Your Anxiety Toolkit - Anxiety & OCD Strategies for Everyday

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 be

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? Yo

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 r

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

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 do I 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

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

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, a

THE RISING TIDE OF TEEN DEPRESSION: UNDERSTANDING AND ADDRESSING A MODERN CRISIS In recent times, the specter of teen depression has loomed larger than ever before, casting a long shadow over the lives of young individuals across the globe. With reports indicating a significant upsurge in cases of depression among adolescents, the need to unravel the complexity of this issue and explore effective strategies for intervention has never been more urgent. At the heart of the matter is the alarming statistic that suicide rates among teenagers aged 15 to 19 have surged by 76% since 2007, with a particularly distressing increase observed in teen girls. The rates of suicide have doubled among female teens compared to their male counterparts, underscoring a gendered dimension to the crisis. Moreover, the youngest demographic, children between the ages of 10 and 14, has witnessed the highest rate of increase in suicide across all age groups, a fact that underscores the severity and early onset of mental health challenges in today's youth. This escalation in teen depression and suicidal ideation can be attributed to a myriad of factors, ranging from societal pressures and the rapid pace of cultural shifts to the unique challenges posed by the digital age. The omnipresence of social media and technology, while offering new avenues for connection, has paradoxically fostered a sense of isolation and disconnection among adolescents. The digital landscape, with its relentless comparison and instant feedback loops, has exacerbated feelings of inadequacy, anxiety, and despair among young people. Furthermore, the impact of depression is not confined to any single demographic. Contrary to previous beliefs that African-American families were less likely to experience suicidal ideation, recent research has unveiled an elevated risk among African-American boys aged five to 11. This revelation challenges preconceived notions about the protective factors supposedly inherent in certain communities and underscores the indiscriminate nature of mental health challenges. The narrative surrounding teen depression and despair is further complicated by the conflation of despair with clinical depression. While depression is a diagnosable condition characterized by a specific set of symptoms persisting over time, despair can embody similar feelings of hopelessness and sadness without necessarily meeting the criteria for a clinical diagnosis. This distinction is crucial for understanding the breadth and depth of the emotional turmoil experienced by adolescents, which may not always fit neatly into diagnostic categories. Addressing this burgeoning crisis requires a multifaceted approach, centered around the power of connection and the cultivation of resilience. Building resilience in young people involves fostering internal coping mechanisms as well as providing robust external support systems. Parents, educators, and mental health professionals play a pivotal role in modeling healthy coping strategies and offering unwavering support to adolescents navigating the tumultuous waters of mental health challenges. One of the key strategies for combatting teen depression involves nurturing meaningful connections between young people and their caregivers. The act of showing up for adolescents in both significant moments and the mundane details of daily life can have a profound impact on their sense of belonging and self-worth. Consistency in presence and support, coupled with genuine engagement in activities that resonate with the interests of young people, can fortify their emotional resilience and counteract feelings of isolation and despair. In the digital realm, it is imperative to strike a balance between leveraging technology for connectivity and mitigating its potential negative impacts on mental health. Encouraging responsible and mindful use of social media, fostering face-to-face interactions, and emphasizing the importance of digital detoxes can help alleviate the pressure and anxiety associated with online environments. As society grapples with the escalating crisis of teen depression, it becomes increasingly clear that a collective effort is required to address the underlying causes and provide a supportive framework for adolescents. By prioritizing mental health education, advocating for comprehensive support services, and fostering an environment of openness and understanding, we can begin to turn the tide against teen depression. In doing so, we not only alleviate the immediate suffering of young individuals but also lay the groundwork for a healthier, more resilient generation. TRANSCRIPTION Kimberley: Welcome, everybody. I am so delighted to have our guest on today, Dr. Chinwé Williams. Welcome, Dr. Chinwé Williams. I’m so happy to have you here. Chinwé: Oh, I’m so excited to be here. Thanks so much for having me. Kimberley: As I said to you, several months ago, I was having a massive influx of cases of teens, my teen clients and my staff’s teen clients reporting really strong waves of depression, including not just my clients, but also my pre-teen, also reporting that that’s what some of our friends are reporting. I think it’s everywhere. And I really feel that, even though we always talk about anxiety here, I really wanted to make sure we’re addressing the really high rates of depression and despair in teens. So, thank you for writing the most wonderful book. As I went to research that, I found your book, it’s called, Seen: Despair and Anxiety in Kids and Teenagers and the Power of Connection. So, thank you for writing that book.  Chinwé: Thank you so much for reading it. Yes.   Kimberley: Yes, I actually listened to it. So, I actually got to hear your voice, which I thought was really beautiful because you and Will Hutcherson, who wrote it, it was lovely. You bounced back and forward between the two of you. Chinwé: Yes, we did. We did.  Kimberley: What made you decide to write this book? Chinwé: I started my career as a high school counselor, my goodness, probably now 18 years ago, which is so weird for me to admit that, or even wrap my mind around that. And I loved working with adolescents. And in the particular high school that I was working at, we were really, really able to do the work of promoting and supporting the mental and emotional well-being of students, not just the academic well-being. And a lot of my school counselor friends at other schools, they were really focused on the schedule and post-secondary options, and SATs. So, I was really fortunate to be at a school where I saw students almost like how I’m seeing clients clinically, 10 o’clock, 11 o’clock, 11:15, 11:30. And so, that was such a great experience for me, especially early in my career.  The reason we wrote the book is because, back then, 18 years ago, I saw a little bit of self-harm. I saw anxiety. I saw depression. I certainly saw despair. I saw kids, students struggling with relationships, struggling with, what is my future going to look like? However, what we are seeing today, what I am seeing in my clinical practice, I still work with adolescents, but I do work with a great deal of adults. I work with parents and families, and I have conversations with just my friends and people that I’m doing life with. The episodes or experiences of anxiety and depression has really just increased significantly. Kimberley, I am sure that you are so aware of just the stats that are out there that really point to the shift that’s occurred in our culture, specifically as it relates to youth mental health.  Just for example, and this seems like such a long time ago, but I think it really gives us an idea of how much has changed, a good bit has changed in a relatively short period of time. But the stats are pointing to the fact that since 2007, suicide rates have increased a whopping 76% for teenagers between the ages of 15 and 19. So 76%. So the bulk of that number really is pointing to how our teen girls are struggling. Suicide rates are double in teen girls versus our boys. The highest rate of increase in suicide among all age groups—and this is where I always have to take a deep breath still—is in kids. These are kids between the ages of 10 and 14 is what the research is showing.  The alarming part of this whole thing is that we’re seeing younger and younger kids impacted by what we sometimes think of as, yes, adolescence is tough. There are hormones. There’s social pressures. There are academic pressures. Kids are worried about the future. Well, younger and younger kids are also being impacted by feelings of hopelessness and discouragement.  And the other thing—you and I talked about this before we started recording. The other thing that’s been really shocking for a lot of people to learn is when I started my career, way back in the day, we were told that families of color, specifically African-American families, were really the least likely to take their own lives. But what we have learned recently, and this is a stat that has really shocked, but also confused and confounded a lot of clinicians, as well as mental health researchers, is that there’s an elevated risk of suicidal thoughts for African-American boys between the ages of five and 11. So once again, just younger and younger kids are experiencing really hopeless feelings, but we are seeing the most anxiety, the most despair, and depression among adolescents and young adults. So that’s why we wrote the book.  Kimberley: I get teary just hearing about it. My heart aches, and I feel like it’s a crisis. It’s a crisis that they’re experiencing and parents. I think what was really also very beautiful that you talked in the book about how, I think, even as clinicians, we perceive kids who are struggling with, “Oh, they must have gone through a trauma.” But also, it’s just kids who haven’t been through a trauma. I mean, I think the COVID in and of itself and all of the unrest of our world is traumatic for everybod

In the realm of mental health, the role of an anxiety therapist is often shrouded in mystery and misconceptions. To shed light on this crucial profession, Joshua Fletcher, also known as AnxietyJosh, shares insights from his latest book, "And How Does That Make You Feel?: Everything You (N)ever Wanted to Know About Therapy," in a candid conversation with Kimberley Quinlan on her podcast. Joshua's book aims to demystify the therapeutic process, offering readers an intimate look behind the therapy door. It's not just a guide for those struggling with anxiety but an engaging narrative that invites the general public into the world of therapy. The book's unique angle stems from a simple yet intriguing question: Have you ever wondered what your therapist is thinking? One of the book's key revelations is the humanity of therapists. Joshua emphasizes that therapists, like their clients, are complex individuals with their own vices, flaws, and inner dialogues. The book begins with a scene where Joshua, amidst a breakthrough session with a client, battles an array of internal voices—from the biological urge to use the restroom to the critical voice questioning his decision to drink an Americano right before the session. This honest portrayal extends to the array of voices that therapists and all humans contend with, including anxiety, criticism, and analytical thinking. Joshua's narrative skillfully normalizes the internal chatter that professionals experience, even as they maintain a composed exterior. The conversation also touches upon the diverse modalities of therapy, highlighting the importance of finding the right approach for each individual's needs. Joshua jests about "The Yunger Games," a fictional annual event where therapists from various modalities compete, underscoring the passionate debates within the therapeutic community regarding the most effective treatment methods. A significant portion of the book delves into the personal growth and challenges therapists face, including dealing with their triggers and the balance between professional detachment and personal empathy. Joshua shares an anecdote about experiencing a trigger related to grief during a session, illustrating how therapists navigate their emotional landscapes while maintaining focus on their clients' needs. The awkwardness of encountering clients outside the therapy room is another aspect Joshua candidly discusses. He humorously describes the internal turmoil therapists experience when meeting clients in public, highlighting the delicate balance of maintaining confidentiality and acknowledging the shared human experience. Joshua's book, and his conversation with Kimberley, paint a vivid picture of the life of an anxiety therapist. It's a role filled with challenges, personal growth, and the profound satisfaction of facilitating others' journeys toward mental wellness. By pulling back the curtain on the therapeutic process, Joshua hopes to demystify therapy, making it more accessible and less intimidating for those considering it. In essence, being an anxiety therapist is about embracing one's humanity, continuously learning, and engaging in the most human conversations without judgment. It's a profession that requires not only a deep understanding of mental health but also a willingness to confront one's vulnerabilities and grow alongside their clients. Through his book and the insights shared in this conversation, Joshua Fletcher invites us all to appreciate the intricate dance of therapy—a dance that, at its best, can be life-changing for both the therapist and the client. Transcript:  Kimberley: I’m very happy to have back on the show Joshua Fletcher, a dear friend of mine and quite a rock star. He has written a new book called And How Does That Make You Feel?: Everything You (N)ever Wanted to Know About Therapy. Welcome back, Josh. Joshua: It’s good to be back. Thanks, Kim. When was the last time we spoke together on a podcast? I think you were on The Disordered podcast not so long ago. That was lovely. But I remember my guest appearance on Your Anxiety Toolkit was lovely. HOW DOES THAT MAKE YOU FEEL?  Kimberley: I know. I’m so happy to actually spend some time chatting with you together. I’m very excited about your new book. It’s all about therapy and anxiety and what it’s really like to be an anxiety therapist and the process of therapy and all the things. How did this book come about? Joshua: I wanted to write a book about people who struggle with anxiety, but in the mainstream, because a lot of the literature out there is very self-help, and it’s in a certain niche. One of my biggest passions is to write something engaging with a nice plot where people are reading about something or a storyline that they’re interested in whilst inadvertently learning without realizing you’re learning. That’s my kind of entertainment—when I watch a show and I’ve learned a lot about something or when I’ve read a book and I’ve inadvertently learned loads of things because I’m taking in the plot.  With this book, I wanted to write a book about therapy. Now, that initially might not get people to pick it up, might not interest you, might not interest you about anxiety therapy, but I wanted to write something that anyone could pick up and enjoy and learn lots because I want to share our world that we work in with the general public. And so, the hook that I focused on here was, have you ever wanted to know what your therapist is thinking? And I thought, well, I’m going to tell people what I’m thinking, and I’m going to invite people behind the therapy door, and you’re going to see what I do and what’s going on in my head as I’m trying to work with people who struggle with mental health.  I wrote the pitch for it. People went bananas, and they loved it because it’s not been done before. Not necessarily a good thing if it’s not been done before. And here we are. I love it. I’m really proud of it. I want people to laugh, cry, be informed. If you go on a journey, learn more about therapy, learn more about anxiety. All in one book. THERAPISTS ARE HUMANS TOO Kimberley: Yeah. I think that one of the many cool things about it is, as a therapist, people seem to be always very curious or intrigued about therapists, about what it’s like and what it’s like to be in a room with someone who’s really struggling, or when you’re handling really difficult topics, and how to be just a normal human being and a therapist at the same time. Joshua: Yeah. What I want to write about is to remind people that therapists are humans. We have our vices and flaws. I’m not talking on behalf of you, Kim. I’m sure you’re perfect.  Kimberley: No, no. No, no. Flawed as flawed could be. Joshua: Yeah, but to a level that it’s like, even our brains have different voices in them all the time, different thought processes as part of our rationalization. And I want people to peer inside that and have a look. So, one of them is like the book opens with me and a client and it’s going really well, and this person’s talking, this character’s talking about where they’re up to, and celebrating on the brink of something great. And then there’s the voice of biology that just pops into the room, into my head. And it’s the biology of you need to go to the toilet. Why did it? And then the voice of critic comes in and says, “Why did you drink an Americano moments before this client?” Now you’re sat here, and you can leave if you want, but it would be distasteful. And you’re on this brink of this breakthrough.  And so, I’ve got this argument going on in my head, going, “You need the toilet.” “Yeah, but this person’s on a breakthrough.” And then I got empathy, like, “Yeah, but they feel so vulnerable. They want to share this.” And then you’ve got analytical and all the chaotic conversations that are happening as a therapist as I’m sat there nodding and really wanting the best for my client. THE VOICES IN OUR HEAD Kimberley: Exactly. That’s why I thought it was so brilliant. So, for those of you who haven’t read it, I encourage you to, but Josh really outlines at the beginning of the book all of these different voices that therapists and all humans have. There’s the anxiety’s voice and there’s biology, which you said, like, “I need to go to the restroom,” or there’s the critic that’s judging you, or there’s the analytical piece, which is the clinical piece that’s making sense of the client and what’s going on and the relationship and all the things. And I really resonated with that because I think that we think as clinicians, as we get better and more seasoned, that we only show up with this professional voice we’re on the whole time, but we’re so not. We’re so not on the whole time. This whole chatter is happening in the background. And I think you did a beautiful job of just normalizing that. Joshua: Thanks, Kim. It’s a book that therapists will like, but do you know what? People will identify their own voices in this, particularly the anxiety. You and I talk about anxiety all day every day, always beginning with what if—that voice of worry that sits around a big table of thoughts and tries to shout the loudest and often gets our attention. And I tried to show that this happens to a lot of people as well. It’s just the what-if is different. So, for some people, it’s, “What if this intrusive thought is true?” For some people, it’s, “What if I have a panic attack?” For some people, it’s, “What if this catastrophe I’ve been ruminating on for so long happens?” For therapists, it’s, “What if the worst thing that happens here, even in the therapy room?”  I’m an anxiety therapist that has been through anxiety, and I still get anxiety because I’m human. So, I celebrate these voices as well. Also, because I’m human, I can be critical almost always of myself in the book. So, I’m not just criticizing the people I’m working with. Absolutely not. But that voice come

In the realm of mental health, the significance of structured daily routines for depression cannot be overstated. Kimberley Quinlan, an anxiety specialist with a focus on mindfulness, Cognitive Behavioral Therapy (CBT), and self-compassion, emphasizes the transformative impact that Daily Routines for Depression can have on individuals grappling with this challenging condition. Depression, characterized by persistent feelings of sadness, hopelessness, and a lack of interest in once-enjoyable activities, affects every aspect of one's life. Quinlan stresses that while professional therapy and medication are fundamental in the treatment of depression, integrating specific daily routines into one's lifestyle can offer a complementary path toward recovery and mental wellness. THE POWER OF MORNING ROUTINES FOR DEPRESSION Starting the day with a purpose can set a positive tone for individuals battling depression. Quinlan recommends establishing a consistent wake-up time to combat common sleep disturbances associated with depression. Incorporating light physical activity, such as stretching or a gentle walk, can significantly boost mood. Mindfulness practices, including meditation, journaling, or gratitude exercises, can help foster a healthier relationship with one's thoughts and emotions. Additionally, a nutritious breakfast can provide the necessary energy to face the day, an essential component of "Daily Routines for Depression." DAYTIME ROUTINES FOR DEPRESSION Throughout the day, setting realistic goals and priorities can help maintain focus and motivation. Quinlan advocates for the inclusion of pleasurable activities within one's schedule to counteract the anhedonia often experienced in depression. Techniques like the Pomodoro Method can aid in managing tasks without becoming overwhelmed, breaking down activities into manageable segments with short breaks in between. Exposure to natural light and ensuring a balanced diet further contribute to improving mood and energy levels during the day. EVENING ROUTINES FOR DEPRESSION As the day draws to a close, engaging in a digital detox and indulging in relaxation techniques become crucial. Limiting screen time and investing time in hobbies or skills can provide a sense of accomplishment and fulfillment. Establishing a calming bedtime routine, including activities like reading or taking a bath, can enhance sleep quality, an essential factor in "Daily Routines for Depression." WEEKLY ACTIVITIES TO OVERCOME DEPRESSION Quinlan also highlights the importance of incorporating hobbies and community engagement into weekly routines. Finding a sense of belonging and purpose through social interactions and new skills can offer a much-needed respite from the isolating effects of depression. NAVIGATING TOUGH DAYS WITH COMPASSION Acknowledging that the journey through depression is fraught with ups and downs, Quinlan advises adopting a compassionate and simplified approach on particularly challenging days. Focusing on basic self-care and seeking support when needed can provide a foundation for resilience and recovery. In conclusion, Daily Routines for Depression are not just about managing symptoms but about rebuilding a life where mental wellness is prioritized. Through mindful planning and self-compassion, individuals can navigate the complexities of depression and move towards a more hopeful and fulfilling future. PODCAST TRANSCRIPT If you’re living with depression today, we are going to go through some daily routines for your mental wellness.  Welcome. My name is Kimberley Quinlan. I’m an anxiety specialist. I talk all about mindfulness, CBT, self-compassion, and skills that you can use to help you with your mental wellness.  Let’s talk about living with depression, specifically about daily routines that will set you up for success. My goal first is to really highlight the importance of routines. Routines are going to be the most important part of your depression recovery, besides, of course, seeing your therapist and talking with your doctor about medication.  This is the work that we do at home every day to set ourselves up for success, finding ways that we can manage our depression, overcome our depression by tweaking the way in which we live our daily life because the way we live our lives often will impact how severe our depression can get. There are some behaviors and actions that can very much exacerbate and worsen depression. And there are some behaviors and routines that can very much improve your depression. So, let’s talk about them today. DEPRESSION SYMTPOMS Let’s first just get really clear on depression and depression symptoms. Depression is a common and can be a very serious mental illness and medical condition that can completely negatively impact your life—the way you feel, the way you think, the way you act. It often includes persistent feelings of sadness, emptiness, hopelessness, worthlessness that can really impact the way you see yourself and your own identity. It often includes a lack of interest in pleasure in the activities that you once enjoyed.  Depression symptoms can vary from mild to very severe. They can include symptoms such as changes in appetite, sleep disturbances, loss of energy, excessive guilt, difficulty thinking or concentrating. Sometimes you can feel like you have this whole brain fog. And again, deep, overwhelming feelings of worthlessness and hopelessness.  Now, it is important to recognize that depression is not just a temporary bout of sadness. It’s a chronic condition. It’s one that we can actually recover from, but it does require a long-term treatment plan, a commitment to taking care of yourself, including therapy and medication. So, please do speak to your medical professional and a mental health professional if you have severe depression or think you might have severe depression.  It can also include thoughts of wanting to die and not feeling like you want to live on this earth anymore. Again, if that’s something that you’re struggling with, please go to your local emergency room or immediately seek out professional mental health or medical health care.  It is so important that you do get professional help for depression because, again, depression can come down like a heavy cloud on our shoulders, and it tells a whole bunch of lies. We actually have a whole podcast episode about how depression is a big fat liar. And sometimes when you are under the spell of those lies, it’s hard to believe that anything else might be true. So, it’s very important that we take it seriously. And as we’re here today to talk about, it’s to create routines that help really nurture you and help you towards that recovery.  TREATMENT FOR DEPRESSION Before we move into those routines, I want to quickly mention the treatment for depression. The best treatment for depression is cognitive behavioral therapy. Now there is often a heavy emphasis on mindfulness and self-compassion as well. Cognitive behavioral therapy looks at both your thoughts and your behaviors. And it’s important that we look at both because both can impact the way in which this disorder plays out.  If you don’t have access to a mental healthcare professional, we also have an online course called Overcoming Depression. Overcoming Depression is an on-demand online course where I teach you the exact steps that I use with my clients to propel them into setting up their cognition so that they’re healthy, their behaviors, so that they bring a sense of pleasure and motivation, and structure into their daily lives. And then we also very heavily emphasize self-compassion and that mindfulness piece, which is so important when it comes to managing highly depressive and hopeless thoughts. So, that’s there if you want to go to CBTSchool.com/depression, or you could go to CBTSchool.com, and we have all the links right there.  DAILY ROUTINES FOR DEPRESSION All right, so let’s talk about daily routines for depression. Research shows that, specifically for depression, finding a routine and a rhythm in your day can greatly improve the chances of your long-term recovery. And so, I really take time and slow down with my patients and talk to them about what routines are working and what routines are not. I’m not here to tell you or my patients, or my students how to live their lives and what to do specifically. I’m really interested at looking at what’s working for you and what’s not. Let’s first start with morning routines.  What often very much helps—and maybe you already have this, but if not, this is something I want you to consider—is the importance of a consistent wake-up time. When you’re depressed, as I mentioned before, a common depression symptom is sleep disturbance. Often, people lay awake all night and sleep all day, or they sleep all night and they sleep all day, and they’re heavily overwhelmed with this sleepy exhaustion. It is really important when it comes to morning routines that you set a time to wake up every morning and you get up, even if it’s for a little bit, if that’s all you can handle. Try to set that really consistent wake-up time.  What I want to emphasize as we go through these routines for depression is I don’t mind if you even do tiny baby steps. One thing you might want to start from all of the ideas I give you today, you might just want to pick one. And if that’s all you can do, that is totally okay.  What we also want to do is we want to, if possible, engage in some kind of light movement, even stretching, to boost mood. There’s a lot of routine, even just stretching or gentle walks outside. It doesn’t have to be fast. It doesn’t have to be for an hour. It could be for a quarter of a block to start with. But that light exercise has been shown to boost mood significantly. And then if you’re able, maybe even to do that multiple times throughout the day.  Another morning routine that you may want to consider is some type of mindfulness practice. Again, we cover this in overc

In the insightful podcast episode featuring Joanna Hardis, author of "Just Do Nothing: A Paradoxical Guide to Getting Out of Your Way," listeners are treated to a deep dive into the concept of distress tolerance and its pivotal role in mental health and personal growth. Joanna Hardis, with her extensive background in treating anxiety disorders such as panic disorder, OCD, and Generalized Anxiety Disorder, shares her professional and personal journey toward understanding and teaching the art of effectively managing internal discomfort without resorting to avoidance or escape tactics. The discussion begins with an exploration of the title of Joanna's book, "Just Do Nothing," which encapsulates the essence of her therapeutic approach: the intentional practice of stepping back and allowing thoughts, feelings, and sensations to exist without interference. This practice, though seemingly simple, challenges the common impulse to engage with and control our internal experiences, which often exacerbates suffering. A significant portion of the conversation is dedicated to "distress intolerance," a term that describes the perceived inability to endure negative emotional states. This perception leads individuals to avoid or escape these feelings, thereby increasing vulnerability to a range of mental health issues including anxiety, depression, and substance abuse. Joanna emphasizes the importance of recognizing and altering the self-limiting beliefs and thoughts that fuel distress intolerance. Practical strategies for enhancing distress tolerance are discussed, starting with simple exercises like resisting the urge to scratch an itch and gradually progressing to more challenging scenarios. This gradual approach helps individuals build confidence in their ability to manage discomfort and makes the concept of distress tolerance applicable to various aspects of life, from parenting to personal goals. Mindfulness is highlighted as a crucial component of distress tolerance, fostering an awareness of our reactions to discomfort and enabling us to respond with intention rather than impulsivity. The podcast delves into the importance of connecting with our values and reasons for enduring discomfort, which can provide the motivation needed to face challenging situations. Joanna and Kimberley also touch on the common traps of negative self-talk and judgment that can arise during distressing moments, advocating for a more compassionate and accepting stance towards oneself. The idea of "choice points" from Acceptance and Commitment Therapy (ACT) is introduced, encouraging listeners to make decisions that align with their values and move them forward, even in the face of discomfort. The episode concludes with a message of hope and empowerment: everyone has the capacity to work on expanding their distress tolerance. By starting with small, manageable steps and gradually confronting more significant challenges, individuals can cultivate a robust ability to navigate life's inevitable discomforts with grace and resilience. EPISODE HIGHLIGHTS:  The Concept of "Just Do Nothing": This core idea revolves around the practice of intentionally not engaging with every thought, feeling, or sensation, especially when they're distressing. It's about learning to observe without action, which can reduce the amplification of discomfort and suffering. Understanding Distress Intolerance: Distress intolerance refers to the belief or perception that one cannot handle negative internal states, leading to avoidance or escape behaviors. This concept highlights the importance of recognizing and challenging these beliefs to improve our ability to cope with discomfort. Building Distress Tolerance: The podcast discusses practical strategies to enhance distress tolerance, starting with simple exercises like resisting the urge to scratch an itch. The idea is to gradually expose oneself to discomfort in a controlled manner, thereby building resilience and confidence in handling distressing situations. Mindfulness and Awareness: Mindfulness plays a crucial role in distress tolerance by fostering an awareness of our reactions to discomfort. This awareness allows us to respond intentionally rather than react impulsively. The practice of mindfulness helps in recognizing when we're "gripping" distressing thoughts or sensations and learning to gently release that grip. Aligning Actions with Values: The podcast emphasizes the significance of connecting actions with personal values, even in the face of discomfort. This alignment can motivate us to face challenges and make choices that lead to personal growth and fulfillment, rather than making decisions based on the urge to avoid discomfort. These concepts together form a comprehensive approach to managing distress and enhancing personal well-being, as discussed by Joanna Hardis in the podcast episode. TRANSCRIPTION:  Kimberley: Welcome, everybody, today. We have Joanna Hardis. Joanna wrote an amazing book called Just Do Nothing: A Paradoxical Guide to Getting Out of Your Way. It was a solid gold read. Welcome, Joanna. Joanna: Thank you. Thank you for having me. Thank you for reading it, too. I appreciate it. Kimberley: It was a wonderful read and so on point, like science-backed. It was so good, so you should be so proud. Joanna: Thank you. Kimberley: Why did you choose the title Just Do Nothing? Joanna: I mean, it’s super catchy, but more importantly than that, it is really what my work involves on a personal level and on a professional level—learning how to get out of my own way or our own way by leaving our thoughts alone, learning how to leave uncomfortable feelings alone, uncomfortable sensations alone, uncomfortable thoughts alone. Because that’s what creates the suffering—when we get so engaged in them. Kimberley: Yeah. It’s such a hard lesson. I talk about this with patients all the time. But as I mentioned to you, even my therapist is constantly saying, “You’re going to have to just feel this one.” And my instinct is to go, “Nope. No thanks. There has to be another way.” Joanna: A hundred percent. Yes. I mean, it really is something on a daily basis. I have to remind myself and work really hard to do. Kimberley: It is. But it is such powerful work when you do it.  Joanna: Mm-hmm.  Kimberley: Early in the book, you talk about this term or this concept called ‘distress intolerance.’ Can you tell us what both of those are and give us some ideas on why this is an important topic? Joanna: Sure, and this is what got me interested in the book and everything. Distress tolerance is a perception that you can handle negative internal states. And those internal states can be that you feel anxious, that you feel worried, you feel bored, vulnerable, ashamed, angry, sad, mad, off. There’s an A to Z alphabet of those unpleasant and uncomfortable emotional states. And when we have that perception that we can handle it, our behavior aligns, so we tend to do things.  When we are distress-intolerant, we have a perception—often incorrect—that we cannot handle negative internal states. So then we will either avoid them or escape them or try to figure them out or neutralize them or try to get rid of them, make them stop—all the things that we see in our work every day.  Before I had my practice in anxiety disorders, I worked over a decade in an eating disorder treatment center, and we know that when someone has really low distress tolerance, they are more vulnerable to developing eating disorders, anxiety disorders, depressive disorders, substance use disorders. So, it’s a really important concept. Kimberley: It’s such an important concept. And you talk about how the thoughts we have which can determine that. Do you want to share a little bit about that? Because there was a whole chapter in the book about the thoughts you have about your ability to tolerate distress. Joanna: Sure, and I didn’t answer the second part of your question., I just realized, which will tie into that, which is how it sounds. How it sounds is, “I can’t bear to feel this way, so I’m going to avoid that party,” or “I’m having too good of a day, so I can’t do my homework,” or “I can’t bear if my kids see me anxious, so we’re not going to go to the playground.” And so, what drives someone’s perception are their thoughts and these thoughts and these self-limiting stories that we all have, and that oftentimes we just buy into as either true, or perhaps at one point, they may have been true, but we’ve outlived them. Kimberley: Yeah. We’re talking about distress tolerance, and I’m always on the hunt to widen my distress tolerance to be able to tolerate higher levels of distress. And I think what’s interesting is, first, this is more of a question that I don’t know the science behind it, but do you think some people have higher levels of distress which makes them more intolerant, or do you think the intolerance which is what makes the distress feel so painful? Joanna: I don’t know the research well enough to answer it. Because I think it’s rare that you see -- I mean, this is just one construct. So it’s very hard to isolate it from something like emotional sensitivity or anxiety sensitivity or intolerance for uncertainty, or something else that may be contributing to it. Kimberley: Yeah. No, I know. It’s just a question I often think about, particularly when I’m with patients. And this is something that I think doesn’t really matter at the end of the day. What matters is—and maybe this will be a question for you—if our goal is to increase our distress tolerance, how might somebody even begin to navigate that? Joanna: Sure. I love that question. I mean, in the book, I take it down to such a micro level, which is learning how—and I think you’ve talked about it on podcasts—itch serve. So, one of the exercises in the book is learning how you set your timer for five minutes and you get itchy, which of course is going to happen. And it’s learning how to r

Visual Staring OCD (also known as Visual Tourrettic OCD), a complex and often misunderstood form of Obsessive-Compulsive Disorder, involves an uncontrollable urge to stare at certain objects or body parts, leading to significant distress and impairment. In an enlightening conversation with Kimberley, Matt Bannister shares his journey of overcoming this challenging condition, offering hope and practical advice to those grappling with similar issues. Matt's story begins in 2009, marked by a sense of depersonalization and dissociation, which he describes as an out-of-body experience and likened to looking at a stranger when viewing himself in the mirror. His narrative is a testament to the often-overlooked complexity of OCD, where symptoms can extend beyond the stereotypical cleanliness and orderliness. Kimberley's insightful probing into the nuances of Matt's experiences highlights the profound impact of Visual Staring OCD on daily life. The disorder manifested in Matt as an overwhelming need to maintain eye contact, initially with female colleagues, out of fear of being perceived as disrespectful. This compulsion expanded over time to include men and intensified to such a degree that Matt felt his mind couldn't function normally. The social implications of Visual Staring OCD are starkly evident in Matt's recount of workplace experiences. Misinterpretation of his behavior led to stigmatization and gossip, deeply affecting his mental well-being and leading to self-isolation. Matt's story is a poignant illustration of the societal misunderstandings surrounding OCD and its variants. Treatment and recovery form a significant part of the conversation. Matt emphasizes the role of Cognitive Behavioral Therapy (CBT) and Exposure and Response Prevention (ERP) in his healing process. However, he notes the initial challenges in applying these techniques, underscoring the necessity of a tailored approach to therapy. Kimberley and Matt delve into the power of community support in managing OCD. Matt's involvement with the IOCDF (International OCD Foundation) community and his interactions with others who have overcome OCD, like Chris Trondsen, provide him with valuable insights and strategies. He speaks passionately about the importance of self-compassion, a concept introduced to him by Katie O'Dunne, and how it transformed his approach to recovery. A critical aspect of Matt's journey is the realization and acceptance of his condition. His story underscores the importance of proper diagnosis and understanding of OCD's various manifestations, which can be as unique as the individuals experiencing them. Matt's narrative is not just about overcoming a mental health challenge; it's a story of empowerment and advocacy. His transition from a struggling individual to a professional peer support worker is inspiring. He is now dedicated to helping others navigate their paths to recovery, using his experiences and insights to offer hope and practical advice. In conclusion, Matt Bannister's journey through the complexities of Visual Staring OCD is a powerful testament to the resilience of the human spirit. His story offers valuable insights into the disorder, challenges misconceptions, and highlights the importance of tailored therapy, community support, and self-compassion in overcoming OCD. For anyone struggling with OCD, Matt's story is a beacon of hope and a reminder that recovery, though challenging, is within reach. Instagram - matt bannister27 Facebook - matthew.bannister.92 Facebook group - OCD Warrior Badass Tribe Email :matt3ban@hotmail.com Kimberley: Welcome back, everybody. Every now and then, there is a special person that comes in and supports me in this way that blows me away. And today we have Matt Bannister, who is one of those people. Thank you, Matt, for being here today. This is an honor on many fronts, so thank you for being here. Matthew: No, thank you for bringing me on, Kim. This is a huge honor. I’m so grateful to be on this. It’s just amazing. Thank you so, so much. It’s great to be here. Kimberley: Number one, you have been such a support to me in CBT School and all the things that I’m doing, and I’ve loved hearing your updates and so forth around that. But today, I really want you to come on and tell your story from start to end, whatever you want to share. Tell us about you and your recovery story. Matthew: Sure. I mean, I would like to start as well saying that your CBT School is amazing. It is so awesome. It’s helped me big time in my recovery, so I recommend that to everyone. I’m an IOCDF grassroots advocate. I am super passionate about it. I love being involved with the community, connecting with the community. It’s like a big family. I’m so honored to be a part of this amazing community. My recovery story and my journey started back in 2009, when—this is going to show how old I am right now—I remember talking on MSN. I remember I was talking; my mind went blank in a conversation, and I was like, “Ooh, that’s weird. It’s like my mind’s gone blank.” But that’s like a normal thing. I can just pass it off and then keep going forward. But the thing is with me. It didn’t. It latched on with that. I didn’t know what was going on with me. It was very frightening. I believe that was a start for me with depersonalization and dissociation. I just had no idea of what it was. Super scary. It was like I started to forget part of my social life and how to communicate with people. I really did start to dissociate a lot when I was getting nervous. And that went on for about three or four years, but it gradually faded naturally. Kimberley: So you had depersonalization and derealization, and if so, can you explain to listeners what the differences were and how you could tell the differences? Matthew: Yeah. I think maybe, if I’m right with this, with the depersonalization, it felt like I knew how it was, but I didn’t at the same time. It was like when I was looking in a mirror. It was like looking at a stranger. That’s how it felt. It just felt like I became a shell of myself. Again, I just didn’t know what was happening. It was really, really scary. I think it made it worse. With my former friends at that time, we’d make fun of that, like, “Oh, come on, you’re not used to yourself anymore. You’re not as confident anymore. What’s going on? You used to try and take the [03:19 inaudible] a lot with that.” With the dissociation, I felt like I was having an out-of-body experience. For me, if I sat in a room and it was really hitting me hard, as if I were anxious, it would feel like I was floating around that room. I couldn’t concentrate. It was very difficult to focus on things, especially if it was at work. It’d be very hard to do so. That came on and off. Kimberley: Yeah, it’s such a scary feeling. I’ve had it a lot in my life too, and I get it. It makes you start to question reality, question even your mental health. It’s such a scary experience, especially the first time you have it. I remember the first time I was actually with a client when it started. Matthew: Yeah, it is. Again, it is just a frightening experience. It felt like even when I was walking through places, it was just fog all the time. That’s how it felt. I felt like someone had placed a curse on me. I really believe that with those feelings, and how else can I explain it? But that did eventually fade, luckily, in about, like I said, three to four years, just naturally on its own. When I had those sensations, I got used to that, so I didn’t put as much emphasis on those situations. Then I carried on naturally through that. Then, well, with going through actually depersonalization, unfortunately, that’s when my OCD did hit. For me, it was with, I believe, relationship OCD because I was with someone at the time. I was constantly always checking on them, seeing if they loved me. Like, am I boring you? Because I thought of depersonalization. I thought I wasn’t being my full authentic self and that you didn’t want to be within me anymore. I would constantly check my messages. If they didn’t put enough kisses on the end of a message, I think, “Oh, they don’t love me as much anymore. Oh no, I have to check.” All the time, even in phone calls, I always made sure to hear that my partner would say, “Oh, I love you back,” or “I love you.” Or as I thought, I did something wrong. Like they’re going off me. I had a spiral, thinking this person was going to cheat on me. It went on and on and on and on with that. But eventually, again, the relationship did fade in a natural way. It wasn’t because of the OCD; it was just how it went. And then, with relationship OCD, with that, I faded with that. A search with my friends didn’t really affect me with that. Then what I can recall, what I have maybe experienced with OCD, I’ve had sexual orientation OCD. Again, I was questioning my sexuality. I’m heterosexual, and I was in another warehouse, a computer warehouse, and it was all males there. I was getting what I describe as intrusive thoughts of images of doing sexual acts or kissing and stuff like that. I’m thinking, “Why am I getting these thoughts? I know where my sexuality is.” There’s nothing wrong, obviously, with being homosexual or queer. Nothing wrong with that at all. It’s just like I said, that’s how it fades with me. I mean, it could happen again with someone who’s queer, and it could be getting heterosexual thoughts. They don’t want that because they know they’re comfortable with their sexuality. But OCD is trying to doubt that. But then again, for me, that did actually fade again after about five or six months, just on its own. And then, fast forward two years later is when the most severe theme of OCD I’ve ever had hit me hard like a ton of bricks. And that for me was Visual Tourettic OCD, known as Staring OCD, known as Ocular Tourettic OCD. And that was horrendous. The stigma I received with this theme was awful. I remembered the day when it hit me, when I was

If you want to know the 5 Most Common Recovery Roadblocks with Chris Tronsdon (an incredible anxiety and OCD therapist), you are in the right place. Today Chris and I will go over the 5 Most common anxiety, depression, & OCD roadblocks and give you 6 highly effective treatment strategies you can use today.  Kimberley: Welcome everybody. We have the amazing Chris Trondsen here with us today. Thank you for coming, Chris. Chris: Yes, Kim, thanks for having me. I’m super excited about being here today and just about this topic. Kimberley: Yes. So, for those of you who haven’t attended one of the IOCDF Southern California conferences, we had them in Southern California. We have presented on this exact topic, and it was so well received that we wanted to make sure that we were spreading it out to all the folks that couldn’t come.  You and I spoke about the five most common anxiety & OCD treatment roadblocks, and then we gave six strategic solutions. But today, we’re actually broadening it because it applies to so many people. We’re talking about the five most common anxiety treatment roadblocks, with still six solutions and six strategies they can use. Thank you for coming on because it was such a powerful presentation. Chris: No, I agree. I mean, we had standing room only, and people really came up to us afterwards and just said how impactful it was. And then we actually redid it at the International OCD Foundation, and it was one of the best-attended talks at the event. And then we got a lot of good feedback, and people kept messaging me like, “I want to hear it. I couldn’t go to the conference.” I’d play clips for my group, and they’re like, “When is it going to be a podcast?” I was like, “I’ll ask Kim.” I’m glad you said yes because I do believe for anybody going through any mental health condition, this list is bound, and I think the solutions will really be something that can be a game changer in their recovery. Kimberley: Absolutely, absolutely. I love it mostly because, and we’re going to get straight into these five roadblocks, they’re really about mindset and going into recovery. I think it’s something we’re not talking about a lot. We’re talking about a lot of treatment, a lot of skills, and tools, but the strategies and understanding those roadblocks can be so important. Chris: Yeah. I did a talk for a support group. They had asked me to come and speak, and I just got this idea to talk about mindset. I did this presentation on mindset, and people were like, “Nobody’s talking about it.” In the back of my head, I’m like, “Kim and I did.” But we’re the only ones. Because I do think so many people get the tools, right? The CBT tools, they get the ERP tools, the mindfulness edition, and people really find the tools that work for them. But when I really think of my own personal recovery with multiple mental health diagnoses, it was always about mindset. And that’s what I like about our talk today. It’s universal for anyone going through any mental health condition, anxiety base, and it’s that mindset that I think leads to recovery. It shouldn’t be the other way around. The tools are great, but the mindset needs to be there. Kimberley: Yeah. We are specifically speaking to the folks who are burnt out, feeling overwhelmed, feeling a lack of hope of recovery. They really need a kickstart, because that was actually the big title of the presentation. It was really addressing those who are just exhausted with the process and need a little bit of a strategy and mindset shift. Chris: Yeah. I don’t want to compare, but I broke my ankle when I was hiking in Hawaii, and I have two autoimmune diseases. Although those ailments have caused problems, especially the autoimmune, when I think back to my mental health journey, that always wore me out more because it’s with you all the time, 24/7. It’s your mental health. When my autoimmune diseases act up, I’m exhausted, I’m burnt out, but it’s temporary. Or my ankle, when it acts up, I have heating pads, I have things I can do, but your brain is with you 24/7. I do believe that’s why a lot of people resonate with this messaging—they are exhausted. They’re busting their butt in treatment, but they’re tired and hitting roadblocks. And that’s why this talk really came about. Kimberley: Yeah, exactly. All right, let’s get into it here in a second. I just want to give one metaphor with that. I once had a client many years ago give the metaphor. She said, “I feel like I’m running a marathon and my whole family are standing on the out, like on the sidelines, and they’re all clapping, but I’m just like faceplant down in the middle of the road.” She’s like, “I’m trying to get up, I’m trying to get up, and everyone’s telling me, ‘Come on, you can do it.’ It’s so hard because you’re so exhausted and you’ve already run a whole bunch of miles.” And so I really think about that kind of metaphor for today. If people are feeling that way, hopefully they can take away some amazing nuggets of information.  Chris: Absolutely. That’s a good visual. Faceplant. Kimberley: It was such a great and powerful visual because then I understood this client’s experience. Like, “Oh, okay. You’re really tired. You’re really exhausted.” ROADBLOCK #1: YOU BEAT YOURSELF UP! Okay, let’s get into it. So, I’m going to go first because the number one roadblock we talked about, not that these are in any particular order, but the one we came up first was that you beat yourself up. This is a major roadblock to recovery for so many disorders. You beat yourself up for having the disorder. You beat yourself up for not coping with it as well as you could. You beat yourself up if you have OCD for having these intrusive thoughts that you would never want to have. Or you’re beating yourself up because you don’t have motivation because you have, let’s say, some coexisting depression.  The important thing to know there is, while beating yourself up feels productive, it might feel like you’re motivating yourself, or you may feel like you deserve it. It actually only makes it harder. It only makes it feel like you’ve got this additional thing. Again, a lot of my patients—let's use the marathon example—might yell at themselves the whole way through the marathon, but it’s not a really great experience if you’re doing that, and it takes a lot of energy.  SOLUTION #1: SELF-COMPASSION So what we offered here as a strategic solution is self-compassion—trying to motivate and encourage yourself using kindness. If you’re going through a hard day, maybe, just if you’ve never tried this before, trial what it would be like to encourage yourself with kind words or asking for support, asking for help so that you’re not burning all that extra energy, making it so much harder on yourself, increasing your suffering. Because I often say to patients, the more you suffer, the more you actually deserve self-compassion. It’s not the other way around. It’s not that the more you suffer, the less you deserve it. Do you have any thoughts on that, Chris? Chris: Oh yeah. I would say I see that across the board with my clients, this harshness, and there’s this good intention behind it, this idea that if I can just bully myself into recovery. I always try to remind clients that anxiety-based disorders, it’s a part of our bodies as well. Our brain is a part of our body, just like our arm, our tibia, our leg, all these other bones, but there’s a lack of self-empathy that we have for ourselves, as if it’s something that we’re choosing to do. Someone with a broken leg doesn’t wake up in the morning and get mad at themselves that their leg is still broken. They have understanding, and they’re working on their exercises to heal. It’s the same with these disorders.  So, the reason I love self-compassion is when we go and step in to help one of our friends, we use a certain tone, we use certain words, we tap into their strengths, we use encouragement because we know that method is going to be what boosts them up and helps them get through that rough patch. But for some reason, when it’s ourselves, we completely abandon everything we know that’s supportive, and we talk to ourselves in a way that I almost picture like a really negative boot camp instructor, like in the military, just yelling and screaming into submission. The other thing is when we’re beating ourselves up like that, we’re more likely to tap into our unhelpful habits. We’re more likely to shut down and isolate, which we see a lot in BDD, social anxiety, et cetera. But that self-compassion isn’t like a fake pop culture support. It’s really tapping into meeting yourself where you’re at, giving yourself some understanding, and tapping into the strategies that have worked in the past when you’re in a low moment.  I know sometimes people are like, “I don’t know how to do that,” but you’re doing it to everybody else in your life. Now it’s time to give yourself that same self-compassion that you’ve been giving to everybody important to you. Kimberley: Yeah, and we actually have a few episodes on Your Anxiety Toolkit on exactly how to embrace self-compassion, like how that might actually look. So, if people are really needing more information there, I can add in the show notes some links to some resources there as well.  ROADBLOCK #2: THERE WILL BE HARD DAYS  Okay. Now, Chris, can you tell us about the second most common or another common anxiety roadblock around this idea that there will be hard days? Chris: There’s always these great images if you Google about what people think recovery will look like versus what recovery looks like. I love those images because there is this idea. We see a lot of perfectionism in anxiety disorders. In OCD, we see perfectionism. So, this idea of, like, I should be here and I should easily scoot to the end. It’s not going to be like that; it’s bumpy, it’s ups and downs. We know so much factors into or impact how our men

Welcome back, everybody. This is Part 2 of Your 2024 Mental Health Plan, and today we are going to talk about the specific tools that you need to supercharge your recovery. This podcast is called Your Anxiety Toolkit. Today, we are going to discuss all the tools that you are going to have in your tool belt to use and practice so that you can get to the recovery goals that you have. Let’s go. For those of you who are here and you’re ready to get your toolkit, what I encourage you to do first is go back to last week and listen to Part 1 of this two-part series, which is where we do a mental health recovery audit. We go through line by line and look at a bunch of questions that you can ask yourself, journal them down, and find specifically what areas of recovery you want to work on this year.  Now, even if you’re listening to this as a replay and it’s many years later, that’s fine. You can pick this up at any point. This episode and last week’s episode actually came from me sitting down a few weeks ago and actually going, “Okay, Kimberley, you need to catch up and get some things under control here.” You can do this at any time in a month from now or a year from now. We’re here today to talk about tools, so let’s get going.  First, we looked at, when we did our audit, the general category. The general question was, how much distress are you under? How much time is it taking up, and how do you feel or what are your thoughts about that distress? That is a very important question. Let’s just start there. That is an incredibly important question because how you respond to your distress is a huge indicator of how much you will suffer.  If you have anxiety and your response is to treat it like it’s important, try to get it to go away, and spend your time ruminating and wrestling, you’re going to double, triple, quadruple your suffering. You’re already suffering by having the anxiety, but we don’t want to make it worse.  If you’re having intrusive thoughts and you respond to them as if they’re important and need to be solved, again, we’re going to add to our suffering. If you have grief, shame, or depression and you’re responding to that by adding fuel to the fire, by adding negative thoughts, or by saying unkind things to yourself, you’re going to feel worse. How do you respond?  WILLINGNESS Tool #1 you’re going to need in this category is willingness. When you identify that you’re having an emotion, how willing are you to make space for that emotion? I’m not saying give it your attention; I’m saying, are you willing to just allow it to be there without wrestling it, trying to make it go away? Are you willing to normalize the emotion? Yeah, it makes complete sense that I’m having a hard time, or that all humans have these emotions. How willing can you be?  Often, what I will ask my patients is, out of 10, if 10 being the highest, how willing are you? We’re looking for eights, nines, and tens here. If you’re at like a six, seven, that’s okay. Let’s see if we can get it up to the eights, nines, and tens.  VALUES OVER FEAR Another tool (Tool #2) is respond with values, not fear or emotion. We want to work at being very clear on what our values are, what is important to us. Because if we don’t, emotions will show up. They will feel very, very real. When they feel very, very real, you’re likely to respond to them as if they’re real. Again, adding fuel to the fire, adding to the suffering. Instead, we want to respond with values.  If you have fear, you’re going to ask yourself, do I want to respond based on what fear is telling me, or my values, my beliefs, the principles, the things that are important to me? If you’re depressed, do you want to respond based on what depression is telling you to do? Like, "Give up, it’s hopeless, there’s no point." Or do you want to get back in touch with what matters to you? What would you do if depression wasn’t here? What would you do if anxiety was not here?  The third tool I’m going to give you, and this is a huge one—I’m going to break it down into different categories—is mindfulness. Now, if you’ve been here on Your Anxiety Toolkit, you already know that I think mindfulness is the most important tool, one of the most important tools you will have in your tool belt. You should be using it in your tool belt every day. It’s like if you actually had a tool belt, it’d be like the hammer, the thing you probably use the most.  Mindfulness involves four things, and this is the way I want you to think about it.  MINDFULNESS Number one, it’s awareness. Mindfulness is being present and aware of what is happening to you internally. Being able to identify, I feel sad, I feel anxious, I notice uncertainty, I’m noticing I’m having thoughts about A, B, and C. That awareness can help you stay in line with your values, but stay present enough to respond wisely.  Mindfulness is also presence. I’ve already given you that word. It’s being in the here and now. Fear always wants us to look into the future; mindfulness is being in the here and now. Depression often always wants us to look at the past and ruminate on the past and what went wrong or what will potentially go wrong in the future; mindfulness is only tending to the here and now, what’s actually happening.  When I’m anxious and I become present in my body, I realize that the thing that I’m afraid of hasn’t happened yet. If it is happening, if the thing that I’m afraid of is happening, then I can still go, “Okay, what’s happening in the present? How can I relate to it?” As we’ve discussed in earlier tools, how can I relate to it in a way that doesn’t add to my suffering? Can I make some space for it? Can I be willing to have it? Can I respond with values? Really getting present in this moment will give you some space to act very skillfully.  NON-JUDGMENT The next mindfulness tool is non-judgment. We have to be non-judgmental. Often, when I’m with my patients or with my students, they will often say, “I’m having anxiety, and it is bad and wrong, and I’m wrong for having it, and it shouldn’t be here.” All of that is a judgment.  I often bring them back to the fact that anxiety, while yes, it is uncomfortable, it is neutral. Let me say that again. Anxiety, while it is uncomfortable—it’s not fun—it is neutral. It is neither good nor bad. It just is your present experience. This work becomes how willing are you to feel discomfort. How willing are you to widen your distress tolerance for this thing that you’re experiencing, and how can you practice not judging it as bad?  The thing to remember is, if you have an emotion, a sensation, or a thought, and you appraise it as bad, your brain will remember that for next time. So next time you have it, it will more likely send out a bunch of cortisol and adrenaline and a bunch of stress hormones when you have that emotion, that sensation, or that thought. And that’s how we can break this cycle by practicing non-judgment.  WISDOM AND INSIGHT The fourth piece of mindfulness that I want you to consider is wisdom and insight. This is not a typical mindfulness tool, I would say, but it’s an important piece of our work. When we have mental struggles, when we have emotional struggles, it’s very easy to fall into the trap of believing our thoughts and our feelings, going into that narrative, and getting into that story. When we do that, again, we make things worse. We tend to act on those emotions and that distress instead of our values. A lot of mindfulness, if you can practice being present, if you can practice being aware, if you can practice being non-judgmental, you then get to be steady in wisdom. You get to check the facts and respond according to the facts and the reality. You get to be level in how you respond. It doesn’t mean your anxiety will go away. It just means that you’re thinking in a way where you can make decisions. You’re connected to your prefrontal cortex, where you can make good decisions for yourself, not just respond to the emotions that you’re having. That’s sort of like a bigger picture, but that’s sort of more like the result of practicing mindfulness.  When we last week went through the audit of your mental health recovery, we also addressed safety behaviors. Now these were avoidance, reassurance seeking, mental compulsions, physical compulsions, and there is a fifth one, but we’ll talk about that later. We really went through and thoroughly investigated, did an audit, did an inventory of how many of these behaviors and what specific behaviors you do. Again, if you didn’t listen to that episode, go back and look at that because it will help you put together a really good inventory of what’s going on for you. Now, I want to address a couple of things when it comes to these. If you’re someone who does a lot of avoidance, I’m going to strongly encourage you to use Tool #4, which is find ways to face your fear. Identify all the things that you are afraid of and you’re avoiding, and find creative ways to face your fear and make it fun. If you’re afraid of something, try to find ways to make it fun that line up with your values. If you’re afraid of airplanes but love to travel, pick a place when you first start this that you’re interested in going to. Have it be something that you have been wanting to go to for a long time. Do it with someone you enjoy doing it with. If it’s something miscellaneous around the house, include the people around you, make it fun, put the music on that you want. You’re not doing that to take the discomfort away; you’re doing it so that it’s so deeply based on your values, so deeply based on what’s important to you, and purposely every day, find ways to face your fears.  Now, if you have OCD specifically and you want help with this, we have a full, comprehensive course called ERP School. If you go to CBTSchool.com, you can get access to that, and it will take you step by step on how to do that for

f you need a mental health plan for 2024, you are in the right place. This is a two-part series where we will do a full recovery audit. And then next week, we’re going to take a look at the key tools that you need for Your Anxiety Toolkit. We call it an anxiety toolkit here, so that's exactly what you’re here to get. The first step of this mental health plan for 2024 is to look at what is working and what isn’t working and do an inventory of the things that you’re doing, the safety behaviors, the behaviors you’re engaging in, and all the actions that you’re engaging in that are getting in the way of your recovery. Now what we want to do here is, once we identify them, we can break the cycle. And then we can actually start to have you act and respond in a very effective way so that you can get back to your life and start doing the things that you really, really wanted to do in 2023 but didn’t get to. If you’re listening to this in many years to come, same thing. Every year, we have an opportunity to do an audit—maybe even every month—to look at what’s working and what’s not. Let’s do it. Now, one thing I want you to also know here is this is mostly an episode for myself. A couple of weeks ago, I was not coping well. I consider myself as someone who has all the skills and all the tools, and I know what to do, and I’m usually very, very skilled at doing it. However, I was noticing that I was engaging in some behaviors that were very ineffective, that had not the best outcomes, and were creating more suffering for myself.  Doing what I do, being an anxiety specialist, and knowing what I know as a therapist, I sat down and I just wrote it all out. What am I engaging in? What’s the problem? Where am I getting stuck? And from there, naturally, I did a mental health audit. And I thought, to be honest with you, you guys probably need such a thing as well, so let’s do it together. Here is what I did. Let’s get started with this mental health audit that we’re going to do today.  FOUR RECOVERY AUDIT CATEGORIES  General Perspective  Safety Behaviors  Safety  Mindset  What we’re going to do is we’re going to break it down into four main categories. The first category is your general perspective of your mental health, your recovery, and your internal emotional experience.  The second category is the safety behaviors you’re engaging in. A safety behavior is a behavior that you do to reduce or remove your discomfort, to get a sense of safety, or to get a sense of control. Sometimes they’re effective, sometimes they’re not, and we’re going to go through that today.  The third category is actually just safety—looking at how safe you are inside your body with your internal experience. And I’ll explain a lot more of that here in a little bit, so let’s just move on to section number four, which is mindset. What is your mindset about recovery? And we’re going to go through this together.  LET’S PROMISE TO DO THIS KINDLY  As we move forward, I want you to promise me and vow to me as we do this. We are only doing it through the lens of being curious and non-judgmental. This audit should not be a disciplinary action where you wrap yourself over the knuckles and you beat yourself up, and you just criticize yourself for the fact that you’re not coping well. That is not what we’re doing here. WE ARE JUST GATHERING DATA We are ultimately just taking data. We’re just looking at the data of what’s working and what’s not. And then we get to decide what we do differently. And we get to be honest with ourselves about what’s actually happening from a place of compassion, from a place of understanding, knowing that we’re doing the best we can with what we’ve got. Again, I could beat myself up and be like, “You’re a therapist. You do this for a living. What is wrong with you?” But instead, I just recognize. Of course, you fell off the wagon. Things don’t always work out perfectly when you’re under a high amount of stress or when it’s the holidays, when things feel out of your control. We naturally gravitate to safety behaviors that often aren’t the most effective. That’s just the facts.  BE NON-JUDGMENTAL Let’s do this from a non-judgmental standpoint. We are literally just gathering data. How we handle this is a big part of recovery. Okay? Let’s do it.  YOUR RECOVERY AUDIT  Let’s first look at the first section of your recovery audit. This is a general category. We’re going to ask some questions. You can get a pen and notepad, or you could just listen and think about this, pause it, take some stock of what’s been going on for you. But I do strongly encourage you to pause, sit down, write your answers on a piece of paper, on a Google Doc, or whatever you love to do. All right, here we go.  GENERAL   Number one, generally, how much of the day do you experience anxiety, hopelessness, or some kind of emotional distress, whatever it is that you experience? You could give a percentage, a grade, or an amount of hours. How much of the day do you experience emotions that are out of your control? We’re only here to get data on how much this thing is impacting your life. You might say all day, every day. That’s okay. You might say, “A couple of hours every day that I experience panic,” or “A couple of hours every day I’m having intrusive thoughts.” It doesn't matter; just put it down. If you’re someone who has more depressive symptoms, you might say, “For six hours of the day, I experience pretty severe depression.” Whatever you’re experiencing, you can write it down.  The second question in this category is, what are your thoughts about the emotional distress that you just documented? What are your thoughts about them? If you have anxiety, are your thoughts “I shouldn’t have anxiety”? Because what we gather there is if for, let’s say, two hours a day, you’re having anxiety, but for four hours a day, you’re saying, “I shouldn’t have it. I’m bad for having it. What’s wrong with me? Something is wrong. I’m terrible,” and so forth, we want to understand, what are the specific thoughts you’re having about the emotional distress?  If you have OCD and you’re having a lot of intrusive thoughts, what are your thoughts about that? “Oh, my thoughts make me a bad person. Oh, my intrusive thoughts mean I must want to do the thing that I’m having thoughts about.” If you’re having depression, what are your thoughts about that? “Oh, I’ll never get better, that I’m weak for having this struggle, that I should be able to handle it better. I should be able to get out of bed and function normally.” We want to really understand your general mindset and perspective of what you’re going through.  Often, we spend a lot of time thinking about why we have the problem. Why do I have this? What’s wrong with me? What did I do wrong? Why is this happening? Was it my past? Was it something that happened to me? Spending a lot of time trying to figure out why. That’s the general category.  SAFETY BEHAVIORS The second category, safety behaviors, is probably one of the most important, but there is a good chance I’m going to say that about every category, so let’s just go through them.  The first question in safety behaviors is, how much of the day do you spend ruminating, thinking, going over and over the problem, trying to solve it? How many minutes, how many hours, or what percent of the day do you spend ruminating?  We’ve already identified how much of the day you spend with the original, initial problem. But how much of the time do you actually spend engaging in the behavior of mental compulsions, mental rumination, sort of that real stressful solving practice? Write it down. Again, we’re not judging here. Even if you wrote 100% of the day, all day, every day for a year or 10 years, it doesn’t matter, okay?  The next question in safety behaviors is, if you zoomed out and looked at your entire life, what is it that you are avoiding because of this internal emotional experience, whether it be anxiety, uncertainty, depression, grief, whatever it might be, panic? Whatever it is, what is it specifically that you’re avoiding?  Some people say, “I’m avoiding a certain street. I’m avoiding a certain person. I’m avoiding a certain event. I’m avoiding an emotion. I’m avoiding a feeling. I’m avoiding a thought. I’m avoiding a specific book on a specific bookshelf. I’m avoiding a specific movie on the internet or on TV. I’m avoiding a specific topic in every area of my life.” Be as specific as you can. What is it that you are avoiding to try and reduce or remove your distress inside your body? Document all of it.  I tell my patients, it doesn’t matter if this takes 17 pages; just document it down. Don’t judge yourself. Once we have the data, we can next week meet and work on a solution here. Or as you go through this, if you’ve already clearly identified that you have, let’s say, OCD, generalized anxiety, panic, or depression, we have specific courses on CBTSchool.com that will walk you through these and give you specific solutions to specific problems. That is there for you as well.  We will next week go through the main tools you’re going to need. But if you really want to target a specific issue, we may have a course specifically in that area that will help you. If not, there are other areas where you can get resources and therapy as well. But this is going to help you get really clear on what specifically is going on for you. What is it that you’re engaging in that’s getting in the way? The next safety behavior category is, how do you carry your body throughout the day? Are you hypervigilant? Are you tense? Are you rushing around? That was me. That’s when I was like, “Oh, Kimberley, you are going down the wrong channel.” Because I noticed in many areas of my day, I was rushing, trying to avoid some emotions, trying to check boxes, rushing around, hypervigilant, looking around, what bad thing is going to h

Kimberley: Could I have PTSD or trauma? This is a question that came up a lot following a recent episode we had with Caitlin Pinciotti, and I’m so happy to have her back to talk about it deeper. Let’s go deeper into PTSD, trauma, what it means, who has it, and why we develop it. I’m so happy to have you here, Caitlin. Caitlin: Yes, thank you for having me back. INTRODUCING CAITLIN PINCIOTTI Kimberley: Can you tell us a little bit about you and all the amazing things you do? Caitlin: Of course. I’m an assistant professor in the Psychiatry and Behavioral Sciences Department at Baylor College of Medicine. I also serve as the co-chair for the IOCDF Trauma and PTSD in OCD Special Interest Group. Generally speaking, a lot of my research and clinical work has specifically focused on OCD, PTSD, and trauma, in particular when those things intersect, what that can look like, and how that can impact treatment. I’m happy to be here to talk more specifically about PTSD. WHAT IS PTST VS TRAUMA? Kimberley: Absolutely. What is PTSD? If you want to give us an understanding of what that means, and then also, would you share the contrast of—now you hear more in social media—what PTSD is versus trauma? Caitlin: Yeah, that’s a great question. A lot of people use these words interchangeably in casual conversation, but they are actually referring to two different things. Trauma refers to the experience that someone has that can potentially lead to the development of a disorder called post-traumatic stress disorder. When we talk about these and the definitions we use, trauma can be sort of a controversial word, that depending on who you ask, they might use a different definition. It might be a little bit more liberal or more conservative.  I’ll just share with you the definition that we use clinically according to the DSM. Trauma would be any sort of experience that involves threatened or actual death, serious injury, or sexual violence, and there are a number of ways that people can experience it. We oftentimes think of directly experiencing trauma. Maybe I was the one who was in the car accident. But there are other ways that people can experience trauma that can have profound effects on them as well, such as witnessing the experience happening to someone else, learning that it happened to a really close loved one, or being exposed to the details of trauma through one’s work, such as being a therapist, being a 911 telecommunicator, or anyone who works on the front lines.  That’s what we mean diagnostically when we talk about trauma. It’s an event that fits that criteria. It can include motor vehicle accidents, serious injuries, sexual violence, physical violence, natural disasters, explosions, war, so on and so forth—anytime when the person feels as though their bodily integrity or safety is at risk or harmed in some way.  Conversely, PTSD is a mental health condition. That’s just one way that people might respond to experiencing trauma. In order to be diagnosed with trauma, the very first criterion is that you have to have experienced trauma. If a person hasn’t experienced an event like what I described, then we would look into some other potential diagnoses that might explain what’s going on for them, because there are lots of different ways that people can be impacted by trauma beyond just PTSD. PTSD SYMPTOMS AND PTSD DIAGNOSIS  Kimberley: Right. What are some of the specific criteria for being diagnosed with PTSD? Caitlin: PTSD is comprised of 20 potential PTSD symptoms, which sounds like a lot, and it is. It can look really different from one person to the next. We break these symptoms down into different clusters to help us understand them a little bit better. There are four overarching clusters of PTSD symptoms. There’s re-experiencing, which is the different ways that we might re-experience the trauma in the present moment, such as through really intrusive and vivid memories, flashbacks, nightmares, or feeling really emotionally upset by reminders of the trauma.  The second cluster is avoidance. This includes both what we would call internal avoidance and external avoidance. Internal avoidance would be avoiding thinking about the trauma, but also avoiding any of the emotions that might remind someone of the trauma. If I felt extremely powerless at the time of my trauma, then I might go to extreme lengths to avoid ever feeling powerless again in my life. In terms of external avoidance, that’s avoiding any cue in our environment that might remind us of the trauma. It could be people, places, different situations, smells, or anything involving the senses. That’s avoidance.  The third cluster of PTSD symptoms is called negative alterations, cognitions, and mood, which is such a mouthful, but it’s basically a long way of saying that after we experience trauma, it’s not uncommon for that experience to impact our mood and how we think about ourselves or other people in the world. You’ll see some symptoms that can actually feel a little bit like depression, maybe feeling low mood, or an inability to experience positive emotions. But there’s also this kind of impact on cognition—an impact on how I view myself and my capabilities, maybe to the extent that I can trust other people or feel that the world is dangerous. Blame is really big here as well. And then the last cluster of symptoms is called hyperarousal. This is basically a scientific word for your body—sort of kicking into that overdrive feeling of that fight, flight, freeze response. These include symptoms where your body is constantly in a state of feeling like there’s danger or threat. This can impact our concentration. It can impact our sleep. We might have angry outbursts because we’re feeling really on edge. We may feel as though we have to constantly watch our backs, survey the situation, and make sure that we are definitely going to be prepared and aware if another trauma were to happen.  Those are the four overarching symptom clusters. But somebody only actually needs to have at least six of those symptoms to a clinically significant and impairing way. Kimberley: Right. Now, I remember early in my own treatment, a clinician using terms like little T trauma and big T trauma. The example that I was discussing is I grew up on a ranch, a very large ranch. My dad is and was a very successful rancher. Every eight to 10 years, we would have this massive drought where we would completely run out of water and we’d have to have trucks bring in water, and there were dead livestock everywhere. It was very financially stressful. I remember her bringing up this idea of what is a little T trauma and what is a big T trauma—not to say that that’s what was assigned to me, but that was the beginning of when I heard this term. WHAT IS BIG T TRAUMA VS LITTLE T TRAUMA?  What does it actually mean for someone to say big T trauma versus small T trauma? Caitlin: Yeah, this is another common term that people are using. I’m glad that there is language to describe this because a lot of times, when I provide the definition that I gave a few minutes ago about what trauma is according to the DSM, people will hear that and think, “Wait a minute, my experience doesn’t really fit into that criteria, but I still feel like I’ve been really impacted by something. Maybe it’s even making me experience symptoms that really look and feel a lot like PTSD.” Some people can find that really invalidating, like, “Wait a minute, you’re saying that what I experienced wasn’t traumatizing and it feels like it was traumatizing.”  Those terms can be used to separate out big T trauma, meaning something that meets the DSM definition that I provided—that really more strict definition of trauma. Whereas little T trauma is a word that we can use to describe these other experiences that don’t quite fit that strict criteria but still subjectively felt traumatizing to us and have impacted us in some way.  What’s interesting is that there’s some research that suggests that the extent to which somebody subjectively feels like something was traumatic is actually more predictive of their mental health outcomes than whether or not it meets this strict definition because we see people all the time who experience big T traumas and they might be totally fine afterwards. And then there are people who experience little T traumas and are really struggling.  We can use little T trauma to describe things like racial trauma, discrimination, minority stress, the experiences that you described, and even just significant interpersonal losses and things like that. Kimberley: Yeah. Maybe even COVID. For some, it was a capital T trauma, would you say, because they did almost lose their lives or witness someone? Is that correct? Would you say that some others would have interpreted it as a smaller T and then some wouldn’t have experienced it as a trauma at all? Caitlin: Yes, I think that’s a great example because there are definitely a lot of folks who don’t necessarily know someone who became really ill, lost their life, or didn’t have that personally happen to them. But there was this looming stress, maybe even related to quarantine and isolation and things like that. WHO GETS PTSD AND TRAUMA? Kimberley: This is really fascinating. I wonder if you could share a little, like, of all the people, what are the factors that you mentioned that increase someone’s chances of going on to have PTSD? Who goes on to get PTSD, and who doesn’t? How can we predict that? What do we know from the research? Caitlin: This is an interesting question because I think that some people might intuitively think, “Well, somebody experienced this really horrible trauma. Of course, they’re going to go on to develop PTSD.” We actually know that people on the whole can be pretty resilient even in the face of experiencing pretty horrible tragedies.  Our estimates of exposure to what we would call potentially

Radical acceptance when things get hard can be a very difficult practice. In fact, it can be almost impossible. When things get hard, one of the things we often do is we spend a lot of time ruminating about why it’s so hard and what we could have done to prevent it from being so hard. And, instead of using radical acceptance, we often go into beating ourselves up, telling ourselves, “We should have done this; we could have done that. If only we had looked at it this way or treated it this way.” I want us to really zoom in on these safety behaviors that you’re probably doing. Hopefully, today, you leave here committing to reducing or eliminating those behaviors. Now, I get it. When things are hard, we don’t want to feel the suffering that goes with it. I get it. I don’t want to feel it either. You’re not alone. But when things are hard, often, instead of letting it be hard and feeling our feelings and being kind to ourselves so that we can move into effective behaviors, we get stuck resisting the emotions and doing these other behaviors that increase the shrapnel of the event. I call it ‘shrapnel’ because it does look like that. It creates more damage around us. Let’s look at how we might prevent this.  HUMANS SUFFER You’re suffering. The reason I know this is because you’re a human being, and all human beings have sufferings in their lives. Some of us, more than others. If you’re in a season where the suffering is high, I would basically say, the higher the level of suffering, the more you need to listen in. Maybe listen to this multiple times, get your notepad out, and let’s really go to work.  SOLVING DOESN’T ALWAYS WORK When you’re suffering and your suffering is high, again, it’s very normal to want to solve why you’re suffering, thinking that yes, that may prevent it from happening in the future, prevent us from having more pain, or prevent us from having to feel our feelings. That’s effective behavior, except... if you’re relying on that and you’re spending too much time doing that, chances are, you’re increasing your shrapnel. If that’s the case, let’s talk about other alternatives.  When we’re going through difficult things, there is a strong pull toward figuring out why. But my guess is, if you haven’t solved it yet, chances are you won’t. I know this is true for me. It might be true for you, but you’ve probably already identified the problem of one of the things that may be if, in 20/20 hindsight, you could have done differently. And that’s okay, right? There’s many times I’ve looked back and been like, “Yeah, it didn’t handle that well,” or “That didn’t go as well. Maybe now, knowing what I know, I could have done something different.” But often, we spend too much time resisting the fact that it is hard right now.  If you’re someone who’s spending a lot of time going over and over on repetition, all the things you could have done, chances are, you’re not radically accepting what is. What we want to do first is move to radical acceptance as fast as we can. We’re not saying that you can’t go back and do some effective addressing of what went wrong and what went right. You can do that for short periods of time. But if you’re someone who’s doing it repetitively, catch yourself. We want to move into radical acceptance that yes, things are hard right now. WHY DOES RADICAL ACCEPTANCE SUCK? Often, we resist practicing radical acceptance because of one core reason, and that’s because we don’t want to feel bad. We don’t want to feel the guilt. We don’t want to feel shame. We don’t want to feel the uncertainty. We don’t want to feel sad. We don’t want to feel angry, grief, or panic, whatever it might be. It might be physical pain. We don’t want to feel it. And so hand in hand goes this work of radically accepting the suffering that you’re experiencing in whatever form, whether it be emotional, physical, spiritual, or other, and then really being willing and creating a safe place to feel those feelings. I’m not saying ruminate on those feelings, make them worse, or agree with everything you’re thinking and feeling. No. I’m just saying, being able to observe that yes, sadness is here, or grief is here, or anxiety is here. It’s showing up in these ways in my chest, in my head, in my shoulders, in my neck, in my hips, in my tummy, wherever it’s showing up for you. First radically accepting it and then being willing to feel those experiences and those sensations. We alternate between those two. We radically accept, then be willing and open. Then we have to go back and radically accept, be willing, and be open. RADICAL ACCEPTANCE IS REPETITIVE I want to remind you that it’s okay that you have to do this on repeat. Often, with my patients—and I do this too, I have to admit—we practice radical acceptance, we practice self-compassion, we practice willingness for a little while, and then we get frustrated because it’s not making it go away. It’s not fixing it. It’s not making it disappear. So we go back to trying to solve, “Why is this happening? Why shouldn’t it be this way? What did I do wrong?” instead of knowing that this is a repetitive practice that we commit to over and over again. It’s like brushing our teeth. We don’t do it once and go, “Great, it should be done.” No, we go back, and we’ve accepted that we’ll do it every morning and we’ll do it every night. For some of you, at lunchtime too. I really want you guys to catch this deep urge and urgency to resist what really is and resist the feelings that go ahead and accompany that experience. We want to move back as fast as we can into radically accepting that it is what it is.  RESISTING RADICAL ACCEPTANCE Now, if you’re anything like me, a part of your brain is going to go, “But it’s not fair. This is not fair. It is too much. Other people don’t seem to be having these problems. It’s not fair that I have this problem. It’s not fair that mine is so big right now and theirs is not.” I get that too.  Also just acknowledge, you may even want to just validate and go, “Yeah, this is my season. They’ll have theirs.” I promise you, they’ll have theirs. Hopefully not. We don’t want to spread more pain around. But with being a human, it’s 50/50. It’s 50% hard and 50% wonderful, and that’s a part of being human. They’ll have their season; you’re in yours. It is temporary.  Again, resist the urge to stay in the rumination of “It’s not fair.” You can validate that by going, “Yes, it is not fair. This is a hard deck of cards that I’ve been dealt right now. I’m going to again try to reduce the shrapnel by not engaging in the why me and why did this happen and it shouldn’t have, and it’s not fair.”  I want to also say it’s okay that you land there. That is a normal part of the grief process to land in that bargaining phase of grief. What we’re really speaking to today is when you get caught in that.  I NEED RADICAL ACCEPTANCE TOO Now, I am speaking to you about this because I needed to hear this message more than any of you today. This is actually as much for me as it is for you. I think that as I go through very difficult seasons in my life, I find them incredibly humbling because it helps me to see the story that I have told myself, the story that things should go well for me, that things shouldn’t be hard, that I shouldn’t suffer as much as I do in certain areas, that I should somehow magically be able to solve this or control this, and that other people want me to be able to handle this, so therefore, I should be able to.  I forget my humanness. I keep getting humbled by my humanness. I feel like the world keeps coming to show me, “Kimberley, you’re just like everybody else.” Everybody suffers. How can you lean in and have this be an opportunity to deepen your self-compassion practice, deepen your mindfulness practice, and deepen your ability to feel any emotion that shows up? Because they will, many times in my lifetime. They will continue to show up in different ways because I’m a human, not because I’m a faulty person. All humans have these feelings.  For you, you also have to remember, these are normal human feelings. You didn’t do anything wrong. It’s not your fault that you’re having them so strong right now. Resist the urge to go into self-punishment for the fact that you’re suffering.  Again, radically accept that it is painful right now, and then move into willingness and openness to feel those feelings and create the safest, softest, gentlest landing for you as you navigate these really difficult emotions. As you do it, not to replace it, not to make them go away, but to help guide you through them.  YOU CANNOT BYPASS EMOTIONS You can’t bypass emotions. I have learned that one the hard way. You can’t bypass them. If you do, you’re probably increasing your problems. If you’re doing compulsions to get your uncertainty and your anxiety to go away, you’re going to have more of that obsession. If you’re avoiding the thing that’s hard, you’re probably going to feel disempowered, and it’s going to be a bigger problem. If you’re resisting your emotions and you’re resisting your experience, at some point, they will probably blow up and explode, and you’ll feel them a lot.  Our job, again—and this is my goal for myself, and I hope it’s your goal too—is I want to be a place, a container. I want to be able to experience the full range of emotional experiences safely so that in the future, when hard days come, when I lose loved ones, when I go through hard times, when I witness difficult things, I already know that I have the ability to wade through this.  WHEN YOU FEEL LIKE YOU CANNOT HANDLE IT ANYMORE  The people who are struggling with “I can’t handle this,” they’re the ones who have done everything they can to avoid feeling their feelings, and they haven’t gotten much experience with learning to master emotions. When we do learn that we can have emotions and we do learn that we can tolerate them, then we d

Kimberley: Is ERP traumatizing? This is a question I have been seeing on social media or coming up in different groups in the OCD and OCD-related disorders field. Today, I have Amy Mariaskin, PhD, here to talk with us about this idea of “Is ERP traumatizing” and how we might work with this very delicate but yet so important topic. Thank you, Amy, for being here. WHY MIGHT PEOPLE THINK ERP IS TRAUMATIC?  Kimberley: Let’s just go straight to it. Why might people be saying that ERP is traumatic or traumatizing? In any of those kinds of terms, why do you think people might be saying this? Amy: I think there’s a number of reasons. One of which is that a therapy like ERP, which necessitates that people work through discomfort by moving through it and not moving around it or sidestepping it, is different than a lot of other therapies which are based more on support, validation, et cetera, as the sole method. It’s not to say that ERP doesn’t have that. I think all good therapy has support and validation. However, I think that’s part of it. The fact that’s baked into the treatment, you’re looking at facing discomfort and really changing your relationship with discomfort. I think when people hear about that, that’s one reason that it comes up. And then another reason, I think, is that there are people who have had really negative experiences with ERP. I think that while that could be true in a number of different therapeutic modalities and with a number of different clinicians and so forth, it is something that has gained traction because it dovetails with this idea of, well, if people are being asked to do difficult things, then isn’t that actually going to deepen their pain or worsen their condition rather than alleviate it? That’s my take. Kimberley: When I first heard this idea or this experience, my first response was actual shock because, as an ERP therapist and someone who treats OCD, I have seen it be the biggest gift to so many people. I’ve heard even Chris Trondsen, who often will say that this gave him his life back, or—he’s been on the show—Ethan Smith, or anyone really who’s been on the show talk about how it’s the most, in their opinion, like the most effective way to get your life back and get back to life and live your life and face fear and all of those things.  DO PEOPLE FEEL ERP IS A DIFFICULT TREATMENT? I had that first feeling of surprise and shock, but also then asked more questions and asked about their experience of ERP being very pressured or feeling too scared or too soon, too much too soon, and so forth. Do you have any other ideas as to why people might be experiencing this difficult treatment? Amy: I do. I think that sometimes, like any other therapy, if you’re approaching therapy as a technician and not as a clinician, and you’re not as a therapist really being aware of the cues that you’re getting from the very brave people sitting in front of you, entrusting their care to you—if we’re not being clinicians rather than technicians, we can sometimes just follow a protocol indiscriminately and without respect to really important interpersonal dynamics like consent and context, personal history, if there’s not an awareness of the power dynamic in the room that a therapist has a lot of power.  We work with a lot of people as well who might have people pleasing that if you’re going to be quite prescriptive about a certain treatment, you do this, and then you do this, and then you do this without taking care to either lay the foundation to really help somebody understand the science of how ERP works or get buy-in from the front end. I know we’ll talk a little bit more about that, as well as there’s a difference between exposure and flooding. There’s a difference between exposure that serves to reconnect people with the parts of their lives that they’ve been missing, or, as I always call it, reclaims. We want to have exposures that are reclaims, as opposed to just having exposures that generate negative emotion in and of itself.  Now, sometimes there are exposures that just generate negative emotions, because sometimes that’s the thing to practice. There are some people who feel quite empowered by these over-the-top exposures that are above and beyond what you would do to really have a reclaim. I’m going to go above and beyond for an exposure, and I’m going to do something that is off the wall. I am eating the thing off of the toilet, or I have intrusive thoughts about harming myself, and I’m going to go to the top of the parking garage, and I’m really going to lean all the way over. Would I do that in my everyday life? No. There are some clients for whom that is not something that they’re willing to do or it’s not something that’s important for them to do to reconnect with the life that they want to live, and there are others who are quite empowered.  If you’re a therapist and you don’t take care to listen to the feedback from clients and let their voice be a part of that conversation, then you may end up, again, as a technician, prescribing things that aren’t going to land right, and that could result in some harm. My heart goes out to anyone who’s had that experience, because I think that’s valid. Kimberley: I will be completely honest. I think that my early training as an ERP therapy clinician, because I was new, meant that I was showing up as a technician. When I heard this, again, I said my first thought was a little bit of shock, but then went, “Oh, no, that does make sense.” When I was an intern, I was following protocols and I was learning. We all, as humans, make mistakes. Not mistakes so much as if I feel like I did anything wrong, but maybe went too fast with a patient or pushed too hard with a patient or gave an exposure because another person in supervision was saying that that worked for their client, but I was learning this skill of being attuned to my client, and that was a learning process. I can understand that some people may have had that experience, even me. I’m happy to admit to that early in my training, many years ago. Amy: That’s a great point. I think if we’re all being honest with ourselves, whether it be within the context of ERP or otherwise, there is a learning curve for therapists as well. I think going back to the basic skills and tenets of what it means to have a positive therapeutic relationship is that so much of that has to do with the repair as well. If there are times, because there will be times when you misjudge something or a client says, “I really think that I’m ready to try this,” then we say things like when exposures go awry, when the worst-case scenario happens, or what have you.  That’s another philosophical question because I think in doing exposures, we’re not necessarily, at least my style, saying the bad thing’s not going to happen. It’s about accepting the risk and uncertainty, which is a reasonable amount. However, I think when those things happen where it does feel like, “Hey, this felt like too much too soon,” or this felt like, “Wow, I wasn’t ready for this,” or “I don’t feel like that’s exactly what I consented to. You said we were going to do this, and then you took an extra step”—I think being able to create an environment where you can have those conversations with clients and they feel comfortable bringing it up with you and you can do repair work is also important. That it’s not just black or white like, “This happened and I feel traumatized.” Again, I don’t want to sound like I’m blaming anybody who’s had that experience, but I’m just saying that I think that happens on a micro level, probably to all of us at some point.  I think it’s also important to acknowledge, and later we’re going to talk about it, but the notion of the word ‘traumatizing’ is a little bit difficult for me to hear as well because I think from the perspective of an evidence-based practitioner, the treatments that we have, even for so-called big T trauma, many of them integrate in exposure. All of my first-line treatments, including ones that maybe come at it a little bit more obliquely like EMDR or something like that, which is not something that I personally use, are certainly out there as like a second-line trauma treatment. But things like prolonged exposure and cognitive processing therapy, they all have this exposure component to them. Even the notion that if there’s trauma, you can’t go there or that talking about hard things is traumatizing. I don’t know. Can we talk a little bit about that? Because I don’t know if that’s something you’ve thought about too, that it’s hard to reconcile. Kimberley: Yeah. Let me give a personal experience as somebody who had a pretty severe eating disorder. I was doing exposure therapy, but I didn’t get called that, and I didn’t know what to be that at the time. But I had to go and eat the thing that I was terrified to eat. While some people might think, “Well, that’s not a hard exposure,” for me, it was a 10 out of 10. I wanted to punch my therapist in the face at the idea that she would suggest that I eat these things. I’m not saying this is true for other people; I’m just giving a personal experience. I’m actually really glad that she held me to these things because now I can have full freedom over the things that used to run my life. I know that there is nothing on any menu I can’t eat. If I had to eat on any plane, whatever they served me, I knew I was able to nourish my body with what was served to me, which I didn’t have before I did that.  The other piece is somebody who has also been through trauma therapy. A lot of it required me to go back and relive that event over and over. Even though I again wanted to run away and it felt like my brain was on fire, that too was very helpful. But what was really helpful was how I reframed that event. If I was doing it and, as I was doing it, I was saying, “This is re-traumatizing me,” it was a very bad experience. But if I was sayin

Kimberley: Welcome back, Ethan Smith. I love you. Tell me how you are. First, tell me who you are. For those who haven’t heard of your brilliance, tell us who you are. Ethan: I love you. My name is Ethan Smith, and I’m a national advocate for the International OCD Foundation and just an all-around warrior for OCD, letting people know that there’s help and there’s hope. That’s what I’ve dedicated my life to doing. Kimberley: You have done a very good job. I’m very, very impressed. Ethan: I appreciate that. It’s a work in progress. Kimberley: Well, that’s the whole point of today, right? It is a work in progress. For those of you who don’t know, we have several episodes with Ethan. This is a part two, almost part three, episode, just catching up on where you’re at. The last time we spoke, you were sharing about the journey of self-compassion that you’re on and your recovery in many areas. Do you want to briefly catch us up on where you’re at and what it’s been like since we met last? Ethan: Yeah, for sure. We’ll do a quick recap, like the first three minutes of a TV show where they’re like, “So, you’re here, and what happened before?”  Kimberley: Previously on. Ethan: Yeah, previously, on real Ethans of Coweta County, which sounds super country and rural. The last time we spoke, I was actually really vulnerable. I don’t mean that as touting myself, but I said for the first time publicly about a diagnosis of bipolar. At that time, when we spoke, I had really hit a low—a new low that came from a very hypomanic episode, and it was not related to OCD. I found myself in a really icky spot. Part of the reason for coming or reaching that bottom was when I got better from OCD into recovery and maintenance, navigating life for the first time, really for the first time as an adult man in Los Angeles, which isn’t an easy city, navigating the industry, which isn’t the nicest place, and having been born with OCD and really that comprising the majority of my life. The next 10 years were really about me growing and learning how to live. But I don’t know that I knew that at the time. I really thought it was about, okay, now we’re going to succeed, and I’m going to make money, live all my dreams, meet my partner, and stuff’s going to happen because OCD is not in the way. That isn’t to say that that can’t happen, and that wasn’t necessary. I had some amazing life experiences. It wasn’t like I had a horrible nine years. There were some wonderful things. But one of the things that I learned coming to this diagnosis and this conclusion was how hard I was being on myself by not “achieving” all the goals and the dreams that I set out to do for myself. It was the first time in a long time, really in my entire life, that I saw myself as a failure and that I didn’t have a mental illness to blame for that failure. I looked at the past nine years, and I went, “Okay, I worked so hard to get here, and I didn’t do it. I worked so hard to get here in a personal relationship, and I didn’t get there. I worked so hard to get here financially, and I didn’t even come close." In the past, I could always say, “Oh, OCD anxiety.” I couldn’t do it. I couldn’t finish it. I dropped out. That was always in the way. It was the first time I went, “Oh wow, okay, this is on Ethan. This is on me. I must not be creative enough, smart enough, good enough, strong enough, or brave enough.” That line of thinking really sent me down a really dark rabbit hole into a really tough state of depression and hypomania and just engaging in unhealthy activities and things like that until I just came crashing down. When we connected, I think I had just moved from Los Angeles to Atlanta and was resetting in a way. At that time, it very much felt like I was taking a step back. I had left Los Angeles. It just wasn’t a healthy place for me at that time. My living situation was difficult because of my upstairs neighbor, and it was just very complicated. So, I ended up moving back to Georgia for work, and I ended up moving back in with my parents. I don’t remember if we talked about that or not, but it was a good opportunity to reset. At that time, it very much looked and felt like I was going backwards. I just lived for 10 years on my own in Los Angeles, pursuing my dreams and goals. I was living at home when I was sick. What does this mean? I’m not ready to move. I’m not ready to leave. I haven’t given up on my dream. What am I doing? I think if we skip the next three years from 2019 on, in retrospect, it wasn’t taking a step back; it was taking a step forward. It was just choosing a different path that I didn’t realize because that decision led to some of the healthiest, most profound experiences in my life that I’m currently living. I can look back at that moment and see, “Oh, I failed. I’ve given up.” This is backwards. In reality, it was such a beautiful stepping stone, and I was willing to step back to move forward, to remove myself from a situation, and then reinsert myself in something. Where I am now is I’m engaged, to be married. I guess that’s what engaged means. I guess I’m not engaged with a lawyer. I’m engaged, and that’s really exciting. Kimberley: Your phone isn’t engaged. Ethan: Yeah, for sure, to an amazing human being. I have a thriving business. I’m legitimately doing so many things that I never thought I would do in life ever, whether it had to do with bipolar or more prominently in my life, OCD, where I spent age 20 to 31, accepting that I was home-ish bound and that was going to be my life forever and that I’m “disabled” or “handicapped,” and that’s just my normal. I had that conversation with my parents. That was just something that I was going to have to live with and accept. I’m doing lots of things that I never expected to do. But what I’ve noticed with OCD is, as the stakes seem raised because you’re engaging yourself in so many things that are value-driven and that you care about, the stakes seem higher. You have more to lose. When you’re at the bottom, it’s like, okay, so what? I’m already like all these things. Nothing can go wrong now because I’m about to get married to my soulmate, and my business is doing really well. I have amazing friends, and I love my OCD community. The thoughts and the feelings are much more intense again because I feel like I have a lot more to lose. Whereas I was dismissing thoughts before, now they carry a little bit more weight and importance to me because I’m afraid of losing the things that I care about more. There’s other people in my life. It’s not just about me. With that mindset came not a disregard but almost forgetting how to be self-compassionate with myself. One of the things that came out of that bipolar diagnosis in my moving forward was the implementation of active work around self-compassion. I did workbooks, I worked very closely with my therapist, and we proactively did tons and tons of work in self-compassion. You can interrupt me at any time, because I’ll keep babbling. So, please feel free to interrupt. I realized that I was not practicing self-compassion in my life at all. I don’t know that I ever had. Learning self-compassion was like learning Japanese backwards. It was the most confusing thing in the world. The analogy that I always said: my therapist, who I’ve been with for 13 years, would say to me, “You just need to accept where you are and embrace where you are right now. It’s okay to be there. Give yourself grace.” She would say all these things.  I always subscribe to the likes of, “You have to work harder. You can’t lift yourself off the hook. Drive, drive, drive, drive.” That was what I knew. I tried to fight her on her logic. I said, “If there’s a basketball team and they’re in the finals and it's halftime and they’re down by 10, does the coach go to the basketball team and say, ‘Hey guys, let’s just appreciate where we are right now; let’s just be in this moment and recognize that we’re down by 10 and be okay with that.’” I’m like, “No, of course not. He doesn’t go in there and say that. He goes, ‘You better get it together and all this stuff.’” I remember my therapist goes, “Yeah, but they’re getting out of bed.” I’m like, “Oh, okay, that’s the difference.” They’re actually living their life. I’m completely paralyzed because I’m just beating myself down.  But what I’ve learned in the last three or four years is that self-compassion is a continuous work in progress for me and has to be like a conscious, intentional practice. I found myself in the last year really not giving myself a lot of self-compassion. There’s a myriad of reasons why, but I really wanted to come on and talk about it with you and just share some of my own experiences, pitfalls, and things that I’ve been dealing with.  I will say the last two years have probably been the hardest couple of years and the most beautiful simultaneously, but hard in terms of OCD, thoughts and triggers, anxiety, and just my overall baseline comfort level being raised because, again, there’s so many beautiful things happening. That terrifies me. I mean, we know OCD is triggered by good stress or bad stress. So, this is definitely one of those circumstances where the stakes seem higher. They seem raised, so I need more certainty. I need it. I have to have more certainty. I don't, really. I’m okay with uncertainty, but part of that component is the amount of self-compassion that I give myself. I haven’t been the best at it the last couple of years, especially in the last six months. I haven’t been so good. Kimberley: I think this is very validating for people, myself included, in that when you are functioning, it doesn’t seem like it’s needed. But when we’re not functioning, it also doesn’t feel like it’s needed. So, I want to catch myself on that. What are some roadblocks that you faced in the implementation of this journey of self-compassion or the practice of self-compassion? What gets i

Today, we are going to talk about what to do when feeling hopeless. Today’s episode was actually inspired by one of our amazing Your Anxiety Toolkit podcast listeners. They wrote in and asked a question about hopelessness, and I thought it was so important and so relevant in today’s day, with the news being scary and everybody struggling and still readjusting to COVID, mental health, and mental illnesses at an all-time high. I really felt that this was important for us to talk about. So, let’s do this together. We’re going to take it step by step, and we’re going to do it with a whole lot of self-compassion. So let’s talk about what to do when feeling hopeless.  Alright folks, here is the question that was posed to me. It goes like this: “I have been really struggling with hopelessness lately. It feels like my life has no real meaning, and I feel pretty aimless. The things in my life that I want to improve need so much work to improve, such as career, relationship, family stuff. And I have large parts that are out of my control, which feels pretty discouraging despite lots of effort to improve them. I’m working to accept these feelings and trying to stay out of rumination, but it does feel hopeless a lot of the time. What are you telling folks who are in a similar position?” Now, number one, I so resonate with this question. As a clinician, a human, a mom, and someone with a chronic illness, I hear you in this question, and I don’t think you’re alone. In fact, I am a member of a pretty large online group of therapists, and I wanted to do my homework for today. So I left the question, saying, when you have clients who are experiencing hopelessness and they’re feeling stuck, what do you say? A lot of them were coming with these such humble responses of saying, “To be honest, I tell them the truth, which is I don’t know the answer. I too struggle with this.” Or they’ll say, “I often let them know that they’re not alone in this and that this is such something that collectively we’re all going through.” And I loved that they were so real and dropped into reality on the truth of this, the pain of this, and the confusion of this topic.  Now, in addition to that, there were also some amazing pieces of advice, and some of them I really agreed with. I’m going to include them here when we go through specifically some tools that you can use to help you when you’re struggling with this feeling of hopelessness or feeling like what’s the point and feeling like there’s no meaning to life.  Let’s talk about it. Number one—let me just be real with you—is I too have struggled with this. In fact, it wasn’t that long ago that I actually sought out therapy for this specific issue. I looked around my life, and I have these two beautiful children, I have two businesses and a career that I love, and I still felt hopeless. I still felt like this sense of what’s the point? What’s the meaning of all this? I’m working my butt off, trying to manage all the things. What is the real point? It felt a little like an existential crisis, to be honest.  I love that this person reached out to ask this question. I do encourage you all, if you’re struggling with this and navigating this, do go and seek therapy. I’m going to be giving you some tools on how to manage this today, but in no way do I think that my solutions are going to be exactly what you need to hear. There may be some of them that are super helpful for you, but I strongly encourage you to go and navigate them on your own.  Through exploring this, I found that there were some unmet needs that I was not paying attention to. I found that I was grieving living in a country that’s not my home country. So many parts of it were also related to my chronic illness. And so it was very personal work, and I encourage you too to do that personal work.  But, given that we’re here today, I also want to give you some strategies, skills, and direction if you too are wondering what to do when feeling hopeless. Let’s do this together. THERAPY FOR HOPELESSNESS The first thing here is I love that the person who wrote this said, “I’m working at accepting the feelings.” I think that that is probably the biggest key here, which is not accepting that they’ll be there forever but instead accepting that they’re here right now and reminding yourself that they’re temporary.  HOPELESSNESS IS A TEMPORARY EMOTION Hopelessness, like any other emotion, is a temporary emotion. It will rise and fall, rise and fall, and rise and fall. It doesn’t mean that you’ll always feel this way. What we can do is, while we’re accepting it, I often ask my patients, “As you accept it, let’s also be very curious about any resistance you have in your body as you practice accepting.”  I’ve had clients who’ve sat on the couch of my office and said, “No, no, I’m accepting it.” But every part of their body is clenched up. Every part of their face is resistant. They’re obviously accepting that it is here, but also trying to push against it, also trying not to feel it. Yes, accepting feelings is important, but are you creating a safe place for that emotion to rise and fall within you?  Here, we can check in with our bodies. Where is this discomfort in my body? Where am I holding tension around it? Is there a way I can soften around this experience of hopelessness first? And that can be so important as we’re navigating hopelessness and finding meaning in our lives.  HONOR THAT THIS IS HARD FOR YOU The next thing I’m going to encourage you to do is first honor just how hard things are for you. Often, that might be just a moment of saying, “This is really hard for me. Absolutely. This is very hard for me.”  OFFER SELF-COMPASSION WHEN YOU FEEL HOPELESS The next piece here is we want to offer as much compassion as we can. We want to nurture the fact that you’re going through an incredibly hard thing or things. You’re trying so hard. You’re exhausted. You’re feeling lost. You might even be feeling like, “I don’t even know which direction I’m going. I’m just going and getting through the day.” We want to create as much compassion as we can for that.  Now, if you are new to the work of self-compassion, there are so many resources online. We have a meditation vault with tons of different meditations for self-compassion at CBT School. They’re there for you if you’re really wanting to embark on this practice. We’ve also got tons of other episodes of Your Anxiety Toolkit on self-compassion as well.  KEEP AN EYE OUT FOR CATASTROPHIZATION The next thing I want you to think about here is keep an eye on how you’re doing things throughout the day. I’ll tell you a story. Actually, as I did this work for myself when I went into therapy, I looked at my schedule every morning, and all I could see was just a whole bunch of things I had to do. It was just like a list of things that I had to do. It felt like trash things I had to do, even though many of them were joyful things that I love doing and that I’ve signed up to do. But what I noticed was I was looking at the day as if it was just a mountain of chores instead of staying very present and mindful, doing one thing at a time, and practicing non-judgment, curiosity, and kindness as I do those things.  BREAK THINGS DOWN INTO SMALL, DOABLE STEPS What I’m going to encourage you to do is break things down into small, doable steps. When you look at your life and you think, oh my goodness, in the case of this question of relationships, career, work—when you look at all of that, it can become so overwhelming. Maybe sit down, get a notepad, and just pick one thing you want to work on right now, one thing that you can do from a place of wisdom and being effective and kind, and just focus on seeing if you can achieve and accomplish that one thing. Chances are, you might already be doing that, but there’s a piece that you’ve missed, and I can guarantee you’ve missed it—you’ve forgotten to celebrate the fact that you got a small step done.  Often, when things feel so huge, we finish something, and then we just move on to the next thing that we have to do. And that’s when things do feel like there’s no meaning, there’s no point to this life. We’re just in the motions, going with the cycles. We forget to celebrate, validate, and recognize the accomplishments that we’ve made. We forget to go, “Yeah, that’s a big deal. Good for you, you did that,” and take that time to celebrate it. Because again, as I said to you, I was looking at my life going, “Everything looks mostly pretty good. I’ve got this pretty severe chronic illness, but otherwise, things are going well.” But I realized I was just doing thing after thing after thing and after thing and not stopping to go, “Wow, good job. You’re taking care of your kids. Great job, you did something for yourself today,” or “Wow, you accomplished that one thing, and that was really hard.” We’ve got to celebrate our wins.  STOP COMPARING YOURSELF TO OTHERS The next piece of that is, often, people who get stuck in the day-to-day feeling like it’s Groundhog’s Day and there’s no real point, that’s because they’re comparing their experience to somebody else’s. They’re comparing their day-to-day with someone on social media who has made it look beautiful, they’ve got beautiful filters on, and everything looks really great. We’re making a lot of comparisons between how they’re doing and how we’re doing. I want to encourage you, please do not compare your wins and struggles to other people’s wins and struggles. That is a recipe for feeling hopeless, it’s a recipe for feeling depressed, and it’s a recipe for feeling like you’re never going to be enough. It’s so important.  THREE THEMES OF DEPRESSION The next thing I want you to do is catch yourself in the distorted thinking. Now, here is something you must take away from today—depression commonly has three themes. The first one is hopelessness—feeling like there is no hope. The second one is helplessness, feeling like no one can help you, tha