Ep. 281 Anxiety and Arousal

Ep. 281 Anxiety and Arousal

Update: 2022-04-22



This episode addresses some common questions people have about anxiety and arousal. Oftentimes, we are too afraid to talk about anxiety and arousal, so I thought I would take this opportunity to address some of the questions you may have and take some of the stigma and shame out of discussing anxiety and how it impacts arousal, orgasm, intimacy, and sexual interactions.

In This Episode:

  • How anxiety and arousal impact each other (its a cycle)
  • Arousal Non-Concordance and how it impacts people with anxiety and OCD
  • How to take the shame out of arousal struggles
  • Understanding why anxiety impacts orgasms and general intimacy

Links To Things I Talk About:

Article I wrote about OCD and Arousal Non-Concordance

Come as You are By Emily Nagoski, PhD
Come as You Are Workbook By Emily Nagoski, PhD
ERP School: https://www.cbtschool.com/erp-school-lp

Episode Sponsor:

This episode of Your Anxiety Toolkit is brought to you by CBTschool.com. CBTschool.com is a psychoeducation platform that provides courses and other online resources for people with anxiety, OCD, and Body-Focused Repetitive Behaviors. Go to CBTschool.com to learn more.

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Ep. 281 Anxiety and Arousal


This is Your Anxiety Toolkit - Episode 281.

Welcome back, everybody. How are you? It is a beautiful sunny day here in California. We’re actually in the middle of a heatwave. It is April when I’m recording this and it is crazy how hard it is, but I’m totally here for it. I’m liking it because I love summer.

Talking about heat, let’s talk about anxiety and arousal today. Shall we? Did you get that little pun? I’m just kidding really.

Today, we’re talking about anxiety and arousal. I don’t know why, but lately, I’m in the mood to talk about things that no one really wants to talk about or that we all want to talk about and we’re too afraid to talk about. I’m just going to go there. For some reason, I’m having this strong urge with the podcast to just talk about the things that I feel we’re not talking about enough. And several of my clients actually were asking like, “What resources do you have?” And I have a lot of books and things that I can give people. I was like, “All right, I’m going to talk about it more.” So, let’s do it together.

Before we do that, let’s quickly do the review of the week. This one is from, let’s see, Jessrabon621. They said:

“Amazing podcast. I absolutely love everything about this podcast. I could listen to Kimberley talk all day and her advice is absolutely amazing. I highly recommend this podcast to anyone struggling with anxiety or any other mental health professional that wants to learn more.”

Thank you so much, Jess.

This week’s “I did a hard thing” is from Anonymous and they say:

“I learned it’s okay to fulfill my emotions and just allow my thoughts and it gave me a sense of peace. Learning self-compassion is my hard thing and I’m learning to face OCD and realize that it’s not my fault. I’m learning to manage and live my life for me like I deserve, and I refuse to let this take away my happiness.”

This is just so good. I talk about heat. This is seriously on fire right here. I love it so much. The truth is self-compassion practice is probably my hard thing too. I think that me really learning how to stand up for myself, be there for myself, be tender with myself was just as hard as my eating disorder recovery and my anxiety recovery. I really appreciate Anonymous and how they’ve used self-compassion as their hard thing.

Let’s get into the episode. Let me preface the episode by we’re talking about anxiety and arousal. If I could have one person on the podcast, it would be Emily Nagoski. I have been trying to get her on the podcast for a while. We will get her on eventually. However, she’s off doing amazing things. Amazing things. Netflix specials, podcasts, documentaries. She’s doing amazing things. So, hopefully, one day. But until then, I want to really highlight her as the genius behind a lot of these concepts.

Emily Nagoski is a doctor, a psychology doctor. She is a sex educator. She has written two amazing books. Well, actually, three or four. But the one I’m referring to today is Come as You Are. It’s an amazing book. But I’m actually in my hand holding the Come as You Are Workbook. I strongly encourage you after you listen to this podcast episode to go and order that book. It is amazing. It’s got tons of activities. It might feel weird to have the book. You can get it on Kindle if you want to have it be hidden, but it’s so filled with amazing information. I’m going to try and give you the pieces that I really want you to take away. If you want more, by all means, go and get the workbook. The workbook is called The Come as You Are Workbook: A Practical Guide to the Science of Sex. The reason I love it is because it’s so helpful for those who have anxiety. It’s like she’s speaking directly to us. She’s like, it’s so helpful to have this context.

Here’s the thing I want you to consider starting off. A lot of people who have anxiety report struggles with arousal. We’re going to talk about two different struggles that are the highlight of today. Either you have no arousal because of your anxiety, or you’re having arousal at particular times that concern you and confuse you and alarm you. You could be one or both of those camps.

So let’s first talk about those who are struggling with arousal in terms of getting aroused. So the thing I want you to think about is commonly-- and this is true for any mental health issue too, it’s true for depression, anxiety disorders, eating disorders, dissociative disorders, all of them really. But the thing I want you to remember, no matter who you are and what your experience is, even if you have a really healthy experience of your own sexual arousal and you’re feeling fine about it, we all have what’s called inhibitors and exciters. Here is an example.

An inhibitor is something that inhibits your arousal. An exciter is something that excites your arousal. Now you’re probably already feeling a ton of judgment here like, “I shouldn’t be aroused by this and I should be aroused by this. What if I’m aroused by this? And I shouldn’t be,” and so forth. I want us to take all the judgment out of this and just look at the content of what inhibits our arousal or excites our arousal. Because sometimes, and I’ll talk about this more, sometimes it’s for reasons that don’t make a lot of sense and that’s okay.

Let’s talk about an inhibitor, something that pumps the brakes on arousal or pleasure. It could be either. There’s exciters, which are the things that really like the gas pedal. They just really bring on arousal, bring on pleasure, and so forth.

We have the content. The content may be first mental or physical, and this includes your health, your physical health. For me, I know when I am struggling with POTS, arousal is just barely a thing. You’re just so wiped out and you’re so exhausted and your brain is foggy. It’s just like nothing. That would be, in my case, an inhibitor. I’m not going to talk about myself a lot here, but I was just using that as an example. You might say your anxiety or your obsession is an inhibitor. It pumps the brakes on arousal. It makes it go away. Worry is one.

It could also be other physical health, like headaches or tummy aches, or as we said before, depression. It could be hormone imbalances, things like that. It’s all as important. Go and speak with your doctor. That’s super important. Make sure medically everything checks out if you’re noticing a dip or change in arousal that’s concerning you.

The next one in terms of content that may either excite you or inhibit you is your relationship. If your relationship is going well, you may or may not have an increase in arousal depending on what turns you on. If your partner smells of a certain smell or stench that you don’t like, that may pump the brakes. But if they smell a certain way that you do really like and really is arousing to you, that may excite your arousal.

It could also be the vibe of the relationship. A lot of people said at the beginning of COVID, there was a lot of fear. That was really, really strong on the brakes. But then all of a sudden, no one had anything to do and there was all this spare time. All of a sudden, the vibe is like, that’s what’s happening. Now, this could be true for people who are in any partnership or it could be just you on your own too. There are things that will excite you and inhibit your arousal if you’re not in a relationship as well, and that’s totally fine. This is for all relationships. There’s no specific kind.

Setting is another thing that may pump the brakes or hit the gas for arousal, meaning certain places, certain rooms, certain events. Did your partner do something that turned you on? Going back to physical, it could also depend on your menstrual cycle. People have different levels of arousal depending on different stages of their menstrual cycle. I think the same is true for men, but I don’t actually have a lot of research on that, but I’m sure there are some hormonal impacts on men as well.

There’s also ludic factors which are like fantasy. Whether you have a really strong imagination, that either pumps the brakes or puts the gas pedal in terms of arousal. It could be like where you’re being touched. Sometimes there’s certain areas of your body that will set off either the gas pedal or the brakes. It could be certain foreplay.

Really what I’m trying to get at here isn’t breaking it down according to the workbook, but there’s so many factors that may influence your arousal.

Another one is environmental and cultural and shame. If arousal and the whole concept of sex is shamed or is looked down on, or people have a certain opinion about your sexual orientation, that too can impact your gas pedal and your brakes pedal. So, I want you to explore this, not from a place of pulling it apart really aggressively and critically, but really curiously and check in for yourself, what arouses me? What presses my brakes? What presses my gas? And just start to get to know that. Again, in the workbook, there’s tons of worksheets for this, but you could also just consider this on your own. Write it down on your own, be aware over the next several days or weeks, just jot down in a journal what you’re noticing.

Now, before we move on, we’ve talked about a lot of people who are struggling with arousal, and they’ve got a lot of inhibitors and brake pushing. There are the other camp who have a lot of gas pedal pushing. I speak here directly to the folks who have sexual obsessions because often if you have sexual obsessions, the fact that your sexual obsession is sexual in nature may be what sets the gas pedal off, and all of a sudden, you have arousal for reasons that you don’t understand, that don’t make sense to you, or maybe go against your values.

I’ve got a quote that I took from the book and from the workbook of Emily Nagoski. Again, none of this is my personal stuff. I’m quoting her and citing her throughout this whole podcast. She says, “Bodies do not say yes or no. They say sex-related or not sex-related.” Let me say it again. “Bodies do not say yes or no. They say sex-related or not sex-related.”

This is where I want you to consider, and I’ve experienced this myself, is just because something arouses you doesn’t mean it brings you pleasure. Main point. We’ve got to pull that apart. Culture has led us to believe that if you feel some groinal response to something, you must love it and want more of it.

An example of this is for people with sexual obsessions, maybe they have OCD or some other anxiety disorder, and they have an intrusive thought about a baby or an animal. Bestiality is another very common obsession with OCD or could be just about a person. It could be just about a person that you see in the grocery store. When you have a thought that is sex-related, sometimes because the context of it is that it’s sex-related, your body may get aroused. Our job, particularly if you have OCD, is not to try and figure out what that means. It’s not to try and resolve like, does that mean I like it? Does that mean I’m a terrible person? What does that mean?

I want you to understand the science here to help you understand your arousal, to help you understand how you can now shift your perspective towards your body and your mind and the pleasure that you experience in the area of sexuality. Again, the body doesn’t say yes or no, they say it’s either sex-related or not sex-related.

Here’s the funny thing, and I’ve done this experiment with my patients before, is if you look at a lamp post or it could be anything, you could look at the pencil you’re holding and then you bring to mind a sexual experience, you may notice arousal. Again, it doesn’t mean that you’re now aroused by pencils or pens. It’s that it was labeled as sex-related, so often your brain will naturally press the accelerator.

That’s often how I educate people, particularly who are having arousal that concerns it. It’s the same for a lot of people who have sexual trauma. They maybe are really concerned about the fact that they do have arousal around a memory or something. And then that concerns them, what does that mean about me? And the thing to remember too is it’s not your body saying yes or no, it’s your body saying sex-related or not sex-related. It’s important to just help remind yourself of that so that you’re not responding to the content so much and getting caught up in the compulsive behaviors.

A lot of my patients in the past have reported, particularly during times when they’re stressed, their anxiety is really high, life is difficult, any of this content we went through, is they may actually have a hard time being aroused at all. Some people have reported not getting an erection and then it completely going for reasons they don’t understand. I think here we want to practice again non-Judgment. Instead, move to curiosity. There’s probably some content that impacted that, which is again, very, very, normal.

this is why when I’m talking with patients – I’ve done episodes on this in the past, and we’ve in fact had sex therapists on the podcast in the past – is they’ve said, if you’ve lost arousal, it doesn’t mean you give up. It doesn’t mean you say, “Oh, well, that’s that.” What you do is you move your attention to the content that pumps the gas. When I mean content, it’s like touch, smell, the relationship, the vibe, being in touch with your body, bringing your attention to the dance that you’re doing, whether it’s with a partner or by yourself, or in whatever means that works for you. You can bring that back. There’s another amazing book called Better Sex Through Mindfulness, and it talks a lot about bringing your attention to one or two sensations. Touch, smell being two really, really great ones.

Again, if your goal is to be aroused, you might find it’s very hard to be aroused because the context of that is pressure. I don’t know about you, but I don’t really find pressure arousing. Some may, and again, this is where I want this to be completely judgment-free. There’s literally no right and wrong. But pressure is usually not that arousing. Pressure is not that pleasurable in many cases, particularly when it’s forceful and it feels like you have to perform a certain way. Again, some people are at their best in performance mode, but I want to just remind you, the more pressure you put on yourself on this idea of ending it well is probably going to make some anxiety. Same with test anxiety. The more pressure you put on yourself to get an A, the more you’re likely to spin out with anxiety. It’s really no different.

So, here is where I want you to catch and ask yourself, is the pressure I put on myself or is the agenda I put on myself actually pumping the brakes for me when it comes to arousal? Is me trying not to have a thought actually in the context of that, does that actually pump the brakes? Because I know you’re trying not to have the thought so that you can be intimate in that moment and engaged in pleasure. But the act of trying not to have the thought can actually pump the brakes. I hope that makes sense. I want you to get really close to understanding what’s going on for you.

Everyone is different. Some things will pump the brakes, some things will pump the accelerator. A lot of the times, thought suppression pumps the brakes. A lot of the times, beating yourself up pumps the brakes. A lot of the time, the more goal, like I have to do it this way, that often pumps the brakes. So, keep an eye out for that. Engage in the exciters and get really mindful and present.

A couple of things here. We’ve talked about erections, that’s for people who struggle with that. It’s also true for women or men with lubrication. Some people get really upset about the fact that there may or may not be a ton of lubrication. Again, we’ve been misled to believe that if you’re not lubricated, you mustn’t be aroused or that you mustn’t want this thing, or that there must be something wrong with you, and that is entirely true. A lot of women, when we study them, they may be really engaged and their gas pedal is going for it, but there may be no lubrication. And it doesn’t mean something is wrong. In those cases, often a sex therapist or a sex educator will encourage you to use lubrication, a lubricant.

Again, some people, I’ve talked to clients and they’re so ashamed of that. But I think it’s important to recognize that that’s just because somebody taught us that, and sadly, it’s a lot to do with patriarchy and that it was pushed on women in particular that that meant they’re like a good woman if they’re really lubricated. And that’s not true. That’s just fake, false. No science. It has no basis in reality.

Now we’ve talked about lubrication. We’ve talked about erection. Same for orgasm. Some people get really frustrated and disheartened that they can’t reach orgasm. If for any reason you are struggling with this, please, I urge you, go and see a sex therapist. They are the most highly trained therapists. They are so sensitive and compassionate. They can talk with you about this and you can target the specific things you want to work on. But orgasm is another one. If you put pressure on yourself to get there, that pumps the brakes often.

What I want you to do, and this is your homework, is don’t focus on arousal. Focus on pleasure. Focus on the thing that-- again, it’s really about being in connection with your partner or yourself. As soon as you put a list of to-dos with it is often when things go wrong. Just focus on being present as much as you can, and in the moment being aware of, ooh, move towards the exciters, the gas pedal things. Move away from the inhibitors. Be careful there. Again, for those of you who have anxiety, that doesn’t mean thought suppress. That doesn’t mean judge your thoughts because that in and of itself is an inhibitor often.

I want to leave you with that. I’m going to in the future do a whole nother episode about talking more about this idea of arousal non-concordance, which is that quote I use like “The bodies don’t say yes or no, they say sex-related or not sex-related.” I’ll do more of that in the future. But for right now, I want it to be around you exploring your relationship with arousal, understanding it, but then putting your attention on pleasure. Being aware of both, being mindful of both.

Most people I know that I’ve talked to about this-- and I’m not a sex therapist. Again, I’m getting all of this directly from the workbook, but most of the clients I’ve talked to about this and we’ve used some worksheets and so forth, they’ve said, when I put all the expectations away and I just focus on this touch and this body part and this smell and this kiss or this fantasy, or being really in touch with your own body, when I just make it as simple as that and I bring it down to just engaging in what feels good – sort of use it as like a north star. You just keep following. That feels good. Okay, that feels good. That doesn’t feel so great. I’ll move towards what feels good – is moving in that direction non-judgmentally and curiously that they’ve had the time of their lives. I really just want to give you that gift. Focus on pleasure. Focus on non-judgmentally and curiously, being aware of what’s current and present in your senses.

That’s all I got for you for today. I think it’s enough. Do we agree? I think it’s enough. I could talk about this all day. To be honest, and I’ve said this so many times, if I had enough time, I would go back and I would become a sex therapist. It is a huge training. Sex therapists have the most intensive, extensive training and requirements. I would love to do it. But one day, I’ll probably do it when I’m 70. And that will be awesome. I’ll be down for that, for sure. I just love this content.

Now, again, I want to be really clear. I’m not a sex therapist. I still have ones to learn. I still have. Even what we’ve covered today, there’s probably nuanced things that I could probably explain better. Again, which is why I’m going to stress to you, go and check out the book. I’m just here to try and get you-- I was thinking about this. Remember, I just recently did the episode on the three-day silent retreat and I was sitting in a meditation. I remember this so clearly. I’m just going to tell you this quick story.

I was thinking. For some reason, my mind was a little scattered this day and something came over with me where I was like, “Wouldn’t it be wonderful if I didn’t just treat anxiety disorders, but I treated the person and the many problems that are associated with the anxiety disorder? Isn’t that a beautiful goal? Isn’t that so? Because it’s not just the anxiety, it’s the little tiny areas in our lives that it impacts.” That’s when I, out of me, as soon as I finished the meditation, I went on to my-- I have this organization board that I use online and it was arousal, let’s talk about pee and poop, which is one episode we recently did. Let’s talk about all the things because anxiety affects it all. We can make little changes in all these areas and little changes. Slowly, you get your life back. I hope this gives you a little bit of your sexual expression back, if I could put it into words. Maybe not expression, but just your relationship with your body and pleasure.

I love you. Thank you for staying with me for this. This was brave work you’re doing. You probably had cringy moments. Hopefully not. Again, none of this is weird, wrong, bad. This is all human stuff.

Finish up, again, do check out the book. Her name is Emily Nagoski. I’ll leave a link in the show notes. One day we’ll get her on. But in the meantime, I’ll hopefully just give you the science that she’s so beautifully given us.

Have a wonderful day. I’ll talk to you soon. See you next week.

Please do leave a review. It helps me so much. If you have a few moments, I would love a review, an honest review from you.

Have a good day.









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Ep. 281 Anxiety and Arousal

Ep. 281 Anxiety and Arousal