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.
The New York Times listed Your Anxiety Toolkit as one of the “6 Podcasts to Soothe An Anxious Mind” (April 27, 2024). We are on a mission to help people who want to thrive in the face of anxiety and other mental health struggles.
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SUMMARY: In this episode, we explore how to manage uncomfortable sensations. Many people do not struggle with intrusive thoughts and intrusive images, but instead, struggle to manage intrusive sensations. My hope is that this will give you some tools to manage these uncomfortable sensations and help you reduce how many compulsions you do to reduce or remove these feelings. In This Episode: What is an intrusive sensation? What is the difference between an uncomfortable sensation and an intrusive sensation. How to manage uncomfortable sensations such as rapid heartbeat, tingling limbs, numbness, lightheadedness, chest pain, etc. Links To Things I Talk About: ERP School: https://www.cbtschool.com/erp-school-lp Episode Sponsor: This episode of Your Anxiety Toolkit is brought to you by CBTschool.com. CBTschool.com is a psychoeducation platform that provides courses and other online resources for people with anxiety, OCD, and Body-Focused Repetitive Behaviors. Go to cbtschool.com to learn more. Spread the love! Everyone needs tools for anxiety... If you like Your Anxiety Toolkit Podcast, visit YOUR ANXIETY TOOLKIT PODCAST to subscribe free and you'll never miss an episode. And if you really like Your Anxiety Toolkit, I'd appreciate you telling a friend (maybe even two). EPISODE TRANSCRIPTION This is Your Anxiety Toolkit - Episode 292. Welcome back, everybody. Today, we are talking about something that I very rarely talk about that I should be talking about more because it's like 20% of the conversations I have with clients. And I'll explain to you why in just a second. First, I'm going to do the review of the week. This one is from Linelulu. And they said: "Grateful. I am so grateful that I stumbled onto your podcasts. Your soothing voice enhances your messages as I am trying to understand more about anxiety, and panic attacks to be a better support for someone very close to me. Thank you!" You are so welcome, Linelulu. Thank you for that beautiful review. Please, I know I ask you every single episode. If you benefit from this podcast, this is one way that you can help me. So, if for any reason you feel like you have a few spare minutes, please do go and leave a review. The last thing before we get talking about sensations is to do the "I did a hard thing" of the week, and this one is from Camille. Camille says: "I've been managing my dermatillomania," which we also know is compulsive skin picking, "very well. However, I had a very stressful day and picked my skin pretty bad, in my opinion. I had a party to go to that night with a bunch of people. I didn't know. And I almost didn't go. But I pushed myself to go and no one said one thing about my skin. I'm so glad I went and got over the fact that my skin needs to be perfect in that instance." Camille, this is so good on so many levels, that you showed up and you did the thing that you wanted to do. And ugh, it's so good. And how wonderful that you had supportive friends. Again, we sometimes were really hard on ourselves and we think people notice everything about us, every flow, but how wonderful that they embraced you and no one said anything. So, thank you so much for Camille for putting in that "I did a hard thing." I just love hearing you guys doing all the hard things. Now, why do we do this segment? Let's just go back and look at that. So, most of you know that the thing I say all the time is "It's a beautiful day to do hard things." Our brains naturally default to this idea of like, "No, I shouldn't do the hard thing. I should do the easy thing." Marketing keeps telling us don't do the hard thing, do the easy thing. Commercial advertising is always sharing the easy five-step way to do something. And we want to flip the script because while it's good to have things be easy, when it comes to anxiety and these kind of conditions that we're often talking about, it's often important that you stare that scary, hard thing in the face. Now, that is the perfect segue into this week's episode about sensations. Now, at the beginning of the episode, I said it's crazy that I haven't done a lot of these episodes because sensations is 20% of the work. Now, why did I say that? In total, the clients that I see and that my staff see in our private practice, they're coming to us for one of five reasons usually. They either have an intrusive thought that they don't know what to do with, they have an intrusive feeling that they don't know what to do with, they have an intrusive urge that they don't know what to do with, they have an intrusive image that they don't know what to do with, or they have an intrusive sensation that they don't know what to do with. Five things. 99.9% of our patients and of the people that we help come with one of those five problems. It doesn't matter what you call it. They're coming with, "This is the experience that I'm having." That's so overwhelming and difficult and hard that then they go on to do behaviors to try and manage it, and we teach them how to manage those five things in a way that doesn't require them to do the behaviors that cause them trouble. So, let me give you a little more information about that. So, when we're talking about sensations, we're talking about-- let's first get a definition. What is a sensation? A sensation is a physical feeling or a perception resulting from something that happens or that comes into contact with the body. So, really what we're saying is a sensation is an experience you have in your body and it's very specific. So often when I'll say to a client, "Okay, how can I help?" they'll say, "Well, I'm anxious." And I'll say, "Okay, tell me about your anxiety." And they'll then usually go on to say, "Well, I'm having these thoughts," or "I'm having these feelings," or "I'm having these urges. I'm having these images," or "I'm having these sensations, and I don't like it. They make me uncomfortable." And when I have them, I do these again, like I said, behaviors that kept me into a ton of trouble. Meaning they've got big consequences. So, often a sensation we consider to be an obsession, just like an intrusive thought, is an obsession. It's as relevant. And it's important if someone has anxiety for us to go, "Okay." This is a common question. If you were my client, this is a common question I ask. I'll say, "Imagine that I'm an alien and I've never, ever once in my life experienced anxiety, and I want you to tell me what it feels like because it doesn't make any sense to me." And often clients will struggle with this because they'll be like, "Well, I just have anxiety." And I'll say, "No, we need to understand what specifically, how do you specifically know you're anxious?" "Oh, I have tightening in my chest or I have shortness of breath, or I have a lump in my throat or I have these butterflies in my tummy." So, immediately, once we get that, we're like, "Okay, now we know what we're dealing with. Okay, now we have specific sensations and now we can develop tools around them so that when you have them, you don't either engage in avoidant compulsions or physical compulsions or mental rumination or reassurance or self-punishment." So important. Now, let's slow down here a little and look at what that looks like for many of my patients and many of you. So, this is not scientific, what I'm about to tell you. This is really just coming off of my stream of consciousness and my experience as a clinician, is I've broken them down into four main sensations that my patients report to me. Again, this is not a clinical list. So, I want to preface. I don't want to ever mislead you into thinking this is scientific. But often one of the sensations that people will feel are physical experiences of anxiety, like I listed. It could be butterflies in your tummy, tightness in your chest, as I just said, and I've listed them off. The next one is specific sensations around what we call depersonalization and derealization. I've done full episodes on those in the past. So, go back and check them out. But this is the experience of this weird feeling. The sensation is like, everything feels strange. I feel like distorted, like I'm in a daydream. It feels very hazy and strange, or I feel like I'm outside of my body. Now while we have words to describe derealization and depersonalization, they are also at their most basic form of sensation, a basic sensation. So, I put that in its own category. The next one is similar to anxiety and derealization and to personalization, but I've put them under the category of panic. Now, the reason that it's so important for us to talk about sensations is, people who have panic disorder are very sensitive to the sensations that they have because panic is such a 10 out of 10 anxiety. So, it's like can't breathe, racing thoughts, major overwhelmed, dizzy, sweating. These are all sensations. These are all things that we perceive or we experience in our body. And then the last one is physical pain. This is a sensation too. When you physically have pain, a tummy ache, that's also a sensation. Now, let's talk about why I separated those, because I'll give you a really perfect example of how this gets messy. Most of you know that I have postural orthostatic tachycardia syndrome, which is symptoms of dizziness, lightheadedness, headaches, stomach troubles. And often if you stand for too long, you faint. Now, what does that sound very similar to? You guys are probably laughing at me already. Anxiety. It looks exactly like anxiety except the fainting piece, dizziness, lightheadedness, stomach aches, headaches. So similar. And so, when we have, and this is where it gets difficult, when we have a chronic illness or if we have health anxiety, when we experience a sensation, sometimes we can't figure out whether it's real pain and real threat or if it's anxiety. The thing to remember here is the response needs to be similar. So, for me, when I had dizziness and lightheadedness, yes, of course, I'm not going to push myself to a place where I pass out, but I'm going to first stop and go, "Hmm, let me try to dip into these sensations. Instead of catastrophizing them as this is terrible and bad things are going to happen, I wonder what would happen if I just labeled them as a sensation." The thing here is, when we have sensations, and you're having them right now, believe it or not. It could be an itch. It could be a muscle that's sore from a workout you had, it could be a stomach ache because you just ate an amazing dinner and you just had a little more than you wish you had, or you're having anxiety. We all have them. Where we often get into trouble is when we label them as good or bad. So, that's the main point here first. Are you labeling your sensations as good or bad? When I would have my POTS symptoms, I get dizzy. At the beginning, I go, "This is bad, this is bad. Bad things are happening," which would then give me anxiety, which would make it worse. And now I've got this hot mess. Massive hot mess. Same for people with health anxiety. They have tightness in the chest and they go, "Oh my God, I'm dying. I'm having a stroke," or "I'm having a heart attack." And when we label it as bad, we get more anxiety, which makes it worse, and now we're in a cycle. If you're having a panic disorder and you're starting to notice that small little tingle of anxiety coming up, this like whoosh of anxiety that whooshes over you when we have a panic attack, and you label this as, "Oh, this is bad, this is terrible. I got to get it to go away," you can bet your bottom dollar, it's actually going to feed you more anxiety. So, question whether you are labeling your sensations as good or bad. Now I'm guessing some of you are thinking, "Well, Kimberley, of course, I'm going to label it as bad. It is bad. It's terrible. I don't like it." And I get you. But we're here to learn. We're here to grow. We're here to recover. So, I want you to think beyond that judgment and look at first the judgment doesn't help you. Whether it's true or not, it's not helpful. It makes it worse. So, let's work at being nonjudgmental about the sensations that we have. The response we have to your sensations can determine whether you get stuck in a cycle of having more discomfort. Let me rephrase that in a different way to make an even bigger point. The response you have to your sensations can determine whether you have anxiety about them in the future. Because if you treat the sensations today like they're dangerous and harmful and they require immediate emergency, you're training your brain to perceive those sensations as scary and bad and dangerous. And so next time you have them, your brain is going to send out a whole bunch more anxiety. So important. I've had my share of panic attacks in my life, but when I have them and if I'm like, "Oh, dear God, please don't," I know my brain is going, "What, what, what? What's wrong, Kimberley? Why are you telling me this is terrible? Okay, it is terrible. I'll keep sending out anxiety." But when I can respond by going, "Good one, brain. It's cool. There's no amount of sensations I can't tolerate. It's fine. I'm going to ride it out." Again, we don't know how to bypass it with positivity by going, "It's great. I love it." We're not saying that. But we are saying if we can reframe the sensation as tolerable and manageable, you're less likely to have anxiety about the sensation tomorrow. Now, I know a lot of you may be asking, "But how do I know when it's something to just be uncertain and nonjudgmental about or when I should rush to the hospital and so forth?" Number one, you'll know. But the other piece, I don't want to discard you on that one because that's hard to say, especially if you have anxiety, especially OCD and health anxiety. But the other thing is, for me, if I'm having it and I'll use me as an example, if I'm having dizziness and lightheadedness, which could be anxiety or it could be my POTS, I just keep on the deferring. I keep on deferring like, "Okay, can I just stay with it nonjudgmental for another few minutes?" If I'm getting to feel really horrible, of course, I'm going to sit down and take a rest. I'm not going to push through and be unkind. But I just keep being curious. Could I it do a little longer? Could I have a little more? Could I be nonjudgmental for another few minutes? It's so important because when it comes to anxiety, the way in which we respond to the sensations is as important as how we respond to intrusive thoughts. Particularly like I said, if you've got depersonalization, derealization, panic disorder, physical pain, generalized anxiety, health anxiety, so important. If it's social anxiety, it's a big one because a lot of people with social anxiety have an aversion to the sensation of being flushed in their cheeks. But if you respond to your cheeks flushed as bad, you're probably going to get more of it. It's paradoxical. Now, here is one other point I want to make before we fin…
Full show notes at the publisherSUMMARY: A few months ago, I posted on social media and asked "What are your best tips for depression" and the response was incredible. Hundreds of people weighed in and shared their best tips for managing depression with OCD and other anxiety disorders. In This Episode: Hundreds of people with depression shared what skills they use to manage OCD and depression What skills can become compulsions How to manage day-to-day depression when you are feeling hopeless (OCD hopelessness) Links To Things I Talk About: Kimberley's Instagram Page https://www.instagram.com/youranxietytoolkit ERP School: https://www.cbtschool.com/erp-school-lp Episode Sponsor: This episode of Your Anxiety Toolkit is brought to you by CBTschool.com. CBTschool.com is a psychoeducation platform that provides courses and other online resources for people with anxiety, OCD, and Body-Focused Repetitive Behaviors. Go to cbtschool.com to learn more. Spread the love! Everyone needs tools for anxiety... If you like Your Anxiety Toolkit Podcast, visit YOUR ANXIETY TOOLKIT PODCAST to subscribe free and you'll never miss an episode. And if you really like Your Anxiety Toolkit, I'd appreciate you telling a friend (maybe even two). EPISODE TRANSCRIPTION This is Your Anxiety Toolkit Episode 291. Welcome back, everybody. So, I want to set the scene here because things are shifting. Things have shifted. So, I am right now sitting in my office, which is in Southern California, in the United States. But as this launches and goes live, I will be in Australia for the summer. I think I've talked to you guys about this in previous episodes, but my husband and I made a decision that the children and I will go to Australia to see our family for the entire summer. Oh my goodness, what a huge undertaking, but we're doing it and I am so excited. So, really, I've had to batch 10 episodes ahead of time. Now, what I've done is I've done my best to make these the best episodes I can batch for you, like the things that seem to be coming up the most for my clients, the questions my staff seem to be asking the most, and the things that everyone seem to be really, really liking and appreciating on social media. And so, in preparation for today, I was thinking about what's one of the most helpful, most enjoyed, and engaged posts on social media, because I do spend a lot of time over on Instagram. And by far, interestingly by far, my most popular post I have ever made in the whole history of me being on social media is tips on managing depression. What? I'm an OCD and an Anxiety Specialist, but yet my most popular post in the whole time I've been there is on managing depression. So, that's what we're talking about today. Now, in order for me to do 10 posts, 10 podcasts, excuse me, in order, I've had to manage my time down to the minute because right now we are leaving in 18-- no, what is it? Not 18 days. It's like 15 days. So, we're leaving in 15 days. I have all of this in addition to the work because I usually just do these here and there. I've had to manage my time, and what I have relied on the most is managing my time using what we call "calendaring." I talk a lot about this on my online course. If you go to CBT School, we have a whole course on managing time. But the reason I also share that with you is as we talk about skills today, we're going to be talking about cognitive skills and behavioral skills. And if you have depression, I strongly encourage you to go and sign up for that course. It's not an expensive course. It's jam-packed with how to schedule your time so that you can lessen the heavy load that you're carrying or the time about the lists of things you have to do and get done. So, I do recommend you go check that out. Go to CBTSchool.com and I think it's /time management. Yes, it is. We're about to get into the show. First of all, let's do the "I did a hard thing." This one is from Anonymous and it says: "I stopped driving and spending time with children because of OCD. But yesterday, I drove my little sister to school. I was scared, but I'm so proud of myself. Thank you, Kimberley." This is so good. I can't tell you how many people when they're anxious, they stop driving. It's actually a really common question I get on social media. It actually surprised me at first in that how common it is. It's one of the first things people stop doing, is driving. So, Anonymous, amazing. You are just all for the correct courage and all for the bravery and I'm celebrating you right now. That is so, so amazing. Great, great job. And one more thing, let's do quickly a review of the week. This is from Robin. Robin says: "I'm not sure how to condense all of my happiness and thanks, but I'll try. Was recommended to listen to your podcast by my therapist (who is just superb and I'm grateful she exists) and I instantly fell in love with your genuine desire to help which seeps through the sound waves. I am hooked on the real-life stories that I can connect to my own experience and have gotten my sister hooked as well who struggles with anxiety as I do. Thank you for your tools and support!" Thank you, Robin, for that amazing review. Please do go over. And if you listen to the podcast, leave a review. It does help me help other people and more than ever, that is my biggest mission. Tips to Manage Depression (From Hundreds Who Have Been There) All right, let's do it. So, let me just give you a little bit deeper context here. So, what I did is I did a poll on social media. So, just to give you some context, I have around 75,000 followers on social media. So, I posted: "Please just give me your best tips for managing depression." Hundreds of people wrote in and the reason-- I don't give you the numbers because I'm bragging. I want you to know this is not just from me. This is from hundreds of people who weighed in, who've been there, who've had depression and they shared little nuggets of what has helped them. And I want to-- in fact, we actually had to split this post into two because there was just so many submissions that we couldn't fit them all in one post. So, here we go. The number one tip for managing depression and these aren't in order, by the way, this is not the one that was most popular. This is just as we went through, these were the ones that seemed to be really coming up for the same a lot of people. The first one is-- this is going to be a fun one for you, is many people reported that having a dog or a cat or a pet helped them to feel like they had a purpose in the world, that they were there to take care of someone, and that that pet gave them an incredible amount of love. I loved this one. What was interesting, I'll give you feedback right away, is there was a little controversy and feedback around this. A lot of people were saying, "Please don't encourage people to get a pet just because they're depressed. Taking on a pet is a huge responsibility." There was a little controversy, a little backlash, I would say, over that point. But I really do agree that those who do have a pet and can commit to taking on a pet have found that that's really helpful for their mental health. Most people said having a pet is the most mindful they are in the day when they're petting their pet, feeding their pet, cuddling with their pet, listening to their pet, and so forth. So, that I thought was an amazing, amazing tip or thing you could practice. Number two, probably again, one of the most important from a clinical perspective is exercise. Now, yes, I know, it's hard to exercise when you're depressed, but we do have a ton of research to show that exercise is in fact as effective as an SSRI. Not to say you shouldn't be on an SSRI. I actually am on all four meds. But exercise is an additional benefit. And so, I strongly encourage everyone to at least get out. It doesn't have to be strenuous, but around 25 minutes was what most people who have depression said, that was the ideal amount. If you get to that point, you actually get more benefit, which I thought was really cool. The next one is: Practice mindfulness. Now again, so helpful. If you have depression, usually, I'm going to guess, your mind tells you a lot of lies, a lot of horrible lies, a lot of absolute painful lies. And a big part of managing it is using what we call mindful-based cognitive therapy. And so, what we mean by that is, first, we are aware and we just observe thoughts as thoughts. We don't take thoughts as facts. And then the cognitive therapy side is once we identify that we've had a thought, we may actually stop to correct it. So, if your brain says, there's no point, you're a waste of space or the future is going to be nothing but terrible or my life is nothing but terrible – when it tells us these lies, we can actually stop and go, "Okay, now, number one, that's a thought and I'm going to observe that thought nonjudgmentally." And then you can also go, "Okay, let's actually check the evidence for that depressive thought. Hmm, do I bring purpose into the world? Is the world going to be terrible?" and look for maybe some holes in this theory and start to be curious about whether that's in fact correct. It's so important. Mindfulness. I personally think these two, the exercise and the mindfulness, are key, are major keys to managing depression. The next one that was suggested by a lot of people was to talk to family and friends, even if they don't fully understand. And I loved that little caveat to go on. As much as depression makes you want to isolate and shut down, make sure that you are going and you're just connecting with them. You're talking with them, you're sharing what you're going through, even if they don't understand, because the truth is they won't. Even if they've been through what you've been through, they won't fully get it. They're not the ones getting fed the lies of depression like you are. Or if you're a family member, I want you to understand it's really not helpful to say to someone with depression, "I totally get what you're going through," because the chances are you don't. But that doesn't mean that we can't relate on some level. That doesn't mean we can't connect and support each other. So, important. So, so important. This one was an interesting one. And I want to-- some of these surprised me, but lots of people reported that attending couples therapy, couples counseling, if you're in a relationship, was helpful for their depression. Now, I wonder if that is because maybe their relationship was a part of what's very difficult for them, but I can see the benefit in that. I don't talk about this very often, but I personally love couples counseling. I have no problem admitting that we've been to couples counseling before. It is thebomb.com. It is such a beautiful thing to do with your partner. Is it hard? Yes. Is it bumpy? Yes. But there's something really cool about knowing that you're showing up to the same place every week with the same goal, which is to strengthen your relationship. That in and of itself is just really, really cool. And a lot of people responded saying that that was really helpful for their depression, which I thought was really cool. Next one, you guys aren't going to be shocked by this, and I definitely wasn't, which was to practice self-compassion. You guys, depression is nasty. It tells you nasty. I'm doing everything I can not to swear here, but it's like BS. It tells you such nasty BS. And one of the best insurance policies against that, or one of the best defenders against that, or I should say offense, the offense against that is to practice compassion for yourself, to practice being kind and respectful and being tender to the suffering that you're experiencing. Because believe me, I do know, I've experienced depression throughout different parts of my life. It's horrible and it feels-- the only way I can explain it is you can't understand it when you're in depression because you're in depression. But once you're out of the depression, for me, it felt like someone had pulled this gray veil off my head that I didn't even know was there until I'd come out of a depression by going to a lot of therapy and so forth. And I was like, "Whoa, I had no idea everything was under a gray veil until the gray veil was lifted." So, that compassion piece is really important because I didn't know the depression was there until the depression had lifted, if that makes any sense. And had I known it, I probably would've been much, much, much kinder to myself. Next point, I love this. It's very similar to what we talked about before, but it says, no matter how much you don't want to, get up and move your body. Now, I could have easily put this under the category of exercise. But a lot of the comments weren't-- this wasn't talking about exercise. It was saying, stand up and stretch was one of them. Just stand up and swing your body around, move it around, get into the flow, let the blood flow around your body. And they were saying that that is a shift in mentality. It's a shift in mindset. I know even today as I'm recording all these episodes, I'm going to need to practice this, because if I just stay here and I stare into this microphone and I'm looking at the screen, my brain is going to get a little distorted and strange. I'm going to have to go upstairs, shake it off, get a cup of tea, move around. And so, I love that they distinguish this separate from exercise. Next point, oh my gosh, this is gold right here. It says, do something you used to enjoy. Now, when we're depressed, often nothing feels enjoyable. Even food isn't enjoyable anymore, or company might not be enjoyable. The things you used to love, the vibe is gone. But what a lot of people were saying, and this is again from people who've had depression and managed it, is they were saying, whether or not you enjoy it now, continue to do the things you used to enjoy, but also spread out. This is one thing I didn't mention here, is a lot of people said, be curious about little things that you used to enjoy that you never really developed as a hobby. So, an example would be, I think somebody said something to the likes of like, I used to love hopscotch. Of course, they loved it when they were very, very little. So, as they got older, of course, they stopped playing hopscotch into their adulthood. But they were like, "I literally wrote down a list of everything I used to enjoy and I just did it, whether I've done it for 40 years or not." So, little things. It doesn't have to be grand things. It doesn't have to be hobbies. It could be going, "I remember as a kid, I used to love boba or whatever." Go and get some. Do the things you used to enjoy, even if they're teeny tiny. Another huge group of people said sunlight. Sunlight is a huge part of managing depression. Now, thank goodness for these, my community, because if I was putting together a podcast or managing depression, I would've completely forgotten about the people who have seasonal affective depression because I live in California and I wouldn't have thought of that. But so many of my followers are from all around the world and hundreds of people responded saying, you have to get sunlight. You have to get exposure, UV lights. There are all…
Full show notes at the publisherIn This Episode, we discuss:
Is it important that you stop doing all your compulsions? How can I practice Self-Compassion as you move through recovery? How can you balance facing fears and also being gentle on yourself?
Links To Things I Talk About:ERP School: https://www.cbtschool.com/erp-school-lp
Episode Sponsor:This episode of Your Anxiety Toolkit is brought to you by CBTschool.com. CBTschool.com is a psychoeducation platform that provides courses and other online resources for people with anxiety, OCD, and Body-Focused Repetitive Behaviors. Go to cbtschool.com to learn more.
Spread the love! Everyone needs tools for anxiety...
If you like Your Anxiety Toolkit Podcast, visit YOUR ANXIETY TOOLKIT PODCAST to subscribe free and you'll never miss an episode. And if you really like Your Anxiety Toolkit, I'd appreciate you telling a friend (maybe even two).
EPISODE TRANSCRIPTION
This is Your Anxiety Toolkit - Episode 290.
Welcome back, everybody. 290, that sounds like a lot of podcast episodes. It's funny. Sometimes I don't think of it. If you have asked me on the street, I'd say, "Yeah, I'd have about maybe 110 in the can." But 290, that is a lot of episodes. I do encourage you to go back and listen to them, especially the earlier ones. They're my favorite. But no, go back, play around, check out the ones that you love. There's probably some things there that you could probably go back and have a good giggle at.
All right. We today are talking about a question that came from a student in one of my courses. I've found this question to be so important. I wanted to bring it in and have it be a podcast episode because I think this is a very important question and I think it's something we can all ponder for ourselves.
Now, before we go into it, I would like to give you the "I did a hard thing." This is a segment where someone shares a hard thing that they've done. And I love the "I did a hard thing" segment probably as much as anything.
This one is from anonymous and they said:
"I have contamination OCD. And one thing I've avoided for a very long time is raw meat and eggs. Over the winter, I discovered that ERP is so much EASIER (and I use this term very loosely in capital letters) if my exposures are value-based." This is so good, Anonymous. "So I decided that I wanted to be the mom that baked with her kids, anxiety be darned. I wanted my kids to have warm memories baking in the kitchen with their mom as the snow fell. So each week over the winter, we picked a new recipe, and over the weekend we made it as a family. The first time I cracked an egg, my husband took out his phone and took a picture. He was so proud. The exposure was still hard and I didn't feel calmer at least while baking, but I tried my best to present and enjoy the time with my kiddos. Later, my son brought home A Joy Is book made at his school. Each page had something on it that brought him joy – fishing with dad, some are vacations. And there on the page." Oh my God, Anonymous, I'm getting goosebumps. "There on a page was 'making cookies from scratch with mom.'" Oh my God, I think I'm crying. Oh my goodness. I have goosebumps everywhere. "It is so hard to measure success with ERP sometimes, but that gets real, tangible evidence that I had accomplished something and it felt so good."
Holy my stars, Anonymous. This is incredible. Wow. This is what it's all about, you guys. This is what it's all about. For those of you who are listening, I don't read these before the episode. I literally read them as just I pull them up and I read them. This one has taken my breath away. I just need a second. Oh my goodness, that is so beautiful. So beautiful. Thank you for sharing that. Oh my gosh, that is so perfect for this week's episode. All right, here we go.
This week's episode is about a question, like I said, is it okay to keep doing some of my compulsions? Again, this came from one of the courses that we have. We have two signature courses for OCD. One is ERP School, and then the other one is this Mindfulness School for OCD that teaches mindfulness skills.
Now, the reason I love this question is, they're asking me as if I am the expert of all things, OCD. And I want to let you in on a little truth here – I am not. You're probably like, "What is happening? She's been telling us that she's an OCD specialist all this time. And now she's telling me she's not the expert." I am not the expert of you. And I want to really make sure that is clear. Anytime someone says, "What should I do? What's the right thing to do for me?" I try my best not to tell them that is best for them because I'm only telling them what I think is best for them. That doesn't mean it's the facts. So, I want to be very clear. I am not the expert in you. You are. You do get to make choices of your own.
That being said-- and I'll talk more about that here in a second. But that being said, let's look at the question and just look at it from a perspective of just general concepts of OCD.
Now, in the beginning of ERP School, we have a whole module that explains the cycle of obsessions and compulsions. I draw it out on a big sheet of paper, like this huge sticky note. And it's actually really funny because I'm trying to squeeze myself into the frame of the video with this huge sticky note. When I think back to it, it makes me giggle. But here let's take a look.
The thing to remember here regarding this question is, if you have a fear and the fear is what we call egodystonic, meaning it doesn't line up with your values, you know it's a fear, and you know it's probably irrational. If you have this fear and you respond to the fear as if it is dangerous and important and urgent, you actually are keeping your brain afraid of the fear. And you're continually keeping your brain stuck in a cycle where your brain will set off the metaphorical fire alarm every time it has that fear. When you have fear and it doesn't line up with your values and you have the insight to see that it's irrational or that it's keeping you stuck and it's not effective for you and not responding anymore, your job is to practice changing your behaviors and your reaction to that thought so that you can train your brain not to set the fire alarm off next time. It may take several times or many times. But again, if you have a fear and you respond to it like it's important, your brain is going to keep thinking it's important. If you have a fear or an obsession and you keep responding to it with urgency, your brain is going to keep interpreting that fear as urgent, serious, dangerous, scary things.
So, I'm always going to encourage my patients and my students to always check in on this one golden question, which is, what would the non-anxious me do? Or what would I do if I weren't afraid of this thought? Or another question is, am I responding from a place of fear, generally? And if that's the case, then I would encourage my patient to really work at reducing that compulsion because the compulsion keeps the cycle going.
Now, that being said, still, again, I'm going to say, under no circumstances do I get to tell you what to do. Only you will know what's right for you. And I have had clients, I will say, I've had clients where they've written out their hierarchy. They've gone all the way to the top. And there's several things at the top where they're like, "No, I'm actually going to keep these ones. These ones are ones that don't interfere with my life too much. I'm comfortable. I'm not ready to face them yet. And so, no, I'm going to keep doing them." And I respect that. Again. I am not the expert on everybody. Everyone gets to make their own value-based decisions. That's entirely okay.
I always say to them, going to the top of your hierarchy and cutting back on all of the compulsions is, think of it like an insurance policy on your recovery. It's not going to completely promise you and guarantee that you won't have obsessions in the future or you won't have a relapse here or there. No. And that's okay. That will happen. We're going to actually have a conversation about that here in the next few weeks on the podcast. But you can help train your brain by marking off all those compulsions.
So, what I'm going to leave you here with-- this is actually not going to be a long podcast, but what I'm going to leave you with is the actual answer to the question. Is it okay if I keep doing some of my compulsions? Yes, it's okay. You don't have to be perfect. You don't have to win all the challenges. And for reasons that are yours, you get to make those decisions. And really that's your personal decision as well, and-- we don't say "buy," we say "and." And just keep in mind the nature of compulsions. Compulsions keep the cycle going.
Just keep that in mind gently, in a tender place. Put it in your back pocket. And here is the question I'm going to leave you on, is ponder why you don't want to stop this compulsion. What's getting in the way? If you're really honest with yourself, what's the reason you want to keep doing it? Does doing it keep you aligned with your values? Is there a way to be creative and strategic in this situation where you can slowly reduce the compulsion, even if it's a baby step? It's so important just to be pondering and asking yourself questions. I have to always stop and say like, "Okay, Kimberley--" I call myself KQ. Everyone calls me KQ. "KQ, let's get real. What's really happening here.?" And I'm not doing it in a mean way. I'm having a heart-to-heart. What's really happening? What's really getting in the way? Are you being honest with yourself? And sometimes you have to have really honest conversations to be like, "Oh, I know. I'm totally giving myself stuck here." And it might take some time before you're ready, and that's okay too. Okay?
So, I want you to think about those things. Maybe even write the questions down. Go back and listen, or you can go to the transcript of this podcast. Write those questions down and go back and review them every now and then, because those are questions I ask my patients every single day. Every single day. And the questions I ask myself and the questions I ask my patients are often what defines how successful they are because we're questioning the status quo. And that's what gets them better.
Before we finish up, let's do the review of the week. This is from Robyncox and they said:
"Thank you, Kimberley. I'm not sure how to condense all of my happiness and thanks but I'll try. I was recommended to listen to your podcast by my therapist (who is just superb and I'm grateful she exists) and I instantly fell in love with your genuine desire to help which seeps through the sound waves." I love that. "I am hooked on the real-life stories that I can connect to my own experience and have gotten my sister hooked as well who struggles with anxiety as I do. Thank you for your tools and support!"
Thank you, Robin. Again, I love hearing your reviews and I just love hearing that I can be of service and help you and be a part of your day. I love knowing that people are like taking walks, listening to me and we get to have chats together. It's beautiful. It's really, really such an honor.
All right. That's it for Episode 290. That's a lot of episodes, but I think we're doing well. I will see you next week for Episode 291 and we will go from there. Oh, one thing to note. By the time you talk to me next time, I will be in Australia. We are going to spend the summer there this year and I could not be more excited. I'll send you my love from there. Have a great day.
In This Episode: What is whack-a-mole obsessions? Why do my obsessions keep changing? What is the treatment for fears that keep changing? Episode Sponsor: This episode of Your Anxiety Toolkit is brought to you by CBTschool.com. CBTschool.com is a psychoeducation platform that provides courses and other online resources for people with anxiety, OCD, and Body-Focused Repetitive Behaviors. Go to cbtschool.com to learn more. Spread the love! Everyone needs tools for anxiety... If you like Your Anxiety Toolkit Podcast, visit YOUR ANXIETY TOOLKIT PODCAST to subscribe free and you'll never miss an episode. And if you really like Your Anxiety Toolkit, I'd appreciate you telling a friend (maybe even two). EPISODE TRANSCRIPTION This is Your Anxiety Toolkit - Episode 289. Welcome back, everybody. I am so happy to be with you again. I won't lie. I'm still on a high (that rhymed) from the managing mental compulsion series. Oh my gosh, you guys, I am so proud of that series, that six-part series. If you didn't listen to it, please do go back. I'll probably tell you that for the next several podcasts, just because I am really still floating on the coattails of how amazingly, so wonderful that was. And it really seemed to help a ton of people, which is so fulfilling. I do love-- it's not because of the ego piece of it, I just do love when I know I'm making an impact. It's really quite helpful to feel like you're making an impact. And sometimes when I'm putting out episodes, I really don't know whether they're helpful or not. That's the thing about podcasts compared to social media, is with social media, if you follow me on Instagram @youranxietytoolkit or Facebook, I can get a feel based on how many comments or how many likes or how many shares. But with podcast, it's hard to know how helpful it is. And the feedback has been amazing. Thank you, everyone who's left reviews. What a joy, what a joy. What the cool thing is, since then, it's actually created this really wonderful conversation between me and my therapist. So, for those of you who don't know, in addition to me owning CBT School, I also own a private practice where myself and nine of my therapists were actually, now 10 extra therapists, in the process of hiring a new person. We meet once a week or more to discuss cases. And the cool thing about the mental compulsion series is it brought the coolest questions and conversations and pondering, what would this help this client? How would it help that client? These are the struggles my clients are having. Because as I kept saying, not every tool is for everybody. Some you'll be like, "Yes, this is exactly what I needed," and there'll be other things where they might not resonate with you. And that's totally fine. It doesn't mean anything is wrong. That's because we're all different. But it's really brought up a lot of questions. And so, now I'm actually going to hopefully answer some of those questions in the upcoming podcasts. Today, we're actually talking about what to do when your obsessions keep changing. Because we're talking about mental compulsions and reducing those, and that's actually the response prevention part of treatment, what's hard to know, like what exposures do you do for somebody whose obsessions keep changing or their fears keep flip flopping from one to the other? One week, it's this. Next week, it's that. And then it's funny because a lot of clients will say, "What was a 10 out of 10 for me last week is nothing now. And now all I can think about is this other thing. I was really worried about what I said to this one person. Now, all I can think about is this rash on my arm. And the week before that, I was really upset that maybe I had sinned," or there was another obsession. Again, it's just what we call Whack-A-Mole. We're going to talk about that today. But before we do that, we are going to do the "I did a hard thing" segment. This one is from Marisa. And Marisa is at the @renewpodcast. I think that might be her Instagram or their Instagram. Marisa said: "Last week I submitted my dietetic internship applications. It was a long, stressful process and anxiety definitely came up during it. And I was able to move through and do the hard thing. I kept reminding myself that the short-term discomfort of submitting the application was worth the long-term reward of hopefully getting a step closer to my goal of becoming a registered dietician through completing the internship. Even though there is still uncertainty and the outcome that I have to sit with while I wait to find out the results of my application, I have learned through my ERP work that I can sit with the discomfort and uncertainty. Thank you, Kimberley, for reminding me that it is a beautiful day to do hard things." Marisa, I hope that you get in. I hope that you get all of the things that you're applying for. This is so exciting. And yeah, you really walked the walk. This is exactly what we're talking about when we do the "I did a hard thing" segment. It doesn't have to be OCD-related or anxiety-related. It could be just hard things because life is hard for everyone. I love this. Thank you so much, Marisa. If you want to submit your "I did a hard thing," you may go to my-- it's actually my private practice website where I host the podcast. If you go to KimberleyQuinlan-lmft.com and you go to the podcast link, right there, there is a link that says "I did a hard thing." It's actually KimberleyQuinlan-lmft.com/i-did-a-hard-thing/ okay? But it's easier just to go, and I will try to remember to put this in a link in the podcast. All right. One more piece of housekeeping before we get going is, let's do the review of the week. This is from Sass, and Sass said: "I have had an eating disorder for many years and I spent my adult life trying to understand my compulsions and obsessions. When I found your podcast last summer, everything started to make sense to me. You have given me an understanding and acceptance I couldn't get anywhere else. I look forward to your weekly podcast and enjoy going back and listening to the earlier podcasts as well. Thank you for all you do." Sass, I get you. I was exactly in that position when I had my eating disorder. I didn't understand it. I didn't feel like people explained it in a way that made sense to me. And the obsessive and compulsive cycle really made sense to me. So, I am so grateful to have you, and I'm so grateful to be on this journey with you. Really, really, I am. Thank you for leaving that review. Okay, let's do it. Today, we are talking about Whack-A-Mole obsessions. Now, Whack-A-Mole obsessions is not a clinical term. Let's just get that out of the way. There is nothing in the DSM or there's no-- it's not a clinical scientific term, but it is a term we use in the OCD community. But I think it's true of the anxiety disorder community. Maybe even the eating disorder community as well, where the fears flip flop from one thing to the other. This may be true too if you have health anxiety. It might be true if you have generalized anxiety, social anxiety, where one day everything, it just feels like this fear is so intense and it's so important and it must be solved today. It's so painful. And then for no reason, it goes. And then it gets overshadowed by a different fear or obsession or topic. And what can happen in treatment is you can start to treat one, doing exposure. This was actually one of the questions that came up through ERP School, which is our online course that teaches you how to create a plan for yourself to manage OCD. Some people will say, "Oh, I created a hierarchy. I followed the steps in ERP School. I started working on it and I did a few exposures and I did a few marginals. And boom, it just went away and then a new one came or the volume got turned down." It could be that you addressed it a small amount, and then it went away and got replaced by another. Or it could be that you didn't even get time to address it and it just went to a different topic. And this is really, really distressing for people, I'm not going to lie, because you're just constantly whack-a-moling. You know the Whack-A-Mole game? You're whack-a-moling things that feel super important, super scary, super urgent. And so, what I want to do first is just validate and recognize this is not an uncommon situation. If this is happening for you, you are definitely not alone. And it doesn't mean in any respect that you can't get better. In fact, there's a really cool tool, and I'm going to teach it to you here in a second, that you can use. We use it with any obsession. This is not special to Whack-A-Mole obsessions, but you can use it with any exceptions or if things keep changing. But first of all, I just want to recognize it is normal and it's still treatable. What do you do? The thing to remember here is, when you zoom out, and this is what we do as clinicians, our job as clinicians, and I say this to my staff all the time, is to find trends in the person's behaviors and thinking. And what you will find is, when you're having Whack-A-Mole obsessions, while the content may be different, when you zoom out, the process is exactly the same. You have a thought, a feeling, a sensation, or an urge that is repetitive, that is uncomfortable, that creates a lot of distress in your life. And of course, naturally, you don't want that distress. That's scary. And so, what you do is you do a compulsion to make it go away. It doesn't matter what the content is. It doesn't matter what the specific theory is. This is the same trend. And so, when we zoom out, we can see the trend, and then we can go, "Aha. Even though the content is the same, I can still intervene at the same point." When we talk about this in ERP School, is the intervention point is at the compulsion. And so, the work here is the content doesn't matter. Your job is to catch and be aware, like we've talked a lot about mindfulness, is to be aware and identify, "Oh, I'm in the trend. I'm in the cycle." While the one content has changed, the same behaviors are playing out. So, you catch that. You then practice being willing to be uncomfortable and uncertain about the content, because that's the same too. The same cycle is happening. The thought and the fear create some anxiety, some sensations, and so forth. And then we have an aversion to that. And then our job is to work at not engaging in that compulsion. So, that compulsion might be mental rumination. It might be doing certain behaviors, physical behaviors. It might be reassurance seeking. It might be avoidance. It might be self-punishment. It might be self-criticism. And your job is actually to go, "Okay, it really doesn't matter." And I really want to keep saying that to you. If the fear is, what if I have cancer? What if I'm going to hurt someone? What if I'm aroused by this? What if I have sinned? What if things are asymmetrical? What if I got some contaminant? What if I don't love him enough? It doesn't matter. What if it is not perfect? What if I fail? It doesn't matter. I've just listed some, but if I didn't list your obsession, please don't worry. It's for every one of these. The content for all of them are equally as important. Sometimes what we do is we go, "Oh, that one is okay. But this one is really serious, and we have to pay attention to it." And so, we have to catch that and go, "No, it's all content. It's all--" you could say, some people say it's all spam, like the spam folder. Because when we get an email, we have emails that we really need to see – events, meetings coming up. And then we always have spam, the stuff that's like, "Please send me money for Bitcoin," or something. So, we put that in the spam folder. And so, your job is to catch the trends here, the patterns, and learn how to put those obsessions in the spam folder, no matter what the content. Now, this does require, and here's the caveat, or I would say this is the deal-breaker, is it does require a degree of mindfulness in your part to be aware of what's going on. And this is a practice, like a muscle that you grow. So, what it requires is you have to be able to catch that you are in the content. You have to be able to catch that you are in the cycle that keeps you stuck. And that does require you to be mindful again. And I get it. I'm not saying that you'll ever be perfect at this because I don't know anyone who is. There will be times when you're so caught up in the content and you've been doing compulsions for an hour, two hours, two days, two months and you haven't caught it. And you're like, "Oops, wait. Oops, I didn't catch that one." That's okay. We don't beat ourselves up. Then we just go, "All right, I'm at the point where at least I've caught it. I'm aware that I'm in the content. I'm aware how this is playing out exactly the way that it played out yesterday, but with a different obsession." And then you just move on from there. Don't beat yourself up. But it does require you to strengthen the muscle of being able to catch that you're in the content. And it's what we call insight. It's having the insight to recognize. Now, insight is something we can strengthen with practice. It's not just one and done. It's practice. It's repetition. I have to do this all the time for myself. While I don't have OCD, I do have anxiety and I will catch myself going down the rabbit hole with something until I'm like, "Wait, wait, wait, wait, wait, you've been here before. It looks exactly like what you did on Tuesday where you're trying to figure out something that's not in your control. Kimberley, this is not in your control. You're trying to control something that isn't even your business." And I've seen that trend in me. And so, my job is to catch it. Once I can catch it, then I know the steps. I know, "Okay, I got to let this one go. I got to accept the discomfort on this one. I'm going to have to ride this wave of discomfort. I'm going to have to radically be kind to myself." We know the steps. And once we can get those steps down, it's about catching it. But this is what we do when the obsessions do keep changing. Now, I'm not going to say this is easy because it's not. And if you require help doing this, reach out to an OCD therapist or an anxiety specialist who knows ERP. Remember here, and I'm telling you this with the deepest, most absolute degree of love, is CBT School, the whole mission of CBT School is to provide you tools and resources for those who don't have tools and resources. So, if you haven't got a therapist and you're finding this really, really helpful, but you're still struggling, don't be afraid. It doesn't mean anything is wrong with you. It just means maybe you need some more professional help. Maybe you have a therapist and you're listening into this just to get extra tools. Great. Take what you learn and then take what struggles you have and figure that out. I really want to stress here, and the reason I bring that up is, when I say this, it isn't as easy as it sounds and it does require sometimes having somebody else, this is why I go to therapy myself, is even t…
Full show notes at the publisherSUMMARY: Today, I share what to do when you get "bad" news. This episode will share a recent situation I got into where I had to use all of my mindfulness and self-compassion tools. Check it out! Episode Sponsor: This episode of Your Anxiety Toolkit is brought to you by CBTschool.com. CBTschool.com is a psychoeducation platform that provides courses and other online resources for people with anxiety, OCD, and Body-Focused Repetitive Behaviors. Go to cbtschool.com to learn more. Spread the love! Everyone needs tools for anxiety... If you like Your Anxiety Toolkit Podcast, visit YOUR ANXIETY TOOLKIT PODCAST to subscribe free and you'll never miss an episode. And if you really like Your Anxiety Toolkit, I'd appreciate you telling a friend (maybe even two). EPISODE TRANSCRIPTION This is Your Anxiety Toolkit - Episode 288. Welcome back, everybody. We literally just finished the six-week series on managing mental compulsions. My heart is full, as full as full can be. I am sitting here looking into my microphone and I just have a big, fat smile on my face. I'm just so excited for what we did together, and I felt like it was so huge. I have so many ideas of how I want to do something similar in the future with different areas. And I will. Thank you so much for your feedback and your reviews. I hope it was as helpful as it was for me, even as a clinician. I found it to be incredibly helpful, even as a supervisor, supervising my staff. I have nine incredible staff who are therapists, who help treat my clients and we constantly keep referring back during supervision of like, "Do you remember what Lisa said? Do you remember what Reid said? Listen, let's consider what Jon said or Jon Hershfield said, or Shala Nicely said." It was just so beautiful. I'm so grateful. If you haven't listened, go back and listen to it. It's a six-week series and ugh, it was just so wonderful. I keep saying it was just so wonderful. So, if you go back, I did an introduction, Episode 282. And then from there, it was these amazing, amazing experts who just dropped amazing truth bomb after amazing truth bomb. So, that's that. Today, I am going back to the roots of this podcast. And I'm sharing with you-- for those of you who have been listening for a while, we usually start the episode with a segment called the "I did a hard thing" segment. This is where people write in and tell me a hard thing that they've done. If you go to my website, which is KimberleyQuinlan-lmft.com. There on the podcast page is a place to submit your "I did a hard thing." And today's "I did a hard thing" is from yours truly. I just had to share this story with you. I feel like it's an important story to tell you guys, and I wanted to share with you that I'm not just talking the talk over here, I'm walking the walk. So, today's episode is called When You Get Bad News. I'm just going to leave it at that. Before we get started, I would love to leave you and share with you the review of the week. This is from hannabanana3131, and they said: "Fantastic mental health podcast. Such an amazing podcast. I have learned so many useful tools for dealing with my anxiety and OCD. And Kimberley is such a loving, compassionate coach - I feel like she's rooting for me every step of my healing journey," and she's left a heart emoji. Thank you so much, hannabanana. I love, love, love getting your reviews. It does help me so much. So, if you have a moment of time and the podcasts are helpful for you, that is the most helpful thing you can do back. When we get reviews, then when people who are new come over and see it, it actually makes them feel like they can trust the information we're giving. And in today's world, trust is important. There is so much noise and so many people talking about OCD and anxiety, and it's easy to get caught up in nonsense stuff. And so, I really want to build a trust factor with the listeners that I have. So, thank you so much for doing that. Okay. It's funny that hannabanana says, "I feel like she's rooting for me," because the "I did hard thing" is me talking about my recent experience of having a root canal. Worse than a root canal. So, let me tell you a story now. I'm not just telling you this story to tell you a story. I'm telling you this story because I want to sometimes-- when we do the "I did a hard thing" segment, it's usually very, very short and to the point, but I'd actually like to walk you through how I got through getting some really bad news. So, let's talk about it. And I'll share. I'm not perfect. So, there were times when I was doing well and there was times when I won't. So, for those of you who don't know, which I'm guessing is all of you, I have very bad gums. My gums, I inherited bad gums. It comes in my family. I go in every three months for a gum routine where they do a deep cleaning or they really check my gums to make sure there's not receding too much. And because of that, I take really good care of my teeth. And because of that, I usually have very little dental issues. I never had a cavity. I've never had any cracks or any terrible swollen problems. That just isn't my problem. My problem is gums and it's an ongoing issue that I have to keep handling. So this time, I go in, I get my x-rays, and the doctor comes in. And I have this really hilarious dentist who has not got the best bedside manner, but I do love him and he has been with me through some really tough times that when I found out I have a lesion on my brain, I fully broke down in front of him and he was so kind and gave me his cell phone number. He was just so lovely. But he comes in and he rubs his hands together and says, "What are we doing here today, Kimberley?" And he looks at the x-rays and I kid you not, he says, "Holy crap!" Literally, that was his response, which is pretty funny, I think. From there, I proceed to go into some version of a panic attack. I'm like, "What? What's wrong? What do you see? What happened?" And I think that was pretty appropriate for me to do that. So, I want to validate you. When you get big news, it's normal to go into a fight or flight, like what's going on, you're hypervigilant, you're looking around. Now, he waited about 45 seconds to answer my question. I just sat there in a state of panic while he stared at the x-rays on the wall. And these 45 seconds, I think, was the longest 45 seconds of my life because he wouldn't answer me. And I was just like, "Tell me what's wrong. What's wrong?" So, he turns around and he says, "Kimberley, you have a dead tooth." And I'm like, "What? A dead tooth? What does that even mean?" And he says, "You have a tooth infection that is dormant. Do you have any pain? Do you have a headache? What's going on?" And I'm like, "Nothing, nothing. I'm fine. Everything is fine." And so, he proceeds to immediately in this urgent, panicky way, call in his nurses, "Bring me this, bring me that, bring me this, bring me that. Bring me this tool, bring me this chemical or medicine or whatever." And they're all poking at me and prodding at me and they're trying to figure it out. And he's like, "I cannot figure out what this is and why it's here." So, bad news. Just straight-up bad news. Now, the interesting thing about this is, it's hard to be in communication with someone, particularly when they're your doctor and they appear to be confused and panicking. Not that he was panicking, but he was acting in this urgent way. That's a hard position to be in. And if you've ever been in a position like that, I want to first validate you. That's scary. It is a scary moment that your trusted person is also panicking. Just like when you're on an airplane and it's really bumpy. But if you see that the air hostesses are giggling and laughing, you're like, "Okay, it's all good." But when you see their faces looking a little nervous, that's a scary moment. So, first of all, if you've been in that position, that's really, really hard. What he then proceeded to tell me is, "Kimberley, this tooth has to come out. It has to come out immediately. We cannot wait. It's going to cost a god-awful amount of money. And this has to happen right away." Now in my mind, you guys know me, I am really, really strict about scheduling. I have a schedule. I'm not compulsive about it, but I run two businesses. I have a podcast, I have two children. I have a medical illness. I have to manage my mental illnesses all the time. So, I have to be really intentional with my calendar. So, this idea that immediately, everything has to change was a little alarming to me. But what I remember thinking, and this is one of the tools I want to offer you for today, is being emotionally flexible is a skill. And what we want to do in those moments, and this is what I practiced was, "Okay, Kimberley, this is one of those moments where your skills come in handy. Thank God for them." How can you be flexible here? Because my mind wanted to go, "You got to pick up the kids and you've got to do this and you've got to a meeting tomorrow and you've got clients and you can't do this. This can't happen this week." But my mind was like, "I'm going to practice flexibility." In addition to that, when things change really quickly, we tend to beat ourselves up like, "Such and such is going to hate me. They're going to be mad at me. They're going to think I'm a loser for having to change the schedule." And I just gently said to myself, "Kimberley, we're going to be emotionally flexible here and we're going to let everybody have their emotions about it." So, the kids get to have their emotions about everything changing and my clients get to have their emotions about it too. And having to cancel the meetings, they get to have their emotions. Everyone's allowed to have their emotions about the fact that many, many things are going to be canceled in the next few days. And that has been such a work of art for me, but it has been so beautiful for me to say, instead of me going, "No, no, no, I can't do this," because I don't want them to have feelings and I don't want them to think this about me, now I'm just like, everyone gets to have their feelings. They get to feel disappointed. They get to feel angry. They get to feel annoyed. They get to feel irritated. They get to feel sad. Everybody gets to feel their feelings about it because that's a part of being a human. That's one of the tools I want you to think about. Just play with these ideas. You've just come off the six-week series. These are some more ideas to play with. But then from there, I had about 36 hours where I had to wait for this surgery. And during that time, I had to have an x-ray where I was told, and this is the real bad news, is this infection, actually, this is gross. So, trigger warning, guys. The infection actually ate through a part of my jaw bone. I know. Isn't that crazy? The infection was so bad and it was right at this area where I guess nerves come out of your jaw. There's this tiny hole right at the front, around the sides where the nerves come out of your jaw and up into your lips and the infection spread and was all over that area. I know that is gross, but it's also really scary. So, not only did I have to think about all of the changes, but he, the doctor, the dentist had made me very aware that this surgery has to go really well, and that if he pushes too hard or he pulls too hard with a tooth or he had to put in a-- there's these words I don't even know, but like a canal, like some kind of fixture so that he can create a new tooth because I had to have a tooth completely pulled out. He was like, "If I push it in too far, I actually may hit this nerve, which could be very, very bad." So, this uncertainty felt horrible to me. And of course, I'm going to have these intrusive thoughts like, "What if I never get to speak again? What if I lose a feeling in my gums and what if he pushes hard and this is terminal? What if, what if, what if, what if?" And so, my skill here, and we've learnt this from managing mental compulsions, is bring it back to the present. Until there's a problem, we don't solve them. So, that's what I kept doing. "It's not happening now. Kimberley, it's not happening now. It's not happening now," even though it's a real threat, even though it's going to be something I have to face, because sometimes our fears are like, "What if something happens?" But it's just a what-if. There's no actual event that you know for certain is going to happen. This was like, "Yeah, you're going to do this in literally 30 hours and all of these risks are here." You guys have probably got stories like this, where you've gone in for some brain surgery or any surgery where there's a risk, but this risk was pretty huge. He was very concerned. I think appropriately concerned. So, here I am for 30 hours, managing this stuff where I'm like, "Okay, this could go really well or this could go really bad, like really, really bad." I giggle just because it makes me nervous just to think about it. That's a nervous giggle that you just heard me. I don't know. I often giggle when I'm nervous. But it's a big deal. So, I, in these moments, had to weigh up, go back to what Lisa Coyne was talking about. I was like, "Okay, values versus fear. Which one do I consult with?" I had reached out to the dentist to say, "You know what, let's just not do this. I'm not in any pain. Let's just keep it there. Let's just not." And his response was like, "That's not even an option. If you've already got this much damage, this could get worse and be very, very problematic." So, I didn't even have the option to back out. I had to do this. And so, as I proceeded forward, I had to keep being aware like what Jon Hershfield talked about and Dr. Grayson and Dr. Reid Wilson, and Shala. I had to really allow all the intrusive thoughts to come like, "Yup. Possible. Yup, that's possible too. Yup, that's possible too. Maybe it does. Maybe it will. Not going to give it my attention right now. I see you're back again. Good one, bro. Hi there, I see you. I fully accept the uncertainty." That was me for l30 hours, literally bringing in every tool I have. The cool thing is it was a hugely busy week. And because I have been really doubling down on my mindfulness skills over the last few months, that actually really helped. Every time I noticed that I was getting anxious, I was like, "Okay, what does the keyboard feel under my fingers?" I have these fiddles that I play with and I'm like, "Okay, what does this feel like? This rubber feel like, or this metal feel like, and so forth?" So, that was really helpful. The day of the surgery, I go in and I'm fully anxious. I'm going to the bathroom. I'm needing to pee. I feel dizzy. I'm not allowed to be on my medication. Oh, and that's the other thing, is this maybe the-- what do you call it? The silver lining. Just a little update for you guys, is there is a small chance, because this infection has been…
Full show notes at the publisherSUMMARY: In this episode, we talk with Lisa Coyne about ACT For mental compulsions. Lisa Coyne addressed how to use Acceptance and Commitment therapy for overcoming mental compulsions. We cover how to identify your values using a fun little trick! In This Episode: How to use Acceptance & Commitment Therapy to manage mental compulsions How to practice Willingness in regards to reducing mental rituals and mental rumination A fun little Value Based tool for identifying your values. How to be curious instead of thinking in a limited way. Links To Things I Talk About: Stuff thats Loud Stop Avoiding Stuff https://www.newenglandocd.org/ ERP School: https://www.cbtschool.com/erp-school-lp Episode Sponsor: This episode of Your Anxiety Toolkit is brought to you by CBTschool.com. CBTschool.com is a psychoeducation platform that provides courses and other online resources for people with anxiety, OCD, and Body-Focused Repetitive Behaviors. Go to cbtschool.com to learn more. Spread the love! Everyone needs tools for anxiety... If you like Your Anxiety Toolkit Podcast, visit YOUR ANXIETY TOOLKIT PODCAST to subscribe free and you'll never miss an episode. And if you really like Your Anxiety Toolkit, I'd appreciate you telling a friend (maybe even two). EPISODE TRANSCRIPTION This is Your Anxiety Toolkit - Episode 287. Welcome back, everybody. I am so excited. We are at Episode 6 of this six-part series of how to manage mental compulsions. You guys, we could not end this series with anyone better than Dr. Lisa Coyne. I don't know if you've heard of Lisa Coyne. I bet you, you probably have. She is the most wonderful human being. I have met Lisa, Dr. Lisa Coyne multiple times online, never in person, and just loved her. And this was my first time of actually getting to spend some really precious time with her. And, oh my gosh, my heart exploded like a million times. And you will hear in this episode, you will hear my heart exploding at some point, I'm sure. I am so honored to finish out the six-part series with Lisa. This series, let me just share with you how joyful it has felt to be able to deliver this as a series, as a back-to-back piece of hope. I'm hoping it has been a piece of hope for you in managing something really, really difficult, which is managing mental compulsions. Now, as we finish this series up, I may or may not want to do a recap. I'm not sure yet. I'm going to just see where my heart falls, but I want to just really first, as we move into this final part of the series, to remind you, take what you need. You've been given literally back-to-back some of the best advice I have ever heard in regards to managing mental compulsions. We've got world-renowned experts on this series. You might have either found it so, so educational and so, so helpful while also feeling sometimes a little bit like, "Oh my goodness, there's so many tools, which one do I use?" And I really want to emphasize to you, as we finish this out, again, so beautiful. What a beautiful ending. I almost feel like crying. As we finish it out, I really want to remind you, take what you need, take what's helpful, or – well, I should say and – try all of them out. Practice with each of the skills and the concepts and the tools. See what happens when you do. Use them as little experiments. Just keep plugging away with these skills and tools. Because number one, they're all evidence-based. I very carefully picked the experts on this series to make sure that we are bringing you evidence-based, really gold standard treatment. So, that's been a priority. Just practice with them. Don't be hard on yourself as you practice them. Remind yourself, this is a long-term journey. These are skills I still practice. I'm sure everyone who's come on the show, they are still practicing them. And so, I really want to send you off with a sense of hope that you get to play around with these. Be playful with them. Some of them will be we've giggled and we've laughed and we've cried. So, I want you to just be gentle as you proceed and you practice and remind yourself this is a process and a journey. That being said, I am going to take you right into this next part of the six-part series with Dr. Lisa Coyne. This is where we bring it home and boy, does she bring it home. I feel like she beautifully ties it all up in a ribbon. And I hope it has been so helpful for you. Really, I do. I want this to be a resource that you share with other people who are struggling. I want to be a resource that you return to when you're struggling. I want it to be a place where you feel understood and validated. And so, thank you so much for being a part of this amazing series. That being said, let's get over onto the show, and here is Dr. Lisa Coyne. ------ Kimberley: I literally feel like I'm almost in tears because I know this is going to be the last of the series and I'm so excited. I had just said this is going to bring it home. I'm so excited to have Dr. Lisa Coyne. Welcome. Lisa: Thank you. It's so nice to be here with you, Kim. Hi, everyone. What is a Mental Compulsion? Do you call it a Mental Compulsion or a Mental Ritual? Kimberley: Yes. So, first of all, the question I've asked everybody, and I really am loving the response is, this is a series on managing mental compulsions, but do you call them mental compulsions, mental rituals, rumination? How do you conceptualize this whole concept? Lisa: I would say, it depends on the person and it depends on what they're doing. I call them any number of things. But I think the most important thing, at least for me in how I think about this, is that we come at it from a very behavioral perspective, where we really understand that-- and this is true for probably all humans, but especially so for OCD. I have a little bit of it myself, where I get caught up in the ruminations. But there's a triggering thought. You might call it a trigger like a recurrent intrusive thought that pops up or antecedent is another word that we think of when we think of behavior analysis. But after that thought comes up, what happens is the person engages in an on-purpose thing, whatever it is that they do in their mind. It could be replacing it with a good thought. It could be an argument with yourself. It could be, "I just need to go over it one more time." It could be, "I'm going to worry about this so I can solve it in advance." And that part is the part that we think of as the compulsion. So, it's a thing we're doing on purpose in our minds to somehow give us some relief or safety from that initial thought. Now the tricky part is this. It doesn't always feel like it's something we're doing on purpose. It might feel so second nature that it too feels automatic. So, part of, I think, the work is really noticing, what does it feel like when you're engaging in this activity? So, for me, if I'm worrying about something, and worry is an example of this kind of doing in your mind, it comes with a sense of urgency or tightness or "I just have to figure it out," or "What if I--" and it's all about reducing uncertainty really. So, the trick that I do when I notice it in me is I'll be like, "Okay, I'm noticing that urgency, that tension, that distress. What am I up to in my head? Am I solving something? Is that--" and then I'll step back and notice what I'm up to. So, that's one of my little tricks that I teach my clients. Kimberley: I love this. Would you say your predominant modality is acceptance and commitment therapy? What would you say predominantly you-- I mean, I know you're skilled in so many things, but what would you-- Lisa: I would say, it's funny because, yeah, I guess you would. I mean, I'm pretty skilled in that. I'm an ACT trainer. Although I did start with CBT and I would say that for OCD, I really stick to ERP. I think of it as the heart of the intervention, but we do it within the context of ACT. ACT for Mental Compulsions Kimberley: Can you tell me what that would look like? I'm just so interested to understand it from that conceptualization. So, you're talking about this idea. We've talked a lot about like, it's how you respond to your thoughts and how you respond and so forth. And then, of course, you respond with ERP. What does ACT look like in that experience? I'd love to hear right from your mouth. Lisa: Okay. All right. So, I'm going to do my best here to just say it and then we'll see if it sounds more like ACT or it sounds more like ERP. And then you'll see what I mean when I say I do both of them. So, when you think about OCD, when you think about anxiety, or even maybe depression where you're stuck in rumination, somebody is having an experience. We call it a private event like feeling, thought, belief that hurts, whatever it is. And what they're doing is everything that they can to get away from that. So, if it's OCD, there's a scary thought or feeling, and then there's a ritual that you do. So, to fix that, it's all about learning to turn towards and approach that thing that's hard. And there's different ways you can do that. You can do that in a way where you're dialing it in and you're like, "Yeah, I'm going to do the thing," but you're doing everything that you can to not feel while you're doing that. And I think that's sometimes where people get stuck doing straight-up exposure and response prevention. It's also hard. When I was a little kid, I was really scared to go off the high dive. I tell my clients and my team the story sometimes where it was like a three-meter dive. And I was that kid where I would be like, "I'm going to do it. All the other kids are doing it." And I would climb up, I'd walk to the end of the board, freak out, walk back, climb down. And I did this so many times one day, and there's a long line of other kids waiting to get in the water. And they were pissed. So, I got up and I walked out to the end of the board and I was like, "I can't." And I turned around to go back. And there was my swim coach at the other side of the board with his arms crossed. I was like, "Oh no." Kimberley: "This is not the way I planned." How do you apply Acceptance & Commitment Therapy for OCD and Mental Compulsions? Lisa: And he is like, "No, you're going." And I went, which was amazing. And sometimes you do need that push. But the point is that it's really hard to get yourself to do those really hard things sometimes when it matters. So, to me, ACT brings two pieces to the table that are really, really important here. You can divide ACT into two sets of processes. There's your acceptance and mindfulness processes, and then there's your commitment and valuing processes, which are the engine of ACT, how do we get there? So, for the first part, mindfulness is really paying attention on purpose. And if you want to really learn from an exposure, you have to be in your body, you have to be noticing, you have to be willing to allow all of the thoughts and sensations and whatever shows up to show up. And so, ACT is ideal at shaping that skillset for when you're in the exposure. So, that's how we think of it that way. And then the valuing and commitment is, how do you get yourself off that diving board? There has to be something much more important, bigger, much bigger than your fear to help motivate you for why to do this hard thing. And I think that the valuing piece and really connecting with the things that we most deeply care about is part of what helps with that too. So, I think those two bookends are really, really important. There's other ways to think about it, but those are the two primary ways that we do ERP, but we do it within an ACT framework. Using Values to manage Mental Compulsions Kimberley: Okay. I love this. So, you're talking about we know what we need to do. We know that rumination isn't helpful. We know that it creates pain. We know that it keeps us stuck. And we also know, let's jump to like, we know we have to drop it ultimately. What might be an example of values or commitments that people make specifically for rumination, the solving? Do you have any examples that might be helpful? Lisa: Yeah. I'm just thinking of-- there's a bunch of them, but for example, let's take, for example, ROCD, relationship OCD. So, let's say someone's in a relationship with a partner and they're not sure if the right partner is. Are they cheating on me? Are they not? Blah, blah, blah, blah. And it's this like, "But I have to solve if this is the right person or not. Am I going to be safe?" or whatever the particular worry is. And so, one of the things that you can do is once folks notice, they're trying to solve that. Notice, what's the effect of that on your actual relationship? How is that actually working? So, there's this stepping back where an ACT, we would call that diffusion or taking perspective self-as-context, which is another ACT, acceptance, and mindfulness piece. And first of all, notice that. Second of all, pause. Notice what you're up to. Is the intent here to build a strong relationship, or is the intent to make this uncertainty go away? And then choose. Do I want to work on uncertainty or do I want to work on being a loving partner and seeing what happens? Because there's so much we're not in charge of, including what we're thinking and feeling. But we are in charge of what we choose to do. And so, choosing to be present and see where it goes, and embracing that uncertainty. But the joyfulness of it, I think, is really, really important. So, that would be one example. Kimberley: I love that example. Actually, as you were saying, I was thinking about an experience of my own. When your own fears come up around relationship, even you're ruminating about a conversation or something, you've got to stop and be like, "Is this getting in the way here of the actual thing?" It's so true. Tell me about this joy piece, because it's not very often you hear the word joy in a conversation about mental compulsions. Tell me about it. Lisa: Well, when you start really noticing how this is working, and if you're willing to step back from it, let it be, and stay where you are in that uncertainty, all sorts of new things show up. Stuff you never could have imagined or never could have dreamed. Your whole life could be just popping up all of these possibilities. In that moment you stop engaging with those compulsions, you could go in a hundred different directions if you're willing to let the uncertainty be there. And I think that that's really important. I want to tell a story, but I have to change the details in my head just for confidentiality. But I'm thinking of a person who I have worked with, who would be stuck and ruminating about, is this the right thing? I could make decisions and how do I-- for example, how do I do this lecture? My slides need to be perfect and ruminating, ruminating, ruminating about how it works. And one day they decided, "Okay, I'm just going to be present and I'm just going to teach." And they taught with a partner. And the person themself noticed like, "Wow, I felt so much more connected to my students. This was amazing." And the partner teaching with them was like, "I've never seen you so on. That was amazing." They contacted this joy and like, "This is what it could be like." And…
Full show notes at the publisherSUMMARY: In this week's podcast, we talk with Dr. Reid Wilson. Reid discussed how to get the theme out of the way and play the moment-by moment game. Reid shares his specific strategies for managing mental compulsion. You are not going to want to miss one minute of this episode. Covered in This Episode: Getting your Theme out of the way The importance of shifting your additude Balancing "being aggressive" and implementing mindfulness and acceptance How to play the "moment by moment" game Using strategy to achieve success in recovery OCD and the 6-moment Game Other tactics for Mental compulsions Links To Things I Talk About: Reid's Website anxieties.com https://www.youtube.com/user/ReidWilsonPhD?app=desktop DOWNLOAD REID's WORKBOOK HERE Episode Sponsor: This episode of Your Anxiety Toolkit is brought to you by CBTschool.com. CBTschool.com is a psychoeducation platform that provides courses and other online resources for people with anxiety, OCD, and Body-Focused Repetitive Behaviors. Go to cbtschool.com to learn more. Spread the love! Everyone needs tools for anxiety... If you like Your Anxiety Toolkit Podcast, visit YOUR ANXIETY TOOLKIT PODCAST to subscribe free and you'll never miss an episode. And if you really like Your Anxiety Toolkit, I'd appreciate you telling a friend (maybe even two). EPISODE TRANSCRIPTION This is Your Anxiety Toolkit - Episode 286. Welcome back, everybody. I am so excited. You guys, we are on number five of this six-part series, and this six-part series on Managing Mental Compulsions literally has been one of the highlights of my career. I am not just saying that. I'm just flooded with honor and pride and appreciation and excitement for you. All the feedback has been incredible. So many of you have emailed me or reached out to me on social media just to let me know that this is helping you. And to be honest with you, I can't thank you enough because this has been something I've wanted to do for so long and I've really felt that it's so needed. And it's just been so wonderful to get that feedback from you. So, thank you so much. The other plus people I want to be so grateful for are the guests. Each person has brought their special magic to how to manage mental compulsions. And you guys, the thing to remember here is managing mental compulsions is hard work, like the hardest of hard work. And I want to just honor that it is so hard and it is so confusing and it's such a difficult thing to navigate. And so, to have Jon talking about mental compulsions and mindfulness and Shala talking about her lived experience and flooding, and Dr. Jonathan Grayson talking about acceptance last week. And now, we have the amazing Reid Wilson coming on and sharing his amazing strategies and tools that he uses with his patients with mental rumination, mental compulsions, mental rituals. Literally, I can't even explain it. It's just joy. It's just pure joy that I get to do this with you and be on this journey with you. I'm going to do this quick. So, I'll just do a quick introduction. We do have Dr. Reid Wilson here. Now we've had Reid on before. Every single guest here, I just consider such a dear friend. You're going to love this episode. He brings the mic drops. I'm not going to lie. And so, I do hope that you squeeze every little bit of juice out of this episode. Bring your notepad, get your pen, you're going to need it, and enjoy. Again, have a beautiful day. As I always say, it is a beautiful day to do hard things. Let's get onto the show. Kimberley: I am thrilled to have you, Dr. Reid Wilson. Reid: Thanks. Glad to be here. Kimberley: Oh my goodness. Okay. I have been so excited to ask you these questions. I am just jumping out of my skin. I'm so really quite interested to hear your approach to mental compulsions. Before we get started, do you call them mental compulsions, mental rituals, mental rumination? How do you-- Reid: Sure. All of the above doesn't matter to me. I just don't call it "pure obsessions, pure obsessionals" because I think that's a misnomer, but we can't seem to get away from that. Kimberley: Can you maybe quickly share why you don't think we can get away from that? Do you want to maybe-- we'd love to hear your thoughts on that. We haven't addressed that yet in the podcast. Reid: Well, typically, we would call-- people write to me all the time and probably do that too, say, "I'm a pure obsessional." Well, that's ridiculous. Nobody's a pure obsessional. What it really is, is I have obsessions and then I have mental compulsions. And so, it's such a misnomer to be using that term. But what I mean is, how we can't get away from it is it's just gotten so completely in the lexicon that it would take a lot of effort to try to expel the term. Getting the theme out of the way Kimberley: Okay. Thank you for clearing that up, because that's like not something we've actually addressed up until this time. So, I'm so grateful you brought that up. So, I have read a bunch of your staff. I've had you on the show already and you're a very dear friend. I really want to get to all of the main points of your particular work. So, let's talk first about when we're managing mental compulsions. We'll always be talking about that as the main goal, but tell me a little bit about why the theme, we've got to get out of the way of that. Reid: Right. And my opinion is this is one of the most important things for us to do and the most difficult thing to accomplish. It's really the first thing that needs to be accomplished, which is we have to understand. And you're going to hear me say this again. This is a mental health disorder and it's a significant disorder. And if we don't get our minds straight about what's required to handle it, we're going to get beaten down left and right. So, of course, the disorder comes into the mind as something very specific. Focusing on the specific keeps us in the territory of the disorders control. So, we need to understand this is a disorder of uncertainty. This is a disorder of uncertainty that brings distress. So, we have that combination of two things. If we're going to treat the disorder, we cannot bring our focus on our theme. But the theme is very ingrained in everyone. I talk about signal versus noise, and this is how I want to help people make that transition, which is of course, for all of us in all humanity, every worry comes into the prefrontal cortex as a signal. And we very quickly go, "Oh yeah, well, that's not important. I don't need to pay attention to that." And we turn it over to noise and let go of it and keep going. With OCD, the theme, the topic, the checking, and all the mental rituals that we do are perceived and locked down as signals. And if we don't convert them into noise, we are stuck. What I want the client to do is to treat the theme as nothing, and that is a big ask. And not only do we have to treat the theme as nothing, we have to treat it as nothing while we are uncertain, whether it's nothing or not. So, in advance of an obsession popping up, we really need to dig down during a no problem time and get clear about this. And then we do want to figure out a way to lock that down, which includes "I'm going to act as though this is nothing," and it has to be accomplished like that. Go ahead. Kimberley: No. And would you do the same for people, let's say if they had social anxiety or health anxiety, generalized anxiety? Would you also take the theme out of it? Reid: Absolutely. But if the theme is in the way, then we need to problem-solve that. So, if we go to health anxiety, okay, I've got a new symptom, some pain in the back of my head that I've never had before. I have to decide, am I going to go into the physician and have it checked out or am I not? Or am I going to wait a few days and then do it? With that kind of anxiety and fear around health, we have to get closure around "I don't need to do anything about this." Sometimes I use something called "postponing." So, with social anxiety, it can-- I mean, with health anxiety, it can work really well to go, "Well, I'm having this new symptom, do I have to immediately go in and see the physician and get it checked out? Can I wait 24 hours? Yes, I can. I've already been diagnosed with health anxiety. So, I know I get confused about this stuff. So, I'm going to wait 24 hours." So, what does that give us then? Now I have 24 hours to treat the obsession as nothing because I don't need to focus on it. I've already decided, if I'm still worried tomorrow, I'm making an appointment, we're going in. That gives me the opportunity to work on this worry as an obsession because I've already figured it out. The reason we want to do that so diligently is we have to go up one level of abstraction up to the disorder itself. And that's why we have to get off of this to come up here and work on this. Kimberley: This is so good. And you would postpone, use that same skill for all the themes as well? I'm just wanting to make sure so people clarify. Reid: Well, sure. I mean, postponing is a tactic. I wouldn't say we can do postponing across the board because some people have-- it really depends on what the obsession is and what the thinking ritual is as to whether we can use it. But it's one of them that can be used. Shifting your attitude Kimberley: Amazing. Tell me about-- I mean, that requires a massive shift in attitude. Can you share a little bit about that? Reid: Yeah. And if you think about-- I use that term a lot around attitude, but we've got some synonyms in attitude. What is my disposition toward this? Have I mentioned mental health disorder? What do I want my orientation to be? How do I want to focus on it? And we want to think about really attitude as technique, as skill set. So, what we know is the disorder wants some very specific things from us. It wants us to be frightened by that topic. It wants us to have that urge to get rid of it and have that urge to get rid of it right now. And so, that begins to give us a sense of what is required to get better. And that again is up here. So, why do you do mental counting? Why do you do rehearsal mentally? Why do you try to neutralize through praying? When you look at some of those, the functions of some of those or compulsions and urge to do the compulsions, it is to fill my mind so I don't get distracted again, it is to reassure myself, it is to make sure everything is going to be okay. It is to get certain. And so, when we know that that is the drive of the disorder, we begin to see, what do we need to do broadly in general? And that is, I need to actually operate paradoxically. If it needs me to do this, feel this, think this, I'm going to do everything I can to manipulate that pattern and do the opposite. It wants me to take this theme seriously, I'm going to work on-- and really it has to be said like that. I'm going to work on not taking it seriously. So, that's the shift. If we can get a sense of the attitude and the principles that go along with all of that, then moment by moment, we'll know what to do in those moments. Do you need to be aggressive with OCD and intrusive thoughts? Kimberley: We've had guests talking about mindfulness and we will have Lisa Coyne talking about act and Jon Grayson talking about acceptance, and you really talk more about being aggressive. How do you feel about all of those and where do they come together, or where are they separate? How would you apply these different tools for someone with mental compulsions? Reid: Yeah, sure. Mindfulness is absolutely a skill set that we need to have. Absolutely. We are trying to get perspective. We're trying to get some distance. We would like to detach. That's what we're trying to do. But what are we trying to be mindful of? We're trying to be mindful of the belief that this topic is important. We're trying to be mindful of the need to ritualize that is created by the theme. So, the end game is mindfulness and detachment. That's where we're going. My opinion is, the opening gambits, the opening moves, it's very difficult to go from a frightened, terrified, scared, and slide over to neutral and detached. It's just difficult. And so, I think initially, we need to be thinking about a more aggressive approach, which is I'm going to go swing in this pendulum from, "I can't stand this, this is awful." I'm going to swing over right past mindfulness over to this more aggressive stance of, "I want this, let's get going. I'm taking this theme on." The aggressiveness is a determination of my commitment to do the work. And here's the paradox of it. I'm going to address on the disorder by sitting back. My action is to go, "I'm okay. This is all right." And that's a mindful place to get to. But you have to know we're going after this big, aggressive bully, and it requires an intense amount of determination and you have to access your determination over and over and over again. You don't just get determined and it's steady. So, we just got to keep getting back to that. "No, no, I want to do this work. I want to get my outcome picture. I want to have my mind back. I want to go back to school. I want to be able to connect with my family in a loving way, with having one-third of my mind distracted. I want that back very strongly. And therefore, If I have to go through this work to get there, I want to go through this work." We can maybe talk more about what that whole message of "I want this" means, but here it is, which is, "I want this" is a kind of determination that's going to help drive the work. Kimberley: Yeah. Let's go there because that is so important. So, tell me about "I want this." Tell me about why that is so important. So, you've talked about "I want to get better and I want to overcome this," and so forth. Tell me more about the "I want this comfort." Reid: Well, let's think about-- you really only have two choices in terms of your reaction to any present moment, either I want this moment, so I'm present to this moment, or I don't want this moment. It's very simple in that way. When I don't want this moment, I'm now resisting this present moment. And what that means practically speaking is, now I've taken part of my consciousness, part of my mind that is available for the treatment and I've parked it. I've taken it offline and actually provoking myself, sticking myself with, "Are you sure you want to do this? Is this really safe? Don't you think-- maybe we could do this later and not now." So, there's a big drive to resist that we need to be aware of. Have I mentioned this yet? This is a mental health disorder that is very tough to treat. I want 100% of my mental capacities available to do the treatment. I'll never have all of that because I'm always going to have some form of resistance, but I need to get that resistant part of me on the sideline not messing with me, and then let me go forward all like that. One of the confusions sometimes people get around this work when I talk about it is it's not, "Oh, I want to have another obsession right now," or "I want to have an urge to do my compulsion right now. I want that." No. What we're talking about is a present moment. S…
Full show notes at the publisherSUMMARY: In this weeks podcast, we talk with Dr Jon Grayson about managing mental compulsions. Jon talks about how to use Acceptance to manage strong intrusive thoughts and other obsessions. Jon addressed how to use acceptance with OCD, GAD and other Anxiety disorders. Covered in This Episode: What is a Mental Compulsion? What is the difference between Mental Rumination and Mental Compulsions? How to use Acceptance for Mental Compulsions How to practice acceptance when the intrusive thoughts are so strong. Links To Things I Talk About: Jon's Book Freedom from Obsessive Compulsive Disorder: A Personalized Recovery Program for Living with Uncertainty Jon's Website https://www.laocdtreatment.com/ ERP School: https://www.cbtschool.com/erp-school-lp Episode Sponsor: This episode of Your Anxiety Toolkit is brought to you by CBTschool.com. CBTschool.com is a psychoeducation platform that provides courses and other online resources for people with anxiety, OCD, and Body-Focused Repetitive Behaviors. Go to cbtschool.com to learn more. Spread the love! Everyone needs tools for anxiety... If you like Your Anxiety Toolkit Podcast, visit YOUR ANXIETY TOOLKIT PODCAST to subscribe free and you'll never miss an episode. And if you really like Your Anxiety Toolkit, I'd appreciate you telling a friend (maybe even two). EPISODE TRANSCRIPTION This is Your Anxiety Toolkit Episode - 285. Welcome back, everybody. We are on episode three of the six-part series. And if you have listened to the previous episodes, I am sure you are just full of information, but hopefully ready to hear some more. Today, we have Dr. Jonathan Grayson. He's here to talk about his specific way of managing mental compulsions. As you may know, if you've listened before, I strongly urge you to start and go in order. So, first, we started with Mental Compulsions 101. That was with yours truly, myself. Then Jon Hershfield came in. He talked about mindfulness and really went in, gave some incredible tools. Shala Nicely, again, gave some lived experience and really the tools that worked for her. And I have just been mind-blown with both of their expertise. And it doesn't stop there. We have amazing Dr. Jonathan Grayson today talking about all of the ways that he manages mental compulsions and how he brings specific concepts to help a client be motivated and lean into that response prevention and to reduce those mental compulsions. I am again blown away with how amazing and respectful and kind and knowledgeable these experts are. I just am overwhelmed with joy to share this with you. Again, please remember this should not replace professional mental health care. We are here at CBT School, who is the host of this series. We're here to provide you skills and tools, and resources specifically if you don't have access to those resources. That is a huge part of our mission. So, even though we have ERP School – and that is an online course, you can take it from your home – we wanted to offer this freely because so many people are seeming to be misunderstanding mental compulsions, and it's an area I really have been excited to share with you in this free series. So, I'm not going to yammer on anymore. I'm going to let you hear the amazing wisdom of Jonathan Grayson. Have a wonderful day. Kimberley: Welcome. I am so honored to have you here, Jon Grayson. Jonathan: It is always a pleasure. Kimberley: Okay. So, I actually am really, really interested to hear your point of view. As we go through a different episode, I actually am learning things. I thought I knew it all, but I'm learning and learning. So, I'm so excited to get your view on managing mental compulsions or how you address them. My first question is, do you call them mental compulsions, mental rituals, rumination? How do you frame it? Jonathan: I'm never really too big on jargony, but mental compulsions are mental rituals. And I think that's trying to-- and I think the thing about mental rituals is some people don't know they have them. I mean, some people know, but some people will describe it as, "I just obsess, I don't have rituals." but then when you listen, they do. And the ritual part is trying to reassure themselves or convince themselves that whatever it is they're worrying about isn't. So, they have both the fear part like, "Oh my God, what if this is true? But wait, here's why it's not true. Now I know that's not really true. But what if it is true?" So, that is what I would call mental compulsion or rituals. Kimberley: Right. How do you-- let's say you're sitting across from a patient or a client they are doing either predominantly mental compulsions or that's a huge part of the symptoms that they have. How would you address in your own way, teaching somebody how to manage mental compulsions? Jonathan: I think there's two answers to the question because I never have, and one has to do with what is the content, because I believe every set of mental rituals – I believe it for all forms of OCD, whether there's a very strong behavioral component or it's all mental – it has its own set of arguments that we're going to use. Of course, when I talk about arguments, I know this will be a shock to you, but to me, it always has to do with coping with uncertainty, because I think the purpose of mental compulsions is to deny reality. That is, there is something I don't want to be true and I keep trying to convince myself it's not true. Now often it's a low probability. But low probability is not no probability. Sometimes I have clients a little confused, saying like, "I tell myself it's low probability," and they actually feel better. Is that okay? And the answer is, it depends. If I'm trying to convince myself, I don't have to worry about it because it's a low probability, no, that's a ritual. If I'm just saying it's a low probability, I mean, way actually with OCD, it's very easy because people don't mind saying it's low prob they. They like saying it's low probability, but they don't want the last sentence to be "But it might happen." So, it's like, as long as you're answering "It might happen," then you're dealing with reality because everything is a low probability, even if it's really small. So, one part has to do with the content. And I think for every set of obsessions, there is, what is the content they're doing? I think in a more general way, the goal of treatment is basically accepting that low probability things might happen. I was recently saying to people that I hope the probability of nuclear war is no worse than that. It was as bad as likely as a worldwide pandemic. Some people would freak out like, "You think there's going to be a war?" First of all, I know anything, but they were missing the point. It's like, no, I really mean it's as likely as a pandemic, which means it's not likely. However, the thing about the pandemic, low probability things can happen. So yeah, we're probably okay. And so, the thing about acceptance that everyone hates is acceptance is second best. We spend so much time talking about how great acceptance is and I really think it's a disservice in some respects to not point out what acceptance means because it almost always is. Here's something you don't want that you might have to live with. If I lose a loved one, we start in denial. And for me, denial is defined as I'm comparing life to a fantasy. I have a woman in a bad relationship and she thinks he really loves the guy, but it's like, he'd be so good if only he would change X, Y, and Z. And of course, if he changed X, Y, and Z, he would be someone else. So, they're in love with a fantasy. And when somebody dies, the fantasy is life would be better if they were here. It's a fantasy because that's never happening again. So, we have to get them to the point. And of course, the thing, the reason I mentioned death is it points out a really important thing about acceptance. You don't get to just decide, "I'm going to accept." I lose a loved one. I don't care how or where you are. You're starting in denial because you're missing them and you want them there. And after about a year, if you've gone through mourning, you accept it. It's not like you don't care they're gone. You can still cry. You can still miss them. But when you're doing something you're enjoying and in the present not comparing to what it would be with that person. So, acceptance, I'm pretty sure, always sucks. However, it's better than fantasy because the fantasies never happen. So, it doesn't matter if it's likely or unlikely. It's just a matter that this is your fear and the thing that's hard for people to deal with fear is to cope with it. You're going to say, "How would I try to live with the worst happening?" And people's initial response to something is, "Yeah, but I don't want that." There are multiple reasons that we need to do acceptance. If I'm correct about denial, that's comparing reality to fantasy. Well, not acceptance means what I want will never happen. So, for me to want that there's no possibility something will occur is probably not true. I don't care if it means that maybe this reality doesn't exist and I'm going to wake up, and some of the things that discover I've created all of reality, there's nothing. I don't know that that's likely, but I can't prove it's not likely. So, I think people go in circles. And you can hear it. The thing about the pandemic, you could hear the regular population denial. Because when I say it's comparing reality to fantasy, a lot of times that sounds cool. And people don't quite get what it means, but here are statements of denial early in the pandemic, "Well, this can't go on more than a few weeks." Honestly, at the beginning, I was like, "Of course, it's going on for a few weeks. They have to have a vaccination. They're telling us that's two years down the road. This is going on for a long time." Kimberley: I was in team two weeks. Jonathan: Yeah. "It can't last. I can't take it." Saying "I can't take it," although you're expressing the feeling like "I really hate this," but including in the words "I can't take it" is a fantasy as if you have a choice. And in a way, luckily, most people who say they can't take it didn't kill themselves. It's proved that they can't take it. They took it. They kept going on. It's like, they didn't want to imagine continuing to live that way. So, acceptance is like, "Yeah, this is going to happen. Yes, it can keep going." How will you try to cope with the worst? And go on, I'll shut up. You look like you want to say something. Kimberley: No, no. I'm following you. I'm really enjoying this. I actually wrote down the word "cope" right at the beginning because I think that that's such a keyword here. To stay out of the fantasy, would you say that's true? Jonathan: Well, yes. The worst might-- I mean, I always feel like if I'm doing therapy and if somebody has intolerance of uncertainty, they don't like uncertainty, I have to treat that problem. And what I mean by that is we have a lot of therapists who impose their own feelings on the client. If I have a therapist that I have somebody who's socially anxious and saying, "I'm afraid if I go in a room, some people won't like me." Almost every therapist is going to say, "Oh, well, that's the fact, they might not like you." But that same patient is like, "I'm afraid if I touch the doorknob, I'm going to get sick." "Oh no, that won't happen." Well, that's not the issue. Now therapist is-- if I have a problem of threat estimation, that's fine, but that's not it. I don't want to know that it's a low probability, I want no probability. So, we have to deal with the fact that this is what the person's afraid of. This is what they fear. Somebody will say, "Well, but they don't have cancer issue. Why should they worry about it?" But let's face it. If they did have cancer, the focus would be coping with the fact they're dying. And if they're afraid of having cancer, I'd say the treatment is the same. Now, the only great thing is they probably won't have cancer, so it's not a fear they will have to probably deal with. They want to have the second part of it like, "And I'm dying." But to be more prepared-- and I think what you've done wisely, like hearing that, yes, what you've done wisely is you're talking about the fact that this is not just a nosy problem. This is a problem for everyone, coping with uncertainty. I hate to do a plug. It's okay. It's a while away. Actually, Liz McIngvale and I, we're working on a book, talking about-- well, the book is partially-- and we'll be doing some talks on it. We're saying that ERP is not the gold standard of treatment for OCD. And we're going to say that it's not the gold standard because it's lacking the gold. It really needs to be ERP plus gold. But that's awkward because I like to be calling these initials. So, we want to use initials. Do you happen to know the chemical symbol for gold? Kimberley: F-- no. FE is copper. Jonathan: No, that's iron. Kimberley: Iron. Jonathan: Yeah. AU. Kimberley: AU. Jonathan: The gold standard of treatment-- Kimberley: Like Australia. Jonathan: Well, no. ERP plus AU. AU as in Accepting Uncertainty. Kimberley: Oh, my trap. Jonathan: Yeah. It took me a while to work that around. Kimberley: Now you sure it's not Australia. Jonathan: But our point is what we want to write. We want to write a book that's not only about helping therapists deal with every presentation of OCD and how you deal with the uncertainty problem, but we're also arguing that it's a book for everyone that people can learn from OCD, a disorder that intolerance uncertainty is like the core. Because I always feel that our clients who get better, they're not normal. They are better than normal because they're coping with uncertainty, because the average person really doesn't do that. Well, I mean, in the pandemic, you got to see how bad non-sufferers are. So, I think the core of coping with mental obsessions is this. Well, what if the worst happens? And so many people, "I don't want to think it," and that leaves us stuck because we're not stupid. If you say to somebody-- if you get a phone call from police and they say your spouse has died, your first response is you're just in this shock and you're just like frozen. And for a lot of things that are bad, that's the way people stop thinking. It's like, "I don't want to think about it." The thing is, if the police make that call, something happens next. And life goes on. And back for clients, I often ask that in a sneaky way. What if this did happen? What would be next? What if he did have-- the doctor says, "Yeah, it can," so I freak out. What does that look like? "I'd be screaming." You're in the doctor's office, screaming. How long are you going to do that? And then you're going to go home and you need dinner. What do you do the next…
Full show notes at the publisherSUMMARY: In this weeks podcast, we have my dearest friend Shala Nicely talking about how she manages mental compulsions. In this episode, Shala shares her lived experience with Obsessive Compulsive Disorder and how she overcomes mental rituals. In This Episode: How to reduce mental compulsions for OCD and GAD. How to use Flooding Techniques with Mental Compulsions Magical Thinking and Mental Compulsions BDD and Mental Compulsions Links To Things I Talk About: Shalanicely.com Book: Is Fred in the Refridgerator? Book: Everyday Mindfulness for OCD ERP School: https://www.cbtschool.com/erp-school-lp Episode Sponsor: This episode of Your Anxiety Toolkit is brought to you by CBTschool.com. CBTschool.com is a psychoeducation platform that provides courses and other online resources for people with anxiety, OCD, and Body-Focused Repetitive Behaviors. Go to cbtschool.com to learn more. Spread the love! Everyone needs tools for anxiety... If you like Your Anxiety Toolkit Podcast, visit YOUR ANXIETY TOOLKIT PODCAST to subscribe free and you'll never miss an episode. And if you really like Your Anxiety Toolkit, I'd appreciate you telling a friend (maybe even two). EPISODE TRANSCRIPTION This is Your Anxiety Toolkit - Episode 284. Welcome back, everybody. We are on the third video or the third part of this six-part series on how to manage mental compulsions. Last week's episode with Jon Hershfield was bomb, like so good. And I will say that we, this week, have Shala Nicely, and she goes for it as well. So, I am so honored to have these amazing experts talking about mental compulsions, talking about what specific tools they use. So, I'm not going to take too much time of the intro this time, because I know you just want to get to the content. Again, I just want to put a disclaimer. This should not replace professional mental health care. This series is for educational purposes only. My job at CBT School is to give you as much education as I can, knowing that you may or may not have access to care or treatment in your own home. So, I'm hoping that this fills in a gap that maybe we've missed in the past in terms of we have ERP School, that's an online course teaching you everything about ERP to get you started if you're doing that on your own. But this is a bigger topic. This is an area that I'd need to make a complete new course. But instead of making a course, I'm bringing these experts to you for free, hopefully giving you the tools that you need. If you're wanting additional information about ERP School, please go to CBTSchool.com. With that being said, let's go straight over to this episode with Shala Nicely. Kimberley: Welcome, Shala. I am so happy to have you here. Shala: I am so happy to be here. Thank you for having me. Kimberley: Okay. So, I have heard a little bit of your views on this, but I am actually so excited now to get into the juicy details of how you address mental compulsions or mental rituals. First, I want to check in with you, do you call them mental compulsions, rituals, rumination? How do you address them? Shala: Yeah. All those things. I also sometimes call it mental gymnastics up in your head, it's all sorts of things you're doing in your head to try to get some relief from anxiety. Kimberley: Right. So, if you had a patient or a client who really was struggling with mental compulsions, whether or not they were doing other compulsions as well, how might you address that particular part of their symptomology? Shala: So, let me answer that by stepping back a little bit and telling you about my own experience with this, because a lot of the way I do it is based on what I learned, trying to manage my own mental rituals. I've had OCD probably since I was five or six, untreated until I was 39. Stumbled upon the right treatment when I went to the IOCDF Conference and started doing exposure mostly on my own. I went to Reid Wilson's two-day group, where I learned how to do it. But the rest of the time, I was implementing on my own. And even though I had quite a few physical compulsions, I would've considered myself a primary mental ritualizer, meaning if we look at the majority, my compulsions were up in my head. And the way I think about this is I think that sometimes if you have OCD for long enough, and you've got to go out and keep functioning in the world and you can't do all these rituals so that people could see, because then people will be like, "What's wrong with you? What are you doing?" you take them inward. And some mental compulsions can take the place of physical compulsions that you're not able to do for whatever reason because you're trying to function. And I'd had untreated OCD for so long that most of my rituals were up in my head, not all, but the great majority of them. Exposure & Response Prevention for Mental Compulsions So, when I started to do exposure, what I found was I could do exposure therapy, straight up going and facing my fears, like going and being around things that might be triggering all I wanted, but I wasn't necessarily getting better because I wasn't addressing the mental rituals. So, basically, I'm doing exposure without response prevention or exposure with partial response prevention, which can make things either worse or just neutralize your efforts. So, what I did was I figured out how to be in the presence of triggers and not be up in my head, trying to do analyzing, justifying, figuring it out, replaying the situation with a different ending, all the sorts of things that I would do over and over in my head. And the way I did this was I took something I learned from Jonathan Grayson and his book, Freedom From OCD. I know you're having him on for this series too. And he talked about doing all this ERP scripting, where you basically write out the worst-case scenario, what you think your OCD thinks is going to happen and you write it in either a worst-case way or an uncertainty-focused way. And what I did was after reading his book, I took that concept and I just shortened it down, and anything that my OCD was afraid of, I would just wrap may or may not surround it. So, for instance, an example that I use in Is Fred in the Refrigerator?, my memoir, Taming OCD and Reclaiming My Life was that I used to-- when I was walking through stores like Target, if I saw one of those little plastic price tags that had fallen on the ground, if I didn't pick it up and put it out of harm's way, I was afraid somebody was going to slip and fall and break their neck. And it would be on some security camera that I just walked on past it and didn't do anything. So, a typical scrupulosity obsession. And so, going shopping was really hard because I'm cleaning up the store as I'm shopping. And so, what I would do is I would either go to Target, walk past the price tag. And then as I'm just passing the price tag, I would say things. And in Target, I obviously couldn't do this really out loud, mumble it out loud as best, but I may or may not cause somebody to kill themselves by they're going to slip and fall on that price tag because I didn't pick it up. I may or may not be an awful, terrible rotten human being. They may or may not catch me and throw me into jail. I may or may not rot in prison. People may or may not find out what a really bad person I really am. This may or may not be OCD, et cetera, et cetera, et cetera. And that would allow me to be present with the obsessions, all the what-ifs – those are basically what-ifs turned into 'may or may nots' – without compulsing with them, without doing anything that would artificially lower my anxiety. So, it allowed me to be in the presence of those obsessive thoughts while interrupting the pattern of the mental rituals. And that's really how I use 'may or may nots' and how I teach my clients to use 'may or may nots' today is using them to really be mindfully present of what the OCD is worried about while not interacting with that content in a way that's going to make things worse. So, that's how I developed it for myself. And I think that-- and that is a tool that I would say is an intermediary tool. So, I use that now in my own recovery. I don't have to use 'may or may nots'. It's very often at all. If I get super triggered, which doesn't happen too terribly often, but if I get super triggered and I cannot get out of my head, I'll use 'may or may nots'. But I think the continuum is that you try to do something to interrupt the mental rituals, which for me is the 'may or may nots'. You can also-- people can write down the scripts, they can do a worst-case scenario. But eventually, what you're trying to get to is you're trying to be able to hear the OCD, what-ifs in your head and completely ignore it. And I call that my shoulders back, the way of thinking about things. Just put your shoulders back and you move on with your day. You don't acknowledge it. What I'll do with clients, I'll say, "If you had the thought of Blue Martian is going to land on my head, I mean, you wouldn't even do anything with that thought. That thought would just go in and go out and wouldn't get any of your attention." That's the way we want to treat OCD, is just thoughts can be there. I'm not going to say, "Oh, that's my OCD." I'm not going to say, "OCD, I'm not talking to you." I'm not going to acknowledge it at all. I'm just going to treat it like any other weird thought that we have during the day and move on. Your question was, how would you help somebody who comes in with mental rituals? Well, first, I want to understand where are they in their OCD recovery? How long have they been doing these mental rituals? What percentage of their compulsions are mental versus physical? What are the kind of things that their OCD is afraid of? Basically, make a list or a hierarchy of everything they're afraid of. And then we start working on exposure therapy. And when I have them do exposures, the first exposure I do with people, we'll find something that's-- I start in the middle of the hierarchy. You don't have to, but I try. And I will have them face the fear. But then I'll immediately ask them, what is your OCD saying right now? And they'll tell me, and I'll say, "I want you to repeat after me." I have them do this, and everyone that I see hates this, but I have them do it. Standing up with their shoulders back like Wonder Woman, because this type of power pose helps them. It changes the chemistry of your body and helps you feel more powerful. OCD thinks it's very powerful. So, I want my clients to feel as powerful as they can. So, I have them stand like Wonder Woman and they repeat after me. Somebody could-- let's just say we are standing near something red on the floor. And I'll say, "Well, what is your OCD saying right now?" And they'll say, "Well, that's blood and it could have AIDS in it, and I'm going to get sick." I'll say, "Well, that may or may not be a spot of blood on the floor. I may or may not get sick and I may or may not get AIDS, but I want to do this. I'm going to stay here. OCD, I want to be anxious, so bring it on." And that's how we do the exposure, is I ask them what's in their head. I have them repeat it to me until they understand what the process is. And then I'm having them be in the presence of this and just script, script, script away. That's what I call it scripting, so that they are in the presence of whatever's bothering them, but they're not up in their head. And anytime something comes in their head, I teach them to pull it down into the script. Never let something be circulating in your head without saying it out loud and pulling it into the script. I will work on this technique with clients as we're working on exposures, because eventually what we'll want to do is instead of going all over the place, "That may or may not be blood, I may or may not get AIDS, I may or may not get sick," I'll say, "Okay, of all the things you've just said, what does your OCD-- what is your OCD scared of the most? Let's focus on that." And so, "I may or may not get AIDS. I may or may not get AIDS. I may or may not have HIV. I may or may not get AIDS," over again until people start to say, "Oh, okay. I guess I don't have any control over this," because what we're trying to do is help the OCD habituate to the uncertainty. Habituate, I know that'd be a confusing word. You don't have to habituate in order for exposure to work due to the theory of inhibitory learning, but we're trying to help your brain get used to the uncertainty here. Kimberley: And break into a different cycle instead of doing the old rumination cycle. Shala: Yes. And so then, I'll teach people to just find their scariest fear. They say that over and over and over again. Then let's hit the next one. "Well, my family may or may not survive if I die because if I get a fatal disease and I die and my family may or may not be left destitute," and then over and over. "My family may or may not be left destitute. My family may or may not be left destitute, whatever," until we're hitting all the things that could be circulating in your head. Now, some people really don't need to do that scripting because they're not up in their head that much. But that's the minority of people. I think most people with OCD are doing something in their head. And a lot of people aren't aware of what they're doing because these mental rituals are incredibly subtle at times. And so, as people, as my clients go out and work on these exposures, I'll have them tell me how it's going. I have people fill out forms on my website each day as they're doing exposures so I can see what's going on. And if they're not really up in their head and they don't really need to do the 'may or may nots', great. That's better. In fact, just go do the exposure and go on with your life. If they're up in their head, then I have them do the 'may or may nots'. And so, that's how I would start with somebody. And so, what I'm trying to do is I'm giving them what I call a bridge tool. Because people who have been mental ritualizing for a long time, I have found it's virtually impossible to just stop because that's what your mind is used to doing. And so, what I'm doing is I'm giving them a competing response. And I'm saying here, instead of mental ritualizing, I'd like you to say a bunch of 'may or may nots' statements while standing up and say them out loud while looking like Wonder Woman. Everybody rolls their eyes like, "Really?" But that's what we do as a bridge tool. And so, they've lifted enough mental weights, so to speak, with this technique that they can hear the OCD and start to disengage and not interact with it at all. Then we move to that technique. Flooding Techniques for Mental Rumination Kimberley: Is there a reason why-- and for some of the listeners, they may have learned this before, but is there a reason why you use 'may or may nots' instead of worst-case scenarios? Shala: For me, for my personal OCD recovery journey, what I found with worst-case scenario is I got too lost in the content. I remember doing-- I had had a mammogram, it had come back with some abnormal findings. I spent the whole weekend try…
Full show notes at the publisherSUMMARY: In this weeks podcast, we have my dearest friend Shala Nicely talking about how she manages mental compulsions. In this episode, Shala shares her lived experience with Obsessive Compulsive Disorder and how she overcomes mental rituals. In This Episode: How to reduce mental compulsions for OCD and GAD. How to use Flooding Techniques with Mental Compulsions Magical Thinking and Mental Compulsions BDD and Mental Compulsions Links To Things I Talk About: Shalanicely.com Book: Is Fred in the Refridgerator? Book: Everyday Mindfulness for OCD ERP School: https://www.cbtschool.com/erp-school-lp Episode Sponsor: This episode of Your Anxiety Toolkit is brought to you by CBTschool.com. CBTschool.com is a psychoeducation platform that provides courses and other online resources for people with anxiety, OCD, and Body-Focused Repetitive Behaviors. Go to cbtschool.com to learn more. Spread the love! Everyone needs tools for anxiety... If you like Your Anxiety Toolkit Podcast, visit YOUR ANXIETY TOOLKIT PODCAST to subscribe free and you'll never miss an episode. And if you really like Your Anxiety Toolkit, I'd appreciate you telling a friend (maybe even two). EPISODE TRANSCRIPTION This is Your Anxiety Toolkit - Episode 284. Welcome back, everybody. We are on the third video or the third part of this six-part series on how to manage mental compulsions. Last week's episode with Jon Hershfield was bomb, like so good. And I will say that we, this week, have Shala Nicely, and she goes for it as well. So, I am so honored to have these amazing experts talking about mental compulsions, talking about what specific tools they use. So, I'm not going to take too much time of the intro this time, because I know you just want to get to the content. Again, I just want to put a disclaimer. This should not replace professional mental health care. This series is for educational purposes only. My job at CBT School is to give you as much education as I can, knowing that you may or may not have access to care or treatment in your own home. So, I'm hoping that this fills in a gap that maybe we've missed in the past in terms of we have ERP School, that's an online course teaching you everything about ERP to get you started if you're doing that on your own. But this is a bigger topic. This is an area that I'd need to make a complete new course. But instead of making a course, I'm bringing these experts to you for free, hopefully giving you the tools that you need. If you're wanting additional information about ERP School, please go to CBTSchool.com. With that being said, let's go straight over to this episode with Shala Nicely. Kimberley: Welcome, Shala. I am so happy to have you here. Shala: I am so happy to be here. Thank you for having me. Kimberley: Okay. So, I have heard a little bit of your views on this, but I am actually so excited now to get into the juicy details of how you address mental compulsions or mental rituals. First, I want to check in with you, do you call them mental compulsions, rituals, rumination? How do you address them? Shala: Yeah. All those things. I also sometimes call it mental gymnastics up in your head, it's all sorts of things you're doing in your head to try to get some relief from anxiety. Kimberley: Right. So, if you had a patient or a client who really was struggling with mental compulsions, whether or not they were doing other compulsions as well, how might you address that particular part of their symptomology? Shala: So, let me answer that by stepping back a little bit and telling you about my own experience with this, because a lot of the way I do it is based on what I learned, trying to manage my own mental rituals. I've had OCD probably since I was five or six, untreated until I was 39. Stumbled upon the right treatment when I went to the IOCDF Conference and started doing exposure mostly on my own. I went to Reid Wilson's two-day group, where I learned how to do it. But the rest of the time, I was implementing on my own. And even though I had quite a few physical compulsions, I would've considered myself a primary mental ritualizer, meaning if we look at the majority, my compulsions were up in my head. And the way I think about this is I think that sometimes if you have OCD for long enough, and you've got to go out and keep functioning in the world and you can't do all these rituals so that people could see, because then people will be like, "What's wrong with you? What are you doing?" you take them inward. And some mental compulsions can take the place of physical compulsions that you're not able to do for whatever reason because you're trying to function. And I'd had untreated OCD for so long that most of my rituals were up in my head, not all, but the great majority of them. Exposure & Response Prevention for Mental Compulsions So, when I started to do exposure, what I found was I could do exposure therapy, straight up going and facing my fears, like going and being around things that might be triggering all I wanted, but I wasn't necessarily getting better because I wasn't addressing the mental rituals. So, basically, I'm doing exposure without response prevention or exposure with partial response prevention, which can make things either worse or just neutralize your efforts. So, what I did was I figured out how to be in the presence of triggers and not be up in my head, trying to do analyzing, justifying, figuring it out, replaying the situation with a different ending, all the sorts of things that I would do over and over in my head. And the way I did this was I took something I learned from Jonathan Grayson and his book, Freedom From OCD. I know you're having him on for this series too. And he talked about doing all this ERP scripting, where you basically write out the worst-case scenario, what you think your OCD thinks is going to happen and you write it in either a worst-case way or an uncertainty-focused way. And what I did was after reading his book, I took that concept and I just shortened it down, and anything that my OCD was afraid of, I would just wrap may or may not surround it. So, for instance, an example that I use in Is Fred in the Refrigerator?, my memoir, Taming OCD and Reclaiming My Life was that I used to-- when I was walking through stores like Target, if I saw one of those little plastic price tags that had fallen on the ground, if I didn't pick it up and put it out of harm's way, I was afraid somebody was going to slip and fall and break their neck. And it would be on some security camera that I just walked on past it and didn't do anything. So, a typical scrupulosity obsession. And so, going shopping was really hard because I'm cleaning up the store as I'm shopping. And so, what I would do is I would either go to Target, walk past the price tag. And then as I'm just passing the price tag, I would say things. And in Target, I obviously couldn't do this really out loud, mumble it out loud as best, but I may or may not cause somebody to kill themselves by they're going to slip and fall on that price tag because I didn't pick it up. I may or may not be an awful, terrible rotten human being. They may or may not catch me and throw me into jail. I may or may not rot in prison. People may or may not find out what a really bad person I really am. This may or may not be OCD, et cetera, et cetera, et cetera. And that would allow me to be present with the obsessions, all the what-ifs – those are basically what-ifs turned into 'may or may nots' – without compulsing with them, without doing anything that would artificially lower my anxiety. So, it allowed me to be in the presence of those obsessive thoughts while interrupting the pattern of the mental rituals. And that's really how I use 'may or may nots' and how I teach my clients to use 'may or may nots' today is using them to really be mindfully present of what the OCD is worried about while not interacting with that content in a way that's going to make things worse. So, that's how I developed it for myself. And I think that-- and that is a tool that I would say is an intermediary tool. So, I use that now in my own recovery. I don't have to use 'may or may nots'. It's very often at all. If I get super triggered, which doesn't happen too terribly often, but if I get super triggered and I cannot get out of my head, I'll use 'may or may nots'. But I think the continuum is that you try to do something to interrupt the mental rituals, which for me is the 'may or may nots'. You can also-- people can write down the scripts, they can do a worst-case scenario. But eventually, what you're trying to get to is you're trying to be able to hear the OCD, what-ifs in your head and completely ignore it. And I call that my shoulders back, the way of thinking about things. Just put your shoulders back and you move on with your day. You don't acknowledge it. What I'll do with clients, I'll say, "If you had the thought of Blue Martian is going to land on my head, I mean, you wouldn't even do anything with that thought. That thought would just go in and go out and wouldn't get any of your attention." That's the way we want to treat OCD, is just thoughts can be there. I'm not going to say, "Oh, that's my OCD." I'm not going to say, "OCD, I'm not talking to you." I'm not going to acknowledge it at all. I'm just going to treat it like any other weird thought that we have during the day and move on. Your question was, how would you help somebody who comes in with mental rituals? Well, first, I want to understand where are they in their OCD recovery? How long have they been doing these mental rituals? What percentage of their compulsions are mental versus physical? What are the kind of things that their OCD is afraid of? Basically, make a list or a hierarchy of everything they're afraid of. And then we start working on exposure therapy. And when I have them do exposures, the first exposure I do with people, we'll find something that's-- I start in the middle of the hierarchy. You don't have to, but I try. And I will have them face the fear. But then I'll immediately ask them, what is your OCD saying right now? And they'll tell me, and I'll say, "I want you to repeat after me." I have them do this, and everyone that I see hates this, but I have them do it. Standing up with their shoulders back like Wonder Woman, because this type of power pose helps them. It changes the chemistry of your body and helps you feel more powerful. OCD thinks it's very powerful. So, I want my clients to feel as powerful as they can. So, I have them stand like Wonder Woman and they repeat after me. Somebody could-- let's just say we are standing near something red on the floor. And I'll say, "Well, what is your OCD saying right now?" And they'll say, "Well, that's blood and it could have AIDS in it, and I'm going to get sick." I'll say, "Well, that may or may not be a spot of blood on the floor. I may or may not get sick and I may or may not get AIDS, but I want to do this. I'm going to stay here. OCD, I want to be anxious, so bring it on." And that's how we do the exposure, is I ask them what's in their head. I have them repeat it to me until they understand what the process is. And then I'm having them be in the presence of this and just script, script, script away. That's what I call it scripting, so that they are in the presence of whatever's bothering them, but they're not up in their head. And anytime something comes in their head, I teach them to pull it down into the script. Never let something be circulating in your head without saying it out loud and pulling it into the script. I will work on this technique with clients as we're working on exposures, because eventually what we'll want to do is instead of going all over the place, "That may or may not be blood, I may or may not get AIDS, I may or may not get sick," I'll say, "Okay, of all the things you've just said, what does your OCD-- what is your OCD scared of the most? Let's focus on that." And so, "I may or may not get AIDS. I may or may not get AIDS. I may or may not have HIV. I may or may not get AIDS," over again until people start to say, "Oh, okay. I guess I don't have any control over this," because what we're trying to do is help the OCD habituate to the uncertainty. Habituate, I know that'd be a confusing word. You don't have to habituate in order for exposure to work due to the theory of inhibitory learning, but we're trying to help your brain get used to the uncertainty here. Kimberley: And break into a different cycle instead of doing the old rumination cycle. Shala: Yes. And so then, I'll teach people to just find their scariest fear. They say that over and over and over again. Then let's hit the next one. "Well, my family may or may not survive if I die because if I get a fatal disease and I die and my family may or may not be left destitute," and then over and over. "My family may or may not be left destitute. My family may or may not be left destitute, whatever," until we're hitting all the things that could be circulating in your head. Now, some people really don't need to do that scripting because they're not up in their head that much. But that's the minority of people. I think most people with OCD are doing something in their head. And a lot of people aren't aware of what they're doing because these mental rituals are incredibly subtle at times. And so, as people, as my clients go out and work on these exposures, I'll have them tell me how it's going. I have people fill out forms on my website each day as they're doing exposures so I can see what's going on. And if they're not really up in their head and they don't really need to do the 'may or may nots', great. That's better. In fact, just go do the exposure and go on with your life. If they're up in their head, then I have them do the 'may or may nots'. And so, that's how I would start with somebody. And so, what I'm trying to do is I'm giving them what I call a bridge tool. Because people who have been mental ritualizing for a long time, I have found it's virtually impossible to just stop because that's what your mind is used to doing. And so, what I'm doing is I'm giving them a competing response. And I'm saying here, instead of mental ritualizing, I'd like you to say a bunch of 'may or may nots' statements while standing up and say them out loud while looking like Wonder Woman. Everybody rolls their eyes like, "Really?" But that's what we do as a bridge tool. And so, they've lifted enough mental weights, so to speak, with this technique that they can hear the OCD and start to disengage and not interact with it at all. Then we move to that technique. Flooding Techniques for Mental Rumination Kimberley: Is there a reason why-- and for some of the listeners, they may have learned this before, but is there a reason why you use 'may or may nots' instead of worst-case scenarios? Shala: For me, for my personal OCD recovery journey, what I found with worst-case scenario is I got too lost in the content. I remember doing-- I had had a mammogram, it had come back with some abnormal findings. I spent the whole weekend try…
Full show notes at the publisher
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