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

Welcome back, everybody. This is Part 2 of Your 2024 Mental Health Plan, and today we are going to talk about the specific tools that you need to supercharge your recovery. This podcast is called Your Anxiety Toolkit. Today, we are going to discuss all the tools that you are going to have in your tool belt to use and practice so that you can get to the recovery goals that you have. Let's go. For those of you who are here and you're ready to get your toolkit, what I encourage you to do first is go back to last week and listen to Part 1 of this two-part series, which is where we do a mental health recovery audit. We go through line by line and look at a bunch of questions that you can ask yourself, journal them down, and find specifically what areas of recovery you want to work on this year. Now, even if you're listening to this as a replay and it's many years later, that's fine. You can pick this up at any point. This episode and last week's episode actually came from me sitting down a few weeks ago and actually going, "Okay, Kimberley, you need to catch up and get some things under control here." You can do this at any time in a month from now or a year from now. We're here today to talk about tools, so let's get going. First, we looked at, when we did our audit, the general category. The general question was, how much distress are you under? How much time is it taking up, and how do you feel or what are your thoughts about that distress? That is a very important question. Let's just start there. That is an incredibly important question because how you respond to your distress is a huge indicator of how much you will suffer. If you have anxiety and your response is to treat it like it's important, try to get it to go away, and spend your time ruminating and wrestling, you're going to double, triple, quadruple your suffering. You're already suffering by having the anxiety, but we don't want to make it worse. If you're having intrusive thoughts and you respond to them as if they're important and need to be solved, again, we're going to add to our suffering. If you have grief, shame, or depression and you're responding to that by adding fuel to the fire, by adding negative thoughts, or by saying unkind things to yourself, you're going to feel worse. How do you respond? WILLINGNESS Tool #1 you're going to need in this category is willingness. When you identify that you're having an emotion, how willing are you to make space for that emotion? I'm not saying give it your attention; I'm saying, are you willing to just allow it to be there without wrestling it, trying to make it go away? Are you willing to normalize the emotion? Yeah, it makes complete sense that I'm having a hard time, or that all humans have these emotions. How willing can you be? Often, what I will ask my patients is, out of 10, if 10 being the highest, how willing are you? We're looking for eights, nines, and tens here. If you're at like a six, seven, that's okay. Let's see if we can get it up to the eights, nines, and tens. VALUES OVER FEAR Another tool (Tool #2) is respond with values, not fear or emotion. We want to work at being very clear on what our values are, what is important to us. Because if we don't, emotions will show up. They will feel very, very real. When they feel very, very real, you're likely to respond to them as if they're real. Again, adding fuel to the fire, adding to the suffering. Instead, we want to respond with values. If you have fear, you're going to ask yourself, do I want to respond based on what fear is telling me, or my values, my beliefs, the principles, the things that are important to me? If you're depressed, do you want to respond based on what depression is telling you to do? Like, "Give up, it's hopeless, there's no point." Or do you want to get back in touch with what matters to you? What would you do if depression wasn't here? What would you do if anxiety was not here? The third tool I'm going to give you, and this is a huge one—I'm going to break it down into different categories—is mindfulness. Now, if you've been here on Your Anxiety Toolkit, you already know that I think mindfulness is the most important tool, one of the most important tools you will have in your tool belt. You should be using it in your tool belt every day. It's like if you actually had a tool belt, it'd be like the hammer, the thing you probably use the most. Mindfulness involves four things, and this is the way I want you to think about it. MINDFULNESS Number one, it's awareness. Mindfulness is being present and aware of what is happening to you internally. Being able to identify, I feel sad, I feel anxious, I notice uncertainty, I'm noticing I'm having thoughts about A, B, and C. That awareness can help you stay in line with your values, but stay present enough to respond wisely. Mindfulness is also presence. I've already given you that word. It's being in the here and now. Fear always wants us to look into the future; mindfulnes

f you need a mental health plan for 2024, you are in the right place. This is a two-part series where we will do a full recovery audit. And then next week, we're going to take a look at the key tools that you need for Your Anxiety Toolkit. We call it an anxiety toolkit here, so that's exactly what you're here to get. The first step of this mental health plan for 2024 is to look at what is working and what isn't working and do an inventory of the things that you're doing, the safety behaviors, the behaviors you're engaging in, and all the actions that you're engaging in that are getting in the way of your recovery. Now what we want to do here is, once we identify them, we can break the cycle. And then we can actually start to have you act and respond in a very effective way so that you can get back to your life and start doing the things that you really, really wanted to do in 2023 but didn't get to. If you're listening to this in many years to come, same thing. Every year, we have an opportunity to do an audit—maybe even every month—to look at what's working and what's not. Let's do it. Now, one thing I want you to also know here is this is mostly an episode for myself. A couple of weeks ago, I was not coping well. I consider myself as someone who has all the skills and all the tools, and I know what to do, and I'm usually very, very skilled at doing it. However, I was noticing that I was engaging in some behaviors that were very ineffective, that had not the best outcomes, and were creating more suffering for myself. Doing what I do, being an anxiety specialist, and knowing what I know as a therapist, I sat down and I just wrote it all out. What am I engaging in? What's the problem? Where am I getting stuck? And from there, naturally, I did a mental health audit. And I thought, to be honest with you, you guys probably need such a thing as well, so let's do it together. Here is what I did. Let's get started with this mental health audit that we're going to do today. FOUR RECOVERY AUDIT CATEGORIES General Perspective Safety Behaviors Safety Mindset What we're going to do is we're going to break it down into four main categories. The first category is your general perspective of your mental health, your recovery, and your internal emotional experience. The second category is the safety behaviors you're engaging in. A safety behavior is a behavior that you do to reduce or remove your discomfort, to get a sense of safety, or to get a sense of control. Sometimes they're effective, sometimes they're not, and we're going to go through that today. The third category is actually just safety—looking at how safe you are inside your body with your internal experience. And I'll explain a lot more of that here in a little bit, so let's just move on to section number four, which is mindset. What is your mindset about recovery? And we're going to go through this together. LET'S PROMISE TO DO THIS KINDLY As we move forward, I want you to promise me and vow to me as we do this. We are only doing it through the lens of being curious and non-judgmental. This audit should not be a disciplinary action where you wrap yourself over the knuckles and you beat yourself up, and you just criticize yourself for the fact that you're not coping well. That is not what we're doing here. WE ARE JUST GATHERING DATA We are ultimately just taking data. We're just looking at the data of what's working and what's not. And then we get to decide what we do differently. And we get to be honest with ourselves about what's actually happening from a place of compassion, from a place of understanding, knowing that we're doing the best we can with what we've got. Again, I could beat myself up and be like, "You're a therapist. You do this for a living. What is wrong with you?" But instead, I just recognize. Of course, you fell off the wagon. Things don't always work out perfectly when you're under a high amount of stress or when it's the holidays, when things feel out of your control. We naturally gravitate to safety behaviors that often aren't the most effective. That's just the facts. BE NON-JUDGMENTAL Let's do this from a non-judgmental standpoint. We are literally just gathering data. How we handle this is a big part of recovery. Okay? Let's do it. YOUR RECOVERY AUDIT Let's first look at the first section of your recovery audit. This is a general category. We're going to ask some questions. You can get a pen and notepad, or you could just listen and think about this, pause it, take some stock of what's been going on for you. But I do strongly encourage you to pause, sit down, write your answers on a piece of paper, on a Google Doc, or whatever you love to do. All right, here we go. GENERAL Number one, generally, how much of the day do you experience anxiety, hopelessness, or some kind of emotional distress, whatever it is that you experience? You could give a percentage, a grade, or an amount of hours. How much of the day do you experience emotions th

Kimberley: Could I have PTSD or trauma? This is a question that came up a lot following a recent episode we had with Caitlin Pinciotti, and I'm so happy to have her back to talk about it deeper. Let's go deeper into PTSD, trauma, what it means, who has it, and why we develop it. I'm so happy to have you here, Caitlin. Caitlin: Yes, thank you for having me back. INTRODUCING CAITLIN PINCIOTTI Kimberley: Can you tell us a little bit about you and all the amazing things you do? Caitlin: Of course. I'm an assistant professor in the Psychiatry and Behavioral Sciences Department at Baylor College of Medicine. I also serve as the co-chair for the IOCDF Trauma and PTSD in OCD Special Interest Group. Generally speaking, a lot of my research and clinical work has specifically focused on OCD, PTSD, and trauma, in particular when those things intersect, what that can look like, and how that can impact treatment. I'm happy to be here to talk more specifically about PTSD. WHAT IS PTST VS TRAUMA? Kimberley: Absolutely. What is PTSD? If you want to give us an understanding of what that means, and then also, would you share the contrast of—now you hear more in social media—what PTSD is versus trauma? Caitlin: Yeah, that's a great question. A lot of people use these words interchangeably in casual conversation, but they are actually referring to two different things. Trauma refers to the experience that someone has that can potentially lead to the development of a disorder called post-traumatic stress disorder. When we talk about these and the definitions we use, trauma can be sort of a controversial word, that depending on who you ask, they might use a different definition. It might be a little bit more liberal or more conservative. I'll just share with you the definition that we use clinically according to the DSM. Trauma would be any sort of experience that involves threatened or actual death, serious injury, or sexual violence, and there are a number of ways that people can experience it. We oftentimes think of directly experiencing trauma. Maybe I was the one who was in the car accident. But there are other ways that people can experience trauma that can have profound effects on them as well, such as witnessing the experience happening to someone else, learning that it happened to a really close loved one, or being exposed to the details of trauma through one's work, such as being a therapist, being a 911 telecommunicator, or anyone who works on the front lines. That's what we mean diagnostically when we talk about trauma. It's an event that fits that criteria. It can include motor vehicle accidents, serious injuries, sexual violence, physical violence, natural disasters, explosions, war, so on and so forth—anytime when the person feels as though their bodily integrity or safety is at risk or harmed in some way. Conversely, PTSD is a mental health condition. That's just one way that people might respond to experiencing trauma. In order to be diagnosed with trauma, the very first criterion is that you have to have experienced trauma. If a person hasn't experienced an event like what I described, then we would look into some other potential diagnoses that might explain what's going on for them, because there are lots of different ways that people can be impacted by trauma beyond just PTSD. PTSD SYMPTOMS AND PTSD DIAGNOSIS Kimberley: Right. What are some of the specific criteria for being diagnosed with PTSD? Caitlin: PTSD is comprised of 20 potential PTSD symptoms, which sounds like a lot, and it is. It can look really different from one person to the next. We break these symptoms down into different clusters to help us understand them a little bit better. There are four overarching clusters of PTSD symptoms. There's re-experiencing, which is the different ways that we might re-experience the trauma in the present moment, such as through really intrusive and vivid memories, flashbacks, nightmares, or feeling really emotionally upset by reminders of the trauma. The second cluster is avoidance. This includes both what we would call internal avoidance and external avoidance. Internal avoidance would be avoiding thinking about the trauma, but also avoiding any of the emotions that might remind someone of the trauma. If I felt extremely powerless at the time of my trauma, then I might go to extreme lengths to avoid ever feeling powerless again in my life. In terms of external avoidance, that's avoiding any cue in our environment that might remind us of the trauma. It could be people, places, different situations, smells, or anything involving the senses. That's avoidance. The third cluster of PTSD symptoms is called negative alterations, cognitions, and mood, which is such a mouthful, but it's basically a long way of saying that after we experience trauma, it's not uncommon for that experience to impact our mood and how we think about ourselves or other people in the world. You'll see some symptoms that can actually feel a litt

Radical acceptance when things get hard can be a very difficult practice. In fact, it can be almost impossible. When things get hard, one of the things we often do is we spend a lot of time ruminating about why it's so hard and what we could have done to prevent it from being so hard. And, instead of using radical acceptance, we often go into beating ourselves up, telling ourselves, "We should have done this; we could have done that. If only we had looked at it this way or treated it this way." I want us to really zoom in on these safety behaviors that you're probably doing. Hopefully, today, you leave here committing to reducing or eliminating those behaviors. Now, I get it. When things are hard, we don't want to feel the suffering that goes with it. I get it. I don't want to feel it either. You're not alone. But when things are hard, often, instead of letting it be hard and feeling our feelings and being kind to ourselves so that we can move into effective behaviors, we get stuck resisting the emotions and doing these other behaviors that increase the shrapnel of the event. I call it 'shrapnel' because it does look like that. It creates more damage around us. Let's look at how we might prevent this. HUMANS SUFFER You're suffering. The reason I know this is because you're a human being, and all human beings have sufferings in their lives. Some of us, more than others. If you're in a season where the suffering is high, I would basically say, the higher the level of suffering, the more you need to listen in. Maybe listen to this multiple times, get your notepad out, and let's really go to work. SOLVING DOESN'T ALWAYS WORK When you're suffering and your suffering is high, again, it's very normal to want to solve why you're suffering, thinking that yes, that may prevent it from happening in the future, prevent us from having more pain, or prevent us from having to feel our feelings. That's effective behavior, except... if you're relying on that and you're spending too much time doing that, chances are, you're increasing your shrapnel. If that's the case, let's talk about other alternatives. When we're going through difficult things, there is a strong pull toward figuring out why. But my guess is, if you haven't solved it yet, chances are you won't. I know this is true for me. It might be true for you, but you've probably already identified the problem of one of the things that may be if, in 20/20 hindsight, you could have done differently. And that's okay, right? There's many times I've looked back and been like, "Yeah, it didn't handle that well," or "That didn't go as well. Maybe now, knowing what I know, I could have done something different." But often, we spend too much time resisting the fact that it is hard right now. If you're someone who's spending a lot of time going over and over on repetition, all the things you could have done, chances are, you're not radically accepting what is. What we want to do first is move to radical acceptance as fast as we can. We're not saying that you can't go back and do some effective addressing of what went wrong and what went right. You can do that for short periods of time. But if you're someone who's doing it repetitively, catch yourself. We want to move into radical acceptance that yes, things are hard right now. WHY DOES RADICAL ACCEPTANCE SUCK? Often, we resist practicing radical acceptance because of one core reason, and that's because we don't want to feel bad. We don't want to feel the guilt. We don't want to feel shame. We don't want to feel the uncertainty. We don't want to feel sad. We don't want to feel angry, grief, or panic, whatever it might be. It might be physical pain. We don't want to feel it. And so hand in hand goes this work of radically accepting the suffering that you're experiencing in whatever form, whether it be emotional, physical, spiritual, or other, and then really being willing and creating a safe place to feel those feelings. I'm not saying ruminate on those feelings, make them worse, or agree with everything you're thinking and feeling. No. I'm just saying, being able to observe that yes, sadness is here, or grief is here, or anxiety is here. It's showing up in these ways in my chest, in my head, in my shoulders, in my neck, in my hips, in my tummy, wherever it's showing up for you. First radically accepting it and then being willing to feel those experiences and those sensations. We alternate between those two. We radically accept, then be willing and open. Then we have to go back and radically accept, be willing, and be open. RADICAL ACCEPTANCE IS REPETITIVE I want to remind you that it's okay that you have to do this on repeat. Often, with my patients—and I do this too, I have to admit—we practice radical acceptance, we practice self-compassion, we practice willingness for a little while, and then we get frustrated because it's not making it go away. It's not fixing it. It's not making it disappear. So we go back to trying to solv

Kimberley: Is ERP traumatizing? This is a question I have been seeing on social media or coming up in different groups in the OCD and OCD-related disorders field. Today, I have Amy Mariaskin, PhD, here to talk with us about this idea of "Is ERP traumatizing" and how we might work with this very delicate but yet so important topic. Thank you, Amy, for being here. WHY MIGHT PEOPLE THINK ERP IS TRAUMATIC? Kimberley: Let's just go straight to it. Why might people be saying that ERP is traumatic or traumatizing? In any of those kinds of terms, why do you think people might be saying this? Amy: I think there's a number of reasons. One of which is that a therapy like ERP, which necessitates that people work through discomfort by moving through it and not moving around it or sidestepping it, is different than a lot of other therapies which are based more on support, validation, et cetera, as the sole method. It's not to say that ERP doesn't have that. I think all good therapy has support and validation. However, I think that's part of it. The fact that's baked into the treatment, you're looking at facing discomfort and really changing your relationship with discomfort. I think when people hear about that, that's one reason that it comes up. And then another reason, I think, is that there are people who have had really negative experiences with ERP. I think that while that could be true in a number of different therapeutic modalities and with a number of different clinicians and so forth, it is something that has gained traction because it dovetails with this idea of, well, if people are being asked to do difficult things, then isn't that actually going to deepen their pain or worsen their condition rather than alleviate it? That's my take. Kimberley: When I first heard this idea or this experience, my first response was actual shock because, as an ERP therapist and someone who treats OCD, I have seen it be the biggest gift to so many people. I've heard even Chris Trondsen, who often will say that this gave him his life back, or—he's been on the show—Ethan Smith, or anyone really who's been on the show talk about how it's the most, in their opinion, like the most effective way to get your life back and get back to life and live your life and face fear and all of those things. DO PEOPLE FEEL ERP IS A DIFFICULT TREATMENT? I had that first feeling of surprise and shock, but also then asked more questions and asked about their experience of ERP being very pressured or feeling too scared or too soon, too much too soon, and so forth. Do you have any other ideas as to why people might be experiencing this difficult treatment? Amy: I do. I think that sometimes, like any other therapy, if you're approaching therapy as a technician and not as a clinician, and you're not as a therapist really being aware of the cues that you're getting from the very brave people sitting in front of you, entrusting their care to you—if we're not being clinicians rather than technicians, we can sometimes just follow a protocol indiscriminately and without respect to really important interpersonal dynamics like consent and context, personal history, if there's not an awareness of the power dynamic in the room that a therapist has a lot of power. We work with a lot of people as well who might have people pleasing that if you're going to be quite prescriptive about a certain treatment, you do this, and then you do this, and then you do this without taking care to either lay the foundation to really help somebody understand the science of how ERP works or get buy-in from the front end. I know we'll talk a little bit more about that, as well as there's a difference between exposure and flooding. There's a difference between exposure that serves to reconnect people with the parts of their lives that they've been missing, or, as I always call it, reclaims. We want to have exposures that are reclaims, as opposed to just having exposures that generate negative emotion in and of itself. Now, sometimes there are exposures that just generate negative emotions, because sometimes that's the thing to practice. There are some people who feel quite empowered by these over-the-top exposures that are above and beyond what you would do to really have a reclaim. I'm going to go above and beyond for an exposure, and I'm going to do something that is off the wall. I am eating the thing off of the toilet, or I have intrusive thoughts about harming myself, and I'm going to go to the top of the parking garage, and I'm really going to lean all the way over. Would I do that in my everyday life? No. There are some clients for whom that is not something that they're willing to do or it's not something that's important for them to do to reconnect with the life that they want to live, and there are others who are quite empowered. If you're a therapist and you don't take care to listen to the feedback from clients and let their voice be a part of that conversation, then you may

Kimberley: Welcome back, Ethan Smith. I love you. Tell me how you are. First, tell me who you are. For those who haven't heard of your brilliance, tell us who you are. Ethan: I love you. My name is Ethan Smith, and I'm a national advocate for the International OCD Foundation and just an all-around warrior for OCD, letting people know that there's help and there's hope. That's what I've dedicated my life to doing. Kimberley: You have done a very good job. I'm very, very impressed. Ethan: I appreciate that. It's a work in progress. Kimberley: Well, that's the whole point of today, right? It is a work in progress. For those of you who don't know, we have several episodes with Ethan. This is a part two, almost part three, episode, just catching up on where you're at. The last time we spoke, you were sharing about the journey of self-compassion that you're on and your recovery in many areas. Do you want to briefly catch us up on where you're at and what it's been like since we met last? Ethan: Yeah, for sure. We'll do a quick recap, like the first three minutes of a TV show where they're like, "So, you're here, and what happened before?" Kimberley: Previously on. Ethan: Yeah, previously, on real Ethans of Coweta County, which sounds super country and rural. The last time we spoke, I was actually really vulnerable. I don't mean that as touting myself, but I said for the first time publicly about a diagnosis of bipolar. At that time, when we spoke, I had really hit a low—a new low that came from a very hypomanic episode, and it was not related to OCD. I found myself in a really icky spot. Part of the reason for coming or reaching that bottom was when I got better from OCD into recovery and maintenance, navigating life for the first time, really for the first time as an adult man in Los Angeles, which isn't an easy city, navigating the industry, which isn't the nicest place, and having been born with OCD and really that comprising the majority of my life. The next 10 years were really about me growing and learning how to live. But I don't know that I knew that at the time. I really thought it was about, okay, now we're going to succeed, and I'm going to make money, live all my dreams, meet my partner, and stuff's going to happen because OCD is not in the way. That isn't to say that that can't happen, and that wasn't necessary. I had some amazing life experiences. It wasn't like I had a horrible nine years. There were some wonderful things. But one of the things that I learned coming to this diagnosis and this conclusion was how hard I was being on myself by not "achieving" all the goals and the dreams that I set out to do for myself. It was the first time in a long time, really in my entire life, that I saw myself as a failure and that I didn't have a mental illness to blame for that failure. I looked at the past nine years, and I went, "Okay, I worked so hard to get here, and I didn't do it. I worked so hard to get here in a personal relationship, and I didn't get there. I worked so hard to get here financially, and I didn't even come close." In the past, I could always say, "Oh, OCD anxiety." I couldn't do it. I couldn't finish it. I dropped out. That was always in the way. It was the first time I went, "Oh wow, okay, this is on Ethan. This is on me. I must not be creative enough, smart enough, good enough, strong enough, or brave enough." That line of thinking really sent me down a really dark rabbit hole into a really tough state of depression and hypomania and just engaging in unhealthy activities and things like that until I just came crashing down. When we connected, I think I had just moved from Los Angeles to Atlanta and was resetting in a way. At that time, it very much felt like I was taking a step back. I had left Los Angeles. It just wasn't a healthy place for me at that time. My living situation was difficult because of my upstairs neighbor, and it was just very complicated. So, I ended up moving back to Georgia for work, and I ended up moving back in with my parents. I don't remember if we talked about that or not, but it was a good opportunity to reset. At that time, it very much looked and felt like I was going backwards. I just lived for 10 years on my own in Los Angeles, pursuing my dreams and goals. I was living at home when I was sick. What does this mean? I'm not ready to move. I'm not ready to leave. I haven't given up on my dream. What am I doing? I think if we skip the next three years from 2019 on, in retrospect, it wasn't taking a step back; it was taking a step forward. It was just choosing a different path that I didn't realize because that decision led to some of the healthiest, most profound experiences in my life that I'm currently living. I can look back at that moment and see, "Oh, I failed. I've given up." This is backwards. In reality, it was such a beautiful stepping stone, and I was willing to step back to move forward, to remove myself from a situation, and then reinsert mysel

Today, we are going to talk about what to do when feeling hopeless. Today's episode was actually inspired by one of our amazing Your Anxiety Toolkit podcast listeners. They wrote in and asked a question about hopelessness, and I thought it was so important and so relevant in today's day, with the news being scary and everybody struggling and still readjusting to COVID, mental health, and mental illnesses at an all-time high. I really felt that this was important for us to talk about. So, let's do this together. We're going to take it step by step, and we're going to do it with a whole lot of self-compassion. So let's talk about what to do when feeling hopeless. Alright folks, here is the question that was posed to me. It goes like this: "I have been really struggling with hopelessness lately. It feels like my life has no real meaning, and I feel pretty aimless. The things in my life that I want to improve need so much work to improve, such as career, relationship, family stuff. And I have large parts that are out of my control, which feels pretty discouraging despite lots of effort to improve them. I'm working to accept these feelings and trying to stay out of rumination, but it does feel hopeless a lot of the time. What are you telling folks who are in a similar position?" Now, number one, I so resonate with this question. As a clinician, a human, a mom, and someone with a chronic illness, I hear you in this question, and I don't think you're alone. In fact, I am a member of a pretty large online group of therapists, and I wanted to do my homework for today. So I left the question, saying, when you have clients who are experiencing hopelessness and they're feeling stuck, what do you say? A lot of them were coming with these such humble responses of saying, "To be honest, I tell them the truth, which is I don't know the answer. I too struggle with this." Or they'll say, "I often let them know that they're not alone in this and that this is such something that collectively we're all going through." And I loved that they were so real and dropped into reality on the truth of this, the pain of this, and the confusion of this topic. Now, in addition to that, there were also some amazing pieces of advice, and some of them I really agreed with. I'm going to include them here when we go through specifically some tools that you can use to help you when you're struggling with this feeling of hopelessness or feeling like what's the point and feeling like there's no meaning to life. Let's talk about it. Number one—let me just be real with you—is I too have struggled with this. In fact, it wasn't that long ago that I actually sought out therapy for this specific issue. I looked around my life, and I have these two beautiful children, I have two businesses and a career that I love, and I still felt hopeless. I still felt like this sense of what's the point? What's the meaning of all this? I'm working my butt off, trying to manage all the things. What is the real point? It felt a little like an existential crisis, to be honest. I love that this person reached out to ask this question. I do encourage you all, if you're struggling with this and navigating this, do go and seek therapy. I'm going to be giving you some tools on how to manage this today, but in no way do I think that my solutions are going to be exactly what you need to hear. There may be some of them that are super helpful for you, but I strongly encourage you to go and navigate them on your own. Through exploring this, I found that there were some unmet needs that I was not paying attention to. I found that I was grieving living in a country that's not my home country. So many parts of it were also related to my chronic illness. And so it was very personal work, and I encourage you too to do that personal work. But, given that we're here today, I also want to give you some strategies, skills, and direction if you too are wondering what to do when feeling hopeless. Let's do this together. THERAPY FOR HOPELESSNESS The first thing here is I love that the person who wrote this said, "I'm working at accepting the feelings." I think that that is probably the biggest key here, which is not accepting that they'll be there forever but instead accepting that they're here right now and reminding yourself that they're temporary. HOPELESSNESS IS A TEMPORARY EMOTION Hopelessness, like any other emotion, is a temporary emotion. It will rise and fall, rise and fall, and rise and fall. It doesn't mean that you'll always feel this way. What we can do is, while we're accepting it, I often ask my patients, "As you accept it, let's also be very curious about any resistance you have in your body as you practice accepting." I've had clients who've sat on the couch of my office and said, "No, no, I'm accepting it." But every part of their body is clenched up. Every part of their face is resistant. They're obviously accepting that it is here, but also trying to push against it, also

Kimberley: Welcome, everybody. This is a very exciting episode. I know I'm going to learn so much. Today, we have Caitlin Pinciotti and Shala Nicely, and we're talking about when OCD and PTSD collide and intertwine and how that plays out. This is actually a topic I think we need to talk about more. Welcome, Caitlin, and welcome, Shala. Caitlin: Thank you. Shala: Thanks. Kimberley: Okay. Let's first do a little introduction. Caitlin, would you like to go first introducing yourself? Caitlin: Sure thing. I'm Caitlin Pinciotti. I'm a licensed clinical psychologist and an assistant professor in the Department of Psychiatry and Behavioral Sciences at Baylor College of Medicine. I also serve as a co-chair for the IOCDF Trauma and PTSD and OCD SIG. If people are interested in that special interest group as well, that's something that's available and up and running now. Most of my research specifically focuses on OCD, trauma, and PTSD, and particularly the overlap of these things. That's been sort of my focus for the last several years. I'm excited to be here and talk more about this topic. Kimberley: Thank you. You're doing amazing work. I've loved being a part of just watching all of this great research that you're doing. Shala, would you like to introduce yourself? Shala: Yes. I'm Shala Nicely. I am a licensed professional counselor, and I specialize in the treatment of OCD and related disorders. I am the author of Is Fred in the Refrigerator?: Taming OCD and Reclaiming My Life, which is my story, and then co-author with Jon Hershfield of Everyday Mindfulness for OCD: Tips, Tricks, and Skills for Living Joyfully. I also produce the Shoulders Back! newsletter. It has tips and resources for taming OCD. Kimberley: Shoulders Back! was actually the inspiration for this episode. Shala, you recently wrote an article about post-traumatic OCD or how PTSD and OCD collide. Can you tell us about your story, particularly going back to, I think you mentioned, May 2020, and what brought you to write that article? Shala: Sure, and thank you very much for having Caitlin and me on today because I really appreciate the opportunity to talk about this and to get more information out in the world about this intertwined combination of PTSD and OCD. In May of 2020, I moved to a new house, the house that I'm in now. Of course, we had just started the pandemic, and so everybody was working at home, including me. The house that I moved into was in a brand new neighborhood. While the houses on this side of me were completed, the houses behind me and on that side were not completed. I didn't think anything of that when I moved in. But what I moved into was a situation where I was in a construction zone all the time. I was working at home, so there was no escape from it. One day I was walking behind my house, where most of the houses were in the process of being built and there were no sidewalks. As I was walking down the street, I saw, down at the end of the street, a big forklift come down the street where I was walking with my two little dogs backwards at a really high rate of speed, and the forklift driver seemed to be looking that way, and he was going that way. It happened so fast because he was going so quickly that all of a sudden I realized he was going to hit us, my dogs and me, and there was no place for us to go because we were on the road because there was nowhere else for us to be. I screamed bloody murder, and he heard me. I mean, that's how loud I screamed, and he stopped. That was not all that pleasant. I was upset. He was not happy. But we moved on. But my brain didn't move on. After that incident, what I noticed was I was becoming really hypervigilant in my own house and finding the construction equipment. If I go outside, I tense up just knowing that construction equipment is there. Over time, my sleep started becoming disturbed. I started to have flashbacks and what I call flash-forwards, where I would think about all these horrible things that could happen to me that hadn't happened to me yet but could. I'd get lost in these violent fantasies of what might happen and what I need to do to prevent that. I realized that I seemed to be developing symptoms of PTSD. This is where being a therapist was actually quite helpful because I pulled the DSM open one night and I started going through symptoms of PTSD. I'm like, "Oh my gosh, I think I have PTSD." I think what happened, because having a forklift driver almost hit you, doesn't seem like that could possibly cause PTSD. But if you look at my history, I think that created a link in my brain to an accident I was in when I was four where I did almost die, which is when my mom and I were standing on the side of a road, about to cross. We were going to go between two parked cars. My mom and I stepped between two parked cars, and there was a man driving down the road who was legally blind, and he mistook the line of parked cars where we were standing as moving traffic. He plowed i

When things get hard, it's really quite difficult to find a reason to keep going. Today, we have an incredible guest, Shaun Flores, talking about what keeps us going. This was a complete impromptu conversation. We had come on to record a podcast on a completely different topic. However, quickly after getting chatting, it became so apparent that this was the conversation we both desperately wanted to have. And so, we jumped in and talked about what it's like in the moments when things are really difficult, when we're feeling like giving up, we are hopeless, we're not sure what the next step is. We wanted to talk about what does keep us going. This is, again, a conversation that was very raw. We both talked about our own struggles with finding meaning, moving forward, and struggling with what keeps us going. I hope you find it as beautiful a conversation as I did. My heart was full for days after recording this, and I'm so honored that Sean came on and was so vulnerable and talked so beautifully about the process of finding a point and finding a reason to keep going. I hope you enjoy it just as much as I did. Shaun: Thank you so much for being able to have this conversation. Kimberley: Can you tell us just a little background on you and what your personal, just general mental health journey has looked like? Shaun: Yeah. My own journey of mental health has been a tumultuous one, to say the very least. For around five to six years ago, I would say I was living with really bad health anxiety to the point where I obsessed. I constantly had an STI or an STD. I'd go to the clinic backward and forward, get tested to make sure I didn't have anything. But the results never proved to be in any way, shape, or form sufficient enough for me to be like, "Okay, cool. I don't have anything." I kept going back and forward. How I knew that became the worst possible thing. I paid 300 pounds for the same-day test results. Just to give people's perspective, 300 pounds is a lot. That's when I was like, "There's something wrong. I just don't know what it is." But in some ways, I thought I was being a diligent citizen in society, doing what I needed to do to make sure I take care of myself and to practice what was safe sex. But then that fear migrated onto this sudden overnight change where I woke up and I thought, "What if I was gay?" overnight. I just quite literally woke up. I had a dream of a white guy in boxes, and I woke up with the most irrational thought that I had suddenly become gay. I felt my identity had come collapsing. I felt everything in my world had shaken overnight. I threw up in the toilet that morning, and at that time I was in the modeling industry. Looking back now, I was going through disordered eating, and I'm very careful with using the word "eating disorder." That's why I call it "disordered eating." I was never formally diagnosed, but I used to starve myself. I took diuretics to maintain a certain cheekbone structure. Because in the industry that I was in, I was comparing myself to a lot of the young men that were there, believing that I needed to look a certain kind of way. When I look back at my photos now, I was very gaunt-looking. I was being positively affirmed by all the people around me. I hated how round my face was. If I woke up in the morning and my face was round, I would drink about four liters of water with cleavers tincture. I took dandelion extracts. Those are some of the things that I took to drain my lymphatic system. I went on this quest for a model face. And then eventually, I left the industry because it just wasn't healthy for me in any way, shape, or form. I was still living with this fear that I was gay. If I went to the sauna and steam room in the gym, I would just obsess 24/7 that if I could notice the guy's got a good-looking body, or if he's good-looking, this meant I'm gay. It was just constant, 24/7. From the minute I slept to the minute I woke up, it was always there. Then that fear moved on to sexual assault. I had a really big panic attack where I was terrified. I asked one of my friends, "Are you sure I haven't done anything? Are you sure I haven't done anything?" I kept asking her over and over. I screamed at her to leave because I was so scared. I must've been hearing voices, and I was terrified that I could potentially hurt her. I tried to go to sleep that night, and there were suicide images in my head, blood, and I was like, "There's something up." I just didn't know what was going on. I had no scooby, nothing. That night, I went to the hospital, and the mental health team said that they probably would suggest I get therapy. I said, "It's cool. I'll go and find my own therapist." I started therapy, and the therapy made me a hundred times worse. I was doing talk therapy. We were trying to get to the root of all my thoughts. We were trying to figure out my childhood. Don't get me wrong, there's relevance to that. By that time, it was not what I needed. And then last year

If you want to know how to be uncomfortable without making it worse, you're in the right place. Today, we're talking all about being uncomfortable and learning how to be uncomfortable in the most skillful, compassionate, respectful, and effective way. This applies to any type of discomfort, whether it be your thoughts, your feelings, any physical sensations, or the pain that you're feeling. Anything that you're experiencing as discomfort, we're here to talk about it today. Let's do it. Welcome back, everybody. For those of you who are new, welcome. My name is Kimberley Quinlan. I'm a marriage and family therapist in the state of California. I'm an anxiety specialist, and I love to talk about being uncomfortable. It's true, I don't like being uncomfortable, but I love to talk about being uncomfortable, and I love talking about skillful ways to manage that. WHAT IS DISCOMFORT, REALLY? Now, before we get started, let's first talk about what we mean by being uncomfortable. There are different forms of discomfort. One may be feelings or emotions that you're having—shame, guilt, anxiety, sadness, anger. Whatever it is that you experience as a feeling can be interpreted and experienced as uncomfortable. Another one is sensations. Physical sensations of anxiety, physical sensations of shame, and physical sensations of physical pain. I myself have a chronic illness. Physical sensations can be a great deal of discomfort for us as human beings. We're also talking about that as well. We're also talking about intrusive thoughts, because thoughts can be uncomfortable too. We can have some pretty horrific, scary, mean, and demanding thoughts, and these thoughts can create a lot of discomfort within us. What we want to do here is we want to first acknowledge that discomfort is a normal, natural part of life. It truly is. I know on social media, and I know in life, on TV, and in movies, it's painted that there are a certain amount of things you can do, and if you were to attain those, well, then you would have a lot less discomfort. But as someone who is a therapist who has treated the widest range of people, I've learned that even when they reach fame, a lot of money, or a degree of success, we can see that they have some improved wellness. They do have some decrease in discomfort, but over time, they're still going to have uncomfortable thoughts. Sometimes having those things creates more uncomfortable thoughts. They're still going to have physical pain, and they're still going to have emotions that cause them pain, particularly when they're not skillful. What I've really learned as a human being as well is we can have a list of all the things that we think we need in these circumstances to be happy. But if our thoughts and our feelings and our reactions to them aren't skillful, compassionate, wise, and respectful, we often create more suffering, and we're right back where we started. Now, I don't want it to be all doom and gloom, because the truth is, I'm bringing you some solutions here today—things that you can apply right away and put into practice, hopefully, as soon as you've listened to this podcast. Let's get to it. WHAT MAKES DISCOMFORT WORSE? First, I'm wondering whether we can first discuss what it means to make it worse because a lot of you go, "What? Make it worse? Are you telling me I'm to blame?" And that's not what I'm doing here. But I do think that we can do some kind of inquiry, nonjudgmental inquiry into how we respond to our suffering. LIFE IS 50/50 Think of it this way: I am a huge proponent of some Buddhist philosophy here, which is that suffering is a part of life. Discomfort is a part of life. I believe that life is 50/50. There is 50% wonderful, but you're still going to have 50% hard. Sometimes that percentage will be different, but I think it creates a lot of acceptance when we can come to the fact that there's going to be good seasons, but there's also going to be some really hard seasons in our lives. It doesn't have to be that it's 50/50 all the time. Sometimes you might be in a really wonderful season. Maybe you're in a really tough season right now. I'm guessing that's the case because you're listening to this episode. I recently went through a really tough season, which inspired me to make this episode for you. But in life, there is suffering. But what we know about that is how we respond to that suffering can actually determine whether we create more and more suffering. WE RESIST IT One way that we make it worse is, when we are experiencing discomfort, we resist it. We try to get rid of it. We clench up around it. We try to push it away. What often happens there is, what you resist persists. That's a common saying we use in psychotherapy. Another thing to consider here is, the more you try to push it down, the more it's going to bubble up anyway, but in ways that make you feel completely out of control, completely lost in this experience, and maybe overwhelmed with this experience. Anoth

In today's episode of Your Anxiety Toolkit podcast, you will learn how to meditate to reduce anxiety. You'll also learn which meditation is best for anxiety and how to find a meditation practice that suits your lifestyle and your recovery needs. With the pressure of today's society and the news being so scary, people are rapidly turning to meditation as a powerful tool to calm their minds and ease their anxiety. My name is Kimberley Quinlan. I am a licensed therapist and anxiety specialist, and my hope today is to teach you how you can use meditation to help manage and reduce your anxiety. What Is Meditation? Now, what is meditation? Meditation is a training in awareness, and the goal is to help you get a healthy awareness and understanding of what is going on in your mind. So often, our minds are like a puppy. They are just going all over the place, jumping, skipping, yelling, screaming, and going in all different directions. If we aren't skilled, and if we aren't intentional with that, we can be off with that, off down the track in negative thinking, scary thinking, and depressive thinking. The Benefits Of Meditation For Anxiety Relief There are many benefits of meditation for anxiety relief. Meditation helps train your brain. Now, there are so many benefits to meditation for anxiety relief, and I want to share with you some of those benefits. The first one is, it rewires your brain. It reduces the activity in the amygdala, which is the part of the brain that is responsible for the fear response. Meditation can also lower stress hormones such as cortisol. It can increase the production of those feel-good neurotransmitters like serotonin and dopamine. This is really important, particularly if you struggle with depression. It can also shift the brain chemistry and lead to improved mood, reduced anxiety, and an overall sense of well-being. We could also argue that this would be helpful for anybody, even if they don't have anxiety. We also know that meditation cultivates mindfulness, which we talk a lot about here on Your Anxiety Toolkit, which is the practice of being fully present and nonjudgmental in the moment. Meditation increases self-compassion and acceptance, which I think we all agree can help us with our mental health, and it helps reduce negative thinking patterns and also reduces self-criticism. Common Problems People Have With Meditation Now, there are a couple of problems here, though, with meditation. Often, when people come to me, they'll say, "I don't know about this whole meditation thing. It sounds a bit like a cult or a bit like a scam or a fad, a psychology fad." Often, that's because people have a misled idea about what meditation is and how it works. One of the main problems that I hear is that people expect that meditation will, poof, make their anxiety go right away. As they're practicing meditation—and it is a meditation practice—as they're starting to practice this meditation, they're getting frustrated because they're thinking, "This isn't working. It's not making my anxiety go away." We want to first challenge the idea that meditation is not a quick fix. It's not something that's going to, poof, make your anxiety go away, but there are so many benefits that I will talk to you about here in just a second. Another problem that people have with meditation is they get frustrated with the practice. They have these expectations that they should be able to do it. Well, simply because it's often sitting or very stationary, they assume, "I must be really good at this. It's such a basic task." But the truth is, it's not. We have to remove those expectations that we will be excellent at it, that it should be easy, or that discomfort won't arise. Another problem people have is that they do experience anxiety while they're meditating, and they'll say, "I'm here to get away from my anxiety, but when I'm meditating, everything is still, and I actually feel more anxious." We'll talk about that here in just a second. People also don't like meditation because they have been told that the solution to anxiety is to make it go away. And so, what would this mindfulness meditation practice really do if we're actually just sitting there thinking? What a waste of time, actually putting more focus on the actual problem of anxiety. Again, not true, but these are the common problems people have. The last one is, people say, "I don't have time for meditation." I always laugh because I do know that the Dalai Lama said, "For those who don't have time to meditate, they're the ones who need to meditate twice as long." That always made me laugh because there's been many times where I've said, "Oh, I don't have time today," and I laughed thinking, okay, even more important that these are the days that I focus on meditation. Which Meditation Is Best For Anxiety? Let's talk about which meditation is best for anxiety, because I know you're here to talk about how meditation can help with your anxiety. Now, there are ma

If you are scared to take medication, you are in the right place. Today, we are going to take a deep dive into a very common fear that impacts many people and their recovery, and that is the fear of taking medication. If you're someone who needs help with this, I think this is going to be really helpful for you. Hello, my name is Kimberley Quinlan. I am an anxiety specialist, and I help people with anxiety. My hope is to make it an easy and a kind recovery for you. FEAR OR TAKING MEDICATION Now, today we're talking about the fear of taking medication, and a lot of what I do with my patients in my private practice, which is in California, is really helping them work through that fear. In addition, on my online platform called CBT School, I often get a lot of questions about this, such as whether or not people can take meds, should they take meds, and so forth. But before we get into all that, what I want to share with you first are a few housekeeping points that will keep us on point and in the right direction today. If you're someone who is scared to take meds, we first have to acknowledge that this episode is not going to cover whether you should take meds or not. I am not a medical doctor. I am not a medical professional. I am a mental health professional, and I do not prescribe medication. I am not licensed to do that. But I am here to help you manage the fear around it. If you are someone who wants to take medication but is afraid of it because of the side effects, or maybe because of the shame, the guilt, and the stigma around it, my hope today is that we can work on managing that fear and getting you the information and skills you need so that you can speak with your medical professionals and make a decision based on what is best for you. It is important to remember that every person is different, and it's important that you make these decisions with your medical doctor so that we're making a decision based on your medical history, where you're at in your mental health recovery, your genetics—all of the things that you need to discuss with your medical doctor. But today, let's get going. We're talking about managing medication anxiety. Where did this episode come from? I actually made a post about this on Instagram not long ago, and the response was overwhelming, with people saying, number one, "I'm too afraid to do it. Help me," and number two, a lot of people said, "I had a lot of anxiety around taking medication. I got the help I needed and I managed it, and now I'm so relieved that I did." I wanted to spend some time today talking about the reasons people are scared to take an antidepressant or other psychiatric medications or even medications in general. REASONS PEOPLE A SCARED TO TAKE AN ANTIDEPRESSANT OR OTHER PSYCHIATRIC MEDICATIONS There are multiple reasons patients do not take their medications, due to fear. In this episode, we are coming the core reasons fears stops people from taking their antidepressants or other medicines. FEAR THAT MEDICATION WILL CAUSE SIDE EFFECTS The number one reason that people reported being scared to take medication is the fear that medication will cause side effects. This is a very common fear around taking medication, and it is true. We will talk about the side effects here later in this episode, but that is a valid concern. But often, people are afraid of the side effects, even though they are not afraid of it being a catastrophic side effect. They're often afraid of just change, or they're afraid of what is uncertain and unknown, and that is a big thing for them. OCD FEAR OF TAKING MEDICATION Another reason that people are afraid to take any kind of medication is an OCD fear of taking medication. The reason I say it like that is, it's beyond just a generalized fear of the side effects. It's often around a belief of what this medication will do to you. One example I've had in my private practice has been the subtype of OCD called emotional contamination. They're afraid that by taking the medication, it will dramatically change their personality or that they'll turn into a different person. There's a lot of compulsions around that, rumination around that, and avoidance around that. They're also doing this kind of avoidant compulsions in other areas of their lives as well. HEALTH ANXIETY: WHAT IF MEDICATION CAUSES AN ILLNESS Another OCD fear of taking medication is under the umbrella of health anxiety. A lot of people are afraid that the side effects will be catastrophic, that it will give them some catastrophic medical condition if they were to take this psychiatric drug or any medication in general. PHARMACOPHOBIA (PHOBIA OF DRUGS AND ALCOHOL) Now, in addition to that, there is actually a specific medication phobia called pharmacophobia, which is a phobia of drugs and alcohol. This is a specific phobia where people are afraid of any and all drugs. Often, in this case, they're afraid to take headache medication or allergy medication. They're even afraid to loo

If you are wondering if you have (Generalized Anxiety Disorder) GAD vs. OCD (Obsessive Compulsive Disorder) and how to tell the difference, this episode is going to be exactly what you need. My name is Kimberley Quinlan. I'm a cognitive behavioral therapist. I specialize in all anxiety disorders, and I help people overcome their anxiety in the kindest way possible. Now, I have treated generalized anxiety disorder and OCD for over 15 years, and I want to share with you that it is true—there is a massive overlap between OCD and GAD. They do look very similar. So I'm going to break it down and address the GAD and OCD overlap. Let's go. GAD versus OCD. You might know this, but in the world of anxiety disorders, this is actually a very controversial topic right now. I've been to conferences and master classes where clinicians will very much disagree on how we differentiate between the two. In fact, some people believe that they are so similar that they should be labeled as the same thing. We don't all agree, and the reason for that, as I said, is that they do look similar. They do follow a very similar cycle. My hope is that in order to understand what GAD is and what OCD is, we need to actually go through the diagnostic criteria. And that's what we're going to do for you today so that you too can understand the difference between GAD and OCD and determine for yourself what you think will help move you in the right direction. Let's talk about it. GENERALIZED ANXIETY DISORDER SYMPTOMS As I mentioned, in order to get a GAD diagnosis, you do have to have a specific set of symptoms, and we're going to go through them. Number one, if you have GAD, the first symptom you need to have is anxiety and worry, and that's usually focused on everyday events like work, school, relationships, money, and so on. Now, the frequency of GAD needs to occur more days than not for at least six months. The person needs to find it difficult to control this worry and anxiety, and it focuses on areas that are not consistent with other mental health struggles. What we mean by that is, let's say the focus was on being judged by other people. Well, that's better understood as social anxiety. Or if the focus of your worry was on your health, then we would actually be better diagnosing you or understanding your symptoms as health anxiety. If it was focused on a specific thing, like planes, needles, or vomit, we would better understand that as a specific phobia. In order to have the diagnosis of GAD, it needs to not be under the umbrella of a different diagnosis. Other things that we would rule out when we're thinking about GAD are things like panic disorder, body image, or even a previous trauma. Now, the fifth symptom is it needs to cause distress and impairment. That's very, very important here because, again, we're talking about a disorder. What that means is a lack of order, no order. So what we want to see here is that it's highly impacting their daily lives, highly impacting their ability to function. And then the sixth criteria is it has to be ruled out that these symptoms could be from a medical condition or substance abuse. An example of that might be even me with POTS. I have postural orthostatic tachycardia syndrome. A lot of the symptoms of POTS can actually look a little bit like generalized anxiety. The seventh criteria are the specific symptoms, and this is important to recognize because this might be true of a lot of different situations, symptoms, diagnoses, medical and mental. You need to have symptoms such as restlessness or being on edge. You need to be either easily fatigued, have difficulty concentrating, or have what we call a blank mind. You might have irritability, you might have muscle tension, and you could also have sleep disturbances. That is the breakdown for GAD. As I said, it's very easy to mix it up with other mental health disorders, such as OCD, because they can look very, very similar. OBSESSIVE COMPULSIVE DISORDER SYMPTOMS Let's talk about OCD now. What is OCD? Now, in order to understand what OCD is, we need to again address the specific criteria to get a diagnosis of OCD. The symptoms of OCD include the presence of obsessions and compulsions or one. Sometimes, again, you might have obsessions without the compulsions, but usually, at the onset of the disorder, you will have both. You'll also have intrusive, unwanted, repetitive thoughts, feelings, sensations, urges, or images, and these cause a very high degree of distress and anxiety, as we mentioned with GAD. The individual with OCD will often attempt to avoid or suppress these thoughts, feelings, sensations, or urges, and they will try to neutralize them using what we call compulsions. Now there are five different types of compulsionS. A lot of you who have followed Your Anxiety Toolkit will know about these compulsions. We've talked about them. We actually go over them extensively in our online course for OCD called ERP School. If you're interested to l

If you want to live a life according to your values, not fear, you're in the right place. I am going to give you a detailed look at how you can do this for yourself, but I will also show you how not to do this. Lots of people are talking about this idea of living life according to their values, not fear. I want to really inspire you, highlight the way that you can do this, and also show you how it cannot be done so well. I'll actually give you some personal experiences. Hopefully, my goal here is to inspire you to live a life where your values lead the way and fear no longer makes your decisions. Your fear is no longer in the driver's seat; you are. If that's good for you, let's go. Hello, my name is Kimberley Quinlan. I'm a marriage and family therapist. I, myself, have struggled for many years with anxiety. In little ways, anxiety just took away the things I wanted, took me away from doing the things I wanted, showing up the way I wanted, and learning how to live a life according to my values, not fear, has literally changed my life. Now, my hope here is that I can explain this to you. There have been times where my clients have said, "I'm hearing about this idea of values, but it literally doesn't make any sense to me. Like, how would I navigate that?" So my hope here is to make it nice and clear, give you some clarity and some directions so that you too can live your life according to your values and not fear. Now, the thing to remember here is that this idea of values has probably been spoken about in many different modalities, but the one that's really popular right now that people are talking about is a type of therapy modality called Acceptance and Commitment Therapy. What they do is they talk about values as this idea of principles that govern how you want to act. Again, it's not being perfect. It's principles that are going to guide you. Now, unlike just setting goals, values are never fully accomplished. They're something that involves continuous behaviors. They're small baby decisions and little pivots that you are going to make throughout your entire life, and they guide your choices and your decisions according to the person that you want to be, the kind of person you want to see yourself as, or that you identify with. Now, often when we're talking about values, the biggest question I get asked is, "How do I determine these values?" Let's just stop for a minute and just talk about how we're going to apply this. As you probably already know, fear is a very, very good motivator, and it's a driver of behaviors. Let's say you're just walking along or you're at home enjoying your day, and then you have a thought or a feeling of danger, like what if something really bad happens? For you, it will be a specific thought or feeling, but for the sake of just making this really broad, basically, your brain has interpreted, "There might be something wrong. There could be danger. Bad things could happen. I feel uncertain about the future." When that happens, our natural human instinct is to fight that fear, run away from that fear, freeze in that fear, or go into people-pleasing mode. We call it the fight, flight, freeze, and fawn response. This is a normal human reaction. We all do it. It's nothing to be ashamed of. It doesn't mean that you're wrong or bad. If there was actual danger, if there was somebody who was intruding on you or making you uncomfortable and that you were in danger, this 5Fs, the FFFFF approach, is a very appropriate response to being in danger. But when our brain tricks us or sets off the alarm, the danger alarm too fast or inappropriately, we often perceive there to be danger, and we go into a response where we respond to that fear as if it is a real danger, and before we know it, we've completely gone in the wrong direction from the way we wanted our day to be. Again, I might be dropping off my children at school, and I might have the thought, "What if something happens to them today?" I have to make a decision in that moment whether I'm going to respond to that fear, that thought, that feeling as if it's fact, or if it is just a thought, a feeling, or an experience or sensation. The first step here is being able to stop and identify when fear is showing up and identify then, "How do I want to respond?" And that's where your values come in. What I'm going to encourage you to do once you've finished listening to this is go onto Google or whatever search engine you use and Google 'Values List PDF.' There are hundreds of them, and they're going to give you a list of all of the different values that you then may want to think about as things that can guide you in the direction that lines up with the way you want to show up in your life. Again, think of it like a crossroads. You're going up to this crossroad; there's a stop sign. The stop sign says, "There could be danger here." You have to make a decision. Am I going to take a right or a left, which doesn't matter, towards fear and tryi

Perfectionism anxiety almost destroyed my life. If you are someone who suffers from perfectionism, you know exactly what it's like to be stuck in the perfectionistic trap. It's hell, quite frankly. We're here today to talk about how to overcome perfectionism and how to create a life where you can still succeed. You can still do the things you want just without being constantly anxious and depressed and never feeling like you're enough. Hello, my name is Kimberley Quinlan. I'm a marriage and family therapist. I'm an anxiety specialist, and I personally have walked the walk of perfectionism and have had to overcome it as it was starting to severely impact my life. I am so excited to be here with you today to talk all about perfectionism and perfectionism anxiety. Now I am 15 years recovered from an eating disorder. I was personally completely overwhelmed with perfectionism anxiety, and I was in a perfectionism trap. So, let's talk about it. First, let me give you a little bit of a personal update or a background. When I went off to college, I was really naive. I was wise and smart, but I had no idea what I was getting myself into. I had lived at home with my family on a rural farm, on a ranch, if you live in America, for my entire life. And then I went off to what was considered the big city for college, and I felt like I had to be perfect. I had this belief as soon as I left my family that if I could be perfect, I would be safe. I would be emotionally safe. I would be physically safe, and as long as I could keep everything perfect, nothing bad would happen. I also believe that if I could be perfect, people would not abandon me, disprove of me, or judge me. And so, I went out of my way to make sure everything was as perfect as I could make it, even though I understood that I wasn't perfect. I was on a mission to try and get to the top of that hill and stay at the top of that hill. It was a protective measure, a safety behavior I engaged in to manage the anxiety and overwhelm I felt going off to college. I also believe that if I could stay perfect, it would protect me from really uncomfortable emotions like shame and guilt, and it would help me feel like I'm in control. I would try to give myself a false sense of control in a world where I felt very out of control. THE PERFECTIONISM TRAP Now, a big part of this was me understanding what we call the 'perfectionism trap.' The perfectionism trap is, yes, when you start perfecting yourself and perfecting your life, you start to get praised from people around you. You start to get rewarded for your perfectionistic behaviors. My grades started to improve because I was being perfectionistic. My bosses gave me extra shifts because I was so good at my job. But the problem with that is, as I was getting better and trying to perfect everything in my life and please all of the people, I started to feel overwhelmed with all that I had taken on. In addition to that, once I had gotten to this 'perfect place,' which again, I totally understood that I wasn't perfect, but as I started to climb that mountain and get to the peak and start to have the relief of anxiety that I made it, I'm at the top, I'm doing really well, then I started to have the influx of anxiety. "What if I can't maintain this? What happens if I make a mistake and fall off this perfectionism mountain that I have climbed?" And then I was constantly anxious and constantly feeling hopeless about the fact that I can't maintain staying at this high level for as long as I was. This is the perfectionistic trap. The more you try to become perfect, the more pressure, stress, and anxiety you feel. The more hopeless you feel about being able to maintain that, the more depressed you feel that you're stuck in this cycle, and all of a sudden, nothing is worth it. Often, people completely fall down. They can't go on in this way. They burn out, they get sick, which happened to me, or they become so paralyzed with anxiety that they have to avoid things and start telling little white lies just to get through the day because they've built up this idea of being perfect on the people around them. If you're experiencing this, you're not alone. Please do not feel bad about this. This is a common experience, particularly if you're someone who's set up for anxiety. PERFECTIONISM ANXIETY SYMPTOMS OR SIGNS Let's go through some additional perfectionism anxiety symptoms or signs. The first one is, people with perfectionism have a severe fear of failure. They're overwhelmed by the idea that they might mess up, they might make a mistake, and when they do make a mistake, they see it as a failure. Not a blip on the road, not a challenge that they will learn from, but it's that they are a failure, that their mistake and their failure mean that that person is. In fact, their identity is a failure, and that can be incredibly emotionally painful. Another perfectionism anxiety symptom is shame and vulnerability. There is so much shame around mak

What if I never get better? This is a common and distressing fear that many people worry about. It can feel very depressing, it can be incredibly anxiety-provoking, and most of all, it can make you feel so alone. Today, I'm going to address the fear, "What if I never get better?" and share tools and strategies to stay hopeful and focused on your recovery. If you have the fear, "What if I never get better?" I want you to settle in. This is exactly where you need to be. I want to break this episode down into two specific sections. So, when we are talking about "What if I never get better?" we're going to talk about first the things I don't have control over, and then the things we do have control over. That will determine the different strategies and tools we're going to use. Before we do that, though, let's talk about first validating how hard it is to recover. Recovery is an incredibly scary process. It can feel defeating; it can feel, as I said, so incredibly lonely. When we're thinking about recovery, we often compare it to other people's recovery, and that's probably what makes us think the most. Like, will I ever recover? Will I get to be like those people who have? Or if you see people who aren't recovering, you might fear, "What if I don't recover either?" even if you're making amazing steps forward. It can be an exhausting process that requires a lot of care, compassion, and thoughtful consideration. Most of all, recovery requires a great deal of hard work. Most people, by the time they come to me, are exhausted. They've given up. They don't really feel like there's any way forward. And I'm here to share with you that there absolutely is, and we're going to talk about some strategies here today. Now, that being said, while all of those things are true—that it is hard and distressing and can be defeating—I wholeheartedly believe that recovery is possible for everyone. But what's important is that we define recovery depending on the person. I do not believe that there is a strict definition of recovery, mainly because everybody is different, everybody's values are different, and everybody's capacity is different. So we want to be realistic and compassionate, and we want to make sure our expectations are safe and caring as we move towards recovery. Let's talk about what that might look like. Again, it's going to be different for every person. WHAT IF I DON'T GET BETTER FROM OCD? If we're talking about recovery for OCD, let's say we're going to be talking about what's realistic. Again, what's compassionate? So, if someone comes to me and says, "I want my goal of recovery to be never to have anxiety and never have intrusive thoughts ever again," I'm going to say to them, "That sounds really painful and out of your control. Let's actually work at controlling your reaction to them instead of trying to tell your brain not to have thoughts and not to have feelings, because we all know how that works. You're going to have more of them, right?" But again, the degree in which you recover is entirely up to you. WHAT IF I DON'T GET BETTER FROM GENERALIZED ANXIETY DISORDER? Recovery for anxiety or generalized anxiety is going to be the same. I am probably going to use me as an example. I have generalized anxiety disorder—it doesn't stop me from living my life as fully as I can. It's still there, but I'm there to gently, compassionately respond to it and think about how I can respond to this effectively. I think I'm genetically set up to have anxiety, so my goal of recovery being like never having anxiety again is probably not kind; it's probably not compassionate or realistic. WHAT IF I DON'T GET BETTER FROM DEPRESSION? Recovery for depression—again, it's going to look different for different people. Some people are going to have a complete reduction of depressive symptoms. Other people are going to have a waxing and waning, and I consider that to still be a part of recovery. It might be that your definition of recovery is, "As long as I'm functioning, I can take care of my kids, and I can go to work and do my hobbies." If that's your definition of recovery, great. Other people might say, "My definition of recovery is to make sure I get my teeth cleaned, go to the doctor once a year, and have an exercise schedule," and whatever's right to them. Really, again, I want to be clear that you get to decide what recovery looks like for you. I've had people in the past say, "I've considered my recovery to be great. I'm not ready to take those next extra hard steps. I'm happy with where I am, and I'm actually going to work at really accepting where I'm at and living my life as fully as I can, whether these emotions or these feelings are here or not," and I love that. WHAT IF I DON'T GET BETTER FROM HAIR PULLING AND SKIN PICKING? Recovery for hair pulling and skin picking—another disorder that we treat at our center in Calabasas, California—might be some reduction of those behaviors. For others, it might be complete eliminat

[00:00:00] If social media causes anxiety, you will find this incredibly validated. Today, we are covering the nine reasons why social media causes anxiety and depression, and we will get specific about how you can overcome social media anxiety and depression. In a way that feels right to you, so let's go. If you hear yourself saying, social media gives me anxiety, you are not alone. In fact, many people say it gives them such overwhelm and panic they just want to shut it down completely. That is a common experience, and I want to provide a balanced approach here today. So, let's first look at some social media stats. Research shows that people use an average of 6.6 social media networks monthly. When I heard that, I thought that couldn't be true, but I counted the ones that I use, and it is. I thought that was [00:01:00] very interesting. That sounds like an incredibly massive amount of social media networks. But the average time spent on social media daily is two hours and 24 minutes, not weekly, daily. While 67% say they have a drop in self-esteem as they compare their lives to others they see on social media, 73% of people report. They also find solace and support in these platforms during tough times. We all experienced that during COVID-19, and I know that as someone who lives in America but is Australian, social media has allowed me to be friends with people from high school & college; I get to be connected with my parents' friends. I have found it to be an incredibly beautiful process, but today, we're looking specifically at how social media impacts our mental health, particularly how it causes anxiety and depression. Now [00:02:00], we have some social media depression stats here as well. We do have research to show a link between social media use and depression. More than three hours on social media daily does increase your risk of mental health problems. This study was done specifically for teens, but I think as adults, we could all agree that's probably true as well. There are also some social media addiction statistics that we want to know. We know that 39% of social media users report being addicted to social media, meaning they want to get off but can't. Or, they experience adverse experiences and consequences when they're not using it in moments of distress and needing to regulate. We may also look at some social media anxiety disorder statistics. Studies showed that around 32% of teenagers say social media increases their anxiety and hasn't had a [00:03:00] negative impact on people of their age. However, I found it interesting that only 9% believed it was the case for themselves, but they believed that for others. Interesting statistic. 67% of adolescents report feeling worse about their own lives after using social media, and most teenagers say that social media has had neither a positive nor a negative effect on themselves. So, we are getting some mixed statistics here. The real point for you is to decide for yourself. Is it helping me, or is it hindering my mental health? And if it is, let's discuss some skills we can use. So here we go. NINE REASONS SOCIAL MEDIA CAUSES ANXIETY We have nine reasons social media causes anxiety. Now, to be clear, this needs to be scientifically backed. I did a review from people on Instagram. It's funny how it's a social media platform. Still, I did interview them and did a poll and also have a question box where they get to put [00:04:00] their specific reasons why some social media has impacted them negatively. And here are the results. SOCIAL MEDIA COMPARISON So, the number one reason social media causes anxiety is comparison. Social media comparison seems to be the biggest reason for increasing anxiety and depression, and I think it's important that we identify how social media comparison impacts us. Now, what I've found as a clinician and a marriage and family therapist in helping people with anxiety is how often social media reinforces untrue beliefs they have about themselves. Or, we could say negative beliefs that they had already. Examples: I'm not good enough. I'm not doing enough. I'm not happy enough. I'm not making enough money. I don't have enough followers. I'm not succeeding enough. And that constant, having it in your face of what they're doing and seeing their highlight reels makes us feel like we're not doing enough [00:05:00] and maybe bringing up the insecurities that we aren't enough. So, it's really important that we first use social media as an opportunity to take a look at those beliefs and those thoughts. What thoughts does social media bring up for you? Are the thoughts true? Are they helpful? Do they determine facts, or are they just feelings and thoughts you've had on a whim because of your anxiety? When we look at those thoughts, we can then determine whether we want to respond as if those thoughts are true. It's also important to recognize that people only post what I call their "A-roll." They don't post their B roll. They

Am I doing ERP correctly? This is a common roadblock I see every week in my private practice. I think it is a common struggle for people with anxiety and OCD. Today, we will talk about the three common OCD traps people fall into and how you can actually outsmart your OCD and overcome it. https://youtu.be/Ngb_lQK5Fnk?si=9FU42GZZZDJ58f-W Now, when we're talking about Expsoure & response prevention ERP, we must go over the basics of ERP therapy, so let's talk about what that means before we talk about the specific traps that we can fall into. ERP is exposure and response prevention. It's a specific type of cognitive behavioral therapy and is the gold standard treatment for OCD to date. And it's a detailed process, right? It's something that we [00:01:00] have to go through slowly. It's a detailed process where we first identify OCD obsessions and OCD intrusive thoughts. So, you'll identify precisely the repetitive, intrusive, and distressing things for you. Once we have a good inventory of your OCD obsessions, we then identify what specific OCD compulsions you are doing now. A compulsion is a behavior that you do to reduce or remove your anxiety, uncertainty, or doubt, or any kind of discomfort that you may be experiencing. And once we do that, then we can move towards exposing you to your fears. Exposure therapy for OCD involves exposing yourself to those specific obsessions. And then engaging in [00:02:00] response prevention, which is the reduction of using those compulsive safety behaviors. Now, common OCD response prevention will involve reducing physical behaviors, reducing avoidant behaviors, or reducing thought suppression. It's reducing reassurance, seeking, reducing mental compulsions, and in reducing any kind of self-punishment that you're engaging in to beat yourself up for the obsessions that you're having. Then we get you engaged back into doing the things you love to do; getting you back to engaging in your daily life, your daily functioning, the things that you find pleasurable, and your hobbies as soon as possible. That's the whole goal of ERP. Right? The important thing to remember here is that ERP therapy for OCD is greatly improved by adding in [00:03:00] other treatment modalities, such as acceptance and commitment therapy or mindfulness-based cognitive therapy, DBT, and medication. I should have mentioned medication first because most of the science shows that that's one of the most helpful to really augment ERP therapy for OCD. If you want to go deeper into that, I strongly encourage you to check out Exposure and Response Prevention School. I'll show you how to do all of those steps in ERP school, our online course for OCD. You must know how to do those steps and that you're doing them in a way that's careful and planned so that we're not overwhelming you and throwing you in a direction that you're not quite prepared for; you don't have the tools for yet. And so today, I wanted to discuss three questions that come directly from people who've taken ERP school [00:04:00], and they're really trying to troubleshoot these three common OCD traps that OCD gets them stuck into. So, let's get to the good stuff now. OCD TRAP #1: IF I DON'T ENGAGE WITH AN OBSESSION, AM I THOUGHT SUPPRESSING? What if I don't engage with an obsession? Am I thought suppressing? One of our listeners said, "I know what you resist persists. We talk about that in ERP school, but I also know that obsessive thinking and worrying can become compulsive. Is it possible I could be caught in both situations, and how common is this?" So I want to really be clear here in what we're saying when we say to practice ERP. So when you have an obsession or the onset of an intrusive thought or intrusive feeling, sensation, urge, it could also be an image. When you have that,[00:05:00] you're old way of dealing may have been to try and push that thought away with some urgency and aggression. We call that thought suppression and that's an avoidant compulsion, so yes. This student of mine is correct. That becomes compulsive, right? But we also know if we go into the obsession, try and figure the obsession out, give it too much of our attention. We're also engaging too much with it in terms of using mental compulsions. That too is a compulsion. So we want to see that these two things can happen. But when we have the thought, and we observe that it's there the obsession, we've noticed it's there. Right? We talked about this in previous episodes of your Anxiety Toolkit podcast. When you identify it's there and then you say, I am gonna let it be there and still move on. To what you love to do, [00:06:00] what you value that is not resisting it, that is engaging back into what you find important and effective, and valuable for your life. It's not avoidance, it's not thought suppression. Now, if you do that in a way where you're like, oh, I don't want that thought. I want to engage in what I'm doing. Now you're crossing into that reaction being wi

If you are interested in stopping compulsions using attention control, this is the episode for you. I am really excited for this episode. This was a deep dive into really how to fine-tune your mindfulness practice for anxiety and OCD. Today we have the amazing Max Maisel, who is an OCD and anxiety specialist here in California. He came on to talk about these really nuanced differences of mindfulness, where we might go wrong with mindfulness, how we can get a deeper understanding of mindfulness, and this idea of attentional control. The real thing that I took away from this is how beneficial it can be at reducing mental compulsions, putting our attention on the things that we value, putting our attention on what we want to put attention on, not in a compulsive way at all. In fact, we addressed that throughout the episode, and it's just so, so good. I'm so grateful to you, Max, for coming on, and I just know you guys are going to love this episode. Now, we are talking about some pretty difficult things, like things that are hard to do. I even roleplayed and explained how hard it was for me to do it. I want, as you listen to this, for you to please practice an immense amount of self-compassion and recognition and acknowledgment of just how hard it is to do these practices and how we can always learn more. Hopefully, something in this episode clicks for you and feels very true for you and is hopefully very, very beneficial. I'm going to go take you straight to the show because that's what you're here for. Have a wonderful day everybody, and enjoy this interview with Max Maisel. Kimberley: Welcome. I am so excited for this episode, mainly because I actually think I'm going to leave learning a ton. We have the amazing Max Maisel here today. Welcome. Max: Thank you, Kim. It's really good to be here. I'm super excited for our conversation. MINDFULNESS FOR OCD Kimberley: Yeah. Okay. You know I use a lot of mindfulness. I am a huge diehard mindfulness fan, but I love that you have brought to us today, and hopefully will bring to us today, some ways in which we can drop deeper into that practice or zone in, or you might say a different word, like how to focus in on that. Tell me a little bit about how you conceptualize this practice of mindfulness and what you use to make it more effective for people with anxiety and OCD. Max: Yes, for sure. So, I'm a major proponent of mindfulness practices. I use it myself in my personal life. I integrate it in the clinical work that I do with clients with OCD and anxiety. But one of the concerns that I've seen in my clinical work is that mindfulness is such a broad concept and it covers so many different types of psychological suffering. The research behind mindfulness is just like hundreds, maybe even thousands of studies. But when it comes to very specific and nuanced concerns like OCD and anxiety, it could be a little bit confusing for people sometimes to figure out, "Well, how do I apply this really healthy, beautiful, amazing tool to how my own brain is wired in terms of like sticky thoughts or just to engage in all sorts of compulsive behaviors." I like to think about mindfulness from Jon Kabat-Zinn's definition at the core—paying attention to the present moment in a way that's non-judgmental and with this curious intentionality to it. But then within that, there's some really nuanced details that we can talk more about how to make that really relevant to folks with OCD and anxiety. THE DIFFERENCE BETWEEN ATTENTION & AWARENESS Kimberley: Tell me a little bit. When we're talking about mindfulness, we often talk about this idea of awareness. Can you differentiate first—and this is using some terminology just to set the scene—can you differentiate the difference between attention, awareness, and even a lot of people talk about distraction? Can you share a little bit about how they may be used and what they may look like? Max: I love that question. I think in a good OCD treatment, people really need to have a good solid understanding of those differences. I'm actually going to borrow from a neuroscientist named Amishi Jha. She's this incredible professor at the University of Miami. In her research lab, they look at the neurological underpinnings of mindfulness, and that very much includes attention and awareness. I highly encourage anybody to look up her work. Again, it's Amishi Jha. She talks about attention or focused attention. If you imagine there's a dark room, and if you turn on a flashlight and you shine that beam of light into that room and say that beam of light hits a vase on a table, again, what happens to that vase? What's different compared to all the things in the background? Kimberley: Is that a question for me? Max: Yeah. If you imagine a beam of light, what goes on with that? Kimberley: You would see the front of the vase, maybe it's a bit shiny, or you would see the shadow of the vase. You would see the colors of the vase. The texture of the vase. Max: That's ex

Welcome back, everybody. This is a last-minute episode. I usually am really on schedule with my plan for the podcast and what I want to do, but I have recently got back from vacation and I have been summoned to jury duty. For my own self-care, the idea of going to this master plan that I created for all of the other episodes that I do a lot of planning and a lot of prep and really think it through today, I was like, "I deeply need this episode to land on my own heart." This is as much for me as it is for you, and it is a community effort, which also was very helpful for me. As you may know, I'm a huge proponent of self-compassion, which isn't just having bubble baths and lighting a candle. It's actually stopping and asking, "What do you need in this moment?" And I really dropped in and I was like, "I need this to be really simple, really easy, and I need this to be also something that will land." Let's do it. Today, we're talking about the 14 things you should say to a loved one with anxiety. I asked everyone on Instagram to weigh in on what they need to hear, and the response was so beautiful, it actually brought me to tears. I am going to share with you the 14 things that you should say to a loved one with anxiety, and I'm also going to talk about, it's not just what we say. I was thinking about this the other day. When we're anxious, the advice we get can make us feel very soothed and validated, or it can feel really condescending. Saying "stop worrying" can be really condescending. It can make us enraged. But if someone so gently says, "Listen, don't worry, I got you." You know what I mean? The tone makes a huge difference. For those of you who are family members or loved ones who are listening to this, to really get some nuggets on what they can do to support their loved one, remember that the tone and the intent are really 80% of the work. That is so, so important. Here we go. Let's go through them. I AM HERE FOR YOU. The first thing you should say to a loved one with anxiety is, "I am here for you." The beauty of this is it's not saying, "How can I make your discomfort go away?" It's not saying, "What should we do to fix this and make you stop talking about it and stop having pain about it?" It's just saying, "I'm here, I'm staying in my lane and I'm going to be there to support you." It's beautiful. HOW CAN I SUPPORT YOU? The second thing you could say to a loved one with anxiety is, and this is actually my all-time favorite, this is probably the thing I say the most to my loved ones when they're anxious or going through a difficult time, "How can I support you?" It's not saying, "What can I do?" It's not saying, again, "How can I fix you?" or "Let's get rid of it." It's just saying, "What is it that you need? Because the truth is, I don't know what you need and I'm not going to pretend I do because what may have worked for you last week mightn't work this week." That's really important to remember. How can I support you? YOU ARE NOT BAD FOR EXPERIENCING THIS. The third thing you could say to a loved one with anxiety is, "You are not bad for experiencing this." So often when we are going through a hard time, we're having strong emotions. We then have secondary shame and blame and guilt for having it. We feel guilty, we feel weak, we feel silly, we feel selfish, we feel juvenile for struggling—often based on what we were told in childhood or in our early days about having emotions. We can really start to feel bad for having it. Or for you folks with OCD or intrusive thoughts, you might feel bad because of the content of your obsessions. Now let's pause here for a second and be very clear. We also have to recognize that we don't want to be providing reassurance for our loved ones with OCD and intrusive thoughts because, while giving them reassurance might make them feel better for the short term and might make you feel like you're really a great support person, it probably is reinforcing and feeding the disorder and making it worse. So in no way here am I telling you to tell your loved ones like, "You're not bad. You're not going to do the thing that you think you're going to do," or "That fear is not going to come true." We don't want to go down that road because that's going to become compulsive and high in accommodation. Those two things can really, really make your OCD and intrusive thoughts much, much, much worse. But we can validate them that having a single emotion like anxiety, shame, anger, sadness does not make them a bad person. So, so important. THINGS WILL GET BETTER... THIS WILL NOT LAST FOREVER. The fourth thing you should say to a loved one with anxiety is, "Things will get better," and another thing that the folks on Instagram said is, "This will not last forever." This was something that was said many, many times. I pulled together the main common themes here. But what I loved about this is they were bringing in the temporary nature of anxiety, which is a mindfulness concept, which i

Today, we're talking about when anxiety causes depression and vice versa. This is a topic that I get asked about all the time. It can be really confusing and a lot of time, it's one of those things that we talk about in terms of like, is it the chicken or the egg? I want to get to the bottom of that today. When anxiety causes depression, it can feel like your world is spinning and racing from one thought to another. You may feel a complete loss of interest in the things that you're doing. You may have racing thoughts, depressive thoughts, or thoughts of doom. This can be really, really overwhelming. Today, I want to talk about when anxiety causes depression and how you might target that, and also when depression causes anxiety. Let's get into it. We're going to go through a couple of things today. Number one is we're going to go through why does anxiety cause depression, how does depression cause anxiety, how common is depression and anxiety, particularly when they're together, and what to do when depression and anxiety mix. Now, stick around till the end because I'm also going to address how OCD causes depression and how social anxiety causes depression, and what to do when anxiety and depression impact your sleep, and in this case, cause insomnia. I'm so excited to do this. Let's get started. WHAT CAUSES ANXIETY AND DEPRESSION What causes anxiety and depression? Let's look at that first. What we understand is that anxiety and depression—we don't entirely know just yet to be exact, but what we know so far is that there is a combination between genetics, biology, environment, and also psychological factors. That's a big piece of what we're going to be talking about today. Now, if you want to know specifically the causes of anxiety, and that's really what you're wanting, you can actually go over to Episode 225 of Your Anxiety Toolkit. We have a whole episode there on what causes anxiety and what you can do to overcome anxiety. That might be a more in-depth understanding of that. But just in general, we do know that genetics play a huge component. However, we do know, talking about the psychological factors, that often people who do have depression, that depression does cause an increase in anxiety. A lot of people who have an anxiety disorder do notice that they feel themes of depression like hopelessness, helplessness, and worthlessness. WHY DOES ANXIETY CAUSE DEPRESSION? Now, let's first look at, why does anxiety cause depression? The thing to remember here is, anxiety alone doesn't cause depression in all cases. There are lots of people who do have an anxiety disorder who don't experience depression. However, we do know that for those who have a lot of anxiety, maybe untreated anxiety or anxiety that is very complex and they're in the early stages of recovery or learning the tools and mastering those tools, it is common for people with anxiety or uncertainty to start to feel doom and gloom about their life. Often it comes in the form of feeling like, "Is this going to be here forever?" A lot of people will say, "What's the point really of life if I'm going to be experiencing this level of suffering with my anxiety every single day?" And that's very, very valid. When you're suffering to the degree that some of you are with very chronic anxiety disorders, very severe degrees of anxiety disorders, it makes complete sense that you would start to feel like, "What is the point? How do I get through this? No one can help me. Am I someone who can be helped?" These are very common concerns. I myself have struggled with this as well, particularly when your anxiety feels so out of control and you don't feel like you have mastery over it yet. I think that that is a very, very normal experience for people who have that degree of anxiety. This also includes other anxiety disorders like phobias, panic disorder, PTSD, and eating disorders. I know when I had my eating disorder, I felt so stuck, "How am I ever going to climb out of this deep hole that I'm in?" And that in and of itself made me feel depressed. I had what we call secondary depression. My primary condition was an eating disorder, and then I had a secondary depression because of how heavy and how overwhelming my primary condition was. If that's something that you resonate with, I first want to acknowledge and recognize that this is very normal, very common, but also very treatable, particularly if you have a mental health professional who can help you. But again, I want to go back and say, just because you have anxiety or intrusive thoughts, doesn't mean that you will be anxious and depressed for the rest of your life. With mastery and tools and recovery and practice and patience and compassion, you can actually slowly peel those layers of depression and anxiety away. WHY DOES DEPRESSION CAUSE ANXIETY? So then we move over now and look at, why does depression cause anxiety? If your primary diagnosis or your primary disorder is depression, meaning that's the fi

Welcome back, everybody. It is so good to have you here talking about hyper-responsibility & hyperresponsibility OCD. A lot of you may not even know what that means and maybe have never heard it, or maybe you've heard the term but aren't quite sure what it entails. And some of you are very well acquainted with the term hyper-responsibility. I thought, given that it's a theme that's laced through so many anxiety disorders through depression that we should address it. I think that's a really great starting point. WHAT IS HYPER-RESPONSIBILITY OCD? Let's talk about first what is hyper-responsibility. Hyper-responsibility is an inflated sense of responsibility. It is feeling responsible for things that are entirely out of your control, such as accidents, how other people feel about you, how other people behave, events happening in your life. It's ultimately this overwhelming feeling that the world rests on your shoulders, that it's up to you and it's your job to keep yourself and everybody else safe. Even as we look at this definition of what hyper-responsibility is, I'm actually feeling and noticing in my body this heaviness, this weight that you're carrying, and it is an incredible weight to carry. It is an incredibly stressful role to play. If you're someone who experiences hyper-responsibility, you often will have additional exhaustion because of this. WHAT IS THE DIFFERENCE BETWEEN HYPER-RESPONSIBILITY AND RESPONSIBILITY OCD? One thing I want to clear up as we move forward is first really differentiating the difference between hyper-responsibility and responsibility OCD. When we say "hyper-responsibility," we're talking about a heightened sense of responsibility. Actually, let me back up a little bit. We do have responsibility. I am an adult. I'm responsible for my body, I'm responsible for two young children, a dog. Responsibility is one thing. You need to keep them safe, you need to take care of them, you need to show up in respectful ways. But hyper-responsibility is so much more than that. It's taking an incredible leap of responsibility and feeling responsible for all the teeny tiny things, like I said before, that are out of your control. Now, once we've determined what responsibility is, then we can also look at responsibility OCD. Now specifically for those who have responsibility OCD is where this sense of hyper-responsibility has crossed over into meeting criteria for having the obsession of hyper-responsibility that's repetitive, intrusive, unwanted, and you're also engaging in a significant degree of compulsions that, again, meet criteria for OCD. They could be mental compulsions, physical compulsions, avoidant compulsions, reassurance-seeking compulsions, and so forth. The way I like to think of it is on a spectrum. We have responsibility on one side, then in the middle, we have hyper-responsibility, and then it goes all the way over to responsibility OCD. Some people will differentiate them differently in terms of they will say, hyper-responsibility is the same thing as responsibility OCD. But I'm not here to really diagnose people, and I'm not here to tell people that they have OCD if they don't quite resonate with that. I'll use me as an example. I 100% struggle with hyper-responsibility in certain areas of my life. But the presentation of that hyper-responsibility, I don't feel, and I'm sure my therapist doesn't feel, meets criteria for me to get the diagnosis of OCD. That's why I want to make sure this is very loose so that you can decide for yourself where you fit on that spectrum. HYPER RESPONSIBILITY SYMPTOMS OR RESPONSIBILITY OCD SYMPTOMS A little bit more about hyper-responsibility symptoms or even responsibility OCD symptoms. Examples will include: when something goes wrong, you're probably likely to blame yourself and feel guilty for the fact that something went wrong. Even disregarding whether it was your fault or not, you'll feel a sense that this was your mistake, that you should have prevented it. Another hyper-responsibility symptom is you might believe that it is up to you to control the outcomes of your life. It is up to you to control the outcomes of other people's lives—your dependence, your partner, your family members, and so forth, the people at your work, the projects at your work, or at school. Another symptom of hyper-responsibility and responsibility OCD is this act of always trying to "fix" the problem. Even when you've recognized that there is no solution, you feel this need to just keep chipping away and finding the solution to prevent the bad thing from happening or being responsible for the bad thing. You may spend hours trying to prevent accidents or bad things from happening. What I mean by spending hours is it takes up a significant degree of your time, and it's usually quite distressing. It's a heavy feeling. There is a difference between responsibility and hyper-responsibility. An example might be my husband found that one of our decks was rickety and shaki

Kimberley: Welcome. This conversation is actually so near and close to my heart. I am so honored to have Jessie Birnbaum and Sandy Robinson here talking about Managing the anxiety of chronic illness and disability. Welcome and thank you both for being here. Sandy: Thank you for having us. Kimberley: For those of you who are listening on audio, we are three here today. We're going to be talking back and forth. I'll do my best to let you know who's talking, but if anything, you can look at the transcripts of the show if you're wondering who's saying what. But I am so happy to have you guys here. You're obviously doing some amazing work bringing awareness to those who have an anxiety disorder, specifically health anxiety OCD, panic disorder. These are all very common disorders to have alongside a chronic illness and disability. Jessie, will you go first in just telling us a little bit about your experience of managing these things? Jessie: Yeah, of course. I've had OCD since I was a little kid but wasn't diagnosed until around age 14, so it took a little while to get that diagnosis. And then was totally fine, didn't have any physical limitations, played a lot of sports. And then in 2020, which seems like it would coincide with the pandemic (I don't think it did), I started getting really physically sick. I started out with these severe headaches and has continued on and morphed into new symptoms, and has been identified as a general chronic illness. I'm still searching for an overall diagnosis, but I've seen a lot of different ways in which my OCD has made my chronic illness worse. And then my chronic illness has made my OCD worse, which is really why Sandy and I are so passionate about this topic. Kimberley: Thank you. Sandy, can you share a little about your experience? Sandy: Yeah. Just briefly, I was born really prematurely at about 14 weeks early, which was a lot. And then I was born chronically ill with a bowel condition and I also have a physical disability called [02:31 inaudible] palsy. And then I wasn't diagnosed with OCD until I was 24, but looking back now, knowing what I do about OCD, I think I would say my OCD probably started around age three or something. So, quite young as well. Kimberley: You guys are talking about illnesses or medical conditions that create a lot of uncertainty in your life, which is so much of the work of managing OCD. Let's start with you Jessie again. How do you manage the uncertainty of not having a diagnosis or trying to figure that out? Has that been a difficult process for you, or how have you managed that? Jessie: It has been such a difficult process because that's what OCD latches onto, the uncertainty of things. That's been really challenging with not having a specific diagnosis. I can't say, "Oh, I have Crohn's disease or Lyme disease," or something that gives it a name and validates the experience. I feel like I have a lot of intrusive thoughts and my OCD will latch onto not having that diagnosis. So, I'll have a lot of intrusive thoughts that maybe I'm making it up because if the blood work is coming back normal, then what is it? I'll have to often fight off those intrusive thoughts and really practice mindfulness and do a lot of ERP surrounding that to really validate my experience and not let those get in the way. Kimberley: Sandy—I can only imagine, for both of you, that is the case as well—how has your anxiety impacted your ability to manage the medical side of your symptoms? Sandy: I think that's an interesting question because I think both my OCD and my medical symptoms are linked. I think when I get really stressed and have prolonged periods of stress, my bowel condition especially gets a lot worse, so that's tricky. But I think as I've gone through ERP, and I'm now in OCD recovery, that a lot of the skills I've learned from being chronically ill and disabled my whole life, like planning, being a good self-advocate at the doctors or at the hospital and that flexibility, I think those tools really helped me to cope with the challenges of having additional anxiety on top of those medical challenges. Kimberley: Right. Of course, and I believe this to be from my own experience of having a chronic illness, the condition itself creates anxiety even for people who don't have an anxiety disorder. How have you managed that additional anxiety that you're experiencing? Is there a specific tool or skill that you want to share with people? And then I'll let Jessie chime in as well. Sandy: Yeah. I think the biggest thing is, it was realizing that my journey is my journey and it might be a little slower than other people's because of all the complicating factors, but it's still a good journey. It's my journey, so I can't really wish myself into someone else's shoes. I'm in my own shoes. I guess the biggest thing is realizing like my OCD isn't special because I have these complicating factors, even though I myself am special. My OCD is just run-of-the-mill OCD and can st

Kimberley: My tummy already hurts from laughing too much. I'm so excited to have you guys on. Today, we are talking about thriving in relationships with OCD and we have Rev. Katie O'Dunne and Ethan Smith. I'd love for you both to do a quick intro. Katie, will you go first? Katie: Yeah, absolutely. My name is Reverend Katie O'Dunne. I always like to tell folks that I always have Reverend in my title because I want individuals to know that ordained ministers and chaplains can in fact have OCD. But I am super informal and really just go by Katie. I am an individual who works at the intersection between faith and OCD, helping folks navigate what's religious scrupulosity versus what is true authentic faith. I'm also an OCD advocate on my own journey, helping individuals try to figure out what it looks like for them to move towards their values when things are really, really tough. Outside of being a chaplain and faith in OCD specialist and advocate, I'm also an ultramarathon runner, tackling 50 ultramarathons in 50 states for OCD. As we get into stuff with Ethan today, Ethan is my biggest cheerleader throughout all of those races. I'm sure we'll talk all about that too, running towards our values together. Ethan: My name is Ethan Smith. Katie is my fiancé. I'm a national advocate for the International OCD Foundation, a filmmaker by trade, and a staunch advocate of all things OCD-related disorders. Definitely, my most important role is loving Katie and being her biggest cheerleader. Katie: Since you said that, one of my things too, I am the fiancé of Ethan Smith. Sorry. Ethan: Please note that this is an afterthought. It's totally fine. Kimberley: No, she knew you were coming in with it. She knew. Ethan: Yeah, I was coming in hot. Yup, all good. WHAT IS IT LIKE BEING IN A RELATIONSHIP WITH SOMEONE WITH OCD? Kimberley: Thank you both for being on. I think that you are going to offer an opportunity for people to, number one, thriving in Relationships with OCD, but you may also bring some insight on how we can help educate our partners even if they don't have OCD and how they may be able to manage and navigate having a partner with OCD. I'm so excited to have you guys here. Thank you for being on. Can you first share, is it easier or harder to be in a relationship with someone with OCD? For you having OCD? Ethan: I'll let Katie start and then I'll end. Katie: Yes. No, I think it's both. I think there are pros and cons where I think for so long being in relationships with individuals who didn't have OCD, I desperately wanted someone to understand the things that I was going through, the things that I was experiencing, the intensity of my intrusive thoughts. I was in so many relationships where individuals felt like, well, you can just stop thinking about this, or you can just stop engaging in compulsions. That's not how it works. It has been so helpful to have a partner through my journey who understands what I'm going through that can really say, "I actually get it and I'm here with you in the midst of that." But I always like to be honest that that can also be really, really challenging where there are sometimes points, at least for me, having OCD with a partner with OCD, where if we are having a tough point at the same time, that can be really tough. It can also be really tough on a different level when I see Ethan struggling, not reassuring him even more so because I know how painful it is and I want so badly to take that away. There are times that that can feed into my own journey with OCD when I see him struggling, that my OCD latches onto his content, vice versa. There's this amazing supportive aspect, but then there's also this piece I think that we have to really be mindful of OCD feeding off of each other. Ethan: I was just making notes as you were-- no, go ahead. Kimberley: No, go ahead, Ethan. I'm curious to know your thoughts. Ethan: Katie made all great points, and I agree. I mean, on the surface, it makes a lot of sense and it seems like it's fantastic that we both can understand each other and support each other in really meaningful and value-driven ways. I always like to say that we met because of OCD, but it by no means defines our relationship or is at the heart of our relationship. It's not why we work. It's not what holds us together. I think Katie brings up two good points. First of all, when I would speak and advocate with parents and significant others and things like that, and they would say, "I'm having a really hard time not reassuring and not enabling," I'd be like, "Just don't, you're making them sicker. Just say what you got to say and be tough about it." Then I got in a serious relationship with Katie and she was suffering and hurting, and I was like, "Oh my God, I can't say hard things to her." I became that person. I suddenly understood how hard it is to not engage OCD and to say things that aren't going to make her comfortable. I struggle with that. I struggle with standing my ground

Welcome back, everybody. Alright, alright, alright. You may already notice the sound of my voice has shifted, the tone has shifted, and that is on purpose. Actually, I've never thought of this, but it's true. I often show up when I'm ready to do a podcast. I sit in front of my microphone, I'm in front of my desk, I take a deep breath and I just talk to you from a place of centeredness and calm, gathering as much wisdom as I can. That is a part of what I'm bringing today. But my other hope is I want to shift the tone a little bit because that's what you have to do when you're addressing this particular topic, which is motivation during depression. We're talking about how to get things done during depression. That's what we're here for today. Thank you for being here. My name is Kimberley Quinlan. I'm a marriage and family therapist. I'm an OCD and anxiety specialist, and a lot of what I do is manage depression. That is because nearly 85% of cases of an anxiety disorder also have depression. That's because anxiety is hard and it creates these feelings of depression inside us. Today, I wanted to talk about how to cultivate motivation during depression because so often when we're talking about either just managing depression or managing another mental health condition, you're usually required to do a lot of homework, use a lot of skills, and also go about daily functioning. That is really hard when you're experiencing depression. DEPRESSION MOTIVATION CYCLE One thing I wanted to talk about first is just to get you guys familiar with what we call the depression motivation cycle. This is something that I talk to my clients about. I wouldn't say it's a science-based theory, but definitely, I think a lot of us will resonate with this. What I mean by the depression motivation cycle is when you have depression, you experience symptoms of depression, which I'll share here in just a few minutes. But you experience these symptoms that cause you to then have lower motivation. But when you have lower motivation, you tend to not get to your daily functioning activities and you tend to maybe avoid some of the hard things in your life, which then causes more depression. And then once you have more depression, that often ends up leading you back into the cycle of having even less motivation because you're feeling so hopeless, and the cycle continues and continues and widens and widens and spreads throughout your life. My hope today is that we can work towards breaking that cycle. I'm not going to overpromise that we will break it today because I'm always going to be as honest and realistic as I can with you guys. I don't want to oversell that this is going to be a simple snap of the fingers, I have the solution for you. No, there's a slow, gradual breaking of this cycle. Number one, do I believe you can do this work? Absolutely. I want to heavy-load you with confidence at the front end, but also very much validating that it's a process, it's a practice. I want you to be as gentle with yourself as you can as we talk about this today. Let's take a breath, but let's also stay in our mindset. COMMON DEPRESSION SYMPTOMS & HOW TO GET MOTIVATED In understanding motivation during depression, we must consider, like I just said, common depression symptoms. We must understand them. One of the common depressive symptoms is hopelessness. Hopelessness is feeling like there is no hope for you. You might be having a lot of depressive thoughts such as, "What's the point? There's no hope. It's not getting better." These are symptoms of hopelessness. In addition to hopelessness, or maybe instead of hopelessness, if you have depression, you may experience the depression symptom of helplessness. Helplessness is where you feel like no one can help you. That your problem is different or separate to other people's or too big than everybody else's, and that there's no one out there that can help you. That's important to notice because one of the lies depression tells us is you are the only one that has this particular type of depression and you are the only one that can't be helped, and that that means something about you. There's some innate flaw about you that makes your life hopeless. It's all lies. I just want you to know that. Another common depression symptom is worthlessness—feeling like you're not enough, you're not worthy. You don't deserve to be here, to be loved, to be in connection with. Maybe you feel like you don't deserve kind, wonderful, loving things or even pleasure. Worthlessness isn't a very common piece of depression. As you can imagine, just hearing these words that I'm saying, it's a horrible feeling. It's a very deep, dark, gray place to be, and it's not your fault. Another common depression symptom is sleepless nights. You're unable to sleep or oversleeping, sleeping day and night, hitting the alarm over and over again, turning it off, going back to bed, not getting to your daily functioning. Another huge one is exhaustion. P

Welcome back, everybody. Today we are talking about a topic that I commonly get asked as a clinician, I commonly get asked as an advocate for anxiety online and so forth, which is how to let go of intrusive thoughts. I think that this is such an interesting question because words matter. For those of you who know me, you're going to know that words really do matter when it comes to managing anxiety and we have to get it "right." When I say "right," what I'm really saying is our mindset about anxiety and intrusive thoughts and any emotion really that is uncomfortable, we have to approach it with a degree of skill, effectiveness, and wisdom. My hope is to help you move in that direction. I know you're already in that direction, but hopefully, this episode will be really powerful. I'm going to give you a metaphor that I hope really, really helps you. It really helps me. I've talked about it on the podcast before, but I feel like it's important so I have to talk about it again. When we talk about this idea of how to let go of intrusive thoughts, we have to ask, what do we mean by that? Often when people first start seeing me as a clinician or they start seeing my therapist—we have a private practice in Calabasas, California—we commonly will get, "Okay, just I'm here. I'm ready to do the work. Teach me how to let go of intrusive thoughts." A lot of the beginning stages of treatment is educating on how letting go, meaning not having them anymore or quickly avoiding them or distracting against that, could actually be what's making your anxiety worse. For those of you who've taken ERP School, which is our online course for OCD. If you're interested, you can go to CBTSchool.com to learn more about that course. That's where you can learn how to manage your own OCD. It's an on-demand course. But we talk a lot about understanding that trying to push thoughts away or suppress thoughts, not having them actually reinforces the problem. I also want to mention, it makes total sense that your goal is to be able to have the thoughts and have no discomfort related. Like I just want to have the thoughts and I don't want them to bother me, and I just want them to create no suffering at all. I get that. That is a very normal desire to have. But what we want to do here is, when we're talking about how to "let go" of intrusive thoughts, what we are really talking about is how we can be skillful in how we respond to them, because we know, based on science, that we can't control our intrusive thoughts. Often there are mechanisms in the brain that's making it very difficult for you to pump the brakes on thoughts, which is why you're struggling with so many of them, and they're happening so repetitively. We know this. When I first learned about mindfulness, one of the most important metaphors that just shook me to the core—it really changed the way that I learned to deal with thoughts, feelings, sensations, emotions, urges, and all the things—was to think of my thoughts like water in a stream, and that my mind is this stream of water. As you're thinking like these beautiful green banks, and there's the river in the stream, and it's flowing in one direction. What happens for us when we're experiencing our mind is we hit a rock in the stream. When we hit that rock, we want to imagine that that rock is a metaphor for an intrusive thought. Here you are, you're the water. You're just rolling over all of the banks and commandeering back and forth, and then all of a sudden you hit this very sharp, jagged rock. Of course, your reaction is to get jolted and go, "Oh my goodness, what is this? Why is this here? I'm just trying to get from A to B." Often what we do is when we hit the rock, we make a huge splash. The splash goes everywhere. We're like, "Wait, what happened?" When we do this, we actually create a lot of pandemonium for ourselves. Now, that's what we do. But if we were to think about a stream, what does the stream water normally do when it hits a rock? It hits the rock, it notices the shape of the rock, and then it gently goes around them. It doesn't stop to go, "Is this a good rock or a bad rock? How do I feel about this rock? What does this rock mean about me? Why is there a rock here? There shouldn't be a rock here." The water just notices the rock, observes that the rock's here. It doesn't make a huge splash. It doesn't try to go under it. It doesn't try to stay on the left side of the bank and avoid it. It just notices the rock and it goes around it and it moves on. Mindfulness is just that. Mindfulness is observing what shows up from a place of non-judgment, from a place of non-attachment. What I mean by that is that the water's not attached to what this rock means about them. It doesn't assign value to the rock. It doesn't say the river is bad now because we have a jagged rock, or it doesn't say the river is good because it's a small rock. It just says "rock" and it goes around it. Mindfulness is also very present. It notices

TALKING BACK TO ANXIETY Welcome back, everybody. Today we're talking about talking back to anxiety, and we're really talking about the power of positive self-talk. Now I know when it comes to this idea of talking back to anxiety, it can get somewhat controversial. In fact, even talking about this idea of positive self-talk can be controversial, and I will be the first to say there is nothing worse than when you're struggling with something that's really painful. People say, "Oh, just be positive." That is not what we're talking about here today. In fact, I have a personal twist on how I like to consider a positive self-talk. You probably have heard me talk about it before, but I felt like it was time for me to revisit these concepts that I find so incredibly powerful when it comes to talking back to anxiety, or being positive, staying positive, engaging in some form of positive self-talk. WHAT DOES TALKING BACK TO ANXIETY LOOK LIKE? Let's talk about it. When we consider what we mean, when we say "talking back to anxiety," what do I really mean by that? First of all, I want to get to one of the controversies. What I'm not saying is that when you have anxiety, you tell it to go away or stop, because we know that when we do that, when we try and suppress anxiety or we try to suppress our intrusive thoughts, it usually means we have more of them. Let's just get that scientific fact out in the eye. We know that is true. But when we are talking about talking back to anxiety, when I'm talking about it, what I mean is, when you experience anxiety, whether that be in the form of sensations or in thoughts or feelings or images, how do you respond? How do you converse with your anxiety? I always make a metaphor with my clients, and I've done it here on the podcast before, that I always think of anxiety as this little short Lorax-looking guy that sits on my shoulder. For you, it might look different. But he sits on my shoulder and he's in a beach chair and he is really lazy and he is wearing sunglasses, and he just wants to mess with me as much as he can, but in the most effective, lazy way. And how does he do that? He does it by knowing exactly what bothers me and throwing that at me first. He's not going to throw some random thing at me. He's going to go straight for the thing that he knows I value, because that's where my anxiety is going to show up the most. And then when he shows up, it's up to me then to be skilled in how I respond. One of the ways we respond is how we talk back to it. The first thing I'm going to ask you is, when your anxiety tells you of the thing that you value, talks to you about the thing that scares you, that hits you right in the gut, how do you respond? Do you yell at him and say, "Get off my lawn, you horrible thing." None of this is bad, I just want you to get to know. How do you respond? You say, "No, no, no, please go away. I don't want you. I'll do whatever you say. I'll do whatever compulsion you tell me to do. I'll avoid whatever you tell me to avoid if you just quiet down." Some of this, instead of doing that, instead of yelling at anxiety, we yell at ourselves. We say, "What is wrong with you? Why are you always anxious? You're a loser. You're bad. What's wrong with you? Something is seriously broken about you. Why have you got to have anxiety all the time?" You engage in a ton of self-criticism and self-punishment. The ones I just gave you are some negative self-talk examples like, "What's wrong with you? You're a loser. You're such an idiot for having this anxiety. You're stupid." I want to remind you that you're not. This is not about your intelligence; it's not about who you are, what you are. Your anxiety has nothing to do with any of that. Some of us are just genetically prone to having more anxiety. But we use this negative self-talk. We use this criticism, this self-judgment to try and beat out the anxiety, as if we could beat it out of ourselves. But the facts are, this negative self-talk doesn't motivate us to change because we were never in control at the start. We can't control our anxiety and whether it shows up, so that doesn't work. What we do know that does work is positive self-talk. It is one of the most successful ways of motivating ourselves. When anxiety does show up, I want you to explore how you might respond differently to whatever discomfort or whatever form of suffering you're experiencing. It doesn't even have to be anxiety. It might be pain, it might be stress, it might be sadness, any emotion. We can actually use these skills with any of these emotions. WHAT POSITIVE SELF-TALK IS NOT Let's talk about what I mean by this. What does positive self-talk look like in my definition, not what you may have seen online. Number one, in my definition, positive self-talk—let's talk about what it actually isn't—it's not just positive affirmations. While that's great, and if that works for you, by all means, keep it. But for me, it never ever lands. I could say the

Welcome back, everybody. Today we're talking about sleep anxiety relief. We're talking about how to get a good night's rest. Oh, the beauty of a good night's sleep. I can't even tell you and I can't even explain for me personally how much sleep impacts my mental health and my mental health impacts my sleep. Hence why we're doing this episode today. For those of you who are new, my name is Kimberley Quinlan. I'm a marriage and family therapist in the State of California. I have a private practice. I am the developer of an online program called CBTSchool.com. I'm an author and I am the host of this podcast. A few weeks ago, a psychiatrist reached out and said, "I have been listening to you for years, not realizing that I work literally down the street from you." It made me realize that I never introduced myself on the podcast. I just talk and talk and talk and I actually don't tell people where I am and what I do and what I offer. So that was a really big lesson. Let's talk about sleep anxiety relief. I'm going to tell you a bit of a story first. For years, my daughter has been telling us that she can't sleep, that she has terrible sleep. She lays awake, staring at the roof. She said she always feels tired during the day and that she "can't get to sleep" when she tries. We have taken her to the pediatrician and we've talked to her about it and checked in, "Are you worrying about anything in particular?" She says, "No, I just worry about getting enough sleep." Again, she's saying, "When will I go back to sleep? Will I go back to sleep? Will I wake up at night?" She says she struggles to get comfortable as she settles into bed. We took the plunge and took her to a sleep specialist and we were expecting either a sleep disorder diagnosis or a sleep anxiety diagnosis. He did this thorough assessment and asked her all these questions and he was incredible. At the end, he said, "I'm going to tell you, it sounds like you're getting good sleep. You sound like you sleep very normally for a kid your age and we address some issues that may be happening." But he said, "A lot of this is about managing anxiety about sleep," because he tracked like, "You're getting enough. We will track it during the night. Everything looked good. This is actually about you managing your mind around sleep." Now I understand that may not be your experience, but this blew me off my feet. I was expecting serious bad news. I have this conversation with my patients so often and it made me feel like, let's talk about sleep anxiety relief. SLEEP ANXIETY SYMPTOMS Now, before we talk about sleep anxiety relief, let's talk about sleep anxiety symptoms because some people who don't experience this or aren't sure if they're experiencing this, I wanted to make sure you feel like you're in the right place. For those who have sleep anxiety, they experience a lot of anxiety around going to bed or when going to bed. They may report racing thoughts in bed, inability to concentrate when they're preparing to go to sleep or they're laying in bed. They might experience a lot of irritability, whether that's emotional or physical sensations in the body. A lot of jitteriness. There may be also an experience of nervousness or restlessness. They may have feelings of being overwhelmed. Some people report this impending danger or doom as they approach the bed or as they approach bedtime. They may experience a lot of anticipatory anxiety about it. There are also some physical sensations or effects of anxiety before bed and that might include some tummy troubles. Kids in particular will report before bed, "My tummy hurts," and often their tummy hurts is a sign of anxiety. This is true for adults too. They may have an increase in heart rate, which may make them feel like something bad is about to happen. They may have rapid breathing. They may experience sweating. They may experience tense muscles. They may experience trembling, even nausea. These are symptoms that could be your regular day-to-day anxiety, or it could be that you're specifically managing anxiety related to sleep. IS THERE A CURE FOR SLEEP ANXIETY? When talking about sleep anxiety relief, often people talk about this idea of a sleep anxiety cure. Now, I'm not going to give you any specific "cure" today because I don't know your exact case and you would need to be assessed by a doctor. I encourage you to go and see your doctor if you're struggling with sleep because it is so important. If you need, go and get a referral for a sleep specialist or do some research. There are some amazing books on sleep as well. Now, do I consider that we can overcome sleep anxiety? Yes, 100%. I do believe you can get to a place where you have healthy sleep. Again, I'm always very cautious about talking about the word "cure," but if we were to really address sleep anxiety relief in terms of what you need to practice, I'm going to first always do a ton of psychoeducation with my patients and with you today about sleep hygiene. W

Welcome back, everybody. Today we are talking about Acceptance Scripts with Dr Jon Grayson. So happy to be here with you as we tie together our series on imaginals and scripts. Today, we have the amazing Dr. Jon Grayson and he is going to talk about acceptance scripts and the real importance of making sure we use acceptance when we're talking about scripts and imaginals. I'm so excited to share this episode with you. I think it really does, again, tie together the two other guests that we've had on the show in this series. For those of you who are listening to this and haven't listened to the other two episodes of the series, go back two weeks. We've got the first one with Krista Reed and she's talking about scripts and the way she uses them. Then we have Shala Nicely and she talks about her own specific way of using scripts. Again, the reason that I didn't just have one person and leave it at that is I do think for each person, we have to find specific ways in which we do these skills and tools so we can make it specific to your obsessions and your intrusive thoughts. One explanation or one version or variety of this is probably not enough. I want to really deep dive in this series so that you feel, number one, you have a good understanding of what an imaginal and a script is. Number two, you know how to use them, you know the little nuanced pieces of information that you need to help make sure OCD and your OCD-related disorder doesn't make it a compulsion because it can. I really wanted to get some groundwork so that you feel confident using imaginal and scripts in your own treatment and your own recovery. Again, for those of you who are a little lost and feel like you need a better understanding of OCD, of how OCD works, how it keeps you stuck, the cycle of OCD and you want to make your own individual OCD and ERP plan, you can go to CBTSchool.com. We have a full seven-hour course that will walk you through exactly how I do it with my patients, and you can do that at your own pace. It's an on-demand course. It is not therapy, but it will help you if you don't have access to therapy or if you're really just wanting to understand and do a deep dive and understand what ERP is and how you can use it. That is there for you. But if you are someone who is just wanting to get to the good stuff, let's go over to the episode with Dr. Jon Grayson. Thank you, Dr. Jon Grayson, for coming on the show again. Always a pleasure to have such amazing people who really know their stuff. I'll enjoy this episode with you. Let's go. Kimberley: Welcome, Dr. Jon Grayson. I'm so happy to have you back. Jon: It is always fun to be with you. Kimberley: Okay. It's funny that you are number three, because I probably need you to be number one. Almost all of the scripting I ever learned was from your book. I think that even Shala Nicely came on and spoke about how a lot of what she does is through your book as well. Let's just talk about the way in which you walk people through an imaginal or a script. Now do you call it imaginal or script? Do you think they're synonymous? Do you have a different way of explaining it? Jon: I think jargon-wise, they're synonymous. I think by definition-- I feel weird saying that by definition because we made it up. I came up with the name "script" because originally, imaginal exposure suggested I'm just dealing with all the horrors and person's just going to think about it. I changed the name to "script" because I was including both. What are you being exposed to? What might happen and why would you take this risk? Because I feel like the script is not only to get used to the material, but we remind the person, why am I doing this? What am I getting out of taking this horrible risk? Why would I want to live with that? WHAT IS AN ACCEPTANCE SCRIPTS/IMAGINALS? Integral to the Acceptance Script is the whole idea of learning acceptance. Because too often, I think the biggest problem I see in most therapists is they just jump into doing exposure without making sure the person has done level 1 acceptance, which is "I want to live with uncertainty," because to say "I want to live with uncertainty" is to say, "I am willing to cope if the worst things happen." It's not just this general idea, it's like going to the extreme. "I'm willing to live, even if this happens. I'm willing to drive a car knowing that I might get paralyzed and disfigured in a car crash." I think that's acceptance because if you're telling me you're never going to crash in a car and you know that's true, I guess that's a nice comforting thought that you might be in for a shock. We're willing to take that risk. I think across the board, it's always willing to live with the worst possible. Scripts try to encapsulate that. They're trying to help bring the person not only to confront their fear but remind them of all the ways they want to cope with it. It is not a reassurance thing because let's face it, the worst thing happening, saying "I'll co

Today we are talking all about ERP Scripting with Shala Nicely. Welcome back, everybody. We are on Week 2 of the Imaginals and Script Series. This week, we have the amazing Shala Nicely on the show. She's been on before. She's one of my closest friends and I'm so honored to have her on. For those of you who are listening to this and haven't listened to any of the previous episodes, I do encourage you to go back to last week's episode because that is where we introduce the incredible Krista Reed and she talks about how to use scripts and imaginals. I give a more detailed intro to what we're here talking about if this is new for you. This will be a little bit of a steep learning curve if you're new to exposure and response prevention. Let me just quickly explain. I myself, I'm an ERP-trained therapist, I am an OCD Specialist, and a part of the treatment of OCD and OCD-related disorders involve exposing yourself to your fear and then practicing response prevention, which is reducing any of the safety behaviors or compulsions you do in effort to reduce or remove whatever discomfort or uncertainty that you feel. Now, often when we go to expose ourselves to certain things, we can't because they're not something we can face on a daily basis or they're often very creative things in our mind. This is where imaginals and scripts can come in and can be incredibly helpful. If you want a more detailed understanding of the steps that we take regarding ERP, you can go to CBTSchool.com, which is where we have all our online courses. There is a course called ERP School that will really do a lot of the back work in you really understanding today's session. You don't have to have taken the course to get the benefits of today's session because a lot of you I know already have had ERP or are in ERP as we speak, or your clinicians learning about ERP and I love that you're here. Honestly, it brings me so much joy. But that is there for you if you're completely lost on what's going on today, and that will help fill you in on the gold standard treatment for OCD and the evidence-based treatment for OCD and OCD-related disorders. That being said, let's get on with the good stuff. We have the amazing Shala Nicely. I am so honored again to have you on. You are going to love how applicable and useful her skills and tools are. Let's just get straight over to Shala. Kimberley: Welcome, Shala. I am so happy to have you back. I know we have a pretty direct agenda today to talk about imaginals versus scripting in your way in which you do it. I'd love to hear a little bit about, first, do you call it imaginals or do you call it scripting? Can you give me an example or a definition of what you consider them to be? SHALA'S STORY OF ERP SCRIPTING Shala: Sure. Well, thank you very much for having me on. Love to be here as always. I'll go back to how I learned about exposure when I first became a therapist. I learned about exposure being two different things. It was either in vivo exposure, so in life. Meaning, you go out and do the thing that your OCD is afraid of that you want to do, or it was imaginals where you imagine doing the thing that you want to do that your OCD is afraid to do. Research shows us that the in vivo is more effective, but sometimes imaginals is necessary because you can't go do the thing for whatever reason. But I don't think about it like that anymore. That's how I learned it, but it's not how I practice it. To help describe what I do, I'll take you back to when I had untreated OCD or when I was just learning how to do ERP for myself because I think that would help it make sense what I do. When I was doing ERP, I would obviously go out and do all the things that I wanted to do and my OCD didn't want me to do. What I found was that I could do those things, but my OCD was still in my head, getting me to have a conversation about what we were doing in my mind. I might go pick up a discarded Coke can on the side of the road because it's "contaminated," and I would then go either put it in the trash, which would be another exposure because that would be not recycling. There are layers of exposures here. But my OCD could be in my head going, "Well, I don't think that one is contaminated. It doesn't look all that contaminated because it's pretty clean and this looks like a clean area so I'm sure it's not contaminated. What do you think, Shala?" "Oh, I agree with you." "Well, we threw it away, but I bet you, these people, they're going to get wherever we threw it. They're actually going to sort it out and it's going to get recycled anyway." There was this carnival in my head of information about what was going on. I determined what I was doing because I was doing the exposure, but I wasn't really getting all that much better. I was getting somewhat better but not all that much better. What I realized I was doing is that I'm having these conversations in my head, which are compulsive. In my recovery journey, what I was doing was I

Welcome back, everybody. Thank you for joining me again this week. I'm actually really excited to dive into another topic that I really felt was important that we address. For those of you who are new, this actually might be a very steep learning curve because we are specifically talking about a treatment skill or a tool that we commonly use in CBT (Cognitive Behavioral Therapy) and even more specifically, Exposure and Response Prevention. And that is the use of imaginals or what we otherwise call scripts. Some people also use flooding. We are going to talk about this because there are a couple of reasons. Number one, for those of you who don't know, I have an online course called ERP School. In ERP School, it's for people with OCD, and we talk about how to really get an ERP plan for yourself. It's not therapy; it's a course that I created for those who don't have access to therapy or are not yet ready to dive into therapy, where they can really learn how to understand the cycle of OCD, how to get themselves out of it, and gives you a bunch of skills that you can go and try. Very commonly, we have questions about how to use imaginals and scripts, when to use them, how often to use them, when to stop using them, when they become compulsive and so forth. In addition to that, as many of you may not know, I have nine highly skilled licensed therapists who work for me in the state of California and Arizona, where we treat face-to-face clients. We're actually in Los Angeles. We treat patients with anxiety disorders. I also notice that during my supervision when I'm with my staff, they have questions about how to use imaginals and scripts with the specific clients. Instead of just teaching them and teaching my students, I thought this was another wonderful opportunity to help teach you as well how to use imaginals and why some people misuse imaginals or how they misuse it. I think even in the OCD community, there has been a little bit of a bad rap on using scripts and imaginals, and I have found using scripts and imaginals to be one of the most helpful tools for clients and give them really great success with their anxiety and uncertainty and their intrusive thoughts. Here we are today, it is again a start of another very short series. This is just a three-week series, talking about different ways we can approach imaginals and scripts and how you can use it to help manage your intrusive thoughts, and how you can use it to reduce your compulsions. It is going to be three weeks, as I said. Today, we are starting off with the amazing Krista Reed. She's been on the show before and she was actually the one who inspired this after we did the last episode together. She said, "I would love to talk more about imaginals and scripts." I was like, "Actually, I would too, and I actually would love to get some different perspectives." Today, we're talking with Krista Reed. Next week, we have the amazing Shala Nicely. You guys already know about Shala Nicely. I'm so happy to have her very individual approach, which I use all the time as well. And then finally, we have Dr. Jon Grayson coming in, talking about acceptance with imaginals and scripts. He does a lot of work with imaginals and scripts using acceptance, and I wanted to make sure we rounded it out with his perspective. One thing I want you to think about as we move into this series or three-part episode of the podcast is these are approaches that you should try and experiment with and take what you need. I have found that some scripts work really well with some clients and others don't work so well with other clients. I have found that some scripts do really well with one specific obsession, and that doesn't do a lot of impact on another obsession that they may have. I want you just to be curious and open and be ready to learn and take what works for you because I think all of these approaches are incredibly powerful. Again, in ERP School, we have specific training on how to do three different types of scripts. One is an uncertainty script, one is a worst-case scenario script, and the last is an acceptance script. If you're really wanting to learn a very structured way of doing these, head on over to CBTSchool.com and you can sign up for ERP School there. But I hope this gets you familiar with it and helps really answer any questions that you may have. Alright, let's get over to the show. Here is Krista Reed. Kimberley: Welcome back, Krista Reed. I am so happy to have you back on the show. Krista: Thank you. I am elated to be able to chat with you again. This is going to be great. Kimberley: Yeah. The cool thing is you are the inspiration for this series. Krista: Which is so flattering. Thank you. IMAGINAL OR SCRIPT? Kimberley: After our last episode, Krista and I were having a whole conversation and you were saying how much you love this topic. I was like, "Light bulb, this is what we need to do," because I think the beautiful piece of this is there are different ways i

Welcome back, everybody. Today, we are going to have a discussion, and yes, I understand that I am here recording on my own in my room by myself, so it's not really a discussion. But I wanted to give you an inside look into a discussion I had, and include you hopefully, on Instagram about a post I made about being busy. Now, let me tell you a little bit of the backstory here. What we're really looking at here is, is being busy a compulsion or an effective behavior? Here's the backstory. I am an anxious person. Nice to meet you. Everybody knows it, I'm an anxious person. That's what my natural default is. I have all the tools and practice using all the tools and continue to work on this as a process in my life. Not an end goal, but just a process that I'm always on, and I do feel like I handle it really, really well. In the grand scheme of things, of course, everyone makes mistakes and recovery is an up-and-down climb. We all know that. But one thing I have found over and over and over and over again is my inclination to rely on busyness to manage my anxiety. The reason I tell you this over and over is it's a default to me. When I'm struggling with anything, I tend to busy myself. Even when I had the beginning of an eating disorder, that quickly became a compulsive exercise activity because trying to manage my eating disorder created a lot of anxiety, and one way I could avoid that anxiety and check the eating disorder box was to exercise, move my body. Even though I fully recovered from that, and even though I consider myself to be doing really well mentally overall, I still catch myself relying on work and busyness as a compulsion, as a safety behavior to reduce or remove or avoid my anxiety. I made a post on this and it had overwhelming positive responses. Meaning, I agree, there was a lot of like, "Oh, I feel called out or hashtag truth." A lot of people were resonating with this idea that being busy can be a very sneaky compulsion that we do to run away from fear or uncertainty or discomfort or sadness and so forth. But then some of my followers, my wonderful followers came in hot—when I say "hot," like really well—with this beautiful perspective on this topic and I really feel like it was valid and important for us to discuss here today. Let's talk about that, because I love a good discussion and I love seeing it from both sides. I love getting into the nitty gritty and determining what is what. Let's talk about me just because it's easy for me to use an example. Let's say I have a thought or a feeling of anxiety. Something is bothering me. I'm having anticipatory anxiety or uncertainty about something. My brain wants to solve it, but because I have all these mindfulness tools and CBT tools, I know there's no point in me trying to solve it. I know there's no point in me ruminating on it. I'm not going to change it or figure it out. I have that awareness, so I go, "Okay, now I'm going to get back to life," which is a really wonderful tool. But what I find that I do is I don't just get back to life. I, with a sense of urgency, will start typing, cleaning, folding laundry, whatever it is, even reading. I will notice this shift in me to do it fast, to do it urgently, to try and get the discomfort to be masked, to be reduced. And then, of course, I want to share with you, what I then do is when I catch that is I go, "Okay." I feel the rev inside me and then I ease up on it. I pump the brakes and I try to return back to that activity without that urgency, without that resistance to the anxiety, or without that hustle mentality. But it is a default that I go to that often I don't catch until later on down the track. It's usually until I start to feel a little dizzy, I feel a little lost, a little bit overwhelmed. And then I'm like, "Oh, okay, I'm overusing busyness to manage my anxiety." The perspective that I loved was people saying, and one in particular said, "I want us to be really careful around that message because I think that some people can hear this idea that being busy is a compulsion and then start to question their own normal busyness throughout the day." I'll use the exact terms because I thought it was so beautifully said. They said, "You have to be pretty careful with how you explain this to some people with OCD because we're told to lean into our values or live a 'value-based' life, and that does require us to be busy," and I wholeheartedly agree. I think that's where I'm coming from. I want to offer to you guys that I want you to just check in and see if you're using busyness, this urgent, rushing movement, or frantic experience in your body to avoid discomfort. And if so, that's good to know. Let's not judge that. Let's not beat you up. Let's not be unkind. Let's just acknowledge that that is a normal response to having anxiety. In fact, it's a big part of what's kept us alive for all these years. That's true. And we can return back. Once we catch that we're doing those behaviors, we can re

Hello and welcome back, everybody. We have an amazing guest today. This is actually somebody I have followed, sort of half known for a long time through a very, very close friend, Shala Nicely, who's been on the show quite a few times, and she connected me with Dr. Ashley Smith. Today, we are talking about happiness and what makes a "good life" regardless of anxiety or of challenges you may be going through. Dr. Ashley Smith is a Licensed Clinical Psychologist. She's the co-founder of Peak Mind, which is The Center for Psychological Strength. She's a speaker, author, and entrepreneur. She has her own TED Talk, which I think really shows how epic and skilled she is. Today, we talk about how to be happy. What is happiness? How do you get there? Is it even attainable? What is the definition of happiness? Do we actually want it or is it the goal or is it not the goal? I think that this is an episode I needed to hear so much. In fact, since hearing this episode as we recorded it, I basically changed quite a few things. I will be honest with you, I didn't actually change things related to me, but I changed things in relation to how I parented my children. I realized midway through this episode that I was pushing them into the hamster wheel of life. Ashley really helped me to acknowledge and understand that it's not about success, it's not about winning things, it's not about achievement so much, while they are very important. She talks about these specific things that science and research have shown to actually improve happiness. I'm going to leave it at that. I'm going to go right over to the show. Thank you, Dr. Ashley Smith, for coming on. For those who want to know more about her, click the links in the show notes, and I cannot wait to listen back to this with you all. Have a great day, everybody. Kimberley: Welcome, Dr. Ashley Smith. I'm so happy to have you here. Dr. Ashley: I am excited to be here today. I've wanted to be on your podcast for years, so thank you for this. Kimberley: Same. Actually, we have joint friends and it's so good when you meet people through people that you trust. I have actually followed you for a very long time. I'm very excited to have you on, particularly talking about what we're talking about. It's a topic we probably should visit more regularly here on the show. We had discussed the idea of happiness and what makes a good life. Can you give me a brief understanding of what that means or what your idea about that is? Dr. Ashley: Yeah. Oh, this is a topic that I love to talk about. When I think about it, I have a little bit of a soapbox, which is that I think our approach to mental health is broken. I say that as someone who is a mental health practitioner, and I really love my job and I love working with people and helping. But what I mean by that is our traditional approach has been, "Let's reduce symptoms. Let's correct the stuff that's 'wrong' with someone." When it comes to anxiety or depression, it's how do we reduce that? And that's great. Those are really important skills, but we've got this whole other side that I think we need to be focusing on. And that is the question of how do we get more of the good stuff. More happiness, more well-being. How do we create lives that are worth living? That's not the same as how do we get rid or reduce anxiety and depression. In the field of psychology, there's this branch of it called Positive Psychology. I stumbled on that 20 years ago as a grad student and thought, "This is amazing. People are actually studying happiness. There's a science to this." I looked at happiness and optimism and social anxiety and depression and how those were all connected. Fast forward, 15 years or so, I really hit a point with my professional life and my personal life where I was recognizing, "Wait a minute, I need more. I need more as an individual. The clients I work with need more. How do we get more of this good stuff?" This is the longest preamble to say, I did a deep dive into the science of happiness and learned a lot over the years, and I want to be really clear about a couple of things. When we talk about happiness, a lot of people think pleasure. "I want good experiences, I want to enjoy this." That's a part of it, this positive emotion that we all call happiness or joy. But that's only a piece of it. There's actually this whole backfiring process that can happen when we chase that. If I'm just chasing the next pleasant event, what that actually does is set me up to not have a happy life. Think about it. I mean, I love chocolate, and if I eat that unchecked because it brings me pleasure, at some point, it's going to take a toll on my health. What does that actually do to my well-being and happiness? What was really interesting getting into this area was, it's not just this transient state of pleasure or enjoyment, but they're the other factors that contribute to a good life. It's things like relationships. It's things like meaning and purpose.

Hello and welcome back, everybody. I'm so happy to be here with you. This is not the normal format in which we do Your Anxiety Toolkit podcast, but I wanted to really address a question that came up in ERP School about how to manage 10 out of 10 anxiety. For those of you who don't know, over at CBTSchool.com, we have a whole array of courses—courses for depression, generalized anxiety, panic, OCD, hair pulling, time management, mindfulness. We have a whole vault of courses. In fact, we have a new one coming out in just a couple of weeks, which is a meditation vault. It will have over 30 different meditations. The whole point of this is, often people say to me that the meditations that they listen to online can become very compulsive. It's things like, "Oh, just let go of your fear or make your fear go. Cleanse away and dissolve," and all the things. That's all good. It's just, it's hard for people with severe anxiety to conceptualize that. That whole vault will be coming out very, very soon. But this is actually a question directly from ERP School. Under each video of all the courses, there is always a place you can ask questions, and I do my best to respond to them as soon as I can. But I did say to this student, I will actually do an entire podcast on your question because I think it's so important. Here is what they said: "Hi Kimberley, I love all the information you give us. I get so much more out of this than I do with a therapy session for one hour once a week. That being said, I'm feeling a little bit overwhelmed. There is just so much information and so many tools." Yes guys, I admit to that. I do tend to heavy-dose all of my courses with all the science. I can bring in as many tools as I can with the point being that I want you to feel like you have a tool belt of tools, in which you can then choose which one you want to use, so I totally get what they're saying here. They said: "When I'm at a 10 out of 10, I'm hardly able to function and it all seems to go out the window. It either seems that noticing works as I run through my list of tools or I can't even think straight enough to check in with myself or even think about the tools I could use. So, where do I even start in those terrible moments?" This is a really good question, and I think every single one of my clients in my history of being a therapist has asked this question. I know I have asked this question to my therapist because even as a therapist who has all the tools in those moments, it can feel overwhelming. What I did here is I pulled all of my followers on Instagram and asked them to give me their tools that they find helpful, and then I'm going to weigh in myself, and then I'm going to encourage you to just practice any of them. Now, often what happens—and this is the case for what obviously someone's bought a course from me—is when you have all of these options, we fall into the trap of thinking there is a "right" tool to use, and I want to reframe that. In addition, there's another myth that that one tool will make all your discomfort go away or that will be the tool of all tools for recovery. I want to really normalize that there is no one tool. The whole reason that I do Your Anxiety Toolkit is to remind you that you're going to have to practice multiple different things, you can't put all your eggs in one basket, and it's okay if it's not a 10 out of 10 win. Meaning, it's okay if it's not perfect. Often I'll say to clients, use the tools, even if it's 50% effective. That's still 50% effective more than what it would be in the past, which might be 0% effective or 1% effective. We take any wins we can take and we use it not as a fact that you're a failure if it didn't work, but more as just data on what to use for the next time. At the end of the day, the goals are: Did it give me a 1 or 2% improvement on how I handled it the last time? 1 or 2%, folks. That's all I'm goaling for here. Was I kind as I practiced it? And, did it move me towards the five-year you, or the three-year you, or the one-month you? The you who's in one month, does it move you towards that person that you're trying to be? I often will think about me through the terms of, what would the five-year me do in this situation? What would the three-year me do? What would the three-month me do? It might be different, and then I just pick one. Knowing it's probably not perfect, but that's okay. I have polled a whole bunch of people on Instagram because I honestly feel like folks who were in the thick of it actually are better at giving tools than even I am as a trained clinician who's been through it. Of all of the different responses we got, I've actually broken it down into two separate sections per se. We've got mindset shifts and tools and actions. Again, these may actually feel again like, "Oh my gosh, now I have even more tools," which is not a bad problem. TAKE ONE MOMENT AT A TIME But I want you in the moment that you're at a 10 out of 10 to just pick one and

Welcome back, everyone. I am so happy to do the final episode of our Sexual Health and Anxiety Series. It has been so rewarding. Not only has it been so rewarding, I actually have learned more in these last five weeks than I have learned in a long time. I have found that this series has opened me up to really understanding the depth of the struggles that happen for people with anxiety and how it does impact our sexual health, our reproductive health, our overall well-being. I just have so much gratitude for everyone who came on as guests and for you guys, how amazing you've been at giving me feedback on what was helpful, how it was helpful, what you learn, and so forth. Today, we are talking about PMS and anxiety, and it is so hopeful to know that there are people out there who are specifically researching PMS and anxiety and depression, and really taking into consideration how it's impacting us, how it's affecting treatment, how it's changing treatment, how we need to consider it in regards to how we look at the whole person. Today, we have the amazing Crystal Edler Schiller on. She is a Psychologist, Assistant Professor, and Associate Director of Behavioral Health for the University of North Carolina Center for Women's Mood Disorders. She provides therapy for women who experience mood and anxiety symptoms across the lifespan. She talks about her specific research and expertise in reproductive-related mood disorders. She was literally the perfect person for the show, so I'm so excited. In today's episode, we talked about PMS, PMDD, the treatments for these two struggles. We also just talked about those who tend to have an increase in symptoms of their own anxiety disorder or mood disorder when at different stages of their menstrual cycle. I found this to be so interesting and I didn't realize there were so many treatment options. We talked about how we can implement them and how we may adjust that depending on where you are in terms of your own recovery already. I'm going to leave it there and get straight over to the show. Thank you again to Crystal Schiller for coming on, and I hope you guys enjoy it just as much as I did. Kimberley: Thank you so much for being here, Crystal. This is a delight. Can you just share quickly anything about you that you want to share and what you do? Crystal: Sure. I'm a clinical psychologist at UNC Chapel Hill. I'm an Associate Director of the UNC Center for Women's Mood Disorders, where we provide treatment to people with reproductive hormones across the lifespan—starting in adolescence, going through pregnancy, postpartum, and all the way up through the transition to menopause. We also do research. My research focuses on how hormones trigger depression and anxiety symptoms in women. I do that by administering hormones, so actually giving women hormones and looking at the impact on their brain using brain imaging and then also studying specific symptoms that they have with that treatment. We've given hormones that mimic pregnancy and postpartum, and we also use hormones to treat symptoms as women transition through menopause and look at, like I said, how that impacts how their brain is responding to certain kinds of things in the environment and also how they report that changes their mood. WHAT IS PMS? AND WHAT IS THE DIFFERENCE BETWEEN PMS AND PMDD? Kimberley: Wow. You couldn't be more perfect for this episode. You've just confirmed it right there. Thank you for being here. Before we get started, mostly we're talking about what we call PMS, but I know that's actually maybe not even a very good clinical term and so forth. Can you share with us what is PMS and What is the difference btween PMS and PMDD? Crystal: Yeah. PMS stands for premenstrual syndrome. It actually is a medical diagnosis and it includes a host or a range of physical symptoms as well as some mild psychological symptoms. It can be things like breast tenderness or swelling, bloating, cramps, menstrual pain, as well as some anxiety, low mood, mood fluctuations. But those tend to be mild in a PMS diagnosis. PMS is really common in the general population. Some studies estimate 30, 40, 50% of women experience these symptoms. Very, very common. On the other hand, premenstrual dysphoric disorder is a condition that is associated with more severe depression and anxiety symptoms. The mood symptoms are more at the forefront, although those physiologic symptoms like the breast tenderness, swelling, pain, cramps can certainly be a part of it. HOW CAN WOMEN DISTINGUISH BETWEEN NORMAL PREMENSTRUAL SYMPTOMS AND THOSE ASSOCIATED WITH PMS OR PMDD? Most women with PMDD do have those physical symptoms as well. Pain is a commonly reported symptom in folks with PMDD, but the mood fluctuations are more severe. People spend about half their menstrual cycle usually with pretty severe symptoms. And then once the period starts, those symptoms go away in PMDD. That's actually part of the criteria for the disorder that the symptoms ha

In this week's podcast episode, we talked with Dr. Katherine Unverferth on Menopause, anxiety, and mental health. We covered the below topics: How do we define peri-menopause and menopause? What causes menopause? Why do some have more menopausal symptoms than others? Why do some people report rapid rises in anxiety (and even panic disorder) during menopause. Is the increase in anxiety with menopause biological, physiological, or psychological? Why do some people experience mood differences or report the onset of depression during menopause? What treatments are avaialble to help those who are suffering from menopause (or perimenopause) and anxiety and depression? Welcome back, everybody. I am so happy to have you here. We are doing another deep dive into sexual health and anxiety as a part of our Sexual Health and Anxiety Series. We first did an episode on sexual anxiety or sexual performance anxiety. Then we did an episode on arousal and anxiety. That was by me. Then we did an amazing episode on sexual side effects of antidepressants with Dr. Aziz. And then last week, we did another episode by me basically going through all of the sexual intrusive thoughts that often people will have, particularly those who have OCD. This week, we are deep diving into menopause and anxiety. This is an incredibly important episode specifically for those who are going through menopause or want to be trained to understand what it is like to go through menopause and how menopause impacts our mental health in terms of sometimes people will have an increase in anxiety or depression. This week, we have an amazing guest coming on because this is not my specialty. I try not to speak on things that I don't feel confident talking about. This week, we have the amazing Dr. Katherine Unverferth. She is an Assistant Clinical Professor at The David Geffen School of Medicine and she also serves as the Director of the Women's Life Center and Medical Director of the Maternal Mental Health Program. She is an expert in reproductive psychiatry, which is why we got her on the show. She specializes in treating women during periods of hormonal transitions in her private practice in Santa Monica. She lectures and researches and studies areas on postpartum depression, antenatal depression, postpartum psychosis, premenstrual dysphoric disorder—which we will cover next week, I promise; we have an amazing guest talking about that—and perimenopausal mood and anxiety disorders. I am so excited to have Dr. Unverferth on the show to talk about menopause and the collision between menopause and anxiety. You are going to get so much amazing information on this show, so I'm just going to head straight over there. Again, thank you so much to our guest. Let's get over to the show. Kimberley: Welcome. I am so honored to have Dr. Katherine Unverferth with us talking today about menopause and anxiety. Thank you for coming on the show. Dr. Katie: Of course. Thanks for having me. HOW DO WE DEFINE PERI-MENOPAUSE AND MENOPAUSE? Kimberley: Okay. I have a ton of questions for you. A lot of these questions were asked from the community, from our crew of people who are really wanting more information about this. We've titled it Menopause and Anxiety, but I want to get really clear, first of all, in terms of the terms and whether we're using them correctly. Can you first define what is menopause, and then we can go from there? Dr. Katie: Definitely. I think when you're talking about menopause, you also have to think about perimenopause. Menopause is defined as the time after the final menstrual period. Meaning, the last menstrual period somebody has. It can only be defined retrospectively, so you typically only know you're in menopause a year after you've had your final menstrual period. But that's the technical definition—after the final menstrual period, it's usually defined one year after. Perimenopause is the time leading up to that where people have hormonal changes. Sometimes they have vasomotor symptoms, they can have mood changes, and that period typically lasts about four years but varies. I think that people often know that they're getting close to menopause because of the perimenopausal symptoms they might be experiencing. Kimberley: Okay. How might somebody know they're going into perimenopause? I think that's how you would say you go into it. Is that right? Dr. Katie: Yeah. You start experiencing it there. I don't know if there's a specific term. Kimberley: Sure. How would one know they're moving in that direction? Dr. Katie: Typically, we look for a few different things. One of the earliest signs is menstrual cycle changes. As someone enters perimenopause, their menstrual cycle starts to lengthen, whereas before, it might have been a normal 28-day cycle. Once it lengthens to greater than seven days, over 35 days, we would start to think of someone might be in perimenopause because it's lengthened significantly from their baseline before. Other symptoms that are

Welcome. This is Week 4 of the Sexual Health and Anxiety Series. I have loved your feedback about this so far. I have loved hearing what is right for you, what is not right for you, getting your perspective on what can be so helpful. A lot of people are saying that they really are grateful that we are covering sexual health and anxiety because it's a topic that we really don't talk enough about. I think there's so much shame in it, and I think that that's something we hopefully can break through today by bringing it into the sunlight and bringing it out into the open and just talking about it as it is, which is just all good and all neutral, and we don't need to judge. Let's go through the series so far. In Episode 1 of the series, we did sexual anxiety or sexual performance anxiety with Lauren Fogel Mersy. Number two, we did understanding arousal and anxiety. A lot of you loved that episode, talking a lot about understanding arousal and anxiety. Then last week, we talked about the sexual side effects of anxiety and depression medication or antidepressants with Dr. Sepehr Aziz. That was such a great episode. This week, we're talking about sexual intrusive thoughts. The way that I structured this is I wanted to first address the common concerns people have about sexual health and intimacy and so forth. Now I want to talk about some of the medical pieces and the human pieces that can really complicate things. In this case, it's your thoughts. The thoughts we have can make a huge impact on how we see ourselves, how we judge ourselves, the meaning we make of it, the identity we give it, and it can be incredibly distressing. My hope today is just to go through and normalize all of these experiences and thoughts and presentations and give you some direction on where you can go from there. Because we do know that your thoughts, as we discussed in the second episode, can impact arousal and your thoughts can impact your sexual anxiety. SEXUAL OCD OBSESSIONS Let's talk a little bit today about specific sexual intrusive thoughts. Now, sexual intrusive thoughts is also known as sexual obsessions. A sexual obsession is like any other obsession, which is, it is a repetitive, UNWANTED—and let's emphasize the unwanted piece—sexual thought. There are all different kinds of sexual intrusive thoughts that you can have. For many of you listening, you may have sexual intrusive thoughts and OCD that get together and make a really big mess in your mind and confuse you and bring on doubt and uncertainty, and like I said before, make you question your identity and all of those things. In addition to these intrusive thoughts, they often can feel very real. Often when people have these sexual intrusive thoughts, again, we all have intrusive thoughts, but if they're sexual in nature, when they're accompanied by anxiety, they can sometimes feel incredibly real, so much so that you start to question everything. SEXUAL SENSATIONS Now, in addition to having sexual intrusive thoughts, some of you have sexual sensations, and we talked a little bit about this in previous episodes. But what I'm really speaking about there is sensations that you would often feel upon arousal. The most common is what we call in the OCD field a groinal response. Some people call it the groinal in and of itself, which is, we know again from previous episodes that when we have sexual thoughts or thoughts that are sexual in nature, we often will feel certain sensations of arousal, whether that be lubrication, swelling, tingling, throbbing. You might simply call it arousal or being turned on. And that is where a lot of people, again, get really confused because they're having these thoughts that they hate, they're unwanted, they're repetitive, they're impacting their life, they're associated with a lot of anxiety and uncertainty, and doubt. And then, now you're having this reaction in your body too, and that groinal response can create a heightened need to engage in compulsions. As we know—we talk about this in ERP School, our online course for OCD; we go through this extensively—when someone has an obsession, a thought, an intrusive thought, it creates uncertainty and anxiety. And then naturally what we do is we engage in a compulsion to reduce or remove that discomfort to give them a short-term sense of relief. But then what ends up happening is that short-term relief ends up reinforcing the original obsession, which means you have it more, and then you go back through the cycle. You cycle on that cycle over and over again. It gets so big. It ends up impacting your life so, so much. INTRUSIVE SEXUAL URGES Now, let's also address while we're here that a lot of you may have intrusive sexual urges. These are also obsessions that we have when you have OCD or OCD-related disorders where you feel like your body is pulling you towards an action to harm someone, to do a sexual act, to some fantasy. You're having this urge that feels like your body is pulling you like a ma

Hello and welcome back everybody. We are on Week 3 of the Sexual Health and Anxiety Series. At first, we talked with the amazing Lauren Fogel Mersy about sexual anxiety or sexual performance anxiety. And then last week, I went into depth about really understanding arousal and anxiety, how certain things will increase arousal, certain things will decrease it, and teaching you how to get to know what is what so that you can have a rich, intimate, fulfilling life. We are now on Week 3. I have to admit, this is an episode that I so have wanted to do for quite a while, mainly because I get asked these questions so often and I actually don't know the answers. It's actually out of my scope. In clinical terms, we call it "out of my scope of practice," meaning the topic we're talking about today is out of my skill set. It's out of my pay grade. It's out of my level of training. What we're talking about this week is the sexual side effects of antidepressants or anxiety medications, the common ones that people have when they are anxious or depressed. Now, as I said to you, this is a medical topic, one in which I am not trained to talk about, so I invited Dr. Sepehr Aziz onto the episode, and he does such a beautiful job, a respectful, kind, compassionate approach to addressing sexual side effects of anxiety medication, sexual side effects of depression medication. It's just beautiful. It's just so beautiful. I feel like I want to almost hand this episode off to every patient when I first start treating them, because I think so often when we're either on medication or we're considering medication, this is a really common concern, one in which people often aren't game to discuss. So, here we are. I'm actually going to leave it right to the doctor, leave it to the pro to talk all about sexual side effects and what you can do, and how you may discuss this with your medical provider. Let's do it. Kimberley: Welcome. I have been wanting to do this interview for so long. I am so excited to have with us Dr. Sepehr Aziz. Thank you so much for being here with us today. Dr. Aziz: Thanks for having me. Kimberley: Okay. I have so many questions we're going to get through as much as we can. Before we get started, just tell us a little about you and your background, and tell us what you want to tell us. Dr. Aziz: Sure. Again, I'm Dr. Sepehr Aziz. I go by "Shepherd," so you can go ahead and call me Shep if you'd like. I'm a psychiatrist. I'm board certified in general adult psychiatry as well as child and adolescent psychiatry by the American Board of Psychiatry and Neurology. I completed medical school and did my residency in UMass where they originally developed mindfulness-based CBT and MBSR. And then I completed my Child and Adolescent training at UCSF. I've been working since then at USC as a Clinical Assistant Professor of Psychiatry there. I see a lot of OCD patients. I do specialize in anxiety disorders and ADHD as well. Kimberley: Which is why you're the perfect person for this job today. Dr. Aziz: Thank you. WHAT ARE THE BEST MEDICATIONS FOR PEOPLE WITH ANXIETY & OCD (IN GENERAL)? Kimberley: I thank you so much for being here. I want to get straight into the big questions that I get asked so regularly and I don't feel qualified to answer myself. What are the best medications for people with anxiety and OCD? Is there a general go-to? Can you give me some explanation on that? Dr. Aziz: As part of my practice, I first and foremost always try to let patients know that the best treatment is always a combination of therapy as well as medications. It's really important to pursue therapy because medications can treat things and they can make it easier to tolerate your anxiety, but ultimately, in order to have sustained change, you really want to have therapy as well. Now, the first-line medications for anxiety and OCD are the same, and that's SSRIs or selective serotonin reuptake inhibitors. SNRIs, which are selective norepinephrine reuptake inhibitors, also work generally, but the best research that we have in the literature is on SSRIs, and that's why they're usually preferred first. There are other medications that also might work, but these are usually first-line, as we call it. There are no specific SSRIs that might work better. We've tried some head-to-head trials sometimes, but there's no one medication that works better than others. It's just tailored depending on the patient and the different side effects of the medication. SSRI'S VS ANTIDEPRESSANTS DEFINITION Kimberley: Right. Just so people are clear in SSRI, a lot of people, and I notice, use the term antidepressant. Are they synonymous or are they different? Dr. Aziz: Originally, they were called antidepressants when they first were released because that was the indication. There was an epidemic of depression and we were really badly looking for medications that would work. Started out with tricyclic antidepressants and then we had MAOIs, and then eventually, we develo

Welcome back, everybody. We are on Episode 2 of the Sexual Health and Anxiety Series. Today, I will be the main host and main speaker for the episode, talking about arousal and anxiety. This is a topic that goes widely misunderstood, particularly in the OCD and anxiety field where people are having arousal that they can't make sense of. It's also very true of people with PTSD. They're having arousal that makes no sense to them, that confuses them, that increases anxiety, increases shame, increases guilt, and from there, it all becomes like a huge mess to them. It becomes incredibly painful, and it's just so messy they can't make sense of it. My hope with this episode is to help you understand the science behind arousal and the science behind arousal and anxiety so that you can move forward and manage your anxiety around arousal and manage your shame and guilt and sadness and grief around arousal, and have a better relationship with your body and with yourself and your soul. Now, these are more difficult conversations. I have talked about them in the past, and so I want you just to go into this really, really gentle, really open with con compassion and kindness, and curiosity. Your curiosity is going to help you immensely as you move through this series, as you move through some of the difficult conversations we're going to have, maybe a little bit embarrassing, humiliating, and so forth. Even me telling my kids that I'm so excited, I'm doing a series on sexual health, they're like, "Mom, you can't talk about that to other people." I'm like, "Yes, I can. We're going to talk about it. Hopefully, when you're old enough, you'll be able to listen to this and you'll be so glad that we're having conversations around this and taking the shame and stigma, and misinformation out of it." I'm going to go straight into the episode. This is our episode on understanding arousal and anxiety. We are going to come on next week talking about an entirely different subject about sexual health and intimacy, sex and anxiety, and arousal and anxiety. I am so excited. Stick around. Enjoy every bit of it. Take as many notes as you can, but please, please be kind to yourself. Let's get to the show. ANXIETY AND AROUSAL Let's get into the episode. Let me preface the episode by, we're talking about anxiety and arousal. If I could have one person on the podcast, it would be Emily Nagoski. I have been trying to get her on the podcast for a while. We will get her on eventually. However, she's off doing amazing things—Netflix specials, podcasts, vet documentaries. She's doing amazing things. Hopefully one day. But until then, I want to really highlight her as the genius behind a lot of these concepts. Emily Nagoski is a doctor, a psychology doctor. She is a sex educator. She's written two amazing books. Well, actually three or four, but the ones I'm referring to today is Come As You Are. It's an amazing book, but I'm actually in my hand holding The Come As You Are Workbook. I strongly encourage you after you listen to this podcast episode to go and order that book. It is amazing. It's got tons of activities. It might feel weird to have the book. You can get it on Kindle if you want to have it be hidden, but it's so filled with amazing information and I'm going to try and give you the pieces that I really want you to take away. If you want more, by all means, go and get the workbook. The workbook is called The Come As You Are Workbook: A Practical Guide to The Science of Sex. The reason I love it is because it's so helpful for those who have anxiety. It's like she's speaking directly to us. She's like, "It's so helpful to have this context." Here's the thing I want you to consider starting off. A lot of people who have anxiety report struggles with arousal. We're going to talk about two different struggles that are the highlight of today. Either you have no arousal because of your anxiety, or you're having arousal at particular times that concern you and confuse you, and alarm you. You could be one or both of those camps. Let's first talk about those who are struggling with arousal in terms of getting aroused. The thing I want you to think about is, commonly, this is true for any mental health issue too. It's true for depression, anxiety disorders, eating disorders, dissociative disorders—all of them really. But the thing I want you to remember, no matter who you are and what your experience is, even if you have a really healthy experience of your own sexual arousal and you're feeling fine about it, we all have what's called inhibitors and exciters. Here is an example: An inhibitor is something that inhibits your arousal. An exciter is something that excites your arousal. Now, you're probably already feeling a ton of judgment here like, "I shouldn't be aroused by this, and I should be aroused by this. What if I'm aroused by this and I shouldn't be," and so forth. I want us to take all the judgment out of this and just look at the content of

You guys, I am literally giggling with excitement over what we are about to do together. Last year, we did a series, the first series on Your Anxiety Toolkit where we talked about mental compulsions. It was a six-part series. We had some of the best therapists and best doctors in the world talking about mental compulsions. It was such a hit. So many people got so much benefit out of it. I loved it so much, and I thought that was fun, let's get back to regular programming. But for the entire of last year after that series, it kept bugging me that I needed to do a series on sexual health and anxiety. It seems like we're not talking about it enough. It seems like everyone has questions, even people on social media. The algorithm actually works against those who are trying to educate people around sex and sexual side effects and arousal and how anxiety impacts it. And so here I am. No one can stop us. Let's do it. This is going to be a six-part sexual health and anxiety series, and today we have a return guest, the amazing Lauren Fogel Mersy. She is the best. She is a sex therapist. She talks all about amazing stuff around sexual desire, sexual arousal, sexual anxiety. She's going to share with you, she has a book coming out, but she is going to kick this series off talking about sexual anxiety, or we actually also compare and contrast sexual performance anxiety because that tends to better explain what some of the people's symptoms are. Once we go through this episode, we're then going to meet me next week where I'm going to go back over. I've done an episode on it before, but we're going to go back over understanding arousal and anxiety. And then we're going to have some amazing doctors talking about medications and sexual side effects. We have an episode on sexual intrusive thoughts. We have an episode on premenstrual anxiety. We also have an episode on menopause and anxiety. My hope is that we can drop down into the topics that aren't being covered enough so that you feel like you've got one series, a place to go that will help you with the many ways in which anxiety can impact us when it comes to our sexual health, our sexual arousal, our sexual intimacy. I am so, so, so excited. Let's get straight to it. This is Episode 1 of the Sexual Health and Anxiety Series with Dr. Lauren Fogel Mersy. Lauren is a licensed psychologist. She's a certified sex therapist, she's an author, and she is going to share with us and we're going to talk in-depth about sexual anxiety. I hope you enjoy the show. I hope you enjoy all of the episodes in this series. I cannot wait to listen to these amazing speakers—Lauren, being the first one. Thank you, Lauren. What Is Sexual Anxiety Or Sexual Performance Anxiety? Are They The Same Thing? Kimberley: Welcome. I am so happy to have you back, Dr. Lauren Fogel Mersy. Welcome. Dr. Lauren: Thank you so much for having me back. I'm glad to be here. Kimberley: I really wanted to deep dive with you. We've already done an episode together. I'm such a joy to have you on. For those of you who want to go back, it's Episode 140 and we really talked there about how anxiety impacts sex. I think that that is really the big conversation. Today, I wanted to deep dive a little deeper into talking specifically about sexual anxiety, or as I did a little bit of research, what some people call sexual performance anxiety. My first question for you is, what is sexual anxiety or what is sexual performance anxiety? Are they the same thing or are they a little different? Dr. Lauren: I think people will use those words interchangeably. It's funny, as you say that, I think that performance anxiety, that word 'performance' in particular, I hear that more among men than I do among women. I think that that might be attributed to so many people's definition of sex is penetration. In order for penetration to be possible, if there's a partner who has a penis involved that that requires an erection. I often hear that word 'performance' attributed to essentially erection anxiety or something to do with, will the erection stay? Will it last? Basically, will penetration be possible and work out? I think I often hear it attributed to that. And then sexual anxiety is a maybe broader term for a whole host of things, I would say, beyond just erection anxiety, which can involve anxiety about being penetrated. It could be anxiety about certain sexual acts like oral sex giving, receiving. It could be about whether your body will respond in the way that you want and hope it to. I think that word, sexual anxiety, that phrasing can encompass a lot of different things. WHAT ARE SOME SEXUAL ANXIETY SYMPTOMS? Kimberley: Yeah. I always think of it as, for me, when I talk with my patients about the anticipatory anxiety of sex as well. Like you said, what's going to happen? Will I orgasm? Will I not? Will they like my body? Will they not? I think that it can be so broad. I love how you define that, how they can be different. That perform

Welcome back, everybody. I had a whole other topic planned to talk with you about today and I've had to basically bench it because I feel so compelled to talk to you about this topic, which is the topic of having fun. Now, you might be having a strong reaction to this and maybe there's a bunch of people who didn't listen because the idea of having fun feels so silly when you are anxious and depressed. It feels like a stupid idea, a ridiculous idea. But the last few weeks have taught me such valuable lessons about mental health. I talk about mental health all the time. That's what I live and breathe pretty much. Sometimes when you have an experience—I keep saying it changes your DNA—I feel to a degree my DNA has been changed these last few weeks and let me share with you why. For those of you who follow me on social media, you will know that in the last couple of weeks, I made a very last-minute trip to the United Kingdom. What happened was pre-COVID, I had booked tickets to visit London for a work event, and COVID happened. I had a certain amount of time to use these tickets, and I actually had thought that those tickets had expired on December 30th of last year. And then one Friday morning, I woke up and checked my email and it said, "You have 18 days until you depart." I'm thinking, 18 days to depart, where? I haven't booked any tickets. Only to find out that my tickets were put on what's called an "open hold," which meant they had just put a date to a trip knowing that I would log in and reschedule it when I was ready. It turned out to be three years later. And then I logged on and saw I have 19 days to use my ticket. I went upstairs, I talked to my husband, and I said, "I have this ticket to the United Kingdom I've never been to. I would really love to go." He said, "You should go. I think it would be really good for you. I'll stay home with the kids. You go." That was the plan. I was going to go, I was going to keep working, I was going to see my clients, but when I wasn't working, I would go out and have British food and maybe go walk around London and maybe visit a castle or two. That was the plan. I was so excited. I happened to mention it to my sister-in-law who I love, and I said, "Ha-ha, you should come." She said, "Oh! No, there's no way I could come and I didn't think anything of it." And then the next morning I woke up, she had messaged me and said, "I've changed my mind. I'm coming." Now, there is a point to this story, which is, my first thought was, "Oh my gosh, that's so exciting." My second thought was, "Oh my gosh, that is scary," because my sister-in-law is the most wonderful human being and she loves to have fun. What was shocking to me is I started to notice I was going to pump the brakes on fun. No, no, no, no, no, no. Oh my gosh. Now quickly, of course, I said, "Come, I'm so excited." We went, but that response was so interesting to me. What it was, was my anxiety did not like the idea that we were going to go and let loose. My anxiety did not like that inhibitory piece, that amygdala deep in my brain was like, "Whoa, whoa, whoa, whoa, pump the brakes. This is going way too fast for me." The reason I'm doing today's episode is I bet you that's what your brain does too. It wants to pump the brakes on fun and pleasure because it creates uncertainty and it creates vulnerability and it creates where things aren't in control anymore. Letting go and having fun is hard when you have anxiety. Letting go and having fun is hard when you have depression. "Yes" Week We went and we called the week "YES week." Actually, I called it "YES week" because I knew this was an exposure I needed to do. We made an agreement that if one person wanted to do something, both of us had to say yes. If someone wanted to try a food, and my sister-in-law loves to try all the different foods, we both had to say yes. It was such a deep exposure experience for me. A deep, oh my gosh, pleasurable. I don't want you to think it was all hard because the truth is, it was all pleasurable and I was so surprised at how my brain kept making problems out of having fun. I'll give you another example. We're sitting at this Indian restaurant. We kept saying to the maitre d' or the people at the front desk, "Tell us the best Indian restaurant. Tell us the best high tea. Tell us the best place to go and have drinks. Tell us the best place to get scotch eggs. Tell us the best place to have Scottish pie. Tell us the best." We kept saying that. We were sitting at this Indian restaurant and my sister-in-law was like, "We'll have one of those and one of those and one of those and one of those." She's a foodie. I could even feel my body going like, "No, no, no, no, that's too much fun." It's so interesting to me how my brain was pumping the breaks on fun and how when you have fun, again, after doing this for one week, I felt like my DNA was changed. I realized how-- I don't want to use the word controlling because I don't consider myself

Today, we're going to talk about the 15 depression symptoms you may not know about. My hope is that it will help you, number one, understand your symptoms, and number two, get help faster. Let's do this. Let's get started. I hope you are well. I hope you are kind and gentle to yourself today. I hope you are taking moments to notice that the trees are changing, the leaves are changing, and spring is here. If you're in the Northern Hemisphere, maybe the weather is changing. Also, if you're in the southern hemisphere, my lovely friends in Australia, I just want to remind you to stop and take note of the weather. It can be one of the most mindful activities we engage in, and it can help us be grounded in the present instead of thinking forward, thinking backward, and ruminating on the past and the future. I hope you can take a minute. We can take a breath right here... and you can actually take in this present moment before we get started. Today, we're talking about 15 depression symptoms you may not know about. As I said in the intro, my hope is that these symptoms help you understand what's going on for you if you're depressed or help you get help faster. Mnemonic For Depression Symptoms Now, some of you may really have a good understanding of depression symptoms. Some of you may know the common ways that it shows up, so I will first address those just to make sure you've got a basic understanding of common depression symptoms. I'm going to actually give you a mnemonic for depression symptoms. I find it's very helpful to have this on hand when I'm assessing my clients and my patients. It's a really good check-in even for myself like, what's going on? Could this be depression? Let's go through this mnemonic for depression. D is for depressed mood. I think we all know about that one. That's a very common Hollywood way of understanding people who are sad, feeling very down, and so forth. We mostly all know the D for depression. E is for energy loss and fatigue. In fact, I did a poll on Instagram. For those of you who don't follow me, go ahead and follow me @youranxietytoolkit. I did a poll and I asked, what are the most painful parts of depression, and the most common response was complete fatigue, complete exhaustion, just overwhelming tiredness and energy loss. I think that that's a really common one. It can be confusing because you're like, "What's going on?" It makes you feel like maybe there's a medical condition going on, but often it is depression. The P is for pleasure loss. Now, this is an important one that we look for in clinical work as we're looking for. Is the person with depression completely at a loss and they're not enjoying the things they used to? Are they struggling to get joy out of even the most joyful things that they used to find joyful? That's a very common one. The R is for retardation or excitation. What we're talking about there is moving very slowly, like a sloth pace or even just sitting there and staring and unable to move your body completely, inability to get motivated to move. Excitation is the other one, which is like you feel very jittery and you feel very on edge and so forth. The E is for eating changes such as appetite increase or decrease, or weight increase or decrease. Again, common symptoms for depression. The S is for sleep changes. It is very common for people with depression to either want to sleep or need to sleep all day, again, because of that energy loss. Or they lay awake for hours at night staring at the roof, unable to sleep, experiencing sleep anxiety, which can often then impact their sleep rhythm. They're sleeping all day, staying awake all night, or vice versa, but in a very lethargic way. The next S is for suicidal thoughts or what we call suicidal ideation. These are thoughts of death, thoughts of dying, and sometimes plans to die. If that is you, please do go and see a mental health professional immediately or go to your ER or call the emergency in whatever country you are. For America, it's 911. Suicidal thoughts are very, very common with depression. We have two types of suicidal thoughts in depression, and that's usually passive suicidal thoughts and then active suicidal thoughts. Passive is thoughts of death, but you just want to crawl under a rock and just go to sleep and never wake up. Active suicidal thoughts is where you're actually wishing to die. It's important to differentiate, and clinically, we do make some changes depending on which is which. The I for depression is "I am a failure." This has a lot to do with shame or loss of confidence and self-esteem issues. "I am a failure" is a big one that often doesn't get disclosed until the person is in therapy. We even did an episode a couple of weeks ago. Depression Is A Liar was the title. Depression tells you all these lies. It tells you you're a failure and you start to believe it. It tells you there's something wrong with you and you start to believe it. That is a very common part of having d

In this episode, we are talking about the emotional toll of OCD. Kim: Welcome back, everybody. This week is going to include three of some of my most favorite people on this entire planet. We have the amazing Chris Trondsen, Alegra Kastens, and Jessica Serber—all dear friends of mine—on the podcast. This is the first time I've done an episode with more than one guest. Now, this was actually a presentation that the four of us did at multiple IOCDF conferences. It was a highly requested topic. We were talking a lot about trauma and OCD, shame and OCD, the stigma of OCD, guilt and OCD, and the depression and grief that goes with OCD. After we presented it, it actually got accepted to multiple different conferences, so we all agreed, after doing it multiple times and having such an amazing turnout, that we should re-record the entire conversation and have it on the podcast. I'm so grateful for the three of them. They all actually join me on Super Bowl Sunday—I might add—to record this episode. I am going to really encourage you to drop down into your vulnerable self and listen to what they have to say, and note the validation and acknowledgment that they give throughout the episode. It is a deep breath. That's what this episode is. Before we get into this show, let me just remind you again that we are recording live the Overcoming Depression course this weekend. On March 11th, March 18th, and March 25th, at 9:00 AM Pacific Standard Time, I will be recording the Overcoming Depression course. I am doing it live this time. If you're interested in coming on live as I record it, you can ask your questions, you can work along with me. There'll be workbooks. I'll be giving you a lot of strategies and a lot of tools to help you overcome depression. If you're interested, go to CBTSchool.com/depression. We will be meeting again, three dates in March, starting tomorrow, the 11th of March, at 9:00 AM Pacific Time. You will need to sign up ahead of time. But if for any reason you miss one of them, you can watch the replay. The replays will be uploaded. You'll have unlimited on-demand access to any of them. You'll get to hear me answering people's questions. This is the first time I've ever recorded a course live. I really felt it was so important to do it live because I knew people would have questions and I wanted to address them step by step in a manageable, bite-sized way. Again, CBTSchool.com/depression, and I will see you there. Let's get over to this incredible episode. Again, thank you, Chris Trondsen. Thank you, Alegra Kastens. Thank you, Jessica Serber. It is an honor to call you my friend and my colleague. Enjoy everybody. Kim: Welcome. This has been long, long. I've been waiting so long to do this and I'm so thrilled. This is my first time having multiple guests at once. I have three amazing guests. I'm going to let them introduce themselves. Jessica, would you like to go first? Jessica: I'm Jessica Serber. I'm a licensed marriage and family therapist, and I have a practice specializing in the treatment of OCD and related anxiety and obsessive-compulsive spectrum disorders in Los Angeles. I'm super passionate about working with OCD because my sister has OCD and I saw her get her life back through treatment. So, I have so much hope for everyone in this treatment process. Kim: Fantastic. So happy to have you. Chris? Chris: Hi everyone. My name is Chris Trondsen. I am also a licensed marriage family therapist here in Orange County, California at a private group practice. Besides being a therapist, I also have OCD myself and body dysmorphic disorder, both of which I specialize in treatment. Because of that, I'm passionate about advocacy. I am one of the lead advocates for the International OCD Foundation, as well as on their board and the board of OCD Southern California, as well as some leadership on some of their special interest groups. Kind of full circle for me, have OCD and now treat it. Kim: Amazing. Alegra? Alegra: My name is Alegra Kastens and I am a licensed therapist in the states of California and New York. I'm the founder of the Center for OCD, Anxiety and Eating Disorders. Like Chris, I have lived experience with OCD, anxiety, eating disorders, and basically everything, so I'm very passionate. We got a lot going on up here. I'm really passionate about treating OCD, educating, advocating for the disorder, and that is what propelled me to pursue a career as a therapist and then also to build my online platform, @obsessivelyeverafter on Instagram. GRIEF AND OCD Kim: Amazing. We have done this presentation before, actually, multiple times over the years. I feel like an area that I want to drop into as deeply as we can today to really look at the emotional toll of having and experiencing and recovering from OCD. We're going to have a real conversation style here. But first, we'll follow the format that we've used in the past. Let's first talk about grief and OCD because I think that that seems to be a lot of

I can barely hold in my excitement! We have a three-day live event where I will teach a new course called Overcoming Depression. I have had all of this passion show up in my body after seeing loved ones and clients struggle and after you guys repeatedly asking for a course on depression. Our new online course called Overcoming Depression is finally here. I will record it live on March 11th, 18th and 25th from 9:00 a.m. to 10:30 a.m. If you are interested, please join me, and I will teach you LIVE, and you can ask all your questions. NOTE: This course will not be considered therapy. Just like all of our courses, it will be educational. Overcoming Depression will be me teaching you the skills I teach my clients when it comes to Psychoeducation and strategies and tools to overcome depression. Head over to CBTSCHOOLcom/depression to sign up! I am so excited to have you guys join me live. Ask your questions in the question box. We will tackle not only your negative thinking but also your behaviors your motivation Self-compassion Long-term recovery techniques I'm so excited and hope to see you there. SIGN UP at CBTschool.com/depression

OCD TREATMENT OPTIONS Today, we have Elizabeth McIngvale and we are talking all about different OCD treatment options. Elizabeth (Liz) McIngvale is the Director of the McLean OCDI Houston. She has an active clinical and research and leadership role there. McLean OCDI is a treatment center for people with OCD and she talks extensively about different OCD treatment options in this episode. She's the perfect one to talk to in this episode about knowing when you need a higher level of care, particularly related to OCD. In this episode, we walk through the different levels of care from self-help all the way through to inpatient facilities. Elizabeth spoke so beautifully about how to know when you're ready for the next step of care, what to look out for, what you should be interested in, and questions you should ask. This is such an important episode. I'm actually blown away that I haven't addressed it yet, but I'm so grateful we got to talk about it today. Elizabeth McIngvale is also a lecturer at Harvard Medical School. She treats obsessive-compulsive disorders, anxiety disorders. She's got a special interest in mental health stigma and access to mental health care. It was actually such an educational episode and I felt like it actually made me a better supervisor to my staff and a better educator as well. You're going to love this episode if you're really wanting to understand and take the stigma out of increasing your care if that's something that you need. That being said, I'm going to let you listen to Elizabeth's amazing words, and I hope you enjoy this episode just as much as I did. Have a great day, everybody. Kimberley Quinlan: Well, welcome, Liz McIngvale. I'm so excited to have you on for two reasons. Number one, I really want to talk about giving people information about OCD treatment options, but I also understand that you can also bring in a personal experience here. Anytime, someone can share their personal experience, just lights me up. So thank you for being here. Elizabeth McIngvale: Thank you for having me. I'm so excited to be here and yeah, I hope that both my personal but also professional kind of background in this arena might help guide. Some individuals who are kind of wondering what treatment do they need right now and and what does treatment for them look like Kimberley Quinlan: Wonderful. Do you want to share a little bit about your history with OCD and your story as much as you want to share? Elizabeth McIngvale: For sure. Yeah, I'll try to not take up too much time but you know, basically, I grew up here in Houston, Texas, where I'm from, and was diagnosed with OCD right around 12. I started showing lots of different symptoms prior on and off, but nothing that was disruptive nothing. That really would have warranted a diagnosis. I would do things like track the weather, or every time I read a book, I would start at page one because I didn't like the feeling if I picked up in between and things like that… Elizabeth McIngvale: but nothing was really out of the norm normal in the sense that I was still doing okay. And academically you know, Relationship-wise and I was functioning well until I wasn't, you know, until my intrusive thoughts, got louder and the disruption became more and more severe. Here in Houston, we have the largest medical center in the world and we are known for our healthcare and so you would think access to good care would be really accessible, but unfortunately, it just wasn't and granted, this was a long time ago, almost 20 years ago but we really started searching for treatment here in Houston and, you know, I was lucky enough that pretty early on I got a diagnosis and for most of us in the OCD world, we know that that's rare for it to happen that soon. So that was great. That was a huge blessing for me, however we couldn't find good treatment. Every provider would say things like we've never seen a case like this. We don't know how to treat this and there's not help available. You guys should assume that Liz live in a mental health hospital, the rest of her life. And so my parents were just really struggling with What do I do and How do I help my child. And so they kept researching and kept trying to figure it out and actually they got lucky enough that they stumbled across the newspaper article and in that newspaper article talked about an inpatient treatment center at the time which was called the Meninger Clinic and how they had an OCD program. There was a little bitty excerpt and immediately my dad, called my mom, they ended up calling Meninger and learning more and I ended up going to the Meninger clinic when I was 15. I went three days after my 15th birthday, I'll never forget and I talk about this a lot because my treatment stay at Meninger was the first step to my life being changed. It was the first step to me getting appropriate treatment. It didn't cure me, you know, I want to be honest about that. I think sometimes we think, okay, we go do that. We

Depression is a liar. If you have depression, the chances are, it's lying to you too. Depression is a very, very common mental health disorder, and it tends to be a very effective liar. My hope today is to get you to see the ways that it lies to you—the ways in which depression lies to you, and gets you to believe things that are not true. I believe that this part of depression, this component of managing depression is so important because the way in which depression lies to us, impacts how we see ourselves in the world, how we see the future, how we see other people, how we see our lives playing out. And that in and of itself can be devastating. Today, I want to talk about, number one, the ways in which depression lies to us and what we can do to manage that. Let's get going. THEMES OF DEPRESSION Before we start, let's talk about the themes of depression. Now, the way it was trained to me is that there are three core themes of depression. The first one being hopelessness, the second one being helplessness, and the third being worthlessness. It will often target one, some, or all of these themes. Let's go through those here and break it down. DEPRESSION LIES ABOUT THE FUTURE This is where it can really make us feel very hopeless. Depression says your future won't be good. You won't amount to anything. You won't be successful. You won't have a relationship if that's important to you. You won't have kids if that's important to you. It often will target the things that we deeply value and it'll tell us you won't get those things or you'll be doing those things wrong. Or in some ways, something bad will happen. When it targets the future, that is often when we begin to feel very hopeless. When we think about the way the human brain works, our brain does things right now, even things it doesn't want to do, knowing that it'll get a benefit or a payoff or a wonderful, joyful result. But if your brain is telling you that the result is always going to be bad, that's going to create an experience where you feel like there's no point. What's the point of doing this hard thing if my depression is telling me the future is going to be crummy anyway? What we want to do is get very skilled at catching it in its lies about the future. DEPRESSION LIES ABOUT THE PAST Depression will tell you, you did something wrong. You're terrible. That thing you did really ruined your life or ruined somebody else's life, or is proof that you're a bad person. Depression loves to ruminate on that specific event or an array of events. What we end up doing is cycling and gathering evidence. This is what depression does. It gathers evidence to back its point. What we end up doing is instead of seeing the event for what it is, which is both probably positive and negative, depression likes to magnify all of the things that you did wrong or that didn't go well. And then it wants to disqualify the positive. Often patients of mine with depression will say, "Oh, I'm a terrible person. I did this terrible thing," or "I made this terrible mistake or accident." I'll look and say, "Okay, but what about the other times where maybe you didn't make a mistake and so forth?" They will disqualify that as if it means nothing to them. It does mean something to them, but often the way in fact depression functions is it keeps you looking at the negative. And that's how you get stuck in that cycle of rumination on the negative—feeling worse and worse, feeling more shame, feeling more guilt, feeling more dread, feeling often numb because the depression is so, so strong. Now, this is where I'm going to offer to you to reframe things a little bit and look at helplessness. Depression will also tell us: "There is no one who can help you. There is no amount of support that can help you. You're helpless." Often when people come to me for their first time in session, they will say, "I'm here. I understand you can help me. But at the end of the day, I don't even think you can help me." Maybe they've read one of my articles on the internet or they've listened to a podcast and they go, "You're speaking to exactly what I'm going through, but I still don't even believe you can help me." This is where I can give them all the science and show them that I can help them and that there's treatment for depression, and it's very science-based. The depression will still lie to them and say, "There's no point. You're helpless." Now, the last piece here is about worth, and I'll touch on that here in just a little bit. Before we move into that, I want to share with you that the reason I was so excited to talk about this with you today is I'm in the process of creating a course for OCD. I'm contributing this to a bigger company and I will be creating it. You guys can have access to it too here very soon. As I was creating it, I was really starting to see and talk to a lot of people with depression and talk to people on social media. The biggest message people were saying is, "OCD lies to m

Transcript Kimberley Quinlan: Well welcome, I cannot believe this is so exciting. I've been looking forward to this episode all week. We have the amazing. Reverend Katie O'Dunne with us to talk all about scrupulosity and religious obsessions. So welcome, Katie. Katie O'Dunne: Thank you. I'm so excited to be here and to chat about all things Faith and OCD. So thanks for having me. Kimberley Quinlan: Yeah, so let me just quickly share in ERP school we have these underneath every training, every video. There's a little question and answer and I'm very confident in answering them, but when it comes to the specifics of religion, I always try to refer to someone who is, like an expert. And so this is so timely because I feel like you are perfect to answer some of these questions. Some of the questions we have here are from, ERP school. A lot of them are from social media and so I'm so excited to chat with you. Katie O'Dunne: Thank you. Kimberley Quinlan: So tell us before we get into the questions, a little about your story and you know why you are here today? Katie O'Dunne: Yeah. So I've navigated OCD since before I can remember, but just like maybe a lot of folks listening. I was very private about that for a very long time. I had a lot of shame around, intrusive thoughts. I had a lot of shame around religious obsessions that I had, moral related obsessions, harm obsessions. And this shame particularly came because I was pursuing ministry and OCD really spiked in the midst of me going to graduate school, going to seminary. And when I was in seminary and I started really struggling, I wanted to seek treatment for the first time and was told really by a mentor that it would not help me to do that. In my ministry that I wouldn't pass my psych evaluations and that I shouldn't pursue treatment that I needed to keep that on the down low. So as many of us know, that might not get that effective evidence-based treatment I continued to get sicker Katie O'Dunne: And had a really pretty full-blown OCD episode in my first role in ministry. Katie O'Dunne: So I ended up in school chaplaincy working, with lots of students from different faith backgrounds, some of what we'll be talking about today, through an OCD lens. And I was trying to keep my OCD a secret, but in the midst of navigating, some difficult tragedies and traumas with students, my OCD latched on to every aspect of what I was navigating. And particularly in the midst of that, I was experiencing losses and mental health crises with students from different faith backgrounds. And when I came out of my own treatment, where exposure and response prevention, very much saved my life. I felt like, I had an obligation to those students that I worked with to let them know that their chaplain, that their faith leader had gone through mental health treatment and that there was no shame around doing that. And I went from the space, in seminary of being told that I shouldn't seek treatment to a space of having families call me for the first time and say, Oh now we can actually talk to you about what's going on in our life. Can you help us talk with our rabbi or our imam, or our priest about my child's diagnosis? How can we reconcile faith with treatment and that opened the door for me to continue this work in a full-time way. Where moving from those students that I love so much and now work in the area of faith and OCD full-time helping folks, navigate religious scrupulosity and very much lean into evidence-based treatment while also reconnecting with their faith in ways that are value driven to them and not dictated by OCD. Kimberley Quinlan: Hmm, it makes me teary. Just to hear you say that folks were saying, Well, now, I can share with you. That is so interesting to me. You know, I think of a reverend, as like, you can go to them with anything, you know, and for them to say that you're disclosing has open some doors, that's incredible. Katie O'Dunne: And particularly, I worked really heavily with my Hindu and Muslim students. And we had the chance to do some really awesome mental health initiatives for the South Asian community, where students started then doing projects actually in their own faith communities, and opening up about their own journeys, and then giving other space to do the same. And I really, I think about the work I do now, which is very much across faith traditions around OCD. And every person I work with, I think of those awesomely brave students, who started to come to me after my disclosure and say, Okay, we want help and also we want to share our stories and continues to inspire me. DOES RELIGIOUS OCD/SCRUPULOSITY SHOW UP BEYOND THE CHRISTIAN RELIGION? Kimberley Quinlan: Yeah, so cool! It leads me to my first question which is, does this for OCD religious scrupulosity, have you found, and I definitely have, that It goes outside of just the Christian religion. I know we hear a lot about just the Christian religion, but can you kind of give me your exper

5 TIPS FOR HEALTH ANXIETY DURING A DRS VISIT If you want my five tips for health anxiety during a Drs visit, especially if you have a medical condition that concerns you, this is the episode for you. Hello and welcome back everybody. Today, I'm going to share some updates about a recent medical issue I have had, and I'm going to share specific tips for dealing with health anxiety (also known as hypochondria). A lot of you who have been here with me before know I have postural orthostatic tachycardic syndrome. I also have a lesion on my left cerebellum and many other ups and downs in my medical history where I've had to get really good at managing my health anxiety. I wanted to share with you some real-time tips that I am practicing as I deal with another medical illness or another medical concern that I wanted to share with you. Here I'm going to share with you five specific tips, but I think in total, there's 20-something tips all woven in here. I've done my best to put them into just five. But do make sure you listen to the end of the podcast episode because I'm also going to give some health anxiety journal prompts or questions that you can ask yourself so that you can know how to deal with health anxiety if you're experiencing that at this time. Before we get into it, let me give you a little bit of a backstory. Several months ago, I did share that I've been having these what I call surges. They're like adrenaline surges. They wake me up. My heart isn't racing. It's not like it's racing fast, but the only way I can explain it is I feel like I have like a racehorse's heart in my chest, like this huge heart that's beating really heavily. Of course, that creates anxiety. And so then I would question like, is it the heartbeat or is it just my anxiety? You go back and you go forward trying to figure out which is which. But because this was a symptom that was persisting and was also showing up when I wasn't experiencing a lot of stress or anxiety, I thought the right thing to do is to go and see the doctor. WHAT HEALTH ANXIETY FEELS LIKE Before we get started, be sure to make sure you're not avoiding doctors. Make sure you're not dismissing symptoms. We do have to find a very, very wise balance between avoiding doctors but also not overdoing it with doctors. We'll talk about that a little bit here in a minute. But first, I wanted to just share with you what health anxiety feels like for me. Because for me, I'm very, very skilled at identifying what is anxiety and what is not. I've become very good at catching that by experience, folks. It's not something that comes naturally, but by experience, I can identify what is health anxiety and what is a real medical condition or what is something worthy of me getting checked out. For me, for the health anxiety piece, it's really this sort of anxiety that is a sense of catastrophization and it's usually in the form of thoughts like, what if this is cancer? What if this is a stroke? All the worst-case scenarios. What if this is life-threatening? What if I miss this and you are responsible, you should have picked it up. These are very common health anxiety intrusive thoughts or health anxiety thoughts that I think you really need to be able to catch and be aware and mindful of. First of all, that is the biggest symptom for me. The other thing is when you have health anxiety, you do tend to hyper-fixate on the symptom and all of the surrounding symptoms that are going with that. And then you can really catastrophize those like, "Well, my heart's beating really heavily and I feel dizzy. Oh my gosh. And I've been having a headache. Yeah, you're right, I've been having a headache. Oh my gosh." I call it 'gathering.' That's not an actual clinical term, but I do use it with my clients. We gather data that is catastrophic to make it seem like, yeah, we actually have a really big point, and this is actually a catastrophe. Some other health anxiety symptom that I experience is panic. When you notice a symptom, it is very common to start panicking. And then again, you go back to this chicken or the egg or is it the horse or the carriage in terms of I'm panicking, and now the panic has all these symptoms. Are these symptoms an actual medical condition or are they actually just anxiety and panic? You could spend a lot of time stuck in that cycle trying to figure that out. Let's now talk about how to manage these symptoms and some tips and tools that you can use. Tip #1: No Googling Let me tell you what has recently happened to me. I've been having these symptoms. I made an appointment to see my cardiologist. It was two months out and I was like, "It's not a big deal. I can handle these symptoms." I'm feeling super confident about my ability now to just ride out some pretty uncomfortable sensations and not catastrophize. I go in for my checkup, they do an echocardiogram, and it's taking a long time. She's asking me these strange questions like, "Why are you here again," as she's doi

5 TIPS FOR HEALTH ANXIETY DURING A DRS VISIT If you want my five tips for health anxiety during a Drs visit, especially if you have a medical condition that concerns you, this is the episode for you. Hello and welcome back everybody. Today, I'm going to share some updates about a recent medical issue I have had, and I'm going to share specific tips for dealing with health anxiety (also known as hypochondria). A lot of you who have been here with me before know I have postural orthostatic tachycardic syndrome. I also have a lesion on my left cerebellum and many other ups and downs in my medical history where I've had to get really good at managing my health anxiety. I wanted to share with you some real-time tips that I am practicing as I deal with another medical illness or another medical concern that I wanted to share with you. Here I'm going to share with you five specific tips, but I think in total, there's 20-something tips all woven in here. I've done my best to put them into just five. But do make sure you listen to the end of the podcast episode because I'm also going to give some health anxiety journal prompts or questions that you can ask yourself so that you can know how to deal with health anxiety if you're experiencing that at this time. Before we get into it, let me give you a little bit of a backstory. Several months ago, I did share that I've been having these what I call surges. They're like adrenaline surges. They wake me up. My heart isn't racing. It's not like it's racing fast, but the only way I can explain it is I feel like I have like a racehorse's heart in my chest, like this huge heart that's beating really heavily. Of course, that creates anxiety. And so then I would question like, is it the heartbeat or is it just my anxiety? You go back and you go forward trying to figure out which is which. But because this was a symptom that was persisting and was also showing up when I wasn't experiencing a lot of stress or anxiety, I thought the right thing to do is to go and see the doctor. WHAT HEALTH ANXIETY FEELS LIKE Before we get started, be sure to make sure you're not avoiding doctors. Make sure you're not dismissing symptoms. We do have to find a very, very wise balance between avoiding doctors but also not overdoing it with doctors. We'll talk about that a little bit here in a minute. But first, I wanted to just share with you what health anxiety feels like for me. Because for me, I'm very, very skilled at identifying what is anxiety and what is not. I've become very good at catching that by experience, folks. It's not something that comes naturally, but by experience, I can identify what is health anxiety and what is a real medical condition or what is something worthy of me getting checked out. For me, for the health anxiety piece, it's really this sort of anxiety that is a sense of catastrophization and it's usually in the form of thoughts like, what if this is cancer? What if this is a stroke? All the worst-case scenarios. What if this is life-threatening? What if I miss this and you are responsible, you should have picked it up. These are very common health anxiety intrusive thoughts or health anxiety thoughts that I think you really need to be able to catch and be aware and mindful of. First of all, that is the biggest symptom for me. The other thing is when you have health anxiety, you do tend to hyper-fixate on the symptom and all of the surrounding symptoms that are going with that. And then you can really catastrophize those like, "Well, my heart's beating really heavily and I feel dizzy. Oh my gosh. And I've been having a headache. Yeah, you're right, I've been having a headache. Oh my gosh." I call it 'gathering.' That's not an actual clinical term, but I do use it with my clients. We gather data that is catastrophic to make it seem like, yeah, we actually have a really big point, and this is actually a catastrophe. Some other health anxiety symptom that I experience is panic. When you notice a symptom, it is very common to start panicking. And then again, you go back to this chicken or the egg or is it the horse or the carriage in terms of I'm panicking, and now the panic has all these symptoms. Are these symptoms an actual medical condition or are they actually just anxiety and panic? You could spend a lot of time stuck in that cycle trying to figure that out. Let's now talk about how to manage these symptoms and some tips and tools that you can use. Tip #1: No Googling Let me tell you what has recently happened to me. I've been having these symptoms. I made an appointment to see my cardiologist. It was two months out and I was like, "It's not a big deal. I can handle these symptoms." I'm feeling super confident about my ability now to just ride out some pretty uncomfortable sensations and not catastrophize. I go in for my checkup, they do an echocardiogram, and it's taking a long time. She's asking me these strange questions like, "Why are you here again," as she's doi

5 TIPS FOR HEALTH ANXIETY DURING A DRS VISIT If you want my five tips for health anxiety during a Drs visit, especially if you have a medical condition that concerns you, this is the episode for you. Hello and welcome back everybody. Today, I'm going to share some updates about a recent medical issue I have had, and I'm going to share specific tips for dealing with health anxiety (also known as hypochondria). A lot of you who have been here with me before know I have postural orthostatic tachycardic syndrome. I also have a lesion on my left cerebellum and many other ups and downs in my medical history where I've had to get really good at managing my health anxiety. I wanted to share with you some real-time tips that I am practicing as I deal with another medical illness or another medical concern that I wanted to share with you. Here I'm going to share with you five specific tips, but I think in total, there's 20-something tips all woven in here. I've done my best to put them into just five. But do make sure you listen to the end of the podcast episode because I'm also going to give some health anxiety journal prompts or questions that you can ask yourself so that you can know how to deal with health anxiety if you're experiencing that at this time. Before we get into it, let me give you a little bit of a backstory. Several months ago, I did share that I've been having these what I call surges. They're like adrenaline surges. They wake me up. My heart isn't racing. It's not like it's racing fast, but the only way I can explain it is I feel like I have like a racehorse's heart in my chest, like this huge heart that's beating really heavily. Of course, that creates anxiety. And so then I would question like, is it the heartbeat or is it just my anxiety? You go back and you go forward trying to figure out which is which. But because this was a symptom that was persisting and was also showing up when I wasn't experiencing a lot of stress or anxiety, I thought the right thing to do is to go and see the doctor. WHAT HEALTH ANXIETY FEELS LIKE Before we get started, be sure to make sure you're not avoiding doctors. Make sure you're not dismissing symptoms. We do have to find a very, very wise balance between avoiding doctors but also not overdoing it with doctors. We'll talk about that a little bit here in a minute. But first, I wanted to just share with you what health anxiety feels like for me. Because for me, I'm very, very skilled at identifying what is anxiety and what is not. I've become very good at catching that by experience, folks. It's not something that comes naturally, but by experience, I can identify what is health anxiety and what is a real medical condition or what is something worthy of me getting checked out. For me, for the health anxiety piece, it's really this sort of anxiety that is a sense of catastrophization and it's usually in the form of thoughts like, what if this is cancer? What if this is a stroke? All the worst-case scenarios. What if this is life-threatening? What if I miss this and you are responsible, you should have picked it up. These are very common health anxiety intrusive thoughts or health anxiety thoughts that I think you really need to be able to catch and be aware and mindful of. First of all, that is the biggest symptom for me. The other thing is when you have health anxiety, you do tend to hyper-fixate on the symptom and all of the surrounding symptoms that are going with that. And then you can really catastrophize those like, "Well, my heart's beating really heavily and I feel dizzy. Oh my gosh. And I've been having a headache. Yeah, you're right, I've been having a headache. Oh my gosh." I call it 'gathering.' That's not an actual clinical term, but I do use it with my clients. We gather data that is catastrophic to make it seem like, yeah, we actually have a really big point, and this is actually a catastrophe. Some other health anxiety symptom that I experience is panic. When you notice a symptom, it is very common to start panicking. And then again, you go back to this chicken or the egg or is it the horse or the carriage in terms of I'm panicking, and now the panic has all these symptoms. Are these symptoms an actual medical condition or are they actually just anxiety and panic? You could spend a lot of time stuck in that cycle trying to figure that out. Let's now talk about how to manage these symptoms and some tips and tools that you can use. Tip #1: No Googling Let me tell you what has recently happened to me. I've been having these symptoms. I made an appointment to see my cardiologist. It was two months out and I was like, "It's not a big deal. I can handle these symptoms." I'm feeling super confident about my ability now to just ride out some pretty uncomfortable sensations and not catastrophize. I go in for my checkup, they do an echocardiogram, and it's taking a long time. She's asking me these strange questions like, "Why are you here again," as she's doi