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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This is Your Anxiety Toolkit - Episode 198. Welcome to Your Anxiety Toolkit. I'm your host, Kimberley Quinlan. This podcast is fueled by three main goals. The first goal is to provide you with some extra tools to help you manage your anxiety. Second goal, to inspire you. Anxiety doesn't get to decide how you live your life. And number three, and I leave the best for last, is to provide you with one big, fat virtual hug, because experiencing anxiety ain't easy. If that sounds good to you, let's go. Okay, friends, how are you doing really? How are you doing? It's summertime, you guys. Oh my goodness. We're here. How did this happen? Just to let you know, I will be taking a break as I have done for the last several years over the summer. So I will probably take a few weeks off in July so I can have some time with my kids to really rest and repair and play and be human. It's such a weird year. And so as I'm recording this, it's not summer yet, but it's crazy to think that we've landed in summer already of 2021. Am I right? Holy smokes. Okay, before we get started, as I always say, please do go and leave a review. I will be giving away Beats headphones to one lucky winner when we get a thousand reviews. We're on our way, guys. So please do go and leave a review. I would so be grateful. It just really helps me strengthen the podcast, and it's one of my big goals for 2021, is just to really help people with this amazing platform. All right. So here we go. Today, I am talking about how I am protecting my daughter from an eating disorder. But what I'm really going to be talking about is how we, me and my husband, are protecting my daughter and my son from an eating disorder. The reason I preface that is because, number one, yes, while women are more likely to develop an eating disorder, there is an increase of prevalence of young men and young boys getting and experiencing an eating disorder. There are many different types of eating disorder. It doesn't have to be anorexia. They can be binge eating. There's also types of eating disorders, such as bigorexia, which is around developing muscle. There's orthorexia. There's so many kinds of, again, bulimia anorexia, of course, we've discussed. There's so many types and it's so important that we recognize that this is not just a problem for women and girls. So let's talk about it. How myself and my husband are protecting my daughter and my son from an eating disorder. So there are two main things I want to discuss today. Number one is how we talk and number two, how we model. And so I'm going to give you much more detail into how we are doing that and how we're choosing to do that and the struggles that we're having. I, myself, had an eating disorder. So I'm really, really protective of this topic with my children. It's something I really want to try and protect them from while I know that I can't entirely protect them. I can do a lot of education to give them everything they need to hopefully not have to go through what I have gone through and what so many people have gone through with eating disorders. So, first of all, let's talk about what we talk about. Let's talk about what we talk about, shall we? All right. So the first thing, and you guys have heard me say this probably before, the first thing we talk about is diet culture. This is where we identify how our society is teaching us to believe that we should be a certain way. Our bodies should be a certain way. Our skin should be a certain way. Our hair should be a certain way. We should look a certain way. And we want to be able to identify this so we can call the BS on it. So the reason that I call BS on it is, just because society tells us our body should be a certain way doesn't mean it's true. In fact, it's entirely BS. Your body, my body, my daughter's body, my son's body, and my husband's body – doesn't have to be any particular way. Society and diet culture is going to tell us that it should be thin. It's going to give us all of these messages. "We should be thin. We should be strong. We should be tall. We should be short. We should be eating this certain thing. This product will help us with our metabolism. This product is bad. These foods are good. These foods are bad." And there's so many messages that are faulty and proven to be wrong. So, so important. So we talk a lot about this with my children. When my daughter and I go shopping, which we haven't done in a long time, but when we see advertisements, when we watch TV shows, when we look in magazines or pitches of books in books, when we look at Barbie dolls, we talk about diet culture. I might say, "What about her body? Let's talk about Bobby." And we look at Bobby and I'll say, "What do you think about her body?" And she'll be like, "It's kind of weird. It looks kind of strange." And I'll say, "Yeah, why do you think that is?" And she says, "Well her waist is really small." And I'll have a conversation with her. We talked to her about, "Do you feel like you need that to be beautiful? No, no, you don't." How might we change this? And I might say to her, "You don't have to look anything like that. You know that your body is genetically set up to be exactly the way your body is and there's nothing you need to do any differently about that." So important. Same with my son. Look at the action figures. We might say, "Your body doesn't have to look like that." That's diet culture. You don't have to have a six-pack of abs. He's only six, but we're still already having these conversations. Now, what's interesting is my husband right now is reading the book to our children, and it was a book that he read when he was a young kid with his parents. It's interesting because there's all these references to fat, like fat this and fat boy and fat girl, and she was fat and so forth. We talk about the word "fat." We talk about, is that a good word or a bad word? No, it's just a word. It's a descriptive word. But would we use it to describe somebody else? No. We would use many other things to describe somebody than using that kind of word. Not that there's anything wrong with the word. It's just that we don't want to encourage them to define a person by their body. We try our hardest not to compliment our children's body. You might think that's crazy. Some people go, "Oh, no, no. My child won't have an eating disorder. I tell them how beautiful they are every day." I often will educate them and say, "That doesn't actually prevent anything. In fact, it just adds to that kid and that child thinking that the way they look is important. Because what if their body changes? Then they're going to be like, 'Oh no, mom's always complimenting me on my body, and now my body changed. So does that mean I'm bad?'" So we do our best not to compliment their body or anybody's body. I have worked really hard since my own recovery to never congratulate someone for losing weight, which is really hard. In fact, I've had one really difficult conversation with our friend where she was saying, "I really just want you to compliment me because I have lost a lot of weight." And I've said to her, "That doesn't line up with my values. I love you, but I never want to engage in something where you believe your worth is caught up in your body. I just can't do that. I'm sorry. But I love you and I love everything about you, every part of you, whether your body is in a large body, a small body, a tall body, a short body, whatever color skin. I love you." And we say the same to the kids. Now, of course, we also don't ridicule their bodies. We don't comment on their bodies, their ever-changing bodies, as they, my daughter moves into preadolescence. We're still in the talk section. We talk about what we do value. That person is very kind. He has kind eyes. She has a beautiful smile. She radiates love. She is a fun person. She's very intelligent. My five-year-old son says intelligent a lot. "He is very intelligent. I am very intelligent." Not that we want to overvalue that either. Because we want to really remind them that unconditionally, we will love them and that their worth is consistent. It doesn't matter what. It doesn't matter what. That they're worth and our love for them is consistent. And to be honest, I will say there is nothing more powerful than hearing that from a father, particularly if you're a young woman, a young child like my daughter. For my husband to say, "I love you, no matter what. Don't ever let a man judge you or comment on your body and you believe what they say, because you're more than a body." To teach our son that other girls and other boys are more than a body. To teach him that he's more than a body. So important. Now another thing we do is we praise all foods. We celebrate all foods. We are grateful for all foods. We do not have good and bad foods in our family. We don't talk about things being healthy and unhealthy. While we do very much value health, we really try to help the kids understand that they can listen to their body and our body. This is the kind of funny story, I'll tell you. My daughter is going to be 10 and she can outeat anybody. It's really quite phenomenal. She's always hungry. And my instinct is to go, "You've already eaten. Stop eating. You certainly cannot be hungry." I'm feeling full and she's eating double what I have. But I really catch how we talk to her about her food and we celebrate, "Good for you, honey. You're listening to your body." She'll often come to me and say, "Mom, I'm starving. What can I eat?" And we laugh. And she smiles. And I say, "Hun, what do you think I'm going to say?" And she rolls her eyes and she says, "You're going to say, 'You can eat whatever you want.'" Now, of course, we have some rules around this. We don't encourage and we don't allow the kids to eat a lot of snacks before a meal. We try to really have them understand the importance of waiting for their meal. But that's probably 45 minutes at the most. Often my daughter will have a full peanut butter and jelly sandwich 45 minutes before a meal and still eat her whole meal, and we praise her for that. My son is really, really picky around food. There's certain things he really, really likes. And interestingly, he has no interest in sweets. If he could choose between salty and a birthday cake, he would choose salty all the time. We encourage him to just listen to his body. I talk to them about me listening to my body. They'll be like, "Mom let's go have ice cream." And I'll usually sometimes not eat ice cream. That's not because I'm restricting. I might say, "No, I'm listening to my body. I don't really need ice cream right now." And then there's other days where I'm ordering three scoops of ice cream because I'm really hunkering down for some ice cream. So I try to also teach them that it's okay to listen to your body as does my husband. So these are all really, really important things we talk a lot about. And this is the last thing we talk about, which is health. What is health? Is health only eating sugar-free foods? Is health being thin? Is health being tall? No, none of those things. Is healthy eating only organic food? No, absolutely not. Health is having balance and taking away judgment. We have to remember here too, health is not just physical, it's mental. I know people who eat the most "clean diet" and they exercise, but they're not healthy because emotionally they've got a really unhealthy relationship with food and their body. They're hard on themselves. They beat themselves up. Maybe they binge. So this is the thing to remember. Your definition of health might not be what is the real definition of health. Now this is really true and I'm going to make sure I have some people on coming here once we get back after the summer on talking about health at every size. This is a crucial conversation we need to have. If you haven't read yet a book called Health at Every Size, I urge you to. It's so important to really understand the science behind that and understand the issues we have around how we have stigmatized people in bigger bodies as being unhealthy when we've actually got lots of science to prove that you can be really healthy in any size body, that health is not indicated by just your size. Okay. So now we move on to what we model. This is similar, but very important. So my husband and I have two completely different body sizes. Not that that's super important, but I feel it's important for our children to have those two examples and to have family members with different body sizes, where we celebrate every single body, and we do a lot of modeling around that. We do a lot of modeling, celebrating bodies – all the body sizes, shapes, skin colors, nationalities, sexualities. We try to model to our children and normalize differences instead of things being like, "This is good and this is bad." We also model, like I've mentioned to you, how we eat. We try not to judge each other for what we eat in front of each other. We try to really encourage by modeling like there's no time you should eat food. A lot of my patients will say like, "Oh, I had a bagel for breakfast so I can't have a bagel for snack." And we go, "No, you can eat a bagel for breakfast and for lunch if you want." My son loves more than anything to put cream cheese and sprinkles on his bagels in the morning. He loves really sprinkled-up bagels and we allow it. We figured it's no different than him putting jelly or jam on his bagel. And so we allow it, we allow him to enjoy his food. Given that he's a kid who doesn't like a lot of sweets, we're all for it. We also model by not saying negative things about our own body. My son is a personal story, but my son once came in and I was getting out of the shower and he said, "Mom, your belly's all jiggly," which is most moms' nightmare. You know what I said? I said, "Yeah, it is. Isn't it beautiful though, that I had two babies in that belly? Isn't that cool?" He might say, "Daddy's belly is big," or whatever he may say. And we'll go, "Yeah, isn't that wonderful? We have so much fun eating food and what a wonderful body. Isn't it so great that we have our bodies, that our bodies do all these things for us, like pump blood and breathe and digest food and run and hold our hearts and hold our brains and filter nutrients and things like that? Isn't that incredible?" We model body acceptance and body love. This has been really helpful for us, particularly because I know a lot of women and men who've developed eating disorders because their parents were on a diet all the time, that their parents model these strict diet culture rules, and good and bad rules, and all of this stuff that's so dangerous for young ears to hear. Now, we also model this or share one more personal story is, so much of eating disorders is around restriction. Over the last two years, my daughter has had some medical issues where she had to restrict several di…
Full show notes at the publisherThis is Your Anxiety Toolkit - Episode 197. Welcome to Your Anxiety Toolkit. I'm your host, Kimberley Quinlan. This podcast is fueled by three main goals. The first goal is to provide you with some extra tools to help you manage your anxiety. Second goal, to inspire you. Anxiety doesn't get to decide how you live your life. And number three, and I leave the best for last, is to provide you with one big, fat virtual hug, because experiencing anxiety ain't easy. If that sounds good to you, let's go. Welcome back, you guys. So grateful to have this precious time with you. Thank you so much for coming and spending your very, very precious time with me. As we do this together, it's exciting, we're almost at 200 episodes. You guys, I cannot believe it. I am pretty, pretty proud of that, I'm not going to lie. Today's episode is with the amazing Jon Hershfield. He's been on the show multiple times and I have been really reflecting and thinking about how important it is for us to practice response prevention and how that is so, so important for everybody who has any type of anxiety, whether that be an anxiety disorder like OCD, social anxiety, specific phobia, generalized anxiety. Even for myself, I've been reflecting on any time I'm responding to fear and responding to discomfort. It's just a topic that I want to continue to address because I think from you guys, I just continue to see how much it's a struggle for you. As I thought about continuing education on tools you can use, I thought, who else can I have none other, but Jon Hershfield to talk about using mindfulness to manage compulsions. Now we talk about compulsions like mental compulsions and rumination. We talk about reassurance-seeking, avoidance, any kind of physical compulsion. We also talk about how to practice mindfulness so that it doesn't become a compulsion. And so I'm just so grateful to have John give us his very valuable time and to talk with you guys about these amazing concepts. I'm not going to spend too much more time doing the introduction. You guys know how amazing Jon Hershfield is. He has some amazing books. He has The Mindfulness Workbook for OCD, and he has Everyday Mindfulness that he co-authored with Shala Nicely, and The Teen OCD Workbook, and Harm OCD book. He's just written amazing books. So please do go out and support him. He does share all that information at the end of the show, and I can't wait for you guys to listen. In the meantime, please do go and leave a review. It helps us to reach more people. I'm going to be quiet now and let you listen to Jon's wisdom. Have a wonderful day. ----- Kimberley: All right, welcome. I am so happy to have the amazing Jon Hershfield with us again today. Jon: Thanks for having me. You make me sound like Spiderman of the OCD world. Kimberley: You are the Spiderman of the OCD world. I love it. Jon: What does that mean? Kimberley: Yeah, it's true. Well, that's a good thing. I know my son is probably jumping up and down at the idea of me meeting the Spiderman of something. Thank you for coming on. I really wanted to invite you on, of course, because I love the work that you're doing regarding mindfulness in OCD. I really wanted to talk about how we can use mindfulness, particularly to address compulsion, because a big part of Exposure and Response Prevention is the response prevention piece. I would really love to pick your mind on how you implement mindfulness as a part of that and also address some of the misunderstandings that happen regarding mindfulness. So, let me first ask you, just for those who don't know or new to the show, how would you give a definition? How would you explain mindfulness, particularly in the respect of treatment? Jon: It's interesting because we all make this same grammatical error. I do it too. We say we use mindfulness as if mindfulness was an act or an action or a thing that you use as opposed to a perspective that you take. So I'm thinking about what mindfulness means. Usually, the definition we hear is "Paying attention to the present moment as it is without judgment and without the desire to change it." And that's a great definition. It's escaping me at the moment who actually coined that exact language, but I think it applies to most mindfulness concepts. But I don't like that it starts with the word "paying" because it still implies that you're doing something. I think mindfulness is actually the perspective that you have when you're paying attention to the present moment. If you want to play around with the words, it's really noticing the fullness of the mind – mindfulness, right? It's a position that you take as opposed to a thing that you do. Right now, I'm sitting here in my desk chair. I'm aware of the sensation of my body in the chair, hearing my voice in the headphones and I have coffee and tasting that coffee. These are all things that I'm noticing and I'm being mindful of. The other part of mindfulness that I think is important to understand is that, in a state of mindfulness, you're best able to observe the difference between an experience – I just listed for you a bunch of experiences – and a story. A story is a narrative. It's the meaning and the webs that we weave around those experiences. So it's me thinking I'd had too much coffee today, right? That's a story about the taste of coffee in my mouth right now and its significance, but they're two separate things. When we're treating something like OCD, which is very much about being pulled away by your mind into these narratives, these fear-based narratives – to be able to drop out of the narrative and into the experience would be to take a mindful perspective, or in colloquial terms "to use mindfulness." But I think a lot of times when we say "using mindfulness," we associate that with stopping what we're doing and focusing on the breath, or pulling out an app and doing a meditation, or trying to execute change in our environment by being mindful. When in fact, mindfulness is very much the opposite of that. It's not about executing change. It's actually about stepping back and seeing the way things really are. Kimberley: Right. I love this. So would you say in this perspective that mindfulness is not adding something on, it's just dropping down into what was already there? Jon: Yes. I would agree with that. Kimberley: I like that. So how might we use this, particularly in terms of managing anxiety or uncertainty or any other discomfort? Can you give me a walk-through of what that might sound like or look like for somebody who is practicing mindfulness? Jon: Well, one of the things you might think about, when somebody feels triggered, something happens. You've touched something you think is contaminated or you've become aware of an unwanted, intrusive thought, a harming thought, or something like that. Then you have an experience in the brain and in the body that alerts you to the fact that you're under attack, that you're distressed, something is wrong and it needs to be fixed. What most people do is they immediately go into the story of, "This is bad. I'm triggered. I need to get away from this trigger. How do I make this feeling go away? Because it's unpleasant." Of course, it's unpleasant because it's your brain's way of trying to help you jump into action to get away from the things that could harm you. So it's natural that we want to get rid of this feeling. And then we do these things called compulsions that reliably, in the short term, get rid of these feelings. If you know anything about OCD as you do, it's like you get stuck in that loop. The more you compulse, the more you really feel the responsibility towards your obsessions as they arise. In that space, between the trigger and the compulsion, there's an experience you're having. A person who has been practicing mindfulness or who is mindfully aware can show up to that experience in the same way they might show up to other experiences, again, without having to make it go away. So you render the compulsion less important because you're willing to be in the presence of that triggering experience. If you were to take this to the mat and think about, "Well, what happens when you're meditating and you get an itch?" what is the instruction? It's not, "Well, just scratch it so you can be more comfortable." It's usually, "Okay, well, notice what itching is like. Notice what it's like to be sitting, which is what you're doing, and then have your attention pulled away from the sitting to the sensation of itching, to be able to say, 'Oh, that's itching.'" Now at some point, we all break and we start scratching ourselves all over it because it's too much, but that's fine. But that's not the first instruction. The first instruction is simply notice itching. And then if you're capable of letting go of that and going back to what you were doing before you got distracted by the itch, you'd go back to your breath or whatever the anchor of your meditation might've been. It's the same thing in real life. You're minding your own business. You're trying to read a book and then you have an intrusive thought that something terrible is going to happen. And then you notice that experience of this mental itching and you're, "Okay, that's happening." And then you have a choice. You can drop down out of that back into your book, or you can dwell on it, ruminate on it, try to figure it out, try to figure out a way to make it go away, and then give yourself permission to go back to your book. Kimberley: So, we call it in my practice, my staff have called it "itch surfing." Jon: Itch surfing. Yeah. Kimberley: I always laugh when I say "itch surfing." So, let's say you have the presence of a thought that's really concerning, right? It's triggering. And you're trying to be mindful, but you're also not trying to step across the line to where you are ruminating or being compulsive related to that. How might someone differentiate between the two? Jon: So there's a couple of things to consider here. One is that a lot of people will say, mindfulness is about watching your thoughts come and go. There's a good reason why we use that metaphor, that idea of sitting at the bank of the stream and watching the leaves go by. But it's not really accurate in the sense that it's more about just noticing thoughts coming and going. Watching thoughts coming and going implies that you're supposed to sit there and stare at them and give them special attention. You're supposed to remember, right? It's a perspective. It's not an act. You're supposed to remember like, "Oh yeah, it was a thought coming and going. Okay, that's cool." And then let go of it. Ruminating is when you're digging up that thought for the purpose of trying to figure it out to digest it. You're trying to act on the thought and get certainty about it. It's a very active thing you're doing when you're ruminating. To be mindful would really be the opposite of that. It would be to notice that you're ruminating and stop. Because the whole point, if you're being mindful, it's not that you're executing change on your environment, but you're simply noticing what's coming up. So it was really impossible to be mindful and ruminate at the same time because that would be like being mindful while trying to figure out some problem. So the instruction would be to notice that urge to ruminate, to notice what's coming up for you in your body, that experience of, "I really want to figure this out," and then to allow that experience to be there, and again, drop back down into your anchor. In real life, it's whatever you were doing before you got distracted. In meditation, it's whatever your anchor is – the breath, the feeling of your body in the seat. Kimberley: So it'd be like using the metaphor of, if you're sitting at the edge of the stream and you're just watching the leaves come and go, that would be mindfulness. But ruminating or being hyper-aware would be like watching the leaf after it's way, way, way, way down the river, but you're still giving that attention and missing what's right in front of you? Jon: Yeah. It's easy to make that mistake because you could feel like you're being mindful. You could say like, "Well, I'm just watching this leaf and seeing how far it goes." But in fact, when you're doing that, you're missing everything that's happening in the present moment, all those other leaves that are going by. A lot of times, people think of themselves as being very negative because they get distracted by negative thoughts, and the thought comes down the stream and they follow it. And while they're falling, those negative thoughts, all sorts of other nice things are happening – the smell of their breakfast or the warmth of the sun or whatever it might be. But they're not noticing that stuff because they're immersed in tracking that negative experience that they had. They think of their lives as being negative instead of thinking of their lives as just being whatever it happens to be in any given moment. Kimberley: Right. Talk about, if you will, hyper-awareness, because I think sometimes people think they're being mindful, and I think it's going to be very similar maybe in your answer, but I just want to be really clear for people who I've heard struggle with. They're trying to be mindful, but it becomes hyper-awareness. Do you have any thoughts on that? Jon: A lot of this, I think, comes down again to language. Most of us are trained to say things like "Sit with uncertainty," which sounds like a good idea, but the implication for some is that you're literally sitting and there's literally uncertainty in front of you. It's like sitting on your head and you're immersed in it and you're dwelling on it. So it gets translated as "Dwell on uncertainty," and feel bad as long as you can feel bad. Actually, I interviewed Jon Abramowitz who some of you may know in a lecture series here at Sheppard Pratt not too long ago. He said he likes to say, "Act with uncertainty instead." I really like that because to me, that is still mindfulness. You're doing something, you notice you became distracted, cool. That's what that's like. Now I'm going to go back to what I was doing before I got distracted. I'm going to act with the uncertainty instead of sitting, letting the uncertainty sit on my head. I think it's such an important distinction because to be mindful of your thought process is to be aware of it. But it's not the same thing as to be trying to figure it out or be certain about it. That would be the opposite of mindfulness. And so the whole instruction, if you've had a lot of experience meditating, it might sound something like you wander away from your anchor and you start trying to figure out what's wrong with your life. And then you go, "Oh yeah, thinking." And then you go back to your anchor. No meditation teacher is going to tell you like, "Well, just notice that you're trying to figure it out and keep trying to figure it out and try to get to some sort of outcome." That really would go against the larger project. Kimber…
Full show notes at the publisherThis is Your Anxiety Toolkit - Episode 196. Welcome to Your Anxiety Toolkit. I'm your host, Kimberley Quinlan. This podcast is fueled by three main goals. The first goal is to provide you with some extra tools to help you manage your anxiety. Second goal, to inspire you. Anxiety doesn't get to decide how you live your life. And number three, and I leave the best for last, is to provide you with one big, fat virtual hug, because experiencing anxiety ain't easy. If that sounds good to you, let's go. Welcome back, you guys. We have had a break. We are back. I'm actually recording this before I was back, so I don't even really know how I feel once this episode will be out, but nonetheless, I have been holding off and wanting to do this episode as the welcome back episode for the new season of Your Anxiety Toolkit. Today we have with us, my Assistant, my Executive Assistant, one of the most important people behind the scenes at CBT School and in my private practice. She is my intake coordinator. She is the doer of all things. She was originally hired as my Chief Copywriter. She does a lot of work behind the scenes for me. Her name is Elle Warren. Her and I have been working together for some time now. It has been such a pleasure to get to know her. She today is going to share with you, just so you know, who it is behind the scenes if you're ever in contact with us or you're reading out Instagram posts or a newsletter or emails. She's doing a lot of this stuff for me and we're working together very closely. I wanted you to feel like you knew her, just like you know me. She also comes with a beautiful recovery story where she shares her experience with mental health and OCD and health anxiety, and grief, and post-traumatic stress disorder and experiencing, and really coming to find a place of peace with her sexual orientation. It is a beautiful, beautiful episode. I'm so, so excited to share it with you. Again, I want you to feel like you know us. I want you to feel like you trust us and you know who's behind the scenes, and that's why this was so important to me. So, I hope you do enjoy the show. Elle really does share her story so vulnerably. If you do notice some background noises, Elle was in a really rural location, a lot of background noise. So, bear with us there. We were doing the best we can. I wanted to make sure we had this episode recorded before we left, so please bear with me. The content is still fabulous. I hope that isn't too difficult on your listening. In addition, welcome back. So thrilled to be back. I've been trying to do episodes through the school year and then take some time off for the summer. This season, we have some big plans, some amazing guests. I am really dialed in with specifically what I want to address this season. So, get excited about that. I hope you're well. I hope you're being kind to yourself and you had a lovely summer and you had some time to rest and recover. I will share here very soon about our trip and what happened and what I learnt and what I experienced. I always like to refer to a couple of reflections later on, but first, I hope you enjoy this episode with Elle. ----- Kimberley: All right. Welcome, everybody. This is a really wonderful start to another season of the podcast because I have here with me one of my core team members, Elle Warren. Thanks so much for coming on, Elle. Elle: I'm so excited to be here. Thank you for having me. Kimberley: All right. Let me share. I know everyone's listened to the intro, but let's just talk about how important you are as a part of helping me. I'm so grateful for all the work that you do to help me, so thank you. Elle: Yes. I love it. Kimberley: Yeah. The reason that you're so special is because you're so special. But in addition to being so special, you're so wonderful as a part of this team because you get it. You get what we're talking about, and that's why I'm so grateful to have you on our team. I'd love to spend some time you sharing that story if you're comfortable and telling us a little bit about your background. Do you want to give us an intro to your story? Elle: Sure. Yeah. It is a long and winding journey, but I will try my best. I have had OCD for as long as I can remember, but I did not know that it was OCD until about two years ago. I was only actually diagnosed in February of 2020, so right before the pandemic, but I had been learning a lot on my own before that and came to that conclusion. Big themes for me growing up were sexual orientation, health anxiety, safety things. I remember I would always ask my mom for reassurance all the time. And then my mom passed away a little over three years ago now when I was 20, and that was the catalyst for my mental health feeling more unmanageable. I started having panic attacks. I was later much more recently diagnosed with PTSD from her illness and death and all of that as well. At the time, I just thought that my brain was broken, that I was broken. I can see now that it was just the intersections of OCD and PTSD and grief that is a pretty nodded up ball of things. So, that's an overview. Kimberley: When did you notice these symptoms first start? Was it in childhood, you said? Elle: Yeah. I can definitely look back and see it in childhood. I remember one time when I was little, I don't know, I was probably five or six, and there was a storm going on outside and I was so convinced that a tree was going to fall on our house. I remember I just kept asking my mom, "The tree was going to fall on our house." That's one example. Kimberley: Did your mom suspect anything? I mean, was that something that was in your family, or was that just like Elle being Elle? Elle: I think no one really talked about mental health in my family. I know now that there is a history of mental illness, at least on one side, maybe on both, but it wasn't talked about at the time. Kimberley: Isn't it crazy when you find out, after the fact that you have this whole long line of genetics? It's like, "Why didn't I get told this information?" Elle: Yeah, exactly. Right. It's like, okay, there were definitely some signs that could have been. I mean, I don't blame my parents. They were only doing what they knew and what they were taught, but it would have been nice if those things were acknowledged and then noticed earlier on and if treatment was offered earlier on. Kimberley: Right. Sometimes it's that our parents didn't even know they had stuff. Often not even a parenting blunder. It's like they had no idea the words to use to describe things either, right? Elle: Right. Exactly. Kimberley: Yeah. Do you want to share that about your themes? For those who are listening, we will share at the end that you've written some amazing blogs for us and we will make sure we have those in the show notes, but do you want to share about the specific themes that you've struggled with? Elle: Yeah. I think the most significant one, like I said, was the sexual orientation one. That was definitely the one that I can remember taking up the most time and causing me the most distress. One day when I was probably 12 or 13, I was in middle school and I remember I was sitting on the sidelines at cheerleading practice and I had this memory come back to me of this girl in my neighborhood that when we were little, we used to kiss sometimes, which is a very innocent thing. We were four years old. But I agonized over that and wanted to know what it meant and be certain of what it meant. I grew up Catholic and I grew up in a relatively more conservative area, so to me, the idea that I could be anything besides straight was just unthinkable. I think I said this in my blog post about it, but almost equivalent to remembering I had killed someone or something super dramatic like that. Kimberley: And that was because of what you'd been taught? Elle: Yes. Really from the ages of 13 to 20, 21, that was a really big thing. It would come in and out, like I'd let it go for a little while, and then it would come back in full force. I would be imagining scenarios in my head all the time and trying to predict how I would feel in them. I would look at people when I was out and ask myself if I was attracted to them and all of that. Now, I identify as bisexual. I think that adds to it as well because bisexuality is often invalidated and there's the pressure to pick a side and all of that. I didn't really know. I didn't know much about my bisexuality. I didn't know anyone that was openly bisexual. I didn't see people on TV that were bisexual. I think it was not only hard for me to accept that I could not be straight, but it also didn't really feel like a possibility that I could be open to more than one gender. Kimberley: What was that transition like? It sounds like from what you've told us, there's this absolute struggle with this idea at the start and it being a lot of uncertainty. I think you're mentioning you have a lot of rumination around that. How did you get to the place where you are now? Elle: After my mom died, about a year after, I ended up moving from Michigan to Denver. Denver is what I would call a fairly liberal city. I knew a lot of people that were open with their sexuality and I wasn't around the people that have known me my whole life, because it's a lot harder to go against the expectations of people who have known your whole life. It's different when you can create the self that you feel like you are when you can start with that. I think I felt like I had the freedom to explore who I really was. I knew I had people that I could identify with. Also, I think the experience of losing my mother, who was the absolute, closest person in my life, I think it just made me less afraid, in general, because, it sounds cliché, but it was like, you're hit with the fact that time is limited, and you don't want to waste it. You don't want to waste it by being unhappy or hiding parts of yourself. I think in general, it just made me a lot less afraid and less timid because I realized that if there's so much out of my control, I'm definitely not going to waste time not being who I am. Kimberley: You move from a place of being uncertain to just fully accepting radically who you were and just waited to land wherever you landed. Is that how the shift was? Elle: Yeah, pretty much. I don't know. I remember I was laying in bed one day trying to go to sleep and it just went off like a light bulb in my head. I was like, "Oh, I'm--" other times, pansexual has felt more, right? Truthfully, I don't get too caught up in a specific label, but at the time I was like, "Yeah, I'm not straight." It just went off like a light bulb. I think maybe the groundwork for that was laid by the radical acceptance that I had cultivated for my mental health, because like I said, after losing my mom, my brain and my nervous system really went into overdrive and my mental health was really, really, really a struggle. But at that point, I had cultivated a lot of acceptance and self-love for that. And so, I think maybe that foundation was laid there and then paved the way for me to also accept my sexuality. I think I just realized that it actually doesn't matter that much. These days, I embrace the uncertainty. Like I said, I don't care that much about the label. If bisexual feels right now, cool. If lesbian feels right one day, cool. I more so just have the attitude of like, I'm going to date who I want to date and listen to my heart. The certainty doesn't actually matter. Kimberley: Yeah. It's such a cool concept too. I think a lot of the interviews I've heard around sexual orientation is like, "Oh, I had all this uncertainty and I did the treatment and none of my fears came true or whatever." You know what I mean? Elle: Yeah. Kimberley: I love that you're really walking the walk because you had fear and uncertainty and you just continued to be uncertain. It's not like you have some resolution at the enemy. There was. But I love that you're just in a place of just being at it. It is what it is. I feel like that's a story that's missing when it comes to sexual orientation OCD. Elle: Right. I think that's a really good point because it's true. The uncertainty didn't go away. My attitude on the uncertainty just changed. I think you're getting over the hump of shame that comes along with non-heterosexuality is a big part of that too, because I've seen on social media, I feel like a lot of people, it really scares them that someone else who had sexual orientation OCD actually turned out to be not straight. I think that that's scary for a lot of people. That's a whole other thing. That's not just OCD, that's the shame that many of us have grown up associating with non-heterosexuality. Kimberley: Right. That internalized stigma that is placed on us. Elle: Right. Kimberley: I really love when you wrote that article and we will share it again, and you share a lot of this story. I really do love it because I really worry sometimes when I see Instagram posts and things of like, "Everything I've ever worried about never came true." You know what I mean? I see that's true for a lot of people, but it is a form of reassurance almost of like, "Don't worry, your fear is just a thought." I think this is an opportunity to fully embrace these concepts. The thing I love about what you're talking about the most, and I don't hear enough people talking about it, is it's coming from a place of just genuine love. Not from a place of like, "Well, my therapist told I have to radically accept it." You know what I mean? Elle: Yeah. Right. Kimberley: Yeah. Thank you for sharing that. I've just loved that story so much, even though I hate that you have gone through a difficult time. You talked about your moms and the grief around that, you talked about how her loss helped you move into radical acceptance, but how else did that impact you and your recovery or your struggles? Elle: In so many ways. The person that I was before and the person that I am now are two very, very different people. I think the biggest thing is like, my mom and I were very close. I'm the youngest of four kids and I'm the youngest by a lot. So, I definitely got my parents, especially my mom, all to myself a lot. I was very emotionally dependent on her. She was a huge source of love and the most loving mom that I could have asked for. That said, I hadn't really learned how to mother myself, how to be my own source of love and affirmation, and all of that. That's terrifying to just be dropped into. I think the ideal situation, if we all got to have ideal situations, would be that we gradually get to that point. We grow into adulthood while we still have that support, which is the same, my dad is supportive but in a very different way. I felt like there was no one there to hold me up or to witness me. I just felt very alone. She was, I think, the person that I was the most vulnerable with. So, not having that just was really scary. I didn't know how to cultivate that in myself for a long time. I do now, which is a really good thing. Kimberley: How did you learn that? I feel like I don't know how to do that really, really perfectly. You know what I'm saying? I think there should be a course in middle school that teaches you how to do that. Elle: Yeah. There should be. I think part of it is like, what I learned from her in terms of how she cared for me, I…
Full show notes at the publisherThis is Your Anxiety Toolkit - Episode 195. Welcome to Your Anxiety Toolkit. I'm your host, Kimberley Quinlan. This podcast is fueled by three main goals. The first goal is to provide you with some extra tools to help you manage your anxiety. Second goal, to inspire you. Anxiety doesn't get to decide how you live your life. And number three, and I leave the best for last, is to provide you with one big, fat virtual hug, because experiencing anxiety ain't easy. If that sounds good to you, let's go. Kimberley: Hello there. I have with me a very special friend who is going to talk about something so important. So, so important. I am so excited to have with us Shala Nicely. Oh my goodness, thank you for coming back onto the show. Shala: Thank you so much for having me. I love being here. Kimberley: Oh my goodness. Okay. So, probably the reason that I have been so adamant about getting you onto this episode is this topic that we are going to talk about is probably one of the topics that comes up the most with my patients and clients that nobody is talking about. Shala: Yes. Kimberley: Nobody. And I am seeing it more and more and more and more and more, which is why I wanted to have you on. So, thank you. Shala: Yeah. Kimberley: Thank you. Okay. So, you wrote a blog about depression as a compulsion. Can you tell us what does that mean? Shala: Yes. I'll start off by saying that this is one of the many subtleties of OCD. Sometimes OCD takes a long time to figure out. I spent years becoming a therapist. I spent years thinking about my own experience and when I was writing my memoir Is Fred in the Refrigerator?. It wasn't until after Fred was published, that I figured out this particular compulsion that I had been doing. By identifying it, it's been able to help me make a huge difference in my recovery, and that's why I wanted to share it and write the blog. Kimberley: Right. It's so important. I mean, I can't tell you, I've been practicing for many, many years and I only came across this in the last year or two. But the more I get to know it and the more I understand it, I'm just like, I feel like I see it in almost all the cases in some way. So, go ahead. Tell us what it is. Tell us what it looks like. Shala: So, I'll give you an example that I used in Fred, which is, when I was in my twenties, I was convinced I'd given myself HIV aids because I had gotten cut with a broken beer bottle at a party and I had spent all this time in my head arguing with OCD about whether or not that you can transmit HIV aids through that. It went on for months and months and months. While I was doing all this ritualizing in my head, trying to figure this out and prove to myself I didn't have this disease, which this was years and years and years ago, the treatments for HIV aids are much better now, they weren't. This was 25 years ago. I know people with OCD are still frightened of it. I was really frightened of it back then because there weren't very many treatments for it. And so I would spend all day long thinking about how I had given myself a fatal disease and how I was going to die. And then I started acting as though I had a fatal disease that there weren't good treatments for and I was going to get it and die. So I would go into situations and put on a happy face and smile, but in my head, I was thinking, "Oh, this is the last time I'm going to be doing this. Oh, this is so sad. Just wait until people find out what is really going on with me." So I would focus in those situations on how awful this was and how depressed I was and how this was going to be the last time I was going to do it. So, I was actually acting as though what OCD was telling me, which is that I'd given myself fatal disease, was true. And the depression that came from that became the compulsion because I took that emotion and I acted on that emotion. So I started acting depressed, making depressed choices, living in a depressed lifestyle, having a depressed attitude as I went out into the world because I had given in completely to what OCD was saying. When I realized that, again, this was after I'd written the story, after it had been published, and I started seeing this in my clients. I started recognizing I still did some of this. I'm like, "Wait a minute, it's the depression itself, which was really propping all this up." It's really a very subtle form of compulsion that if you don't recognize it can sabotage your ERP work. Kimberley: Yeah. I would admit as a young intern of treating OCD, I think if I saw this, I would have stopped ERP and focused on depression and really worked on that, which is not a bad solution, but without really recognizing it under the lens of OCD, right? So, I would have seen it as separate. I love it. Let me explain how I've seen it a lot. Once I've shown them your article, patients and clients have said, "I recognize in the moment that I'm having uncertainty. I try doing a compulsion to make the uncertainty go away and that doesn't work. So, going into depression is our easy way to just exit out of uncertainty. It's the worst-case scenario. That's where I'm going to hang out." That has been so helpful for people to be able to recognize that. It's a response to not wanting to be uncertain. Shala: And I think it's important to differentiate between depression that comes secondary to having a diagnosis of OCD from this, because a majority of people with OCD will end up with some form of depression at some point, because it's just so debilitating. It's the 10th most debilitating condition in the world. So people will end up depressed just because of how exhausting it is to manage this monster in your head all day long. But that's very different than being depressed because you've decided to believe that the OCD is true because you cannot figure it out otherwise. And OCD just wants certainty. It doesn't care what kind of certainty it gets. If it can't get certainty, for instance, that I don't have HIV aids, it's just going to go the other way and say, "Well, I'm going to get certainty that she does have it," and then go from there and then becoming depressed as a result of that obsession. So, I think that's really important for people to understand. You can have both going on at the same time too, which makes this even more tricky. Kimberley: Yeah. Even more tricky, but even great to know that we can differentiate the two now, because we'll talk later about how to manage that. Now, this is where I want to look at insight because, in your blog, you talk about insight. I think that's an important piece of this, right? Because when you first have the onset of OCD, you might recognize that this is like ego, what we would call egodystonic, like this stuff. "I know it's not true, but I keep fearing it's true." Can you share how insight impacts this specific situation? Shala: Yes. In fact, it was Jon Hershfield who introduced the two of us years ago, who helped me put this insight about insight together, because I was talking with him about this depression is a compulsion. What he pointed out is that typically, when an OCD obsession starts, you're doing compulsions to try to prove that it's false. If you can't get that to work, which of course you can't because there's no way to prove all this stuff that I see he's worried about, then sometimes you can start going the opposite way and trying to prove that it's true. Really that's the difference between insight. When you're trying to prove that it's false, then you know that what OCD is saying in some part of you is nonsense. "I don't have HIV aids, come on." Not like in a reassuring way, just there's a part of you that still recognizes, "Yeah, this is super scary, but this is OCD reacting to an intrusive thought. This isn't actually a real problem." So, you've got that insight there. You're still stuck, but you got insight. When you start trying to prove it's right, that's when you've lost insight. When you really give in to everything that OCD is saying, really hook, line, and sinker, and you don't have any insight anymore. That's really when this depression as a compulsion becomes a big problem. The longer that a particular obsession is maintained by doing compulsions, the more likely you are to lose insight, the longer it's been going on. Kimberley: And this is where it's hard, isn't it? Because we know the whole story of when you stare at something for too long, it starts to look weird and distorted. I think that's very much true here. I think it's true of depression in general and in this subtle compulsion. When we look at things as negative, we notice more and more things that are negative. Is that what you feel to be true here? Or is it just the same story that you hear over and over? Share with me how that might sound in your head. Shala: I think it starts to sound like a soundtrack for my life because most of my rituals became internal. And the way I see mental rituals, it's physical rituals taken inside. So you can't do things physically because you don't want people to see or whatever. So you start pulling it inside. The more that I would do that, the more I would argue with OCD, of course, the more I'm strengthening in it. So the more I hear it and the more I argue, it just expands to fill every waking moment. It really becomes a soundtrack playing 24 hours a day because I was doing those mental rituals. And then the longer that that went on, the more likely I was to start becoming depressed because I was losing insight, which then also further reinforces this cycle. Kimberley: So interesting and so helpful. One thing that you talk about is emotions as a ritual. Can you share how this may play out with other emotions such as – you've written guilt and shame, regret and grief? Shala: Yes. So what I'm going to do to describe this is I'm going to take you through the OCD cycle in some anatomical details, so to speak, so we can piece together how this is all happening. So you have an intrusive thought. That is not OCD because everybody has intrusive thoughts. The OCD is the next stage where OCD reacts to the intrusive thought – "Why did I have this? What does this mean? Am I going to do it? Am I going to make it come true because I have the thought?" That reaction, that's the OCD. Of course, that makes you feel anxious. And then if you haven't had treatment, you typically do some form of compulsion, something to try to get certainty about what the OCD is bothering you about, because this is all based on an intolerance of uncertainty. And OCD just picks content that you care about and puts uncertainty about it in your mind and then gets you stuck in that cycle. When you do a compulsion, it tells your brain that this is a dangerous thought, "This intrusive thought I had is dangerous," and you need to keep doing something about it. These steps just repeat on an endless loop. And then what happens is that when it repeats on the loop long enough, the acceptance of the scary thoughts that OCD is presenting causes you to experience the emotions that you would feel if those stories were true. Those emotions tend to be things like depression, as we've talked about, guilt, regret, shame, grief, and others. And then in classic cognitive behavioral therapy perspective where our emotions and our thoughts and our actions all come together in this triangle, the emotions then dictate how we act, so we begin to act depressed or guilty or regretful or shamed or grief-stricken. Those emotions can then become compulsions because they're driven specifically by believing the content of the OCD, by acting like what OCD is saying is true. That's the definition of doing compulsions. So that's how emotions can become part of the compulsion cycle because you start acting as though they're true. Kimberley: Right. This is so true and this is where I see it play out a lot, is when people have an intrusive thought that they've done something wrong, and then they feel... Because they start to believe it, they go into regret and then they go into confessing, right? Then they'll go into like, "Well, I have to confess it because I've done something wrong," instead of that they had a thought that they did something wrong. Or that they feel such deep guilt that they're saying things like, "I'm a terrible person. I'm terrible. And I'm so guilty. What kind of human am I?" because of a thought like you've just described, how then that plays out and keeps playing out over and over again. Let's play out because we haven't really talked about this, but what would the action be as a result to regret? It would be reassurance seeking or confessing. What else would you say? Shala: Maybe going back in your mind and trying to undo it and, "Gosh, what would it be like if it had only gone like this?" Almost like a wishing compulsion that I think [14:22 inaudible] talks about in his book. All sorts of things like that. Kimberley: What about guilt? Similar, but what about guilt? Shala: I think with guilt, it's a lot of self-punishment as a ritual. "I'm bad. I did something bad." With guilt and shame, guilt is, "I did something bad," shame is, "I am bad." I think in this case, those can get conflated together and people just start punishing themselves. "Well, I don't deserve this because I did this bad thing," or "I am this bad person." They start being very uncompassionate with themselves and treating themselves like they're this horrible human being. Kimberley: Right. And that's a big part of how I see it play out is that the self-punishment is pleasure withholding, like you don't deserve the nice-- it could be as subtle as you can't have the nice brand of crushed tomatoes. You have to have the crappy brand because you don't deserve good things or you don't deserve the nice sheets or so forth. And that will make you feel-- when there's no pleasure in your life, you get depressed, right? I think that's a very subtle way that OCD plays out. I've heard lots of people will say, or the flip side is they'll say something like, "Oh, because I have harm thoughts about my child, I have to buy them the best diapers," which is treating yourself as if you've done something wrong. Shala: Yes. You're making up. Kimberley: You're making up for something that you had a thought about, right? Shala: Yeah. Kimberley: Right. It's so subtle. What about grief? Can you kind of give an example of that? Shala: I think with grief, it's pre-planning things. So, for instance, I'm not kidding you, I've pre-planned my funeral in my head – "Well, this is what it's going to be like. It's going to be so sad and I wonder if this will happen and that will happen," as though it's an event two weeks from now on my calendar, Shala's funeral. So I think it's almost like you act like the loss has occurred already and you begin to start going through the grieving process. People with OCD tend to be really empathic people, so it's really easy to go there. It's easy to put yourself in that, "Oh, so-and-so has died. This horrible thing has happened. Let me go ahead and get into that grief state," because we're just good at being able to put ourselves in…
Full show notes at the publisherThis is Your Anxiety Toolkit - Episode 194. In today's episode, I had the most amazing conversation with Hayden Dawes. Now, Hayden Dawes is a therapist, a PhD student. He is what he calls an "aspiring compassion warrior" – we talk about in the interview what that means. Hayden is just doing some really cool work. As I share, and we go into detail in this episode, he's really brought out some stuff for me as I've watched him and learned from him. It's been incredible to see this journey that it's put me on. So, I cannot wait to share this episode with you. We're talking about radical permission, writing compassion slips for ourselves. We're talking about being petty. It'll make sense when we get there. It's just such a beautiful conversation. So I'm so happy to share this with you. If you haven't already, please do go and leave a review. The reviews help us reach more people and gain the trust of more people. So, go ahead and leave a review wherever you listen, and let's get onto the show. Twitter and IG : @hcdawes Website: hcdawes.com FB Group https://www.facebook.com NEWSLETTER: https://www.hcdawes.com/newsletter ----- Kimberley: Okay, welcome. I'm actually so excited to have this conversation. This was a really, really great one to me because I have with me Hayden Dawes. He is an aspiring compassion warrior – which I can't wait to hear more about what that means – a PhD student. He is a social worker and has been practicing for many years. So, thank you so much for coming on, Hayden. Hayden: I am so excited to be here, no one else can see us, but to see your smile, just to see a little of me. That just makes me even feel more welcome and more excited to be here. So, thank you. Kimberley: Yeah. I'm really excited. So, let me fan go on you for a second. For those who don't know, and you'll hear all of Hayden's work, Hayden has these really cool Instagram profile. I love the work you're doing with compassion, but we're also going to share a couple of other things that I love about your work. We'll talk about that here very soon, but tell me about the work you're doing around like an aspiring compassion warrior. Tell me what that means and how you are putting that out into the world. Hayden: Yeah. So, one of the things, I was raised in the Catholic church and Roman Catholic, and I've looked for different faith traditions, things that felt close to me and really fit my experience. So, stumbling upon Buddhism and more contemplative practices like Quakerism and Buddhism, and finding the idea of a Bodhisattva, someone that is willing to just do the tough work of delving deeply into what it means to be human, the suffering piece to it, and learning from that experience and then trying to help others along the way as we're all on this human journey. So, I said, "Bodhisattva is a mouthful. Why don't I call myself a compassion warrior?" And part of that is delving deeply into my own stuff, my own pains, and challenges so that I can learn more about myself and be compassionate with that and I can be compassionate with other people. Kimberley: Yeah, respiring. I actually think you're a warrior. I don't think you're aspiring. You could drop the aspiring. Hayden: It's interesting. Sometimes I do, sometimes I don't. It's like, I think part of the journey is like, "Am I really aligned with that completely? What does the aspiring mean?" Sometimes taking it out of like, "Let me hold closer to this idea that this is what I am." So, I think that's influx too, but I appreciate that. Kimberley: Yeah, of course. Okay. So, we talk a lot about compassion here on the show, but I love those little twists that you bring into it. So, I'd love if you could share, you're often talking about the permission slip. Can you share it with everyone, for those who don't know what that means? Can you kind of give me a little rundown of what that is? Hayden: Yeah. So, back in 2018, I had a friend of mine share on Instagram, a haiku a day for 100 days. I thought, "I'm not counting out all of those syllables." But what I can do is following up on the work of Brené Brown. I was like, "I can write a permission slip to myself a day." I can slow down and center myself and think, "If I think about the whole day that I'm going to have, what is it that I most need? What is the thing that I might need to give to myself?" I also know from my clinical practice, and I'm sure you can relate to this, people will come in and they'll say, "I'm thinking about doing this," or "I'm thinking about doing that," and like, "Sweetie, let's slow down. You probably know exactly what you need to do." "What do I do?" I'm like, "Yeah, you're looking for me to give you permission to do that." So, I thought, "Well, what if we can just skip through that step?" What would it be like for me to start a practice that I was like, "I'm going to offer myself this permission to do whatever that I might need in the world for myself." Kimberley: Why do you think people need permission from other people first? Hayden: Yeah. I think there's a lot of different factors, but I think we have a lot of different noise, societal noise about who you're supposed to be, who you're supposed to love, how you're supposed to walk in the world. I think some of that noise trickles into our family spaces. A lot of us are taught to really trust our own intuition, our own inner guide. I might even argue the God that lives within us. So, we end up delegating that task to someone else because we've been practicing that, rather than really slowing down and listening and honoring the wisdom that dwells. I believe in each and every one of us. Kimberley: Okay. So, I love this, and I think that's so important, particularly for my community who have a tremendous degree of anxiety. They've sort of lost touch with their own guide and their own wisdom because fear runs the show all the time. And I think that's true for anybody who has fear, but especially the folks who have an anxiety disorder. So, I love that. Okay. So, can you walk us through? What would you do? What do you say like WWHD (What would Hayden do)? Hayden: Yeah. If I'm feeling really anxious, maybe my permission slip is, "Hayden, give yourself permission to just breathe." Or if that feels like too much, "Hayden, give yourself permission to feel your anxiety. Hayden, give yourself permission to feel your feet on the floor. Nothing else, nothing more, just feet on the floor." If your anxiety and sort of the thing that you need, you know you need to do is have that tough conversation. "You know what, I'm going to give myself permission to be assertive and to ask for exactly what I need." Kimberley: Yeah. I love that. So, it's in that compassion realm. It's got like the real boundary-setting one, but also the gentleness. So, there's both those pieces to it in many situations. I know on, I think Twitter, on Instagram, you post these. Are these ones that you're writing because you really needed to hear it yourself, or is it that you had a session with someone and you wanted to put that out for other people? How do you do it? Hayden: Yeah. What a great question. Honestly, all of my permission slips that I've written are generally for myself. I want to think that is what connects with people. They know I'm not a phony. They know I'm not trying to sell them some program that I'm not trying to work myself. I have not scheduled any of my posts really thus far when it comes to my permission slips. So, the ones I put on Twitter and oftentimes the one I put on Instagram, sometimes I'll pull back an archive of what I did in 2018, just to show people that I too am on this path, because I do think throughout my day, like, "What is it that I need?" Oftentimes with me, and I'm sure many of your listeners can really understand this, that I am someone that does a lot. So, if anything, I need a lot more like parasympathetic energy, giving myself permission to rest, giving myself permission to foster self-love and self-acceptance. But then there might be some people that your permission slip might be a little bit more of like, you need to get up poo and you need to go. Kimberley: Exactly. I know it's true. It's true. As you were saying that, I mean, my permission slips, I could write them for the next month. It would say, "I give myself permission to rest." I know it's going to say that, but there are other people who will need for the-- they'll probably be able to recognize that their permission will need to say like, "Face your fears and do the scary thing." So, that's beautiful. Hayden: Yeah. So, just to give you a little bit more of the story, I didn't know how much of a big deal that permission slips would be to my work until I was meeting with someone that was helping me to think about my social media a little bit with more strategy. She said, "Hayden, these permission slips are really cool. This is something that I think I could do," my friend, Emily. And I was like, "Really? I didn't see it." That was maybe two or three years ago. And then what happened was, last spring when I felt like COVID was making our world so much smaller. I was talking to my therapist and she was saying, one of the themes that kept coming up was this sense of reminding people the autonomy that they have. And so one big facet of this is permission slips remind us that we have the ability to choose. Even if you decide not to do that thing, it's so much more empowering to recognize that you're choosing not to do that thing. So then what happened was, I said, "Well, what if I open the permission slips for 14 days on social media?" My following was much smaller than it is now. I did it for 14 days, just how powerful it is to have a collective practice of people all over the world, all over the country, writing permission slips, because there's something so magical in that by you seeing me give myself permission. It's contagious. You then give yourself permission. Kimberley: I agree. I think that's why it's so powerful, right? It's interesting because-- and I hear people say this to me often too. I think people see therapists like, they're got it all together, which I most definitely do not. I'm not afraid to admit it. I'm totally fine with that, but I still am shocked. I tell people, I share my story because we're going to break the stigma that therapy is like this idea that you just get better kind of thing, like we're still so human. I love that you're a therapist sharing it, because I do think it helps people to recognize like, "Oh, that's not the goal. I'm not supposed to be perfect. I'm going to be giving myself permission forever." I love that you're doing that. Hayden: Yeah. It reminds me of-- I don't know, I was jabbering about something with my therapist. She was like, "Are you trying to hack the human out of this process?" And I was like, "I'm trying to hack the Hayden." It took me weeks later. I was like, "Gosh, she's so right. I'm trying to do this without feeling any discomfort." And that's not going to be possible. How beautiful is it that I can practice giving myself permission by practicing self-compassion literally for the rest of my life. Kimberley: Isn't that beautiful? Hayden: Yeah. I don't love it, but it's beautiful. Kimberley: It is beautiful. I actually have a book coming out on self-compassion for-- Hayden: Congratulations. Kimberley: Thank you. Yeah. It's not out yet. It'll be out in October. But a big piece of it is, if you can hold space for your pain, you're sad because you will have pain. We're not going to avoid it. But if you can always be that frontline person, that's what these permission slips are, right? It's you being at the front line. Hayden: Oh my gosh, I love what you're saying. Now you're making me think. If you hold space for your pain, you hold space for everyone else's. I think so much of the inner work really brings out an outward change. You feel so much more connected to the people in your life, maybe it's your children, your partner, it's your boss. And then you see the world just so much differently and you see yourself differently and you stop looking at other people's thinking. Like you said, they have it all together and they live these beautiful airbrushed social media lives. It's like, "Oh, we're all trying to be a part of this world and figure it out." And no one is ever done. If they tell you're done, I got this for you. They're lying. Kimberley: Well, they're completely in denial. Hayden: Right. Kimberley: Right. It's so true. So, I think I love that you're giving this very simple but impactful tool. So, thank you. It's so cool. It's so, so cool. I have one more question about that before we move on to the other piece of the work, which is, do you actually write them out? I mean, you do because you're doing it on social media, but I know with Brené Brown, she has had-- you can actually write the permission slip, like it was like, you're getting a permission slip to leave school early from your parents. Do you write them? Are you now at a place where you can just stop and think it through? What has been your progression with this? Hayden: Good question. No one's ever asked me that. So, for me, I generally write them and I think that has been a good practice for me to slow down and stop. But I had a conversation with a friend who has been writing his permission slips, and he said that he's noticing that he'll fall into giving himself permission. And then later he can say, "Oh wow, I just allowed myself to do that." Kimberley: It's just a new habit. Hayden: Absolutely. I really have to sit back and reflect on that to think about, what are the times that I'm just allowing something to happen that I generally wouldn't have allowed to happen before in the past? Kimberley: Right. Oh, I love it. I do. I really do. I really encourage people to go and follow you because I do think it is-- even though I know it's perfect for us and it's ideal for us to be doing it on our own, I do think it's lovely to have it be modeled for other people. I think that that's really powerful. Hayden: Oh, I have to jump in. I think for me, if you think-- so I actually had a class assignment where I had to really conceptualize what I think radical permission is. Honestly, I think there's three levels to it. It's nested within a community. And then the community has an instructional leader. I think of myself as that leader, as someone that is modeling both how to do a permission slip and also modeling how to support others with their permission slips. And then the final component of that is the self-practice. Kimberley: Right. Hayden: But one piece can exist without the other. If not, to me, I don't think it's radical permission. It's just not. We don't exist in containers. Some of the more Western mental health practices, especially in the last 30 years, are so individually focused. Kimberley: Yeah. I know I've got goosebumps listening to you say that because it is so true, isn't it? Hayden: This is…
Full show notes at the publisherThis is Your Anxiety Toolkit - Episode 193.
Hello, my loves, how are you?
So, recently, I've been having lots of conversations with my patients and my clients around one really helpful metaphor around managing mental compulsions.
Now, before we go into this, let me just do a quick overview. We have obsessions, which show up in the form of intrusive thoughts, intrusive feelings, like anxiety and uncertainty and doubt and guilt and disgust. There's intrusive thoughts, there's intrusive feelings, there's intrusive sensations, which is whatever physical sensations you experience that are intrusive and repetitive, and then intrusive urges. Urges like this urge – you feel like you're going out of control and you're about to hurt someone or you're about to harm someone or do something that is ineffective or not helpful in your life.
We have these intrusive thoughts, feelings, sensations, and urges, and sometimes images as well. It might be a quick flash image of something scary. In effort to either solve that or remove that or lessen the discomfort of that, we engage in a compulsion. Now, the compulsion could be physical, like washing your hands or moving an object or so forth, checking something, or it can be mental. I'm really specifically, in this episode, talking about mental compulsions – the mental compulsion of trying to solve and ruminate on an obsession. A lot of you have said that mental compulsions are one of the most difficult to reduce or prevent or stop, and I think that's very, very, very common.
When I'm talking with my patients about this, usually, they report that once they have the obsession, because we know that – let's sort of just preface – trying to prevent the thought or suppress the thought won't work. You're going to have these thoughts. Thoughts suppression usually makes you have the thought even more.
We're not talking about thoughts suppression here, but what we are talking about is, once you identify that you've had the thought, how much attention do you give it and how much leash do you give it? This is the metaphor I want you to think of.
When you've had this intrusive thought, think of the thought like a really baby puppy, like a really active bouncy baby puppy, and you've got the baby puppy on a leash. You're taking the puppy for a walk.
Now often I'll ask my patients, "When you take your puppy for a walk, particularly if you live in a suburban or city area, which I do, do you give the puppy a long leash or do you give it a short leash? As you're walking down the sidewalk, are you letting the puppy walk down the middle of the road with a long leash, and then it jumps over the sidewalk into the garden, it pees on the garden and then wraps its leash around your legs, and then it takes you off into some at the park that you don't want to go into? Does it walk down a street that you don't want to walk down? Or do you keep the leash shorter? And what you're doing there is you're pulling it back. You're not allowing it to go into areas that you don't want it to go."
Now, that's what I want you to think of in regards to mental compulsions. Once you know that you've had an intrusive thought, your job is to keep that thought on a short leash, meaning you don't explore the whole neighborhood and what it means and what it could happen, and this could happen, and that could happen, and let's go down the rabbit hole of trying to figure this out. Instead, you want to keep it on a shorter leash. Again, in this case, you're being really skilled in what road you're letting yourself go down or what rabbit hole you're letting yourself go down. The whole idea here is, keep your intrusive thoughts on a short leash.
You still have the dog. You're not trying to get rid of the dog. You're not cutting the leash short and going, "Runaway, I don't want you." You're saying, "I have this thought. It's going to be here. I'm going to be very intentional on where I allow this thought to go. I'm going to be very intentional on how much I let this thought be the focus of the walk I'm taking."
As you're walking your dog, you're not only looking at your dog. You're also looking at the path that you're walking on so you don't trip. You're looking at the nature around you. You're waving to the neighbor or however. You're engaging with the outside world. You're not just gripping and holding the leash and fighting it.
This is important for you as you manage your mental compulsion. I'm going to say to you, this may be the most important skill you'll learn. The skill of managing mental compulsion is so important if you have generalized anxiety, OCD, social anxiety, health anxiety, depression. It's so important that we are skilled at setting boundaries with our mental compulsions or our rumination and our worry. All of these things are the same. Worry is just a form of mental compulsion.
What we want to do is, if you notice that you're going way down the wrong street and you're going in the direction of doing mental compulsions, you may want to yank on that chain and say no, as you would with your dog. "We're not going down that street. We don't poop in people's yards. We don't poop in our own yard. We stay on the sidewalk." And then the dog tries to go the other direction into that person's garden, and you say, "No, sorry. We're not doing that today. We're staying on this path. You can be here. The thought can be here, but I will not let it determine what I do on my walk."
This is so important. Just think of it. Think about when you're in your daily life, do you allow your thoughts to be on a tremendously long leash and do they go wherever they want and they're pulling you in every direction, or are you in the practice of shortening that leash and taking more control over where you let your head go?
Now, a major thing to remember: It's entirely okay if you suck at this. You are going to suck at this. Please, don't be hard on yourself. This is a practice. There are some days I am excellent at this. There are some days I am terrible at this. That is okay. It's similar to anything in your life. You're going to have ups and downs. But really reflect as often as you can, what's the intrusive thought, what's the intrusive feeling, sensation, urge, image. That's the obsession. We don't want to control that, but we do want to work on being skilled at how we respond. That's the most important piece.
Be gentle. Be kind. Be diligent. Be patient. You will get this with time. Keep that dog on a shorter leash, if you can. Be gentle with the puppy on the leash too. Don't yank on it too hard because we don't want to get into a wrestle with our thoughts. Okay?
I love you. I hope that is helpful. Please, please let me know your thoughts on this. It's just a metaphor, so it may be helpful for some and some maybe not for others. I just am so grateful that I get to spend this time with you.
Please go and leave a review. I know I say it every single time. I cannot tell you how much it helps me and brings me so much joy to see the reviews. I love them. Thank you so much. I read every single one. Thank you. We will give a pair of free Beats headphones to one lucky person who leaves a review as we hit a thousand reviews.
Thank you so much. I love you, guys. Have a nice walk, my friends. It's a beautiful day to do hard things.
This is Your Anxiety Toolkit - Episode 192.
Welcome back, everybody. I am really excited to do this episode with you. It's a little bit different to episodes I've done in the past, which might be why I'm really excited about it, but it is a skill I have been practicing for several months. No, maybe more than that. I would actually say closer to six months to a year, and I was reflecting on, what are the things that... I took a lot about mindfulness skills and a lot about therapy skills and cognitive behavioral therapy skills, but is there something I haven't really talked about in terms of just lifestyle? And I thought this, of all the topics, is probably one of the things that helps me manage my anxiety and depression the most, literally the most. In fact, I would go as far as to say it has been probably one of the most important things that has helped me recover in my recovery, and I'm really excited to share it with you.
Today, we're talking about how activity scheduling and managing your schedule can be a really important anxiety management tool. Before you completely sign off and say, "Oh my gosh, this is not for me," please just hear me out because there is so much greatness to being really intentional about your schedule and scheduling.
A couple of reasons I say that is because, number one, if you are somebody who has a job or goes to school or has a mental illness, and that's really, really debilitating and taking up a lot of your time, or you have children or all of the above, it's really easy for the day to just come and go. And before you know it, you haven't gotten done what you wanted to get done. You're feeling more and more anxious about tomorrow. You're feeling more and more depressed about yourself and what you've got to do. You're feeling bombed out because you didn't get to prioritize your time.
And that was exactly me. Every time I opened my eyes in the morning, I had this sensation of dread because I just was like, "Oh my gosh, today's going to be another huge day. I'm going to run all day. I'm in a rush all day," or "I'm going to feel anxiety all day."
Let me tell you a couple of skills that I teach all of my clients because, as I've said before, this is something that they talked to me about, at least once in their treatment, is how to manage their time.
Okay. I have learned and I have practiced this, like I said, for almost a year now – the art of scheduling in a way that is in the intention of benefiting my mental health. I don't schedule because I want to be super time efficient. I don't schedule because I want to get a ton done. I schedule for my mental health, literally. Forgive me, if you can hear beeping car alarm, it's been going all day. So I'm sorry if you hear that in the background.
I literally schedule for my mental health. And what I have learned, I took a whole course on this, is one of the biggest mistakes we make with scheduling is we schedule what we have to do first, and that basically means we're prioritizing work and school and to-do's, instead of scheduling pleasure first. So that is what I want you to practice first.
That already might be mind-blowing to you. You might be like, "Wait, what? Like pleasure? That's important?" Yes. Schedule your pleasure time first. Look at your schedule, even write it on a piece of scrap paper. What do you love to do? Make sure you schedule that something. Even if it's for 10 minutes, you schedule it every single day.
Once you've done that, then you schedule what you need to do for your recovery. It may be different for every person. Some of you may need to schedule exposures, and again, be very intentional. Let's say you have a driving exposure. You have to go driving for your exposure and practice having intrusive thoughts, or you have to practice going and doing a certain thing that concerns you or scares you. You're going to schedule that time first.
If you're not someone who's doing exposures, maybe you have to schedule time to correct your thinking or schedule your time to meditate. Schedule your time to read your mindfulness book. I have almost all of my patients read some kind of book that will complement their treatment all the time, meaning throughout treatment. Once they finish one book, I send them a book to read after that, and I tell them, "You don't need to read all day every day." I might ask you to read a page a day or a chapter a week, or whatever works for you, but schedule that in because really literally, I'll give you an example.
I have a private practice and an online business, two complete businesses. I'm managing up to 15 to 20 people a week. If I worked at scheduling my to-do list first, I would never take care of myself. Never. I would only work for other people. I would only be doing a million to-do's. I would never get any exercise. I would never meditate. I would never have any time because I would have just clogged up my schedule with that.
Reverse it. First, schedule your pleasure and then schedule your mental health practices, whatever that may be – your self-compassion practices, listening to a podcast, whatever it may be.
Now, when it comes to the things you have to do, this is going to go against some of the advice you've been given. I know it will. But hear me out and you can take what you want and leave what you don't want. What I do is I sit down with a piece of scrap paper and I write a to-do list. Every Sunday, I do this. I write a list of all the things I need to get done this week. I write a list of what emails I need to write and what phone calls I need to make and what bills I need to pay, and who I need to talk to, who I need to consult with, and so forth.
Now, for those of you who compulsively list-write, we're not writing things that are daily activities, like I'm not going to write "Brush my teeth." I'm not going to write "Have breakfast." I'm not going to write "Lock the door." I'm not going to write things that I would be doing anyway. I'm going to be writing the things that I have anxiety about and that are important that I get done and that I value. I'm not writing down things that are compulsions or things I'm doing to make my anxiety go away. These are just really logical things that I have to do.
Once I've got everything down, I don't keep that list. I transport that list into my schedule. Of course, I have to see my clients. Of course, I have my clients in my schedule weekly. But then from there, let's say I needed to make an email to, let's say my website programmer, I would put that in the calendar. Tuesday at four o'clock or Monday at six o'clock or whatever it may be. I take everything from the to-do and I put it on the calendar.
If you're noticing now that the calendar is full, something has to go, because what's happened in the past is you put all the to-do list in, and so the thing to go is your mental health, is your self-care. We can't do that anymore. That's why I'm telling you, like, that's why scheduling is so important because if you don't, you're going to realize that there is actually no time for self-care and there is no time for your mental health. If that's the case, like the whole saying is "Nothing changes if nothing changes." So this is so important.
You may need to ask for help. I'm always talking with my patients about asking for help. Okay, you need to go out for a drive. You need to do your homework, but you also need to take the kids to school. Can you ask someone to help you? Can you pay someone to help you? Can you find creative ways where you take your kids and someone else's kids one day and they take their kids and your kids the next day? Again, I really love to do this on the cheap, so I don't want this to cost you money. Can you find ways to prioritize your mental health in your schedule, on the books, and open up time so that it becomes the priority?
I know I've told you this story before about, I was at a lunch and I was with my friends and they didn't have children. They were all talking about these beautiful hikes that they were going on. I said, "Well, I can't go on a hike because I have children." He's like, "Yes, you can. You just haven't prioritized taking a hike. If you really wanted to, you would take your kids on a hike or you would find some time or find someone to take care of the kids so you could go on a hike. But you haven't prioritized that. You've prioritized being with your kids or working or taking a bath."
There's no judgment. There's no judgment to what he was saying. He was just saying, "You can do it. It's just that you have to figure out what is a priority." For me, that was shocking because I was like, the truth is I say my mental health is a priority, but I don't. That doesn't show up in my schedule that way. This was many years ago, and it was a crazy aha moment where I was like, "Huh, I say self-care is important, but it's totally not evident by the look of my schedule."
The other thing that I have found that's so fascinating is, once I started doing this, I started actually realizing how much I was working or how much I was doing behaviors that bring me no pleasure. I spoke with a client about this just the other day, is I wasn't feeling so well. I went to bed early. I laid in bed. I opened up Instagram. And two hours later, two hours later, I come out of a thick fog of Instagram and realize that I've lost two hours. The thing to remember here is, number one, that's neither good nor bad because some people love Instagram and it brings them tons of pleasure. But in that moment, as I checked in with myself, I didn't feel any better. If anything, I felt more stressed.
So what I was doing was I was engaging in behavior that I could have done that would have felt so much better and aligned more with my mental health, which again is why I say to you, please, please, please, if you take one thing away from today, please schedule your pleasure. Please schedule your pleasure, the things that bring you joy.
Now, some people say, "I can't do those because my anxiety has taken those things away from me." Even more reason to schedule them. If you love to read and your anxiety or your depression has sucked the joy out of reading or writing or whatever you love to do, schedule that and work at what's getting in the way. Talk with your therapist or journal or try and figure out what's getting in the way and work at making sure that fear isn't your scheduler. Fear isn't your assistant who schedules your day. That's not cool. That's not kind to you. Do not let fear schedule your day. Do the best you can is what I should say, because there will be times it will. But just do your best to make a deal with yourself.
We've talked about transferring your to-do lists onto the calendar. You rip the to-do list up, you take it away. And then your job is to do your best to stick to the calendar. It's not going to be perfect. In fact, it'll be far from perfect, but really look at the end of the week or at the beginning of the week, and look at your calendar and make decisions with that.
Now, of course, I understand that there is some degree of privilege involved here. I want to make sure we respect that some people don't have control over their schedules, and that's true for many people. But what I want to ask you is, if that is the case, where you have control, can you implement really good exercises and activities during that time, like really resting.
I just read an amazing book where they were basically saying "Schedule rest." If you're someone who's working a double shift and money is tight and life is really difficult right now, maybe the first step is you just schedule rest. Maybe the only step is for you to schedule rest. Maybe we start really simple. This is a lot of change. I encourage you to take baby steps, even if you've got full control over your schedule. It's really important here that we take baby steps and empower ourselves to prioritize your mental health. Believe me, it is going to make such a change.
The other thing is, and I'll say one more point, what was really interesting to me is, I really then, once I started scheduling, noticed all the "shoulds." Well, I should work out five days a week and I should go and help other people, and I should be putting this in my schedule, and I should be calling this person.
As you do this, ask yourself, do you really want to? If it's not a "have to," meaning you have to go to work and you have to go to the staff meeting and you have to show up for school and so forth, really check in with yourself. Are the things you're doing on your schedule because you feel like you should do it, or because you want to do it, or because you have to do it? Be honest with yourself about that, because I found on my schedule a bunch of stuff. I would even say a bunch of swear words, a bunch of crap that I really didn't have to do. I was only doing it because I'd made up a story about the fact that I should, and it wasn't even a fact and I was doing it out of fear.
That's why I really, really wanted to chat with you about this. Easier said than done, like I said, but really think about this. Look at your schedule. If you can – I schedule on Google calendar, it's free –look at your schedule and ask yourself, is it reflecting the level of recovery that I am wanting?
Make small changes. This is really important. If you've learned one thing from today, it's please schedule your pleasure. Really schedule your wellness. Schedule your rest. Work the rest around that.
Okay. I love you guys. Have a wonderful, wonderful, wonderful, wonderful, wonderful, wonderful day. I believe in you. I believe you can do this hard thing. Do the best you can with what you've got. I am so grateful for you spending your time with me and being on this journey with me and taking me along with you. Thank you. I know your time is valuable and I'm so grateful.
Don't forget to leave a review. I would love nothing more than to get your honest opinions about the podcast. So, please do that, and have a wonderful day.
If you're interested in any of the resources that we have, go over and look at cbtschool.com. Check it out, and have a wonderful day.
This is Your Anxiety Toolkit - Episode 191. Well, welcome friends. How are you? How are you doing really? I want you to reflect for a second on just that... on just that question. How are you? I have not prepared for this episode. I just thought I would sit down and take some time to reflect some of, I'm sure, what I reflect on will be the first time I've reflected on it and not just that for reflecting with you. So what I wanted to talk with you guys about is life with a chronic illness or a disability. This is something that has shaken me a lot over the last, I would say two to three months. A lot of you have the background story with me, but if you're new here, welcome, and I'll tell you a quick background. In 2019, I got very sick. Through that process, I also got very... not just medically, but mentally struggled because of the symptoms that were incredibly debilitating. After pretty much every single medical test under the sun, I was diagnosed with a lesion in my brain, that they still don't know what it is, and a disorder called postural orthostatic tachycardia syndrome. It sounds scary and it can be scary, but mostly, it's a disorder to do with your autonomic nervous system and it basically involves lightheadedness and fainting and headaches and overall exhaustion and nausea and very, very big degree of brain fog. It can be mild and it can be very severe and extreme to the point where you can't stand up. For months and months and months, particularly throughout COVID, I have been doing my very best to manage this disorder and this syndrome and have been doing really, really well. I'm not going to lie, I thought I'd mastered this disorder. I really did. I think there was a cocky piece of me that was like, "Oh yeah, look at me." Once again, hard work pays off. And yes, it does. Hard work does pay off. But recently, I have been hit with another... I call it an event, another wave of POTS – POTS is the acronym for postural orthostatic tachycardia syndrome – and it has knocked me off my feet literally. Not figuratively. I think both. For those of you who don't know, I was, two weeks ago, taking a tennis lesson, a part of my attempts to take care of myself as I have cut back immensely with work. I've mentioned my kids are gone back to school and my husband's gone back to work. And so I really decided, I made a conscious decision to put my mental health first. I had started taking tennis lessons, and in the middle of my tennis lesson, it was very hot. I collapsed and had to go to the hospital. I'm sorry if this is scary for some of you. It had to be monitored and got IV bags and medications and all the things. Again, once again, I really thought this was a short-term thing. What I am reflecting on today is the realization that I'm not going to manage this. I'm not going to master it. This is something I will probably have to handle for the rest of my life. I was expecting to bounce back and I didn't. I've had many days of not being able to stand. I'm not able to drive. I can drive on certain days, depending on how busy I am, but I have mostly not been able to drive. I am unable to work out. I wear these most fabulous compression socks right now, the compression socks I'm wearing. I have bright colors in stripes. I have ones with spots and reindeers and all of the things. So, that's very fun. But no matter how much I hydrate, I'm struggling to eat and so forth. The reason I wanted to share this isn't just to... of course, I can share. I want to share with you. But the main reason I wanted to share with you is to talk about what it's like to wrap your head around long-term suffering. I'm really interested in this because I've been really mindful and watching my thoughts about this syndrome. I wonder if this resonates with you guys because a lot of you are dealing with either. A lot of you have reached out and said you have a chronic illness too, or chronic mental illness, anxiety, depression, or any of the disorders. What has been really interesting for me is to catch the thoughts I have around disability. now, the first thing – and I'm really open about this, and I'm really happy to share how far I have to go – is I didn't realize I had all this stigma around the word "disability." I have a career in people with disabilities or struggles or long-term chronic stuff. I wouldn't judge anybody else, but interestingly, as soon as I had to recognize, I kept saying, "I don't know why this happened. I don't know why this happened. Why did this happen? This shouldn't have happened." My doctors said, "No, you're going to have really big ups and really big downs. That's going to happen. That is a part of this disability." I really was able to observe how judgmental I was about that in myself. The word "disability" was not okay with me, the word "long-term chronic illness." I was like, "Uh-uh, no way, I will solve this," until I had to be like, "Wait, that's a lot of energy, negative energy on something that does not serve me and is built around a stigma and a judgment of me having a disability." It's so painful folks to observe that. Thank goodness I have those skills to be able to go, "Okay. That was judgment. Interesting." I encourage you guys to take that approach when these types of thoughts come in. Because again, I'm always working with my patients and clients and people on social media around the stigma of the word "disorder" or "disability" or "mental health" or "mental illness." It's important that we catch those judgments. Now, once I caught it, to be honest, I didn't do much with it because I really just had to hold some space there to wrap my head around, "Whoa, okay. This is a long time for me now." I thought I was the special one who could get through it and it's not going to bother me again, but it's not. It's going to come back. This one has been particularly painful, physically 100%. This was probably my most serious event or wave of POTS. But also, just to be able to really look at how it has impacted me mentally. Now, here's the thing. Once I came to the understanding, not just the acceptance yet, but the understanding that this is long-term and something I have that I will have to continue to manage, it was so interesting how my thoughts wanted to go to hopelessness. "Okay, well, now my life's going to suck," or "I should give up. This is going to impact my life and terribly impact my life. This is going to ruin my life," and so forth. Again, it was being able to observe and catch and watch myself go into hopelessness and be able to... If you could see me, I would smile and go, "Ah, okay, interesting." That's the story I'm telling myself because here's the thing, I've had this since 2019. I've been managing it this whole time with the thought "I can manage this." And therefore, I was happy. Now, nothing has changed. I'm still having POTS. I had another incident. The only thing that changed was now that I had a recognition of this being a problem long-term and I started to think negatively about it. That's the only thing that changed. I've had POTS this whole time. I've had good days and bad days this whole time. I happened to have a significantly bad period and I'm still in that. The only thing that's changed is the story I tell myself, and I have to keep catching the story, catching it, catching it. Now, I know some of you are saying, "No, but my disability is making my life have a lower quality." I'm not saying that's just a story. I understand that it's a situation and a circumstance. So I'm not discounting that. But what we need to do, and this is why I wanted to reflect with you, is to catch the story we tell ourselves about things that are not true, like the future, because we don't know. We don't know the future. There may be a POTS drug that comes out and I take it and I'm happy for the rest of my life. I am going to recognize that having this disorder has had some benefits. It's forced me to slow down. It's forced me to be grateful for my medical health, for my legs and my arms, and for my heart and my brain. This is where I ponder how wonderful that our body tells us what to eat. How wonderful is that? Because when you have POTS, you have nausea. And when you have nausea, nothing feels good to eat. You have to force yourself to eat. Every meal, I have to force myself to eat. Sometimes, I have to tell you guys, I was cracking up. I eat mostly healthy, meaning I ate all varieties. There is no good or bad food. I have a very good relationship with food. I love food. Food brings me incredible amounts of pleasure. I never judged myself for what I eat. I was telling my sister, who's a doctor, she was like, "Well, are you eating?" And I was like, "Yeah, I had chicken nuggets for breakfast." And she was like, "Why?" And I was like, "It's literally the only thing I could eat. That's the only thing I could get down. It's the only thing that sounded good." And she was like, "Okay, what did you have for lunch?" And I was like, "I had ribs." And she said, "Kimberley, what is happening?" And I said, "No, this is how it is. I have to..." It's so hard. And I'm now so grateful for the pleasure around food that I have experienced and hopefully, we'll experience it again here very soon. I really want to watch (1) the story I tell myself and (2) the hope catch the hopelessness in its tracks. I know a lot of my patients and I know a lot of you because you're going through a particularly difficult season like me. You're telling yourself this season will never end, and it will. Seasons come and go. Some last for longer than others. Sometimes it's a particularly chilly season, sometimes it's not. The main piece here is for me to catch the judgment, the stigma. Here's another one guys and I hope this resonates. It's so humiliating. I collapsed right at the entry of the tennis. People were walking past me, and my instinct was to say sorry to every person that passed by. Even though I was pretty much not in consciousness, I was frequently apologizing to my tennis coach, my husband. My tennis coach called my husband. I frequently apologized to him. I apologized to anybody who saw it. "I'm so sorry. I didn't mean to scare you." And how much that apologizing was embedded in shame around suffering. I'm on the floor, completely limp, but I'm apologizing to other people. That is completely related to the shame I noticed that I am carrying around suffering and struggling and not being super, super-duper high functioning. This is dangerous. We have to check this. I'm going to encourage you to check this because the problem with that is it stigmatizes disability in general and it stigmatizes you being a human who suffers, and you will. You'll have illnesses or struggles like seasons that are difficult. It's so important that we break down that judgment we have around suffering and disability, meaning when you don't have the ability to do things. So important. When we break that down and we work through that, then when we do struggle, there's not this second layer or fifth layer of pain. It's just like, "Oh no, I'm just suffering. I'm suffering right now. This is a difficult season." Instead of, "This is a difficult season. I'm suffering. It's never going to go away, and I'm weak and dumb and stupid and inconveniencing other people for suffering." So, I really want us, hopefully, to learn from my own experience here. Hopefully, this resonates with you where you can really break down the stories and the beliefs and the judgments we have about disabilities. I think it will make a safer place for those who do have a disability. I think it'll make a safer place for you when you're suffering. I think it'll make a safer place for us as a human race around the idea of suffering. It's so, so important. The last piece here is when we're suffering, I noticed this whole back and forth on the solution. Should I do this? Should I go on this medication, that medication, that treatment, these treatments, see that doctor, see this doctor? I'm sure a lot of my patients are like, "Am I doing the right thing? Have I got the right treatment? Have I got the right therapist? Have I got the right medication? What's happening?" There's so much indecision around seasons that are filled with suffering. I just want to validate that. I don't want to give you advice. I don't want to guide you in any different direction. I think all I want you to do is to recognize that indecision and not punish yourself by staying there too long. Consult with your doctors. Consult with your therapist. Talk with respected people or people you trust. Be careful of how much mental space indecision takes when you're in a difficult season because you're suffering. It's enough. We don't need to add. We don't want to add. We don't want to make more problems and more suffering for you because you matter and your recovery matters and your healing matters. That's just something I'm noticing. It's funny, every morning, I am negotiating with myself in terms of like, "Will I take my meds today?" I mean, I always take my meds. So I'm not going to ever discard someone from making a medical decision without seeing your doctor. I always do, but I really catch myself going, "Maybe I won't take it today. This is just too much. It's too hard. It's too many side effects. It's too difficult, too painful, too scary." And I have to go, "Okay, Kimberley, get your head out of your indecision. Honor what's right. If you really need to do that, be effective and call your doctor. Don't spend time in your head." So, that's just where I'm at. What I will say, just in case any of your worries, I am okay. I have a great team. I have tremendous support. My husband, oh my God, he's just amazing at showing up when things fall apart. He is incredible. I'm so, so lucky. I hope that I don't worry you with me sharing this. Someone asked me the other day on social media, "Is it hard for you as a clinician to share this?" And I said to them, "No, really not." A part of my mission is to de-stigmatize therapy, to take the stigma out of going to therapy. I think a really big part of how to do that is for the therapist to show up as real humans. I think when we do that, when therapists show up as real humans, in the process, we do this stigmatize mental health and therapy because we don't see the therapist as this person who holds all the secrets and is the knower of all things and is analyzing you instead of just seeing them as humans. You're just going to therapy to talk to a human who also suffers. I just wanted to share that with you because I think it's important that I model that to you. That's one of the things that I hold very strong in my values. So that's that. There are my thoughts on struggling and going through a chronic illness and wrapping my head around the stigma of the word "disability" and the concept of disability. So, that's it. That's all I have to say. I hope this has been hel…
Full show notes at the publisherThis is Your Anxiety Toolkit - Episode 190.
Welcome back, everybody. Hello, Happy Friday, for those of you who are listening on the release day, and happy day to you who are not.
Okay. Well, how are you? How is everybody doing? I am sitting in my bedroom. We've actually had to completely rearrange because our life is changing so much here at the Quinland house. Kids are at school and people are in and out of the house, and it's very, very different.
So I'm coming to you from my room, and life just continues to change. Have you guys noticed that? It does continue to change. I cannot keep up with it. We embrace. We adapt. We are flexible. We keep trying. We are gentle with ourselves, and that's the best we can do.
Today, I wanted to talk with you guys about questions.
I have been sort of... What I would say is 'reflecting,' but I would actually say, a better word is 'studying' the art of asking better questions, and this has been life-changing to me. It has been a practice that I have adopted as per advice of a colleague and a friend in terms of catching the story you tell yourself and asking better questions. Catching the poorly written questions that we now ask ourselves on habit, right? We just habitually ask ourselves not very skilled questions.
Let me explain to you more about this.
When something happens – and you can even do it here together – when something happens in your life, let's say in the last week or so, something unexpected, unwanted, maybe not so ideal happens, I want you to check in and say, "What is the question I ask?" Some of you may say, it's a really simple what-if thought question. Like, what if such and such happens? What if ABC happens? What if XYZ happens?
Not a super-skilled question mainly because it's so open-ended and it's so in the pursuit of removal of that discomfort. We've talked a lot about being uncertain. We've talked a lot about willingly allowing discomfort.
Other questions that I have observed my patients asking themselves or reflecting on lately are questions like: What is wrong with me? So they have an uncomfortable, unexpected, not-so-great experience, and their immediate question is: "What's wrong with me?" And that question never ends. Well, rarely would you have the thought "what's wrong with me," and then you respond by going, "Nothing is wrong with me, I am a normal human being responding in the way that any other human being would respond." We don't answer those questions. The question sets us up for a failure, just like what-if.
Another one is: "How can I make this go away?" Now, in some cases, this would actually be a really adaptive question. So, let's say you have an ant invasion in your house. It makes sense. Because we're highly functioning human beings and we have adapted over time, it makes sense that our question would be: "How can I make this go away?" That in and of itself could be a good question, a solid, skilled question. But when it comes to our emotions, it's really not. It actually gets us into tons of trouble. Asking ourselves how we can make this go away usually means we're going to probably have more of it and we're going into resistance mode.
Another one, which I see a lot of, and I've actually done a whole podcast on this one before, which is: "Why is this happening to me? It's such an innocent question, but yet it gets us into so much trouble because the answer isn't that great. Why is this happening to me? Nobody knows. It's not the answer we are looking for. Or the answer you probably catch giving yourself is, it's because there's something wrong with you. Go back to the first question because you did it wrong or because you shouldn't have, or because you're bad, or because you're weak, or because... The list goes on and on and on. It's rare that you'll go, "Why is this uncomfortable thing happening? Oh, because uncomfortable things happen sometimes." Again, none of these are bad questions. They're just not super effective.
Another one, and this is the last one I'll use as an example, is: "What does this mean?" Oh, that's a really bad one. It can get us into so much trouble. "What does this mean?" And before you know it, you're 20 minutes in going around and around, trying to give meaning to something, which probably has no meaning at all.
The reason I really want you to first reflect on what questions are you asking yourself is you'll probably find that the questions you're asking yourself are setting you up for self-criticism, self-doubt, punishment, a lot of negativity, maybe for some really unhelpful emotions, and we want to get better at asking better questions. We want to be skilled at asking skilled questions. The questions we ask ourselves can then move us to and into an action that helps us and is beneficial and effective and kind and less work. Less work is good. We don't want questions that, again, can give you more work. Go back to "How can I make this go away?" Oh my goodness. That's a lot of work.
Okay. Let me give you some questions that I am practicing when uncomfortable things happen, events, experiences, emotions, and so forth.
Okay, first question. What emotion right now am I not willing to feel? So, let's say somebody you love has judged you. Okay, that's not going to feel good. Your instinct is to make it go away. But we're going to say, "What emotion am I not willing to feel here? Oh, it's embarrassing. It's vulnerability. It's sadness." Okay. That's the emotion. At least now we know, we know what it is.
Again, what emotion am I not willing to feel? Let's say you did an exposure and you tried so hard and it fell apart and you had a big panic attack and you couldn't back out. Okay. Your question would be: What emotion am I not willing to feel? Maybe it's fear. "Oh, I totally backed out because I didn't want to feel fear. I didn't want to feel uncertainty. I didn't want to feel doubt. I didn't want to feel dread, impending doom."
Next question: Is it true? Let's say you... This was me the other day. I'm unpacking the groceries and I'm so happy because we picked them up and we didn't have to go into the grocery store. I just love this. It's one of the silver linings of COVID – the grocery stores are so good at doing drop-offs. I bring in this huge bag of groceries, and off the counter I fell a spaghetti sauce bottle and glass and spaghetti sauce is everywhere. Your original thought again is like, "What's wrong with me?" And then my next question is, "Uh-oh," instead, "is it true?" The thought I had is like, "You're so stupid. Why are you going to be so clumsy? Is that true?"
Now, I'm not asking that question to invite a long layer of rumination. In dialectical behavioral therapy, it's called checking the facts. When you say a negative thing to yourself, check the facts. If I said that in a court of law, what would the jury decide on? "Kimberley is an idiot. She should have known better." I'm pretty sure the jury would say, "There's no way Kimberley would have known the specific weight of that jar, and the edge was so close and that it was going to fall at this angle. We're actually going to probably let her off." Is it true? Check the facts.
Now, a quick note there. If you're having OCD obsessions, we don't need to check the facts of those because that could become compulsive. I'm talking more here about things we say to ourselves like, "You are bad. You are dumb. You are stupid, what's wrong with you?" Those kinds of comments and more depressive thoughts like, "The world is bad. My future is going to suck." You may want to ask yourself, is it true?
Now, if your instinct is to say, "Yeah, it's true. My past has been crappy. So, therefore, my future will be too," I'm going to say, "I don't know if that's going to stand up in a court of law. Because they did it once does not hold you guilty. If it's happened a hundred times, it still doesn't give me enough evidence to convict that your future is going to be bad." So let's just stop and check in with what we're saying.
Another question. This is my favorite, guys. This is the king of all questions. I really want you to get good at asking this one – what in this situation would the non-anxious Kimberley deal? What does the non-anxious you do in this situation or with this emotion? Best question ever. That's a really solid question right there. It doesn't mean you have to do it all perfectly, but it at least let you inquire as to how you would act, given that fear wasn't there to make your decisions. How would your values have you act? How would your character have you act in this situation?
So, if I, let's say, was going to take a test and my fear was saying like, "What if you fail? What's wrong with you? You should be better than this. You should be fully prepared. You're asking not-so-great questions," and you said, "Okay, what would the non-anxious Kimberley do right now?" It would be: "Okay. She would get a drink and get a piece of fruit and eat it and then go and take the test. She would be kind and she wouldn't be ruminating about how it's going to go bad." Okay, go do that. That's your blueprint on how you should be acting. That's the skills and the perfect outline of what direction you might want to go into. Fabulous.
And the last question... You can have more, you can add more to this. I want you to really think about it because I want this to be specific to you. But the last question I want you to ask, the question I think is a really good question, which is: What do I need? Not what do I want, but what do I need? What will help me here? What will help me get my long-term benefit here? Get me to long-term recovery? What do I need?
Let's use a couple of examples. You've just spilled spaghetti sauce all over the fridge and the counters and everywhere and there's glass everywhere. What do I need? I need to be kind to myself. I need to take my time cleaning this up because my instinct was to clean it up in a rush because I was like, "Oh, this shouldn't have happened. What's wrong with me? I'm going to clean it up in a real rush so that I can get to my happy things." But the problem with that is, it only ended up making me more aggravated because I was rushing. So what do I need? I want to clean it up gently and slowly, compassionately.
Let's say you've just done an exposure and it didn't go so well and you had a massive panic attack. What do I need? I need to slow down. I need to celebrate my attempt. I need to breathe. I need to reflect on how that went and what got in the way. I need a nap. Sometimes when we do exposures, we need big naps, and that's fine. What do I need?
Someone just said something really unkind to you. What do I need? I need to cry. I need to feel my feelings. I need to give myself permission to be sad. I need to call a friend. I need to maybe set a boundary with that friend. Much better than saying, "Why is this happening? What's wrong with me? how can I make it go away? What does all this mean?"
So what I want you to do is I want you to leave today's episode and I want you to spend the day or the week or the month thinking about what are good questions, how can I ask myself really good questions, better questions? Be really intentional about this.
I often say to my patients, if your thoughts are a dog and you're the owner of the dog, sometimes we let our thoughts just go all over the shop. We just let them go. We follow them. If the dog is sniffing into one corner, you go with it and you sniff into one corner. Sometimes with our thoughts, not so much the intrusive thoughts, but the thoughts we say about ourselves, the criticisms, the stories we tell ourselves, sometimes we're going to yank on that chain a little bit, on its leash, and be like, "Come on. No, no, no." We're not going over into that corner and sniffing out that horrible hole. No, we're not doing that today. We're asking better questions.
You're allowed to do that. That's not thought suppression. That's being skilled with your cognitions. We're not trying to prevent thoughts. We're just catching when you're spiraling on them and you're yanking on the chain. And then come on back. You're going too far. You're resisting too much. Let's lean in.
I hope that's helpful. Ask better questions.
Thank you so much for listening. I am going to ask you for a favor. Would you please leave us a review? It would help us so much, us meaning all the team at CBT School. We are working really hard to expand our reach to help more people, provide free content. So if you would be willing, I would love nothing more than for you to leave an honest review on Apple podcasts or wherever you listen. We are going to give away a free pair of Beats headphones once we hit a thousand reviews. So I'd love for you to be in the running for that. Thank you.
All right. I love you guys so much. I hope you're doing well. I'm thinking of you always. I'm so grateful I get to spend this time. Thank you. I know your time is valuable.
Have a wonderful day. It is a beautiful day to ask better questions and do hard things. Let's do it.
Have a wonderful day, everyone.
Welcome to Your Anxiety Toolkit. I'm your host, Kimberley Quinlan. This podcast is fueled by three main goals. The first goal is to provide you with some extra tools to help you manage your anxiety. Second goal, to inspire you. Anxiety doesn't get to decide how you live your life. And number three, and I leave the best for last, is to provide you with one big, fat virtual hug, because experiencing anxiety ain't easy. If that sounds good to you, let's go. Hello friends, you are going to love this episode. Holy smokes, I just recorded it, so you've got me fresh, and I'm so excited. I just had such an amazing conversation with Mike Heady. He is an LCPC and he treats OCD and anxiety disorders. We talked about shame and shame and shame and shame, and he brought so much wisdom. You guys are going to love this episode. It is packed full of all the good stuff. So, I'm not going to waste your time. I just want you to get straight there and listen to it. Before we get started, if you haven't left a review, please do so. I love getting reviews from you. When we get good reviews, it doesn't just stroke my ego. That's not the point. It is because the more reviews we get, the more people will come and listen to the podcast, which means then I get to help people with these incredible tools, these science-based tools. Hopefully, even just from today, if you're first time listening, welcome. We are talking about shame, and you are going to get so much from this. So if you are listening, please do leave a review. I would be so grateful. And enjoy the show. ----- Kimberley: Welcome. I am so excited to have with us today, Mike Heady. He is an LCPC. That's correct. Right? Michael: That is, yes. Kimberley: Yes. We're going to have a conversation that actually might be my favorite topic in the whole of the podcast. We're talking about shame. So, welcome. Michael: Thanks for having me. I share your passion for the conversation. Kimberley: Yes. Not that I love shame, but I like talking about shame. Michael: Yes. I agree. It's hard to say you love shame. It's like saying I love fear. Kimberley: Exactly. So, why are you interested in this topic? Michael: It's been a professional evolution for me, originally being trained to treat anxiety disorders and OCD. We talk a lot about fear and uncertainty and we have a ceremonial way of responding to shame. We're like, "Oh yeah, and there's a shame too." In the last couple of years, I've really done a deep dive into like, "Well, what is this?" Because a lot of clients are having a hard time getting better. I don't think it's the fear that's hard for them to get past sometimes. I don't think it's the uncertainty. I think it's the shame. I think it's a different animal. When I started doing a lot of digging, I realized there's a whole world of shame out there in the literature, and how it applies to OCD fascinated me. So, that's my new passion project. Kimberley: Yeah. Same. Exact same experience. Also seeing how much fear in and of itself is a generator of suffering. But as you said, there's this shame that's generating suffering at exponential levels. So, I'm so grateful to have this conversation with you. for those who are listening and who might not really understand shame, would you be interested in giving me your working definition of what shame is? Michael: Sure. Are you okay if I elaborate on it a little bit? Kimberley: Yeah. Go for it. Michael: Okay. I think a good definition is that shame is a really painful, aversive, unpleasant emotional experience. Fear or disgust, it's natural or instinctive for us to want to back away and get rid of shame. Shame is often brought on by some kind of real or perceived violation of a social norm that we actually believe in. So it's not this mystical emotional thing. It's a thing either real or perceived occurred. And then I experienced this negative, painful emotion of shame. That's the short version of the definition. I think it's worth talking about shame as having two levels of shame. We might call an adaptive kind of shame, the shame where we view it as a response to a specific episode, rather than some generalizable character flaw or full-on assault of our identity. I violated something I believed in, I feel bad, which is different than guilt because guilt is about apologizing to the other person for something you've done. But I might feel bad for violating a norm I believe in. Okay, there's nothing toxic about that. There's another level of shame that we tend to want to talk about more. It's the toxic shame. That's the shame that is unworkable. It's always unhelpful. It is a response to a perceived or real violation of a norm that has broad sweeping characteristics to it. It is a full-on assault on our identity. It is a condemnation of the self. That's the toxic shame. I can wrap up this as saying, what was incredibly helpful for me when I was going deep dive into what shame was is, yes, shame is an emotion. We know what emotions are. We all feel emotions. We've all felt shame. You and I, as therapists, spend our careers trying to help our clients have a different relationship towards painful emotions, and understanding what an emotion is, specifically around shame, I think was really enlightening for me. I derive a lot of this understanding from some work that occurred in the sixties and seventies, probably before then, but the work from the sixties and seventies is what brought it to my attention, that emotions are an emergent experience constructed by an interaction between our biology and our biography. The biography piece comes out of Silvan Tomkins work in the late sixties where he suggested that, yes, there's a universal kind of biological experience that contributes to an emotion. But the part that completes it is our own narrative, which is unique to us. My interaction with the world, as I develop from a child to an adult, the experiences I have, my environment, that's the secret ingredient to my shame. So what makes me feel shame isn't necessarily what makes you feel shame. For instance, if I were to, while talking to you, suddenly break out into a red flush on my face, start sweating, and my voice start cracking, I might experience that as an embarrassment, like a small shame. But if you perhaps had terrible social anxiety disorder and the same thing happened to you, the same exact event, you might see that as a humiliation. Both are derivative emotions of shame. But humiliation is different from embarrassment in orders of magnitude of pain. Humiliation is closer to trauma than it is to anxiety. This is anyway my long-winded way of saying, yes, shame is a complex animal, and that's the working definition I tend to have. Kimberley: Yeah. It's a different way of explaining it. This opportunity makes me so happy. What you're saying is, it's on a spectrum, would you say? Michael: Oh, absolutely. Yeah. Kimberley: Now, let's play that out. We're talking about the biology, and then there's the story we tell ourselves. Would you give an example for you? You and me, let's say we both got embarrassed. Let's say we both made a mistake or something. We embarrassed ourselves in front of each other, which is not going to happen here. But if we did, what might be a difference in the story we told each other which would indicate that higher level of shame or toxic shame? Michael: Sure. Let me clarify the story. It's not just how we appraise the shame itself. That's a part of it. But the story is like my upbringing. I was brought up in a blue-collar family. There wasn't a lot of room for emotions, especially for the male members of the family. So if I encountered a situation where I felt vulnerable or sensitive or hurt, the expression of that emotion could be shut down. That expression of that emotion could be punished, ridiculed. Not that I was ridiculed, but it could have been. Someone's narrative about a negative emotional experience could have been that and ongoing. They could have been bullied for being a sensitive kid, whereas you may not have. now you both may experience the same thing as a generic sense of shame. "I wasn't the way I wanted to be. I wanted to be put together and intelligent and I made a stupid GAF, and I came across looking silly." One kind of embarrassment for one is not necessarily the embarrassment for the other. That's what I mean when I say "the narrative." Kimberley: Yeah. Okay. This is wonderful. I think that maybe we want to take a look at, and I know I have a few questions. What I'd love to take a look at is, why would, let's say someone feel shame for having a mental illness? Michael: Well, yeah, that's a great question. I think there's a whole lot of reasons why someone might feel shame. One of them could be, I feel shame because the mental illness – we can say OCD in particular since this is one of the things I primarily treat – is that the content of my obsessions themselves could have a taboo theme or they could be otherwise conceived as bizarre. That's going to create a sense of "I shouldn't have this thought, there's something wrong with me I have this thought." The helping field, in general, commonly misinterprets and doesn't understand OCD. If you present this set of thoughts to them, you're going to get a sense of judgment and rejection or humiliation, and that's not made up fear. That's a real fear. That stuff happens to people. That's an example of how someone with a mental health issue can develop shame. It's because they may have gotten that feedback or fear rightfully so that they would get that feedback. Another way of looking at it is just, "I shouldn't have this because having this means I'm not working properly. I'm otherwise defective or broken." It's a silent problem for people – these emotional and psychological things. We have a lot more empathy and understanding for people with a physical problem than we do for someone who has a psychological or emotional problem. So, I think that there's this built-in-- Kimberley: Stigma. Michael: Yes. Stigma. Right. Thanks. Yeah, exactly. And then there's the people who've tried to get better. I've certainly seen a number of clients who've gone through years of therapy. They've worked diligently with great therapists, all very well-intentioned, and they failed to get better. "What's wrong with me? I must be really broken." I'm sure there's countless other ways, but I'll pass that off to you, I think. Kimberley: Yeah. I mean, I think these are all societal expectations that are placed on us. It's funny, you brought up the question about the concept around being humiliated for having an emotion. Somebody had written a question like: How can I be considered "the man of the house" if I have anxiety? I mean, there's so much shame in that question. There's so much societal expectations in that question and stigma in that question. I think it's definitely there, and I think you're right. For the things that are unknown, I see that to be more shame. I think everybody understands sadness. So we don't feel so much shame around it. But fear of harming your baby – let's not talk about that. You know what I mean? Let's push that down. Michael: Right. And not only because it's universally taboo. We know that instinctually. We don't need to really be told that. We know that, because that's our response if we were to hear that from someone else. Until we have that intrusive thought ourselves and they're like, "Oh, me too?" Shame, I think it's distinguishing shame from the other negative emotions that people have, because I don't think they're all the same. Oh, negative emotions or negative emotions – let's just learn how to handle them. Fear, that's a tough one. But shame? Shame is the most painful. Kimberley: It's ouch because it's in silence too, I think. My thing I say all the time is that shame thrives in secrecy. One of the best things you could do is to tell it out loud. Michael: I was having a conversation with colleagues about this a couple of weeks ago, and someone brought up a slogan that comes from AA, which is, "We're only as sick as our secrets." It's such a powerful message. The idea that speaking that secret allowed, speaking that shame aloud can be healing. Now it can also be traumatizing. We can probably get into that later in the episode. But I think that there's discernment about how and who we share with, and us as therapists creating a space where that's good and healthy for the person. But you're right. Absolutely. The things that thrive in darkness are painful. Kimberley: Okay, so you have a client and they have just very typical symptoms of OCD, even if it's very typical taboo, obsessions – this is for people listening – any disorder, depression, BFRB, eating disorders, how do you work with that shame with your patients? Michael: That's a fantastic question. I'm always evolving on how I figure that out with a particular client. I think if I were to try to distill that down to something helpful to the listeners, I think as a therapist, it would start with the very first interaction I had with the client. The first contact is the first opportunity, probably the best opportunity to provide a safe space that's understanding, validating, authentic so that the client can then experience this interpersonal interaction that they're having with this therapist as welcoming towards disclosure of a secret or their shame. I think that that first contact is vital. You can come across as the kind of person they want to talk to and try to set the stage and make that an effort, build that therapeutic alliance, continue to work on a therapeutic alliance because if you don't, it might be a lot harder to build the work to let them disclose that shame. And then from there, I think education about what shame is, like I brought up in the beginning, that shame can exist on this continuum, that there is actually an adaptive kind of shame. We don't tend to talk about it. We don't tend to see it because we talk about the toxic and the pathological shame, the one that keeps people stuck in hurt. Through that education, through a demystifying of it, I think, is incredibly valuable. I'll talk about the compass of shame in a minute. I don't want to steal all the time from you. It's like I talk a lot. Kimberley: Go for it. No, do. Michael: I've been thinking about this in preparation for our conversation today. I was thinking like, how would I want to set up an ideal way of dealing with shame with a client and again, creating that therapeutic space that they'd want to share that. And then if we have this experience that once we hand our secret or shame over to another person like, "Here you go," that's what the clients are doing to us, they're handing it to us. If we receive it and hold it with compassion and understanding, if we hold it with acceptance of them as a person, I think we introduced them to common humanity – one of the three things that show up with self-compassion, that common humanity – perhaps for the very first time in their life. Because this is such a secret, quiet problem, this might be the first time they've ever been met with common humanity and acceptance when they've revealed this. I think tha…
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