specifically tell my patients on their first day of OCD therapy. Hello, my name is Kimberley Quinlan. I'm an OCD specialist. I specialize in cognitive behavioral therapy, and I have helped hundreds of people with OCD over the course of the 10, 15 years I have been in practice. Now, whether you have an OCD therapist or not, my goal is to help you feel confident and feel prepared when addressing your OCD treatment and symptoms, whether you have an OCD therapist or not. That is the big goal here at CBTSchool.com and Your Anxiety Toolkit podcast. Make sure you stick around until the end because I will also be sharing specific things that you can remember if you don't have a therapist, because I know a lot of you don't. And I'll be sharing what you need to know so that you don't feel like you're doing it alone. Now, if you're watching this here on YouTube, or you follow me on social media at Your Anxiety Toolkit, let me know if there's anything I've missed or anything that you were told on your first session that was particularly helpful, because I'm sure your knowledge can help someone else or another person with OCD who is in need of support and care and advice. So let's go. Here are the 11 things that I tell my patients on their first day of OCD therapy. Number one, I congratulate them for showing up, because showing up for OCD treatment is probably one of the most brave things you can do. I really make sure I validate them that this is scary, and I'm really glad they're here. And I'm pretty impressed with the fact that they showed up, even though it's scary. The second thing I tell them is that OCD treatment is successful. You can come a long way and make massive changes in your life by going through the steps of OCD treatment, showing up, being willing to take a look at what's going on in your life, and making appropriate changes so that you can get your life back, do things you want to do, spend more time with your family, your friends, the things you love to do, like hobbies, and that OCD treatment can be very effective. We're very lucky that OCD is a very treatable condition. It doesn't mean it'll go away completely, but you can have absolute success in getting your life back. Now, one thing to know here is, how do we know this? Well, OCD treatment research and OCD treatment articles. If you go onto Google Scholar, you will find a lot of articles that show a meta-analysis of the OCD treatments available, where it shows that ERP and cognitive behavioral therapy are the gold standard of treatment. And using a meta-analysis, that basically means that they've surveyed all of the large, well-done research articles and found which one shows the most results and shows that they have the most repeated results over periods of time. And that's why it is so important that you do follow the research because there is a lot of bad information out there, absolutely. Now, the third thing I tell my patients on their first day of therapy is that OCD treatment is not talk therapy. It's not just talking, that it requires OCD therapy exercises and homework and lots of worksheets. I have a packet that we give our patients at the center that I own in Calabasas, California. Everyone gets a welcome manual. And in the welcome manual, it's got worksheets on identifying obsessions and compulsions. It's got mindfulness worksheets. It's got logging worksheets. And I will send you home with those to do for homework. You'll come back. Let me know what worked, what didn't work, what was helpful, what wasn't. And you will be doing a lot of this work on your own. Now, again, as I mentioned at the beginning, if you do not have access to OCD therapy or you don't have the resources to get that, we have an online course called ERP School. It is a course specifically for people with OCD, where I walk you through the specific steps that I take my patients through. And all of those worksheets are there. They have worksheets on identifying your obsessions, identifying your compulsions, mindfulness, self-compassion worksheets, things that can remind you and prompt you in the direction of setting up a plan so that you can get moving and make the steps on your own. The fourth thing that you need to know on the first day of your therapy is that there is no such thing as bad thoughts. Let's just sit with that for a second. There is no such thing as bad thoughts. Your thoughts do not define you, nor do your behaviors, that you might have these thoughts that you think are going to really freak you out. You might have this idea, these thoughts, these intrusive, repetitive, scary thoughts, and you might think, "Well, I can't even tell Kimberley about them yet." I will often tell my patients like there is nothing these walls haven't heard, and you probably won't shock me because I haven't been shocked in many, many, many years working as an OCD therapist. I've heard it all. I've heard the most, what people perceive as the grossest thoughts. It's a normal part of the work that we do. And your thoughts are neither good nor bad and they do not define you. And I really make that point made because, as we move forward, I want you to know that I've seen a lot of cases and that "your thoughts aren't special" in that they're not something that I would be alarmed by. The fifth thing that I would tell my patients is that you cannot control your thoughts. And I bet you believe it because you've probably tried over and over again, and all you found is the more you try and control it, the more thoughts you have. The more you try to suppress your thoughts, the more thoughts you have. There are, as we've already discussed, OCD treatment options that will really solidify this concept. Now, the most important one is exposure and response prevention, which is the type of treatment that we use for OCD and is the type of treatment that all of those research articles I discussed before show and direct to as a really successful treatment for OCD. Now, in addition, there are other OCD treatment options. One of those treatment options is OCD treatment with medication. Now, again, when you do that meta-analysis, we have found that a combination of CBT and ERP with medication is the most successful. Now, that doesn't mean you have to take medication, though. I'm never going to tell my patients that they have to take medication. So we can have OCD treatment with medication. We can have OCD treatment without medication. In fact, some of my most difficult cases, the clients, for medical reasons or for personal values reasons, chose not to go on medication. You can still get better. It might make it a little more difficult. You may want to speak with your therapist, or if you're doing this alone, you might need to put in a little extra homework, have a team of support, and people who are really there holding you accountable. Absolutely. But medication is another treatment option that you may want to consider as you move through this process. Now there are also new treatments for OCD recovery. They might include acceptance and commitment therapy, mindfulness practices, self-compassion. We even have some research around dialectical behavioral therapy as other OCD treatment interventions. I will be implementing those as we go, depending on what roadblocks show up. And again, if you're doing this on your own, there are amazing resources that can also help you, and I'll share about those here in a bit. Again, as we've talked about, there is also OCD treatment online. Since COVID-19, we've done a lot of growing in terms of being able to utilize CBT via the internet, via our computers, via our smartphones. A lot of people come to us because they've looked for OCD treatment in Los Angeles, which is where we are. And even though they only live a few miles down the street, they're still doing sessions online because it's so convenient. They can do it at home between sessions with their work or between getting their kids to school. So, OCD treatment online has become a very popular way to also access treatment. And I give these to my clients as we go, because sometimes they're going to need a little extra help. Now, as I've mentioned to you earlier in there, if you don't have access to OCD treatment, there are tons of self-led OCD courses. Again, one of the ones that we offer is ERP School. Now you can go to CBTSchool.com, or you can click the link below in the show notes, where we have all of these courses for OCD and other anxiety disorders. But there are others as well—other amazing therapists who have created similar products. When we're really looking at treatment depending on your age, the treatment does look very similar for OCD treatment for adults and OCD treatment for children. They are very, very similar. With children, we might play more games, have more rewards, use those strategies, but to be honest with you, adults are just big kids in adult bodies. So I really believe that we want to make this as fun as we can. Have rewards. Have there be something that you're working towards. Make it fun. Make it a part of a game. I use a lot of games in treatment and a lot of ERP games because why do we want to make everything boring all the time? Why not make it a little bit fun if we can? Number seven, the main thing I'm going to tell you here, and this is really, really important, is I will not ask you to do something that you don't want to do. I have this in our welcome manual. We don't ask people to do things that go against their values, and we don't ask people to do things that I myself would not do. There are a lot of TV shows that sort of use ERP and exposure work as sort of like doing your worst, worst, worst, worst, worst case. And that's fine. But often we're not doing that. We're doing exposures, we're facing your fears so that you can get back to functioning, so you can get back to d…
Full show notes at the publisherIn the realm of managing anxiety and panic attacks, we often find ourselves inundated with advice on what to do. However, the path to understanding and controlling these overwhelming experiences also involves recognizing what not to do. Today, we shed light on this aspect, offering invaluable insights for those grappling with panic attacks.
Stop doing these things if you are having panic attacks, and do not forget to be kind to yourself every step of the way.
1. DON'T TREAT PANIC ATTACKS AS DANGERIt's a common reaction to perceive the intense symptoms of a panic attack—rapid heartbeat, dizziness, or a surge of fear—as signals of immediate danger. However, it's crucial to remind ourselves that while these sensations are incredibly uncomfortable, they are not inherently dangerous. Viewing them as mere sensations or thoughts rather than threats can create a helpful distance, allowing for more effective response strategies.
2. DON'T FLEE THE SCENEThe urge to escape a situation where you're experiencing a panic attack is strong. Whether you're in a grocery store, on an airplane, or in a social setting, the instinct to run away can be overwhelming. However, leaving can reinforce the idea that relief only comes from escaping, which isn't a helpful long-term strategy. Staying put, albeit challenging, helps break this association and builds resilience.
3. DON'T ACCELERATE YOUR ACTIONSDuring a panic attack, there might be a tendency to speed up your actions or become hyper-vigilant in an attempt to alleviate the discomfort quickly. This response, however, can signal to your brain that there is a danger, perpetuating the cycle of panic. Slowing down your breath and movements can alter your brain's interpretation of the situation, helping to calm the storm of panic.
4. AVOID RELIANCE ON SUBSTANCESTurning to alcohol or recreational drugs as a quick fix to dampen the intensity of a panic attack can be tempting. Nonetheless, this can lead to a dependency that ultimately exacerbates the problem. It's important to let panic's intensity ebb and flow naturally, without leaning on substances that offer only a temporary and potentially harmful reprieve.
5. STOP BEATING YOURSELF UPSelf-criticism and judgment can add fuel to the fire of anxiety and panic. It's vital to adopt a compassionate stance towards yourself, recognizing that experiencing panic attacks doesn't reflect personal failure or weakness. Embracing self-kindness can significantly mitigate the added stress of self-judgment, creating a more supportive environment for recovery.
SEEKING SUPPORTRemember, you're not alone in this struggle. Whether through therapy, online courses, or community support, reaching out for help is a sign of strength. Resources like "Your Anxiety Toolkit" are there to remind you that it's possible to lead a fulfilling life, despite the challenges panic attacks may present.
Lastly, embrace the notion that it's a beautiful day to do hard things. Facing panic with acceptance rather than resistance diminishes its hold over you, opening the door to healing and growth.
TRANSCRIPT:
Stop doing these things if you have panic attacks. I often, here on Your Anxiety Toolkit, talk about all the things you need to do—you need to do more of, you need to practice skills that you can get better at. But today, we're talking about the things you shouldn't do if you are someone who experiences panic attacks, panic disorder, or any other disorder that you also experience panic attacks in. Let's get to it. Let's talk about the things not to deal.
Welcome back. Stop doing these things if you have panic attacks. When I say that, in no way do I mean that the things we're going to discuss you should beat yourself up for. If you're doing any of the things that we talk about today, please be gentle. It is a normal human reaction to do these things. I don't want you to beat yourself up. Please feel absolutely zero judgment from me because even I am someone who needs to keep an eye out for this, keep myself on check with these things when I am experiencing panic attacks as well. Let's go through them.
The number one thing to stop doing if you're having a panic attack is to stop treating them like they are dangerous. If you experience symptoms of panic or you experience panic disorder, you know that feeling. You feel like you're going to die. You feel like your heart is going to explode or implode, or your brain will explode or implode. You'll know that feeling of adrenaline and cortisol rushing around your body. You get it; I get it. It feels so scary. But we must remind ourselves that it's not dangerous, and we can't treat them like they're dangerous. We can't respond to these symptoms as if they're dangerous. We want to instead treat them like they are, which is sensations in the body or thoughts that appear in your brain. Once we can do that, then we have a little bit of distance from them and we can respond effectively.
Now, the second thing I want you to stop doing if you have panic attacks is to never leave. If you are at the grocery store and you're having a panic attack, do not leave the grocery store. If you're on an airplane, boarding an airplane, and you're having a panic attack, do not leave the airplane. If you're in a room and you're experiencing panic, don't leave.
Now, I know in that moment, it can feel so dangerous, as we just discussed, and so scary, but when we leave, we will associate relief with running away, and we actually don't want that. Instead, with panic, we want the relief to be that we wrote it out and we were able to tolerate that feeling and navigate that feeling effectively and compassionately and not from the place of running away and escaping. If you can do one thing, the most important thing to do is to not leave where you're at.
Now, does that mean that you can't take a minute to step away for a second? That's fine. Does it mean that you can't, if you're in a conversation, just say, "Can I have a few minutes? I just need to run to the restroom," or whatever it be, take some time to get yourself back together? That's okay. We're not here to win any races or anything, but do your best not to leave the actual environment or place that you are having the panic attack.
Now, the third thing you can not do if you're having a panic attack is don't speed up your actions. We talk a lot about this in our online course called Overcoming Anxiety and Panic. How you respond to a panic attack can really determine how your brain interprets the event. If you're having a panic attack and you really speed up and you start to act frantic or in an urgent way, and you're sort of like hypervigilant looking around or trying to urgently frantically change something, your brain will interpret that high-paced activity or that speeding up of your actions as if it is a danger, and it will keep sending out hormones like cortisol and adrenaline, which will keep the panic attack and the anxiety going.
What we want to do instead is slow it down, slow your breath down, slow your actions down, really get in tune. If you can just slow it down a little and change how you respond. And what we want to do here—and we do this in Overcoming Anxiety and Panic, if you're interested in taking this course and you don't have access to therapy or you're wanting a step-by-step way of working through generalized anxiety and panic, go ahead and take a look. It's at CBTSchool.com. You can go and check it out there, but if not, you can also do this with your clinician or by yourself—is do an inventory of how you respond when you are panicking. What safety behaviors do you engage in to try and get it to go away? What do you do to respond to it as if it is dangerous? Do you leave? Do you speed up? Do you become hypervigilant? Do you seek reassurance? Do you do mental compulsions?
We can go through and do an audit of those behaviors and see what you're doing to sort of control and manage that anxiety. And we want to really work hard at reducing those behaviors. Do an inventory and get very clear so that next time you are having a panic attack, you can instead change those behaviors or replace them with more effective behaviors. If you're interested again in that course, you can go to CBTSchool.com/overcominganxiety.
Now, the fourth thing you need to stop doing if you have panic is to not rely on substances. And when I say substances, I mean alcohol or recreational drugs. There is a massive overlap between people with panic attacks and panic disorder and substance use, and I get it. Having a quick drink of alcohol can sometimes take the edge off a panic attack. However, once again, if that is your way of coping, you will build a reliance and a dependence on that behavior. And we want to work instead at allowing that discomfort to rise and fall on its own without intervening with ineffective behavior. And recreational substances are a really big no-no if you're someone who is experiencing a panic attack.
Now, that is different from prescribed medications. If you have been prescribed a psychiatric medication and you're following the doctor's orders, that is a different story. And please do go and speak to your doctor about those specific directions. What I'm speaking about right here is substances like recreational drugs or alcohol to help manage that panic attack.
Now, the last thing you need to stop doing if you have panic disorder or panic attacks is you have to stop beating yourself up. Beating yourself up will only make it worse. In fact, we have research to show that the more you criticize yourself, beat yourself up, judge yourself, the more likely you are for your brain to release more anxiety hormones and increase the experience of anxiety and panic. And so, that goes against everything that we want and need. We don't need to add more anxiety to the mix if you're already experiencing a panic attack.
And so, what we want to do here is work at not beating yourself up, not criticizing yourself for having this because it's not your fault. It doesn't mean there's anything wrong with you. It's a normal human reaction to want to run away and do everything you can to make it go away, including drinking substances and doing recreational drugs. We don't want to beat ourselves up, whether you've done those in the past or if you're currently doing them.
If you're struggling, reach out for help. There are clinicians around the world who can help. We have, again, online courses, if you haven't got access or you can't afford those services. There are books, there are podcasts like this one that are free. Do what you can to get support and get help so that you're not doing this alone.
You aren't alone. Thousands and millions of people around the world struggle with panic attacks. Again, they do not mean that there's anything wrong with you. And there are important, very effective skills you can use to manage them, and go on and live a very, very, very, very wonderful, successful, fulfilling life.
Of course, I'm always going to end with this because I always do, but do also remind yourself it is a beautiful day to do hard things. The more you can willingly have panic and allow it to rise and fall on its own, the less power it has over you. So, do remember today is a beautiful day to do hard things.
Thank you so much for being here with me. I look forward to seeing you next week on Your Anxiety Toolkit, and I'll see you there.
Anxiety can often feel like a relentless storm, clouding your thoughts and overwhelming your sense of calm. It's during these turbulent times that finding the right words can be akin to discovering a lifeline amidst the chaos. To aid you in navigating these stormy waters, we've curated a list of 20 empowering phrases based on expert advice. These phrases are designed to validate your feelings, soothe your inner critic, fill you with encouragement, and help you respond proactively to anxiety. Here's how you can incorporate them into your life to foster resilience, kindness, and self-compassion. VALIDATE THE DIFFICULTY "This is hard, and it's okay that it's hard for me." Acknowledge the challenge without judgment. "I'm doing the best I can in this moment." Remind yourself of your effort and resilience. "My feelings are valid and understandable." Affirm the legitimacy of your emotions. "I am human, and having a difficult day is okay." Normalize the ups and downs of human experience. "I give myself permission to feel this while being kind to myself." Embrace your feelings with compassion. SOOTHE THE CRITICAL VOICE "This is not my fault." Release unwarranted guilt and blame. "It's okay that I'm not perfect." Celebrate your humanity and imperfections. "It's okay to make mistakes." View errors as opportunities for growth. "My challenges do not define my worth." Separate your worth from your struggles. "May I be gentle with myself as I navigate this difficult season?" Practice self-compassion and kindness. FILL YOURSELF WITH ENCOURAGEMENT "It's a beautiful day to do hard things." Empower yourself to face challenges. "I can tolerate this discomfort." Recognize your strength and resilience. "This anxiety or discomfort will not hurt me." Acknowledge your capacity to withstand anxiety. "Humans are innately resilient." Remind yourself of your inherent ability to overcome adversity. "I am more than my worst days." Focus on the breadth of your life's narrative. GET CLEAR ON YOUR RESPONSE TO ANXIETY "I REFUSE to lead a life based on fear." Commit to acting on your values. "I choose to speak to myself with understanding and patience." Cultivate a compassionate inner dialogue. "I have already chosen how I'm going to respond, and now I'm going to honor that decision." Preemptively decide on positive actions. "I will treat myself with the same kindness that I offer others." Extend your empathy inward. "I'm going to honor my journey and respect my own pace." Accept your unique path and timing. BONUS PHRASE FOR CONTINUOUS SUPPORT "We are just going to take one step at a time." Focus on the present moment to manage overwhelm. These phrases, thoughtfully designed to address different facets of anxiety, are tools at your disposal. Use them to navigate through moments of anxiety, to remind yourself of your strength, and to cultivate a kinder relationship with yourself. Remember, it's not about employing all of them at once but finding the ones that resonate most with you. Anxiety is a complex and deeply personal experience, and thus, your approach to managing it should be equally personalized. Let these phrases be your guide as you continue on your journey toward a more peaceful and empowered state of being. TRANSCRIPTION: Here are 20 phrases to use when you are anxious. Now I get it, when you're anxious, sometimes it's so hard to concentrate. It's so hard to know where you're going, what you want to do, and it's so easy just to focus on anxiety and get totally stuck in the tunnel vision of anxiety or feel completely overwhelmed by it. Today, I want to offer you 20 phrases that you can use when you're feeling anxious or experiencing OCD. These are yours to try on and see if you like them. You don't have to use all of them. They're here for you to use as you wish, and hopefully, they're incredibly helpful. All right, my loves, let's talk about the 20 phrases you can use when you're feeling anxious. Now, I have prepared these in four different steps. You can actually go through and pick one or several of these and go through these, write them down, and have them in your pocket or in your wallet, or whatever you want, a sticky note on your fridge to use as you need. These are to help guide you towards a life where you lean into your fear. You treat yourself kindly. You encourage yourself. You champion the direction you want to go in. And my hope is that you can use these in many different scenarios, and they can help you get to the life that you want. Let's go and do it. The first category is validate the difficulty. Most people, when they're anxious, they get caught up in this wrestle of, "I shouldn't have this. Why do I have it? It's not fair," and I totally get it. But what we want to do is first validate the difficulty. If you can say that, and you can do that by using one of these five phrases: Number one, "This is hard, and it's okay that it's hard for me." Again, let's say it together. "This is hard, and it's okay that it's hard for me." The second phrase that I'm going to offer to you is, "I'm doing the best I can in this moment." The truth is, you are doing the best you can with what you have and given the circumstances. I want you to remember that as best as you can as well. Number three, "My feelings are valid and understandable." If anybody else was in this exact situation, they'd probably be thinking, feeling, and acting in the same way. The fourth one is, "I am human, and having a difficult day is okay." Not only is it okay, it's normal. Humans have difficult days. This is a total normal part about being human. You might be having an immense amount of anxiety, but please do remember the millions of other human beings around the globe who are having a very similar experience to you. It doesn't mean there's anything wrong with you. And then the fifth way I want you to validate the difficulty is to say, "I give myself permission to feel this while being kind to myself." Remember I said "while." I give myself permission to feel this way while being still kind to myself. Let's move on to the second category, which is soothing the critical voice. I know when we have anxiety, we can be really, really hard on ourselves. The phrase I want you to practice or trial is, number one, "This is not my fault." And it's not your fault. You did not ask for this. You can't stop the fact that your brain sometimes gets hijacked and throws a bunch of anxiety or thoughts, or feelings towards your urges. It is not your fault. The second one is, "It's okay that I'm not perfect." Nobody is. We want to remember that this is our first time being a human and we're not going to get it right the first time. It's okay that you're not perfect, nobody is. You might also want to try the phrase, "It's okay to make mistakes." That is how I learn and grow. Remember here of all the people who have succeeded in their recovery, or all the people who are succeeding in other areas of their life, they didn't get there because of easy, breezy times. They got there by making mistakes, and they'd keep going and they keep trying, and they'd go again and they go again and they learn and they grow. The next thing you may want to try on, and another phrase you can use is, "My challenges do not define my worth." You're not either better or worse for having this anxiety. You're not less than or more than depending on whether you have a mental illness or not. Your worth is not something that's up for discussion, and it's not up for measurement. We all have equal worth. And this challenge that you're experiencing or this anxiety you're experiencing does not define your worth. Now, the last one I want you to practice here, you can actually practice more from a meditation or a meditation practice, which is a practice of loving kindness. We could call it a metta meditation or a loving-kindness meditation. And the goal from this is to actually meditate on sending yourself loving kindness. Now, if you're someone who wants to learn how to do this, we have an entire meditation vault called the Meditation Vault, where I have created over 30 different meditations for people, specifically with anxiety, to help you practice meditation and learn how to practice loving kindness. You can go to CBTSchool.com to learn more about that. I would, again, need to spend a whole other episode talking to you about that. But if you want to practice the art of sending yourself loving kindness, you can go there to learn more. But for right now, to finish out this category, what we want to do is practice one of those meditations, which is to offer yourself the phrase, "May I be gentle with myself as I navigate this difficult season?" What we are doing here is we're offering ourselves a promise per se of saying, "May I be gentle with myself?" In a true loving-kindness meditation, often what we do say is, "May I be happy? May I be well? May I live with ease?" And if you particularly like my voice and it feels very soothing to you, all of those meditations are there in the meditation vaul, and we go through that extensively. The next section is to fill yourself up with encouragement. Now, when we are anxious, it's easy to feel very discouraged and just want to run away and change every part of our plans for the day. But what we want to do is we want to fill yourself up with encouragement. Here are some phrases that you can use to help with that goal. Number one, you know I'm always going to say this, "It's a beautiful day to do hard things." We can do hard things. We have to keep repeating this to ourselves. You may even want to add some sass to it and add a little swear word. A lot of my patients have said, "It's a beautiful day to blank hard things." Now that's okay too. You can sass it up, whatever feels most empowering to you. Another way you can fill yourself up with encouragement is to offer yourself the phrase, "I can tolerate this discomfort," because you can, and you have, and you will. "I can tolerate this discomfort." Another thing you can offer is, "This anxiety or this discomfort will not hurt me. I am stronger than I could ever know." And the truth is, anxiety does not hurt you. It's uncomfortable, and it's painful. I understand that. But it won't hurt you. It won't damage you. It won't destroy you, that we're stronger than we could ever, ever believe we could be. The next thing you may offer to yourself, and this is one that I particularly love, is that humans are innately resilient. They do most of their growing through hard things. And I've already mentioned this to you before. Most of the really successful people got there, not because it was easy and breezy; it's because we are resilient, and that's how we grow, and that's how we learn, that we can get through very, very difficult things. And then the last thing is, "I am more than my worst days." That this might be a difficult day, but I am more than this difficult day. There's a bigger story here for me. This uncomfortable moment or this uncomfortable day is just a part of that story. But the bigger picture is that I am much more than these hard, difficult days. And then the last category, which you have to also include, is to get very clear on how you are going to respond. This is where we get a little more firm with ourselves in the phrases. You will hear, I get a little sassy myself in this, and we get a little more decisive or confident. Even if you don't feel confident, we want to speak in this confident, assured way. Number one is, "I REFUSE," and I've written refuse in capital letters. "I REFUSE." And I say this to myself, I want you to say this to yourself. "I REFUSE to lead a life based on fear." I will move forward, acting on my values and my beliefs, and who I want to be. That's the first phrase. And we want to emphasize, "I refuse to act out on this fear." The second is, "I choose to speak to myself with understanding and patience." I'm choosing that because it's so easy to fall back into criticism and blame and humiliation and critical self-punishing words. I choose to speak to myself with understanding and patience. Now, the third one involves you being very proactive. Now, I'll give you the phrase first, and then I'll explain it to you. The phrase is, "I have already chosen how I'm going to respond, and now I'm going to honor that decision." What I want you to do, if you are someone with anxiety, is to create a plan ahead of time—to have a plan on how you are going to respond to anxiety. Now, if this is difficult for you, we have two courses that I want you to rely on. Number one is Overcoming Anxiety and Panic, and the other one is ERP School. And that's for people with OCD and health anxiety. If you're someone who struggles with generalized anxiety or panic or OCD, you are going to need a plan ahead practice. You're going to need to know what fear and obsessions and thoughts and fear and all the things get you to do normally. And then you're going to have to be able to break that cycle with a specific plan on attack on how you're going to handle that. And we go through those steps in those two courses or any of our courses. We break it down so that you have a specific plan on how you're going to handle this, what you're going to do, what you're not going to do, how you're going to treat yourself, and so forth. If you haven't got a therapist and you want to learn how to do that, head over to CBTSchool.com. Those courses, there is low cost as we could make them, and they're there for you to help you have a plan so that you can say to your anxiety when you're struggling, "I've already chosen how I wish to respond, and now I'm going to honor that decision. " Now, the reason that I say that phrase that way is when you have a plan up ahead head, that's one part of it, but then you have to honor your plan. And what often happens is, when we have a plan and we don't honor that plan, that's often when we start to feel like we distrust ourselves. We feel like we've let ourselves down. And so what we want to do is we want to make a plan, and then we want to choose to honor that plan. And by honoring the plan that you set out -- and I'm not going to tell you what that plan should be. The cost isn't going to tell you what you have to do. You get to decide that for yourself based on your own core values. But once you do that, and when you follow through by honoring that decision that you made ahead of time, that's when you start to trust yourself. That's when you start to really feel empowered. That's when you start to break that cycle of anxiety because you've stood firm on the ground on what your plan was and how you're going to show up. I'll repeat it again. "I have already chosen how I want to respond, and now I'm going to honor that decision because I matter, and this is my life, and I want to follow through in the way I said I would." Now, the fourth one is, "I w…
Full show notes at the publisherTHE RISING TIDE OF TEEN DEPRESSION: UNDERSTANDING AND ADDRESSING A MODERN CRISIS In recent times, the specter of teen depression has loomed larger than ever before, casting a long shadow over the lives of young individuals across the globe. With reports indicating a significant upsurge in cases of depression among adolescents, the need to unravel the complexity of this issue and explore effective strategies for intervention has never been more urgent. At the heart of the matter is the alarming statistic that suicide rates among teenagers aged 15 to 19 have surged by 76% since 2007, with a particularly distressing increase observed in teen girls. The rates of suicide have doubled among female teens compared to their male counterparts, underscoring a gendered dimension to the crisis. Moreover, the youngest demographic, children between the ages of 10 and 14, has witnessed the highest rate of increase in suicide across all age groups, a fact that underscores the severity and early onset of mental health challenges in today's youth. This escalation in teen depression and suicidal ideation can be attributed to a myriad of factors, ranging from societal pressures and the rapid pace of cultural shifts to the unique challenges posed by the digital age. The omnipresence of social media and technology, while offering new avenues for connection, has paradoxically fostered a sense of isolation and disconnection among adolescents. The digital landscape, with its relentless comparison and instant feedback loops, has exacerbated feelings of inadequacy, anxiety, and despair among young people. Furthermore, the impact of depression is not confined to any single demographic. Contrary to previous beliefs that African-American families were less likely to experience suicidal ideation, recent research has unveiled an elevated risk among African-American boys aged five to 11. This revelation challenges preconceived notions about the protective factors supposedly inherent in certain communities and underscores the indiscriminate nature of mental health challenges. The narrative surrounding teen depression and despair is further complicated by the conflation of despair with clinical depression. While depression is a diagnosable condition characterized by a specific set of symptoms persisting over time, despair can embody similar feelings of hopelessness and sadness without necessarily meeting the criteria for a clinical diagnosis. This distinction is crucial for understanding the breadth and depth of the emotional turmoil experienced by adolescents, which may not always fit neatly into diagnostic categories. Addressing this burgeoning crisis requires a multifaceted approach, centered around the power of connection and the cultivation of resilience. Building resilience in young people involves fostering internal coping mechanisms as well as providing robust external support systems. Parents, educators, and mental health professionals play a pivotal role in modeling healthy coping strategies and offering unwavering support to adolescents navigating the tumultuous waters of mental health challenges. One of the key strategies for combatting teen depression involves nurturing meaningful connections between young people and their caregivers. The act of showing up for adolescents in both significant moments and the mundane details of daily life can have a profound impact on their sense of belonging and self-worth. Consistency in presence and support, coupled with genuine engagement in activities that resonate with the interests of young people, can fortify their emotional resilience and counteract feelings of isolation and despair. In the digital realm, it is imperative to strike a balance between leveraging technology for connectivity and mitigating its potential negative impacts on mental health. Encouraging responsible and mindful use of social media, fostering face-to-face interactions, and emphasizing the importance of digital detoxes can help alleviate the pressure and anxiety associated with online environments. As society grapples with the escalating crisis of teen depression, it becomes increasingly clear that a collective effort is required to address the underlying causes and provide a supportive framework for adolescents. By prioritizing mental health education, advocating for comprehensive support services, and fostering an environment of openness and understanding, we can begin to turn the tide against teen depression. In doing so, we not only alleviate the immediate suffering of young individuals but also lay the groundwork for a healthier, more resilient generation. TRANSCRIPTION Kimberley: Welcome, everybody. I am so delighted to have our guest on today, Dr. Chinwé Williams. Welcome, Dr. Chinwé Williams. I'm so happy to have you here. Chinwé: Oh, I'm so excited to be here. Thanks so much for having me. Kimberley: As I said to you, several months ago, I was having a massive influx of cases of teens, my teen clients and my staff's teen clients reporting really strong waves of depression, including not just my clients, but also my pre-teen, also reporting that that's what some of our friends are reporting. I think it's everywhere. And I really feel that, even though we always talk about anxiety here, I really wanted to make sure we're addressing the really high rates of depression and despair in teens. So, thank you for writing the most wonderful book. As I went to research that, I found your book, it's called, Seen: Despair and Anxiety in Kids and Teenagers and the Power of Connection. So, thank you for writing that book. Chinwé: Thank you so much for reading it. Yes. Kimberley: Yes, I actually listened to it. So, I actually got to hear your voice, which I thought was really beautiful because you and Will Hutcherson, who wrote it, it was lovely. You bounced back and forward between the two of you. Chinwé: Yes, we did. We did. Kimberley: What made you decide to write this book? Chinwé: I started my career as a high school counselor, my goodness, probably now 18 years ago, which is so weird for me to admit that, or even wrap my mind around that. And I loved working with adolescents. And in the particular high school that I was working at, we were really, really able to do the work of promoting and supporting the mental and emotional well-being of students, not just the academic well-being. And a lot of my school counselor friends at other schools, they were really focused on the schedule and post-secondary options, and SATs. So, I was really fortunate to be at a school where I saw students almost like how I'm seeing clients clinically, 10 o'clock, 11 o'clock, 11:15, 11:30. And so, that was such a great experience for me, especially early in my career. The reason we wrote the book is because, back then, 18 years ago, I saw a little bit of self-harm. I saw anxiety. I saw depression. I certainly saw despair. I saw kids, students struggling with relationships, struggling with, what is my future going to look like? However, what we are seeing today, what I am seeing in my clinical practice, I still work with adolescents, but I do work with a great deal of adults. I work with parents and families, and I have conversations with just my friends and people that I'm doing life with. The episodes or experiences of anxiety and depression has really just increased significantly. Kimberley, I am sure that you are so aware of just the stats that are out there that really point to the shift that's occurred in our culture, specifically as it relates to youth mental health. Just for example, and this seems like such a long time ago, but I think it really gives us an idea of how much has changed, a good bit has changed in a relatively short period of time. But the stats are pointing to the fact that since 2007, suicide rates have increased a whopping 76% for teenagers between the ages of 15 and 19. So 76%. So the bulk of that number really is pointing to how our teen girls are struggling. Suicide rates are double in teen girls versus our boys. The highest rate of increase in suicide among all age groups—and this is where I always have to take a deep breath still—is in kids. These are kids between the ages of 10 and 14 is what the research is showing. The alarming part of this whole thing is that we're seeing younger and younger kids impacted by what we sometimes think of as, yes, adolescence is tough. There are hormones. There's social pressures. There are academic pressures. Kids are worried about the future. Well, younger and younger kids are also being impacted by feelings of hopelessness and discouragement. And the other thing—you and I talked about this before we started recording. The other thing that's been really shocking for a lot of people to learn is when I started my career, way back in the day, we were told that families of color, specifically African-American families, were really the least likely to take their own lives. But what we have learned recently, and this is a stat that has really shocked, but also confused and confounded a lot of clinicians, as well as mental health researchers, is that there's an elevated risk of suicidal thoughts for African-American boys between the ages of five and 11. So once again, just younger and younger kids are experiencing really hopeless feelings, but we are seeing the most anxiety, the most despair, and depression among adolescents and young adults. So that's why we wrote the book. Kimberley: I get teary just hearing about it. My heart aches, and I feel like it's a crisis. It's a crisis that they're experiencing and parents. I think what was really also very beautiful that you talked in the book about how, I think, even as clinicians, we perceive kids who are struggling with, "Oh, they must have gone through a trauma." But also, it's just kids who haven't been through a trauma. I mean, I think the COVID in and of itself and all of the unrest of our world is traumatic for everybody. But it was also very validating to see that this is also for reasons that we yet don't really understand. Do you want to speak to that at all? Chinwé: Yes, absolutely. So in the book, I wrote about clients that I've experienced throughout the years. I've changed factors and variables that would easily identify them. But many people will point to some of the illustrations in the book that are of kids who come from really supportive families. Many of them are high achieving. Many of them have a lot of resources that they just have access to, and yet they still experience levels of anxiety, sadness, even are self-harming, even espouse suicidal thoughts, or we call it suicidal ideation. What that tells us, again, I think just sort of zooming out, is the bigger picture of just so many things that have shifted in our culture, so many things that have shifted from a societal perspective where young people are feeling disconnected, they're feeling more anxious, they are more resourced. The research tells us that Gen Alpha and Gen Z are the most diverse, more resourced, tech-savvy. They're so connected to the technological and global world, but they feel so disconnected oftentimes from themselves, from their family members, and also their friends. And so, I think it really is so interesting that it really speaks to, regardless of the walk of life or where you or your family falls from an income perspective, none of us are immune. I try to be pretty transparent. My daughter has given me permission to share. She is 20 years old. She's in college. She is brilliant and kind and thoughtful and highly sensitive and gifted and has a mother who's a mental health professional. And at 13, she experienced high, high anxiety and high levels of despair. And again, she's given me permission to share, and I do share this when I talk to parents and educators across the country, and I'm so grateful that she's given me that permission. But just to show that she had resources. She was in private school. She's my bonus daughter. She had support from me, her dad, and also her biological mom, and her grandparents, and she still experienced what a lot of kids across the country are experiencing. Kimberley: I'm so grateful you share that. I think that that's it too. We would assume that if your bonus mom is a therapist and you have all the resources, it just wouldn't happen to you. But it doesn't discriminate, does it? It can affect any family. As a clinician, I don't think I was really trained to really understand that either. I was trained to think like, okay, there must be something wrong with the family, they must be fighting at home, or there must be discord at home, or so forth. So I'm so grateful that you share that. And thank you to her. How brave and wonderful that she struggled and obviously came through on the other side, absolutely. In the book, this blew my mind, really, honestly. I'm almost embarrassed to say, but it blew my mind that you described that there is a difference between despair and depression. Can you share what that is all about? Chinwé: Yes. As you know, depression is a clinical term. It's a diagnosis that has a set of symptomology that's connected to it. So, we as clinicians are looking for certain symptoms that exist more days than not over a two-week period of time, right? At that two-week mark, I'm starting to pay a lot of attention when parents are sharing what's happening with their kids. Because when you're an adolescent, we know that hormones will shift your mood, you'll be high on something that you're watching on TV. Not high literally, because we got to make that distinction. You're not vaping or using marijuana, but you're feeling euphoric and you're elated about something maybe you're seeing on television. And then you look down at your phone, or your mom asks you to clean your room or do your work. And then you can look like you have a level of despair. But that may not be the case, right? We know with adolescents, there are just normal ups and downs that are just a part of that stage of development. So it's important to really share that in order to get a diagnosis of depression. You want to see a number of symptoms for a period of time that really impact your child's level of functioning in a persistent and pervasive way. Maybe they're not functioning as well as they normally would at school or if they have an after-school job or an extracurricular activity or you're noticing that some things at home. So those are some things that we look at from a clinical perspective. Now, despair is something different, but not by a whole lot. There's a whole lot of overlap, and we do go into it with pretty great in-depth in the book, but essentially, despair really has a lot of those same symptoms of depression where you're feeling lethargic, perhaps low energy. You struggle with thoughts that tell you maybe that you're not enough, you're inadequate, or inferior. Sometimes you don't feel like doing those things that you normally love to do. In clinical terms, we call it anhedonia, right? Those things that you typically enjoy that make you happy—playing with your pet, going for a walk, hanging out with your friends. If you're not doing those things, we do start to wonder about some mood issues, some internalizing disorders. So, anxiety, mood issues such as depression, but with despair, and we make this distinction on purpose with intentionality, and here's why. Despair does share a lot of the symptoms as depression, but it doesn't need to meet the criteria for major depression for us to really know that is a tough place to be. And many of us, especially young people, we may…
Full show notes at the publisherIn the realm of mental health, the role of an anxiety therapist is often shrouded in mystery and misconceptions. To shed light on this crucial profession, Joshua Fletcher, also known as AnxietyJosh, shares insights from his latest book, "And How Does That Make You Feel?: Everything You (N)ever Wanted to Know About Therapy," in a candid conversation with Kimberley Quinlan on her podcast. Joshua's book aims to demystify the therapeutic process, offering readers an intimate look behind the therapy door. It's not just a guide for those struggling with anxiety but an engaging narrative that invites the general public into the world of therapy. The book's unique angle stems from a simple yet intriguing question: Have you ever wondered what your therapist is thinking? One of the book's key revelations is the humanity of therapists. Joshua emphasizes that therapists, like their clients, are complex individuals with their own vices, flaws, and inner dialogues. The book begins with a scene where Joshua, amidst a breakthrough session with a client, battles an array of internal voices—from the biological urge to use the restroom to the critical voice questioning his decision to drink an Americano right before the session. This honest portrayal extends to the array of voices that therapists and all humans contend with, including anxiety, criticism, and analytical thinking. Joshua's narrative skillfully normalizes the internal chatter that professionals experience, even as they maintain a composed exterior. The conversation also touches upon the diverse modalities of therapy, highlighting the importance of finding the right approach for each individual's needs. Joshua jests about "The Yunger Games," a fictional annual event where therapists from various modalities compete, underscoring the passionate debates within the therapeutic community regarding the most effective treatment methods. A significant portion of the book delves into the personal growth and challenges therapists face, including dealing with their triggers and the balance between professional detachment and personal empathy. Joshua shares an anecdote about experiencing a trigger related to grief during a session, illustrating how therapists navigate their emotional landscapes while maintaining focus on their clients' needs. The awkwardness of encountering clients outside the therapy room is another aspect Joshua candidly discusses. He humorously describes the internal turmoil therapists experience when meeting clients in public, highlighting the delicate balance of maintaining confidentiality and acknowledging the shared human experience. Joshua's book, and his conversation with Kimberley, paint a vivid picture of the life of an anxiety therapist. It's a role filled with challenges, personal growth, and the profound satisfaction of facilitating others' journeys toward mental wellness. By pulling back the curtain on the therapeutic process, Joshua hopes to demystify therapy, making it more accessible and less intimidating for those considering it. In essence, being an anxiety therapist is about embracing one's humanity, continuously learning, and engaging in the most human conversations without judgment. It's a profession that requires not only a deep understanding of mental health but also a willingness to confront one's vulnerabilities and grow alongside their clients. Through his book and the insights shared in this conversation, Joshua Fletcher invites us all to appreciate the intricate dance of therapy—a dance that, at its best, can be life-changing for both the therapist and the client. Transcript: Kimberley: I'm very happy to have back on the show Joshua Fletcher, a dear friend of mine and quite a rock star. He has written a new book called And How Does That Make You Feel?: Everything You (N)ever Wanted to Know About Therapy. Welcome back, Josh. Joshua: It's good to be back. Thanks, Kim. When was the last time we spoke together on a podcast? I think you were on The Disordered podcast not so long ago. That was lovely. But I remember my guest appearance on Your Anxiety Toolkit was lovely. HOW DOES THAT MAKE YOU FEEL? Kimberley: I know. I'm so happy to actually spend some time chatting with you together. I'm very excited about your new book. It's all about therapy and anxiety and what it's really like to be an anxiety therapist and the process of therapy and all the things. How did this book come about? Joshua: I wanted to write a book about people who struggle with anxiety, but in the mainstream, because a lot of the literature out there is very self-help, and it's in a certain niche. One of my biggest passions is to write something engaging with a nice plot where people are reading about something or a storyline that they're interested in whilst inadvertently learning without realizing you're learning. That's my kind of entertainment—when I watch a show and I've learned a lot about something or when I've read a book and I've inadvertently learned loads of things because I'm taking in the plot. With this book, I wanted to write a book about therapy. Now, that initially might not get people to pick it up, might not interest you, might not interest you about anxiety therapy, but I wanted to write something that anyone could pick up and enjoy and learn lots because I want to share our world that we work in with the general public. And so, the hook that I focused on here was, have you ever wanted to know what your therapist is thinking? And I thought, well, I'm going to tell people what I'm thinking, and I'm going to invite people behind the therapy door, and you're going to see what I do and what's going on in my head as I'm trying to work with people who struggle with mental health. I wrote the pitch for it. People went bananas, and they loved it because it's not been done before. Not necessarily a good thing if it's not been done before. And here we are. I love it. I'm really proud of it. I want people to laugh, cry, be informed. If you go on a journey, learn more about therapy, learn more about anxiety. All in one book. THERAPISTS ARE HUMANS TOO Kimberley: Yeah. I think that one of the many cool things about it is, as a therapist, people seem to be always very curious or intrigued about therapists, about what it's like and what it's like to be in a room with someone who's really struggling, or when you're handling really difficult topics, and how to be just a normal human being and a therapist at the same time. Joshua: Yeah. What I want to write about is to remind people that therapists are humans. We have our vices and flaws. I'm not talking on behalf of you, Kim. I'm sure you're perfect. Kimberley: No, no. No, no. Flawed as flawed could be. Joshua: Yeah, but to a level that it's like, even our brains have different voices in them all the time, different thought processes as part of our rationalization. And I want people to peer inside that and have a look. So, one of them is like the book opens with me and a client and it's going really well, and this person's talking, this character's talking about where they're up to, and celebrating on the brink of something great. And then there's the voice of biology that just pops into the room, into my head. And it's the biology of you need to go to the toilet. Why did it? And then the voice of critic comes in and says, "Why did you drink an Americano moments before this client?" Now you're sat here, and you can leave if you want, but it would be distasteful. And you're on this brink of this breakthrough. And so, I've got this argument going on in my head, going, "You need the toilet." "Yeah, but this person's on a breakthrough." And then I got empathy, like, "Yeah, but they feel so vulnerable. They want to share this." And then you've got analytical and all the chaotic conversations that are happening as a therapist as I'm sat there nodding and really wanting the best for my client. THE VOICES IN OUR HEAD Kimberley: Exactly. That's why I thought it was so brilliant. So, for those of you who haven't read it, I encourage you to, but Josh really outlines at the beginning of the book all of these different voices that therapists and all humans have. There's the anxiety's voice and there's biology, which you said, like, "I need to go to the restroom," or there's the critic that's judging you, or there's the analytical piece, which is the clinical piece that's making sense of the client and what's going on and the relationship and all the things. And I really resonated with that because I think that we think as clinicians, as we get better and more seasoned, that we only show up with this professional voice we're on the whole time, but we're so not. We're so not on the whole time. This whole chatter is happening in the background. And I think you did a beautiful job of just normalizing that. Joshua: Thanks, Kim. It's a book that therapists will like, but do you know what? People will identify their own voices in this, particularly the anxiety. You and I talk about anxiety all day every day, always beginning with what if—that voice of worry that sits around a big table of thoughts and tries to shout the loudest and often gets our attention. And I tried to show that this happens to a lot of people as well. It's just the what-if is different. So, for some people, it's, "What if this intrusive thought is true?" For some people, it's, "What if I have a panic attack?" For some people, it's, "What if this catastrophe I've been ruminating on for so long happens?" For therapists, it's, "What if the worst thing that happens here, even in the therapy room?" I'm an anxiety therapist that has been through anxiety, and I still get anxiety because I'm human. So, I celebrate these voices as well. Also, because I'm human, I can be critical almost always of myself in the book. So, I'm not just criticizing the people I'm working with. Absolutely not. But that voice comes in, and it's about balancing it and showing the work and what a lot of training to be a therapist is. It's about choosing the voice. And I didn't realize how much training to be a therapist actually helps me live day-to-day. Actually, I'm more rational when making more life decisions because I can choose to observe each voice, which was integral to me overcoming an anxiety disorder, as well as just facing life's challenges every day. WHAT IS IT LIKE TO BE A THERAPIST? Kimberley: Right. Because we're really today talking a lot about what it's ACTUALLY like to be a therapist—and I emphasize the word 'actually'—what is it actually like to be a therapist, if we were to be really honest? Joshua: One thing I mentioned is that I talk about the therapeutic hour, which is how long, Kimberley? Kimberley: Fifty minutes. Joshua: Yeah. The therapy took out and I explained what we do in the 10 minutes that we have between clients on a busy day. And people imagine us doing meditation or grounding ourselves or reflecting or whatever. Sometimes I do do that. Sometimes I just scroll Reddit, look at memes, eat candy, and do nothing. And it's different each time. That's what I'm doing. I'm not some mystic sage in my office, sitting sinisterly under the lamplight waiting for you to come in. No, I'm usually faffing around, panicking, checking that I don't look like a scruff, putting a brush through my hair, trying to hide the stains of food I've got on my shirt because I overzealously consume my lunch. And there's obviously some funny stories in there, but also there's dark stuff in there as well. When I trained to be a therapist, I went through grief, and I made some quite unethical decisions back when I was training. Not the ones I'm proud of, but it actually shows the serious side of mental health and that a lot of therapists become therapists because of their own journeys. And I know that that applies to a lot of therapists I know. Kimberley: For sure. I have to tell a story. A few months ago—I'm a member of lots of these therapist Facebook groups—one of the therapists asked a question and said, "Tell me a little bit what your hour looks like before you see a client. What's your routine or your procedure pre-clients?" And all these people were saying, "I journal and I meditate and all of these things." Some people were like, "I water the plants and I get my laptop open." And I just posted a meme of someone who's pushing all the crap off my table and screeching into the computer screen and being like sitting up straight. And all of these people responded like, "Thank God," because all the therapists were beautifully saying, and I just came in here honestly, "Sometimes I literally sit down, open the laptop, and it is a mess. But I can in that moment be like, 'Take a breath,' and be like, 'Tell me how you're doing.'" Like you said, how does that end? We start the therapeutic hour. And I think that we have to normalize therapists being that kind of person. Joshua: Definitely. I think one of the barriers to people seeking therapy is that power dynamic, that age-old trope that someone stood leaning against a mahogany bookcase. You've probably got a mahogany bookcase. Your practice is really nice. I certainly have. I've got an Ikea KALLAX unit full of books I've never read. Kimberley: Exactly. Your books aren't organized by color because mine are not. Joshua: No, no. There's just some filler books in there. Just like, why is Catcher in the Rye? Why is Catcher in the Rye? I don't know, I just put it on there. I just want to look clever. Anyway, it's like people are afraid of that power dynamic of some authority figure going in there about to judge them, mind-read them, shame them, or analyze them. And no, I think dispelling that myth by showing how human we are can challenge that power dynamic. It certainly did for me. I would much rather open up to someone who isn't showing the pretense that they have all of life together. Don't get me wrong, professionalism is essential, but someone who's professional and human, because going to therapy is some of the most human experiences you'll ever do. I don't want someone who isn't showing too scared to show that sign or certain elements of being human, but obviously professionally. And it's a fine balance to get. But when you do find a therapist like that, for me personally, one who's knowledgeable, compassionate, empathetic, has humility, I think beautiful things can happen. Kimberley: Yeah. I think you use the word that I exactly was thinking of, which is, it's such a balancing act to, as a therapist, honor your own humanity from a place of compassion. Like, yeah, we're not going to have it all together and it's not going to be perfect, and we won't say the right thing all the time. But at the same time, be thoughtful and have the skills and the supervision to balance it so that you are showing up really professional and from that clinical perspective. DO THERAPISTS GET CONSULTATION? Tell me a little bit about consultation as a clinician. I know for me, I require a lot of consultation for cases, not because I don't know what I'm doing, but I'm always going to be honest with the fact that maybe I'm seeing it from a perspective that I h…
Full show notes at the publisherIn the realm of mental health, the significance of structured daily routines for depression cannot be overstated. Kimberley Quinlan, an anxiety specialist with a focus on mindfulness, Cognitive Behavioral Therapy (CBT), and self-compassion, emphasizes the transformative impact that Daily Routines for Depression can have on individuals grappling with this challenging condition. Depression, characterized by persistent feelings of sadness, hopelessness, and a lack of interest in once-enjoyable activities, affects every aspect of one's life. Quinlan stresses that while professional therapy and medication are fundamental in the treatment of depression, integrating specific daily routines into one's lifestyle can offer a complementary path toward recovery and mental wellness. THE POWER OF MORNING ROUTINES FOR DEPRESSION Starting the day with a purpose can set a positive tone for individuals battling depression. Quinlan recommends establishing a consistent wake-up time to combat common sleep disturbances associated with depression. Incorporating light physical activity, such as stretching or a gentle walk, can significantly boost mood. Mindfulness practices, including meditation, journaling, or gratitude exercises, can help foster a healthier relationship with one's thoughts and emotions. Additionally, a nutritious breakfast can provide the necessary energy to face the day, an essential component of "Daily Routines for Depression." DAYTIME ROUTINES FOR DEPRESSION Throughout the day, setting realistic goals and priorities can help maintain focus and motivation. Quinlan advocates for the inclusion of pleasurable activities within one's schedule to counteract the anhedonia often experienced in depression. Techniques like the Pomodoro Method can aid in managing tasks without becoming overwhelmed, breaking down activities into manageable segments with short breaks in between. Exposure to natural light and ensuring a balanced diet further contribute to improving mood and energy levels during the day. EVENING ROUTINES FOR DEPRESSION As the day draws to a close, engaging in a digital detox and indulging in relaxation techniques become crucial. Limiting screen time and investing time in hobbies or skills can provide a sense of accomplishment and fulfillment. Establishing a calming bedtime routine, including activities like reading or taking a bath, can enhance sleep quality, an essential factor in "Daily Routines for Depression." WEEKLY ACTIVITIES TO OVERCOME DEPRESSION Quinlan also highlights the importance of incorporating hobbies and community engagement into weekly routines. Finding a sense of belonging and purpose through social interactions and new skills can offer a much-needed respite from the isolating effects of depression. NAVIGATING TOUGH DAYS WITH COMPASSION Acknowledging that the journey through depression is fraught with ups and downs, Quinlan advises adopting a compassionate and simplified approach on particularly challenging days. Focusing on basic self-care and seeking support when needed can provide a foundation for resilience and recovery. In conclusion, Daily Routines for Depression are not just about managing symptoms but about rebuilding a life where mental wellness is prioritized. Through mindful planning and self-compassion, individuals can navigate the complexities of depression and move towards a more hopeful and fulfilling future. PODCAST TRANSCRIPT If you're living with depression today, we are going to go through some daily routines for your mental wellness. Welcome. My name is Kimberley Quinlan. I'm an anxiety specialist. I talk all about mindfulness, CBT, self-compassion, and skills that you can use to help you with your mental wellness. Let's talk about living with depression, specifically about daily routines that will set you up for success. My goal first is to really highlight the importance of routines. Routines are going to be the most important part of your depression recovery, besides, of course, seeing your therapist and talking with your doctor about medication. This is the work that we do at home every day to set ourselves up for success, finding ways that we can manage our depression, overcome our depression by tweaking the way in which we live our daily life because the way we live our lives often will impact how severe our depression can get. There are some behaviors and actions that can very much exacerbate and worsen depression. And there are some behaviors and routines that can very much improve your depression. So, let's talk about them today. DEPRESSION SYMTPOMS Let's first just get really clear on depression and depression symptoms. Depression is a common and can be a very serious mental illness and medical condition that can completely negatively impact your life—the way you feel, the way you think, the way you act. It often includes persistent feelings of sadness, emptiness, hopelessness, worthlessness that can really impact the way you see yourself and your own identity. It often includes a lack of interest in pleasure in the activities that you once enjoyed. Depression symptoms can vary from mild to very severe. They can include symptoms such as changes in appetite, sleep disturbances, loss of energy, excessive guilt, difficulty thinking or concentrating. Sometimes you can feel like you have this whole brain fog. And again, deep, overwhelming feelings of worthlessness and hopelessness. Now, it is important to recognize that depression is not just a temporary bout of sadness. It's a chronic condition. It's one that we can actually recover from, but it does require a long-term treatment plan, a commitment to taking care of yourself, including therapy and medication. So, please do speak to your medical professional and a mental health professional if you have severe depression or think you might have severe depression. It can also include thoughts of wanting to die and not feeling like you want to live on this earth anymore. Again, if that's something that you're struggling with, please go to your local emergency room or immediately seek out professional mental health or medical health care. It is so important that you do get professional help for depression because, again, depression can come down like a heavy cloud on our shoulders, and it tells a whole bunch of lies. We actually have a whole podcast episode about how depression is a big fat liar. And sometimes when you are under the spell of those lies, it's hard to believe that anything else might be true. So, it's very important that we take it seriously. And as we're here today to talk about, it's to create routines that help really nurture you and help you towards that recovery. TREATMENT FOR DEPRESSION Before we move into those routines, I want to quickly mention the treatment for depression. The best treatment for depression is cognitive behavioral therapy. Now there is often a heavy emphasis on mindfulness and self-compassion as well. Cognitive behavioral therapy looks at both your thoughts and your behaviors. And it's important that we look at both because both can impact the way in which this disorder plays out. If you don't have access to a mental healthcare professional, we also have an online course called Overcoming Depression. Overcoming Depression is an on-demand online course where I teach you the exact steps that I use with my clients to propel them into setting up their cognition so that they're healthy, their behaviors, so that they bring a sense of pleasure and motivation, and structure into their daily lives. And then we also very heavily emphasize self-compassion and that mindfulness piece, which is so important when it comes to managing highly depressive and hopeless thoughts. So, that's there if you want to go to CBTSchool.com/depression, or you could go to CBTSchool.com, and we have all the links right there. DAILY ROUTINES FOR DEPRESSION All right, so let's talk about daily routines for depression. Research shows that, specifically for depression, finding a routine and a rhythm in your day can greatly improve the chances of your long-term recovery. And so, I really take time and slow down with my patients and talk to them about what routines are working and what routines are not. I'm not here to tell you or my patients, or my students how to live their lives and what to do specifically. I'm really interested at looking at what's working for you and what's not. Let's first start with morning routines. What often very much helps—and maybe you already have this, but if not, this is something I want you to consider—is the importance of a consistent wake-up time. When you're depressed, as I mentioned before, a common depression symptom is sleep disturbance. Often, people lay awake all night and sleep all day, or they sleep all night and they sleep all day, and they're heavily overwhelmed with this sleepy exhaustion. It is really important when it comes to morning routines that you set a time to wake up every morning and you get up, even if it's for a little bit, if that's all you can handle. Try to set that really consistent wake-up time. What I want to emphasize as we go through these routines for depression is I don't mind if you even do tiny baby steps. One thing you might want to start from all of the ideas I give you today, you might just want to pick one. And if that's all you can do, that is totally okay. What we also want to do is we want to, if possible, engage in some kind of light movement, even stretching, to boost mood. There's a lot of routine, even just stretching or gentle walks outside. It doesn't have to be fast. It doesn't have to be for an hour. It could be for a quarter of a block to start with. But that light exercise has been shown to boost mood significantly. And then if you're able, maybe even to do that multiple times throughout the day. Another morning routine that you may want to consider is some type of mindfulness practice. Again, we cover this in overcoming depression and with my patients in CBT, but some kind of mindfulness practice. It might be journaling, it could be a gratitude practice, it could be preferably some kind of meditation. Often, what I will encourage my clients to do is just listen to a guided meditation, even if you don't really follow along exactly. But you're just learning about these concepts. You're learning about the tools. You're getting curious about them if that's all you can do. Or if you want, you could even go more into reading a book about mindfulness, starting to learn about these ideas and concepts because they will, again, help you to have a better relationship with your thoughts and your feelings. Another morning routine I want you to maybe consider here is to have some type of nutritious breakfast, something that supports your mental health. We want to keep an eye out for excessive sugar, not that there's anything wrong with sugar, but it can cause us to have another energy dump, and we want to have something that will improve our energy. With depression, usually, we don't have much energy at all. So, whatever tastes yummy, even if nothing feels yummy, but there's something that maybe slightly sounds good, have that. If it's something that you enjoy or have good memories about, or if it's anything at all, I'm happy just for you to eat anything at all if it's not something that you've been doing. Let's now move over to work-day or daytime strategies or routines. The first thing I want you to consider here throughout the day is setting realistic daily goals and priorities. We have a course at CBT School called Optimum Time Management, and one of the core concepts of that course, which teaches people how to manage their time better, is we talk about first prioritizing what's most important. If you have depression, believe it or not, one of the most important things you can do to prioritize in your daily schedule is pleasure. And I know when you have depression, sometimes nothing feels pleasurable. But it's so important that you prioritize and schedule your pleasure first. Where in the day can you make sure that you do something enjoyable, even if it's this enjoyable, even if nothing is enjoyable, but you used to find it enjoyable? We want to prioritize your self-care, prioritize your eating, having a shower, brushing your teeth. If nothing else gets done that day, that's okay. But we want to prioritize them depending on what's important to you. Now, if you're someone who's depressed because you're so overwhelmed with everything that you have to do—again, we talk about this in the time management course—we want to really look at the day and look at the schedule and say, "Is this schedule nurturing a mental health benefit to me? Is it maybe time for me to reprioritize and take things off my schedule so I can get my mental health back up to the optimum level?" I have had to do this so many times in the last few years, especially as I have suffered a chronic illness, really separate like an hour to really look at the calendar and say, "Are these things I'm doing actually helping me?" Sometimes I found I was doing things for the sake of doing them to check them off the list, but I was getting no mental benefit from them. No real value benefit from them either. Another daytime strategy you can use is a technique or a tool called the Pomodoro Technique or the Pomodoro Method. This is where we set a timer for a very short period of time and we go and we do the goal and we focus on the thing for a short period of time. So, an example might be I might set a timer for 15 minutes, and all I'm going to do during that 15 minutes is write email. If 15 minutes is too much for you, let's say maybe you need to tidy up your dishes, you might set a timer for 45 seconds and just get done with what you can for 45 seconds and then take a short break. Then you set the timer again. All I have to do is 45 seconds or a minute and a half or three minutes or five minutes, whatever is right for you, and put your attention on just getting that short Pomodoro little bout done. This can be very helpful to maintain focus. It can be very helpful to maintain the stress of that activity, especially if it's an activity that you're dreading. And so, do consider the Pomodoro technique. You can download free apps that have a Pomodoro timer that will set you in little increments. It was actually, first, I think, created for exercise. So, it sets it like 45 minutes on, 20 seconds off, 45 seconds on. And so, you can do that with whatever task you're trying to get done as well. Another daytime routine I want you to consider is getting some kind of natural light or going outdoors. There is so much research to show that going outside, even if it's for three minutes, and taking in the green of the earth or the dirt under your feet, really getting in touch and grounding with some kind of nature, or being in the sunlight, can significantly improve mood. So, consider that as well. And again, I'm going to mention, make sure you eat lunch. Eat something that boosts your mood and boosts your energy levels. Now let's talk about evening or wind-down routines for depression or practices. Now, number one, one of the things that we often do the most, which we really need to be better about, and this is me too, is doing some kind of digital detox in the evenings. Try your hardest to limit screen time before bed because we know screens before bed actually disturb our sleep. We also know that often we spend hours, hours of our day scrolling on social media. And even though that might feel pleasurable, it act…
Full show notes at the publisherIn the insightful podcast episode featuring Joanna Hardis, author of "Just Do Nothing: A Paradoxical Guide to Getting Out of Your Way," listeners are treated to a deep dive into the concept of distress tolerance and its pivotal role in mental health and personal growth. Joanna Hardis, with her extensive background in treating anxiety disorders such as panic disorder, OCD, and Generalized Anxiety Disorder, shares her professional and personal journey toward understanding and teaching the art of effectively managing internal discomfort without resorting to avoidance or escape tactics. The discussion begins with an exploration of the title of Joanna's book, "Just Do Nothing," which encapsulates the essence of her therapeutic approach: the intentional practice of stepping back and allowing thoughts, feelings, and sensations to exist without interference. This practice, though seemingly simple, challenges the common impulse to engage with and control our internal experiences, which often exacerbates suffering. A significant portion of the conversation is dedicated to "distress intolerance," a term that describes the perceived inability to endure negative emotional states. This perception leads individuals to avoid or escape these feelings, thereby increasing vulnerability to a range of mental health issues including anxiety, depression, and substance abuse. Joanna emphasizes the importance of recognizing and altering the self-limiting beliefs and thoughts that fuel distress intolerance. Practical strategies for enhancing distress tolerance are discussed, starting with simple exercises like resisting the urge to scratch an itch and gradually progressing to more challenging scenarios. This gradual approach helps individuals build confidence in their ability to manage discomfort and makes the concept of distress tolerance applicable to various aspects of life, from parenting to personal goals. Mindfulness is highlighted as a crucial component of distress tolerance, fostering an awareness of our reactions to discomfort and enabling us to respond with intention rather than impulsivity. The podcast delves into the importance of connecting with our values and reasons for enduring discomfort, which can provide the motivation needed to face challenging situations. Joanna and Kimberley also touch on the common traps of negative self-talk and judgment that can arise during distressing moments, advocating for a more compassionate and accepting stance towards oneself. The idea of "choice points" from Acceptance and Commitment Therapy (ACT) is introduced, encouraging listeners to make decisions that align with their values and move them forward, even in the face of discomfort. The episode concludes with a message of hope and empowerment: everyone has the capacity to work on expanding their distress tolerance. By starting with small, manageable steps and gradually confronting more significant challenges, individuals can cultivate a robust ability to navigate life's inevitable discomforts with grace and resilience. EPISODE HIGHLIGHTS: The Concept of "Just Do Nothing": This core idea revolves around the practice of intentionally not engaging with every thought, feeling, or sensation, especially when they're distressing. It's about learning to observe without action, which can reduce the amplification of discomfort and suffering. Understanding Distress Intolerance: Distress intolerance refers to the belief or perception that one cannot handle negative internal states, leading to avoidance or escape behaviors. This concept highlights the importance of recognizing and challenging these beliefs to improve our ability to cope with discomfort. Building Distress Tolerance: The podcast discusses practical strategies to enhance distress tolerance, starting with simple exercises like resisting the urge to scratch an itch. The idea is to gradually expose oneself to discomfort in a controlled manner, thereby building resilience and confidence in handling distressing situations. Mindfulness and Awareness: Mindfulness plays a crucial role in distress tolerance by fostering an awareness of our reactions to discomfort. This awareness allows us to respond intentionally rather than react impulsively. The practice of mindfulness helps in recognizing when we're "gripping" distressing thoughts or sensations and learning to gently release that grip. Aligning Actions with Values: The podcast emphasizes the significance of connecting actions with personal values, even in the face of discomfort. This alignment can motivate us to face challenges and make choices that lead to personal growth and fulfillment, rather than making decisions based on the urge to avoid discomfort. These concepts together form a comprehensive approach to managing distress and enhancing personal well-being, as discussed by Joanna Hardis in the podcast episode. TRANSCRIPTION: Kimberley: Welcome, everybody, today. We have Joanna Hardis. Joanna wrote an amazing book called Just Do Nothing: A Paradoxical Guide to Getting Out of Your Way. It was a solid gold read. Welcome, Joanna. Joanna: Thank you. Thank you for having me. Thank you for reading it, too. I appreciate it. Kimberley: It was a wonderful read and so on point, like science-backed. It was so good, so you should be so proud. Joanna: Thank you. Kimberley: Why did you choose the title Just Do Nothing? Joanna: I mean, it's super catchy, but more importantly than that, it is really what my work involves on a personal level and on a professional level—learning how to get out of my own way or our own way by leaving our thoughts alone, learning how to leave uncomfortable feelings alone, uncomfortable sensations alone, uncomfortable thoughts alone. Because that's what creates the suffering—when we get so engaged in them. Kimberley: Yeah. It's such a hard lesson. I talk about this with patients all the time. But as I mentioned to you, even my therapist is constantly saying, "You're going to have to just feel this one." And my instinct is to go, "Nope. No thanks. There has to be another way." Joanna: A hundred percent. Yes. I mean, it really is something on a daily basis. I have to remind myself and work really hard to do. Kimberley: It is. But it is such powerful work when you do it. Joanna: Mm-hmm. Kimberley: Early in the book, you talk about this term or this concept called 'distress intolerance.' Can you tell us what both of those are and give us some ideas on why this is an important topic? Joanna: Sure, and this is what got me interested in the book and everything. Distress tolerance is a perception that you can handle negative internal states. And those internal states can be that you feel anxious, that you feel worried, you feel bored, vulnerable, ashamed, angry, sad, mad, off. There's an A to Z alphabet of those unpleasant and uncomfortable emotional states. And when we have that perception that we can handle it, our behavior aligns, so we tend to do things. When we are distress-intolerant, we have a perception—often incorrect—that we cannot handle negative internal states. So then we will either avoid them or escape them or try to figure them out or neutralize them or try to get rid of them, make them stop—all the things that we see in our work every day. Before I had my practice in anxiety disorders, I worked over a decade in an eating disorder treatment center, and we know that when someone has really low distress tolerance, they are more vulnerable to developing eating disorders, anxiety disorders, depressive disorders, substance use disorders. So, it's a really important concept. Kimberley: It's such an important concept. And you talk about how the thoughts we have which can determine that. Do you want to share a little bit about that? Because there was a whole chapter in the book about the thoughts you have about your ability to tolerate distress. Joanna: Sure, and I didn't answer the second part of your question., I just realized, which will tie into that, which is how it sounds. How it sounds is, "I can't bear to feel this way, so I'm going to avoid that party," or "I'm having too good of a day, so I can't do my homework," or "I can't bear if my kids see me anxious, so we're not going to go to the playground." And so, what drives someone's perception are their thoughts and these thoughts and these self-limiting stories that we all have, and that oftentimes we just buy into as either true, or perhaps at one point, they may have been true, but we've outlived them. Kimberley: Yeah. We're talking about distress tolerance, and I'm always on the hunt to widen my distress tolerance to be able to tolerate higher levels of distress. And I think what's interesting is, first, this is more of a question that I don't know the science behind it, but do you think some people have higher levels of distress which makes them more intolerant, or do you think the intolerance which is what makes the distress feel so painful? Joanna: I don't know the research well enough to answer it. Because I think it's rare that you see -- I mean, this is just one construct. So it's very hard to isolate it from something like emotional sensitivity or anxiety sensitivity or intolerance for uncertainty, or something else that may be contributing to it. Kimberley: Yeah. No, I know. It's just a question I often think about, particularly when I'm with patients. And this is something that I think doesn't really matter at the end of the day. What matters is—and maybe this will be a question for you—if our goal is to increase our distress tolerance, how might somebody even begin to navigate that? Joanna: Sure. I love that question. I mean, in the book, I take it down to such a micro level, which is learning how—and I think you've talked about it on podcasts—itch serve. So, one of the exercises in the book is learning how you set your timer for five minutes and you get itchy, which of course is going to happen. And it's learning how to ride out that urge to scratch the itch. So, paying attention to. If you zoom in on the itch, what happens? What happens when you zoom out? What else can you pay attention to? And so when someone learns that process, that is on such a micro level. I often tell patients it's like a one-pound weight. Kimberley: Yes. Joanna: And then what are some two-pound weights that people can use? So then, for many people, it's their phone. So, it's perhaps not checking notifications that come in right away. They begin to practice in low-distress situations because I want people to get confident that they know how to zoom in, they know how to zoom out. They know if they're feeling a sensation, the more that they pay attention to it, the worse it's going to feel. And so, where else can they put their awareness? What else can they be doing? And once they get the hang of it, we introduce more and more distress. So then, it might be their phone, then it might be them intentionally calling up a thought. And we work up that way with adding in, very gradually, more distress or more discomfort. Exercise is a great way, especially if it's not married to anxiety, to get people interacting with it differently. Kimberley: Yeah. We use this all the time with anxiety disorders. It's a different language because we talk about an ERP hierarchy, or your exposure menu, and so forth. But I love that in the book, it's not just specific to that. It could be like you talked about. It's for those who have depression. It's those who have grief. It's those who have eating disorders. It's those who have anger. I will even say the concept of distress tolerance to me is so interesting because there's so many areas of my life where I can practice it. Like my urgency to nag my kids another time to get out the door in time, and I have to catch like, "You don't need to say it the third time." Can you tolerate your own discomfort about the time it's taking them to get out the door? And I think that when we have that attitudinal shift, it's so helpful. Joanna: Yes. I find parenting as one of the hardest places for me, but it was also a reminder like the more I keep my mouth shut, the better. Kimberley: Yeah. And I think that's really where I was talking before. I found parenting to be quite a triggering process as my kids have gotten older, but so many opportunities for my own personal growth using this exact scenario. Like your fear might come up, and instead of engaging in that fear, I'm actually just going to let it be there and feel it and parent according to my values or act according to my values. And I've truly found this to be such a valuable tool. Joanna: Yes. And I have found what's been really interesting, when my kids were at home, that was where my distress was. Now that the two of the three are out of the house, my distress is when we're all together and everyone have a good time. And so, it morphs, because what I tell myself and my perception and the urgency, it changes. It's still so difficult with them, but it changes based on what's happening. Kimberley: Yeah. And I think this is an opportunity for everyone, too. How much do you feel that awareness piece is important in being aware that you are triggered? For the folks listening, of course, you're on the Your Anxiety Toolkit podcast. Most are listening because they have anxiety. Do you encourage them to be aware of other areas? They can be practicing this. Joanna: Yes. Kimberley: Can you talk to me about that? Joanna: 100%, because I feel like -- what is that metaphor about the onion? It's like the layers of an onion. So, people will come, and they'll think it's about their anxiety. But this is really about any uncomfortable feeling or uncomfortable sensation. And so. It may be that they're bored or vulnerable or embarrassed or something else. So, once someone learns how to allow those feelings and do what is important to them or what they need to do while they feel it, then yes, I want them to go and notice where else in their life this is showing up. Kimberley: Talk to me specifically about how in real-time, because I know that's what listeners are going to ask. Joanna: Of course. Kimberley: I have this scary thing I want to be able to do, but I don't want to do it because I'm scared, and I don't want to feel scared. How might someone practice tolerating their distress in real-time? Joanna: I'm going to answer two ways. One, I would say that might be something to scale. Sometimes people want to do the thing because doing the thing is like the goal or the sexy thing, but if it's outside of their window of tolerance, they may not be able to do it. So, it depends on what they want to do. So, I might say, as just a preface, this might be something that people should consider scaling. Kimberley: Gradual, you mean? Joanna: Yes. So, for instance, they want to go to the gym, but they're scared of fainting on the treadmill or something. Pretty common for what we see. It would be like, scale it back. So it might be going to the parking lot. It might be taking a tour. It might be going and standing on the treadmill. It might be walking on the treadmill. But we have to put it in smaller pieces. In the moment that we're doing something that is difficult, first, we have to notice if we're starting to grip. I use this "if we're starting to grip" something. If we're starting to zoom in on what we don't like, if we're starting to zoom in on a sensation we don't like, a thought we don't like, a feeling…
Full show notes at the publisherVisual Staring OCD (also known as Visual Tourrettic OCD), a complex and often misunderstood form of Obsessive-Compulsive Disorder, involves an uncontrollable urge to stare at certain objects or body parts, leading to significant distress and impairment. In an enlightening conversation with Kimberley, Matt Bannister shares his journey of overcoming this challenging condition, offering hope and practical advice to those grappling with similar issues. Matt's story begins in 2009, marked by a sense of depersonalization and dissociation, which he describes as an out-of-body experience and likened to looking at a stranger when viewing himself in the mirror. His narrative is a testament to the often-overlooked complexity of OCD, where symptoms can extend beyond the stereotypical cleanliness and orderliness. Kimberley's insightful probing into the nuances of Matt's experiences highlights the profound impact of Visual Staring OCD on daily life. The disorder manifested in Matt as an overwhelming need to maintain eye contact, initially with female colleagues, out of fear of being perceived as disrespectful. This compulsion expanded over time to include men and intensified to such a degree that Matt felt his mind couldn't function normally. The social implications of Visual Staring OCD are starkly evident in Matt's recount of workplace experiences. Misinterpretation of his behavior led to stigmatization and gossip, deeply affecting his mental well-being and leading to self-isolation. Matt's story is a poignant illustration of the societal misunderstandings surrounding OCD and its variants. Treatment and recovery form a significant part of the conversation. Matt emphasizes the role of Cognitive Behavioral Therapy (CBT) and Exposure and Response Prevention (ERP) in his healing process. However, he notes the initial challenges in applying these techniques, underscoring the necessity of a tailored approach to therapy. Kimberley and Matt delve into the power of community support in managing OCD. Matt's involvement with the IOCDF (International OCD Foundation) community and his interactions with others who have overcome OCD, like Chris Trondsen, provide him with valuable insights and strategies. He speaks passionately about the importance of self-compassion, a concept introduced to him by Katie O'Dunne, and how it transformed his approach to recovery. A critical aspect of Matt's journey is the realization and acceptance of his condition. His story underscores the importance of proper diagnosis and understanding of OCD's various manifestations, which can be as unique as the individuals experiencing them. Matt's narrative is not just about overcoming a mental health challenge; it's a story of empowerment and advocacy. His transition from a struggling individual to a professional peer support worker is inspiring. He is now dedicated to helping others navigate their paths to recovery, using his experiences and insights to offer hope and practical advice. In conclusion, Matt Bannister's journey through the complexities of Visual Staring OCD is a powerful testament to the resilience of the human spirit. His story offers valuable insights into the disorder, challenges misconceptions, and highlights the importance of tailored therapy, community support, and self-compassion in overcoming OCD. For anyone struggling with OCD, Matt's story is a beacon of hope and a reminder that recovery, though challenging, is within reach. Instagram - matt bannister27 Facebook - matthew.bannister.92 Facebook group - OCD Warrior Badass Tribe Email :matt3ban@hotmail.com Kimberley: Welcome back, everybody. Every now and then, there is a special person that comes in and supports me in this way that blows me away. And today we have Matt Bannister, who is one of those people. Thank you, Matt, for being here today. This is an honor on many fronts, so thank you for being here. Matthew: No, thank you for bringing me on, Kim. This is a huge honor. I'm so grateful to be on this. It's just amazing. Thank you so, so much. It's great to be here. Kimberley: Number one, you have been such a support to me in CBT School and all the things that I'm doing, and I've loved hearing your updates and so forth around that. But today, I really want you to come on and tell your story from start to end, whatever you want to share. Tell us about you and your recovery story. Matthew: Sure. I mean, I would like to start as well saying that your CBT School is amazing. It is so awesome. It's helped me big time in my recovery, so I recommend that to everyone. I'm an IOCDF grassroots advocate. I am super passionate about it. I love being involved with the community, connecting with the community. It's like a big family. I'm so honored to be a part of this amazing community. My recovery story and my journey started back in 2009, when—this is going to show how old I am right now—I remember talking on MSN. I remember I was talking; my mind went blank in a conversation, and I was like, "Ooh, that's weird. It's like my mind's gone blank." But that's like a normal thing. I can just pass it off and then keep going forward. But the thing is with me. It didn't. It latched on with that. I didn't know what was going on with me. It was very frightening. I believe that was a start for me with depersonalization and dissociation. I just had no idea of what it was. Super scary. It was like I started to forget part of my social life and how to communicate with people. I really did start to dissociate a lot when I was getting nervous. And that went on for about three or four years, but it gradually faded naturally. Kimberley: So you had depersonalization and derealization, and if so, can you explain to listeners what the differences were and how you could tell the differences? Matthew: Yeah. I think maybe, if I'm right with this, with the depersonalization, it felt like I knew how it was, but I didn't at the same time. It was like when I was looking in a mirror. It was like looking at a stranger. That's how it felt. It just felt like I became a shell of myself. Again, I just didn't know what was happening. It was really, really scary. I think it made it worse. With my former friends at that time, we'd make fun of that, like, "Oh, come on, you're not used to yourself anymore. You're not as confident anymore. What's going on? You used to try and take the [03:19 inaudible] a lot with that." With the dissociation, I felt like I was having an out-of-body experience. For me, if I sat in a room and it was really hitting me hard, as if I were anxious, it would feel like I was floating around that room. I couldn't concentrate. It was very difficult to focus on things, especially if it was at work. It'd be very hard to do so. That came on and off. Kimberley: Yeah, it's such a scary feeling. I've had it a lot in my life too, and I get it. It makes you start to question reality, question even your mental health. It's such a scary experience, especially the first time you have it. I remember the first time I was actually with a client when it started. Matthew: Yeah, it is. Again, it is just a frightening experience. It felt like even when I was walking through places, it was just fog all the time. That's how it felt. I felt like someone had placed a curse on me. I really believe that with those feelings, and how else can I explain it? But that did eventually fade, luckily, in about, like I said, three to four years, just naturally on its own. When I had those sensations, I got used to that, so I didn't put as much emphasis on those situations. Then I carried on naturally through that. Then, well, with going through actually depersonalization, unfortunately, that's when my OCD did hit. For me, it was with, I believe, relationship OCD because I was with someone at the time. I was constantly always checking on them, seeing if they loved me. Like, am I boring you? Because I thought of depersonalization. I thought I wasn't being my full authentic self and that you didn't want to be within me anymore. I would constantly check my messages. If they didn't put enough kisses on the end of a message, I think, "Oh, they don't love me as much anymore. Oh no, I have to check." All the time, even in phone calls, I always made sure to hear that my partner would say, "Oh, I love you back," or "I love you." Or as I thought, I did something wrong. Like they're going off me. I had a spiral, thinking this person was going to cheat on me. It went on and on and on and on with that. But eventually, again, the relationship did fade in a natural way. It wasn't because of the OCD; it was just how it went. And then, with relationship OCD, with that, I faded with that. A search with my friends didn't really affect me with that. Then what I can recall, what I have maybe experienced with OCD, I've had sexual orientation OCD. Again, I was questioning my sexuality. I'm heterosexual, and I was in another warehouse, a computer warehouse, and it was all males there. I was getting what I describe as intrusive thoughts of images of doing sexual acts or kissing and stuff like that. I'm thinking, "Why am I getting these thoughts? I know where my sexuality is." There's nothing wrong, obviously, with being homosexual or queer. Nothing wrong with that at all. It's just like I said, that's how it fades with me. I mean, it could happen again with someone who's queer, and it could be getting heterosexual thoughts. They don't want that because they know they're comfortable with their sexuality. But OCD is trying to doubt that. But then again, for me, that did actually fade again after about five or six months, just on its own. And then, fast forward two years later is when the most severe theme of OCD I've ever had hit me hard like a ton of bricks. And that for me was Visual Tourettic OCD, known as Staring OCD, known as Ocular Tourettic OCD. And that was horrendous. The stigma I received with this theme was awful. I remembered the day when it hit me, when I was talking to a female colleague. Like we all do, we all look around the room and we try and think of something to say, but my eyes just landed on the chest, like just an innocent look. I'm like, "Oh my God, why did I do that? I don't want to disrespect this person in front of me. I treat her as an equal. I treat everyone the same way. I don't want to feel like she's being disrespected." So I heavily maintained eye contact after that. Throughout that conversation, it was fine. It was normal, nothing different. But after that, it really latched onto me big time. The rumination was massive. It was like, you've got to make sure you're giving every single female colleague now eye contact. You have to do it because you know otherwise what stigma you could get. And that went on for months and years, and it progressed to men as well a couple of years later. It felt like my mind can't function anymore. I remember again I was sitting next to my friend, who was having a game on the PlayStation. And then I just looked at his lap, just for no reason, just looked at his lap, and he said, "Ooh, I feel cold and want to go and change." I instantly thought, "Oh my God, is it because he thought I might have stared that I creeped him out?" And then it just seriously latched onto me big time. As we all know, with this as well, when we think of the pink elephant allergy, it's like when we don't think of the pink elephant, what do we do? And that's what it was very much like with this. I remember when it started to get really bad, my eyes would die and embarrass somebody part places. It was like the more anxious I felt about not wanting to do it, the more it happened, where me and my good friend, Carol Edwards, call it a tick with the eye movement. So like Tourette, let's say, when you get really nervous, I don't know if this is all true. When someone's really nervous, maybe they might laugh involuntarily, like from the Joker movie, or like someone swearing out loud. This is the same thing with eye movement. Every time I was talking to a colleague face-to-face to face, I was giving them eye contact, my mind would be saying to me, "Don't look there, don't look there, don't look there," and unfortunately think it would happen. That tick would happen. It would land where I wouldn't want it to land. It was very embarrassing because eventually it did get noticed. I remember seeing female colleagues covering their hi vis tops, like across their arms. Men would cover their crotches. They would literally cross their legs very blatantly in front of me. Then I could start to hear gossip. This is when it got really bad, because I really heard the stigma from this. No one confronted me by the way of this face-to-face, but I could hear it crystal clear. They were calling me all sorts, like deviant or creep or a perv. "Have you seen his eyes? Have you seen him looking and does that weird things with his eyes? He checks everyone out." It was really soul-destroying because my compulsion was to get away from everyone. I would literally hide across a room. Where no one else was around, I would hide in the cubicles because it was the only place where I wasn't triggered. It got bad again. It went to my family, my friends, everyone around me. It didn't happen with children, but it happened with every adult. It was horrendous. I reached out to therapy. Luckily, I did get in contact with a CBT therapist, but it was talk therapy. But it's better than nothing. I will absolutely take that. She was amazing. I can't credit my therapist enough. She was awesome. If this person, maybe this is like grace, you're amazing, so thank you for that. She was really there for me. It was someone I could really talk to, and it can help me and understand as best as she could. She did, I believe, further research into what I had. And then that's when I finally got diagnosed that I had OCD. I never knew this was OCD, and everything else made sense, like, "Oh, this is why I was going through all those things before. It all now makes concrete sense what I was going through." Then I looked up the Facebook group called Peripheral Vision/Visual Tourettic OCD. That was a game-changer for me. I finally knew that I wasn't alone because, with this, you really think you're alone, and you are not. There are thousands of people with this, or even more. That was truly validating. I was like, "Thank God I'm not the only one." But the problem is, I didn't really talk in that group at first because I thought if other people saw me writing in that group, it's going to really kill my reputation big time. That would be like the final nail in the coffin. Even though it was a private group, no one could do that. But I didn't still trust it that much at that time. I was doing ERP, and I thought great because I've researched ERP. I knew that it's effective. Obviously, it's the gold standard. But for me, unfortunately, I think I was doing it where I was white-knuckling through exposures. Also, when I was hearing at work, still going back to my most triggering place, ERP, unfortunately, wasn't working for me because I wasn't healing. It was like I was going through the trigger constantly. My mind was just so overwhelmed. I didn't have time to heal. I remember I eventually self-isolated in my room. I didn't go anywhere. I locked myself away because I thought I just couldn…
Full show notes at the publisherIf you want to know the 5 Most Common Recovery Roadblocks with Chris Tronsdon (an incredible anxiety and OCD therapist), you are in the right place. Today Chris and I will go over the 5 Most common anxiety, depression, & OCD roadblocks and give you 6 highly effective treatment strategies you can use today. Kimberley: Welcome everybody. We have the amazing Chris Trondsen here with us today. Thank you for coming, Chris. Chris: Yes, Kim, thanks for having me. I'm super excited about being here today and just about this topic. Kimberley: Yes. So, for those of you who haven't attended one of the IOCDF Southern California conferences, we had them in Southern California. We have presented on this exact topic, and it was so well received that we wanted to make sure that we were spreading it out to all the folks that couldn't come. You and I spoke about the five most common anxiety & OCD treatment roadblocks, and then we gave six strategic solutions. But today, we're actually broadening it because it applies to so many people. We're talking about the five most common anxiety treatment roadblocks, with still six solutions and six strategies they can use. Thank you for coming on because it was such a powerful presentation. Chris: No, I agree. I mean, we had standing room only, and people really came up to us afterwards and just said how impactful it was. And then we actually redid it at the International OCD Foundation, and it was one of the best-attended talks at the event. And then we got a lot of good feedback, and people kept messaging me like, "I want to hear it. I couldn't go to the conference." I'd play clips for my group, and they're like, "When is it going to be a podcast?" I was like, "I'll ask Kim." I'm glad you said yes because I do believe for anybody going through any mental health condition, this list is bound, and I think the solutions will really be something that can be a game changer in their recovery. Kimberley: Absolutely, absolutely. I love it mostly because, and we're going to get straight into these five roadblocks, they're really about mindset and going into recovery. I think it's something we're not talking about a lot. We're talking about a lot of treatment, a lot of skills, and tools, but the strategies and understanding those roadblocks can be so important. Chris: Yeah. I did a talk for a support group. They had asked me to come and speak, and I just got this idea to talk about mindset. I did this presentation on mindset, and people were like, "Nobody's talking about it." In the back of my head, I'm like, "Kim and I did." But we're the only ones. Because I do think so many people get the tools, right? The CBT tools, they get the ERP tools, the mindfulness edition, and people really find the tools that work for them. But when I really think of my own personal recovery with multiple mental health diagnoses, it was always about mindset. And that's what I like about our talk today. It's universal for anyone going through any mental health condition, anxiety base, and it's that mindset that I think leads to recovery. It shouldn't be the other way around. The tools are great, but the mindset needs to be there. Kimberley: Yeah. We are specifically speaking to the folks who are burnt out, feeling overwhelmed, feeling a lack of hope of recovery. They really need a kickstart, because that was actually the big title of the presentation. It was really addressing those who are just exhausted with the process and need a little bit of a strategy and mindset shift. Chris: Yeah. I don't want to compare, but I broke my ankle when I was hiking in Hawaii, and I have two autoimmune diseases. Although those ailments have caused problems, especially the autoimmune, when I think back to my mental health journey, that always wore me out more because it's with you all the time, 24/7. It's your mental health. When my autoimmune diseases act up, I'm exhausted, I'm burnt out, but it's temporary. Or my ankle, when it acts up, I have heating pads, I have things I can do, but your brain is with you 24/7. I do believe that's why a lot of people resonate with this messaging—they are exhausted. They're busting their butt in treatment, but they're tired and hitting roadblocks. And that's why this talk really came about. Kimberley: Yeah, exactly. All right, let's get into it here in a second. I just want to give one metaphor with that. I once had a client many years ago give the metaphor. She said, "I feel like I'm running a marathon and my whole family are standing on the out, like on the sidelines, and they're all clapping, but I'm just like faceplant down in the middle of the road." She's like, "I'm trying to get up, I'm trying to get up, and everyone's telling me, 'Come on, you can do it.' It's so hard because you're so exhausted and you've already run a whole bunch of miles." And so I really think about that kind of metaphor for today. If people are feeling that way, hopefully they can take away some amazing nuggets of information. Chris: Absolutely. That's a good visual. Faceplant. Kimberley: It was such a great and powerful visual because then I understood this client's experience. Like, "Oh, okay. You're really tired. You're really exhausted." ROADBLOCK #1: YOU BEAT YOURSELF UP! Okay, let's get into it. So, I'm going to go first because the number one roadblock we talked about, not that these are in any particular order, but the one we came up first was that you beat yourself up. This is a major roadblock to recovery for so many disorders. You beat yourself up for having the disorder. You beat yourself up for not coping with it as well as you could. You beat yourself up if you have OCD for having these intrusive thoughts that you would never want to have. Or you're beating yourself up because you don't have motivation because you have, let's say, some coexisting depression. The important thing to know there is, while beating yourself up feels productive, it might feel like you're motivating yourself, or you may feel like you deserve it. It actually only makes it harder. It only makes it feel like you've got this additional thing. Again, a lot of my patients—let's use the marathon example—might yell at themselves the whole way through the marathon, but it's not a really great experience if you're doing that, and it takes a lot of energy. SOLUTION #1: SELF-COMPASSION So what we offered here as a strategic solution is self-compassion—trying to motivate and encourage yourself using kindness. If you're going through a hard day, maybe, just if you've never tried this before, trial what it would be like to encourage yourself with kind words or asking for support, asking for help so that you're not burning all that extra energy, making it so much harder on yourself, increasing your suffering. Because I often say to patients, the more you suffer, the more you actually deserve self-compassion. It's not the other way around. It's not that the more you suffer, the less you deserve it. Do you have any thoughts on that, Chris? Chris: Oh yeah. I would say I see that across the board with my clients, this harshness, and there's this good intention behind it, this idea that if I can just bully myself into recovery. I always try to remind clients that anxiety-based disorders, it's a part of our bodies as well. Our brain is a part of our body, just like our arm, our tibia, our leg, all these other bones, but there's a lack of self-empathy that we have for ourselves, as if it's something that we're choosing to do. Someone with a broken leg doesn't wake up in the morning and get mad at themselves that their leg is still broken. They have understanding, and they're working on their exercises to heal. It's the same with these disorders. So, the reason I love self-compassion is when we go and step in to help one of our friends, we use a certain tone, we use certain words, we tap into their strengths, we use encouragement because we know that method is going to be what boosts them up and helps them get through that rough patch. But for some reason, when it's ourselves, we completely abandon everything we know that's supportive, and we talk to ourselves in a way that I almost picture like a really negative boot camp instructor, like in the military, just yelling and screaming into submission. The other thing is when we're beating ourselves up like that, we're more likely to tap into our unhelpful habits. We're more likely to shut down and isolate, which we see a lot in BDD, social anxiety, et cetera. But that self-compassion isn't like a fake pop culture support. It's really tapping into meeting yourself where you're at, giving yourself some understanding, and tapping into the strategies that have worked in the past when you're in a low moment. I know sometimes people are like, "I don't know how to do that," but you're doing it to everybody else in your life. Now it's time to give yourself that same self-compassion that you've been giving to everybody important to you. Kimberley: Yeah, and we actually have a few episodes on Your Anxiety Toolkit on exactly how to embrace self-compassion, like how that might actually look. So, if people are really needing more information there, I can add in the show notes some links to some resources there as well. ROADBLOCK #2: THERE WILL BE HARD DAYS Okay. Now, Chris, can you tell us about the second most common or another common anxiety roadblock around this idea that there will be hard days? Chris: There's always these great images if you Google about what people think recovery will look like versus what recovery looks like. I love those images because there is this idea. We see a lot of perfectionism in anxiety disorders. In OCD, we see perfectionism. So, this idea of, like, I should be here and I should easily scoot to the end. It's not going to be like that; it's bumpy, it's ups and downs. We know so much factors into or impact how our mental health disorder shows up. We can't always control our triggers. Sometimes if we haven't slept well or there's a lot of change in our life, we could have more anxiety. So, it's going to ebb and flow. So, when we have this fixed mindset of like, it has to be perfect, there has to be absolutely no bumps on the road, no turbulence, we're going to set ourselves up for failure because the day we have a hard day, we want to completely shut down. So I really believe, in this case, the solution is thinking bigger. If you're thinking day to day, sometimes if you're too in it, you're dealing with depression, you're really feeling bad, you skipped school because you have a presentation, social anxiety is acting up. You think bigger picture. Why am I here? Why am I doing this? Why have I sought out treatment? Listen to this podcast. What am I trying to accomplish? SOLUTION #2: KNOW YOUR WHY I know for me in my own recovery, knowing my why was so important. There were certain things in my life that I found important to achieve, and I kept that as the figurative carrot in front of the mule to get me to go. So, that way, if I had a rough day, I thought bigger picture. What do I need to do today to make sure that I meet my goals? And so, I believe everybody needs to know their why. Now, it doesn't have to be grandiose. Some people want to build a school and teach kids in underprivileged countries. Amazing why. But other people are sometimes like, "I just want to be able to make my own choices today and not feel like I base them out of anxiety." There's no right or wrong why, but if you can know what beacon you're going to, it really helps you get through those hard days. What about for you? When we talk about this, what comes up for you? Kimberley: Well, I think that for me personally, the why is a really important mindset shift because often I can get to this sort of, like you said, perfectionistic why. Like, the goal is to have no anxiety, or the goal is to have no bad days. We see on social media these very relaxed people who just seem to go with the flow, and that's your goal. But I have to often with myself do a little reality check and go, "Okay, are you doing recovery to get there? Because that goal might be setting you up for constant disappointment and failure. That mightn't be your genetic makeup." I'm never going to be like the go-with-the-flow Kimberley. That's just not who I am. But if I can instead shift it to the why of like, what do I value? What are the things I want to be able to do despite having anxiety in my life? Or, despite having a hard day, like you said, how do I want that to look? And once I can get to that imagery, then I have a really clear picture. So, when I do have a bad day, it doesn't feel so defeating, like what's the point I give up, because the goal was realistic. Chris: For me, a big part of my why in recovery, once I started getting into a place where I was managing the disorders I was dealing with—OCD, body dysmorphic disorder, I had a lot of generalized anxiety, and major depressive disorder—I was like, "I need to give back. There's not people my age talking about this. There's not enough treatment providers." There was somewhere, like in the middle of my treatment, that I was like, "I don't know how I'm going to advocate. I don't know what that's going to look like, but I have to give back." And so, on those hard days when I would normally want to just like, "Well, I don't care that it's noon, I'm shutting it down, I'm going into my bed, I'm just going to sleep the rest of the day," reminding myself like there's people out there suffering that can't find providers, that can't find treatment, may not even know they have these disorders. I have to be one of the voices in the community that really advocates and gets people education and resources. And so, I didn't let myself get in bed. I looked at the day as quarters. Okay, the morning and the afternoon's a little rough, but I still have evening and night. Let me turn it around. I have to go because I have this big goal, this ambitious dream. I really want to do it. So that bigger why kept me just on track to push through hard days. ROADBLOCK #3: YOU RUN OUT OF STAMINA Kimberley: Amazing. I love that so much. All right. The third roadblock that we see is that people run out of stamina. I actually think this is one that really ties into what we were just talking about. Imagine we're running a marathon. If you're sprinting for the first 20 miles, you probably won't finish the race. Or even if you sprint the first two miles, you probably won't finish the marathon. One of the things is—and actually, I'll go straight to the strategy and the thing we want you to practice—we have to learn to pace ourselves throughout recovery. As I said, if you sprint the first few miles, you will fall flat on your face. You're already dealing with so much. As you said, having a mental health struggle is the most exhausting thing that I've ever been through. It requires such of your attention. It requires such restraint from not engaging in it and doing the treatment and using the tools. It's a lot of work, and I encourage and congratulate anyone who's trying. The fact that you're trying and you're…
Full show notes at the publisherWelcome back, everybody. This is Part 2 of Your 2024 Mental Health Plan, and today we are going to talk about the specific tools that you need to supercharge your recovery. This podcast is called Your Anxiety Toolkit. Today, we are going to discuss all the tools that you are going to have in your tool belt to use and practice so that you can get to the recovery goals that you have. Let's go. For those of you who are here and you're ready to get your toolkit, what I encourage you to do first is go back to last week and listen to Part 1 of this two-part series, which is where we do a mental health recovery audit. We go through line by line and look at a bunch of questions that you can ask yourself, journal them down, and find specifically what areas of recovery you want to work on this year. Now, even if you're listening to this as a replay and it's many years later, that's fine. You can pick this up at any point. This episode and last week's episode actually came from me sitting down a few weeks ago and actually going, "Okay, Kimberley, you need to catch up and get some things under control here." You can do this at any time in a month from now or a year from now. We're here today to talk about tools, so let's get going. First, we looked at, when we did our audit, the general category. The general question was, how much distress are you under? How much time is it taking up, and how do you feel or what are your thoughts about that distress? That is a very important question. Let's just start there. That is an incredibly important question because how you respond to your distress is a huge indicator of how much you will suffer. If you have anxiety and your response is to treat it like it's important, try to get it to go away, and spend your time ruminating and wrestling, you're going to double, triple, quadruple your suffering. You're already suffering by having the anxiety, but we don't want to make it worse. If you're having intrusive thoughts and you respond to them as if they're important and need to be solved, again, we're going to add to our suffering. If you have grief, shame, or depression and you're responding to that by adding fuel to the fire, by adding negative thoughts, or by saying unkind things to yourself, you're going to feel worse. How do you respond? WILLINGNESS Tool #1 you're going to need in this category is willingness. When you identify that you're having an emotion, how willing are you to make space for that emotion? I'm not saying give it your attention; I'm saying, are you willing to just allow it to be there without wrestling it, trying to make it go away? Are you willing to normalize the emotion? Yeah, it makes complete sense that I'm having a hard time, or that all humans have these emotions. How willing can you be? Often, what I will ask my patients is, out of 10, if 10 being the highest, how willing are you? We're looking for eights, nines, and tens here. If you're at like a six, seven, that's okay. Let's see if we can get it up to the eights, nines, and tens. VALUES OVER FEAR Another tool (Tool #2) is respond with values, not fear or emotion. We want to work at being very clear on what our values are, what is important to us. Because if we don't, emotions will show up. They will feel very, very real. When they feel very, very real, you're likely to respond to them as if they're real. Again, adding fuel to the fire, adding to the suffering. Instead, we want to respond with values. If you have fear, you're going to ask yourself, do I want to respond based on what fear is telling me, or my values, my beliefs, the principles, the things that are important to me? If you're depressed, do you want to respond based on what depression is telling you to do? Like, "Give up, it's hopeless, there's no point." Or do you want to get back in touch with what matters to you? What would you do if depression wasn't here? What would you do if anxiety was not here? The third tool I'm going to give you, and this is a huge one—I'm going to break it down into different categories—is mindfulness. Now, if you've been here on Your Anxiety Toolkit, you already know that I think mindfulness is the most important tool, one of the most important tools you will have in your tool belt. You should be using it in your tool belt every day. It's like if you actually had a tool belt, it'd be like the hammer, the thing you probably use the most. Mindfulness involves four things, and this is the way I want you to think about it. MINDFULNESS Number one, it's awareness. Mindfulness is being present and aware of what is happening to you internally. Being able to identify, I feel sad, I feel anxious, I notice uncertainty, I'm noticing I'm having thoughts about A, B, and C. That awareness can help you stay in line with your values, but stay present enough to respond wisely. Mindfulness is also presence. I've already given you that word. It's being in the here and now. Fear always wants us to look into the future; mindfulness is being in the here and now. Depression often always wants us to look at the past and ruminate on the past and what went wrong or what will potentially go wrong in the future; mindfulness is only tending to the here and now, what's actually happening. When I'm anxious and I become present in my body, I realize that the thing that I'm afraid of hasn't happened yet. If it is happening, if the thing that I'm afraid of is happening, then I can still go, "Okay, what's happening in the present? How can I relate to it?" As we've discussed in earlier tools, how can I relate to it in a way that doesn't add to my suffering? Can I make some space for it? Can I be willing to have it? Can I respond with values? Really getting present in this moment will give you some space to act very skillfully. NON-JUDGMENT The next mindfulness tool is non-judgment. We have to be non-judgmental. Often, when I'm with my patients or with my students, they will often say, "I'm having anxiety, and it is bad and wrong, and I'm wrong for having it, and it shouldn't be here." All of that is a judgment. I often bring them back to the fact that anxiety, while yes, it is uncomfortable, it is neutral. Let me say that again. Anxiety, while it is uncomfortable—it's not fun—it is neutral. It is neither good nor bad. It just is your present experience. This work becomes how willing are you to feel discomfort. How willing are you to widen your distress tolerance for this thing that you're experiencing, and how can you practice not judging it as bad? The thing to remember is, if you have an emotion, a sensation, or a thought, and you appraise it as bad, your brain will remember that for next time. So next time you have it, it will more likely send out a bunch of cortisol and adrenaline and a bunch of stress hormones when you have that emotion, that sensation, or that thought. And that's how we can break this cycle by practicing non-judgment. WISDOM AND INSIGHT The fourth piece of mindfulness that I want you to consider is wisdom and insight. This is not a typical mindfulness tool, I would say, but it's an important piece of our work. When we have mental struggles, when we have emotional struggles, it's very easy to fall into the trap of believing our thoughts and our feelings, going into that narrative, and getting into that story. When we do that, again, we make things worse. We tend to act on those emotions and that distress instead of our values. A lot of mindfulness, if you can practice being present, if you can practice being aware, if you can practice being non-judgmental, you then get to be steady in wisdom. You get to check the facts and respond according to the facts and the reality. You get to be level in how you respond. It doesn't mean your anxiety will go away. It just means that you're thinking in a way where you can make decisions. You're connected to your prefrontal cortex, where you can make good decisions for yourself, not just respond to the emotions that you're having. That's sort of like a bigger picture, but that's sort of more like the result of practicing mindfulness. When we last week went through the audit of your mental health recovery, we also addressed safety behaviors. Now these were avoidance, reassurance seeking, mental compulsions, physical compulsions, and there is a fifth one, but we'll talk about that later. We really went through and thoroughly investigated, did an audit, did an inventory of how many of these behaviors and what specific behaviors you do. Again, if you didn't listen to that episode, go back and look at that because it will help you put together a really good inventory of what's going on for you. Now, I want to address a couple of things when it comes to these. If you're someone who does a lot of avoidance, I'm going to strongly encourage you to use Tool #4, which is find ways to face your fear. Identify all the things that you are afraid of and you're avoiding, and find creative ways to face your fear and make it fun. If you're afraid of something, try to find ways to make it fun that line up with your values. If you're afraid of airplanes but love to travel, pick a place when you first start this that you're interested in going to. Have it be something that you have been wanting to go to for a long time. Do it with someone you enjoy doing it with. If it's something miscellaneous around the house, include the people around you, make it fun, put the music on that you want. You're not doing that to take the discomfort away; you're doing it so that it's so deeply based on your values, so deeply based on what's important to you, and purposely every day, find ways to face your fears. Now, if you have OCD specifically and you want help with this, we have a full, comprehensive course called ERP School. If you go to CBTSchool.com, you can get access to that, and it will take you step by step on how to do that for OCD. If you have generalized anxiety or panic disorder, we have a step-by-step process for how you can do that. It's called overcoming anxiety and panic. If you have depression, we actually have a whole comprehensive course for depression as well on how you can face the depression, how you can undo the way that depression has you avoiding things and procrastinating, and how it's demotivating you. That course is there for you as well at CBT School. If you're someone who struggles with mental compulsions, we actually have a free six-part mental compulsion series here on Your Anxiety Toolkit. It's completely free. I'll leave the links for that in the show notes below. But that will help you walk through it with six amazing clinicians from around the world, like the best ones that we can get, talking specifically about different ways to manage mental compulsions. But it does involve a lot of the tools we've already talked about—a lot of mindfulness, a lot of facing your fear, a lot of willingness, a lot of awareness. These are things that you can be using specifically to interrupt those safety behaviors. Now, another tool (Tool #5) is distress tolerance, because as you face your fear, you're going to have some uncomfortable feelings. Distress tolerance is an opportunity for you to lean into that discomfort a little more. It's very skill-based. Let me give you a couple of ideas. BEGINNERS MIND Number one would be this idea of a beginner's mind. Usually, when we're uncomfortable, our natural human instinct is to get out of here. Like, "Let's go. I don't want to be here. I don't want to feel it. Let's run away." Another instinct is to fight. Like, "Oh, I want to wrestle with it." Beginner's mind is the opposite of that. It's the practice of being curious. We actually have a whole podcast episode on beginner's mind. Think of it like you're a baby. I always say, imagine you're like one or two and you hand the baby a set of keys. Now, if you handed a set of keys to an adult, they'd be like, "Yeah, that's keys." They wouldn't really stop to look at the keys. But if you give it to the baby, they're so curious, they're so open-minded, and they look at the keys like I've never seen these. They're shiny, but they're hard, but they're bumpy. They have these round things. What do you do with them? I'll put them in my mouth. What do they taste like? What do they feel like? They're so willing to see these keys as if it's the first time they've ever seen them because it's the first time they've ever seen them. As adults, we have to practice being curious, just like that. When we're uncomfortable, we can be curious instead of nonjudgmental and go, "Okay, let's be curious about this. What does it feel like? I wonder what it's like if I'm willing to feel it. How long does it last? Can I let it be there? I wonder what will happen if I let it be there and go and do this or face the fear." Let's be curious instead of having a fixed mindset of, "I can't feel this. I can't handle it. I don't want to," and so forth. Beginner's mind is very important in helping you relearn the perceived stress or the perceived danger of a certain thing. Another really important distress tolerance skill is radical acceptance. Radical acceptance is a sort of badass response to fear and emotions by going, "Bring it. Let's have it. It's here. There's nothing I can do. Trying to stop it only makes things worse. And so I'm committed to radically accepting it being here." Then you can go on to use other tools like your values and willingness, ERP, CBT, and any of those. You can use any of those skills. But you're coming from a place of just radically accepting that it's there. UNCERTAINTY Another distress tolerance skill is to be uncertain on purpose. "Bring it on." If you have anxiety, you're going to have uncertainty anyway. Bring it on. Let's let it be there. Let's make another relationship with uncertainty—one that's not stressful and one where it's like, I'm allowing it to be there. I actually have some mastery over it because I've practiced letting it be there before, and I tolerated it then, and I'm sure I'll tolerate it again. Remember here, you have gotten through 100% of the hard things in your life. You can do it again, and each time we can make this 1% improvement in how skillful we are in response to it. SELF-KINDNESS AND SELF-COMPASSION The next category that we had in the audit was kindness. We talked about questions such as, how do you treat yourself throughout the day? How kind are you? Do you punish yourself for having emotional struggles? And of course, you guys know this is number six, which is self-compassion. We know that self-punishment doesn't work. In fact, it makes us feel worse. Self-compassion is the practice of making you a safe place to have any emotion, any discomfort, have any thought, have any anxiety. You're willing to have them all, and you're going to promise yourself and commit to yourself that you'll be gentle with yourself no matter what. That's the work. Truly, so many of you have said that you've been working on that, and you've actually made huge strides in that area. We have so much content on Your Anxiety Toolkit on self-compassion. I'd encourage you to…
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