Your Anxiety Toolkit - Anxiety & OCD Strategies for Everyday

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 m

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 p