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Finding Your Perfect Rest-to-Productivity Ratio The Burnout Dilemma Ever felt like you’re constantly running on empty, juggling a never-ending to-do list, and battling that nagging voice that tells you you’re not doing enough?  You’re not alone.  In a world that glorifies hustle and productivity, finding the right balance between rest and work can feel impossible.  But what if I told you that striking this balance is not only achievable but essential for your well-being? Today, let's dive into the concept of the rest-to-productivity ratio—a game-changing approach to ensure you’re resting enough to fuel your productivity and thrive without burning out.

In today’s discussion, we’re delving into the seven mistakes some OCD therapists are making in 2024. While the title might seem provocative, the goal is to highlight concerning trends in OCD treatment and provide insights that could enhance therapeutic approaches. Remember, this is my opinion based on what I've observed in various forums. I don't claim to have all the answers, but I hope to spark a constructive conversation. Mistake #1: Insufficient Initial Education Importance of Education at the Start of Treatment Many clients report feeling thrown into exposure and response prevention (ERP) without adequate preparation. Therapists must take the time to educate clients about OCD, their obsessions, and compulsions, and what to expect from treatment. This foundational knowledge empowers clients, giving them a sense of control and a clearer understanding of their journey. Mistake #2: Failing to Instill Hope and Confidence The Power of Hope in Treatment Therapists must remind clients that they have the potential to succeed. Treatment for OCD can be highly effective, and it's crucial to communicate this. While maintaining a realistic perspective, therapists should focus on the positive aspects of available treatments and instill a sense of hope and confidence in clients. Mistake #3: Neglecting Evidence-Based Modalities Therapists should prioritize evidence-based treatments, particularly ERP. While it's important to integrate supplementary approaches like ACT, mindfulness, and self-compassion, the core of OCD treatment should be grounded in proven methodologies. Clinicians need to stay informed and ensure their clients understand the rationale behind chosen treatments. Mistake #4: Misconceptions About ERP Being Traumatic ERP: Not Abusive When Properly Delivered Concerns about ERP being traumatic often stem from poor delivery rather than the method itself. Proper education and a strong therapist-client rapport can mitigate these fears. It’s vital to ensure clients understand why they’re facing their fears and to provide a supportive environment throughout the process. Mistake #5: Rigid ERP Plans Flexibility in Treatment While structured plans are important, rigid adherence can be detrimental. Treatment should be flexible and tailored to the client's evolving needs. Engaging clients in the planning process and adapting as necessary ensures that the therapy remains client-centered and effective. Mistake #6: Overlooking Barriers to Progress Exploring Underlying Issues When clients struggle with certain exposures, therapists should explore the underlying barriers. Understanding the client's fears, trust issues, or other relational dynamics can provide insights that help adjust the treatment plan accordingly. This approach prevents avoidance behaviors from taking hold. Mistake #7: Not Assigning Homework The Role of Homework in OCD Treatment Homework is a critical component of OCD treatment. Without it, progress can be significantly hindered. Therapists should find creative ways to ensure clients complete their assignments, offering support and accountability measures. This empowers clients to practice skills outside sessions, enhancing overall treatment efficacy. Conclusion These seven mistakes highlight areas where OCD treatment can improve. It's essential for therapists to remain flexible, informed, and supportive, tailoring their approaches to each client's unique needs. Open communication and a collaborative mindset can help address these common pitfalls, ultimately leading to more effective and compassionate care. Remember, this discussion aims to foster growth and improvement. If you're a client, don't hesitate to discuss these points with your therapist. Together, we can create a more effective and empathetic therapeutic environment. Transcript Today we’re talking about the seven mistakes some OCD therapists are making in 2024. Now, I know the title sounds spicy, but in no way am I trying to be spicy. What my goal is today is to talk to you about some of the things I’ve heard, whether that be on social media, on podcasts, on blogs, or at conferences, when people are talking about the treatment of OCD that deeply concern me.  Now, let me first say, in no way do I consider myself the moral police on OCD treatment. In no way do I believe that I am the knower of all things. In no way do I think that I know more than other people, my way or the highway. That is absolutely not what I’m saying here today.  However, I am going to give you my opinion on some of the things that I hear that deeply concern me. I’m just here to share what I think is helpful. I hope, if anything, it’s here to really reassure clinicians that they’re on the right track because there are some amazing, amazing OCD specialists out there. If not, if this is something that you may find is calling you out a little, please, I’m here to hopefully bring some goodness into the world. Let’s talk about the seven mistakes some OCD therapists are making in 2024. As I said, this is all about my opinion. Again, in no way am I the moral police, but let’s talk about it. My guess is you’re probably going to agree with everything I say. If not, I’m totally okay with being disagreed with.  Mistake #1: Not spending enough time at the beginning of treatment educating their client about the research and the science-backed treatment approaches that are here ready for us to use for OCD So often, I hear clients saying in my office that they had this experience of ERP exposure and response prevention where they were just thrown into it, and they were like, “Let’s just go.” I get that. I love an eager therapist. I love a therapist that’s not going to waste people’s time, but we have to spend a lot of time in the beginning educating them about the condition of OCD, helping them to understand their obsessions and their compulsions and how we get stuck in them and how they can be so seductive and how they can trick us, and also talking about what’s coming, what treatment’s going to look like, and what you can expect.  We have to spend a lot of time talking about that as well so that the person who’s engaging in this treatment feels a sense of mastery over what’s about to happen. They feel like they can make decisions as they go because they’ve got a plan. They can see them crossing the finish line. They can keep that. They know what that’s going to look like, and they can use that to inform their decisions and how they connect and communicate with the clinician. Mistake #2: Not instilling hope and confidence in the client We have to remind our clients that they have everything that they need, that the treatment can be very, very successful, and that it’s an experiment. We don’t have to get it perfect the first time. This is a collaborative experience. There’s a lot of hope here that by us collaborating and by us talking through what’s working and what’s not working and having them understand that this is actually a really good thing to have in terms of there are many conditions that the treatment sucks, the treatment isn’t that effective. The treatment doesn’t help as much as it does with OCD.  I never want to do the toxic positive thing with clients, but I also want them to acknowledge the conditions. This is one that we actually have some good research on. We have some good treatment options. We have these great supplement modalities that can help us along the way. We want to infuse them with hope. We want to infuse them with confidence in this process. I do often see particularly younger therapists not spending enough time really bringing a sense of hope to treatment because it’s so scary. They’re already in so much pain. They’ve probably been through treatment that sucked in the past. What we want to do is really focus on that hope, because hope is often what motivates us to take those first baby steps.  Mistake #3: Not engaging in evidence-based modalities This is a huge one. I could spend a whole podcast episode or a week on this topic. There is so much misinformation about treatment and what is considered evidence-based.  Now again, I’m not here to tell anybody what their treatment should look like. That’s a personal decision, and every client gets to make that decision. Who am I to judge? People need to come and know that they have agency over their lives and the decisions they make. But clinicians should be educated, and they should educate their clients on the options for evidence-based treatment modalities.  Now, I am a huge supporter of exposure and response prevention. I have been trained in it. I have been doing it for 14 years. I have seen it succeed over and over and over and over again. As I’ve been public in saying, I see no reason to abandon that.  Now, that’s not to say that I haven’t introduced modalities that supplement ERP. I love the use of ACT. I love the use of mindfulness-based cognitive therapies. I love the application of self-compassion. In many cases, I have applied dialectical behavioral health therapy to clients who are struggling with emotional regulation. Maybe they’re having self-harm or suicidal ideation. Absolutely. As time continues, we’re seeing newer approaches and modalities come up. But I see it in my job as a clinician to educate my clients on the treatment, what has worked, and what I’m skilled at doing too.  The other thing is there is some research on other treatment modalities besides ERP. I think that’s wonderful. I mean, my hope is that one day we have something that is a sure thing, 100%, and we can absolutely promise that we’ve got guaranteed results. This is going to be something that I continue to learn and educate myself on, but my opinion is that I’m sticking with ERP. I love it. I find it so helpful and empowering. It lines up with everything and my treatment that has helped me. For those who are wondering, I am a committed ERP therapist. Mistake #4: Saying that ERP is traumatic or abusive Now, in fact, this concerns me so much that I did an entire episode with Amy Mariaskin. It’s Episode 365. We talk specifically about this very sensitive and important topic, “Is ERP abusive?” What came from that episode, which is very similar to this one, is I don’t actually feel like ERP is an abusive treatment modality. I think that sometimes how it’s delivered can be concerning, but that’s the truth for any treatment modality. You could say the same about cognitive behavioral therapy. We could say the same about any medical treatment in terms of how the delivery can determine whether it harms people who are vulnerable. One thing that I will be very clear, and I believe this in my heart, is the narrative that exposures, that facing your fears is mean, is a traumatic experience. I agree that if you’re having someone face their fear without giving them the education that they need and not explaining to them why they’re doing it -- believe me, guys, let me also disclose here. I’ve made a lot of these mistakes myself as a clinician. Let’s just be open. I have been in this particular situation. Actually, if I’m going to be really honest with you, number one, that mistake of not educating your clients, I learned that by a client telling me, “Kimberly, I do not understand why you’re having me do what you’re doing. I’m someone who needs to know what I’m doing, or I’m not going to trust you. Slow down and tell me what this looks like.” Again, no judgment over here. I’ve made a lot of these mistakes myself. But I think that throwing people too fast and too hard can feel very overwhelming, very activating.  Again, these are things we learn as we get better. Every clinician makes mistakes. That’s what makes them good clinicians. In no way do I want clinicians to feel blamed or judged here. We’re human beings. We’re doing the best we can, and every client is different. Sometimes we also need to build a rapport with clients so that they can share with us. We talked about that in the episode with Amy.  The most important piece here is having a rapport and a connection of trust and respect so that the client knows that they can tell us that this doesn’t feel right, that this crosses my values, my limits, and my boundaries. This doesn’t feel like it’s something that lines up with my values. We can have a conversation about that and be respectful about, “This is what works for me in this relationship, and this is what’s not,” or “Here are my concerns about ERP. Could you help me to work through this, or could we consider having a conversation before we move forward?” I think that’s what also helps this from being experienced as a trauma as well.  But if this is something that is a hot topic for you, go and listen to that because it’s such an important, compassionate, respectful episode. Amy did a beautiful job of going deeper into this specific topic.  Mistake #5: Following an ERP plan that has zero flexibility I get it. When I first started as an OCD therapist, I was trained to use a very structured exposure and response prevention plan. There were modules and systems, and you had to follow the manual. I loved my training. My training literally set me up. It was some of the best OCD training I think anyone could ask for. But there were times when I stuck to the plan so diligently that I missed the client. I missed their needs. I missed hearing from the client on what they think the next step is.  Now, what I have found to be so beneficial is to talk to the client. What would you like to do next? This is our plan that we originally made together because we talked about it at the beginning of treatment. Do you feel like you’re ready to take this next step? What’s getting in the way of you taking this next step? Let’s discuss. Is this the right step based on what we thought we knew, or are we going to shift it up now?  I think that the flexibility in treatment helps teach clients how to be flexible in their daily lives as well. We don’t want to follow a rigid plan unless there’s some clinical reason to do so. I think we also have to understand here that some intensive treatment programs require really rigid plans because of the severity of the disorder. Absolutely, I completely get that. But I think where we’re really going with that is it has to be individualized. We have to understand the client’s needs in order to make a plan. And then from there, we can decide what’s best. But we have to stay away from rigidity.  I also don’t love any treatment modality that has modules that make the clients go through modules because, again, I think it misses the client, where they’re at, what their needs are, and what else is going on in their life. Again, every clinician delivers it differently. I respect every clinician to know what’s best for their clients, but it’s something that we can look out for. Mistake #6: Moving on without exploring what was getting in the way Let’s say you had a treatment plan and the client said, “Ah, that doesn’t work for me.” And then you just say, “Okay, fine,” and you move on without slowing down and getting curious. Tell me about that. What’s getting in the way of you being able to do this exposure? Is there an obsession I’m not aware of? Is there something else happening that’s happening relationally, or is there a trust issue or rapport issue between you and I that might be getting in the way of us not completing that part of the treatment plan that we had originally agreed would be helpful for you?  It’s really important, and I’ve seen this with my own staff, with my own consultation with other clinicians. Moving on too quickly can allow OCD to get sneaky and help them engage in avoidant compulsions. We have to be really careful about not engaging in compulsions with our clients. Sometimes our client’s OCD can be very convincing in getting us to not address certain issues because of an avoidant compulsion.  Again, complete transparency. I’ve been there a million times, so absolutely no judgment here. These are all things we just have to keep an eye out for and do the best that we can. Consult as much as we can. Do a little check-in with ourselves. I try to do a check-in every week. How is each client going? How are they doing? Where am I stuck? Where are they stuck? Am I having any blind spots here for this client? And this could be one where there’s a real big blind spot. Mistake #7: Not assigning homework to clients This one is so hard. Again, I’ve been there. Often, when clients are in a lot of distress and they have a busy life, a family, or a job, we might assign homework, and they might show up on Tuesday at nine o’clock and say, “I’m so sorry, I didn’t do my homework.” You say, “Not a problem. Let’s try and get it done this week.” Send them home with the homework. Next Tuesday at nine o'clock, they show up and still haven’t done their homework. Sometimes, I see this a lot, therapists go, “Okay, they’re not someone who does their homework. I’ll pivot, and I’ll make sure we’re doing extra exposures in session.”  That’s a really great pivot. But I would usually stop there and have a conversation with the client and really help them understand, not from a place of judgment or shame, but that their success in treatment goes way down when they stop engaging in their homework assignments. We have to really stress to clients that one hour a week is not enough and that we have to find creative ways and motivation tools to help them make sure they’re engaging in their assigned homework.  I have allowed clients to send me the thumbs-up emoji in an email to show me that they’ve done it, or maybe they’ve called into my voicemail to confirm that they’ve completed their homework. Again, I don’t make them do this, but I always offer them, what can I do? What service can I offer you that will help you stay accountable for your homework? Because for every minute of homework you do, you have massively pushed the needle in the success of your treatment. I often see a lot of clinicians just disregard homework and say, “It’d be great if they did it, but they won’t.” I would stop and pause there and really explore with the client and make sure they understood that treatment won’t be that super successful if they’re not engaging in homework.  Again, we want to get creative. We want to collaborate with them as much as we can.  What can we do to help get that homework done?  Can we set more realistic goals?  Can we stack it onto another routine that you do?  Can we help with accountability?  Can we bring in a loved one or someone who can support you?  What can we do to help increase the chances of you getting better?  Because I always say to my patients, my hope for this treatment is to teach you everything I know so that you can be your own therapist. Not to say that I don’t want to treat you, and I think you shouldn’t need a therapist. I just want you to be trained to think about it so that when you’re at home and you’re struggling or maybe you’re in recovery, but you have a little lapse, you can recall, “Oh, I remember the steps. I remember what I need to do. I feel empowered. I know this works. I’m going to get to it and trial that first.” There are the seven mistakes some OCD therapists are making in 2024. Please know, there is zero judgment here. Please also know, this is just my opinion. I fully respect that every clinician is going to come from a different perspective. I fully believe that every clinician comes and sees their client and has the ability to really meet them where they are. I just wanted to bring this up because these are topics I’m discussing with my staff, and I think that it’s something that maybe would help you today.  I’m going to send you off with a big, loving hug and remind you that today is a beautiful day to do hard things.  If you’re a client and your therapist is engaging in some of these behaviors, don’t be afraid to bring it up. We’re a collaborative team here. I always tell my patients, I want to hear your honest feedback. I want to hear if something’s not working for you because that helps you, and I’m in the business of helping.  Have a wonderful day. I’ll see you next week.

9 Ways to Stop Picking Your Skin This Summer As summer approaches and the weather gets hotter, many of us are eager to wear shorter sleeves and enjoy the sun. However, this often leads to increased skin exposure and, unfortunately, a greater temptation to pick at our skin. In today's article, we'll explore nine strategies to help you stop picking your skin this summer. These tips have been helpful to many of my clients, and I hope they will be just as beneficial for you. Understanding Skin Picking Before we dive into the strategies, it's important to understand what skin picking is. Clinically known as dermatillomania, skin picking is a type of body-focused repetitive behavior (BFRB). People with this condition may pick at their skin, arms, lips, scalp, nails, and even more sensitive areas like the pubic region. It's similar to trichotillomania, which involves hair pulling. It's crucial to note that skin picking and hair pulling are not forms of self-harm. People who pick their skin are not trying to hurt themselves or seek attention. They often do it because they are either understimulated (bored) or overstimulated (anxious or overwhelmed). Understanding this can provide insight into the strategies we'll discuss. Strategy #1: Awareness Logs Awareness logs are a powerful tool in any stage of recovery. By logging every time you have the urge to pick, noting how much you picked, where, and for how long, you gain a better understanding of how this condition impacts your life. Many people find that having to document their behavior reduces the frequency of picking. Awareness logs are a key component of habit reversal training, a cognitive-behavioral therapy technique specifically designed for BFRBs. For more information about BFRB School, our online course for skin picking and hair pulling, CLICK HERE Strategy #2: Keep Your Hands Busy Engaging in a competing response can help divert your urge to pick. Competing responses might include using fidget toys, holding a stone, or playing with soothing textures. You can find many affordable fidgets online or at dollar stores. Create a basket of tactile items that you can use to keep your hands busy. Place these items around your house, in your car, and at work to ensure they are easily accessible when you need them. Strategy #3: Create a Skincare Routine A good skincare routine can help prevent irritation and dryness that might tempt you to pick. However, it's important not to overdo it, as too much attention to your skin can also trigger picking. Consult with your doctor to develop a routine that keeps your skin healthy without exacerbating your condition. Strategy #4: Use Physical Barriers Using physical barriers (called habit blockers) like gloves, band-aids, or long sleeves can prevent you from touching and picking at your skin. Some people find that keeping their nails short or wearing fake nails can reduce the tactile satisfaction of picking. Identify what works best for you and use these barriers consistently. Strategy #5: Self-Compassion Practicing self-compassion is vital. Beating yourself up for picking only increases negative emotions like shame and guilt, which can lead to more picking. Instead, practice radical acceptance and reduce self-criticism. This approach can help you feel more motivated and improve your overall well-being. Strategy #6: Manage Stress and Anxiety Managing stress and anxiety is crucial, as many people pick their skin to cope with these feelings. Cognitive-behavioral skills can help address faulty cognitions and behaviors that exacerbate stress. Consider taking an online course, like Overcoming Anxiety and Panic, to learn effective stress management techniques. Strategy #7: Establish a Support System Having a support system can make a significant difference. Whether it's family, friends, or online support groups like those at BFRB.org, having people to check in with can help you feel less alone and more accountable. Some people find it helpful to text or call a support person when they feel the urge to pick. Strategy #8: Stay Hydrated and Healthy Good nutrition and hydration can impact your skin's health. Speak with your doctor about how to maintain healthy skin through diet and hydration. Additionally, consider looking into over-the-counter medications like N-acetylcysteine, which has been shown to help with skin picking. Always consult with your doctor before starting any new supplement. Strategy #9: Set Realistic Goals and Track Progress Set achievable goals and track your progress. Instead of aiming to completely stop picking, focus on gradually reducing the behavior by a small percentage each week. Tracking your progress helps you see improvement and identify what strategies are working. Remember, small steps lead to significant changes. Conclusion These nine strategies can help you stop picking your skin this summer. Whether you use awareness logs, keep your hands busy with fidgets, or establish a support system, each step you take brings you closer to managing this behavior. Remember to practice self-compassion and set realistic goals. If you need additional support, consider enrolling in courses like BFRB School or Overcoming Anxiety and Panic. Transcript Today we’re going to cover nine strategies to stop picking your skin this summer. It’s getting hotter. You want to start wearing shorter sleeves or have your skin exposed to the sun more often, which means you’re more likely to start picking at your skin. Let’s talk about nine strategies that you can use right away. Hopefully, you find them as helpful as my clients have. Welcome back. I am so excited to talk with you about nine strategies and skills that you can use to stop picking your skin this summer. But before we do that, let’s just first do a little deep dive into what skin picking is. Clinically, we call it “dermatillomania,” and it’s a kind of body-focused repetitive behavior. Often, people with skin picking will pick out their skin, their arms, their lips, their scalp, and their nails. There’s really no limit to where someone can pick their skin. Some people even pick pubic areas under their arms or around their genitals. There is, as I said, no off-topic area that people will pick. It’s completely normal for people to pick in one or all of these areas. It’s similar to a condition called trichotillomania, which is hair pulling. Again, hair pulling is another type of body-focused repetitive behavior, and people may pick at any area where there is skin on their body. It is important for us to first highlight that skin picking and hair pulling are not self-harm. People who pick their skin aren’t trying to hurt themselves. They’re also not trying to just get attention. They do not want to be damaging their skin or giving their skin abrasions and such. It’s just a part of a condition, and we have a little bit of insight as to why they’re doing it. Often, people with skin picking, or dermatillomania, are skin picking either because they’re understimulated, they’re bored, or we know they may be overstimulated. Maybe they’re very anxious, they’re feeling hyper-reactive to feeling overwhelmed with either emotions, stimulation, or thoughts. We do know that people who engage in this skin-picking behavior are more likely to pick either when they’re overstimulated or understimulated. That’s something to think about, and there is a clue there into some of the strategies that we’re going to use today. Let’s get to it. Let’s start talking about some of the strategies that you can use to stop picking your skin this summer. Strategy #1: Awareness Logs Awareness logs can be so helpful at any stage of recovery. An awareness log is either a piece of paper or a document on your computer or on your phone, where you log every time you have the urge to pick your skin, how much you picked your skin, where you picked your skin, and how long you engaged in skin picking. What this does is, number one, it helps us really understand to what degree this condition is impacting your life. Secondly, people often report that when they have to document it, they’re less likely to engage in the behavior because nobody wants to have to spend all their time logging it as something they don’t want to deal with. Awareness logs can be a very helpful skill for us in understanding our own condition and our own symptoms, and in addition, they can help us with motivation to slowly reduce this behavior. Awareness logs are something we use in a very well-known and researched way of using cognitive behavioral therapy, and the type of therapy is called habit reversal training. It’s the specific modality that we use for skin picking and hair pulling, and it is a key component of that cognitive and awareness work. Strategy #2: Keep Your Hands Busy Now again, when we’re using habit reversal training, we engage in something called a competing response. A competing response is a behavior that competes with the feeling of picking our skin. Now, a competing response might be fiddles or fidget toys. It could be holding a stone or maybe stroking a feather. It could be playing with other fidgets that we have. The cool news is that you can get so many fidgets online these days for a really low price, or you could easily go to your dollar store and look around for textures that feel beautiful to you, feel soothing to you, or help you with either the understimulation or overstimulation. What we want to look for here is, what are the specific tactile experiences that you can use to keep your hands busy? We actually have an online course called BFRB School, which is a specific course for people with hair pulling and skin picking, using skills like habit reversal training and cognitive behavioral therapy. We talk all about the core importance of using competing responses. I often tell my patients and my students to always have a bucket or a basket in the house of different tactile experiences, different tactile things that you can play with objects, so that at that moment, if you’ve identified in your awareness log that you’re feeling bored, you can engage in something that stimulates your creativity, stimulates your awareness. However, if you’re the opposite and you’re feeling overstimulated, you might dig into the basket and find something that’s quite soothing. Maybe it’s more like a silly putty, a gel, or something else that’s more soothing for you. These competing responses are going to be so important for you in getting very clear on what you need at that moment and having it readily available. I often say to my patients and my students, don’t just have it in one area of the house because, in that moment, you’re still going to want to just pick your skin. What we prefer to do is to have little pieces over the house, in your car, or in your office so that they’re easily accessible. Some people have it on their key rings, some people have it in their purses—whatever works for you. Again, that awareness log will help us identify specifically where you are when you’re having these urges to pick your skin. And then we can put in competing responses to compete with the skin-picking behavior. Strategy #3: Create a Skincare Routine That Helps You This is a little bit of a fine line, though, because we don’t want to engage in a skin routine that has you putting too much attention on your skin because, again, too much attention on your skin is going to mean that you’re more likely to pick your skin. However, we also want to make sure that we are not ignoring your skin, letting it get really dry, especially in the summer. Maybe you’ve had a sunburn or such, and you’ve got some wind chafing or something. Again, if you have any irritation on your skin that isn’t taken care of with a skin routine, you are more likely to pick at that skin, especially if there’s already an open wound or a scab. If you already have an open wound that you’ve scratched or maybe you bumped into something and you’ve got a little scab there, we want to make sure that we’re engaging in a really healthy skin routine to help that heal and repair so that you’re less likely to go and pick that. I would encourage you to speak with your medical professional about skincare and what would be best for you. Maybe you have a skin condition. Very commonly, people with skin picking do. Speak with your doctor about a skincare routine that will help your skin picking but not be so extensive that it actually makes it worse. I would trust that your doctor will be able to help you in that area. Strategy #4: Use Physical Barriers Again, going back to the gold standard treatment for skin picking, which is habit reversal training, we use what we call a habit blocker. This is something that blocks you from the habit of picking, and this can involve anything that stops you from being able to touch your skin. A lot of patients and students I have had have used things like gloves or band-aids to cover an area that they’re likely to pick. Maybe in the summer, they may wear longer sleeves even though it’s very hot because that actually stops them from getting to the area that they feel an urge to pick. You may also want to keep your nails really thin or cover your nails. Some people keep nails on, like actual fake nails, as a barrier to being able to touch the skin. Maybe it doesn’t give them that same tactile feeling of picking when their nails are medium-length. What we want to do here is identify for yourself the specific barriers that are helpful. The thing to remember here about skin picking is that everyone is different. Not one strategy that I’ve used for one client is going to be the strategy we use for another client. It’s going to be very much dependent on those awareness logs that you logged out of in that first strategy. Getting clear on specifically what are the triggers that cause you to pick your skin and what specific behaviors and habit blockers are helpful to reduce the skin picking that you feel the urge to engage in. Strategy #5: Self-Compassion We have to engage in not beating yourself up, not judging yourself, not punishing yourself if, in fact, you have picked or recently picked despite all of these strategies. Beating yourself up actually does not motivate you to stop picking. In fact, it usually brings up more emotions such as shame, guilt, sadness, anger, and humiliation. Those emotions can send us into overstimulation, making us want to pick again. Again, we want to engage in a practice of self-compassion. We want to engage in a sense of radical acceptance of ourselves, whether we pick or not. This is so important because we want to reduce our suffering, not make our suffering higher. We do find that people who practice self-compassion tend to have higher levels of motivation, decreased levels of procrastination. They tend to feel better about themselves and have higher self-esteem. They’re more likely to get out there and do the things that they love. Every moment that you’re engaging in in your life is a moment you’re less likely to be picking. It’s very, very important that you practice a self-compassion routine, even if it’s once a day. Anything is better than nothing to reduce that self-criticism where you can. Strategy #6: Manage Stress and Anxiety  I cannot stress this enough. It is so important when it comes to skin picking that we manage our stress. Again, a lot of people pick their skin because it is a way in which they can manage their stress. A lot of people with skin picking say once they start picking, they can exit out of reality and go into a trance-like mode where everything disappears and they feel relaxed and in the zone, and it takes away all of the stress. We can now understand why there is actually an urge and a pull towards picking and pulling, because who really wants to stay in stress and anxiety? Of course, it makes total sense. The more we can manage our stress using strategies, skills, and other tools like cognitive behavioral therapy, the less likely we are to use skin picking as a coping strategy. When it comes to managing stress, again, the most important thing we’re going to do here is what we call cognitive behavioral skills. It’s going to be taking a lot of our cognitions that might be faulty, leading us to have more anxiety, and also looking at our behaviors and the things that we do that may be actually exacerbating the stress and anxiety that we experience. If you’re someone who struggles with anxiety and stress, I strongly encourage you to check out our online course called Overcoming Anxiety and Panic. We go through all of these steps. You can do it from home, and it may help you to get an idea of what might be some of the things that are triggering your stress response, triggering your anxiety response so that you can manage that, so that then you can move on to manage your skin picking as well. Strategy #7: Establish a Support System We want to have a community of people who can support us as we go through these steps. It’s not an easy thing to overcome skin picking, so I really want to encourage you to find a support system, whether that be family or friends, or you can go to BFRB.org. They have a whole array of online support groups that you might be interested in looking at to get support, so you feel like you’re not alone and that you have the support that you need. Another option here is to also look for accountability bodies. Somebody who mightn’t even have skin picking. They might be a loved one, a friend, a parent, or a sibling—someone who you can check in with when your urge is really high. A lot of my students have said that it’s been very helpful when they have the urge to text somebody and say, “I have a strong urge. I’m texting you to let you know.” They may have already set up a plan on what to do. Maybe they jump on a phone call together, they might text each other throughout it to help the person ride that wave of the urge. Or maybe that person might encourage them to say, “Hey, you told me to remind you of this one thing if you have this urge.” Really, the importance of a support group can help you, or a support person can help you not only with feeling less alone, not only with beating yourself up, but also with putting these strategies into action, especially if you let them know about the strategies. Strategy #8: Stay Hydrated and Healthy Now again, I’m going to encourage you to speak with your medical doctor about this, but I just wanted to mention because I try to look at you as a holistic, full person, someone who’s not just your skin picking, but also, we want to have a look at things like your health. Take a look at your nutrition. Take a look at your hydration levels. Again, these things can impact our skin. If, let’s say, you’re having a lot of nutrition that’s causing a lot of breakouts and you’re someone who’s prone to skin picking, those two things together could become a disaster. You want to speak with your doctor or a professional in that area about specific nutrition, things you may want to avoid eating, and how hydrated you need to stay to keep your skin healthy, to reduce the chances of you wanting to pick and pull. A lot of patients I see, and a lot of students that have come through BFRB School, our online course for skin picking, have reported having skin conditions, acne, or certain things that have impacted how much their skin is irritated, how many pimples they’re having. Now, I’m not assuming that nutrition and hydration are the solution to all of that, but I would encourage you to speak with a doctor and just inquire about what you could do to make sure we’re addressing those skin conditions. Another thing to know here, and this is like an inside scoop, is that there are specific over-the-counter medications you can get that have been proven to help with skin picking. I’ll leave a link in the show notes for you to take a look, but there is a vitamin that’s called N-acetylcysteine. It is an over-the-counter medication that has very few side effects and has been shown to help people with skin picking. Now again, I’m not a doctor. I would strongly encourage you to speak with your doctor about that, but again, I’m trying to give you as many resources today as we can to help you get to the goal that you want. These are all things that you can take a look at and speak to your doctor about. Strategy #9: Set Realistic Goals and Make Sure You Track Your Progress  We want to set realistic goals. I always tell my patients at the beginning of treatment that the goal isn’t to completely stop skin picking, even though most people are coming for that goal. Because what I have found is, when you set that huge goal, it sets you up to fail. It makes you feel so bad if you slip. It makes you feel so much pressure. It’s such a scarier experience than if you say, “Hey, I’m just going to reduce this by 3 to 5 percent each week,” or month or day, whatever is right for you. We want to set realistic goals—goals that can help keep you motivated and goals that make you feel like they're achievable. We also want to track progress. One of the most important parts of treatment, once we’ve done that first awareness log—and we do this in BFRB School, I do it with my patients as well—is that once we’re off and running, we then track how well we’re doing. How well did you use your tools? What tools didn’t work? How long did you pick for? Where were you? What went wrong? We are not doing this to beat you up or to scrutinize you; we are doing it from a place of experimenting, gathering information to know specifically what’s getting in the way of your recovery and what your progress looks like. Some people may say, “I’m not making any progress,” but when we actually look at their logs, we’re starting to see progress in these small ways. Remember, small steps lead to medium-sized steps. Medium-sized steps lead to huge changes. The last strategy is probably the most important. I could have spent a whole podcast episode talking about that. It’s about setting realistic goals and tracking your progress. Again, if you are struggling with this and you want to take BFRBSchool.com, head on over to CBTSchool.com. You’ll get access to it there. It will take you through all of these steps. We also have modules on self-compassion, mindfulness, and healthy lifestyles that can really help you with this recovery as well. I’d strongly encourage you to consider that as a hopeful strategy as well. All right, guys, thank you so much. These have been the nine strategies to help you stop skin-picking this summer. I hope you found it helpful, and I’ll see you next week.

Today, we’re diving into a topic on how to become more self-confident, especially if you struggle with anxiety. Self-confidence is a quality we all desire, but for those of us with anxiety, it can seem particularly elusive. Let's explore how to cultivate self-confidence, even when anxiety is a persistent part of your life. Understanding Self-Confidence First, let’s clarify what self-confidence actually is. Many people mistake it for arrogance or an inflated sense of self. True self-confidence, however, is a deep trust in your own abilities, strengths, and judgment, even when faced with adversity. Anxiety can often undermine this trust, making us feel uncertain and vulnerable. But self-confidence is not something you’re born with—it’s something you develop over time. Debunking Myths About Self-Confidence Myth 1: Self-confidence is Innate One common misconception is that self-confidence is an inherent trait. This couldn’t be further from the truth. Self-confidence is a skill that can be nurtured and grown with practice and perseverance. Myth 2: Success Equals Confidence Another myth is that self-confidence only comes after achieving certain milestones or successes. While accomplishments can boost confidence, they are not the sole source. True confidence is built through the process, not just the outcomes. Myth 3: Confident People Don’t Have Anxiety It’s a widespread belief that confident people are free from anxiety. In reality, confident individuals often face anxiety just like anyone else. The difference lies in their willingness to face their fears and grow through the experience. Building Self-Confidence: Practical Steps Embrace Challenges Self-confidence grows from facing and overcoming difficult situations. Initially, the thought of tackling a tough challenge can be overwhelming, but each experience strengthens your trust in your ability to handle adversity. Practice Feeling Your Emotions Confidence isn’t about the absence of fear but rather the ability to feel and manage your emotions effectively. By practicing feeling emotions like fear, inadequacy, or shame, you become more comfortable and resilient in facing them. Identify Specific Scenarios Pinpoint the situations where you feel least confident. Reflect on what emotions these scenarios evoke and work on becoming more comfortable with those feelings. For example, if public speaking makes you anxious, practice feeling that anxiety in smaller, controlled settings until it becomes more manageable. Cognitive and Behavioral Strategies Cognitive Restructuring Changing your thoughts can significantly impact your confidence. Instead of telling yourself, “I’m going to fail,” try affirmations like, “I’m prepared and capable.” This shift in mindset can reduce anxiety and boost your self-assurance. Behavioral Exposure Facing your fears head-on through repeated exposure can be incredibly effective. For example, if public speaking terrifies you, join a group like Toastmasters, or practice in front of friends and family. Repetition helps desensitize you to the fear and builds confidence in your abilities. Reflect and Learn After facing a fear, take time to reflect on the experience. Ask yourself, “What did I learn?” This reflection helps you identify areas for improvement and reinforces your ability to handle challenging situations. Embrace Failure as a Learning Tool Failure is an inevitable part of growth. Instead of viewing failure as a negative outcome, see it as an opportunity to learn and improve. The more you fail and learn from those failures, the more confident you become in your abilities. Conclusion Self-confidence is a journey, not a destination. It involves embracing challenges, feeling your emotions, and learning from both successes and failures. Remember, today is a beautiful day to do the hard thing. Face your fears, practice self-compassion, and celebrate your progress along the way. Have a great day, everyone, and keep building that self-confidence! TRANSCRIPTION:  Hello and welcome back. I’m so happy you’re here. Today we are talking about how to become more self-confident, especially if you’re someone who has anxiety.  Self-confidence is something that a lot of people talk about. It’s something we all want more of. But if you are someone who has anxiety, you might actually find that being self-confident is really, really hard. So I’m here today to talk with you about how you can become more self-confident even if anxiety is here. Let’s do it.  First of all, what is this thing called self-confidence? Some people think that it’s like thinking really highly of yourself and that you think you’re the coolest—sort of arrogance—but that is not the definition of self-confidence. Self-confidence is a deep trust in your own abilities, your own strengths, your own capabilities, and your own judgment in the face of adversity. I get it. When we have anxiety, it’s very hard to feel that sense of trust. In fact, I think anxiety can sometimes make us feel like we can’t trust anything. We’re in a heightened state of fight, flight, freeze, and fawn.  What we want to do today is take a look at how we can improve self-confidence in the face of anxiety. Now, in order to do that, we first have to look at some of the myths about self-confidence. A lot of people think that self-confidence is just something that you’re born with, and that could not be further from the truth. Self-confidence is something we grow over time. Other people believe that self-confidence is something you get once you’ve achieved something, like you’ve achieved some success, or you’ve lost enough weight. That was me when I had an eating disorder. When I’ve finished a course, then I can feel confident. Or, when I’ve done enough practice, then I can feel confident. I understand that. However, that if-then statement creates a lot of opportunities for us to feel out of control and like it’s something that we can’t create on our own. I actually want to really take that idea away and lean towards another strategy.  Another common myth about self-confidence is that some people have it and some people don’t, and that it’s like an inherent piece of who we are—also not true. Anyone can work toward being confident. We have a lot of evidence. You probably know someone who’s really, really confident, and you don’t even think that they are warranted to have that much confidence—again, proof that we can grow self-confidence. It’s something that you can have that doesn’t require a certain accolade or level of success. It’s something that we can take on. Again, we are not using it in a way to hurt other people or to make other people feel bad. That’s actually not self-confidence. That’s usually coming from a place of insecurity.  Another myth is that confident people don’t have anxiety—also not true. Confident people are as afraid, if not maybe even more afraid, than the average person on the street. I don’t want us to believe that confident people don’t bring anxiety to the table, and we are going to take a look at how we can work with that.  Let’s now talk about how you can become more confident. Here’s the thing. As I have gone through some very difficult things, at the beginning of going through those difficult things, I too was overwhelmed with thoughts like, ‘I can’t handle it.’ ‘I don’t have what it takes.’ ‘This is going to destroy me.’ ‘This is going to ruin me.’ It’s like I’m just going to implode with this degree of suffering.  But what I found was that once I had been through that difficult season, I felt more confident. It wasn’t that I succeeded in it, though. It’s not that I conquered all during that difficult turbulence season. There was a different shift towards, again, trusting that I could handle hard things. Often we go into hard, scary things, saying, “If I only had been through this before, well, then I would feel confident.” But that’s actually not true.  A lot of self-confidence is your ability to feel the feelings you will have to feel when you do that hard thing, not the actual doing of the hard thing. The more we practice feelings of fear, threat, inadequacy, shame, or whatever it might be, the more we’re comfortable, open, and caring in feeling those feelings. That’s how we begin to feel self-confident in any situation, whether we’ve been through it before or not.  I had a friend who once told me that a very, very dear loved one, actually a child, had been through cancer. I had said to her, “How are you doing?” She said, “Oh, I’ve been through cancer. Nothing can take me down.” But what she meant by that is that it’s not that everything was in comparison to cancer; it’s that she had mastered feeling her feelings as she navigated something really, really difficult. She could go through something completely different. But because she’s already committed and gone through the willingness to have some really uncomfortable feelings, she had a sense of self-confidence, like, ‘I could handle anything at all.’ What I want you to think about here is, what are the things that you don’t feel confident about? What specifically are the situations, the scenarios, and the times in your life where you don’t feel confident? And then I want to ask you, what would you have to be willing to feel, and what would you have to build comfortability feeling in order to feel confident doing that thing? It’s just a question. Sometimes it’s like, “Oh, to be confident doing my exposure, I’d have to be confident feeling uncertainty.” “Oh, to go through seeing my child struggle, I’d have to be confident feeling maybe guilt or maybe sadness.” “Maybe to handle my parents’ aging, I’d have to be able to confidently and willingly feel grief.” Ask yourself these questions because they can help us identify the emotion that we need to practice feeling on purpose.  Now, when it comes to creating self-confidence, there are two ways we can target it. I talk to my clients about this all the time. We can create self-confidence by changing our thoughts, or we can create self-confidence by changing our behaviors. Let’s talk about creating or changing our thoughts. Let’s say you have something you need to do that’s creating a lot of anxiety. Maybe you have to do a public speaking event. You have a lot of anxiety. You could do some cognitive restructuring by changing your thoughts. Instead of saying, “You’re going to fail and this is going to be terrible,” you could practice saying, “It’s going to go great,” or “I feel like I know my stuff, I’ll be able to do it.” These are great strategies. We could use that.  Another strategy would be, if you have a fear of public speaking, go and do lots of public speaking, Maybe you would join Toastmasters. Maybe you would rehearse it in front of your family, your neighbors, or your colleagues. You would practice doing this behavior over and over and over again with repetition.  These are two very good ways to help with confidence building. However, let’s compare and contrast them. Let’s say that before this public speaking event, you spent a lot of time doing cognitive restructuring. “I’m going to do great. I’m going to do great. Nothing’s going to go wrong,” which we don’t actually know is true. But the thing is, when you walk up onto that stage, you don’t have a lot of proof that it is going to go well. You don’t have a lot of proof. If it doesn’t go well, you mightn’t leave there with a ton of confidence. However, if you’re somebody who instead practices facing that fear over and over and over and over again, as you go to walk onto that stage because you’ve changed your behavior repeatedly and you’ve practiced, you actually have trust in your ability. You have trust in your capability to feel fear. You know what fear feels like, you’ve practiced feeling it, and therefore you’re a little bit desensitized, or you’re a little bit feeling a sense of mastery over that feeling, and you are able to walk up onto that stage. My advice is that the better way, the more superior way to build self-confidence, is to practice facing that emotion as much as you can. In exposure and response prevention, which we use as the gold standard treatment for OCD and many other anxiety disorders, we’ve practiced facing fears over and over. What clients often tell me is, “I actually start to feel confident doing that thing. I start to feel confident taking flights. I’m starting to feel confident going to the post office. I’m starting to feel confident driving my car by actually doing the thing.”  The real moral of the story here is that confidence comes from repeatedly facing the thing that is hard for you. Identifying the specific emotion that makes it more difficult and practicing being willing to have that feeling. Now, here is where, going back to that cognitive changing of your thoughts, it might be very, very beneficial, particularly at the end of when you faced your fear. Meaning, after you faced your fear, you can actually stop and go, “What did I learn? What did I learn about facing my fear?” Let’s say the public speaking example. You go up in front of your partner, your mom, or your dog, and you present your presentation. You might say, “I learned that I don’t know the script well enough,” or “I learned that I’m still anxious, but I can handle the anxiety.” “I learned that when I have anxiety, I beat myself up.” Oh, interesting. So we have an opportunity to make another tweak in behaviors because if beating yourself up doesn’t work—PS, it never does—then we might want to change our behavior in that area. The next time we’re going to go and do that presentation, we’re going to work at not beating ourselves up this time. What else did we learn? “I learned that my body didn’t explode when I gave the presentation to my dog and then to my mom and then to my neighbor.” We’re starting to learn things, and we’re starting to change the way we think because we changed our behavior.  This is a really great strategy for anyone. There’s, again, an important cognitive era that we have that gets in our way of building self-confidence, and it’s this: “I’m a failure if it doesn’t go well.” This belief and this thought could create so much suffering. If I can leave you with one core thing to keep in your back pocket as you practice this, it’s that we need to fail a lot of times to get confident. We need to fail a lot of times to be good at something. That doesn’t mean there’s something wrong with us.  I create these podcasts and these YouTube videos all the time. I sucked at them when I first started, but I didn’t stop, and I didn’t say, “That’s because I’m terrible at it.” It basically meant I had some learning to do. I had some practice to do, and it’s okay to suck at things until you get better. The only way I got better was by doing it over and over and over again. I got a little more comfortable and a little more confident in myself as I strategized how I could tweak it a little bit to be better and not be like, “When I’m better, I’ll feel good about this.” Again, that’s a myth. Self-confident people still have anxiety. They just bring it with them, and they know in their hearts that there’s no emotion I’m not willing to feel. Again, as we get better at this, we can start to have a sense of mastery over the emotions that we have to feel.  Another thing I want you to think about here is if, as you do these scary things, you feel guilt, self-criticism, and shame. What we want to do is soften around that emotion, not add to it and be like, “Oh yeah, you’re right. I am the worst. I’m terrible. This is the worst thing ever. I’m bad and I shouldn’t be doing this and all the things.” Instead, we want to soften into it and change our belief around failure and learning and say, “It’s okay. I’m not bad at this. It’s okay that I’m not perfect at this.”  Everyone starts at zero. The people with a million followers on Instagram originally started with zero followers. The people who win Olympic awards in races were once not the fastest runner. They were once in their school and maybe getting beaten by people in their elementary school, high school, or college. We all start somewhere at the beginning, so give yourself permission to start at the beginning. Don’t let yourself give up trying a couple of times, and expect yourself to feel confident. Confidence comes from the repetition of doing the thing and practicing having the emotion that is uncomfortable in relation to that task or activity.  That is where I want you to change the way you think of self-confidence. It’s how I want you to change the way you lean into a task and an emotion as you do that task. I also want to remind you that today is a beautiful day to do the hard thing. This is why I say it on almost every episode. Today is a beautiful day for you to do the hard thing. I want you to go on after that thing that you want to do and practice this. Let the anxiety come, let whatever emotion come. I’m so impressed and proud of you for trying.  Have a great day, everyone.

Health anxiety is a common yet often misunderstood condition that can significantly impact one's quality of life. Whether it's worrying excessively about potential illnesses or constantly seeking reassurance about your health, the effects can be overwhelming. Understanding the nature of health anxiety and learning effective strategies to manage it can make a world of difference. In this article, we explore five essential things you need to know about health anxiety and offer practical tips for recovery, with expert insights from Michael Steer. 1. UNDERSTANDING HEALTH ANXIETY: WHAT IT IS AND WHAT IT ISN'T Health anxiety is a term often misunderstood by many. It's not just about being overly concerned with your health or frequently looking up symptoms on Google. Health anxiety can be categorized into two main disorders: Illness Anxiety Disorder and Somatic Symptom Disorder. Illness Anxiety Disorder involves a preoccupation with health despite not having significant physical symptoms. On the other hand, Somatic Symptom Disorder includes severe and persistent physical symptoms that cause substantial distress. It's essential to understand these distinctions to recognize that health anxiety isn't simply a matter of being overly cautious or paranoid about one's health. Moreover, health anxiety can often intertwine with Obsessive-Compulsive Disorder (OCD), involving obsessive thoughts and compulsive behaviors centered around health concerns.  2. NAVIGATING THE MEDICAL SYSTEM WITH HEALTH ANXIETY Dealing with health anxiety within the medical system can be particularly challenging. One of the critical aspects to remember is the importance of finding a healthcare provider who listens and validates your concerns. If you feel dismissed or unheard, it is perfectly acceptable to seek a second opinion or switch providers. Additionally, distinguishing between different types of symptoms can help manage health anxiety more effectively. Medical symptoms require immediate attention, such as severe chest pain or sudden numbness. Physical symptoms, like a sore back from yard work, are often benign and manageable with self-care. Psychological symptoms stem from anxiety and can include manifestations like tightness in the chest or dizziness. Understanding these differences can help reduce unnecessary panic and improve communication with healthcare providers. 3. TRUSTING THE RELIABILITY OF YOUR THOUGHTS A common challenge with health anxiety is differentiating between real medical issues and anxiety-driven thoughts. Think of your anxious thoughts as spam emails—they're real, but their content isn't always reliable. Health anxiety often triggers false alarms that feel urgent and terrifying. Learning to question these thoughts and not take them at face value is crucial. Techniques like cognitive diffusion can help change your relationship with these thoughts. For instance, if you've convinced yourself numerous times that you're having a stroke and it hasn't happened, the likelihood that your current fear is another false alarm is high. Questioning the reliability of these thoughts can help manage the overwhelming fear they generate. 4. THE ROLE OF COMPULSIONS AND SAFETY BEHAVIORS Health Anxiety Compulsions and safety behaviors, such as constantly checking symptoms or seeking reassurance, often exacerbate health anxiety. One significant trap is becoming inwardly focused, constantly monitoring your body for signs of illness. This behavior leads to a vicious cycle where anxiety increases symptoms, which in turn heightens anxiety. Shifting your focus outward and engaging in meaningful activities can help break this cycle. It’s essential to become more outwardly focused, enjoying life and participating in activities that bring you joy and fulfillment. This shift can reduce the power of health anxiety over your life. 5. EMBRACING LIFE DESPITE HEALTH ANXIETY Health anxiety often steals the very things we're afraid to lose—time, relationships, and enjoyment of life. The constant preoccupation with health can make us miss out on living fully. Therefore, the goal isn't just to reduce anxiety but to reclaim your life. Engage in activities you love and focus on adding value to your life. This shift in focus is incredibly powerful and can help you live a more fulfilling life despite health anxiety. It’s not just about feeling less anxious; it’s about living more fully and enjoying the moments that matter most. CONCLUSION Health anxiety can be overwhelming, but with the right strategies, it’s possible to regain control and live a fulfilling life. Michael Steer's book, "The Complete Guide to Overcoming Health Anxiety," is a fantastic resource for those seeking further support and information. Additionally, his website, overcominghealthanxiety.com, offers a wealth of resources, including a free virtual support group. Remember, while health anxiety can take a toll on your life, effective strategies and a focus on meaningful activities can help you reclaim your joy and well-being. TRANSCRIPT: Kimberley: [00:00:00] Welcome back, everybody. Today I have Michael Steer here talking about the five things you need to know about health anxiety and how to recover from it. So welcome, Michael. Michael: Thanks for me. I'm really excited to be here and talk a little bit about health Kimberley: Yes. It's actually a very, very requested topic. It there's always questions about it. So I think this is really, really wonderful that we're doing it. Okay. So first of all, what is health anxiety? Let's just do a little bit of a, you know, intro, uh, tell me what it is and then tell me what it isn't. Cause that's point number one. Michael: Absolutely. Yeah. So we'll jump into point number one, which is I kind of was breaking down if I could have people know five things about health anxiety, what would I want them to know? Or people that support people with health anxiety. And number one point that you're going to bring it up is the first thing that I would want [00:01:00] people to know is exactly what health anxiety is. I feel like health anxiety is one of those things where, you know, you see somebody on their phone looking up symptoms and everybody kind of knows, right? They're like, Oh, I've been there before, right? We all kind of know what health anxiety is, but sometimes we don't know exactly like what it looks like or even more so that there's actually treatment that people can get that actually works. Not medical treatment, but maybe psychological treatment. So, um, I break down health anxiety in a couple of different ways, which is one is that. if you actually have a medical condition, so if you were diagnosed with cancer or, you know, whatever that might be. Um, there can still be anxiety around those types of things, but that's not exactly what we would be calling health anxiety. Uh, you know, kind of in a professional community, that would be an adjustment, Kimberley: Yeah. Michael: a massive adjustment, right? It's like you get this scary diagnosis, you're trying to go undergo treatment, those types of things. So that's kind of one category. And then, We also have this other category, maybe [00:02:00] what we would love them to call health anxiety, which actually is kind of awkward, too, because there's really no such thing as health anxiety, like, oops. Um, but there are some categories under health anxiety that we would say, these are actually what we're talking about. One of them is what we call illness anxiety disorder. Um, the other one is what we call somatic symptom disorder. And, uh, these are kind of the two things that we would call health anxiety. Now, Illness Anxiety Disorder is really a very basic way to break that down, is a preoccupation with your health, but you don't have a lot of symptoms that go along with it. I mean, you might have some here or there, and it's like, Oh, one day, like maybe my vision is a little bit more blurry, or I got a kind of weird pain over here. But the, usually the symptoms kind of come and go pretty, pretty quickly. Um, now, Somatic Symptom Disorder is still the preoccupation with your health. But the one big difference that people run into is usually the symptoms are pretty severe. They're [00:03:00] pretty significant, and they're usually a little bit long lasting. So, you know, maybe people are dealing with, you know, chronic stomach pain or pains in their stomach that they really become preoccupied about, but those symptoms are pretty significant where it's like impacting life, those types of things. Um, and then the other category that we can just throw in there real quick is also OCD. Um, and what we'll talk about here and, uh, maybe towards the end of this part is a lot of times I put health anxiety and OCD kind of as hand in hand. Uh, they're not the same thing, but they share so many of the similarities and how they work. And, um, if you ever look through some of the OCD literature. OCD can have health themes and so those would be times where we can be very, become very, you know, have the obsession and compulsion cycle go around health. So that's, that's really what health anxiety is, is usually one of those three things, which is either you don't really have many symptoms and you really worry [00:04:00] about it. You're actually having a lot of symptoms. you're worrying about it, or it may be a bigger dynamic of OCD, where maybe you have other obsessions and compulsions, and then maybe one of them is also just the obsessions and compulsions around your health. Kimberley: Amazing. Michael: yeah. Kimberley: What about hypochondria? Do we, where would you put that? Michael: So that's an older term. Kimberley: Yeah. Michael: So we've kind of, you know, and a lot of times, um, I feel like I'm kind of glad that that term has kind of shifted as just kind of like, you know, illness, anxiety, and somatic symptom. Um, just because there's a lot of judgment and a lot of negativity also around kind of, you know, as soon as somebody is like hypochondria, right? And it's kind of like, it comes with this like really negative experience and like, Oh, you know, they're, they just worry about their health all the Kimberley: Right. Michael: it kind of gets dismissed pretty quickly. So, um, that's just, if you ever see hypochondria, um, it's just an older term or sometimes it's still used in the medical community. [00:05:00] I think it's, even when you look up in some of the, um, Um, things to, uh, you know, for some of the coding, it still comes up as hypochondriasis. Um, however, it's just, it's the same, it's a different terminology just for what we would now call illness, anxiety disorder and somatic symptom disorder. Kimberley Quinlan, Thank you for sharing that too. Cause I think Googling, because that term has been used for decades, that is often what people are looking for. And I think, as you said, people get dismissed like, Oh, you're being such a hypochondriac about it. You know, that. I think is, I'm glad that you, you shared that. Okay. So that was number one. Number two, um, what is the second thing we need to know about health anxiety? Michael: So number two is kind of going right off of what you're saying is a lot of times, you know, what I would really want people to know is to, a lot of times people do get this mess. and even clients that I'm working with, because I work with a lot of health anxiety clients are still trying to navigate [00:06:00] that relationship between, they probably really do have some anxiety around their health, but they're also trying to work with the medical community. and that makes it quite challenging, um, because you know, there can, um, there can be some times where it can be challenging. People can get written kind of off of like, well, this person, you know, they've, they've been anxious about their health before, and then they've sort of become. Um, what could be an obsessive worry but also could be a very realistic worry of I go back into my doctor and they kind of know that I deal with anxiety around my health, they going to take me seriously? Michael: know, if I come in and I say, wow, I've been really having a pain here or here, are they really going to be listening to me? Like really take me seriously and investigating this or are they just kind of writing it off You know, this is, you know, awful, you know, this person has been anxious about a lot of those different things. So the one thing I, I think that we, um, that I think, I think is really important for people to know [00:07:00] is you're working with a medical provider and you don't feel like they're listening to you, they're not validating some of your concerns, they're, they're, you don't feel like they're really invested in some of these things. Um, it's always okay to go find somebody Kimberley: Mm hmm. Michael: That is totally okay to do. You can take it from me. Hell, like, you know, what I would, I don't know if there's no delineation of a health anxiety specialist, but I think there can be some of those times where things are not taken serious. So Kimberley: Yep. Michael: do feel like that is a relationship that you're having with a health provider, find somebody new. Go find somebody that really does listen to you, right? Now if you're also working with somebody that you feel like you really trust, you feel like They feel like they got your back, like they're, they're, you know, but maybe you're kind of running to the end of the road of like, I, don't know really what else we could test for. That's something different, right? Because at least there's that level of trust. So the second thing that we like when it goes into this piece of, you know, like Val or validating people's [00:08:00] symptoms is we also have to realize that there is a difference between physical symptoms, medical symptoms and then also psychological symptoms. And so here's how I break these things down. Medical symptoms is usually the ones we're really afraid of. medical symptom could be like if I have chest pain. And a medical symptom would be I need to go to the hospital because I'm having a heart attack. That is an explanation, a medical explanation of a symptom that I'm Kimberley: Mm hmm. Mm hmm. Mm. Mm. Mm. Mm. Michael: ER, those types of things. one category or one bucket that sometimes we put those in. A second bucket is what we call physical symptoms. And a physical symptom is something that's actually really happening in our body, probably don't need to run to the ER or the urgent care because of that. So like, for instance, if I went and did a bunch of yard work over the weekend, and my back really hurts, um, arguably because I'm getting [00:09:00] older or because I've done a lot of yard work, who knows? Um, Um, I don't, that's a real physical symptom that a lot of times our mind could try to catastrophize, but it's probably not something that I need to go and run to the doctor about. I probably need to take it easy, put a little bit of ice on my back, et cetera, et cetera. So we have medical symptoms, we have physical symptoms, but then also we have psychological symptoms and this is the way that our mental health can also affect our physical body. So for instance, if we're becoming anxious, I'm sure that, you know, if anybody has ever been anxious before, which I'm going to assume everyone has, If we become anxious, sometimes our chest gets tight. That's a real physical symptom. That's a real symptom that we have. But the origins of the conclusions of that is from a psychological standpoint. Now, here's why I think these buckets are important, why I want people to know about them. Surprise, surprise, health anxiety always usually goes to one bucket. Medical symptoms, right? It's like, Lower back pain, medical. You know, my chest is tight, medical. This weird kind of [00:10:00] feeling in the back of my head, medical. You know, all of those different types of things. And one of the things is being able to have this context of if I could start to separate some of these symptoms out to maybe there are some symptoms that I could have that are medical, but maybe there's also physical symptoms that are just happening. There's a great article that I always like to give all my clients The Noisy Body by, uh, Abramowitz, that's just a wonderful handout, a wonderful article. And it just speaks to the nature of like, well, we get signs and symptoms and weird feelings and burps and farts and all these things all the time. The hard thing is, is when our mind gets really preoccupied and starts to put them into the category of, oh no, what if, could this be this really negative thing? So I'd like to, that's the second point that I would really want people to know is. We have to realize that even though there is always this scary explanation of symptoms, it's important to have this perspective of noticing that there could be, there could [00:11:00] be medical symptoms that I need to really do something about, physical symptoms that I need to do to some TLC, and then also psychological symptoms. And then one last thing I just throw in there real quick before we can go on to the third one is, um, the most important part about this is regardless of what bucket you put this in, all of them are valid and real symptoms. that's the other piece that we get into this kind of like stigma or negativity, that sometimes people will talk about a real symptom that they're having, and then they'll be like, Oh, well, that's just your anxiety as almost as if the symptom is not happening. And so I think what I would really want people to know with health anxiety is regardless of what bucket it's coming from, it's always real. You're always valid and feeling it. The one question that we have to just ask, which is going to lead us into number three at some point is. Or can we trust that the explanation for the symptom that our brain has brought us really the explanation of what's happening? Kimberley: Mm. [00:12:00] So, I have a question, which you might answer it in, you can even use this for the, for an example. So, a lot of my followers know that I, in, um, in 2018 was diagnosed with Postural Orthostatic Tachycardic Syndrome. Michael: Mm. Mm Kimberley: one of the main symptoms of that is that you faint and a lot of, I'm very well in recovery of this right now, but one of the things was me without using this terminology, which you've beautifully put out. And I actually learned this terminology from you is it was about passing out, passing, like not, not, not passing out, like, uh, differentiating, sorry, my accent got it, differentiating. Um, is this dizziness from my anxiety? Is this dizziness evidence that I'm going to pass out, like faint? Um, Michael: hmm. Kimberley: because a lot of [00:13:00] having this condition is tolerating dizziness 24 seven of the day. Like it's a symptom of the condition. Um, so in that case, just as that as an example, how would you, which bucket would you put this in? Michael: For sure. Good. Great question. And this is where, like, health anxiety, I think that's why it's really important to, to really notice the stickiness of Kimberley: Mm. Michael: Because, you know, as an, also as an OCD specialist, a lot of times when we deal with OCD themes, not often having people, like, deal with, uh, you know, harm obsession. And also undergoing evaluations to see if they're a Kimberley: Yes. Yes. Michael: Uh, that doesn't really make sense. health anxiety starts to become this kind of interesting dynamic of, well, what happens if we have anxiety around medical Kimberley: Yeah. Michael: And also we have to like, go get evaluations and other things that are actually Kimberley: Yep.[00:14:00] Michael: that's a great point. And it's like, okay, so what if the, um, Um, you know, the symptoms that I'm feeling could be an explanation of a medical condition that's happening, or it also could be, you know, from the place of, um, you know, from my anxiety. Um, think the answer comes down to, um, is going to this, what I usually like try to call a pretty, a best guess. Which is, now, when we're thinking about passing out, the one thing I think is always important. as a person that works on a lot of needle phobias and blood phobias is that if you feel like you're going to pass out, get yourself in a safe place, right? Like sit down, make sure you don't hit your head. You know, Kimberley: Yep. Yep. Yep. Michael: But also there's this kind of conclusion that we can come through with our experience that says, know, um, if I, if I think about the symptoms that I'm having right now, where would I put my best guess on those, right? And if we're putting this, that medical side, then we could say, okay, well, [00:15:00] Um, I need to do whatever the doctor has recommended that I do in those situations because that's just what's most helpful. If I'm feeling like it's more on the anxiety side, that's maybe where I could use some of my tools that we learned in therapy to be able to manage that. Now is it a perfect system? No it's not, right? Because there's always this little piece of uncertainty and the unknown there Kimberley: hmm. Mm hmm. Mm hmm. Mm hmm. Mm hmm. Mm hmm. Michael: that's, I think that's what's also really important about being able to kind of discuss those things either with your doctor or a therapist to be able to really walk those muddy lines. Um, I have quite a few clients that we try to walk that line all the time where, I've had clients where thought that maybe this was or maybe it was assessed as like, Oh, this is just something anxiety related. That's why you're having symptoms. And then it's like, months later, surprise, I'm allergic to this, right? And so, that's why we don't always know the answers to all of [00:16:00] those things. Um, but as we kind of go, we can kind of walk that line to say, could I make my best guess about what this is at this current period of time? And if that was the case, what would I do in that Kimberley: Yeah. Michael: You know, and so do I need to go a medical route? Do I need to go to a psychological Kimberley: Yeah. Which I think takes us to next step number three so beautifully. So go ahead and share what is the third thing we need to know. Michael: Absolutely. So number three talks about. Um, a lot of times our brain can bring us to a lot of different conclusions and we just talked about the conclusions that a lot of times our brain Kimberley: Yeah. Michael: into in terms of medical, physical, psychological. And a lot of times we just take those conclusions as the truth. go with them because they're terrifying, they're scary, right? And they feel really threatening. And so one of the things that I think is important for people to recognize is I like to use the example of a spam email. is I'm sure we've all gotten spam emails. And if you haven't gotten a spam email, please let me know your trick because that would be I could clear out like [00:17:00] 75 percent of my email box. So but a spam email to me is kind of walking this line between is a spam email real? Oh, of course, we all get them in our email box, right? Like they actually come through to us. They have a time stamp, et cetera, et cetera, right? But the one question that we have to start to kind of wrestle with with health anxiety is. is the conclusion or email that I'm getting a reliable source of information. so if you get an email from tomjones1973 at AOL. com that claims to be from the FBI, why would the FBI be sending you from AOL? That doesn't make Kimberley: No. Michael: Now, is that email real? You betcha. However, if we can question its reliability to say, can, you know, do I trust this email to be what I think it is? Kimberley: Mm hmm. Michael: Then that can really start to dictate some of the actions that we take. So when we think about health anxiety, right, is your brain can give you a lot of really scary a lot of really unknown possibilities that could be going on with you. And [00:18:00] so, you know, one of the things that I think we have to really kind of start to become curious about is, do I just go with them? You know, am I there just responding to all of my spam emails in my email box? And if you do, we probably need to help like. Credit monitoring and all those Kimberley: Yeah. Michael: besides, from that point, do we get ourselves into a lot of actions that could be very unhelpful when we take these emails as as reliable? So, like, for instance, if you, you know, you have the dizziness, right? And you're, you're, you know, the initial evaluation or conclusion that your brain comes up with, aka what we could also call an obsession, right? Is like this could be an aneurysm, right? Or maybe you have a stroke or all these different types of really scary things. If we take that as a reliable piece of information, it starts to make Kimberley: Mm hmm. Michael: that we would be like, well, I need to figure that out. I need to be like, look up some symptoms of online or I need to go to the urgent care, whatever those things are, right? but if we get a, oh, by the way, I should have included this earlier, but [00:19:00] that's okay. We'll include it Michael: This is all on the premise that we have a relatively good answer. if you don't. If you're getting dizzy for no reason, and you have no idea why, I don't want you practicing anxiety Kimberley: Yes. Michael: Go to the doctor, right? Like, explore those things, figure those things out, try to get a pretty good answer. However, if we get a pretty good answer about something, and we are going to say it's like, I think this is because of my anxiety, but my brain wants to really convince me of all these other conclusions. can we use some of those tools in terms of, you know, Becoming curious about, can I really trust my brain sending me right Kimberley: Mm hmm. Mm Michael:  if this is like the 937th time that I'm convinced that I've had a stroke, what's the chances the 938th time is going to be it? Probably not. so, I could go look on things online, or probably got a lot of other things to do, too, that I could go and get involved with as well. So, that's it. One of those tools is, is really being [00:20:00] curious about, yeah, your brain's going to give you a lot of really scary medical possibilities. If we can ask that question of not if it's real or not, because those things are totally real, but can I trust the message that I'm being sent? It can start that process. Now, the other tool that I really like to use with people is diffusion. Um, and, and to kind of give it a quick breakdown of cognitive fusion, even though some people may be like some of the listeners may know, is just being able to like what kind of relationship that we have with some of our scary thoughts. so sometimes I kind of describe as like, well, it's not really necessarily getting away from them. It's just about changing our perspective towards them. So like, I kind of think about this example. It's like if you go out into like a really busy highway, you set up a lawn chair right in the middle of a busy highway and you have cars whizzing by you, you can see the traffic, but man, oh man, is it overwhelming. And so if we can use some diffusion skills and those would all be the great things, like, you know. Uh, just repeating or thanking our mind or my favorite is always just [00:21:00] singing, like, you know, the tune to happy birthday, Kimberley: Yep, Michael:  be right is sometimes those start to kind of be able to take us from this position of, could you just take your chair and put it on the side of the highway? And if we can do that, we can still see the traffic that's out in front of us, but it's much less overwhelming at that point because you don't have cars whizzing by Kimberley: all right Michael:  these cognitive interventions, I think, can be really helpful. Um, because a lot of times our brain is leading us to all of these conclusions, giving us these really scary ideas, and it might really start to go against the information that we have at that time, at least medically. Kimberley: Amazing. And I, the reason I love this is that was a big piece of it for me, just to sort of give a real example of me having health anxiety and a chronic illness when you are you're dizzy. My brain was like, this is it. You're going down, you're going down. And I had to get used to just having the thought like, yeah, you're dizzy. It could be it. But we know the symptoms of when you are, and you're just, you know, again, like you [00:22:00] often say, like, it's about being uncertain and being able to just to have the thoughts whenever they show up. So would you add anything to that or, Michael:  Know it. And I think what's important with that is, there's a piece of uncertainty Kimberley: um, Michael:  but we can also act within a reasonable Kimberley: yes, Michael:  right? It is like, you know, we can, we can always make those, you know, I always love delay in these situations Kimberley: um, Michael:  is if I start to become dizzy and I'm concerned that like this is going to be, this is me passing out, right? And if you just like, if you're dizzy and you remain dizzy and you remain dizzy, you know, those types of things and it, you know, you're just kind of like working through it and it's like, okay, maybe that's one thing if you're dizzy and then the wall start closing in, right? And you start to get tunnel Kimberley: yeah, Michael:  Well, that's what you can always make a different, Kimberley: yes, yes, um, Michael: I think the lay, but. nothing about health anxiety that likes delay, right? Because whenever these [00:23:00] symptoms come up, it's always going to be about you need to do this Kimberley urgent, Michael:  to the E. R. Currently, like right Kimberley: yeah, Michael:  wait, Kimberley: yeah, yeah, Michael:  if even if we're able to kind of like practice some type of delay, right? We'll be like, okay, this is what this feels like now. I understand the concerns my brain has, like not quite sure if I can trust it. I don't know. It's giving me some bad advice before. I But could I just wait that out and kind of see how that Kimberley yeah, Michael:  And, you know, if it continues to get worse or you start to get tunnel vision, go take care of it. There's probably something going on. But if those experiences, you know, I think what happens a lot of times for people is they, they try to move themselves on to something else, right? They get back to dinner or whatever it might be. And then they kind of have that reflection point or like later of being like, Oh yeah, I was like dizzy Kimberley: um, Michael:  earlier. And it's like, Oh, Kimberley: um. Michael:  to that? Right? So I think delay can be a really helpful Kimberley: Fantastic. Quickly, just because I have a couple of people in mind, and I know what their questions would be here, is in regards to [00:24:00] the, the point number two, where we were talking about the difference between medical, physical, and psychological. Let's say somebody. Um, has just intrusive thoughts about like, what if, actually maybe no, let's say they have a headache, a physical symptom and their brain is just constantly telling them like, this is a brain aneurysm, or this is a brain tumor, like this is cancer and it doesn't quit, um, Um, and the person also experiences this sort of intuition that this is what it is. What, how would you, what, what bucket would you put that in and would you use the same skills? Michael:  So, yeah, so the, the questions that I would have for that situation, which is number one, have you been to the doctor? You know, have you gotten it checked out? Have you like evaluated some of these, you know, headaches that you've been Kimberley: Mm. Michael:  Now if they say, uh, no, I've never been to the doctor about that. I'm, I'm not a doctor. I'm going to say would be [00:25:00] kind of silly of me at that point to be like, you're Kimberley: Yeah. Michael:  You know, that's Kimberley:  Just tolerate the uncertainty. Michael:  Yeah, that'd be good, right? We're like, that's probably not great. So because nobody would do Kimberley: No. Michael:  Like we, well, hopefully most people would not do that because if there is, so that's the first question I would always Kimberley: Mm. Michael:  is if you're having a physical symptom that's different, that's changed, that's more significant, whatever it might be, question needs to always be, have you gotten this Kimberley: Mm. Mm. Michael:  part that it's, I really wish there was a better answer to this. but there's not the least that I found, which is like how much is too much, you know? So if you're like, okay, so let's say the answer is yes, I have gotten it looked at and they can't find anything. Um, sometimes the conversation starts to become, well, how much, like, should I go for a second opinion or third or fourth or fifth or sixth? Um, and what's really difficult about that [00:26:00] is no one really knows that answer. Okay. And, um, what I try to really do to level with people, too, is that, you know, if you were having that headache and you're like, I don't know, Mike, like, this is like, I've seen like four doctors, still feel like there's something, like the intuition Kimberley: Mm hmm. Michael:  feel like there's something wrong. There's something going on. I can't, I can't fight you on that and being like, no, you shouldn't, right? Because I, the fifth time might actually be the time where it's like something comes back and you're like, oh my goodness, like, I'm so glad they found that. So. always this kind of difficult time that I get these questions where people would say like, what, what, what is too much now getting like a fourth or fifth or sixth opinion, whatever that might be, could just be reassurance Kimberley: Mm hmm. Mm hmm. Michael:  you know, getting another clear scan or whatever that might be. And it just kind of gives us that temporary relief of like, okay, goodness, like nothing's going on. But I think it's reasonable for us to know it's like it's not a very clear cut kimberley-_1_06-04-2024_101032: Mm hmm. Michael:  Of saying, like, [00:27:00] everybody's in their right to go get another opinion. you know, to, you know, however much you want to pursue that. We have to be on board and somewhat of being like, okay, like, go do that. But the other thing that I would always throw in there, too, that I like to try to work with people is, there's going to be productive ways that we can pursue that, there's going to be unproductive Kimberley: Mm. Michael:  you're having those headaches, and you're, and you're like, I've seen three people, I kind of want to go see four, I would say, I can't fight you on that. You should go see that fourth person, see what they say, but that's a productive method of trying to figure something out, right? Like, cause you could possibly, they could give you some scan, right? And be like, Oh my goodness, like right here, we found something, right? also other unproductive behaviors that sometimes people get into, um, that like your brain at 3 a. in the morning while you're ruminating about if there could be something going on in your brain or not, right? have no access to scans, like you're not gonna figure anything [00:28:00] out. You're not gonna come to some revelation of like, Oh, now that I can see inside my brain, I can see what the problem is, right? So, there's, there's kind of an encouragement that I try to give to people, too, is if you really feel like there's something wrong, and even though you've gotten a lot of things that have said maybe nothing is wrong, if you want, if you feel like it's necessary to continue to pursue those productive ways, set an appointment with a doctor. Go to that appointment when it's the time, right? Great, go do those. But some of these other things when we're thinking about like, but are we like ruminating about this for hours on end during the day? never going to become anything Kimberley: Mm. Michael:  not going to come to some insight of like, ah, I see everything clearly now, I see what's wrong. And so we try to practice those tools in those situations of saying, you know, if that's kind of an unhelpful thing to do, could I find something better to do? Uh, to do with my time than just endlessly going over this in my Kimberley: Yeah. Amazing. Which [00:29:00] ties us right into the thing number four. Um, tell us. Michael:  four, the four, I almost held up five, so that's good. Number four is, now, when we think of like, like, you know, for some of the viewers who might be a little bit more familiar with OCD, a lot of times I just use the terminology of TOs Kimberley: Mm. Michael:  triggers, obsessions, and Kimberley: Mm. Michael:  you might be saying, it's like, well, I didn't think health anxiety was really OCD. It's not. But. The functionality of these things kind of operate in the exact same way. So number four is talking about compulsions, or if you just wanted to view it as safety behaviors, that's cool, too. They kind of do the same thing, which is there's going to be physical or behavioral compulsions that we could do or mental. and one of the things that we really have to account for is just their ability to not really be able to give us an answer that we really want. and how sometimes it actually, especially with

Today, we’re going to go through the six reasons you procrastinate so that you can make a plan and hopefully end that procrastination so you can get back to doing the things you want to do.  Recognizing the reasons why you procrastinate is so important. I want to make sure I cover one key point before we get into the six reasons, and that is: you’re not lazy, and you’re not faulty. It’s not a bad personality trait that you procrastinate. I want to dispel that myth right out of the gate so that we can beat the self-criticism, the self-judgment, and the self-punishment that you may be doing or have done in the past. The fact that you procrastinate does not mean that there’s anything wrong with you. You’re not broken.  We engage in these patterns and safety behaviors to manage distress in our bodies. Procrastination is an avoidant behavior to avoid having to be uncomfortable and to work through the deep stuff that’s going on in our brain, mind, and body. First, I wanted to review that this is not your fault. You’re not bad because you do this. I’m even going to reframe a couple of those things here. A PERSPECTIVE SHIFT ON PROCRASTINATION As we talk about why you procrastinate, I want to tell you a story that changed my thoughts about procrastination. As an intern, I had a supervisor when I first became a therapist who supervised us and all our cases. A lot of the interns were talking about how we were so behind on all of our research and our study. We had all these tests, we had all these assignments, and we had to see clients. She questioned us by saying, “Procrastination isn’t necessarily a problem. First, you’ve got to look at the function of procrastination.” She said that if procrastination is working for you and it means you get the work done, you complete it in time, and you’re happy with the product you’ve created, procrastination isn’t a problem. In our society, we tell ourselves that we should be organized and calm when handing in the assignment instead of pressing the button right at the very last minute or sliding into work right as we should start.  Now, she said, if it’s working for you, go ahead and keep doing it. But so many of you, particularly those with anxiety, say, “No, Kimberley, that’s not the case. It is not working for me.” If that’s the case for you, let’s first look at the effects of procrastination. Suppose you are somebody who has an extreme amount of anxiety when you procrastinate, and it’s coming from a place of anxiety. In that case, it increases your panic and stress at the last minute, and you melt down. Then, this is why we want to explore the causes and why you procrastinate so that we can come up with a solution and a strategy that does help you.  The Six Reasons We Procrastinate Fear of Failure This is true for many people because we fear making mistakes. Our society has become allergic to making mistakes and failures. So we create such a story in our heads about how it’s going to be so bad if we fail, and it’s going to be so bad if it doesn’t go right, and how we are going to look stupid and how we are going to feel terrible. But much of that comes from this entrenched belief that we are not supposed to fail. I took a whole year and practiced failing for an entire year. I tried to fail a hundred times, which completely changed my thinking about failure in everything I do. I got good at things because I failed repeatedly and changed how I looked at failure.  Now, I understand that we are expected to perform at such a high level in today's society. But what I want to have you do is act from the place of a B-. What I mean by that is, instead of going for an A+ all the time, try a B-. You will find that if you just drop the bar and let it be imperfect, you’ll have so much less anxiety. It is much easier to practice being gentle and kind to yourself when you mess up or fail. I’ve had so many patients and students tell me, “Failing is not the problem; it’s the beat-up I give myself when I fail that I do not want to do and do not want to experience. That’s why I avoid it. I don’t want to beat myself up if I fail.” We want to make sure we change the way we look at failure. Not Wanting to Be Uncomfortable This could cover all of these categories because all of the reasons we procrastinate are ultimately just trying to avoid discomfort. So often, I procrastinate while recording this episode of Your Anxiety Toolkit, or I avoid and procrastinate while working out. It’s not because I don’t want to do those things. I love making these videos and exercising, but what I do is avoid the uncomfortable feeling that I have. Ultimately, I’m avoiding the hard work stage of any product or anything we do.  So many positive things in our lives that fulfill us require hard work. Nobody likes hard work. It’s not that fun. It’s uncomfortable. As a human species, or any species, we love to avoid discomfort. We do what we can to cut corners, and procrastination is one of those things. Often, we’re scrolling on Instagram or checking our email to avoid having to propel ourselves into doing the hard thing.  The tip is to break things down into small, manageable, tiny, doable steps and open up our willingness to allow for some discomfort. Willingness is a mindfulness skill that will help you so much in your anxiety recovery. I talk about it a lot here on Your Anxiety Toolkit because it is crucial for the management of anxiety. The more we’re willing to lean in, be open, and release the tension we hold from feeling discomfort, the more we get to embrace that discomfort, overcome that discomfort, and, in many cases, recover from anxiety. Willingness will be necessary regarding the discomfort we feel from doing the hard, scary thing. Perfectionism Perfectionism is so similar to the fear of failure. Perfectionism is all through our society. We are told that we have to be perfect, that we have to do it perfectly, and that we can’t make those mistakes. I want to offer you here that if you struggle with perfectionism, we want to adopt the B- mentality. We want to adopt kindness. We also want to pause and acknowledge how our society has created this because the truth is human beings are inherently imperfect. It is impossible to be perfect, yet we’re striving for it. We’re so committed to it as if it’s a reality, and it’s not. We won’t be perfect. Even if you achieve a perfect score on a test, you’ll still have to look in the eye for imperfections three minutes later. We will have to see the other things we’re not perfect at. It’s essential to see that. If your goal is perfection, you’re chaining yourself to having consistent anxiety.  When I was suffering from an eating disorder, I was constantly going for perfection with my body, with my diet, and with my exercise. That kept me stuck, and even when I did get to this “perfect goal,” I had anxiety about maintaining the perfect goal. Even once I achieved it, anxiety was still there. Anxiety was still running the show, and I was in panic mode all the time, either trying to be perfect or fearing that I’d lose this idea of perfection, which I never had anyway. But again, it’s all something like a construct in our brain that keeps us stuck and anxious. It’s essential to understand how that impacts us and the fact that we will never be perfect.  Thank God, I love imperfect people. I find it hard to befriend these “close to perfect” people. I don’t relate to them, and I don’t feel safe with them. I actually sometimes feel uncomfortable around them. You probably think the same way, but I feel so much better when I’m with real people who are comfortable or willing to admit their imperfections, share their imperfections, and connect with our humanness together when we settle into that imperfection.  Feelings of Overwhelm If you have anxiety, yes, overwhelm is a thing. I think of being overwhelmed like there are papers, things, and phones swirling around in my head. All I want in that moment is just a moment of inner peace and outer peace, where I want everything to slow down and stop so I can catch up in my mind. However, that’s probably not going to happen.  There often needs to be a physical way to get everything clear when we have a deadline or something we must do. The only thing I have found helpful with this is to simply write down the steps I need to take and how I will do them. That is the only thing. But at the end of the day, similar to the discomforts, a lot of the work we have to do with overwhelm is to be willing to feel it, slow down, and identify catastrophization. When we catastrophize, we increase our feelings of overwhelm, and that’s a cognitive error we engage in. If you catastrophize a lot, you’ll probably feel overwhelmed frequently. That’s just the way that it goes, unfortunately. We want to create a system where you have something to do that you can break down into small steps. I’m visual, so I like to draw, write circles around it, and put numbers one and two. If you’ve been following me here on Your Anxiety Toolkit, I want a step-by-step process. I like the five reasons for this so that I can comprehend it in my mind. If you need that, lean into it and use it to help you create small baby steps.  Another thing to do here is to breathe. When we’re overwhelmed, we often stop breathing. When overwhelmed, we often clench and hold all this tension in our brain and body. Our main goal here is to slow it down. You’re still going to be uncomfortable. You’re still going to be anxious. You will still be overwhelmed. But can you reduce the problematic response to that? Remember, we can’t control our experience and how it shows up, but we can control how we respond to it. We can control how we react to it. We don’t want to clench as much as we can. Again, we’re going to move slowly into the activity over time. Set some time limits. Maybe you do it for 10 minutes. There are so many Pomodoro apps that you can set a timer for three minutes and say, “I’m just going to do this for three minutes, then I’m going to take a break.” Do some breathing. But you’re moving in small, baby steps. Lack of Motivation If you’re someone who suffers from depression or you’re just not very motivated today, that’s another reason it’s difficult to launch yourself into something. An essential tool to remember when it comes to motivation is that we often rely on motivation to get us started, and that’s fine. That’s actually helpful if we have it. However, we want to flip the script on motivation. If you lack motivation, the only thing that’s going to generate motivation is to get moving. I know what you’re thinking. You’re probably thinking, ‘Yeah, but if I had motivation, I could get going. So I just need motivation to get going.” But I’m here to say no. Sometimes, you just need to go back to creating small baby steps. Once you start, you start having positive feelings about yourself. You begin to have positive feelings about what you’ve generated. And that is what creates motivation. Again, tiny baby steps. That is a very encouraging mindset.  Try to be your inner bestie. Encourage yourself. “You’ve got this. You can do it.” “I believe in you. Just a little more.” “Just get started. I know you can.” You’ll feel so much better when you do. Just keep talking to yourself, coaching yourself, and embracing yourself with that motivational best friend voice that encourages you. That can be very beneficial, as you’re doing this daunting thing that you really don’t want to do.  Poor Time Management This is one of the most important, especially if you have something that has a deadline. If you don’t have time management skills and aren’t good at really understanding how long the activity will take, you’re probably going to procrastinate and miss the deadline. We talk all about this in our online course called Time Management for Optimum Mental Health. We actually sit down and, step by step, plan your day. Not compulsively, but what we do is actually plan pleasure first. That’s the first thing we put on the schedule.  One of the main reasons people procrastinate is that they want pleasure. We want to feel good. We want to have great, fun things in our lives. So we spend a lot of time going back and forth, “I have to do this assignment, but I want to relax. But I have to do this assignment.” Because we haven’t planned our time and scheduled pleasure, we end up negotiating and spending a lot of our time going back and forth.  You plan and schedule your pleasure first so that you know you’ve given yourself what you need. And then you’re so much more likely to do the hard thing because you’ve already promised yourself and followed through that you would do the pleasurable thing so that you can get that more challenging thing done. In addition, you might want to be someone who schedules pleasure, hard, pleasure, hard, pleasure, hard, and gives yourself lots of breaks where you have lots of pleasure and things that bring you fulfillment and joy as you do this hard thing. I often do this with household chores. As I’m doing the hard thing, I’m listening to a podcast that I like. I’ve planned that. For example, I know that there’s a podcast that comes out on Friday, Your Anxiety Toolkit. On Saturday morning, when I know I have to do the laundry and fold the laundry, which I hate doing and often procrastinate with, I go, “Okay, Saturday morning when I want to listen to that podcast, I’m going to marry the positive and that difficult together.” Time management is so important. If you’re interested in taking the Time Management course, it is a deal. It is reasonably priced for something that will help you run your week and your day much more easily. You can go to CBT School or click the link in the show notes to get access to that course.  Those are the six reasons we procrastinate. I hope that this has helped you identify where you’re getting into trouble so that you can make changes and get your life going so that you don’t have to panic and be stuck in that absolute last-minute frantic panic. You can just schedule your time, break it into small steps, be as gentle and kind and motivating and encouraging as you can, and get the things you want done so that you can go and live your life.  Don’t forget, as I always say, today is a beautiful day to do hard things. I want you to remember that none of this is easy breezy. I never want to make it sound like it’s easy breezy. It’s hard work, but we must remind ourselves that hard work is a part of being human. It is a beautiful day to do hard things. I don’t want you to buy into society’s idea that life should be easy. “This should be easy for you. What’s wrong with you?” Nothing’s wrong with you. It’s hard. No one wants to do hard things, but you can do those hard things.  I hope you have a wonderful day. I’ll see you in the next episode.

I have a new best friend just for you.  I know that might sound a little strange, so hang with me here because this was mind-blowing to me, and I hope it is for you as well.  Let's talk about best friends. What does a good best friend look like?  It will be different for everybody, but generally, the way I see a best friend is that they're fun to be with. They're interested in fun things or things that you're interested in. They are there for you. They show up for you. They celebrate your birthday. They want to know how you're doing. They have a genuine interest in you. They're willing to pour into you. But in addition to that, they are also there for you when things get crappy.  It's so important because sometimes we feel vulnerable when sharing with people. But when we do share and are vulnerable, we can be held, and some space is created. There's this beautiful relationship where you share how you're doing, and they hold space for that. They encourage you. They ask how they can support you. Maybe they can give you some helpful advice. They're there for you when things are really hard. When you start to be hard on yourself, they pull you up.    THE BENEFITS OF BEST FRIENDS Best friends can also be brutally honest but in the most beautiful way.  I have two best friends. One is my husband, and one is a friend who lives quite a distance away. It's all via technology—voice chat, FaceTime, phone calls, and so forth. My best friends, not only do they support me, not only are they kind and lovely, but they also do call me out on my crap. They often say, "I don't think you've thought about this one well enough," or "Kimberley, I think you're going a little too urgent here. I think that your anxiety might be getting in the way." Or "Kimberley, have you taken care of yourself today? I'm noticing you mentioned you haven't been getting a lot of sleep. Could that be why this is hard for you?" Best friends aren't just all flowers and roses. They are honest and real. They're there for you when things aren't going well, but they champion you too. They believe in you like nobody else. When you're at your lowest, best friends will be like, "You could do totally that." Or if you're beating yourself up for not being good enough, they're like, "Oh my god, are you kidding me? Look at all the things that you've done." They're so ready to celebrate you, and they see you for way more than you can see yourself.  That is what I want for you so I will introduce you to your new best friend, and it's you. Your new best friend is you. I want you to think about this because you haven't developed a relationship with YOU enough to be your own best friend. It's something you're going to have to invest in. Your new best friend is YOU, whom I'd like you to meet. Hello friend. This new bestie that you're creating is going to be the person who is there for you no matter what.  AN INNER BESTIE VS. THE KIND COACH Let me tell you why I've been thinking about it this way. I wrote a book called The Self-Compassion Workbook for OCD, and I talked about the Kind Coach concept. The kind coach is this warm voice inside you that coaches you through hard things. If you were to think about the mean coach you probably had in high school, he's like, "Get down and give me 20," or "Get going, you loser. Run faster." He or she motivates you through criticism and harsh comments and uses a very aggressive voice.  We don't want that because we know,, based on the research,, that it decreases motivation, increases procrastination, increases punishment, and wreaks havoc on the nervous system and the immune system. We don't want that. Instead, we use this Kind Coach. The Kind Coach encourages us. They know our strengths, and they encourage us based on our strengths. They know our weaknesses, and they don't use our weaknesses to get you moving forward. The kind coach is constantly there, encouraging you to keep going. I love this concept. But as I recently went through a difficult time, I was using this tool,, and I kept thinking, 'Something isn't landing here. This feels a little too professional.' I didn't want it at that time. While the kind coach has helped me through so many things, I didn't want a coach around when things fell apart for me. What I needed was a bestie, a best friend. I needed somebody who was more like a pal, someone who could be in my pocket. Someone who I felt a little sassier with, someone who I could use my humor with because I needed humor to get through this hard thing.  THE INNER BESTIE: THE UNCONDITIONAL FRIEND I was thinking, 'What is it that I need?' This is the golden self-compassion question that you should be asking yourself all the time. What do I need? When I checked in, I was like, "I do. I really need my best friends around." But sometimes my best friends weren't around. My husband would be at work, and my best friend lives far away in a different time zone. They weren't even awake at the time that I needed them. Who do I go to when my best friends aren't there? Some people would say, "It's fine; just go to the next best person." But I needed to be there for myself.  I giggle as I say this to you because practicing leaning on my inner bestie or my inner mate has been so powerful because there's a playfulness to this where you get to goof off with them a little. You get to make fun of it. I really do. I make fun of myself quite regularly, but not in a critical way—in a way where I'm like, "It's really cute and goofy that I do that." Often,, when I think of things that I'm not super proud of, I go, "I love that I am a little goofy." My family always makes fun of me because I love taking bites out of things, like everything. There's often something like a banana that's got a little piece cut off, or if we get a box of chocolates, I take a bite out of every single one and put it back in there because I just want to taste all of them. I'm okay to giggle at that. I want to be able to giggle with my best friends about how that's my little quirky thing.  A best friend is someone who is always there for you. They're okay to giggle. They're okay to warm, be warm, and connect. They're okay to be firm and redirect you when you're totally off track. Over the last few months, I've befriended this friend so much. I call this friend 'babe,' and babe and I have conversations together. As I'm getting ready, I'll be like, "Okay, babe, it's cool. We're doing this together. It's going to be a hard day. You've got this, this, and this to go through. What do you need, babe?" We have a conversation, and it's me. It's not anybody else. It's not the voice of a coach; it's me—my inner bestie, the one who's always going to be there for myself.  THE VOICE OF THE INNER BESTIE As I've gone through these challenging times, I think this voice feels so grounding. I trust her more than I've ever trusted the kind coach. I'm not saying there's no place for the kind coach, but this is the next level for me.  Here's what I want you to do: I want you to find a piece of paper, and I want you to either draw and/or write what this inner bestie is for you and what they look like. They're you, but how they sound, how they look. What do they say to you? How do they say it? What's their body language? How do you talk to it? For me, it's a different way of relating to myself. Now I'm talking to myself like, "Hey, babe, I got you." It's a little more conversational, a little bit more interactive. But that's what best friends are.  Let's also think about how we treat our best friends. One thing I have learned mostly through therapy is how to be a good wife. When I say good wife, I mean, just for me, how to stand next to my husband and encourage him. Even if I'm slightly annoyed, how can I pour into him? How can I show him how much I appreciate him? Even if that doesn't come naturally in the season that I'm in, how can I encourage him? How can I check in with him? I have to think about that consciously.  What I want you to do is think about how you can relate to your new best friend—you, your inner bestie—and also how you can pour into your best friend this inner bestie. Can you check in with it more often? Can you send it love more often? Can you ask how we can be in a relationship? What does it need? I want you to practice having a daily check-in. You can't just have a best friend and take the benefits but ignore them and their needs as well. This is what I want you to journal down.  I am also fine if you want to give it a name. I call mine 'babe,' as I said before. "Hey babe, how are you doing? What do you need?" It calls me babe, and we talk to each other that way. In fact, that's how I talk to most of my friends. I call them babe. Then, I want you to check in with them as much as you can. I want you to start having conversations.  When I was struggling, I started recording myself talking to Babe on my phone and saving it. As I'm getting ready, I'm saying, "Hey babe, you've got a hard day." This is babe talking to me; I'm talking to it. "You've got a hard day. I'm so sorry you're going through this. That sucks. This is just so much. I'm proud of how you got up today. Even though you didn't sleep very well, I'm proud that you didn't lose it on that one person who ran into you at the supermarket because you're so overwhelmed and you have so much going on. That was pretty impressive." Or, "Hey babe, it is so cool how you regulated your emotions at that moment. That was impressive." "Hey babe, I know you didn't do so well at that moment, but I love how you're coming to me and aligning again. you've come back to me. that's cool." Some days I might go, "Hey babe, anxiety's here today.  Alright, we know what to do. We should have expected it, but it's all good. we're going to go with anxiety. it's going to come along with it. what do you need?" This conversation that we're having back and forth doesn't make you crazy. It doesn't mean anything's wrong. What it means is that you are starting to talk to yourself in a way that you deserve, that you need to be respected, and that you deserve to have that person. This is what we want to do.  The cool thing is, if you follow me on Instagram or YouTube, I'm starting to do way more videos where I talk to myself through the lens of my inner bestie. I'm having those conversations. I'm brushing my hair as I talk to myself. I am brushing my teeth. I'm doing the dishes. I'm writing checks if I have to be writing checks. I'm practicing it in all the little places, and I'm trying to show you how to do it so you can go follow me there and see for yourself. But I want you to think about this. The new best friend is here, and you get out what you pour into it. Give it a try. I really, really believe in this.  If this is a bit awkward for you, that's okay. There's no problem with the awkwardness. Let it be awkward. If it feels a little wrong or weird, that's okay too. Let it be weird and awkward and strange and uncomfortable. There's nothing wrong with getting used to these feelings. You might even say, "Hey, babe, it's weird to talk to you. This feels odd. I'm not so sure about this." Then you might even listen and be like, "Yeah, it's okay that it's uncomfortable."  You might even have your babe in my accent, and that's fine as well. What we are really trying to do is get an inner dialogue that is kind, that's got a little sass to it, and that's got a little punk to it, whatever you like. That is exactly what you need, because what I need in a best friend might be different from what you need. Sometimes your best friend needs to be total sassy, like doesn't take crap from anybody and stands up for you no matter what. If that's what you need your babe to be, go ahead. Let your babe be that.  Take what you need. Leave the rest. Play around with this. But I would say give it a full 30 days. Practice having an inner bestie, connecting with and pouring into that inner bestie for 30 days, and you'll be shocked at how your inner narrative changes.  Have fun with your best friends. I cannot wait to hear how this aligns with you and how it's helping with any struggles that you're having. Please let me know on social media if you have any questions. You can catch me on Your Anxiety Toolkit on Instagram or YouTube. Have a great day, everybody, and it's a beautiful day to do hard things.

Imagine being able to walk into a crowded room without feeling your heart pound out of your chest. Envision yourself confidently striking up conversations with strangers or going about your day without being overwhelmed with the fear of being judged by others.  If social anxiety has been holding you back from enjoying life, it's time to take on an exposure challenge and learn how to feel more confident in your skin when you are in public. In this episode of Your Anxiety Toolkit, we will explore one of the most well-known, science-based, and effective strategies for overcoming social anxiety. From gradual exposure to uncomfortable social situations to building a support network, you'll discover practical steps to overcome the grip of social anxiety. Recently, I overheard a therapist (of all people) say that letting our clients experience distress is harmful.  When I heard this, I gasped.  This idea and this narrative concerned me so much.  We have become so fixated on never feeling distressed that we fuel our anxiety and emotions.   Now, I get it. I am not in the business of being a therapist to make people feel terrible. Quite the opposite. However, one of the most powerful messages I give my clients is that we can learn to compassionately and effectively navigate distress because distress is a natural part of being a human.   If we have anxiety and we are committed to not feeling it, it will control every aspect of our lives. If you have social anxiety and you are committed to never being uncomfortable, social anxiety will take everything you love from you, including your future.  Today, we are focusing on pushing yourself outside of your comfort zone and facing your fears.  What you will learn is that you'll gradually build your confidence and become more at ease in social settings.  With each small success, you'll grow more robust and more resilient, expanding your social circle and embracing new opportunities. My hope is that you don't let social anxiety hold you back any longer.  Today, I am going to give you a 30-day Social Anxiety Challenge.  I have seen this work for my clients repeatedly, and I am confident it will change your life, too.  Before we get started, let's first make sure you have a good understanding of social anxiety.  UNDERSTANDING SOCIAL ANXIETY Social anxiety, also known as social phobia, is a common mental health condition characterized by an intense fear and anxiety in social situations. It goes beyond mere shyness and can significantly impact an individual's daily life. People with social anxiety often experience excessive worry about being judged, embarrassed, or humiliated in social settings. This fear can be so overwhelming that it leads to avoidance of social situations altogether. One thing I always share with my students and clients is that while Social anxiety is considered an anxiety disorder, I agree with Christopher Germer, a well-known psychologist who has been on the show (episode 199), that social anxiety is as much a shame disorder as it is an anxiety disorder.   From my experience, people with Social anxiety struggle immensely with shame, and this powerfully painful emotion can disrupt so much of someone's life. It can increase the incidence of depression and even suicidal ideation.  Having social anxiety can leave you feeling like a fool, awkward, and alone.  Commonly, people with social anxiety withdraw and isolate, only making themselves feel more alone, defective, and often more depressed.  Social anxiety can have a profound impact on various aspects of a person's life. It can hinder their ability to form and maintain relationships, limit their career prospects, and diminish their overall quality of life. Simple tasks such as making a phone call, attending social gatherings, or speaking in public can elicit intense anxiety, leading to avoidance behaviors and missed opportunities. The constant fear of being evaluated negatively by others can create a cycle of self-doubt and isolation. But today, we will put our entire attention to turning this around for you.  Today, I am going to give you a 30-day Social Anxiety Exposure challenge where you face your fears and take your life back from social anxiety.   The 30-day Social Anxiety Exposure Challenge: What is it and how does it work The exposure challenge is a science-based therapeutic technique widely used in the treatment of social anxiety. It involves deliberately facing feared social situations in a gradual and controlled manner. The goal is to help you habituate to your anxiety-provoking situations and develop a sense of mastery and confidence.  Exposure can be done in real-life situations or through imaginal exposure, where you vividly imagine yourself in anxiety-inducing scenarios. Today, we are going to focus on real-life situations because I wholeheartedly believe that is where the money is. I have seen it work with hundreds of my clients.  Exposure works by activating the fear response and allowing you to experience the anxiety you feel. Over time, repeated exposure to the feared situations helps retrain your brain, reducing the anxiety response and building resilience and confidence. It is important to note that exposure should always be done at a pace that feels manageable for you, and seeking professional guidance can be beneficial in designing an exposure plan tailored to your specific needs. What are the Benefits of doing a 30-day social anxiety exposure challenge? Facing your social anxiety through exposure can have numerous benefits. Firstly, it allows you to confront and challenge your irrational beliefs about social situations. By repeatedly exposing yourself to feared situations, you'll begin to gather evidence that contradicts your negative thoughts (such as “everyone hates me,” “They will think I am an idiot,” or “I will make a fool out of myself”), gradually reshaping your perception of social interactions. This process can lead to increased self-confidence and a more positive self-image. Exposure also provides an opportunity for skill-building and learning. As you face your fears and navigate social situations, you'll develop new coping strategies and important social skills. These skills will help you manage anxiety and enhance your ability to connect with others and build meaningful relationships in ways that feel authentic to you. The more you expose yourself to different social scenarios, the more adaptable and resilient you become in handling various social challenges. THE 30-DAY SOCIAL ANXIETY EXPOSURE CHALLENGE RULES Okay, before we get started, please know that you can either do these in the exact order or you can put them in the order of easiest to hardest.   My only tip is to make sure you do at least one of these exposures per day. You get extra points if you do them many many times, as this is how you will really learn the most.  Tracking your progress and celebrating small victories is essential for maintaining motivation and building confidence. Keep a record of your exposure activities, noting the level of anxiety experienced and any positive outcomes or insights gained. Reflecting on your progress can help you see how far you've come and provide a sense of accomplishment. Celebrate each small victory, no matter how insignificant it may seem. Recognize that every step forward is a step closer to overcoming social anxiety and living a fulfilling life. Other tips:  Plan ahead.  Some of these exposures will require some planning and arranging.  Do not let fear stop you or make too many excuses.  You will only get out what you put in.Do these exposures with kindness ONLY.  The biggest goal is to not criticize yourself at all. Do the best you can. Catch yourself when you are going down the self-loathing rabbit hole. Challenge your negative thoughts about yourself and be your biggest cheerleader. Once the exposure is over, you are not allowed to think about what happened. Try not to ruminate about it.  Celebrate your wins.  Set up a reward for completing the challenge.  Or several rewards throughout hte 30 days. If you find one of them easy, try to double up and add something challenge to the challenge.    THE 30 DAY SOCIAL ANXIETY CHALLENGE PLAN Day 1: Take a walk in public and give eye contact to 5 people.  Day 2: Take a walk in public and give eye contact and a smile to 5 people.  Day 3: Take a walk in public, make eye contact, smile, and greet five people.  Day 4: Go to the mall or a store and make small talk with a cashier. Day 5: Ask a stranger for directions. Day 6: Order food at a restaurant without rehearsing. Day 7: Compliment 5 strangers. One Week Check-in: What thoughts are you having?  Day 8: Attend a social event without a close friend. Day 9: Speak up in a meeting at work or school. Day 10: Join a club or group related to a hobby. Day 11: Make a phone call instead of sending a text or email. Day 12: Practice introducing yourself to 2 new people. Day 13: Start a conversation with someone in a waiting room. Day 14: Sit in the front row during a presentation or class or at the movies. Day 15: HALF WAY: Join a public speaking group, like Toastmasters. Day 16: Share a personal opinion in a group setting. Day 17: Attend a social gathering and stay for a set amount of time. Day 18: Initiate a conversation with someone you find intimidating. Day 19: Go to a party and introduce yourself to at least three new people. Day 20: Take a class in improv or acting. Day 21: Sing karaoke in front of others or sing as you walk down the street. Day 22: Ask someone for help in a store. Day 23: Participate in a team sport or group exercise class. Day 24: Initiate a conversation with someone sitting alone. Day 25: Practice saying “no” in various social situations. Day 26: Give a compliment to a coworker or classmate. Day 27: Ask someone to coffee or a casual outing. Day 28: Go to a new place and ask a stranger about the best things to do there. Day 29: Introduce yourself to your neighbors. Day 30: Share a positive personal achievement with others. There you go!  There is your 30-day Social Anxiety  Life after the Exposure Challenge. As you continue to face your fears and engage in exposure activities, you'll gradually notice a shift in your confidence and ability to navigate social situations. Embrace this newfound confidence and allow it to propel you forward in life.  Your social world will expand with each successful exposure, and opportunities for personal and professional growth will arise.  Remember that overcoming social anxiety is a journey, and setbacks may occur along the way. Be kind to yourself, celebrate your progress, and continue to challenge yourself to reach new heights of confidence and self-assurance. Don't let social anxiety hold you back any longer. Step out of your comfort zone, face your fears, and embrace the incredible potential that lies within you. I always say, “Today is a beautiful day to do hard thing.” You deserve to live a life free from the shackles of social anxiety.  Get going with this challenge as soon as you can. I promise that you will not regret it.

Behind every smile, there can be hidden struggles and pain. You might even be one of those people struggling so much but puts on a smiling face even though you feel like you are sinking.   Smiling depression, a somewhat new term to describe people who are struggling with high-functioning depression, is a lonely battle that many individuals face. In today’s episode, we dive into the topic of smiling depression, exploring what it is and how it affects those who suffer from it. IS SMILING DEPRESSION A DIAGNOSIS? First of all, let me be clear. Smiling Depression is not a specific mental health diagnosis.  Instead, it is a presentation of depression. Unlike well-known symptoms of depression, those with smiling depression put on a facade of happiness. They may appear perfectly fine on the surface, leaving their inner turmoil hidden from the outside world. Unfortunately, this masks the severity of their emotional struggles, making it difficult for others to offer support or understanding. It is important to acknowledge the hidden struggles of smiling depression and offer compassion and support to those who are silently battling this condition. They are not lying or faking it to deceive you.  Instead, they feel completely trapped. They often see no way but to keep going and keep pretending. They just keep smiling, even though they see an end in sight. They put a smile on their face, and they push through.  Even just saying that makes me want to cry, as I have been in this situation too many times.  I completely understand the pressure (often self-induced pressure) just to keep going and “not complain,” “look at the bright side,” or “be grateful for what I have,” even though I was being crushed with hopelessness, helpfulness and worthlessness.  My hope is by addressing this topic, we can create an environment where you feel safe to express your true emotions and seek help.  You are not broken. You are not wrong for feeling this way.  And asking for help does not make you weak or bad.  You deserve to have support, love, compassion, and time to recover.  SIGNS AND SYMPTOMS OF SMILING DEPRESSION Smiling depression can be difficult to identify, as those who experience it often mask their true emotions behind a smile. However, there are certain signs and symptoms that can help us recognize this hidden condition.  One common characteristic of smiling depression is the apparent contradiction between a person's outward demeanor and their inner emotional state. While they may appear cheerful, happy, and successful, they may be struggling with feelings of hopelessness, helpfulness, worthlessness, emptiness, sadness, or even thoughts of self-harm or suicide. Another smiling depression symptom is the tendency to keep their struggles hidden from others. Individuals with smiling depression often feel the need to maintain a facade of happiness, fearing that opening up about their inner turmoil will burden or disappoint those around them. This can lead to a sense of isolation and loneliness, further exacerbating their emotional struggles. Furthermore, individuals with smiling depression often experience a lack of motivation and interest in activities they once enjoyed. They may withdraw socially, have difficulty concentrating, and experience changes in appetite and sleep patterns. These symptoms, when combined with the constant pressure to maintain a happy facade, can take a toll on their overall well-being. What I think is very interested is the overlap of Smiling depression and perfectly hidden depression.  We previously did an episode with Margaret Rutherford about perfectly hidden depression which is a form of depression where people become hyper fixated on being perfect to mask their experience of depression.  You can listen that episode on the show notes to learn more.  THE HIDDEN STRUGGLES OF SMILING DEPRESSION Smiling depression is not simply a case of "putting on a brave face." It is a complex mental health condition that can have severe consequences if left untreated. While individuals with smiling depression may appear perfectly fine on the surface, they often battle with intense emotional pain behind closed doors. One of the hidden struggles of smiling depression is the constant pressure to maintain a happy facade. Society often expects individuals to be cheerful and optimistic, making it difficult for those with smiling depression to express their true feelings. This can lead to shame, guilt, and a sense of being misunderstood. Additionally, the internal conflict between the outward appearance of happiness and the inner turmoil can be mentally and emotionally exhausting. Individuals with smiling depression often feel like they are living a double life, constantly hiding their pain while wearing a smile. This internal struggle can affect their self-esteem and overall mental well-being. Furthermore, the lack of understanding and awareness surrounding smiling depression can make it difficult for individuals to seek help. Since they appear to function well in their daily lives, others often dismiss or overlook their struggles. This can further isolate them and prevent them from receiving their desperately needed support. THE RELATIONSHIP BETWEEN SOCIAL MEDIA AND SMILING DEPRESSION Social media has become an integral part of our lives in today's digital age. While it has its benefits, it can also contribute to the development and exacerbation of mental health conditions such as smiling depression. Social media platforms often present a distorted reality where everyone appears to be living their best lives. This constant exposure to curated and idealized versions of other people's lives can create a sense of inadequacy and comparison for individuals with smiling depression. They may feel like they are not living up to the standards set by others, further fueling their feelings of emptiness and sadness. Furthermore, the pressure to maintain a positive online presence can be overwhelming for those with smiling depression. They may feel compelled to post happy and upbeat content, even when struggling internally. This can perpetuate the cycle of hiding their emotions and feeling isolated from their online communities. If this is true for you, remember that social media is almost always fake.  It is not the real life of the people you follow. I love seeing posts where people show pictures of themselves looking all glamorous and then show them crying just a few minutes later. Even though I hate that they are struggling, some people are showing what real life is like behind the scenes and I think we all need to remember that.  COPING STRATEGIES FOR INDIVIDUALS WITH SMILING DEPRESSION While overcoming smiling depression can be a challenging journey, there are coping strategies that can help individuals navigate their inner struggles and find some relief. The first coping strategy is to practice self-care. This involves prioritizing your physical, emotional, and mental well-being. Engaging in activities that bring joy and relaxation, such as exercise, hobbies, or spending time in nature, can help alleviate symptoms of smiling depression. Building a routine with healthy habits, such as getting enough sleep and maintaining a balanced diet, can also contribute to overall well-being. If you want to learn more about health routines for depression, we covered that in a recent podcast episode called Living with Depression: Daily Routines for Mental Wellness. The link to that episode will be in the show notes.  Seeking social support is another crucial coping strategy for individuals with smiling depression. Opening up to trusted friends, family members, or mental health professionals can provide a safe space to express emotions and receive support.  Joining support groups or engaging in therapy sessions can also help individuals develop healthy coping mechanisms and learn from others who have faced similar challenges. In addition, practicing mindfulness and self-reflection can be beneficial for individuals with smiling depression. This involves being present in the moment, accepting one's emotions without judgment, and exploring the underlying causes of their struggles. Techniques such as meditation, journaling, or engaging in creative outlets can aid in self-discovery and promote emotional healing. It is important to note that coping strategies may vary from person to person, and what works for one individual may not work for another. The key is to explore different techniques and find a personalized approach that best suits one's needs and preferences. TREATMENT FOR SMILING DEPRESSION While coping strategies can be helpful, it is important to acknowledge that smiling depression is still simply a term to describe a serious mental health condition that often requires professional intervention. Seeking help from a mental health professional, such as a therapist or psychiatrist, can provide individuals with the necessary support and guidance to navigate their journey toward recovery. A mental health professional can help individuals with smiling depression by providing evidence-based treatments, such as cognitive-behavioral therapy (CBT) or medication. To start, the main treatment goal might be to offer a safe and non-judgmental space for individuals to express their emotions and come to terms with the fact that smiling through their pain is not working anymore.  This can be painful and very scary.  It is crucial to remember that seeking professional help is not a sign of weakness, but rather a courageous step towards healing. With the guidance and support of a mental health professional, individuals with smiling depression can find the strength to overcome their inner struggles and live a fulfilling life. CBT treatment will involve addressing any errors in their thinking and also addressing the behaviors that are contributing to their depression.  The real goal of CBT is to compassionately help the person with smiling depression to find new and effective coping techniques, and kind, and move them towards long-term recovery and healing.  If you are looking for help with depression and do not have access to professional mental health care, or if you are interested in learning new ways to manage your depression, you may want to consider our online course called OVERCOMING DEPRESSION.  Overcoming depression is an on-demand online course that will walk you through the exact steps I take my clients through when they have depression.  I will first help you fully understand the science behind why you have depression, and then I will teach you all about how to create a plan of attack to overcome your depression.  Treatment for depression involves learning a lot about self-compassion and mindfulness. These skills will help you manage strong emotions and the depressive thoughts that you have.  I will teach you how to correct the errors in your thinking, create a schedule that will help you reduce overwhelm and hopelessness, and increase your motivation to get the things that you need to get done I will give you printouts and video training to show you just how to do it all.  If you are interested, go to www.cbtschool.com/depression.  Just remember, it is not therapy. This is a home study course to show you the steps others have taken to overcome their depression.  SUPPORT SYSTEMS FOR THOSE WITH SMILING DEPRESSION Building a strong support system is vital for individuals with smiling depression. Having a network of understanding and empathetic individuals can provide a sense of validation and belonging, helping to counteract the feelings of isolation that often accompany this condition. Support can come from various sources, including friends, family members, support groups, and online communities. It is important for individuals with smiling depression to reach out and connect with others who have similar experiences. This can provide a safe space for sharing emotions, exchanging coping strategies, and offering mutual support. Additionally, it is crucial for loved ones to educate themselves about smiling depression and understand the unique challenges faced by those who suffer from it. By learning about the condition, they can provide the necessary support and validation, helping individuals feel heard and understood. CONCLUSION AND ENCOURAGEMENT FOR THOSE WITH SMILING DEPRESSION Smiling depression is a hidden battle that many individuals face. Behind their smiles, they may be struggling with intense emotional pain and a sense of isolation.  If you or someone you know is experiencing smiling depression, remember that you are not alone. Reach out to trusted friends, family members, or mental health professionals. Seek help and support, and remember that there is hope for recovery.

In today's fast-paced and demanding world, it's easy to forget to show ourselves the same compassion and empathy we extend to others. But what if I told you that embracing self-compassion could lead to a happier, more fulfilling life? It's true, and in this article, we will explore the power of self-compassion and how it can positively impact your overall well-being. Self-compassion is about treating ourselves with the same kindness, care, and understanding that we would show to a loved one. It involves acknowledging our imperfections and mistakes without judgment, and embracing our humanity. When we practice self-compassion, we cultivate a positive relationship with ourselves. We learn to be more understanding and forgiving, and that inner critic inside us gradually softens. We become more resilient in the face of challenges, and our self-esteem and self-worth improve. So how can we embrace self-compassion in our daily lives? We will delve into practical strategies and techniques that can help us cultivate self-compassion and create a more loving and compassionate relationship with ourselves. Join us on this journey of self-discovery and learn how to harness the power of self-compassion for a happier and more fulfilling life. Understanding Self-Compassion Self-compassion is about treating ourselves with the same kindness, care, and understanding that we would show to a loved one. It involves acknowledging our imperfections and mistakes without judgment, and embracing our humanity. When we practice self-compassion, we cultivate a positive relationship with ourselves. We learn to be more understanding and forgiving, and that inner critic inside us gradually softens. We become more resilient in the face of challenges, and our self-esteem and self-worth improve. Self-compassion is not about self-pity or self-indulgence. It is about recognizing our common humanity and understanding that we all make mistakes and face challenges. It is about being kind and supportive to ourselves, especially during difficult times. By embracing self-compassion, we can free ourselves from the constant pressure to be perfect and allow ourselves to be authentic and vulnerable. The Benefits of Practicing Self-Compassion The benefits of practicing self-compassion are numerous and far-reaching. Research has shown that individuals who regularly practice self-compassion experience higher levels of well-being and life satisfaction. They are more likely to engage in healthy behaviors, have better mental health, and experience lower levels of stress and anxiety. One of the key benefits of self-compassion is its role in fostering resilience. When we are kind and understanding towards ourselves, we are better able to bounce back from setbacks and failures. Instead of beating ourselves up over mistakes, we can learn from them and grow stronger. Self-compassion also plays a crucial role in our relationships with others. When we are compassionate towards ourselves, we are more likely to show compassion towards others. We become better listeners, more empathetic, and more understanding. This, in turn, leads to healthier and more fulfilling relationships. Self-Compassion vs. Self-Esteem While self-compassion and self-esteem are related, they are not the same thing. Self-esteem is about evaluating ourselves positively and feeling good about our worth and abilities. It is often based on external factors such as achievements, appearance, or social status. On the other hand, self-compassion is about being kind and understanding towards ourselves, regardless of our achievements or external circumstances. It is about accepting ourselves as flawed human beings and embracing our imperfections. Self-compassion is not contingent on success or meeting certain standards; it is a constant source of support and care. Research suggests that self-compassion may be a more stable and nurturing source of self-worth compared to self-esteem. While self-esteem can fluctuate depending on external factors, self-compassion provides a consistent and unconditional sense of acceptance and love. The Science Behind Self-Compassion The benefits of self-compassion have been extensively studied and documented in the field of psychology. Researchers have found that practicing self-compassion activates areas of the brain associated with positive emotions and well-being. It also reduces activity in the areas of the brain associated with self-criticism and negative emotions. Furthermore, studies have shown that self-compassion is linked to lower levels of stress hormones, such as cortisol. It has also been found to enhance the functioning of the immune system, improve cardiovascular health, and promote overall physical well-being. The scientific evidence supports the idea that self-compassion is not just a fluffy concept; it has real, tangible benefits for our physical and mental health. How to Cultivate Self-Compassion Cultivating self-compassion is a journey that requires practice and patience. Here are some practical strategies and techniques that can help you cultivate self-compassion in your daily life: Practice mindfulness: Mindfulness involves being present in the moment and non-judgmentally observing our thoughts and emotions. By practicing mindfulness, we can become aware of our self-critical thoughts and replace them with more compassionate and supportive ones. Challenge your inner critic: Notice when your inner critic is being harsh and judgmental towards yourself. Challenge those negative thoughts by asking yourself if you would say the same things to a loved one. Replace self-criticism with self-compassionate statements. Practice self-care: Take time to prioritize your physical, emotional, and mental well-being. Engage in activities that bring you joy and relaxation. Be kind to yourself by getting enough rest, eating nourishing foods, and engaging in self-care rituals. Cultivate gratitude: Develop a gratitude practice by regularly reflecting on the things you are grateful for. This can help shift your focus from self-criticism to appreciation and self-compassion. Seek support: Reach out to trusted friends, family, or professionals who can provide a compassionate ear and support. Sometimes, sharing our struggles with others can help us gain a fresh perspective and find solace in knowing we are not alone. Remember, cultivating self-compassion is an ongoing process. Be patient with yourself and embrace the journey of self-discovery and self-acceptance. Integrating Self-Compassion into Daily Life Integrating self-compassion into our daily lives requires conscious effort and intention. Here are some practical ways to incorporate self-compassion into your daily routine: Start your day with self-compassion: Set aside a few minutes each morning to practice self-compassion. This could be through meditation, journaling, or simply reminding yourself of your inherent worth and embracing the day with kindness and love. Practice self-compassion during challenging moments: When faced with difficulties or setbacks, pause and offer yourself words of encouragement and support. Remind yourself that mistakes and failures are a natural part of life, and treat yourself with the same kindness and understanding you would offer to a friend. Create a self-compassion mantra: Develop a mantra or affirmation that embodies self-compassion for you. Repeat it to yourself throughout the day as a reminder to be kind and gentle with yourself. Practice self-compassion in self-talk: Pay attention to your inner dialogue and notice when self-critical thoughts arise. Replace them with self-compassionate statements and affirmations. Be your own best friend and cheerleader. Engage in self-compassionate acts: Engage in acts of self-care and self-compassion regularly. This could be treating yourself to a relaxing bath, taking a walk in nature, or engaging in a hobby you love. Prioritize activities that nourish your soul and remind yourself that you deserve kindness and care. Remember, self-compassion is a skill that can be developed and strengthened over time. With practice, it becomes a natural and integral part of your daily life. The Role of Self-Compassion in Relationships Self-compassion not only benefits our relationship with ourselves but also has a profound impact on our relationships with others. When we are kind and compassionate towards ourselves, we are better able to extend that kindness and compassion to others. Self-compassion allows us to be more empathetic and understanding towards others. It helps us recognize that everyone has their own struggles and imperfections, just like we do. Instead of judging or criticizing others, we can approach them with empathy and kindness. Furthermore, self-compassion helps us set healthy boundaries in our relationships. We learn to prioritize our own well-being and recognize when we need to say no or take a step back. This allows us to maintain healthier and more balanced relationships. In romantic relationships, self-compassion plays a crucial role in fostering intimacy and connection. When we are kind and accepting towards ourselves, we are more likely to be vulnerable and open with our partners. This, in turn, creates a safe space for emotional intimacy and strengthens the bond between partners. Self-Compassion Exercises and Techniques There are numerous exercises and techniques that can help us cultivate self-compassion. Here are a few to get you started: Self-compassion meditation: Set aside a few minutes each day to practice self-compassion meditation. This involves directing kind and loving thoughts towards yourself, acknowledging your struggles, and offering yourself comfort and support. There are guided self-compassion meditations available online that can help you get started. Writing a self-compassion letter: Write a letter to yourself from a place of self-compassion. Acknowledge your struggles, validate your emotions, and offer yourself words of kindness and understanding. Read the letter whenever you need a reminder of your own self-worth and compassion. Body scan meditation: Practice a body scan meditation to cultivate self-compassion towards your body. Bring attention to each part of your body, noticing any tension or discomfort, and offering words of kindness and acceptance to each area. Self-compassion journaling: Start a self-compassion journal where you can write down your thoughts, emotions, and experiences with self-compassion. Use this journal as a safe space to explore your feelings and practice self-compassion towards yourself. Remember, these exercises are tools to help you develop and strengthen your self-compassion practice. Explore and experiment with different techniques to find what resonates with you. Self-Compassion Resources and Books If you're interested in delving deeper into the topic of self-compassion, here are some recommended resources and books: "Self-Compassion: The Proven Power of Being Kind to Yourself" by Dr. Kristin Neff: This book explores the science and practice of self-compassion, offering practical exercises and techniques to cultivate self-compassion in daily life. "The Gifts of Imperfection" by Brené Brown: Although not solely focused on self-compassion, this book emphasizes the importance of embracing our imperfections and cultivating self-compassion as a path to wholehearted living. "Radical Acceptance: Embracing Your Life With the Heart of a Buddha" by Tara Brach: This book explores the concept of radical acceptance and offers mindfulness and self-compassion practices to cultivate a deeper sense of self-acceptance and compassion. Online courses and workshops: Many mindfulness and self-compassion experts offer online courses and workshops on cultivating self-compassion. These resources can provide guidance and support as you embark on your self-compassion journey. Remember, self-compassion is a personal and individual experience. Explore different resources and find what resonates with you and supports your own self-compassion practice. Conclusion: Embracing Self-Compassion for a Happier and More Fulfilling Life In a world that often values achievement and perfection, it's easy to forget the importance of self-compassion. However, by embracing self-compassion, we can unlock the power to live a happier and more fulfilling life. Self-compassion allows us to be kind and understanding towards ourselves, even in the face of challenges and setbacks. It helps us develop resilience, improve our relationships, and enhance our overall well-being. Remember, self-compassion is not a destination; it is an ongoing journey. It requires practice, patience, and self-acceptance. Embrace the power of self-compassion and experience the transformative impact it can have on your life. Start today, and be kind and gentle with yourself every step of the way.

If you need an anxiety routine to help you get through the day, you’re in the right place.  My name is Kimberley Quinlan. I am an anxiety specialist. I’m an OCD therapist. I specialize in cognitive behavioral therapy, and I’m here to help you create an anxiety routine that keeps you functioning, keeps your day effective, and improves the quality of your life. Because if you’re someone who has anxiety, you know it can take those things away.  Now, it’s so important to understand that generalized anxiety disorder impacts 6.8 million American adults every single day. That’s about 3.1% of the population. And if that is you, you’re probably going to agree that anxiety can hijack your day. It can take away the things that you love to do, it can impact your ability to get things done.  And so, one of the tools we use—I mean myself as a clinician—is what we call activity scheduling. This is where we create a routine or a schedule or a set of sequences that can help you get the most out of your day and make it so that anxiety doesn’t take over. So if you’re interested, let’s go do that.  Again, if you have anxiety, you know that anxiety has a way of messing up your day. You had a plan. You had goals. You had things you wanted to achieve. And then along comes anxiety, and it can sometimes decimate that plan.  AN ANXIETY SCHEDULE And so the first thing I want you to be thinking about as we go through putting together this schedule is to plan for anxiety to show up. Those of you who show up in the morning and think, “How can I not have anxiety impact my day?” Those are the folks who usually have it impact them the most. So we want to start by reframing how we look at our lives instead of planning, like, “Oh gosh, I hope it’s not here. I hope it doesn’t come.” Instead, we want to focus on planning for anxiety to show up because it will. And our goal is to have a great plan of attack when it does. MORNING ROUTINE FOR ANXIETY First of all, what we want to look at is our morning routine for anxiety. We want to have an anxiety routine specifically for the morning. There will be folks who have more anxiety in the morning. There will be folks who have more anxiety in the evening. You can apply these skills to whatever is the most difficult for you. But for the morning routine, the first thing we need to do is the minute we wake up, we want to be prepared for negative thoughts. Thoughts like, “I can’t handle this. I don’t want to do this. The day will go bad.” We want to be prepared for those and have a strategic plan of attack.  COGNITIVE RESTRUCTURING Now, what we want to do instead of going down the rabbit hole of negative thinking is use what we call cognitive restructuring or reframing. During the day, at a time where you’ve scheduled, I would encourage my patients to sit down and create a planned response for how we’re going to respond to these thoughts. So if your brain says, “You can’t handle the day,” your response will be, “I’ll take one step at a time.” If your brain says, “Bad things are going to happen,” you have already planned to say, “Maybe, maybe not, but I’m not tending to that right now.” Let’s say your brain is going to tell you that this is going to be so painful and, “What’s the point? Don’t do it,” absolutely not. I’m going to show up however I can in my lifetime. I’m not going to let those thoughts dictate how I show up. I’m going to dictate how I show up. So we want to be prepared and have a plan of attack for that negative thinking. MINDFULNESS PRACTICE The second thing we want to do is have a solid mindfulness for anxiety practice. Again, you’re going to start today, and you’ll start to see the benefits of this over the weeks and months, but a mindfulness practice will be where you are able to have a healthier relationship with the thoughts, the feelings, the sensations, the urges, the images that come along with anxiety.  A big piece of mindfulness is learning how to stay present. As you are brushing your teeth in the morning, you’re noticing the taste of the toothpaste, the feeling of it on your gums, the smell of the fluoride, and the toothpaste that you have. A solid mindfulness practice will help you move through each part of the day’s routine that we’re creating in a way that reduces the judgment, reduces the suffering, reduces the self-punishment, reduces the reactions that you would typically have.  Now, one of the most helpful mindfulness skills I use and I tell my patients to use—we actually have a whole episode on this. It’s Episode 3. It’s really early on, but it’s talking about being aware of the five senses. Again, as you’re brushing your teeth, what do you smell? What do you see? What do you taste? What do you hear? What does it feel like? And you’re going through systematically these different senses so that you can be as present as you can. And this will help you with panic attacks, anxiety attacks, or just general anxiety that you’re feeling.  If you’re wanting to deep dive into mindfulness and have a mindful meditation practice, we have an entire vault of meditations that are guided by me that you can look into by going to CBTSchool.com, or I’ll leave the link in the show notes. There is an entire vault specifically for people with anxiety of guided meditations to help you with different emotions, different sensations, different experiences, different struggles that you may be having. That’s there for you.  4. GET SOME EXERCISE  Now the next thing I want you to do in the morning is get some kind of movement activity going. Again, this doesn’t have to be going for a run, but it could be a light walk, some stretching, some yoga. It could be going to the gym and lifting weights, but try to get your body moving. There is a lot of research to show that exercise can be as effective as medication. That’s mind-blowing, and it’s free. It’s something you can do from home, and it’s something that doesn’t have huge side effects except for the fact that it’s not as fun as we would like it to be. But create a routine. It doesn’t have to be every day, either. You might put in your schedule that you just do it a couple of days a week, and that’s a great start. But try to at least stretch, move your body, maybe move around the house, light dancing, whatever floats your boat, but get your body moving.  5. NOURISH YOUR BODY WITH FOOD   The next morning routine activity that I really want to stress is to nourish your body with food. And I picked the word “nourish” very intentionally. I’m not just saying put breakfast in your mouth because I want you to be thinking of food as something that’s fueling your body so that you can be at your best. Again, I believe strongly there is no right or wrong food or good or bad food, but I want you to think about, “How can I nourish my body? Do I need some water? Would it be nourishing to have too much coffee?” Again, coffee is not super helpful if you’re someone with anxiety, and it’s something you should limit as well. So, really be intentional about the food that you nourish in your body. 6. SET AN INTENTION FOR THE DAY And then the last piece of the morning routine for anxiety is to set an intention for a day of kindness. You are committing to kindness all day. If that doesn’t feel good to you, flip it to “I am committing to no self-punishment, no self-judgment, no self-criticism.” That can be a really effective goal. “Okay, if I’m going to do one thing today, I’m committing to no judging,” because literally, there is no benefit to any of those things. Criticism, punishment, judgment, self-loathing, none of it. There’s no benefit. It doesn’t motivate you if you think that is true. It’s actually been proven incorrect by science. These things are not the motivators. We want to work at reducing those. And there are tons of other episodes on the podcast talking about that.  So, that’s what we’re going to focus on for the morning routine.  STRUCTURING YOUR DAY FOR ANXIETY ROUTINE Now we’re going to move on to structuring your day and creating an anxiety routine that is effective for you throughout the day. Now I want to first acknowledge that I don’t know how much you have going on in the day. Some of you are working two jobs, some of you are a stay-at-home mom, some of you don’t have a job at all, some of you are at school. Everybody’s schedule is going to be different, but I want you all to be thinking about these ideas.  WHAT WOULD YOU DO IF YOU DID NOT HAVE ANXIETY?  The first one is plan and organize your day around what you would do if you didn’t have anxiety. Sit down and really think about it. “If I didn’t have anxiety today, what would I get done? How would I show up? What activities would I do?” And make sure you schedule those into your schedule because the main thing that you have to know about someone with anxiety is anxiety will interrupt your day and take you away from the things that you value. So please, please, please, think about this question: What would I do if I didn’t have anxiety? And your job is to schedule and try and get as many of those things done as you could. We don’t want anxiety to run the show here.  PLAN YOUR DAY  The next thing I want you to do is use a planner to activity schedule these things. There are apps to help track tasks and appointments. Do your best to plan and to have structure. People with anxiety and depression need structure. It helps us to be so overwhelmed and chaotic in our brain to have some structure. And believe me, some people will say, “No, it feels too controlled, and it takes away my creativity.” No. In fact, people who have structure tend to report feeling more creative because their day isn’t so overwhelming and they have a little bit of control over where they’re doing, what they’re doing, and where they’re going. Now, if you struggle with this, we have an entire course for this as well. It’s called The Optimum Time Management for Mental Health. I walk you through specifically how to manage time, specifically for those who have anxiety, depression, and OCD. I had to create this for myself. I had to read a whole ton of books and take courses. I found none of them really approached it from the perspective of those who had a mental health or a medical issue. And so I created that course specifically for those who struggle in that area. You again can go to CBTSchool.com to get information about that.  SET REALISTIC GOALS  Now, as you are structuring your day and planning your day, you have to be really intentional about setting realistic goals and prioritizing what’s important. Sometimes when I look at the things I want to get done, there could be like 15, 20, 30 things to do. I know I’m not going to get all of those done, so I have to sit down and go, “Okay, which are the most urgent? Which are the things that must take priority?” and work at prioritizing those. Again, as you do those things, you’re going to be using those mindfulness skills that we’ve already talked about. staying present. You’re going to be using your willingness skills that we often talk about here on Your Anxiety Toolkit. Bringing compassion, radical acceptance, willingness to be uncomfortable—you’re going to bring those with you throughout the day. Again, we are planning for anxiety to come with us every part of the day.   SCHEDULE BREAKS IN YOUR DAY  Now another important thing to do here is to schedule breaks. If you have anxiety, you know as much as anybody that anxiety is exhausting. Schedule breaks, but no breaks where you’re scrolling on Instagram. That’s not a true break. That doesn’t actually give your brain a break. Go outside, sit in nature, listen to some music, read a book, do something that doesn’t drain your battery, do something that increases your battery. It might be taking a walk or doing something active, but make sure you plan those breaks.  SCHEDULE THERAPY HOMEWORK  The next thing to do, and you have to do this every day, specifically if you have an anxiety disorder, is schedule your therapy homework. If you’re not in therapy, still schedule time to be doing something that helps you to work on your mental health, even if it’s correcting those thoughts that we talked about at the beginning of this episode. We want to make sure that with planning times to do exposure and response prevention, with planning time to do our mindfulness practice, with planning time to do our, again, cognitive restructuring, making sure that you’ve scheduled that helps you with your long-term recovery. Not just the recovery of today, not just getting through today, but when we schedule time to do our homework, it means that we push the needle forward in our recovery.  EVENING ANXIETY ROUTINE Now we’re going to move on to the evening anxiety routine. This is where we prioritize unwinding for the day. You’ve used all your energy, you’ve taken anxiety with you, you’re exhausted.  CELEBRATE YOUR WINS  Number one, you have to celebrate. Celebrate what you did get done. Write down what you got done. Because so often, when we have anxiety, we go, “Oh, it’s not a big deal. Everyone can do that. I shouldn’t be celebrating.” No, you’ve got to celebrate this stuff. You’re working your butt off. And so we have to make sure that we’re celebrating every win, even if it’s just one teeny win for the day.  WIND DOWN FOR SLEEP (SLEEP HYGIENE)  The evening is where we must prioritize winding down for sleep. Sleep hygiene is maybe the most important part of your recovery in that it will set you up to do well tomorrow. If you’re like me, not having a good night’s sleep means your mental health hits the trash tomorrow. So we want to start the evening on how can we reduce the impact of being on technology. Do a digital detox if you can, at least an hour before bed. Do something relaxing. Do something pleasurable. Read, take a warm bath, take a walk, garden, talk to a friend, connect with them—anything you can do. Make a lovely meal, watch a funny TV show, whatever you can do to bring yourself down and rest and repair for the day so that you can be ready for bed and moving into the nighttime routine.  CREATE A NIGHTTIME ROUTINE WITH A CONSISTENT WAKETIME You will need a nighttime routine. Have a time or an alarm. You could get an Apple Watch or set an alarm on your phone to prompt you to moving towards the bedroom routine where you brush your teeth or you wash your face or you light a candle or you brush your hair or you start reading, turn the sheets down. Whatever that is, set a timer so that you are prompted to go to bed on time.  What we want to do with anxiety is have a very solid routine of waking up at the same time and falling asleep at the same time, as much as possible that you can achieve. That internal body clock of yours really benefits by having it be as balanced and as routine as we can. LIFESTYLE CONSIDERATIONS FOR YOUR ANXIETY ROUTINE Now, there are some lifestyle considerations you have to consider here if you have anxiety. Number one, you have to also make sure that you’ve had some time for connection. And some of you are like, “No problem. I’ve had connection during the day or my colleagues at work or my family or my partners or my friends.” That’s great. But if you’re somebody who has anxiety and it’s kept you home alone and it’s kept you in avoidance, now that’s going to be really important that you do some type of connection, have a support system, whether it be a support group that you attend or a therapist that you go to because that again is so important for your long-term recovery. MEDICATION AND THERAPY In terms of overall, we may want to incorporate some kind of medication or therapy into your day or into your week. You may need to set alarms to remind you to take your medication. That’s okay, too. Please, please utilize as many alarms as you need to help this go as well as you can. Because again, I want to emphasize, anxiety can make all of this routine go out the window. Before you know it, you’ve spent four hours on TikTok, or you’ve gotten into bed and pulled the sheets up and hidden there, or it could be disrupting your day by having you go into avoidance behaviors. Absolutely, I understand that. Please be gentle with yourself. But if you’re somebody who’s really struggling, please do not hesitate to reach out to a cognitive behavioral therapist who treats anxiety. They will be able to help you set up more structure and create a plan specifically for you.  FIND A STRATEGY THAT WORKS FOR YOU So, what do we need to remember here? Number one, your routine should have some strategy to it. You will have to sit down and plan for it. I spend about an hour a week planning my week. And while that might sometimes feel like a waste of time, having a plan, knowing what I need to do, making sure I’ve prioritized me makes me so much more effective, makes my anxiety management and my recovery so much better. So, sit down and make a plan. BE WILLING TO HAVE SOME HARD DAYS Remember, anxiety will come along the way. We actually want to invite it. Tell it, “Come on, anxiety, we’re going to get groceries right now. Come on, anxiety, it’s time to have a coffee. Come on, anxiety, let’s go and do the hard thing or do my homework and my exposures.” That is a positive thing.  BE GENTLE WITH YOURSELF/ PRACTICE SELF-COMPASSION The last thing I want to incorporate here is to be gentle with yourself. There will be days where this falls apart, and that’s okay. Self-compassion for anxiety is so important.  We’re all learning here. So when it does fall apart, because it will, your job is to take a look and see what happened, what got in the way, how can I plan for that tomorrow so that that doesn’t happen again.  CONCLUSION So there you have it. There is the routine that I want you guys to consider. Some things will work for you, some will not. Just take what you need and leave the rest. But this is an anxiety routine that you can play around with, experiment with, and see what works for you.  Before we end, let’s do the “I did a hard thing” segment. I’m going to try my best to bring this back. This one is from Lindsay, and Lindsay said:  “I’ve been going through a lapse, or what I like to call a flare-up, for the last month. There have been decent days, blah days, and downright crappy days.”  We can agree with you, Lindsay.  “The hard thing I’ve done is to decide it’s time for an ERP refresher, and I have started that this week. I will admit that I’m terrified to be venturing into ERP again. However, I refuse to let fear control me. To anyone who’s going through a lapse or a flare-up, embrace where you are, love yourself, and fight for yourself because you are so worth it.” And I agree with you, Lindsay. Again, if there’s anything we can do to support you on your journey, go to CBTSchool.com. We have all kinds of courses there that can help you get back into the swing of things or get started. So go to CBTSchool.com, and thank you so much for being here with me today.

Helping children navigate the complexities of Obsessive-Compulsive Disorder (OCD) requires a delicate balance of understanding, patience, and empowerment. Natasha Daniels, a renowned expert in this field, shares invaluable insights into how parents can support their children in overcoming OCD with positivity and resilience. Normalizing OCD: One of the first steps in supporting children with OCD is normalizing the condition. Both parents and children need to understand that they are not alone in this journey. Natasha emphasizes the importance of taking things one step at a time and not allowing the overwhelming nature of OCD to overshadow the progress being made. Education is Key: Understanding OCD is crucial for effective support. Natasha urges parents to educate themselves about the condition, its symptoms, and the most effective treatment approaches. By arming themselves with knowledge, parents can better support their children through the challenges of OCD. The Concept of "Crushing" OCD: Natasha introduces the empowering concept of "crushing" OCD.” Instead of viewing OCD as an insurmountable obstacle, children are encouraged to see it as something conquerable. This shift in perspective can be transformative, instilling a sense of empowerment and resilience. Making Treatment Fun: To engage children in treatment, Natasha suggests incorporating fun activities. By turning exposures into games or playful challenges, children are more likely to participate actively in their own recovery journey. This approach not only makes treatment more enjoyable but also fosters a positive attitude towards facing fears. Bravery Points: Natasha introduces the idea of "bravery points" as a motivational tool for children. By rewarding bravery in facing OCD-related fears, children are incentivized to confront their anxieties and engage in exposure exercises. This gamified approach can be highly effective in encouraging progress. Adapting for Teens and Adults: While bravery points may resonate well with children, Natasha also offers insights into adapting these strategies for teenagers and adults. Creative incentives tailored to different age groups can help individuals of all ages stay motivated and committed to their treatment goals. Creative Exposures: Incorporating creative exposures into treatment can make confronting fears more engaging and less daunting for children. By turning exposures into interactive experiences, such as games or role-playing exercises, children can develop essential coping skills in a supportive environment. Collaborative Approach: Natasha emphasizes the importance of collaboration between parents and children in the treatment process. By working together to develop coping strategies and respond to OCD-related behaviors, families can create a supportive and empowering environment for children with OCD. Addressing Parenting Challenges: Managing the emotional challenges of parenting a child with OCD can be overwhelming. Natasha offers insights into coping with feelings of anger, frustration, and helplessness, providing strategies for maintaining patience and support during difficult moments. Long-Term Perspective: Supporting children with OCD requires a long-term perspective. Building resilience and fostering a family culture that promotes bravery and resilience are essential for long-term success. By focusing on progress rather than perfection, families can navigate the challenges of OCD with hope and determination. Conclusion: Natasha Daniels' insights offer a beacon of hope for families navigating the complexities of OCD. By normalizing the condition, educating themselves, and adopting creative and empowering approaches to treatment, parents can support their children in overcoming OCD with positivity and resilience. TRANSCRIPTION:  Kimberley: Welcome everybody. Today we have Natasha Daniels. She's the go to person for the kiddos who are struggling with anxiety and OCD. And I'm so grateful to have her here. We are going to talk about helping your kid crush OCD and how we can make it fun and how we can get them across the finish line. So welcome Natasha. Natasha:  Thanks for having me. I appreciate it. Kimberley okay. We've had you on before and I think so much so highly of you. I'm so honored to have you on here again talking. We were talking about kids as well last time but first of all let's just talk about the kiddo, right? The kiddo who has OCD. They're starting this process. Let's sort of even say like they're ready for help, like they want to get better, but at the same [00:01:00] time getting better feels like a huge mountain that they have to climb. What might you say to the kiddo and the parents at that beginning stage of treatment? Natasha: A lot of times I think kids don't even realize that they're not alone. They think they have like these really bizarre thoughts and that they'll never be able to stop those bizarre thoughts. So I the first step is really normalizing it for both the parent and the child and letting them know that lots of people have this struggle and that they are able to get through it and have a healthy, productive life. And for parents in particular. about tunnel vision, you know, because it can feel so big. And it's like, let's just, what's your next move? What's your next step that tunnel vision so that the overwhelm doesn't skew your perspective Kimberley: Yeah, what might be those steps? Like what, what, [00:02:00] what, how would you, how would you have that conversation? I mean, I know for parents, I think there's some relief in getting a diagnosis and being like, Oh, okay, so we know now what this is. And we're here to get treatment and we're assuming this is the right treatment. But they're still just, you know, it's such a mountain to climb. So what might you say to them? Natasha: The first step is really educating yourself. I think parents learn a little bit and they just like want to jump into the deep end. They learn a little bit, like, Oh, you shouldn't be accommodating the OCD. So they're like, well, now I don't know what to do because I was doing something that at least help my child in the, in the moment. But now I'm hearing that that actually makes it worse. And so they start to feel really overwhelmed by the little bit of information they get. So I would say. You know, get some education, whether you read a parent book, or you take a course, or you just watch a bunch of videos, but [00:03:00] like, get some basic foundation of what OCD is because it's going to shift and morph and change and look different. And so understanding, like, lay of the land of like, oh, okay, this is what OCD is. You know, it, it's demanding and it wants me, my child to do or avoid something to get that brief relief. And sometimes that hooks me in and the more they do or avoid that, the bigger it grows, like understanding it would be the first step. Kimberley: So you wrote an amazing workbook called Crushing OCD Workbook for Kids. Let's talk about this term crushing like crushing OCD and that's sort of the title of our episode as well Like do we want that mindset if we're gonna crush it? Like what does that look like? How does that change our mindset? Do we need to really think of it like crushing it? Can you kind of share a little bit more about that mindset shift? Natasha  Yeah. I do use the word crushing a lot. [00:04:00] My courses are all about crushing. My, my book is crushing um, we're not getting rid of. Um, and so. There is a reason why I use crushing versus like overcoming or getting rid of, it is a powerful, kind of aggressive word. And, and I do feel like seeing OCD as kind of like this adversarial thing that you are crushing. Um, 1 can be very therapeutic and empowering for the child, especially when it's externalized and it's personified. So it's this Mr. OCD or this O cloud is us and we're going to crush it. Um, and then physiologically, do see it differently than anxiety. And I think sometimes with anxiety. we talk about, I kind of equate anxiety as like the overreactive lifeguard, and he's trying to, he's trying to look out for you, but just kind of, [00:05:00] he's sending the emergency alarm bells all the time. So maybe he needs some retraining. Maybe we crush him too, but that I think has more flexibility physiologically. Where I feel like OCD is like this foreign thought that's coming into my brain that is so incongruent with who I am, depending on the theme. And there's no part of it that feels like protective or aligned, um, in the way that OCD can show up. And it's very glitchy, you know, and physiologically, a different part of the brain. And it is. It's a, you know, it's more of a glitch versus an overreactive. So I do feel like about crushing it is a good analogy. Kimberley Well, I think too it's OCD can be so powerful and make us feel like we have to kind of like gulp down and, and wither it. Right. And so it does kind of require our kiddos to stand up to it. And I think crushing it [00:06:00] really gives that metaphor of like, we're going to stand up to it. We're going to win. This is like, we're going, you know, it's point systems or something like that. Like who's going to win this baseball match, but we're going to beat it against OCD. So I think that that is really helpful. And I think kids get behind it too, like Kids want to crush things. Natasha: Yeah. And, and they really need to feel empowered because it is so overpowering more than really any other disorder. It is just, it's they're being bombarded with these thoughts and feelings and to, to sit in a storm. And not do what OCD wants you to do a, is a really brave thing to do. And I do feel like kids can really get behind the idea of overcoming and crushing, not overcoming, but crushing it and feeling empowered that they have more strength than OCD does. Kimberley: Okay. So in the workbook, you talk about these fun activities and I have found having my own [00:07:00] children, but also being a clinician, if it's not fun, they're not that interested. What's the payoff really? So, so can you share with us some of the fun activities or ways in which we can start to approach this topic with our kids? Natasha: Yeah, I think anything can be fun and we want our kids to, to have fun and we want to gamify it. So a lot of the workbook talks about One, how to view OCD in a really fun way. So I use a lot of cartoons and a lot of metaphors so they can see it. Um, also talking about incentivizing them and, you know, adding points or bravery points to do, do scary things. And so it becomes kind of this, Gamified version of, of, of crushing their OCD. Kimberley: So bravery points. What does that mean? Natasha: So bravery points can be different for different families. Um, and we use them in my, my house as well for [00:08:00] my own kids with OCD, where we set up kind of like a virtual store. And there are certain things you can have this pretty structured or not structured where you points and, um, you know, kids can do things that OCD will not. Want them to do or do things or not do things that OCD wants them to do, whichever way OCD is working or do exposures they're purposely triggering OCD and then they earn points and they can cash those points in and so Even at my house, you know, my child does not get Roebucks unless he cashes his points in There's like a direct line there. My daughter doesn't get slime from very expensive place, unless she wants to cash her points in. And those are done through steps that are, that's crushing their anxiety and OCD. Kimberley: And so I was actually going to ask this in terms of bravery points. This is not just for kids. This is for teens too. So you might be doing this for like, how might this apply to [00:09:00] teens or do we use bravery reward points for teens as well? Natasha: Yeah. I think it can be used for anyone. I mean, I think even adults can, can gamify their battles with anxiety and OCD. Um, I mean, I've set that up for myself where I've done something that would be really hard. And then I've offered myself incentives, you know, ironically, or not really ironically, but interestingly. Intrinsic incentive does start to happen. You start to get traction. Um, I know for, for the kids that I've worked with in my practice and even my own kids, I've seen the, the pride when they've done something really scary and the relief of like, Oh my gosh, that was not nearly as bad as I thought it was going to be. And then the empowerment. So I kind of want to preface this with. can have these external reinforcers, but they're there to celebrate those brave moves. They're there to make the association of this is really fun, but the internal motivation does start to get some traction down the [00:10:00] road. And so even with teens offer them incentives, and that might look different. I know, um, I've used this example a lot, like for my older daughter, she would net, she would not be driving today. Absolutely not be driving. If it wasn't for me. ordering her Starbucks. And I would just order her Starbucks and I'd be like, okay, it's ordered, you know, you just need to go pick it up. And she, she has social anxiety as well. So she'd like, and she feels bad about spending money. So there was all sorts of things that were actually working in my favor. Cause she felt so bad. She's like, mom, you just ordered it. But I said, I wasn't ready to drive. And I was like, you don't have to pick it up. It'll just be sitting there. It'll just be wastey wastey. And she would go there. I mean, she had three. cycles of driving school before I did this. Natasha: She was well skilled, but I mean, that's a very basic incentive. It was like, I'm going to reward you. Here's an extent, you know, an incentive to go do it. And, you can be creative with teens, [00:11:00] whether it is. I mean, in my practice, I would get like Xbox controls or like one girl wanted a green screen for her YouTube channel. Like, and it was just that weren't like far, far down the road, but little incentives to celebrate and say, you know, you're doing really hard stuff and it doesn't have to be all boring and, and miserable. It can be fun too. Kimberley: Yeah. In our house, it's Taylor Swift records. We're working our way to get every single one of them. Um, right. And, and, and you get them after you, you know, achieve a certain amount of things. So I think I love this. Um, and I think it, it can, again, it can be age dependent. My son is working towards Pokemon cards as well for different things as well. So I love that. Natasha: Yeah. Kimbelrey: So, okay. So bravery rewards. What about, um, The, the other work of treatment and crushing OCD, are there other [00:12:00] fun activities that you have found to be really powerful, whether it's more in how we educate and conceptualize OCD or get them to do the scary thing? Natasha: Yeah. I think you can get creative and really anything that you're doing, uh, exposures can be fun as far as creating things that are triggering the OCD on purpose. They don't always have to be serious and boring. Um, you can create. Fun things, um, you can do interesting exposures, whether you create a game and you're playing games around it, like go fish, but you change the go fish to different names related to what they're struggling with. Or used, like, um, jelly beans, you know, that tastes gross for my child that has, like, metaphobia and issues. And so thinking out of the box, um, in my practice, I would use, like. like two truths and a [00:13:00] lie they had moral OCD. And so we talk about, you know, I'm going to tell you two truths, but one and the, the third one will be a lie and you have to guess which one it is. And that's a fun game in general, uh, but very overwhelming for someone with moral OCD. And so I think sometimes we think it all has to be serious, but there are a lot of creative ways that we can do exposures that. that can make us laugh. And even when we're responding to our kids, and let's say you don't want to feed the OCD. And so, um, let's just use a concrete example. Like if your child has moral or scrupulosity OCD, and they're always saying, I'm sorry, I'm sorry, I'm sorry. You know, repetitively, that's kind of a compulsive thing and you know that you're not going to feed it. And so you come up with a plan of, I'm not going to accept your sorry. You can even do something silly with that, um, and I've had parents who like, they would say it in a different accent or they would sing it or they'd say, you know, sarcastically, I'm sorry. [00:14:00] You're sorry is not accepted or, you know, like you can, you can even come up with fun, sarcastic things in your response to OCD as long as you're partnering with your child. Kimberley: Tell me about the partnering though, right? So in an example of where you're like, you know, let's say you use your most funny Donald Duck accent, um, in saying, I don't, I don't want to, you're sorry. Um, um, You know, how, how, what if that doesn't feel like partnering to them? What if that feels like, you know, uh, like a, a betrayal to them or they, they're very invested in getting that compulsion done? What would you suggest? Natasha: Yeah. You definitely want to collaborate with your child first and say, you know, I know either they bring it to you or you bring it to them. Like I noticed that when you say this, it's actually your OCD saying that to me. And because I love you, I'm not going to give what OCD wants [00:15:00] anymore. So prefacing it with, I'm noticing that this is a compulsion that I'm part of, and I'm, I love you. And so I'm not going to be part of that compulsion. And can respond in these ways, how would you like me to be, or how do you, how would you like me to respond so you can partner if they can come up with a creative way? Um, like, for instance, in my case with my son, he said, tell me, say, I'm sorry, is not accepted. Like, he literally scripted it for me. when I said it in the moment, he wasn't happy with that because then he was panicking and he was feeling overwhelmed. And so he, I don't like when you say that, but that was our agreement. Um, I might pivot in that moment if he's looking really overwhelmed and I might not say anything because maybe it's not a time to be funny or maybe poking back in a really aggressive way isn't being well received in that moment, but that doesn't mean I'm going to feed the OCD. Okay. you might have a child that doesn't want to partner with you that says, I want you to do this and this makes me feel better. And [00:16:00] why are you being mean? Um, and in that case, humor is not appropriate. You know, you're not going to use humor. You might just say, well, I love you. And so I'm not going to respond and you let them know you're going to respond, but the humor part, if we're the only ones laughing, then it's not really funny. So we have to be very careful about that. Kimberley: Yeah. So, and I mean, it's true that crushing OCD or any, you know, mental health disorder is like a family affair. And so as a, as a parent, What is the training for them in this sort of idea of crushing it and making it fun? What, what personal work would you recommend they do, um, on their own in their own therapy, whether they're with a parenting coach or a therapist or with each other as partners, what would you suggest a parent do to prep for this [00:17:00] sort of marathon that we're on? Natasha: It's a great question because there is so much parenting work that, that needs to be done because it's our journey too. And so I feel like the parent journey is unique in and of itself, you know, raising a child with OCD Um, it's not for the faint hearted. So learning, how do you sit in discomfort when your child is sitting in discomfort? you handle your child being triggered and not swooping in and doing what your child's OCD wants? hard to, to be a witness to your child's struggles, to know that in the short term, you can do something. Some of the time. appeases the OCD, but then grows it long term. And so, um, getting your own support or finding your own way to ground or your own coping skills of how do you handle that when you're, when the child's OCD is having a tantrum. Um, and it will try to kind of break you down so that you [00:18:00] give in so that there's work in that area. I think also, how do we handle our own, how do we handle our own mental health when our child is having mental health issues? Because We are not a blank slate. We come with a lens and that lens has our own childhood. It has our own experiences, has our own mental health issues. And and so we're seeing our child's mental health issues through our lens no one can have a clear lens, but to have some awareness of I'm bringing this to the table, When my child does this, it triggers this for me, which is actually not about my child, but that's about my dad, or that's about my childhood experience. And how do I work through that so that it's not impeding how I'm my child. I'm not dealing with that. Yeah. Kimberley: Yeah, for sure. What's, what's interesting for me. is I was thinking about this about parenting in general is [00:19:00] sometimes I parent the way my parents parented without even Questioning. Is that the way I want to parent like it'd be sometimes I'll catch myself Parenting my child in the way my parents was when I'm like didn't help me like that wasn't helpful You know what? I mean? And and it's so automatic. It really takes slowing down and being like wait I'm What did I need during that time? How can I be that for my child? It's so automatic sometimes. And I think that, um, so many parents, I mean, I wish we were given a manual, but like, it's a lot of emotional regulation work of our own to sit while your child is struggling. Um, especially with anxiety, cause you know, we just, it's so easy to fix it by giving them the compulsion or. You know, so I really feel for the parents that I, you know, that we treat in that it's so much emotional regulation. Would there be a specific [00:20:00] set of tools that you would give them or do you think it's very much dependent on the person? Natasha: I think it's dependent on the person as far as what they're bringing. What they're bringing in the moment. Um, but I do talk about lovingly detach and, and a lot of times parents hear that and they get concerned because they think detachment means that I'm not present for my child. And it's actually the opposite to me. It's like, how can I be? 99 percent or 95 percent there for my child. I'm like, I'm an anchor for them and I'm not bringing anything to the equation. Kimberley: Yeah, Natasha: And that is hard. And a lot of it actually is this. It may seem really weird, but I feel like a lot of it is building up your skills. Through like mindfulness, you know, how do I stay in the moment? I'm only eating this food. I'm only petting my dog and that training like that mental training of your brain of like being Literally only in the [00:21:00] moment and learning how to fine tune that is actually a great survival tool because I find that When I'm in the moment with my kids and I have been working on that muscle in my brain, I'm able to not see as much through that lens of my own childhood or my own triggers. And I'm just like, what does she need from me right now? And that's the question I always tell parents to ask. What do they need from me right now? Like, what is my job in this moment right now? And sometimes it is to ignore them because I know with my daughter, at least, she doesn't like the attention of anxiety. Like when I can tell clearly she's having an anxiety attack, she doesn't want me to hover. And that's really hard because. Inside, you're feeling really anxious about it, but you know that your anxiety or your, your energy is contagious. And so yourself and be like, in this moment, she needs me to go, you know, about the morning routine and just act like nothing's happening. Or it might be the opposite for your child, right? But knowing it's not about us, what do they need in [00:22:00] that moment? Um, and that is a powerful skill that has to be, it's a daily practice. Kimberley: and different for each kid. Natasha: Right. Vastly Kimberley: Yeah, Natasha: Yeah. Kimberley: where it gets complicated. I think he's like because you know, we go Okay, this is the way we do it This is how we do it from now on and then you have another kid and you're like wait that doesn't work for them Natasha: Yup. Kimberley: let's shift it up and let's change it I'm wondering if we, you can quickly speak to a couple of emotions that I know show up with parents, you know, cause again, it's as much the parent game as it is the kids game. So where as clinicians and as parents, where they're to really champion our kids to ride the wave of discomfort and to use their skills and to manage it. What about for the parent they might be experiencing? I know a lot of parents report. anger that shows up at the, you know, when their kid isn't [00:23:00] using their skills and so forth. Um, do you have any, any advice to them when anger does show up or frustration? Yeah. Yeah. And Natasha: being angry then we're like, Oh, I responded angrily or I'm feeling frustrated and I shouldn't. And being accepting of the fact that it's okay, it's normal for me to feel angry. This is a frustrating situation and I want to change it and I want to steer the ship and I can't. Yup. You know, my child's not picking up their part. And so I think just validating that anger, um, which I can be, I think can be sometimes hard because we want to. Kind of we feel guilty about the anger, but then understanding where it's coming from and and again going inward There's so much inward work I think when you're raising a child with anxiety and OCD because it brings out all sorts of stuff for us So asking oh, it's interesting that I'm angry or that made me really [00:24:00] angry or sometimes I'll even say to myself like in my head like Natasha, that was like a huge response. why did you blow up so big on that? That was more than what was actually just happening then. And then do some self diving of like, what was that about it? Oh, that reminded me of this. Or I feel like I'm doing 99 percent of this and he's doing 1%. And what do we, what can we control? And so maybe if I'm feeling that way, then it's a shift of, to pull back. If I'm feeling like I'm doing 99 percent and that's making me angry. I can't control the pace of my child and their ability to use their skills because that's their journey, but I can control invested I am. And so if I'm doing 99 percent of this, then I'm going to pull back a little bit give, you know, invite them to meet me more in the middle. Kimberley: often I find under the fear is, I mean, so under the anger is the fear that we're going to be managing this for a while, or, you know, the parents grief [00:25:00] of This is interrupted the family system. So I think it's so normal. Um, I agree with you just to normalize that as a normal part of parenting, a kiddo who's struggling. Um, yeah. Okay. So in terms of getting that kid across the finish line or setting them up better things like setting them up for success, is there anything that you would tell the parents? as a mindset shift, like, you know, again, this is a marathon, not a sprint. What would you tell them in terms of the whole family system? How, what are skills and tools that they can be using to help set up a system or a family that can help this child crush OCD? Natasha: Yeah. I think mindset's really important because a lot of times is a perception of, I need to cure this, you know, or we need to get the skills and that they can overcome this and OCD is a chronic [00:26:00] condition. so we're wired, you know, if we're going to have anxiety or OCD, that this is going to pop up possibly in our life periodically. yeah, Yeah. So instead of thinking, like, how do I, you know, get rid of this cold or give them the skills and then we've we're done with this because that sets you and your child up for failure. I think having an idea of I'm going to create a home a family culture where we. Where we know we have the skills. We know what OCD is. We know how to identify it. Um, we live a life of exposures. We live a life of doing brave things. we talk about it and it doesn't have to be, I mean, I think once you're in maintenance, and you've really kind of. Learned all the skills that you have learned. I mean, we live in my house. It's a, it's a culture of anxiety. And OCD is kind of just part of our family culture. Like we do scary things or my kids might say that was an exposure or they earn points periodically. And so developing that in your, in your family as a system of like, just part of [00:27:00] your family, just the way your family functions and it works can be really helpful. And there's, there's, Brave things that anyone in the family can do. And so it can be a family affair where I had to go present at work and I didn't really want to present, you know, but I did it. It was really brave. And so using those analogy, using those examples, I think can be really. Normalizing for the child with with OCD. Kimberley: Yeah. So even, even for the non OCD kiddos, you would use that in terms of if they had to do a violin recital or a math. a national math test or that kind of thing. Natasha: Yeah, I mean, I think it can go way beyond OCD. It's how to build resilience because really at the crux of OCD is resilience. It's how to sit with discomfort, how to sit with uncertainty of not being 100 percent of something how to how to deal with something that feels uncomfortable and do it anyway. And so those are those are resiliency [00:28:00] tools that anyone Kimberley: Yeah. And it's such a great mind shift for everyone because parents are doing exposures. They are doing scary things by not accommodating their child as well. That's an exposure for a parent pretty well. Um, so you can conceptualize it that way. I love that. Yeah. Um, What does it look like? I love that you also mentioned in terms of like this is a long term thing. Like this is just a family culture thing. This is how we exist in the world. What does it look long term though? You know, do we do, I've had so many parents say to me, I don't want to give, but you know, the, the, um, The bravery points forever. I don't want to over saturate extrinsic motivation. Like, do you have any thoughts on that in terms of long term use of that method? Natasha: mean, it depends on your child's age and like where they are as far as building up skills. we have it in the background because I don't, [00:29:00] I don't give my kids money for chores, I don't. And so it's just been part of our thing where if they want, I guess what they would call in the UK pocket money, you know, if they want, they want spending money. In general, that really works for me for them to do brave things in general. Um, and so that is just part of the way that we have that now, my 20 year old's not earning like bravery points, you know, across, you know, state lines in California where she's in college, you know, but she's, she's, doing that lifestyle. And so I don't feel like you necessarily have to have these systems or incentives. Um, you might hit a bump and you might say, you want to earn something to overcome this thing that you're working on. Um, you know, a new struggle that they're having. So you might pull it out periodically for me. I don't want I'm like, I'm

Navigating the intricate landscape of mental health can often feel like deciphering a complex puzzle, especially when differentiating between conditions ADHD vs.anxiety. This challenge is further compounded by the similarities in symptoms and the potential for misdiagnosis. However, understanding the nuances and interconnections between these conditions can empower individuals to seek appropriate treatment and improve their quality of life. ADHD, or Attention Deficit Hyperactivity Disorder, is a neurodevelopmental condition characterized by symptoms of inattention, hyperactivity, and impulsivity. While commonly diagnosed in childhood, ADHD persists into adulthood for many individuals, affecting various aspects of their daily lives, from academic performance to personal relationships. On the other hand, anxiety disorders encompass a range of conditions marked by excessive fear, worry, and physical symptoms such as heart palpitations and dizziness. The intersection of ADHD and anxiety is a topic of significant interest within the mental health community. Individuals with ADHD often experience anxiety, partly due to the challenges and frustrations stemming from ADHD symptoms. Similarly, the constant struggle with focus and organization can exacerbate feelings of anxiety, creating a cyclical relationship between the two conditions. A critical aspect of differentiating ADHD from anxiety involves examining the onset and progression of symptoms. ADHD is present from an early age, with symptoms often becoming noticeable during childhood. In contrast, anxiety can develop at any point in life, triggered by stressors or traumatic events. Therefore, a thorough evaluation of an individual's history is vital in distinguishing between the two. Moreover, the manifestation of symptoms can offer clues. For example, while both ADHD and anxiety can lead to concentration difficulties, the underlying reasons differ. In ADHD, the inability to focus is often due to intrinsic attention regulation issues. In anxiety, however, the concentration problems may arise from excessive worry or fear that consumes cognitive resources. Understanding the unique and overlapping aspects of ADHD and anxiety is crucial for effective treatment. For ADHD, interventions typically include medication, such as stimulants, alongside behavioral strategies to enhance executive functioning skills. Anxiety disorders, meanwhile, may be treated with a combination of psychotherapy, such as cognitive-behavioral therapy (CBT), and, in some cases, medication to manage symptoms. The integration of treatment modalities is paramount, particularly for individuals experiencing both ADHD and anxiety. Addressing the ADHD symptoms can often alleviate anxiety by improving self-esteem and coping mechanisms. Similarly, managing anxiety can reduce the overall stress load, making ADHD symptoms more manageable. In conclusion, ADHD and anxiety represent two distinct yet interrelated conditions within the spectrum of mental health. The complexity of their relationship underscores the importance of personalized, comprehensive treatment plans. By fostering a deeper understanding of these conditions, individuals can navigate the path to wellness with greater clarity and confidence. This journey, though challenging, is a testament to the resilience and strength inherent in the human spirit, as we seek to understand and overcome the obstacles that lie within our minds. TRANSCRIPT Kimberley: Welcome, everybody. We are talking about ADHD vs anxiety, how to tell the difference, kind of get you in the know of what is what.  Today, we have Dr. Ryan Sultan. He is an Assistant Professor of Clinical Psychiatry at Columbia University. He knows all the things about ADHD and cannabis use, does a lot of research in this area, and I want to get the tea on all things ADHD and anxiety so that we can work it out. So many of you listening have either been misdiagnosed or totally feel like they don’t really understand the difference. And so, let’s talk about it. Welcome, Dr. Sultan. ADHD vs. ANXIETY  Ryan: Thank you. I really like doing these things. I think it’s fun. I think psychiatrists, which is what I am, I think one of the ways that we really fail, and medical doctors in general don’t do well at this, which is like, let’s spend some time educating the public. And before my current position, I did epidemiology and public health. And so, I learned a lot about that, and I was like, “You know how you can help people? We have a crisis here. Let’s just teach people things about how to find resources and what they can do on their own.” And so, I really enjoy these opportunities.  WHAT IS ADHD vs. WHAT IS ANXIETY?   I was thinking about your question, and I was thinking how we might want to talk about this idea of ADHD versus anxiety, which is a common thing. People come in, and they see me very commonly wanting an evaluation, and they think they have ADHD. And I understand why they think they have ADHD, but their main thing is basically reporting a concentration or focus issue, which is a not specific symptom. Just like if I’m moody today, that doesn’t mean I have a mood disorder. If I’m anxious today, it doesn’t mean I have an anxiety disorder. I might even feel depressed today; it doesn’t mean I have a depression disorder. I could even have a psychotic symptom in your voice, and it does not mean that I have a psychotic disorder. It’s more complicated than that.   I think one of the things that the DSM that we love here in the United States—but it’s the best thing we have; it’s like capitalism and democracy; it’s like the best things that we have; we don’t have better solutions yet—is that it describes these things in a way that uses plain language to try to standardize it. But it’s confusing to the general public and I think it’s also confusing to clinicians when you’re trying to learn some of these conditions.  WHEN IS ADHD vs. ANXIETY DIAGNOSED?  And certainly, one of the things that have happened in my field that people used to talk a lot about is the idea that, is pediatric, meaning kid diagnosis of ADHD, which often in my area here in the United States will be done by pediatrician, are they adequately able to do that? Because poor pediatricians have to know a lot. And ADHD, psychiatric disorders are complicated. Mental health conditions are super complicated. They’re so complicated that there are seven different types of degree programs that end up helping you with them. PsyD, PhD, MD, clinical social worker, mental health counselor, and then there’s nurse practitioner. So, like super complicated counseling. So, how do we think about this?  The first thing I try to remind everyone is, if you’re not sure what’s going on with you, please filter your self-diagnosis. You can think about it, that’s great. Write your notes down, da-da-da, but I would avoid acting purely on that. You really want to do your best to get some help from the outside. And I know that mental health treatment is not accessible to everyone. This is an enormous problem that existed before the pandemic and still exists now. I say that because I say that all the time, and I wish I had a solution for you. But if you have access to someone that you think can help you tease this throughout, you want to do that.  SYMPTOMS OF ADHD vs. ANXIETY  But what I would like us to do, instead of listing criteria, which you can all Google on WebMD, let’s think about them in a larger context. So, mental health symptoms fall into these very broad categories. And so, some of them are anxiety, which OCD used to be under, but it’s now in its own area. Another one, would be mood. You can have moods that are really high, moods that are really low. Another one you could take ADHD, you could lump it in neurodevelopmental, which would mix it with autism and learning disorders. You could lump it with attention, but the problem with that is it would also get lumped with dementia, which are processes that overlap, but they’re occurring at different ends of the spectrum.   So, let’s think about ADHD and why someone might have ADHD or why you might think someone has ADHD, because this should be easier for people to tease out, I think. ADHD is not a condition that appears in adulthood. That’s like hands down. Adult ADHD is people that had ADHD and still have ADHD as adults. And most people with ADHD will go on to still have at least an attenuated version, meaning their symptoms are a little less severe, maybe, but over 60% will still meet criteria. It’s not a disorder of children. Up until the ‘90s, we thought it was a disorder of kids only. So, you turned 18, and magically, you couldn’t have ADHD anymore, which didn’t make any sense anyway.   So, to really get a good ADHD diagnosis, you got to go backwards. If you’re not currently an eight-year-old, you have to think a little bit about or talk to your family, or look at your school records. And ideally, that’s what you want to do, is you want to see, is there evidence that you have, things that look like ADHD then? So, you were having trouble maintaining your attention for periods of time. Your attention was scattered in different ways. Things that are mentally challenging that require you to force yourself to do it, that particularly if you don’t like them, this was really hard for you. You were disorganized. People thought that things went in one year and out the other.   Now this exists on a spectrum. And depending on the difficulty of your scholastic experience and how far you pushed yourself in school, these symptoms could show up at different times. For example, it’s not uncommon for people to show up in college or in graduate school. Less so now, but historically, people were getting diagnosed as late as that, because now they have to write a dissertation. For those of you guys who don’t know, a dissertation is being asked to write a book, okay? You’re being asked to write a book. And what did you do? You went to college. Okay, you went to college, and then you had some master’s classes, and then you get assigned an advisor, and you just get told to figure out what your project is. It is completely unstructured. It is completely self-sufficient. It is absurd. I’m talking about a real academic classic PhD. That is going to bring it. If somebody has ADHD, that’s going to bring it out because of the executive functioning involved in that, the organization, the planning. I got to make an outline, I got to meet with my mentor regularly, I got to check in with them, I got to revise it, I got to plan a study or a literature review. There’s so many steps involved. So, that would be something that some people doesn’t come up with then.   Other kids, as an eight-year-old boy that I’m treating right now, who has a wonderful family that is super supportive, and they have created this beautiful environment for him that accommodates him so much that he has not needed any medication despite the fact that there’s lots of evidence that he is struggling and now starting to feel bad about himself, and he has self-esteem issues because he just doesn’t understand why he has to try so hard and why he can’t maintain his attention in this scenario, which is challenging for him.   So, ADHD kids and adults, you want to think of them as their brains as being three to five years behind everyone else in their development, okay? And they are catching up, but they’re more immature, and they’re immature in certain ways. And so, this kid’s ability to maintain his attention, manage his own behaviors, stay organized, it’s like mom is sitting with this kid doing his homework with him continuously, and if she stops at all, he can’t hold it together on his own. So, when we think about that with him, like, okay, well, that’s maybe when it’s showing up with him. That’s when it’s starting to have a struggle with him.   But let’s relate it to anxiety. One problem would be, do you have ADHD or do you have anxiety? Well, there’s another problem. Another problem is having ADHD is a major risk factor for developing an anxiety disorder, okay? So now I’m the eight-year-old boy, and this eight-year-old boy does not have the financial resources to get this evaluation, or the parents that are knowledgeable enough to know that, it might even have been years ago where there was less knowledge about this. And he’s just struggling all the time, and he feels bad about himself, and he’s constantly getting into trouble because he is losing things because he can’t keep track of things because he’s overwhelmed. And now he feels bad about himself. Okay. He has anxiety associated with that. So now we’re building this anxiety. So he might even get mood symptoms, and now we have a risk for depression.   So, this is just one of the reasons why these things are like these tangled messes. You ever like have a bunch of cords that you have one of the dealies, you keep throwing them in a box, and now you’re like, “What do I do? Do I just throw the cords out or entangle them?” It’s a very tangled mess. Of course, it takes time to sort through it. The reason I started with ADHD is that it has a clear trajectory of it when it happens. And in general, it’s a general rule, symptomatology, meaning like how severe it is and the number of symptoms you have and how impairing it is. They’re going to be decreasing as you get older. At least until main adulthood, there’s new evidence that shows there might be a higher risk for dementia in that population.   But let’s put geriatric aside. There’s a different developmental trajectory. Whereas anxiety, oh God, I wish I could simplify anxiety that much. Anxiety can happen in different ways. So, let’s start with the easy thing. Why would you confuse them in this current moment? If I am always worried about things, if I’m always ruminating about things, I’m thinking about it over and over again, I’m trying to figure out where I should live or what I should do about this, and I just keep thinking about it over and over again, and I’m in like a cycle. Like, pop-pa-pa pop-pa pop-pa-pa-pa. And then you’re asking me to do other things. I promise you, I will have difficulty concentrating. I promise you, I can’t concentrate because it’s like you’re using your computer and how many windows do you have open? How many things are you running? I mean, it doesn’t happen as much anymore, but I think most of us, I meant to remember times where you’re like, “Oh, my computer is not able to handle this anymore.” You’re using up some of your mind, and you can call that being present.   So, when people talk about mindfulness and improving attention, one of the things that they’re probably improving is this: they’re trying to get the person to stop running that 15, 20% program all the time. And it’s like your brain got upgraded because you can now devote yourself to the task in front of you. And the anxiety is not slowing you down or intruding upon you, either as an intrusive thought in an OCD way or just a sort of intrusive worry that’s probably hampering your ability to do something concentration-intensive. And then if you have anxiety problems and you’re not sleeping right, well, now your memory is impaired because of that. So, there’s this cycle that ends up happening over and over again.  IS HYPERACTIVITY ANXIETY OR ADHD? Kimberley: Yeah, I think a lot of people as well that I’ve talked to clients and listeners, also with anxiety, there’s this general physiological irritability. Like a little jitteriness, can’t sit in their chair, which I think is another maybe way that misdiagnosis can -- it’s like, “Oh, they’re hyperactive. They’re struggling to sit in their chair. That might be what’s going on for them.” Is that similar to what you’re saying?  Ryan: Yeah. So, really good example, and this one we can do a little simpler. I mean, the statement I’m going to say is not 100% true, but it’s mostly true. If you are an adult, like over 25 for sure, and you are physically jittery, it is very unlikely that that is ADHD. Because ADHD, the whole mechanism as we understand it, or one of the mechanisms causing the thing we call ADHD, which of course is like a made-up thing that we’re using to classify it, is that your prefrontal cortex is not done developing. So, it needs to get myelinated, which is essentially like -- think about it like upgrading from dial up to some great, not even a cable modem. You’re going right to Verizon Fios. Like amazing, okay. It’s much faster, and it’s growing. And that’s the part of you that makes you most human. That’s the most sophisticated part of your brain. It’s not the part that helps you breathe or some sort of physiological thing, which, by the way, is causing some of those anxiety symptoms. They’re ramped up in a sympathetic nervous system way, fight or fight way. It’s the part that’s actually slowing you down. That’s like, “Whoa, whoa, whoa, whoa, whoa, calm down, calm down, calm down.” This is why, and everyone’s is not as developed. So, we’re all developing this thing through 25, at least ADHD is through 28.   Car insurance goes down to 25 because your driving gets better, because your judgment gets better, because you can plan better, because you are less risk-taking. So, your insurance has now gone down. So, the insurance company knows this about us. And our FMRI scans, you scan people’s brains, it supports that change. These correlate to some extent with symptomology, not enough to be a diagnosis to answer the person’s question that they’re going to have that. I wish it was. It’s not a diagnosis. We haven’t been able to figure out how to do that yet.   So, by the time you’re 25, that’s developed. And the symptoms that go away first with ADHD are usually hyperactivity, because that’s the inability to manage all the impulses of your body, not in an anxious, stressed-out way, but in an excited way. You think of the happy, well-supported, running around ADHD kid is kind of silly and fun. It’s a totally different mood experience than the anxiety experience. Anxiety experience is unpleasant for the most part. Unless your anxiety is targeting you to hyper-focus to get something done, which is bumping up some of your dopamine, which is again the opposite experience of probably having ADHD, it’s a hyper-focus experience, certainly, the deficit part of ADHD, you’re going to be feeling a different physiological, the irritability you talked about 100%. You’re irritable because you are trying so hard to manage this awful feeling you have in your body. You physically feel so uncomfortable. It is intolerable.   I have this poor, anxious young man that has to do a very socially awkward thing today. Actually, not that socially awkward. He created the situation, which is one of the ways we’re working on it with him in treatment. And I’m letting him go through and do this as an exposure because it’ll be fine. And he’s literally interacting with another one of our staff members. But he finds these things intolerable. He talks about it like we are lighting him on fire. So, he’s trying to hold it together, or whatever your physiological experience is. It may not have been as dramatic as I described. You’re irritable when people are asking things of you because you don’t have much left. You’re not in some carefree mood where you’re like, “Whatever, I’m super easygoing. I don’t care.” No, you’re not feeling easygoing right now. You’re very, very stressed out.   Stress and anxiety are very linked. Just like sadness and depression are very linked, and like loneliness and depression are linked, but they’re not the same thing. Stress and anxiety are very, very linked, and they’re similar feelings, and they’re often occurring at the same time and interacting with each other. ADD vs. ADHD  Kimberley: Right. One question really quick. Just to be clear, what about ADD vs. ADHD?  Ryan: We love to change diagnostic criteria. People sit around. There’s a committee, there’s a whole bunch of studies. And we’re always trying to epidemiologically and characterologically differentiate what these different conditions are. That’s what the field is trying to do as an academic whole. And so, there’s disagreements about what should be where. So, the OCD thing moving is one of them.   The ADD thing, it’s like a nomenclature thing. So, the diagnosis got described that the new current version of the diagnosis is attention deficit hyperactivity disorder, and then you have three specifiers, okay? So, that’s the condition you have. And then you can have combined, which is hyperactive and inattentive. Just inattentive, just hyperactive. And impulsive is built in there. So, it’s really not that interesting. People love to be like, “No, no, I have ADD. No, I don’t have the hyperactive.” And I’m like, “I know, but from a billing point of view, the insurance company will not accept that code anymore. It doesn’t exist.” DOES ADHD OR ANXIETY IMPACT CONCENTRATION?  Kimberley: Yeah. So, just so that I know I have this right, and you can please correct me, is if you have this more neurological, like you said, condition of ADHD, you’ll have that first, and then you’ll get maybe some anxiety and some depression as a result of that condition. Whereas for those folks, if their primary was anxiety, it wouldn’t be so much that anxiety would cause the ADHD. It would be more the symptoms of concentration are a symptom of the anxiety. Is that what you’re saying? Ryan: Yes, and every permutation that you can imagine based on what you just said is also an option. Like almost every permutation. Like how are they interacting with each other? How are they making each other worse? How are they confusing each other? Because you can have anxiety disorders in elementary school. I mean, that is when most anxiety disorders, the first win, like the wave of them going up is then. And you think about all the anxiety you have.   I got a friend of mine who’s got infants. And it’s fun to see like as they’re developing, when they go through normal anxiety, that that is a thing that they’re going to pass. And then there’s other things where, at some point, we’re like, actually, now we’re saying this is developmentally inappropriate, which means, nope, we were supposed to have graduated from this and it’s still around.   And so, one of the earlier ways that psychiatric conditions were conceptualized, and it’s still a useful way to conceptualize them, is the normal behavior version of it versus the non-normal behavior version of it. And again, I hate non-normal, I don’t want to pathologize people, but non-normal being like, this is causing problems for you. And if you think about it from an evolutionary point of view, all of these conditions have pretty clear evolutionary bases of how they would be beneficial. Anxiety is going to save your ass, okay? Properly applied anxiety, it’ll save your tribe. You want someone who’s anxious, who’s going to be like, “We do not have enough from this winter.” An ADHD person was like, “It’ll be fine. I’m just going to go find something else.” And you’re like, “No.” And then when that winter’s really bad and you save that little bit of extra food, that 30% that the anxious person pushed for, maybe you didn’t eat all 30% of it, but you know what, it probably benefited you and it might’ve actually made the whole tribe survive or more people survive or better health condition. So, it’s approving everyone’s outcomes.   The ADHD individual, you get them excited about something—gone. They’re going to destroy it. They’re going to find all the berries. They’re going to find all the new places. They’re going to find all the new deer. They’re going to run around and explore. It’s great. Great, great, great.   Depression is like hibernation. And if you look at hibernation in a mammal, like what happens, there’s a lot of overlaps. Lower energy, maybe you store up some food for the winter. It’s related to the seasons. You’re in California, right? This is not a problem you have, but for those of us in New York, where we have seasonality, seasonal depression is a thing. It’s very much a thing. It’s very noticeable, and it’s packed on top of these conditions everyone else is having.  But the idea is that the hibernation or the pullback is like something happens to you that upsets you, which is the psychosocial event that’s kicking you in the face that might set off your depression. That’s why people always say, “Oh, depressions just don’t come out of nowhere. This biochemical thing isn’t true.” What they’re saying is something has to happen to start to kick off the depression, but that’s not enough. It’s that you then can’t recover from it.   And so, a normal version of it is that you get knocked out and you spend a week or two, you think about it. Rumination is a part of depression for many people. You reevaluate, and you say, “You know, I got kicked in the face when I did that. That was not a good plan for me. I need a new plan. I either need to do something different or I need to tackle that problem differently.” And so, that would be the adaptive version of a depressive experience. Whereas the non-adaptive version is like, you get stuck in that and you can’t get out.  Kimberley: Or you avoid.  Ryan: The avoiding doing anything about it, and then that makes it worse. So, you started withdrawing. I mean, that’s the worst thing you can do. This is a message to everyone out there. The worst thing that you can do is withdraw from society for any period of time. Look, I’m not saying you can’t have a mental health day, but systematic withdrawal, which most of us don’t even realize is happening, is going to make you worse because the best treatment for every mental health condition is community. It is really. All of them. All of them, including schizophrenia.   I used to work in Atlanta. I did my residency. There’d be these poor guys that have a psychotic disorder. They hear voices. The kinds of people that, here in New York City, are homeless, they’re not homeless there. Everyone just knows that Johnny’s just a little weird and his mom lives down the street. And if we find Johnny just in the trash can or doing something strange, or just roving, we know he’s fine, and someone just takes him back to his mom’s house and checks on him. Because there’s a community that takes care of him, even though he’s actually quite ill from our point of view. But when you put him in an environment where that community is not as strong, like a city, it does worse, which is why mental health conditions are much higher rates in urban areas. Probably why psychiatry and mental health in general is such a central thing in New York City. TREATMENT FOR ADHD vs. ANXIETY  Kimberley: Yeah. Okay, let’s talk quickly about treatment for ADHD. We’re here always talking about the treatment for anxiety, but what would the research and what’s evidence-based for ADHD if someone were to get that clinical diagnosis?  Ryan: So, you want to think about ADHD as a thing that we’re going to try to frame for that person as much as how is it an asset, because it historically has made people feel bad about themselves. And so, there are positive aspects to it, like the hyper focus and excitability, and interest in things. And so, trying to channel into that and then thinking about what their deficits are. So, they’re functional deficits. If you’re talking adult population, functional deficits are going to be usually around executive functioning and organization planning. Imagine if you’re like a parent of small children and you have untreated ADHD, you’re going to be in crazy fight-or-flight mode all the time because there’s so many things to keep track of. You have to keep track of your wife and their life. Kimberley: I see these moms. My heart goes out to them. Ryan: And they’re probably anxious. And the anxiety is probably protecting them a little bit. Because what is the anxiety doing? You think about things over and over and over again, and you double check them. You know what that’s not a bad idea for? Someone who’s not detail-oriented, who’s an ADHD person, who forgets things, and he gets disorganized. So, there’s this thing where you’re like, “Okay, there may actually be a balance going on. Can we make the balance a little bit better?” So, how do you organize yourself?  MEDICATIONS FOR ADHD Right now, there’s a stimulant shortage. Stimulants are the most effective medication for reducing ADHD symptoms. They are the most effective biological intervention we have to reduce the impact of probably any psychiatric condition, period. They are incredibly effective, like 80, 90% resolution of symptoms, which is great. I mean, that’s great. That’s great news. But you also want to be integrating some lifestyle changes and skills alongside of that. So, how do you organize yourself better? I mean, that’s like a whole talk, but like lists, prioritizing lists, taking tasks, breaking them down into smaller and smaller pieces. Where do you start? What’s the first step? Chipping away. You know what? If you only go one mile a day for 30 days, you go 30 miles. That’s still really far. I know you would have gone 30 miles that day, especially if you have ADHD, but you’re still getting somewhere.  And so, that kind of prioritization is really, really important. And so, you can create that on your own. There are CBT-based resources and things to try to help with that. There are ADHD coaches that try to help with that. It’s consistency and commitment around that. So, how do you structure your life for yourself? That poor PhD candidate really needs to structure their life because there is no structure to their life.  The other things we want to think about with that, I mean, really good sleep, physical exercise. People with ADHD, we see on FMRI scans when you scan someone’s brain, there’s less density of dopamine receptors, less dopamine activity. You want to get that dopamine up. That’s what the medications are doing, is predominantly raising the dopamine. So, physical activity, aerobic exercise, in particular, is going to do that. Get that in every day, and look, it’s good for you. It’s good for you. There is no better treatment for every condition in the world other than exercise, particularly aerobic. It basically is good for everything. If you just had surgery, we still want you to get out and walk around. Really quickly, that actually improves your outcome as fast as possible. So, those are the things I like people to start with if they can do that, depending on the severity of what’s going on, the impact, what other things have already been tried. Stimulant medications or non-stimulant medications like Wellbutrin, Strattera, Clonidine are also pretty effective. Methylphenidate products, which is what Ritalin is. Adderall products mixed in amphetamine salts, Vyvanse, these are very effective medications for it. There’s a massive shortage of these medications that people are constantly talking about, and is really problematic and does not appear to have an endpoint because the DEA doesn’t seem ready to raise the amount that they allow to be made because they are still recovering from the opioid crisis, which is ongoing. And so, they’re worried about that. Really, they want to be very thoughtful about this. These medications have a very low-risk potential for misuse. In fact, people with ADHD, they appear to reduce the risk of developing a substance use disorder. It’s the most common thing that people worry about. So, treatment actually reduces that.  That said, the worst -- I mean, I don’t want to say the worst thing. I mean, people hate me. The really not great way to get psychiatric treatment is to show up to someone once and then intermittently meet with them where they write a prescription for a medication for you that’s supposed to help you, and stimulant medications are included on that. So, that’s probably why I didn’t lead with that, even though there’s actually more science to support them, is that by themselves, it’s really going to limit how much help you’re going to get. Kimberley: Can you share why? Ryan: Because you need to understand your condition, because you need to spend time with your clinician learning about your condition and understanding how it’s affecting your life, and understanding how the medication is actually meant to be a tool. It should be like wearing glasses. It doesn’t do the work for you. It doesn’t solve all your problems, but it’s easier to read when you put your glasses on than without it. It supports you. You still need to figure out how to get these things done. It lowers the activation energy associated with it. But you also want to monitor it. You can’t take these medications 24 hours a day and just be ready to go and work, which is things that people have tried. It doesn’t work because you need to sleep, because you will die. They’ve tried this. We know that you will literally die, like not sleeping. And in the interim, you are damaging yourself significantly. So, taking it and timing it in an appropriate way, still getting sufficient sleep, prioritizing other things—they are like a piece of a puzzle, and they are a really powerful piece. But you really don’t want that to be the only thing driving your decision-making, or that be what the interaction is really about. And by the way, the same thing is true for all psychiatric medications. Kimberley: I was going to say that’s what we know about

Exploring the relationship between faith and recovery, especially when it comes to managing Obsessive-Compulsive Disorder (OCD), reveals a complex but fascinating landscape. It's like looking at two sides of the same coin, where faith can either be a source of immense support or a challenging factor in one’s healing journey. On one hand, faith can act like a sturdy anchor or a comforting presence, offering hope and a sense of purpose that's invaluable for many people working through OCD. This aspect of faith is not just about religious practices; it's deeply personal, providing a framework that can help individuals make sense of their struggles and find a pathway towards recovery. The sense of community and belonging that often comes with faith can also play a crucial role in supporting someone through their healing process. However, it's not always straightforward. Faith can get tangled up with the symptoms of OCD, leading to situations where religious beliefs and practices become intertwined with the compulsions and obsessions that characterize the disorder. This is where faith can start to feel like a double-edged sword, especially in cases of scrupulosity, where religious or moral obligations become sources of intense anxiety and compulsion. The conversation around integrating faith into recovery is a delicate one. It emphasizes the need for a personalized approach, recognizing the unique ways in which faith intersects with an individual's experience of OCD. This might involve collaborating with religious leaders, incorporating spiritual practices into therapy, or navigating the complex ways in which faith influences both the symptoms of OCD and the recovery process. Moreover, this discussion sheds light on a broader conversation about the intersection of psychology and spirituality. It acknowledges the historical tensions between these areas, while also pointing towards a growing interest in understanding how they can complement each other in the context of mental health treatment. In essence, the relationship between faith and recovery from OCD highlights the importance of a compassionate and holistic approach. It's about finding ways to respect and integrate an individual's spiritual beliefs into their treatment, ensuring that the journey towards healing is as supportive and effective as possible. This balance is key to harnessing the positive aspects of faith, while also navigating its challenges with care and understanding. Justin K. Hughes, MA, LPC, owner of Dallas Counseling, PLLC, is a clinician and writer, passionate about helping those impacted by OCD and Anxiety Disorders. He serves on the IOCDF's OCD & Faith Task Force and is the Dallas Ambassador for OCD Texas. Working with a diversity of clients, he also is dual-trained in psychology and theology, regularly helping anyone to understand the interaction between faith and mental health. A sought-after writer and speaker, he is currently mid-way through writing his first workbook on evidence-based care of OCD for Christians. He is seeking a collaborative agent who will help secure the best publishing house to help those most in need. Check out www.justinkhughes.com to stay in the loop and get free guides & handouts! Kimberley: Welcome, everybody. Today, we’re talking about faith and its place in recovery. Does faith help your recovery? Does it hinder your recovery? And all the things in between.  Today, we have Justin Hughes. Justin is the owner of Dallas Counseling and is a clinician and writer. He’s passionate about helping those who are impacted by OCD. He is the Dallas ambassador for OCD Texas and serves on the IOCDF’s OCD and Faith Task Force, working with a diversity of clients. He’s also dual-trained in psychology and theology, regularly helping anyone to understand the interaction between faith and OCD, most commonly Christians. But today, we’re here to talk about faith in general. Welcome, Justin. Justin: Kimberley Jayne Quinlan, howdy. Kimberley: You said howdy just perfectly from your Texas state.  Justin: Absolutely. Kimberley: Okay. This is a huge topic. And just for those who are listening, we tried to record this once before, we were just saying, but we had tech issues. And I’m so glad we did because I have thought about this so much since, and I feel like evolved a little since then too.  So, we’re here to talk about how to use faith in recovery and/or is it helpful for some people, and talk about the way that it is helpful and for some not. Can you share a little bit about your background on why this is an important topic for you? Justin: Absolutely. So, first of all, as a man of faith, I’m a Christian. I went to a Christian college, got my degree in Psychology, and very much desired to interweave studies between psychology and theology. So, I went to a seminary. A lot of people hear that, and they’re like, “Did you become a priest?” No, it was a counseling program at a seminary, Dallas Theological Seminary. I came here and then found my wife, and I stayed in Dallas.  And it’s been important to me from a personal faith standpoint. And I love the faith integration in treatment and exploring that with clients. And of course -- or maybe I shouldn’t say of course, but it’s going to be a lot of Christians, but I work with a lot of different faith backgrounds. And there are some really important conversations happening in the broader world of treatment about faith integration and its place. And we’re going to get into all those things and hopefully some of the history and psychology’s relationship to faith, which has not been the greatest at different points. For me personally, faith isn’t just an exercise. It’s not something that I just add on to make my day better. In fact, a lot of times, faith requires me to do way more difficult things than I want to do, but it’s a belief in the ultimate object of my faith in God and Christ as a Christian. I naturally come across a lot of people who not only identify that as important but find it as very essential to their treatment. And let’s get into that, the folks that find it essential, the people who find it very much not, and the people who don’t. But that’s just a little bit about me and why I find this so important. Kimberley: Yeah. It’s interesting because I was raised Episcopalian. I don’t really practice a lot of that anymore for no reason except, I don’t know, if I’m going to be really honest.  Justin: So honest. I love that.  Kimberley: Yeah, I’ve been thinking about it a lot because I had a positive experience. Sometimes I long for it, but for reasons I don’t know. Again, I’m just still on that journey, figuring that piece out and exploring that.  Where I see clients is usually on the end of their coming to me as a client, saying, “I’m a believer, but it’s all gotten messed up and mushed up and intertwined.” And I’m my job. I think of my job as helping them untangle it. Justin: Yeah. Kimberley: Not by me giving my own personal opinion either, but just letting them untangle it. How might you see that? Are you seeing that also? And what is the process of that untangling, if we were to use that word? Justin: It’s so broad and varied. So, I would imagine that just like with clients that I work with and folks that come to conferences and that I talk with, the listeners in your audience, hi listeners, are going to have a broad experience of views, and it’s so functional. So, I want people to hear right away that I don’t think that there’s just a cookie-cutter approach. There can’t be with this. And whether we’re treating OCD, anxiety disorders, or depression, or eating disorders, or BFRVs, fill in the blank, there are obviously evidence-based treatments which are effective for most, but even those can’t be a cookie cutter when it comes down to exactly what a person needs to do or what is required of them in recovery.  So, yes, let me just state this upfront for the folks that might be unduly nervous at this point. First of all, the faith piece, religious piece, does not have to enter into treatments for a lot of people to get the job done. In fact, actually, for a lot of people, it was much more healing for them, including many of my clients. I have friends and family members that sometimes look at me as scant. So like, “Wait, you went to seminary, and sometimes you don’t talk about God at all.” And it’s like, “Yeah, sometimes we’re just doing evidence-based treatment, and that is that.” And as an evidence-based practitioner, that’s important to me.  So, when people come in, I want to work with what their goals are, their values. And a lot of people have found themselves, for any number of reasons, stuck, maybe compulsions or obsessive thoughts or whatever, are stuck in all things belief, religion, or faith or whatever else. And sometimes actually, the most healing thing for them to do is sometimes get in, get out, do the job clinically, walk away, experience freedom, and then grow and develop personally.  But then I’ve also discovered that there’s this other side that some people do not find a breakthrough. Some people stay stuck. And maybe these are the people that hit the stats that we see in research of 20% or so just turn down things like ERP, (exposure and response prevention) with OCD when they’re offered. And then another 20 to 30% drop out. And we have great studies that tell us that most people who stick with it get a lot of benefits, but there’s all the other folks that didn’t. And sometimes it’s because people -- no offense, you all, but sometimes people just don’t want to put in the work and discipline.  However, we can’t minimize it to that. Sometimes it’s truly people that are willing to show up, and there’s a complex layer of things. And the cookie-cutter approach is not going to work for them. Maybe they have the intersection of complex health issues, intersection of trauma, intersection of even just family of origin things where life is really difficult, or even just right now, a loneliness epidemic that’s happening in the world.  And by the way, I’m a huge believer in the evidence base. There’s a lot in the evidence base that guides us. And as I’m talking today, I want to be really clear that when I work with folks, even when we get into the spiritual, I’m working with the evidence base. Yeah, there’s things that there’s no specific protocol for, but a lot of folks, I think, can hopefully be encouraged that there’s a strong research base to the benefits and the use and the application and also the care of practicing various spiritual practices through treatments.  So, to come back to the original question, it depends so much. It’s like if somebody asked me a question like, “Hey, Justin. Okay, so as a therapist, do you think that --” and I get these questions all the time, “Is it okay for me to...? Like, I am afraid of this.” I got this question at one point. Somebody was curious if I thought it was okay for them to travel to another city. And it’s like, it depends. It’s almost always an “it depends.”  So, that’s where I’m going to leave it, that nice, squeaky place that we all just want a dang answer, but the reality is, it is going to massively depend on the person and where they are, and what their needs are. Kimberley: Yeah, I mean, and I’ll speak to it too, sometimes I’ve seen a client. Let’s give a few examples of a client with OCD. The OCD has attacked their faith and made it very superstitious or very fear-based instead of faith-based. And I think they come in with that, “Everything’s so messy and it used to make so much sense, and now it doesn’t.”  For eating disorders, I’ve had a lot of clients who will have a faith component where there are certain religions that have ways in which you prepare foods and things, and then that has become very sticky and hard for them. The eating disorder gets involved with that as well.  And let me think more just from a general standpoint, and I’ll use me as an example, as just like a generally anxious person. I remember this really wonderful time, I’ll tell you a funny story, when my daughter was like five, out of nowhere, she insisted that we go to every church. Like she wanted to go to a Christian and a Catholic and Jewish temple and Muslim and Buddhist. She wanted to try all of them, and we were like, “Great, let’s go and do it.” And I could see how my anxious brain would go black and white on everything they said. So, if they said something really beautiful, my brain would get very perfectionistic about that and have a little tantrum. I think it would be like, “But I can’t do it that perfect,” and I would get freaked out, but also be able to catch myself. So, I think that it’s important to recognize how the disorder can get mixed up in that. Justin: Yeah, absolutely. Kimberley: Right? Let’s now flip, unless you have something you want to add, to how has faith helped people in their recovery, and what does that look like for you as a clinician, for the client, for their journey? Justin: Yeah, absolutely. Well, on the clinical side of things, the starting place is always going to be the assessments and diagnosis and treatment plan. And then the ethics of it too is going to be working with the person where they are and their beliefs and not forcing anything, of course. And so folks are naturally -- I get it, I respect it. I would be nervous of somebody of a different belief background that’s overt about things. Some people come in, they look at the wall, they see Dallas Theological Seminary, they’ve studied a few things in advance. So, yeah, the starting places, sitting down, honest, building rapport, trust, assessing, diagnosing. So, for the folks where the faith piece is significant, I’ll put it into two categories. So, one is sometimes we have to talk about aspects of faith just from a pure assessment sample. So, a common example of that is scrupulosity in OCD. So, I have worked with even a person on the, believe it or not, Faith and OCD Task Force who is atheist. And so, why in the world do we need to talk about faith? Why is that person even on the Faith and OCD Task Force? Well, they’re representing a diversity of views and opinions on the role of faith and OCD.  Kimberley: Love it. Justin: And it’s so interesting to look at it at a base level with something like OCD. But frankly, a lot of mental disorders or even just challenges in life, if clinicians, one, aren’t asking questions about, hey, do you have any religious views, background, even just in your background? Do you have spiritual practices that are important to you? We’re missing a massive component. And here’s the research piece. We know from the research that, actually, a majority of people find things of faith or spirituality important, and secondarily, that a majority of people would like to be able to talk about those things in therapy. Straight-up research. So, a couple of articles that I wrote for the IOCDF on this reference this research. So, it is evidence-based to talk about this.  And then when we get into these sticky areas of obsessions and anxiety disorders, of course, it’s going to poke on philosophy, worldview, spirituality. And so, it could be even outside of scrupulosity, beliefs that at first it just looks like we need some good shame reduction exercises, self-compassion, and so forth, but we discover that, oh, the person struggling with contamination OCD has a lot of deeper beliefs that they think that somehow, they are flawed because they’re struggling. They’re not a good enough, fill in the blank, Christian. They’re not good enough. Because if so, surely God would break through in a bigger way. If so... Wouldn’t these promises that I’m told in scriptures actually become true?  And the cool thing is, there’s a richness in the theology that helps us understand the nuance there, and it’s not that simple. But if we miss that component, and it’s essential for treatment, it’s not just like, “Oh, I feel bad about myself. And yeah, sometimes I’m critical with myself.” And if we don’t go at that level of core fear, or core distress, or core belief, oftentimes we’re missing really a central part of the treatment, which we talk about in any other domain. People just get nervous sometimes, thinking about spirituality. It’s like politics and religion, right? Nobody talks about those things. Well, if we’re having deeper conversations, we usually are. And as clinicians, those of you that are listening to the podcast as clinicians, you know that you have to work with people of different political leanings, people of different faith leanings, people who actually live in California versus [inaudible]. I love California.  So, the first category is, if we’re doing good clinical work, we’re going to be asking questions because it matters to most people. If we don’t, we’re missing a huge piece. It doesn’t mean you’re a bad therapist, but hey, start asking some questions if you’re not, at a minimum.  But then there’s the second piece that most people actually want to know, and most people have some aspects of practice or integration, or even the most religion church-averse type of person will have any number of things come up such as, “Yeah, I pray occasionally,” or “Yeah, I do this grounding exercise that puts me in touch with the universe or creation or whatever it is.”  So, there’s the second category of when it is important to a person because it’s part of the bigger picture of growth, it’s part of the bigger picture of breaking free from challenges that they have, and, frankly, finding meaning. And I’ll just make one philosophical comment here, because I’m a total nerd. Psychology can never be a worldview. Psychology tells us what. Psychology is a subset of science. And by worldview, I mean a collective set of beliefs, guidance, direction about how life should be lived. We can only say, “Hey, when you do this, you tend to feel this way, or you tend to do these behaviors more or do these behaviors less.” At the end of the day, we have to make interpretations and judgments about right and wrong, how to live life, the best way to live life. These are in the realm of interpretation.  So, surprise, surprise, we’re in the realm of at least philosophy, but we very quickly get into theology. And so back to the piece that most people care about it, most people have some sort of spiritual practice that they’ll resonate with and connect with. And then most people actually want to integrate a little bit into therapy. And then some people find that it is essential. They haven’t been able to find any lasting freedom outside of going deeper into a bigger purpose, `bigger meaning. Kimberley: You said a couple of things that really rang true for me because I really want to highlight here, I’m on the walk here as well as a client. And I love having these conversations with clients, not about me, about them, but them when they don’t have a spiritual practice, longing for one. I’ve had countless clients say, “I just wish I believed.” And I think what sometimes they’re looking for is a motivator. I have some clients who have a deep faith, and their North Star is that religion. Their North Star is following the word of that religion or the outcome of it, whether it be to go to heaven or whatever, afterlife or whatever. They believe like that’s the North Star. That’s what determines every part of their treatment. Like, “Why are we doing this exposure today?” “Because this is my North Star. I know where I’m heading. I know what the goal is.” And then I have those clients who are like, “I need a North Star. I don’t have one. I don’t get the point.” And I think that is where faith is so beautiful in recovery.  When I witness my clients who are going to do the scary thing, they don’t want to do it, but they’re so committed to this North Star, whatever it might be. And maybe there’s a better language than a North Star, again, whatever that is for that person. Like, “I’m walking towards the light of whatever that religion is.” I feel, if I’m going to be honest, envious of that. And I totally get that some people do too.  What would you say to a client who is longing for something like that? Maybe they have spiritual trauma in some respects or they’ve had bad experiences, or they’re just unsure. What would you say to them? Justin: Yeah, that’s really great. And first of all, I just want to really say that it takes a lot of vulnerability and strength to talk as you do. And one of the ways that I admire you, KQ, is through your ability to have these vulnerable conversations. So not just like the platform of expert, because at the end of the day, we’re all just people and on a journey for sure. And so thanks for being honest with that.  And I’m on a journey as well. And certainly, I realized jumping on podcasts, these things put us in the expert role and we speak at conferences and things like that. But I think that’s a bit of the answer right there, is that being where we are to start with is so huge. And I mean, you’re so good with the steps to take around acceptance and compassion. That’s it. It’s like fear presses towards a thousand different possibilities, and none of them come true exactly that way. And it can lead towards people missing a lot of personal growth stuff, spiritual growth stuff. And one of those things, I think, that we do is we sit with that. Clinically, I’m going to assess, ask a lot of questions, Socratic questions as a subset of the cognitive therapy side of doing that. Let me just come back to the simplicity. I think we get there. We sit in it for a second. And otherwise, we miss it. We’re rushing to preconceived solutions or answers, but we’re saying that we don’t necessarily have an answer for that. So, what if we take some time to actually notice it and to be with that and to actually label it and be like, “I’m not sure. I’m yearning. I’m envious. I’m wanting something, but I don’t know. So, put me in, coach.” I’ll sit with people. That’s really the first thing.  Kimberley: Yeah. What I have practiced, and I’ve encouraged clients is also being curious, like trying things out if that lines up with their values, going to a service, reading a book, listening to a podcast, and just trying it on. For me, it’s also interesting with clients, is if they’re yearning for it, try it on and observe what shows up. Is it that black-and-white thinking or perfectionism? Is it your obsessions getting involved? Is it that it just doesn’t feel good in your body? And so forth. Again, just be where you are and take it slow, I think.  I have a few other areas I want you to look at in terms of giving me your professional thoughts. If somebody wants to incorporate faith into their treatment, what can that look like? Can it look like praying together? What does that look like? Justin: You’re asking all the good questions. Yeah, absolutely. And also, one other thing to reference, I know you’re friends with Shala Nicely and Jeff Bell. And so they wrote a book. And for those that are on that, I would say, more “I’m seeking journey,” it’s When in Doubt, Make Belief: An OCD-Inspired Approach to Living with Uncertainty. And I love Shala and Jeff. They’re so great, and they’ve been really pivotal people in my own life, not just as friends, but just as personal growth too. And so, that’s an example specifically where Shala talks about the throes of her suffering. Is Fred in the Refrigerator? is her basically autobiography that goes into the clinical piece too, where at the end of the day, there was a bit of a pragmatic experience that she couldn’t -- the universe being against her, she basically always had that view and she needed something that was different. And so she got there, I think. I hope I’m reflecting her sentence as well, but got there pragmatically. “The universe is friendly” is something that she said.  Now, I just know that my Christian brothers and sisters, if they’re listening to this, they’re probably like, “What the heck is Justin talking about? The universe is friendly?” Because that’s very, very different from the language that we’ve used, but it’s just such a great example to me of just one step at a time, a person on the journey. They’re looking at those things and assessing, okay, what is obsessive, what is compulsive, what is this thing that I can believe in and I ultimately do, but maybe I’m not. I don’t want to or I’m not ready, or it doesn’t make sense to me to make a jump into an organized religious plea for whatever else. And so, how does it look for clients?  So in short, do I pray with clients? Yeah, absolutely. Do I open up the Bible? Yes, absolutely. Actually, it is a minority of sessions, which again, on my more conservative friends and family side of things are almost shocked and scratching their heads. Like, “You’re a Christian, you do counseling, and you’re not doing that.” We’re a bunch of weirdos. We’re in that realm of the inter-Christian circle in a good sense. We believe so deeply that God loves us and God has interceded and does intercede, and interacts with our present, not just a historical event here and there, and we’re left on our own, the deistic watchmaker, to use a philosophical reference there. That because we believe that so strongly, we’re not going to take no for an answer in the sense of the deeper growth and deeper faith.  So, sometimes that backfires though, especially getting into the superstitious, like, “Well, God’s got to be in everything, and I’m not feeling it,” as opposed to like, “Okay. Is it possible that I could just have a brain that gives me some pretty nasty thoughts sometimes and it doesn’t necessarily reflect that I’m in a bad state, that I can be curious about what a person getting mangled by a car might look like mentally and then be terrified by that?” And then like, “Thanks, brain, for giving me the imagination. Glad I can think through accidents so I can maybe be a safer driver.” Yeah, absolutely. But I will say that’s one of those sticky points a lot of times for Christians because we believe that thoughts matter and beliefs matter. And so there can be this overinterpretation of everything is always something really big and serious about my status and my heart, and something that’s really big and serious about spiritual things or demonic stuff, or fill in the blank.  So, the faith integration piece, I do carefully, but I’m not scared of it. I’ve done it so often. It’s through a lot of assessments. It has to be from the standpoint of the client’s wanting that. Usually, the client is asking me specifically, like, “Hey, would you pray at the end of the session?” Sure, absolutely, in most cases.  And this, such a deep topic. I’m fully aware that there are those in the camp that view faith integration as completely antithetical to what needs to happen in treatments. And they argue their case, they’re going to argue it really strongly, but the same exists on the other side as well. And I try and work in that realm of, okay, what’s good for the clients? And are there some things that I don’t do? Yeah, but I’m not really asked to do them.  I’ve had a number of Muslim clients throughout the year. I don’t join in with Ramadan with clients in various practices or fasting with a client, for example. That’s not my faith practice there. But can I walk with the client who is trying to differentiate between the lines of fasting and I had water at this point, and the sun was going down and I thought. And other people were having water, but I’m getting stuck on assessing, like, was it too early, and did I actually violate my commitment, my vow? Did I violate what I was supposed to be doing?  I can absolutely work with that person, and I need to. I can’t really work with OCD or anxiety disorders if I wanted to turn that person away at the door and be like, “Oh, well, I’m not Muslim, so I’m sorry.” No, we’re going to jump into it and be like, “Okay, so tell me about this thought and then this behavior that came up at this time, and you’re noticing that that’s a little different from your community, that other people are starting to drink water, eat food. And so, you mentioned that it was right at sunset, but what time was that?” “Well, actually, it was like 10:30 p.m. It’s two hours dark.” It’s like, “But I think I saw a glow in the distance.” And it’s like, “Okay, now we’re into a pretty classic OCD realm.” And so the simplest way that I can say that faith integration can be done in therapy is carefully, respectfully, with good assessments. Kimberley: Do you have them consult with their spiritual leader if you’re stuck on that? And does that involve you speaking with them, them speaking with them, all three of you? What have you done? Justin: Yeah, absolutely. So, there is a collaboration that goes in a number of different ways. Most of the time, people can speak with their clergy member or faith leader pretty directly, pretty separately, and that is going to work just fine. I would say in most cases, people don’t need to, especially if I’m working with OCD. A lot of folks usually have a pretty good general sense of, “Okay, I know what my faith community is going to say about this is X, but I’m scared because it feels like it’s on shaky ground, I’m obsessing,” et cetera.  So, the clarification with the clergy, for instance, or a leader is more from the standpoint of if there’s not a defined value definition practice, and that does come up for sure. So, helping that person to even find who that might be, especially if they’re not a part of that, and/or maybe a good article to read with some limits, like, okay, three articles max. Check out a more conservative view, a more liberal view, a more fill in the blank.  And then my friend and colleague Alec Pollard up at St. Louis Behavioral Medicine Institute, he’s been on scrupulosity panels with me. He uses this excellent form called the PISA, (Possibly Immoral or Sinful Act). And it’s just a great several-question guide. That or any number of things can be taken to clergyperson, leader in Christian circles a lot of times, like a Bible study or community group. Maybe flesh those things out just a little bit, maybe once, maybe twice max.  And so, back to how much others are integrated, yeah, it’s a mix and match, anything, everything. For me, with direct conversations with clergy, it’s actually because I’m pretty deep into this realm, I have pretty easy access to a lot of folks, so I don’t really need to so much talk directly or get that person on a release. But a lot of people do, especially if they don’t know that religious belief or faith traditions approach on certain topics.  Kimberley: Yeah. It’s so wonderful to talk about this with you.  Justin: Thanks, Kimberley. Same here. Kimberley: Because I really do feel, I think post-COVID, there’s more conversations with my clients about this. This could be totally just my clients, but I’ve noticed an increased longing, like you said, for that connection, the loneliness pandemic. Justin: Yeah, that’s statistical.  Kimberley: Such a need for connection, such a need for community, such a need for that, like what is your North Star? And it can be, even if we haven’t really talked about depression, it can be a really big motivator when you’re severely depressed, right? Justin: Absolutely.  Kimberley: And this is where I’m very much like so curious and loving this conversation with my clients right now in terms of, where is it helpful? Where isn’t it helpful? As you said, do you want to use this as a part of your practice here in treatment, in recovery? And what role does it play? I know I had mentioned to you, I’d even asked on Instagram and did a poll, and there were a lot of people saying, “It gave me a community. It immensely helps. It does keep me focused on the goal,” especially if it’s done intentionally without letting fear take over. Is there anything you wanted to add to this conversation before we finish up?  Justin: Yeah, I guess two things. So, one is you talked about that, and we talked about a couple of those responses before we jumped on to recording. So, in summary, the responses were all across the board, like, “Ooh.” Let me know if I’m summarizing this well, but, “I have to be really careful. That can be really compulsive or not so much. I don’t like to do that. I don’t think it’s necessary.” And then like, yeah, absolutely. This is really integral and really important. Is that a fair summary? Kimberley: Very much. Yep.  Justin: Okay. And so, I’m building this talk, Katie O'Dunne and Rabbi Noah Tile, ERP As a Spiritual Practice. We’re giving here at the Faith and OCD Conference in April, if this is out by then. And in my section that I have, I’m covering the best practices of treatments, specifically ERP (exposure and response prevention) for OCD, and clinically, but then also from a faith standpoint, what do we consider with that? And there’s this three-prong separation that I’m making. I’m not claiming a hold on the market with this, but I’m just observing. There’s one category of a person who comes into therapy, and it’s like, yeah, face stuff, whatever. It doesn’t matter, or even almost antagonistic against it. Maybe they’ve been burnt, maybe they’ve been traumatized or abused with faith. Yeah, I get it. So, that first camp is there. But then there’s also a second camp that people like to add on spiritual practices. They might mix and match, or they might follow a specific system, belief system. And whether it gets into mindfulness or meditation practices or fasting or any number of things, they find that there’s a lot of benefit, but it’s maybe not at the heart of it.  And then there’s this third prong of folks that it is part and parcel of everything they do. And I work with all three. They come up in different ways. And sometimes people cycle between those different ones as well in treatments in the process.   Kimberley: I’m glad you

Now fix this one error in thinking if you want to be less anxious or depressed, either one. Today, we are going to talk about why it is so important to be able to identify and challenge this one error in your thinking. It might be the difference between you suffering hard or actually being able to navigate some sticky thoughts with a little more ease. Let’s do it together. Welcome back, everybody. My name is Kimberley Quinlan. I’m an anxiety and OCD specialist, and I am so excited to talk with you about this very important cognitive error or error in thinking that you might be engaging in and that might be making your life a lot harder. This is something I catch in myself quite regularly, so I don’t want you to feel like you’re wrong or bad for doing this behavior, but I also catch it a lot in my patients and my students. So, let’s talk about it.  The one error you make is black-and-white thinking. This is a specific error in thinking, or we call it a cognitive distortion, where you think in absolutes. And I know, before you think, “Okay, I got the meat of the episode,” stay with me because it is so important that you identify the areas in your life in which you do this. You mightn’t even know you’re doing it.  Again, often we’ve been thinking this way for so long, we start to believe our thoughts. Now, one thing to know, and let’s do a quick 101: we have thoughts all day. Everybody has them. We might have all types of thoughts, some helpful, some unhelpful. But if you have a thought that’s unhelpful or untrue and you think it over and over and over and over again, you will start to believe it. It will become a belief. Just like if you have a lovely, helpful thought and you think that thought over and over and over again, you will start to believe that too.  And what I want you to know is often, for those with mental health struggles, whether that be generalized anxiety, panic disorder, depression, eating disorders, OCD, PTSD, social anxiety, the list goes on and on, one thing a lot of these disorders have in common is they all have a pretty significant level of errors in thinking that fuel the disorder, make the disorder worse, prevent them from recovering. My hope today is to help you identify where you are thinking in black and white so we can get to it and apply some tools, and hopefully get you out of that behavior as soon as possible.  Here are some examples of black-and-white thinking that you’re probably engaging in in some area of your life.  The first one is, things are all good or they’re all bad. An example might be, “My body is bad.” That there are good bodies and bad bodies. There are good people and bad people. There are good thoughts and bad thoughts. That’s very true for those folks with OCD. There are good body sizes and bad body sizes, very common in BDD and eating disorders. There are people who are good at social interaction and bad at social interaction. That often shows up with people with social anxiety. That certain sensations might be good, and certain sensations might be bad. So if you have panic disorder and you have a tight chest or a racing heart rate, you might label them as all bad. And this labeling, while it might seem harmless, is training your brain to be on high alert, is training your brain to think of things as absolutes, which does again create either anxiety or a sense of hopelessness, helplessness, and worthlessness specifically related to depression. So we’ve got to keep an eye out for the all good and the all bad.  The next one we want to keep an eye out for is always and never. “I always make this mistake. I never do things right. I will always suffer. I will never get better.” These absolutes keep us stuck in this hole of dread. “It’ll always be this way. You’re always this way.” And the thing to know here is very, very rarely is something always or never true. We can go on to talk about this here in a little bit, but I want you just to sit with that for a second. It’s almost never true that almost never is the truth. How does that sound for a little bit of a tongue twister?  Next thing is perfect versus failure. If you’re someone who is aiming for that is either perfect or “I’m a failure,” we are probably going to have a lot of anxiety and negative feelings about yourself. This idea that something is a failure. I have done episodes on failure before, and I’ll talk about that here in a second. But the truth is, there is no such thing as failure; it’s just a thought. And all of these are just thoughts. They’re just thoughts that we have. And if we think that our thoughts are facts, we can often again get into a situation where we have really high anxiety or things feel really icky.  Another absolute black-and-white thinking that we do is that this is either easy or it’s impossible. There’s only those two choices. It should be either really easy or it’s not possible at all. Again, it’s going to get us into some trouble when we go to face our fears because facing fears is hard. We’ve talked about, it’s a beautiful day to do hard things. And the reason I say that is to really challenge this idea that things should be easy. And just because they’re hard doesn’t mean they’re impossible. Often people will say, “I can’t.” Again, just because they’re hard doesn’t mean that you can’t do it. It just might take some practice.  So, these are common ways that black-and-white thinking shows up. And by now, if you’re listening, you’re probably thinking, “Oh yeah, I’ve been called out.” And that’s okay. We all do this type of thinking. But let’s talk about now tools and what you can do to target this.  Let me tell you a story. Recently, I found myself managing what I would consider a crisis, a family crisis. It took several months for us to navigate this very, very difficult time. And I often leave voice recordings to my best friend. We communicate that way quite regularly. And every now and then, I listen back to what I’ve said to her just to hear myself and what I’m saying and where my head is. And I was shocked to hear me saying, “It’s always going to be this way. It’ll never get better. This is so bad. I failed. This is impossible. I can’t do this anymore.” I was doing all of the things. And for me, that awareness is what clicked me into like, “Oh, no wonder I’m panicking. No wonder I feel dread the minute I wake up in the morning because my story about this is exacerbating and making this harder on me. It’s creating more suffering.” So the first thing I did is what I would tell my patients as well—to start with just a simple awareness training. Just being aware of when you do it. We don’t have to change anything. We’re not going to judge ourselves, but we’re just going to write down on a sticky note or an app on your phone every time you get caught in a black-and-white thinking, and we’re going to jot it down. “I always will feel this way. I will never get better. This will forever be a failure.” We want to just jot it down. And that is, in and of itself, a huge part of the work—just being aware when you catch it. We’re not here to come down hard on you for doing it. Sometimes it’s just a matter of going, “Oh, okay, Kimberley, I see that I’m doing black-and-white thinking.” And that might be all that we do.  Often, with my patients, I will have them log this for homework because, in CBT, we do a lot of homework. And so I will say, “I want you to write it down and come back to me next week because next week, we’re going to work on the next tool.”  Now this may be a little different depending on the condition, and I want to make sure I’m really thorough here. If you have GAD (generalized anxiety disorder) or panic, we do a lot of cognitive restructuring. We do a lot of cognitive restructuring about how you cope with your discomfort. And in some cases, we might even restructure the content of your thought.  However, if you have OCD, it’s a little tiny bit different. We would still correct your thoughts about your ability to tolerate discomfort or your thoughts about yourself. But we want to be careful because sometimes when we start looking too close at the thought and trying to make sense of it and trying to correct it too much, we can actually start to be doing a little nuanced, subtle compulsion where we’re getting reassurance, we’re confessing, we are reinforcing the whole importance of this by going over it and correcting it, correcting it and correcting it. So just keep an eye out for that. If you’re in therapy, bring it up with your therapist just to make sure that you’re not using this skill today in a way that could become compulsive. Sometimes it does, sometimes it doesn’t, depends on the person.   For eating disorders, I know as my recovery from eating disorder, I did a lot of this, really examining, is my body all good or all bad? Is there such a thing as a perfect body or a failed body? This food or this body size, how do we determine its goodness or its badness? And looking at how extreme it can be.  Now, another really important piece here is with depression. In depression, we use a lot of black-and-white thinking. “I’m all that. They’re all good. I’m a failure. I’ll never get better. It’ll never get better. Things will never look up. It’ll always be this way.” Depression loves to use black-and-white thinking.  And so when we talk about cognitive restructuring, what we’re not talking about is just making it all positive. So here are a couple of examples. If you have depression, and for those of you, if you have depression and you don’t have access to a therapist, we have a whole online course called Overcoming Depression, where we go through this in depth of the common errors, not just black and white thinking, but the common errors in depression. And we work at coming up with helpful ways to respond. But one of the tools and skills that we use is, we don’t want to just come up with positive thoughts. It’s going to feel crappy to you. It’s going to feel fake. It’s not going to land. But what we want to do is find corrections or rebuttals to that thought that are more evidence-based, more rational, more logical, more helpful—things that might feel truer to you, even if it’s still somewhat distorted. It’s better than thinking in these absolutes because, like I said before, if you’re thinking in absolutes, you can guarantee you’re going to feel crummy.  Another example is with GAD (generalized anxiety disorder) or with panic disorder. A lot of it is catching our appraisal of sensations and feelings in our body. Now, again, we actually have a whole course on this as well called Overcoming Anxiety and Panic. Again, we go through a whole module of cognitive restructuring where we identify the specific thoughts that people with generalized anxiety and panic have. And it will be looking for where you make these black-and-white, all-or-nothing statements that “It would be bad if that happened. I will always again feel this way. I’ll never amount to anything. This panic attack will never end. I’m not handling it well. I’m handling it all bad,” or that “This sensation is impossible, and I can’t tolerate it.” So we go through it and really look at what are the things that you’re worrying about, and how are you really bringing in black and white thinking?  There are other distortions. In fact, there are 10 other distortions which we’re not covering today. Those are all in those courses as well. But again, for today, I wanted to really double down on this one. This one is particularly pesky and problematic.  The other thing to remember as we’re looking at black-and-white thinking is to remember that usually, 99.999 % of the time, things happen in the middle, in the gray. I often will hear me say to clients, “Can you be a little more gray about that?” Not to say a little more dark and depressive. I’m saying gray in that, “Is there somewhere in the middle that is more true and factual? Is it all good or all bad or is it a little of both? Or is it none of either? Where in the middle does it land? Oh, you’re having the thought that you’re either successful or a failure? Where is everybody else in this continuum?” Most likely, they’re in the gray. Can you learn to be more comfortable accepting the gray of the world and not going to these absolute black-and-whites?  The beauty is in the gray. We know this. The beauty is being kind to yourself in the gray, which brings me to the last point here, which is to practice self-compassion. We are in the gray. This podcast episode in and of itself is neither all bad nor all good. It’s going to be a variation, and a lot of that’s going to be dependent on people’s opinion, where they are, what they’re thinking, their mood, that things are really black and white. And can we be gentle with ourselves and humble enough to allow ourselves to see that this is neither good, bad, success, failure, always, never? These skills and the awareness of when we’re thinking this way can reduce a significant amount of our suffering, especially when you catch them, label them, and redirect in a kind, compassionate way.  One thing I don’t want you to do is identify how you’re thinking in this black-and-white way and respond to that with black-and-white thinking by saying, “You’ll always think this way. You’ll never ever stop doing this.” Ironic, but we do it all the time. Almost always, when people criticize themselves, they’re using one of the two areas in thinking black and white thinking and labeling, which is like name calling. And again, we want to identify these areas in thinking.  Again, if you want to go back and take a look at those courses, we go through this immensely in depth because there’s such an important part of Overcoming Anxiety and Panic and Overcoming Depression. And again, that’s the names of the courses. You can head over and look into that in the show notes, or go to CBTSchool.com. We have all of our courses listed there.  All right, folks, that’s it. Please fix this error in thinking if you want to be less anxious. Black-and-white thinking will create so much suffering in your life. And my hope is that these episodes and the work we do here at Your Anxiety Toolkit make you suffer a little bit less each week.  Have a great day, everyone, and I’ll see you next week.

Obsessive-Compulsive Disorder (OCD) is a challenging condition, but the good news is that it's highly treatable. The key to effective management and recovery lies in understanding the condition, embracing the right treatment approaches, and adopting a supportive mindset. This article distills essential guidance and expert insights, aiming to empower those affected by OCD with knowledge and strategies for their treatment journey. YOU ARE BRAVE FOR STARTING OCD TREATMENT Taking the first step towards seeking help for OCD is a significant and brave decision. Acknowledging the courage it takes to confront one’s fears and commit to treatment is crucial. Remember, showing up for therapy or seeking help is a commendable act of bravery. YOU CAN GET BETTER WITH OCD TREATMENT OCD treatment, particularly through methods like Exposure and Response Prevention (ERP) and Cognitive Behavioral Therapy (CBT), has shown considerable success. These evidence-based approaches are supported by extensive research, indicating significant potential for individuals to reclaim their lives from OCD’s grasp. The path may not lead to a complete eradication of symptoms, but substantial improvement and regained control over one’s life are highly achievable. OCD TREATMENT IS NOT TALK THERAPY OCD therapy extends beyond the realms of conventional talk therapy, involving specific exercises, homework, and practical worksheets designed to confront and manage OCD symptoms directly. These tools are integral to the treatment process, allowing individuals to actively engage with their treatment both within and outside therapy sessions. THERE IS NO SUCH THING AS “BAD” THOUGHTS A pivotal aspect of OCD treatment involves changing how individuals perceive their thoughts and their control over them. It's essential to recognize that thoughts, regardless of their nature, do not define a person. Attempting to control or suppress thoughts often exacerbates them, which is why therapy focuses on techniques that allow individuals to accept their thoughts without judgment and reduce their impact. YOU CAN NOT CONTROL YOUR THOUGHTS, BUT YOU CAN CONTROL YOUR BEHAVIORS You will have intrusive thoughts and feelings. This is a part of being human, and it is not in your control. However, you can learn to pivot and change your reactions to these intrusive thoughts, feelings, sensations, urges, and images.  YOU HAVE MANY OCD TREATMENT OPTIONS While medication can be a valuable part of OCD treatment, particularly when combined with therapy, it's not mandatory. Decisions regarding medication should be made based on personal circumstances, preferences, and professional advice, acknowledging that progress is still possible without it. In addition to ERP and CBT, other therapies such as Acceptance and Commitment Therapy (ACT), mindfulness, and self-compassion practices have emerged as beneficial complements to OCD treatment. These approaches can offer additional strategies to cope with symptoms and improve overall well-being. The accessibility of OCD treatment has expanded significantly with the advent of online therapy and self-led courses. These digital resources provide valuable support, particularly for those unable to access traditional therapy, enabling individuals to engage with treatment tools and strategies remotely. For those without access to a therapist, self-led OCD courses and resources can offer guidance and structure. Engaging with these materials can empower individuals to take active steps towards managing their OCD, underscoring the importance of self-directed learning in the recovery process. TREATMENT WILL NEVER INVOLVE YOU DOING THINGS YOU DO NOT WANT TO DO I am usually very clear with my patients. Here are some key points I share I will never ask you to do something I do not want you to doI will never ask you to do something that I myself would not do I will never ask you to do something that goes against your values. RECOVERY IS NOT LINEAR Recovery from OCD is not a linear process; it involves ups and downs, successes and setbacks. Embracing discomfort and challenges as part of the journey is essential. Adopting a mindset that views discomfort as an opportunity for growth can greatly enhance one’s resilience and progress in treatment. There will be good days and hard days. This is normal for OCD recovery.  There will be days when you feel like you are making no progress, but you are. Keep going at it and be as gentle as you can SETTING CLEAR TREATMENT GOALS Clarifying treatment goals is crucial for a focused and effective therapy experience. Whether it's reducing compulsions, living according to one’s values, or tackling specific fears, clear goals provide direction and motivation throughout the treatment process. BE HONEST WITH YOUR THERAPIST The success of OCD treatment is significantly influenced by the honesty and openness of the individual undergoing therapy. Without reservation, sharing one’s thoughts, fears, and experiences allows for more tailored and effective therapeutic interventions. IT IS A BEAUTIFUL DAY TO DO HARD THINGS.  No question. You can do hard things!  OCD is a complex but treatable condition. By understanding the essentials of effective treatment, including the importance of evidence-based therapies, the role of mindset, and the value of self-directed learning, individuals can embark on a journey towards recovery with confidence. Remember, every step taken towards confronting OCD is a step towards reclaiming control over one’s life and living according to one's values and aspirations. TRANSCRIPT There is so much bad advice out there about OCD treatment. So today, I wanted to share with you the 11 things I specifically tell my patients on their first day of OCD therapy.  Hello, my name is Kimberley Quinlan. I’m an OCD specialist. I specialize in cognitive behavioral therapy, and I have helped hundreds of people with OCD over the course of the 10, 15 years I have been in practice.  Now, whether you have an OCD therapist or not, my goal is to help you feel confident and feel prepared when addressing your OCD treatment and symptoms, whether you have an OCD therapist or not. That is the big goal here at CBTSchool.com and Your Anxiety Toolkit podcast.  Make sure you stick around until the end because I will also be sharing specific things that you can remember if you don’t have a therapist, because I know a lot of you don’t. And I’ll be sharing what you need to know so that you don’t feel like you’re doing it alone.  Now, if you’re watching this here on YouTube, or you follow me on social media at Your Anxiety Toolkit, let me know if there’s anything I’ve missed or anything that you were told on your first session that was particularly helpful, because I’m sure your knowledge can help someone else or another person with OCD who is in need of support and care and advice. So let’s go. Here are the 11 things that I tell my patients on their first day of OCD therapy. Number one, I congratulate them for showing up, because showing up for OCD treatment is probably one of the most brave things you can do. I really make sure I validate them that this is scary, and I’m really glad they’re here. And I’m pretty impressed with the fact that they showed up, even though it’s scary.  The second thing I tell them is that OCD treatment is successful. You can come a long way and make massive changes in your life by going through the steps of OCD treatment, showing up, being willing to take a look at what’s going on in your life, and making appropriate changes so that you can get your life back, do things you want to do, spend more time with your family, your friends, the things you love to do, like hobbies, and that OCD treatment can be very effective. We’re very lucky that OCD is a very treatable condition. It doesn’t mean it’ll go away completely, but you can have absolute success in getting your life back.  Now, one thing to know here is, how do we know this? Well, OCD treatment research and OCD treatment articles. If you go onto Google Scholar, you will find a lot of articles that show a meta-analysis of the OCD treatments available, where it shows that ERP and cognitive behavioral therapy are the gold standard of treatment. And using a meta-analysis, that basically means that they’ve surveyed all of the large, well-done research articles and found which one shows the most results and shows that they have the most repeated results over periods of time. And that’s why it is so important that you do follow the research because there is a lot of bad information out there, absolutely.  Now, the third thing I tell my patients on their first day of therapy is that OCD treatment is not talk therapy. It’s not just talking, that it requires OCD therapy exercises and homework and lots of worksheets. I have a packet that we give our patients at the center that I own in Calabasas, California. Everyone gets a welcome manual. And in the welcome manual, it’s got worksheets on identifying obsessions and compulsions. It’s got mindfulness worksheets. It’s got logging worksheets. And I will send you home with those to do for homework. You’ll come back. Let me know what worked, what didn’t work, what was helpful, what wasn’t. And you will be doing a lot of this work on your own.  Now, again, as I mentioned at the beginning, if you do not have access to OCD therapy or you don’t have the resources to get that, we have an online course called ERP School. It is a course specifically for people with OCD, where I walk you through the specific steps that I take my patients through. And all of those worksheets are there. They have worksheets on identifying your obsessions, identifying your compulsions, mindfulness, self-compassion worksheets, things that can remind you and prompt you in the direction of setting up a plan so that you can get moving and make the steps on your own. The fourth thing that you need to know on the first day of your therapy is that there is no such thing as bad thoughts. Let’s just sit with that for a second. There is no such thing as bad thoughts. Your thoughts do not define you, nor do your behaviors, that you might have these thoughts that you think are going to really freak you out. You might have this idea, these thoughts, these intrusive, repetitive, scary thoughts, and you might think, “Well, I can’t even tell Kimberley about them yet.” I will often tell my patients like there is nothing these walls haven’t heard, and you probably won’t shock me because I haven’t been shocked in many, many, many years working as an OCD therapist. I’ve heard it all. I’ve heard the most, what people perceive as the grossest thoughts. It’s a normal part of the work that we do. And your thoughts are neither good nor bad and they do not define you. And I really make that point made because, as we move forward, I want you to know that I’ve seen a lot of cases and that “your thoughts aren’t special” in that they’re not something that I would be alarmed by.  The fifth thing that I would tell my patients is that you cannot control your thoughts. And I bet you believe it because you’ve probably tried over and over again, and all you found is the more you try and control it, the more thoughts you have. The more you try to suppress your thoughts, the more thoughts you have. There are, as we’ve already discussed, OCD treatment options that will really solidify this concept. Now, the most important one is exposure and response prevention, which is the type of treatment that we use for OCD and is the type of treatment that all of those research articles I discussed before show and direct to as a really successful treatment for OCD.  Now, in addition, there are other OCD treatment options. One of those treatment options is OCD treatment with medication. Now, again, when you do that meta-analysis, we have found that a combination of CBT and ERP with medication is the most successful. Now, that doesn’t mean you have to take medication, though. I’m never going to tell my patients that they have to take medication.  So we can have OCD treatment with medication. We can have OCD treatment without medication. In fact, some of my most difficult cases, the clients, for medical reasons or for personal values reasons, chose not to go on medication. You can still get better. It might make it a little more difficult. You may want to speak with your therapist, or if you’re doing this alone, you might need to put in a little extra homework, have a team of support, and people who are really there holding you accountable. Absolutely. But medication is another treatment option that you may want to consider as you move through this process. Now there are also new treatments for OCD recovery. They might include acceptance and commitment therapy, mindfulness practices, self-compassion. We even have some research around dialectical behavioral therapy as other OCD treatment interventions. I will be implementing those as we go, depending on what roadblocks show up. And again, if you’re doing this on your own, there are amazing resources that can also help you, and I’ll share about those here in a bit. Again, as we’ve talked about, there is also OCD treatment online. Since COVID-19, we’ve done a lot of growing in terms of being able to utilize CBT via the internet, via our computers, via our smartphones. A lot of people come to us because they’ve looked for OCD treatment in Los Angeles, which is where we are. And even though they only live a few miles down the street, they’re still doing sessions online because it’s so convenient. They can do it at home between sessions with their work or between getting their kids to school. So, OCD treatment online has become a very popular way to also access treatment. And I give these to my clients as we go, because sometimes they’re going to need a little extra help.  Now, as I’ve mentioned to you earlier in there, if you don’t have access to OCD treatment, there are tons of self-led OCD courses. Again, one of the ones that we offer is ERP School. Now you can go to CBTSchool.com, or you can click the link below in the show notes, where we have all of these courses for OCD and other anxiety disorders. But there are others as well—other amazing therapists who have created similar products.  When we’re really looking at treatment depending on your age, the treatment does look very similar for OCD treatment for adults and OCD treatment for children. They are very, very similar. With children, we might play more games, have more rewards, use those strategies, but to be honest with you, adults are just big kids in adult bodies. So I really believe that we want to make this as fun as we can. Have rewards. Have there be something that you’re working towards. Make it fun. Make it a part of a game. I use a lot of games in treatment and a lot of ERP games because why do we want to make everything boring all the time? Why not make it a little bit fun if we can? Number seven, the main thing I’m going to tell you here, and this is really, really important, is I will not ask you to do something that you don’t want to do. I have this in our welcome manual. We don’t ask people to do things that go against their values, and we don’t ask people to do things that I myself would not do. There are a lot of TV shows that sort of use ERP and exposure work as sort of like doing your worst, worst, worst, worst, worst case. And that’s fine. But often we’re not doing that. We’re doing exposures, we’re facing your fears so that you can get back to functioning, so you can get back to doing the things you want to do. So again, I’m not going to have you do anything you don’t want to do. You’re in charge. If you’re taking ERP School, we do the same thing. You create your own plan. You create a hierarchy of what you want to start with, and we work our way up. And we do the same thing in therapy as well.  Now the eighth thing that I will tell you, and by then you’re probably getting a little tired and overwhelmed. We might take a little tea break really quick, but I would tell you that recovery is not linear. While we do have effective treatment for OCD, it will be an up-and-down process. You’ll have really good days, and you’ll have some hard days. And those hard days don’t mean that you’re doing anything wrong. It doesn’t mean that your treatment’s not successful. It just means we have to take a look here and see what’s going well, what’s not going well, what do we need to tweak, do we need to make a pivot here. Or do we need to reassess something and maybe apply some additional tools—mindfulness tools again, self-compassion skills, some distress tolerance skills, maybe? But just remember, your recovery will not be linear, and that is okay.  Now the ninth thing I’m going to tell you is that your OCD treatment goals must be clear. You are going to get really clear on why you’re here, what you want to do, why you’re doing this treatment because it is hard work. Again, there’s homework. I’m going to be giving you some things to do at home, and they’re going to be a little bit difficult. They’re going to cause you to feel some feelings that maybe you don’t want to feel, some sensations you don’t want to feel.  And so, really again, I will ask them, like, what are your goals for treatment? Now, some common OCD goals for OCD therapy is to reduce compulsions. “I want to be able to not be doing these compulsions for hours and hours.” Other people say, “I want to live my life according to my values. I don’t want to let fear constantly be telling me what to do.” Other people will say, “I want to learn how to tolerate this discomfort and this uncertainty because every time I try and run away from it, it just gets worse. It makes it worse. And now I’m stuck in this cycle.” So it’s important that you get really clear.  Sometimes people will come in and they’ll say, “I’ve never been to Paris. I want to be able to go to Paris with my family. And so, that’s the goal.” That’s fine too. You could have a large goal like that, or you could have a really simple goal like, “I just want to have more space in my life to paint,” or “I don’t want to feel like I’m on edge all the time, like the scariest thing is going to happen all the time.” And that’s fine too.  Now, the 10th thing that you’re going to need to know and need to remember is, our recovery is really dependent on how open and honest you are. As I said at the beginning, some people don’t feel yet like they can trust to tell me the depth of their intrusive thoughts, and that’s okay. But throughout therapy, I’m going to need you to be really honest with me and really honest with yourself, because if you’re not disclosing what’s going on and the thoughts you’re having, we can’t actually apply the skills to it. And then it puts a wrench in the success of your treatment.  So we want you to be as open, honest as you can. And I often will say to them, there is nothing I haven’t heard. In fact, if you have taken ERP School already—a lot of you have—we actually play a couple of games where we play a game called One Up, which is where no matter what thought you have, you make it a little worse or little more scary. And I give some demonstrations and show like I’m not afraid to go there. I will go to the scary, yucky place just to show you that that’s what I want you to do as well. Again, it doesn’t have to be all serious. We’re allowed to play games, and we do that in therapy as well.  Often people will ask like, how do I tell my therapist about these horrible thoughts I’m having? Like, how do I share? If you’re having a specific type of thought that you feel is particularly taboo or very scary to share, or you’re afraid of the consequences of sharing, what I would encourage you to do is do a very quick Google search. There are some amazing websites and articles online of your obsession. Print it out and bring it to your therapist, and say, “Hey, this is what I’m dealing with. I’m too scared or I’m too vulnerable to share. It’s so horrendous in my mind, but this is what I’m going through.” And chances are, again, the therapist, if they’re a trained OCD specialist, will go, “Ah, thank you for letting me know. I’ve treated that before. I’m good to go.” Again, if they’re a newer therapist, it’s still okay because they’re getting the education about really common obsessions that happen a lot in our practice.  Okay. Here we go—drum roll to the last one. And I know you guys are probably already guessing what it is. It’s something I say to my patients and to you guys all the time, and it’s this: It’s a beautiful day to do hard things.  We have been taught that life should be easy, shouldn’t be scary, shouldn’t be hard, and that you should be Instagram-ready all the time. But the truth is, life is hard. And today is a beautiful day to do those hard things. I have found that those who recover the fastest and the most successful over time are the ones who see discomfort as a challenge, something that they’re willing to have. They’ll say, “Bring it on, let’s go. Bring my shoulders back. I know it’s going to be here.” And they’re really gentle with themselves when they have this discomfort. And I want you to really walk away feeling empowered that you too can handle some pretty uncomfortable things because you already are. So again, it’s a beautiful day to do hard things.  All right, let’s round it out because I know I promised you some extra things here. Now, what have we covered? We’ve covered the mindset shifts that you need for OCD therapy, behavioral changes that you’re going to need to make. We’ve talked about complementary tools, the most important being self-compassion. And also, guys, you can also follow Your Anxiety Toolkit because we have over 380 episodes of tools and core concepts, and everything like that.  Now, for treatment, just so that you get an idea of what this would look like, I share with my patients what treatment looks like. So usually, once I’ve told them all of this, I send them home with their welcome manual, and I’ll say, “The next two to three sessions, I’m going to be training you for this treatment. And a lot of that is going to involve psychoeducation, me giving you tools, giving you strategies, putting a plan together.” And again, for those of you who don’t have therapy, we do exactly that in ERP School. So if you feel like you need some structure, you can go to CBTSchool.com and access ERP School. We can go through that.  Now, for those of you, again, who don’t have an OCD therapist, does OCD therapy and treatment work for you too? Yes. We actually have some early research to show that self-led programs can be very successful for people with OCD and with other anxiety disorders. So, if you don’t have access to therapy, you could take ERP School. You could buy some workbooks that you buy from Amazon or your local bookstore. There are a ton of workbooks out there. Shameless plug, I also wrote one called The Self-Compassion Workbook for OCD. You can get it wherever you buy books. There are also online groups. I’m a huge, huge proponent of online groups. So if there are support groups in your area, by all means, use those because just knowing other people who are struggling, what you’re struggling with can be so validating and inspiring because you’re seeing them do the hard thing as well.  But either way, treatment requires a lot of homework. So, as I say to patients, showing up here once a week isn’t going to get you better. You’re going to have to practice the skills. And if you don’t have a therapist, you’re going to be doing that anyway. So I want to really hope that you leave here with a sense of inspiration and hope that you can get better even if you don’t have OCD therapy at this time. So there you go, guys. There are the 11 things I tell my patients on the very first session. I will usually end the session by encouraging them and, again, congratulating them for coming in and doing this work with me. Let them know I’m so excited for them.  I hope that this was helpful for you, and my hope is that you too will then go on to learn all the tools that you need in your tool belt and go on to live the life that you want to live because that’s the whole mission here at Your Anxiety Toolkit.  Have a wonderful day, everybody, and I’ll talk to you next week.

In the realm of managing anxiety and panic attacks, we often find ourselves inundated with advice on what to do. However, the path to understanding and controlling these overwhelming experiences also involves recognizing what not to do. Today, we shed light on this aspect, offering invaluable insights for those grappling with panic attacks.  Stop doing these things if you are having panic attacks, and do not forget to be kind to yourself every step of the way.  1. DON'T TREAT PANIC ATTACKS AS DANGER It's a common reaction to perceive the intense symptoms of a panic attack—rapid heartbeat, dizziness, or a surge of fear—as signals of immediate danger. However, it's crucial to remind ourselves that while these sensations are incredibly uncomfortable, they are not inherently dangerous. Viewing them as mere sensations or thoughts rather than threats can create a helpful distance, allowing for more effective response strategies. 2. DON'T FLEE THE SCENE The urge to escape a situation where you're experiencing a panic attack is strong. Whether you're in a grocery store, on an airplane, or in a social setting, the instinct to run away can be overwhelming. However, leaving can reinforce the idea that relief only comes from escaping, which isn't a helpful long-term strategy. Staying put, albeit challenging, helps break this association and builds resilience. 3. DON'T ACCELERATE YOUR ACTIONS During a panic attack, there might be a tendency to speed up your actions or become hyper-vigilant in an attempt to alleviate the discomfort quickly. This response, however, can signal to your brain that there is a danger, perpetuating the cycle of panic. Slowing down your breath and movements can alter your brain's interpretation of the situation, helping to calm the storm of panic. 4. AVOID RELIANCE ON SUBSTANCES Turning to alcohol or recreational drugs as a quick fix to dampen the intensity of a panic attack can be tempting. Nonetheless, this can lead to a dependency that ultimately exacerbates the problem. It's important to let panic's intensity ebb and flow naturally, without leaning on substances that offer only a temporary and potentially harmful reprieve. 5. STOP BEATING YOURSELF UP Self-criticism and judgment can add fuel to the fire of anxiety and panic. It's vital to adopt a compassionate stance towards yourself, recognizing that experiencing panic attacks doesn't reflect personal failure or weakness. Embracing self-kindness can significantly mitigate the added stress of self-judgment, creating a more supportive environment for recovery. SEEKING SUPPORT Remember, you're not alone in this struggle. Whether through therapy, online courses, or community support, reaching out for help is a sign of strength. Resources like "Your Anxiety Toolkit" are there to remind you that it's possible to lead a fulfilling life, despite the challenges panic attacks may present. Lastly, embrace the notion that it's a beautiful day to do hard things. Facing panic with acceptance rather than resistance diminishes its hold over you, opening the door to healing and growth. TRANSCRIPT:  Stop doing these things if you have panic attacks. I often, here on Your Anxiety Toolkit, talk about all the things you need to do—you need to do more of, you need to practice skills that you can get better at. But today, we’re talking about the things you shouldn’t do if you are someone who experiences panic attacks, panic disorder, or any other disorder that you also experience panic attacks in. Let’s get to it. Let’s talk about the things not to deal. Welcome back. Stop doing these things if you have panic attacks. When I say that, in no way do I mean that the things we’re going to discuss you should beat yourself up for. If you’re doing any of the things that we talk about today, please be gentle. It is a normal human reaction to do these things. I don’t want you to beat yourself up. Please feel absolutely zero judgment from me because even I am someone who needs to keep an eye out for this, keep myself on check with these things when I am experiencing panic attacks as well. Let’s go through them.  The number one thing to stop doing if you’re having a panic attack is to stop treating them like they are dangerous. If you experience symptoms of panic or you experience panic disorder, you know that feeling. You feel like you’re going to die. You feel like your heart is going to explode or implode, or your brain will explode or implode. You’ll know that feeling of adrenaline and cortisol rushing around your body. You get it; I get it. It feels so scary. But we must remind ourselves that it’s not dangerous, and we can’t treat them like they’re dangerous. We can’t respond to these symptoms as if they’re dangerous. We want to instead treat them like they are, which is sensations in the body or thoughts that appear in your brain. Once we can do that, then we have a little bit of distance from them and we can respond effectively.  Now, the second thing I want you to stop doing if you have panic attacks is to never leave. If you are at the grocery store and you’re having a panic attack, do not leave the grocery store. If you’re on an airplane, boarding an airplane, and you’re having a panic attack, do not leave the airplane. If you’re in a room and you’re experiencing panic, don’t leave.  Now, I know in that moment, it can feel so dangerous, as we just discussed, and so scary, but when we leave, we will associate relief with running away, and we actually don’t want that. Instead, with panic, we want the relief to be that we wrote it out and we were able to tolerate that feeling and navigate that feeling effectively and compassionately and not from the place of running away and escaping. If you can do one thing, the most important thing to do is to not leave where you’re at.  Now, does that mean that you can’t take a minute to step away for a second? That’s fine. Does it mean that you can’t, if you’re in a conversation, just say, “Can I have a few minutes? I just need to run to the restroom,” or whatever it be, take some time to get yourself back together? That’s okay. We’re not here to win any races or anything, but do your best not to leave the actual environment or place that you are having the panic attack.  Now, the third thing you can not do if you’re having a panic attack is don’t speed up your actions. We talk a lot about this in our online course called Overcoming Anxiety and Panic. How you respond to a panic attack can really determine how your brain interprets the event. If you’re having a panic attack and you really speed up and you start to act frantic or in an urgent way, and you’re sort of like hypervigilant looking around or trying to urgently frantically change something, your brain will interpret that high-paced activity or that speeding up of your actions as if it is a danger, and it will keep sending out hormones like cortisol and adrenaline, which will keep the panic attack and the anxiety going. What we want to do instead is slow it down, slow your breath down, slow your actions down, really get in tune. If you can just slow it down a little and change how you respond. And what we want to do here—and we do this in Overcoming Anxiety and Panic, if you’re interested in taking this course and you don’t have access to therapy or you’re wanting a step-by-step way of working through generalized anxiety and panic, go ahead and take a look. It’s at CBTSchool.com. You can go and check it out there, but if not, you can also do this with your clinician or by yourself—is do an inventory of how you respond when you are panicking. What safety behaviors do you engage in to try and get it to go away? What do you do to respond to it as if it is dangerous? Do you leave? Do you speed up? Do you become hypervigilant? Do you seek reassurance? Do you do mental compulsions?  We can go through and do an audit of those behaviors and see what you’re doing to sort of control and manage that anxiety. And we want to really work hard at reducing those behaviors. Do an inventory and get very clear so that next time you are having a panic attack, you can instead change those behaviors or replace them with more effective behaviors. If you’re interested again in that course, you can go to CBTSchool.com/overcominganxiety.  Now, the fourth thing you need to stop doing if you have panic is to not rely on substances. And when I say substances, I mean alcohol or recreational drugs. There is a massive overlap between people with panic attacks and panic disorder and substance use, and I get it. Having a quick drink of alcohol can sometimes take the edge off a panic attack. However, once again, if that is your way of coping, you will build a reliance and a dependence on that behavior. And we want to work instead at allowing that discomfort to rise and fall on its own without intervening with ineffective behavior. And recreational substances are a really big no-no if you’re someone who is experiencing a panic attack.  Now, that is different from prescribed medications. If you have been prescribed a psychiatric medication and you’re following the doctor’s orders, that is a different story. And please do go and speak to your doctor about those specific directions. What I’m speaking about right here is substances like recreational drugs or alcohol to help manage that panic attack.  Now, the last thing you need to stop doing if you have panic disorder or panic attacks is you have to stop beating yourself up. Beating yourself up will only make it worse. In fact, we have research to show that the more you criticize yourself, beat yourself up, judge yourself, the more likely you are for your brain to release more anxiety hormones and increase the experience of anxiety and panic. And so, that goes against everything that we want and need. We don’t need to add more anxiety to the mix if you’re already experiencing a panic attack.  And so, what we want to do here is work at not beating yourself up, not criticizing yourself for having this because it’s not your fault. It doesn’t mean there’s anything wrong with you. It’s a normal human reaction to want to run away and do everything you can to make it go away, including drinking substances and doing recreational drugs. We don’t want to beat ourselves up, whether you’ve done those in the past or if you’re currently doing them. If you’re struggling, reach out for help. There are clinicians around the world who can help. We have, again, online courses, if you haven’t got access or you can’t afford those services. There are books, there are podcasts like this one that are free. Do what you can to get support and get help so that you’re not doing this alone.  You aren’t alone. Thousands and millions of people around the world struggle with panic attacks. Again, they do not mean that there’s anything wrong with you. And there are important, very effective skills you can use to manage them, and go on and live a very, very, very, very wonderful, successful, fulfilling life.  Of course, I’m always going to end with this because I always do, but do also remind yourself it is a beautiful day to do hard things. The more you can willingly have panic and allow it to rise and fall on its own, the less power it has over you. So, do remember today is a beautiful day to do hard things.  Thank you so much for being here with me. I look forward to seeing you next week on Your Anxiety Toolkit, and I’ll see you there.

Anxiety can often feel like a relentless storm, clouding your thoughts and overwhelming your sense of calm. It's during these turbulent times that finding the right words can be akin to discovering a lifeline amidst the chaos.  To aid you in navigating these stormy waters, we've curated a list of 20 empowering phrases based on expert advice. These phrases are designed to validate your feelings, soothe your inner critic, fill you with encouragement, and help you respond proactively to anxiety. Here's how you can incorporate them into your life to foster resilience, kindness, and self-compassion. VALIDATE THE DIFFICULTY "This is hard, and it's okay that it's hard for me." Acknowledge the challenge without judgment."I'm doing the best I can in this moment." Remind yourself of your effort and resilience."My feelings are valid and understandable." Affirm the legitimacy of your emotions."I am human, and having a difficult day is okay." Normalize the ups and downs of human experience."I give myself permission to feel this while being kind to myself." Embrace your feelings with compassion. SOOTHE THE CRITICAL VOICE "This is not my fault." Release unwarranted guilt and blame."It’s okay that I’m not perfect." Celebrate your humanity and imperfections."It's okay to make mistakes." View errors as opportunities for growth."My challenges do not define my worth." Separate your worth from your struggles."May I be gentle with myself as I navigate this difficult season?" Practice self-compassion and kindness. FILL YOURSELF WITH ENCOURAGEMENT "It's a beautiful day to do hard things." Empower yourself to face challenges."I can tolerate this discomfort." Recognize your strength and resilience."This anxiety or discomfort will not hurt me." Acknowledge your capacity to withstand anxiety."Humans are innately resilient." Remind yourself of your inherent ability to overcome adversity."I am more than my worst days." Focus on the breadth of your life’s narrative. GET CLEAR ON YOUR RESPONSE TO ANXIETY "I REFUSE to lead a life based on fear." Commit to acting on your values."I choose to speak to myself with understanding and patience." Cultivate a compassionate inner dialogue."I have already chosen how I'm going to respond, and now I'm going to honor that decision." Preemptively decide on positive actions."I will treat myself with the same kindness that I offer others." Extend your empathy inward."I’m going to honor my journey and respect my own pace." Accept your unique path and timing. BONUS PHRASE FOR CONTINUOUS SUPPORT "We are just going to take one step at a time." Focus on the present moment to manage overwhelm. These phrases, thoughtfully designed to address different facets of anxiety, are tools at your disposal. Use them to navigate through moments of anxiety, to remind yourself of your strength, and to cultivate a kinder relationship with yourself. Remember, it's not about employing all of them at once but finding the ones that resonate most with you. Anxiety is a complex and deeply personal experience, and thus, your approach to managing it should be equally personalized. Let these phrases be your guide as you continue on your journey toward a more peaceful and empowered state of being. TRANSCRIPTION:  Here are 20 phrases to use when you are anxious. Now I get it, when you’re anxious, sometimes it’s so hard to concentrate. It’s so hard to know where you’re going, what you want to do, and it’s so easy just to focus on anxiety and get totally stuck in the tunnel vision of anxiety or feel completely overwhelmed by it.  Today, I want to offer you 20 phrases that you can use when you’re feeling anxious or experiencing OCD. These are yours to try on and see if you like them. You don’t have to use all of them. They’re here for you to use as you wish, and hopefully, they’re incredibly helpful. All right, my loves, let’s talk about the 20 phrases you can use when you’re feeling anxious. Now, I have prepared these in four different steps. You can actually go through and pick one or several of these and go through these, write them down, and have them in your pocket or in your wallet, or whatever you want, a sticky note on your fridge to use as you need. These are to help guide you towards a life where you lean into your fear. You treat yourself kindly. You encourage yourself. You champion the direction you want to go in. And my hope is that you can use these in many different scenarios, and they can help you get to the life that you want. Let’s go and do it.  The first category is validate the difficulty. Most people, when they’re anxious, they get caught up in this wrestle of, “I shouldn’t have this. Why do I have it? It’s not fair,” and I totally get it. But what we want to do is first validate the difficulty. If you can say that, and you can do that by using one of these five phrases: Number one, “This is hard, and it’s okay that it’s hard for me.” Again, let’s say it together. “This is hard, and it’s okay that it’s hard for me.” The second phrase that I’m going to offer to you is, “I’m doing the best I can in this moment.” The truth is, you are doing the best you can with what you have and given the circumstances. I want you to remember that as best as you can as well.  Number three, “My feelings are valid and understandable.” If anybody else was in this exact situation, they’d probably be thinking, feeling, and acting in the same way. The fourth one is, “I am human, and having a difficult day is okay.” Not only is it okay, it’s normal. Humans have difficult days. This is a total normal part about being human. You might be having an immense amount of anxiety, but please do remember the millions of other human beings around the globe who are having a very similar experience to you. It doesn’t mean there’s anything wrong with you.  And then the fifth way I want you to validate the difficulty is to say, “I give myself permission to feel this while being kind to myself.” Remember I said “while.” I give myself permission to feel this way while being still kind to myself.  Let’s move on to the second category, which is soothing the critical voice. I know when we have anxiety, we can be really, really hard on ourselves. The phrase I want you to practice or trial is, number one, “This is not my fault.” And it’s not your fault. You did not ask for this. You can’t stop the fact that your brain sometimes gets hijacked and throws a bunch of anxiety or thoughts, or feelings towards your urges. It is not your fault.  The second one is, “It’s okay that I’m not perfect.” Nobody is. We want to remember that this is our first time being a human and we’re not going to get it right the first time. It’s okay that you’re not perfect, nobody is.  You might also want to try the phrase, “It’s okay to make mistakes.” That is how I learn and grow. Remember here of all the people who have succeeded in their recovery, or all the people who are succeeding in other areas of their life, they didn’t get there because of easy, breezy times. They got there by making mistakes, and they’d keep going and they keep trying, and they’d go again and they go again and they learn and they grow. The next thing you may want to try on, and another phrase you can use is, “My challenges do not define my worth.” You’re not either better or worse for having this anxiety. You’re not less than or more than depending on whether you have a mental illness or not. Your worth is not something that’s up for discussion, and it’s not up for measurement. We all have equal worth. And this challenge that you’re experiencing or this anxiety you’re experiencing does not define your worth.  Now, the last one I want you to practice here, you can actually practice more from a meditation or a meditation practice, which is a practice of loving kindness. We could call it a metta meditation or a loving-kindness meditation. And the goal from this is to actually meditate on sending yourself loving kindness.  Now, if you’re someone who wants to learn how to do this, we have an entire meditation vault called the Meditation Vault, where I have created over 30 different meditations for people, specifically with anxiety, to help you practice meditation and learn how to practice loving kindness. You can go to CBTSchool.com to learn more about that. I would, again, need to spend a whole other episode talking to you about that. But if you want to practice the art of sending yourself loving kindness, you can go there to learn more.  But for right now, to finish out this category, what we want to do is practice one of those meditations, which is to offer yourself the phrase, “May I be gentle with myself as I navigate this difficult season?” What we are doing here is we’re offering ourselves a promise per se of saying, “May I be gentle with myself?” In a true loving-kindness meditation, often what we do say is, “May I be happy? May I be well? May I live with ease?” And if you particularly like my voice and it feels very soothing to you, all of those meditations are there in the meditation vaul, and we go through that extensively.  The next section is to fill yourself up with encouragement. Now, when we are anxious, it’s easy to feel very discouraged and just want to run away and change every part of our plans for the day. But what we want to do is we want to fill yourself up with encouragement. Here are some phrases that you can use to help with that goal.  Number one, you know I’m always going to say this, “It’s a beautiful day to do hard things.” We can do hard things. We have to keep repeating this to ourselves. You may even want to add some sass to it and add a little swear word. A lot of my patients have said, “It’s a beautiful day to blank hard things.” Now that’s okay too. You can sass it up, whatever feels most empowering to you.  Another way you can fill yourself up with encouragement is to offer yourself the phrase, “I can tolerate this discomfort,” because you can, and you have, and you will. “I can tolerate this discomfort.” Another thing you can offer is, “This anxiety or this discomfort will not hurt me. I am stronger than I could ever know.” And the truth is, anxiety does not hurt you. It’s uncomfortable, and it’s painful. I understand that. But it won’t hurt you. It won’t damage you. It won’t destroy you, that we’re stronger than we could ever, ever believe we could be.  The next thing you may offer to yourself, and this is one that I particularly love, is that humans are innately resilient. They do most of their growing through hard things. And I’ve already mentioned this to you before. Most of the really successful people got there, not because it was easy and breezy; it’s because we are resilient, and that’s how we grow, and that’s how we learn, that we can get through very, very difficult things. And then the last thing is, “I am more than my worst days.” That this might be a difficult day, but I am more than this difficult day. There’s a bigger story here for me. This uncomfortable moment or this uncomfortable day is just a part of that story. But the bigger picture is that I am much more than these hard, difficult days.  And then the last category, which you have to also include, is to get very clear on how you are going to respond. This is where we get a little more firm with ourselves in the phrases. You will hear, I get a little sassy myself in this, and we get a little more decisive or confident. Even if you don’t feel confident, we want to speak in this confident, assured way.  Number one is, “I REFUSE,” and I’ve written refuse in capital letters. “I REFUSE.” And I say this to myself, I want you to say this to yourself. “I REFUSE to lead a life based on fear.” I will move forward, acting on my values and my beliefs, and who I want to be. That’s the first phrase. And we want to emphasize, “I refuse to act out on this fear.” The second is, “I choose to speak to myself with understanding and patience.” I’m choosing that because it’s so easy to fall back into criticism and blame and humiliation and critical self-punishing words. I choose to speak to myself with understanding and patience.  Now, the third one involves you being very proactive. Now, I’ll give you the phrase first, and then I’ll explain it to you. The phrase is, “I have already chosen how I’m going to respond, and now I’m going to honor that decision.” What I want you to do, if you are someone with anxiety, is to create a plan ahead of time—to have a plan on how you are going to respond to anxiety.  Now, if this is difficult for you, we have two courses that I want you to rely on. Number one is Overcoming Anxiety and Panic, and the other one is ERP School. And that’s for people with OCD and health anxiety. If you’re someone who struggles with generalized anxiety or panic or OCD, you are going to need a plan ahead practice. You’re going to need to know what fear and obsessions and thoughts and fear and all the things get you to do normally. And then you’re going to have to be able to break that cycle with a specific plan on attack on how you’re going to handle that. And we go through those steps in those two courses or any of our courses. We break it down so that you have a specific plan on how you’re going to handle this, what you’re going to do, what you’re not going to do, how you’re going to treat yourself, and so forth.  If you haven’t got a therapist and you want to learn how to do that, head over to CBTSchool.com. Those courses, there is low cost as we could make them, and they’re there for you to help you have a plan so that you can say to your anxiety when you’re struggling, “I’ve already chosen how I wish to respond, and now I’m going to honor that decision. “ Now, the reason that I say that phrase that way is when you have a plan up ahead head, that’s one part of it, but then you have to honor your plan. And what often happens is, when we have a plan and we don’t honor that plan, that’s often when we start to feel like we distrust ourselves. We feel like we’ve let ourselves down.  And so what we want to do is we want to make a plan, and then we want to choose to honor that plan. And by honoring the plan that you set out -- and I’m not going to tell you what that plan should be. The cost isn’t going to tell you what you have to do. You get to decide that for yourself based on your own core values. But once you do that, and when you follow through by honoring that decision that you made ahead of time, that’s when you start to trust yourself. That’s when you start to really feel empowered. That’s when you start to break that cycle of anxiety because you’ve stood firm on the ground on what your plan was and how you’re going to show up.   I’ll repeat it again. “I have already chosen how I want to respond, and now I’m going to honor that decision because I matter, and this is my life, and I want to follow through in the way I said I would.” Now, the fourth one is, “I will treat myself with the same kindness that I offer others in this situation.” Again, we’re speaking firmly and kindly with conviction to ourselves. “I will treat myself with the same kindness that I would offer to others.”  And then the last one is, “I’m going to honor my journey and respect my own pace.” This doesn’t have to be a straightforward, linear process. In fact, it won’t be. And we have to honor our own journey and our own pace, because sometimes it takes longer for us than it does for others. And that’s okay. We’re going to honor our journey. We’re going to respect our own pace.  And I will offer you a bonus phrase, which is, “We are just going to take one step at a time.” Just focus on one step at a time. Because if you’re looking too far ahead, it will get overwhelming. You are handling a huge, huge discomfort. And so we want to be as gentle as we can. We want to honor our values. We want to lead with our values, not lead with fear. And my hope is one or many of these phrases will help you get there. I hope this has been helpful.  Again, I want to remind you, some of these won’t land for you, and that’s entirely okay. Just practice and try the ones that you feel will be helpful, and leave the rest. This is your journey. You get to choose it. I just hope that some of these skills and tools that we talk about on Your Anxiety Toolkit are helpful. And I hope you have a wonderful, wonderful day.