What To Do During And After An Exposure? | Ep. 321

Anxiety can often feel like a relentless storm, clouding your thoughts and overwhelming your sense of calm. It's during these turbulent times that finding the right words can be akin to discovering a lifeline amidst the chaos. 

To aid you in navigating these stormy waters, we've curated a list of 20 empowering phrases based on expert advice. These phrases are designed to validate your feelings, soothe your inner critic, fill you with encouragement, and help you respond proactively to anxiety. Here's how you can incorporate them into your life to foster resilience, kindness, and self-compassion.

VALIDATE THE DIFFICULTY

• "This is hard, and it's okay that it's hard for me." Acknowledge the challenge without judgment.
• "I'm doing the best I can in this moment." Remind yourself of your effort and resilience.
• "My feelings are valid and understandable." Affirm the legitimacy of your emotions.
• "I am human, and having a difficult day is okay." Normalize the ups and downs of human experience.
• "I give myself permission to feel this while being kind to myself." Embrace your feelings with compassion.

SOOTHE THE CRITICAL VOICE

• "This is not my fault." Release unwarranted guilt and blame.
• "It’s okay that I’m not perfect." Celebrate your humanity and imperfections.
• "It's okay to make mistakes." View errors as opportunities for growth.
• "My challenges do not define my worth." Separate your worth from your struggles.
• "May I be gentle with myself as I navigate this difficult season?" Practice self-compassion and kindness.

FILL YOURSELF WITH ENCOURAGEMENT

• "It's a beautiful day to do hard things." Empower yourself to face challenges.
• "I can tolerate this discomfort." Recognize your strength and resilience.
• "This anxiety or discomfort will not hurt me." Acknowledge your capacity to withstand anxiety.
• "Humans are innately resilient." Remind yourself of your inherent ability to overcome adversity.
• "I am more than my worst days." Focus on the breadth of your life’s narrative.

GET CLEAR ON YOUR RESPONSE TO ANXIETY

• "I REFUSE to lead a life based on fear." Commit to acting on your values.
• "I choose to speak to myself with understanding and patience." Cultivate a compassionate inner dialogue.
• "I have already chosen how I'm going to respond, and now I'm going to honor that decision." Preemptively decide on positive actions.
• "I will treat myself with the same kindness that I offer others." Extend your empathy inward.
• "I’m going to honor my journey and respect my own pace." Accept your unique path and timing.

BONUS PHRASE FOR CONTINUOUS SUPPORT

• "We are just going to take one step at a time." Focus on the present moment to manage overwhelm.

These phrases, thoughtfully designed to address different facets of anxiety, are tools at your disposal. Use them to navigate through moments of anxiety, to remind yourself of your strength, and to cultivate a kinder relationship with yourself. Remember, it's not about employing all of them at once but finding the ones that resonate most with you. Anxiety is a complex and deeply personal experience, and thus, your approach to managing it should be equally personalized. Let these phrases be your guide as you continue on your journey toward a more peaceful and empowered state of being.

TRANSCRIPTION: 

Here are 20 phrases to use when you are anxious. Now I get it, when you’re anxious, sometimes it’s so hard to concentrate. It’s so hard to know where you’re going, what you want to do, and it’s so easy just to focus on anxiety and get totally stuck in the tunnel vision of anxiety or feel completely overwhelmed by it. 

Today, I want to offer you 20 phrases that you can use when you’re feeling anxious or experiencing OCD. These are yours to try on and see if you like them. You don’t have to use all of them. They’re here for you to use as you wish, and hopefully, they’re incredibly helpful.

All right, my loves, let’s talk about the 20 phrases you can use when you’re feeling anxious. Now, I have prepared these in four different steps. You can actually go through and pick one or several of these and go through these, write them down, and have them in your pocket or in your wallet, or whatever you want, a sticky note on your fridge to use as you need. These are to help guide you towards a life where you lean into your fear. You treat yourself kindly. You encourage yourself. You champion the direction you want to go in. And my hope is that you can use these in many different scenarios, and they can help you get to the life that you want. Let’s go and do it. 

The first category is validate the difficulty. Most people, when they’re anxious, they get caught up in this wrestle of, “I shouldn’t have this. Why do I have it? It’s not fair,” and I totally get it. But what we want to do is first validate the difficulty. If you can say that, and you can do that by using one of these five phrases:

Number one, “This is hard, and it’s okay that it’s hard for me.” Again, let’s say it together. “This is hard, and it’s okay that it’s hard for me.”

The second phrase that I’m going to offer to you is, “I’m doing the best I can in this moment.” The truth is, you are doing the best you can with what you have and given the circumstances. I want you to remember that as best as you can as well. 

Number three, “My feelings are valid and understandable.” If anybody else was in this exact situation, they’d probably be thinking, feeling, and acting in the same way.

The fourth one is, “I am human, and having a difficult day is okay.” Not only is it okay, it’s normal. Humans have difficult days. This is a total normal part about being human. You might be having an immense amount of anxiety, but please do remember the millions of other human beings around the globe who are having a very similar experience to you. It doesn’t mean there’s anything wrong with you. 

And then the fifth way I want you to validate the difficulty is to say, “I give myself permission to feel this while being kind to myself.” Remember I said “while.” I give myself permission to feel this way while being still kind to myself. 

Let’s move on to the second category, which is soothing the critical voice. I know when we have anxiety, we can be really, really hard on ourselves. The phrase I want you to practice or trial is, number one, “This is not my fault.” And it’s not your fault. You did not ask for this. You can’t stop the fact that your brain sometimes gets hijacked and throws a bunch of anxiety or thoughts, or feelings towards your urges. It is not your fault. 

The second one is, “It’s okay that I’m not perfect.” Nobody is. We want to remember that this is our first time being a human and we’re not going to get it right the first time. It’s okay that you’re not perfect, nobody is. 

You might also want to try the phrase, “It’s okay to make mistakes.” That is how I learn and grow. Remember here of all the people who have succeeded in their recovery, or all the people who are succeeding in other areas of their life, they didn’t get there because of easy, breezy times. They got there by making mistakes, and they’d keep going and they keep trying, and they’d go again and they go again and they learn and they grow.

The next thing you may want to try on, and another phrase you can use is, “My challenges do not define my worth.” You’re not either better or worse for having this anxiety. You’re not less than or more than depending on whether you have a mental illness or not. Your worth is not something that’s up for discussion, and it’s not up for measurement. We all have equal worth. And this challenge that you’re experiencing or this anxiety you’re experiencing does not define your worth. 

Now, the last one I want you to practice here, you can actually practice more from a meditation or a meditation practice, which is a practice of loving kindness. We could call it a metta meditation or a loving-kindness meditation. And the goal from this is to actually meditate on sending yourself loving kindness. 

Now, if you’re someone who wants to learn how to do this, we have an entire meditation vault called the Meditation Vault, where I have created over 30 different meditations for people, specifically with anxiety, to help you practice meditation and learn how to practice loving kindness. You can go to CBTSchool.com to learn more about that. I would, again, need to spend a whole other episode talking to you about that. But if you want to practice the art of sending yourself loving kindness, you can go there to learn more. 

But for right now, to finish out this category, what we want to do is practice one of those meditations, which is to offer yourself the phrase, “May I be gentle with myself as I navigate this difficult season?” What we are doing here is we’re offering ourselves a promise per se of saying, “May I be gentle with myself?” In a true loving-kindness meditation, often what we do say is, “May I be happy? May I be well? May I live with ease?” And if you particularly like my voice and it feels very soothing to you, all of those meditations are there in the meditation vaul, and we go through that extensively. 

The next section is to fill yourself up with encouragement. Now, when we are anxious, it’s easy to feel very discouraged and just want to run away and change every part of our plans for the day. But what we want to do is we want to fill yourself up with encouragement. Here are some phrases that you can use to help with that goal. 

Number one, you know I’m always going to say this, “It’s a beautiful day to do hard things.” We can do hard things. We have to keep repeating this to ourselves. You may even want to add some sass to it and add a little swear word. A lot of my patients have said, “It’s a beautiful day to blank hard things.” Now that’s okay too. You can sass it up, whatever feels most empowering to you. 

Another way you can fill yourself up with encouragement is to offer yourself the phrase, “I can tolerate this discomfort,” because you can, and you have, and you will. “I can tolerate this discomfort.”

Another thing you can offer is, “This anxiety or this discomfort will not hurt me. I am stronger than I could ever know.” And the truth is, anxiety does not hurt you. It’s uncomfortable, and it’s painful. I understand that. But it won’t hurt you. It won’t damage you. It won’t destroy you, that we’re stronger than we could ever, ever believe we could be. 

The next thing you may offer to yourself, and this is one that I particularly love, is that humans are innately resilient. They do most of their growing through hard things. And I’ve already mentioned this to you before. Most of the really successful people got there, not because it was easy and breezy; it’s because we are resilient, and that’s how we grow, and that’s how we learn, that we can get through very, very difficult things.

And then the last thing is, “I am more than my worst days.” That this might be a difficult day, but I am more than this difficult day. There’s a bigger story here for me. This uncomfortable moment or this uncomfortable day is just a part of that story. But the bigger picture is that I am much more than these hard, difficult days. 

And then the last category, which you have to also include, is to get very clear on how you are going to respond. This is where we get a little more firm with ourselves in the phrases. You will hear, I get a little sassy myself in this, and we get a little more decisive or confident. Even if you don’t feel confident, we want to speak in this confident, assured way. 

Number one is, “I REFUSE,” and I’ve written refuse in capital letters. “I REFUSE.” And I say this to myself, I want you to say this to yourself. “I REFUSE to lead a life based on fear.” I will move forward, acting on my values and my beliefs, and who I want to be. That’s the first phrase. And we want to emphasize, “I refuse to act out on this fear.”

The second is, “I choose to speak to myself with understanding and patience.” I’m choosing that because it’s so easy to fall back into criticism and blame and humiliation and critical self-punishing words. I choose to speak to myself with understanding and patience. 

Now, the third one involves you being very proactive. Now, I’ll give you the phrase first, and then I’ll explain it to you. The phrase is, “I have already chosen how I’m going to respond, and now I’m going to honor that decision.” What I want you to do, if you are someone with anxiety, is to create a plan ahead of time—to have a plan on how you are going to respond to anxiety. 

Now, if this is difficult for you, we have two courses that I want you to rely on. Number one is Overcoming Anxiety and Panic, and the other one is ERP School. And that’s for people with OCD and health anxiety. If you’re someone who struggles with generalized anxiety or panic or OCD, you are going to need a plan ahead practice. You’re going to need to know what fear and obsessions and thoughts and fear and all the things get you to do normally. And then you’re going to have to be able to break that cycle with a specific plan on attack on how you’re going to handle that. And we go through those steps in those two courses or any of our courses. We break it down so that you have a specific plan on how you’re going to handle this, what you’re going to do, what you’re not going to do, how you’re going to treat yourself, and so forth. 

If you haven’t got a therapist and you want to learn how to do that, head over to CBTSchool.com. Those courses, there is low cost as we could make them, and they’re there for you to help you have a plan so that you can say to your anxiety when you’re struggling, “I’ve already chosen how I wish to respond, and now I’m going to honor that decision. “

Now, the reason that I say that phrase that way is when you have a plan up ahead head, that’s one part of it, but then you have to honor your plan. And what often happens is, when we have a plan and we don’t honor that plan, that’s often when we start to feel like we distrust ourselves. We feel like we’ve let ourselves down. 

And so what we want to do is we want to make a plan, and then we want to choose to honor that plan. And by honoring the plan that you set out -- and I’m not going to tell you what that plan should be. The cost isn’t going to tell you what you have to do. You get to decide that for yourself based on your own core values. But once you do that, and when you follow through by honoring that decision that you made ahead of time, that’s when you start to trust yourself. That’s when you start to really feel empowered. That’s when you start to break that cycle of anxiety because you’ve stood firm on the ground on what your plan was and how you’re going to show up.  

I’ll repeat it again. “I have already chosen how I want to respond, and now I’m going to honor that decision because I matter, and this is my life, and I want to follow through in the way I said I would.”

Now, the fourth one is, “I will treat myself with the same kindness that I offer others in this situation.” Again, we’re speaking firmly and kindly with conviction to ourselves. “I will treat myself with the same kindness that I would offer to others.” 

And then the last one is, “I’m going to honor my journey and respect my own pace.” This doesn’t have to be a straightforward, linear process. In fact, it won’t be. And we have to honor our own journey and our own pace, because sometimes it takes longer for us than it does for others. And that’s okay. We’re going to honor our journey. We’re going to respect our own pace. 

And I will offer you a bonus phrase, which is, “We are just going to take one step at a time.” Just focus on one step at a time. Because if you’re looking too far ahead, it will get overwhelming. You are handling a huge, huge discomfort. And so we want to be as gentle as we can. We want to honor our values. We want to lead with our values, not lead with fear. And my hope is one or many of these phrases will help you get there. I hope this has been helpful. 

Again, I want to remind you, some of these won’t land for you, and that’s entirely okay. Just practice and try the ones that you feel will be helpful, and leave the rest. This is your journey. You get to choose it. I just hope that some of these skills and tools that we talk about on Your Anxiety Toolkit are helpful. And I hope you have a wonderful, wonderful day.

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 everybody. But it was also very validating to see that this is also for reasons that we yet don’t really understand. Do you want to speak to that at all?

 Chinwé: Yes, absolutely. So in the book, I wrote about clients that I’ve experienced throughout the years. I’ve changed factors and variables that would easily identify them. But many people will point to some of the illustrations in the book that are of kids who come from really supportive families. Many of them are high achieving. Many of them have a lot of resources that they just have access to, and yet they still experience levels of anxiety, sadness, even are self-harming, even espouse suicidal thoughts, or we call it suicidal ideation. 

What that tells us, again, I think just sort of zooming out, is the bigger picture of just so many things that have shifted in our culture, so many things that have shifted from a societal perspective where young people are feeling disconnected, they’re feeling more anxious, they are more resourced. The research tells us that Gen Alpha and Gen Z are the most diverse, more resourced, tech-savvy. They’re so connected to the technological and global world, but they feel so disconnected oftentimes from themselves, from their family members, and also their friends. And so, I think it really is so interesting that it really speaks to, regardless of the walk of life or where you or your family falls from an income perspective, none of us are immune. 

I try to be pretty transparent. My daughter has given me permission to share. She is 20 years old. She’s in college. She is brilliant and kind and thoughtful and highly sensitive and gifted and has a mother who’s a mental health professional. And at 13, she experienced high, high anxiety and high levels of despair. And again, she’s given me permission to share, and I do share this when I talk to parents and educators across the country, and I’m so grateful that she’s given me that permission. But just to show that she had resources. She was in private school. She’s my bonus daughter. She had support from me, her dad, and also her biological mom, and her grandparents, and she still experienced what a lot of kids across the country are experiencing.

 Kimberley: I’m so grateful you share that. I think that that’s it too. We would assume that if your bonus mom is a therapist and you have all the resources, it just wouldn’t happen to you. But it doesn’t discriminate, does it? It can affect any family. As a clinician, I don’t think I was really trained to really understand that either. I was trained to think like, okay, there must be something wrong with the family, they must be fighting at home, or there must be discord at home, or so forth. So I’m so grateful that you share that. And thank you to her. How brave and wonderful that she struggled and obviously came through on the other side, absolutely. 

In the book, this blew my mind, really, honestly. I’m almost embarrassed to say, but it blew my mind that you described that there is a difference between despair and depression. Can you share what that is all about?

 Chinwé: Yes. As you know, depression is a clinical term. It’s a diagnosis that has a set of symptomology that’s connected to it. So, we as clinicians are looking for certain symptoms that exist more days than not over a two-week period of time, right? At that two-week mark, I’m starting to pay a lot of attention when parents are sharing what’s happening with their kids. Because when you’re an adolescent, we know that hormones will shift your mood, you’ll be high on something that you’re watching on TV. Not high literally, because we got to make that distinction. You’re not vaping or using marijuana, but you’re feeling euphoric and you’re elated about something maybe you’re seeing on television. And then you look down at your phone, or your mom asks you to clean your room or do your work. And then you can look like you have a level of despair. But that may not be the case, right? We know with adolescents, there are just normal ups and downs that are just a part of that stage of development. 

So it’s important to really share that in order to get a diagnosis of depression. You want to see a number of symptoms for a period of time that really impact your child’s level of functioning in a persistent and pervasive way. Maybe they’re not functioning as well as they normally would at school or if they have an after-school job or an extracurricular activity or you’re noticing that some things at home. So those are some things that we look at from a clinical perspective. 

Now, despair is something different, but not by a whole lot. There’s a whole lot of overlap, and we do go into it with pretty great in-depth in the book, but essentially, despair really has a lot of those same symptoms of depression where you’re feeling lethargic, perhaps low energy. You struggle with thoughts that tell you maybe that you’re not enough, you’re inadequate, or inferior. Sometimes you don’t feel like doing those things that you normally love to do. In clinical terms, we call it anhedonia, right? Those things that you typically enjoy that make you happy—playing with your pet, going for a walk, hanging out with your friends. If you’re not doing those things, we do start to wonder about some mood issues, some internalizing disorders. So, anxiety, mood issues such as depression, but with despair, and we make this distinction on purpose with intentionality, and here’s why. 

Despair does share a lot of the symptoms as depression, but it doesn’t need to meet the criteria for major depression for us to really know that is a tough place to be. And many of us, especially young people, we may not be able to just relate or connect to having major depression or bipolar, but many of us on this earth can relate to having an experience of loss or grief or deep disappointment, or pain that we just continue to stuff and we rally and we show up for the next thing and we show up for the next thing. But that pain is still there, and it doesn’t really have a place to go because we haven’t really shared with people that we were going through this pain. We just kept going with our routine. 

Despair can make you feel the exact same way, but it doesn’t necessarily rise to the level of a mental health diagnosis. And it’s important to point out because young people right now are going to social media outlets like TikTok, and they’re hearing from social media influencers—I put that in quotation marks—that are saying, “If you have this symptom, then you have this diagnosis.” And so, young people are attaching to those labels, and we did not want that in this book. This book is for anyone who has a child, a student, someone that you’re coaching, leading, guiding, that is struggling with a mental health issue, or just struggling emotionally, but it doesn’t necessarily lead to a criteria that indicates that there’s some sort of diagnosis.

 Kimberley: Thank you for differentiating that, because that was really cool for me to hear from a clinician diagnostically. That was really cool to know. Let’s talk about solutions. So we know this is happening. You talk about, and I am too is going to say, like we’re sending all the love to the parents who are navigating this. We’re sending all the love to the clinicians and the teachers and the school counselors and the guidance counselors who are navigating this with their teens. What can we do for our teens, or how can we help them?

 Chinwé: Excellent question. As a mental health practitioner and a parent of three kids, I know how difficult it can be to sort of see the big picture when your child is struggling. We all can relate to feeling overwhelmed, again, even as a professional. I’ve talked to my pediatrician friends and my medical doctor friends. It’s the same thing when it’s your kid. You have all the head knowledge, but sometimes it can still be difficult. 

I think for all of the families that are listening right now, I want you to remember a really important word that’s actually overused. That word is resilience. We’re hearing a whole lot about resilience. We’re hearing a whole lot about emotional resilience, mental resilience. In the book Seen, we call it grit. We acknowledge because I’m talking to educators across the country that are seeing this and parents and even employers that are feeling this. We acknowledge that in a lot of ways, the younger generation, they have lost their grit. They don’t appear to be as resilient as the older generations. 

But where I want to step in is by saying that we don’t shame them or blame them. And how many times have we turned on the news and we heard, “Oh, these kids are snowflakes,” or “These kids are weak,” or “They’re not tough, and they just need to pull their pants up,” and whatever the saying is.

Kimberley: Pull them up by the bootstraps.

Chinwé: Thank you. And your big girl panties—I’ve heard that too. And I was traveling the other day, someone said, “Yeah, my dad always said, ‘Just put some mud on it, put some dirt on it, and keep it going.’” And the older generation, we have a tendency to blame the younger generation for experiencing this mental health crisis, and that just isn’t fair. 

We do want to help them to develop grit and build grit, but the way that we help them with resilience is remembering that a key element of resilience is internal coping resources with external support. That external support is key. When young people are facing any sort of mental health challenge, again, it doesn’t have to be depression; it could just be a period of high anxiety or sadness that’s just gone on for too long. They need to know that they have what it takes, but they need people to remind them and people to walk alongside them because life will be full of difficulty, of course. But we want to teach our young people that they can face this, anything that overwhelms them. They can experience that overwhelm, but also know that they have the ability to pull on those internal coping resources, assuming that they’ve been taught those resources, and also access the support of families. 

The first thing that I want to tell parents is to model exactly what you want to see. And this is big, and this could be its own episode, and maybe you’ve already done an episode. But the way that we help young people when they’re having a tough time is to model good mental health even—and this is important—even when you’re struggling. Because I struggle sometimes, and I have the coping resources. Life can feel really overwhelming and can test us. But do we pretend like we don’t struggle just because we’re parents or adults or because I’m a licensed professional? Well, how’s that going to help my child? 

So, it’s important for parents to know that the very first lesson around mental and emotional wellness has to come from you. When your kids are able to see how you, first of all, identify that you’re having a challenge and then respond to the challenge, that helps them. That helps them know that, okay, I can go through a tough situation or feel a level of distress, but I don’t have to sit with it and rally, or I don’t have to pretend like it hasn’t happened or whatever’s happening hasn’t affected me. 

So, what a parent can do is when you get home from work or your day or a meeting with a friend that just was hard and heavy, acknowledge that. We don’t want to weigh kids down, and I get that. We don’t want to put our problems onto them, but it’s okay to say in a very general or conversational way it has been a really long day. Or, “I met with mommy’s friend, Cindy. Oh, she’s had a lot going on in her family. Oh, I just need a moment. I think what I’m going to do is before I get dinner started, I’m going to go for a walk, or I’m going to just take a couple of deep breaths, or I’m just going to have a seat. I’m going to rest.”

How many of us—Kimberley, I’m guilty of this—come home, we’ve had a hard day, we heard something heavy, and we go straight to cooking and cleaning and checking homework and all the things. So, what happens to that energy? So, I feel like this is just a really good opportunity to show kids the value of acknowledging that every day isn’t going to be great and it’s not supposed to be, but what can you do about it?

 Kimberley: Yeah. That is so important, I think. And I think it’s easier said than done. I think that parents are exhausted too, right? They’re struggling at high rates too, I’m assuming. I don’t know the research on that. So, I think we also need to wrap everyone in compassion in that we’re doing the best we can. 

You also talked about social media before and about how much connecting to social media disconnects them from the family. And I think that as parents, sometimes we let them be on tech because parents need a break, you know what I mean? I know I’ve caught myself with that with my nine-year-old of, “I’m just going to let him have some tech time because I need a break,” but then that’s disconnecting them. Can you speak to the impact of social media for teens?

 Chinwé: Yeah. I think the first thing that would really highlight this topic is to mention that just so recently, I want to say probably a couple of months ago, we learned that the federal government, along with at that time 13 separate states—I’m sure it’s more at this point—sued the social media giant, Meta, which many of your listeners will recognize Meta as the parent organization for Facebook and Instagram. Now, we use Facebook and Instagram to promote mental health. And so, there are benefits to social media 100%, and I think it’s important to highlight that for parents because some kids really are getting information about causes that they want to support. They are getting information about mental health. Sometimes it’s in the bite-size way where we want them to dig in a little bit more, right? But they’re good aspects to mental health. 

But the reason for the lawsuit was because the social media giant was being accused of creating intentionality features that are causing addiction to social media, which is one of the things that has been identified as fueling this mental health crisis among youth. So, there are real stats that are -- we probably have always had a sense that being connected or over-connected to technology wasn’t good. During COVID, what the heck else were we supposed to do as parents? We were doing Zoom school. I’m sure you had your own podcasts at that point. I was doing podcasts. I was doing telehealth. So I appreciated technology, but like you said, a lot of parents really leaned on technology during that time because we didn’t have a whole lot else going on and kids still needed to stay connected, and so did we. But I think that balance is so key.  

I’m going to tell you, when I travel and people ask me, what’s the thing that worries you the most about young people as a former high school counselor, someone who works with adolescent mental health? And I say very quickly, without hesitation, that I am really concerned about the fast-paced nature of our culture. We are moving, I think, at lightning speed as a culture. We’re becoming increasingly more digitally connected, which means that we’re becoming more and more less physically connected. So how does that impact our young people? And we’re so quick to point to these things (I’m holding my phone right now) and ask young people, especially teenagers, to do less of this. But if we’re honest, aren’t we just as guilty as parents? 

I have a colleague, and I don’t know if you would agree with this at all. I’m still kind of wrapping my mind around it because I like to see hard stats. But I had a colleague that said that he believes that most adults have some level of digital addiction. I don’t know. I don’t know that for a fact, but I know again that we are very much so attached to our phones. And so, the younger generation sees that. And if they’re going through despair, if they’re having thoughts of self-harming, if they’re having anxious thoughts, and they see that we are super duper connected to our phones, where then do they go? Are we essentially modeling the same thing? 

So again, I’m not here to say that technology doesn’t have its utility. It’s not all bad. But when our world is moving so fast that our nervous systems can’t keep up, what do we need to do? The answer is to slow down and have more face-to-face connections.

Kimberley: Yeah. I think that without the research, I can say for myself, it’s interesting. I actually had a colleague of mine, we both agreed we would track how many times we picked up our phone. And when I tracked it, it was always like, “Oh, I’m overwhelmed. I’ll just watch Instagram for a minute,” or “I’m feeling sad. I’ll just watch Instagram for a second.” And it was like, that’s my first coping skill. This is not good. That’s not good. So I totally agree with what you’re saying. 

I have one more question for you. So, the real word that felt so yummy to my whole body when I read your book was the word connection and how important that is for our teens but also for, I think, all humans. How might we connect better with our teens?

Chinwé: Oh gosh, can I throw a stat that’s sticking in my head? Can I throw that out right now? 

Kimberley: Please.

Chinwé: From birth to graduation, I still get goosebumps, and I’ve been saying this for about a year now. From birth to graduation, we have 936 weeks with our kids. 936 weeks and roughly 3,000 hours in one year. So, just depending on where you are in your parenting phase, depending on just who you are and the makeup of your nervous system, that’s going to land differently for you. But I know the first time, and even today when I hear that, I’m like, “There’s not enough time. Am I doing enough? Should I not be on this podcast? Should I be with her in school?” So it’s fine. 

But I think that, like, am I spending enough time? Am I connecting? And I don’t know one parent that I’ve counseled or that I do life with that doesn’t want to be a good parent. And I always remind parents that it’s not this whole connection piece that we’re seeing in the attachment research and the neuroscientific research. It’s not about being a perfect parent. It really is about being an intentional parent and showing up undistracted. So that whole conversation about before we check our kids, let’s see if we’re modeling the behavior we want them to see as it relates to technology. And again, tons of compassion. I’m a huge proponent on giving yourself the kindness that you would give someone else who might be struggling. So, that’s really important. But showing up undistracted, but also showing up when it’s not convenient. 

We know through brain research that connection can help bring down all of that energy that happens on the right side of the brain when an individual is highly activated, high anxiety for far too long, a state of despair for far too long, which can actually end up feeling like just numbness, like I feel nothing. 

So, what helps individuals to begin to heal, promote that healing is connection with another human being that they feel loved and cared for, that they feel respected, someone that respects them, someone that values who they are, not just what they do. “I love you just for who you are.” That’s something that I say. 

I’m actually being reminded of a Valentine’s Day card that my third grader made for me. And he wrote the sweetest thing, and I’m not going to read all of it, but at the very end, he said, “Thank you for loving me even when I’m unlovable.” And I sort of chuckled, and he read it to me and we laughed at the same time because that’s something I say to him all the time. Regardless of the behavior, regardless of what we are facing right now, the correction or the challenge, or you’re not getting along with your brother, I love you no matter what. 

So, even just hearing that, even just hearing that as adults that someone is going to be by our side and going to help us through a tough time, even when maybe we’re not acting lovable or “acceptable” from society’s perspective, what’s better than that? 

One of the very first tools that we talk about in our book Seen, we have five connection tools. The very first tool is showing up and showing up when it’s not convenient. As mama bears and papa bears, we have that instinct to swoop in and protect our kids when they’re struggling. And we also show up during those huge milestone moments—the concerts, the graduations, the big sporting events. And by the way, kids want to look up and see us and see grandparents in the stands. That’s important.

But the kids that I’ve been counseling throughout the years, they want their parents to show up in the seemingly insignificant and mundane moments of life, just to do basic things. Not to check the homework, not to talk about the boy that texted last night, but go for a coffee to just connect. Go in the front yard and play basketball. Go fishing. 

The key is whatever is meaningful and valuable to your child, those are the things that we want parents to engage in. And consistency really matters. And we’re talking about teenagers. This is what I’ve learned throughout the years, especially when I was a school counselor—the tendency is to think that as our kids get older, they need us less and less. And this is what my teenagers in therapy are telling me—I find that when they hit 13, 14, and 15, ooh, they are making huge life decisions. And even though there’s sometimes that conflict that happens between parents and teenagers or parents and preteens that can cause parents to sometimes disconnect because we get our feelings hurt sometimes and disengage, that’s when our kids are making really tough life decisions, so that’s when they need us the most. 

Consistency matters. So, it’s not showing up here and there. No knock on people who have busy lives and busy jobs, but the research shows that consistency builds trust. So, we show up, we show up undistracted, and we show up before they ask us to.

Kimberley: So beautiful. For me, it’s been a constant reminder of like, look them in the eyes. It’s so easy to be talking while chopping vegetables or checking email. It’s like, “Kimberley, stop and look at them in the eyes. That’s what they need to be seen.” So, I love that so much. 

I understand that you have a new book out. Please tell us all about where people can find you and learn about you. And you have a new book out. Tell us all the things.

Chinwé: Oh, thank you so much. Yes, our first book was Seen, which is really a book for connecting with a young person, if you’re a parent, educator, coach, regardless of mental health diagnosis. However, as we were traveling and sharing about the contents of Seen, everywhere we would go, parents would say, “Oh, this is awesome. I’m going to give this to my teenager.” And Will and I would be like, “No, this is not for your teenager; this is actually for you and another caring adult.” And then they would say, “Well, where’s the book for teenagers or is there a workbook?” 

And so, we wrestled with this for about a year, and we decided, looking at the stats, that’s really pointing to anxiety being super high, very rampant among all of us, including adults, 28% of adults have an anxiety disorder. We also are seeing that young people, adolescents, and young adults are struggling with anxiety. So we wrote a book that’s specifically for strategies to help with anxiety, and it’s called Beyond the Spiral: Why You Shouldn’t Believe Everything Anxiety Tells You. And it’s really going over six different lies that anxiety tells you. And here’s a sneak peek: Anxiety tells you that you have no control. Anxiety tells you that you’re going to miss out. Anxiety tells you that you should just ignore it, and anxiety tells you that you’re not safe. And there are two more. But then every single chapter, we talk about the lie, we talk about what’s happening in the brain that’s really highlighting that lie. And then we talk about psychological strategies that are tried and true, probably many of the ones that you’ve written about in your books and resources, many of the ones that I use with my clients today. And then there’s a spiritual piece for those who really have a strong faith. We bring in spiritual elements and practices that we believe are also really important to ease in anxiety.

Kimberley: Amazing. Thank you so much for being here. Is there any social media handles or websites that people can find your information?

Chinwé: Thank you for asking. So I am also pretty active on Instagram, and my Instagram handle is dr.chinwewilliams. So dr.chinwewilliams. And if you want to just learn a little bit more about me and my practice, I have a website, and it’s drchinwewilliams.com.

Kimberley: Amazing. And we’ll link all that in the show notes. I am so grateful for this book. I’m so grateful for you. I love the work that you’re doing. So thank you for coming on.

Chinwé: Thank you for your kindness. Thank you for your -- I’ll be honest with you, when I’m preparing for podcasts, I don’t have a lot of time, but I really do think it’s important to just get a flavor of the host, the content that they produce, the guests that they have on. But I don’t have a lot of time, right? So, I usually have time to listen to maybe 15 or 20 minutes of maybe one or two podcast episodes.

When I tell you, I was like, “Where am I going to start?” I was looking through your title list, and I was blown away. I listened to two and a half episodes, two entire episodes, and a half of one. And I was thinking, where has she been all my life? She’s going to be an amazing resource for my clients who -- I’m a trauma therapist, and as you know, that was formerly considered an anxiety disorder. So this is something that I’m really excited to present to my clients. So thank you for the work that you do.

Kimberley: Oh, thank you so much. I’m so grateful.

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 comes in, and it’s about balancing it and showing the work and what a lot of training to be a therapist is. It’s about choosing the voice. And I didn’t realize how much training to be a therapist actually helps me live day-to-day. Actually, I’m more rational when making more life decisions because I can choose to observe each voice, which was integral to me overcoming an anxiety disorder, as well as just facing life’s challenges every day.

WHAT IS IT LIKE TO BE A THERAPIST? 

Kimberley: Right. Because we’re really today talking a lot about what it’s ACTUALLY like to be a therapist—and I emphasize the word ‘actually’—what is it actually like to be a therapist, if we were to be really honest?

Joshua: One thing I mentioned is that I talk about the therapeutic hour, which is how long, Kimberley?

Kimberley: Fifty minutes.

Joshua: Yeah. The therapy took out and I explained what we do in the 10 minutes that we have between clients on a busy day. And people imagine us doing meditation or grounding ourselves or reflecting or whatever. Sometimes I do do that. Sometimes I just scroll Reddit, look at memes, eat candy, and do nothing. And it’s different each time. That’s what I’m doing. I’m not some mystic sage in my office, sitting sinisterly under the lamplight waiting for you to come in. No, I’m usually faffing around, panicking, checking that I don’t look like a scruff, putting a brush through my hair, trying to hide the stains of food I’ve got on my shirt because I overzealously consume my lunch. 

And there’s obviously some funny stories in there, but also there’s dark stuff in there as well. When I trained to be a therapist, I went through grief, and I made some quite unethical decisions back when I was training. Not the ones I’m proud of, but it actually shows the serious side of mental health and that a lot of therapists become therapists because of their own journeys. And I know that that applies to a lot of therapists I know.

Kimberley: For sure. I have to tell a story. A few months ago—I’m a member of lots of these therapist Facebook groups—one of the therapists asked a question and said, “Tell me a little bit what your hour looks like before you see a client. What’s your routine or your procedure pre-clients?” And all these people were saying, “I journal and I meditate and all of these things.” Some people were like, “I water the plants and I get my laptop open.” And I just posted a meme of someone who’s pushing all the crap off my table and screeching into the computer screen and being like sitting up straight. And all of these people responded like, “Thank God,” because all the therapists were beautifully saying, and I just came in here honestly, “Sometimes I literally sit down, open the laptop, and it is a mess. But I can in that moment be like, ‘Take a breath,’ and be like, ‘Tell me how you’re doing.’” Like you said, how does that end? We start the therapeutic hour. And I think that we have to normalize therapists being that kind of person.

Joshua: Definitely. I think one of the barriers to people seeking therapy is that power dynamic, that age-old trope that someone stood leaning against a mahogany bookcase. You’ve probably got a mahogany bookcase. Your practice is really nice. I certainly have. I’ve got an Ikea KALLAX unit full of books I’ve never read. 

Kimberley: Exactly. Your books aren’t organized by color because mine are not.

Joshua: No, no. There’s just some filler books in there. Just like, why is Catcher in the Rye? Why is Catcher in the Rye? I don’t know, I just put it on there. I just want to look clever. Anyway, it’s like people are afraid of that power dynamic of some authority figure going in there about to judge them, mind-read them, shame them, or analyze them. And no, I think dispelling that myth by showing how human we are can challenge that power dynamic. It certainly did for me. I would much rather open up to someone who isn’t showing the pretense that they have all of life together. Don’t get me wrong, professionalism is essential, but someone who’s professional and human, because going to therapy is some of the most human experiences you’ll ever do. I don’t want someone who isn’t showing too scared to show that sign or certain elements of being human, but obviously professionally. And it’s a fine balance to get. But when you do find a therapist like that, for me personally, one who’s knowledgeable, compassionate, empathetic, has humility, I think beautiful things can happen.

Kimberley: Yeah. I think you use the word that I exactly was thinking of, which is, it’s such a balancing act to, as a therapist, honor your own humanity from a place of compassion. Like, yeah, we’re not going to have it all together and it’s not going to be perfect, and we won’t say the right thing all the time. But at the same time, be thoughtful and have the skills and the supervision to balance it so that you are showing up really professional and from that clinical perspective. 

DO THERAPISTS GET CONSULTATION? 

Tell me a little bit about consultation as a clinician. I know for me, I require a lot of consultation for cases, not because I don’t know what I’m doing, but I’m always going to be honest with the fact that maybe I’m seeing it from a perspective that I hadn’t thought of yet. What are your thoughts on that kind of topic?

Joshua: Therapy’s got to work for both people as well, because the therapeutic connection, I believe, is one of the drivers that promotes therapeutic growth and change. It promotes trust. I will consult with clients and my supervisor and make sure it’s right. I’m not everyone’s cup of tea, but for people, particularly with anxiety disorders, I think they like to know and come to therapy. I think I’ve used self-disclosure on my public platforms tastefully in the sense that I know what it’s like to have gone through an anxiety disorder, whether it’s OCD or panic disorder or agoraphobia, and come out the other side. 

But also, it’s balancing that with, “Actually, I’m your therapist here. I will help you in a therapeutic setting and use my training.” You know I’m not someone who’s got everything worked out, but you do know that someone who can relate that can step into your frame of reference, something I talk about a lot in the book frame of reference and empathy. If you feel like a therapist has done that and is in your frame of reference and it’s like, “Ah, yeah, they get it or they’re at least trying,” and we as therapists feel like there’s a connection there too on a professional and therapeutic level, I think magic can happen. And I love therapy for that. Not all therapy is great and beautiful and wonderful. Some of it is messy, and some of it just doesn’t work sometimes. And I do talk about that too, but it’s about when you get that intricate dance and match between therapist and client, I think it’s life-changing.

WHAT TYPE OF PERSON DO YOU NEED TO BE TO BECOME AN ANXIETY THERAPIST?

Kimberley: Yeah. What do you think about the type of person you would have to be to be an anxiety specialist, especially if you’re doing exposure and response prevention? The reason I ask that is I have a private practice in California. I have eight clinicians that work for me. Almost every time I have a position that’s open, and when I’m interviewing people to come on to my team, I would say 60% come in, and they’re good to go. They’re like, “I want to do this. I love the idea of exposure therapy.” But there is often 40% who say, “I’m not cut out for this work. This is not how I was trained. It’s not how I think about things.” After I’ve explained to them what we do and the success rate and the science behind it, they clearly say, “This isn’t for me.” What are your thoughts about what it takes or what kind of person it takes to be an anxiety specialist?

Joshua: That’s a great question. First of all, you’ve got to trust and believe in the modality that you’re trained in. You and I use the principles a lot of cognitive behavioral therapy and exposure response prevention. I’ve got first-hand experience of that. You’ve got to trust the science and what we know about human biology, which is really important. It’s about what you’re trading in that modality. What I talk about -- again, see how I’m segueing it back to the book. Brilliant. I’ve done my media training, Kim. It’s like, “Always go back to the book. Come on, Josh.” One of my favorite chapters in the book is explaining about modalities because a lot of people just think therapy is one big world where you see a therapist, they wave a magic wand, you feel better, and suddenly our parents love us again. No, that’s not how it works. 

Kimberley: It’s not?

DIFFERENT TYPES OF ANXIETY THERAPISTS

Joshua: No, it’s not. Mental health has different presentations, and a modality is a school of thought that approaches difficulties in mental health. So, the first modality I go to is person-centered, which is counseling skills, listening, empathy, unconditional positive regard. 

The Carl Rogers way of thinking—I think I love that. Is that good for OCD, intrusive thoughts, exposure therapy, and phobias? Not really. It’s nice to have a base of that because there’s more chance of a therapist being understanding, stepping in your frame of reference, and supporting you through that modality. But I wouldn’t say it’s equipped for that. 

Whereas in CBT, a lot of it is psychoeducation, which I love. And that’s a different modality. Cognitive behavioral sciences, whether it’s third wave, when you’re looking at acceptance commitment, where are you looking at exposure response prevention. There’s lots of song and dance about I-CBT at the moment and things like that. They’re all different modalities and skills of thought. 

Then you’ve got psychodynamic, which is the mahogany bookcase, lie on the sofa, let’s play word association. Oh yeah, you want to sleep with your mom, Josh? No, I don’t. That’s nothing to do with why I keep having panic attacks in the supermarket. Stop judging me. But that’s a different type of approach. Jungian approach can be quite insightful, but it’s got to match what the presentation is for you. 

I think CBT is my favorite, but it sucks for stuff like grief. When I was grieving, I did not want CBT. I did not want my grief formulated. I did not want to see that my behaviors were perpetuating discomfort. I was like, “Yeah, that’s just part of my grieving process.” And in this chapter, I just talk about the different modalities.

Therapists are very passionate about the modality of the school that they train in because you have to give part of yourself to it. You have to go through it yourself. And I’m very passionate about the modalities I’m trained in. And so, I play on this in the book. There’s a chapter called The Younger Games or The Yunger Games, a play on words. And basically, it’s once-a-year therapists from every modality, whether it’s hypnotherapy, transactional analysis, CBT, person-centered, the trauma-informed. All of these, they all meet up in a field, and we all fight to the death. And the last remaining person is crowned the one true modality. Now last year, it was hypnotherapy. And what I also say is that a betting tip for next year is the trauma-informed. So, every year, I’ll keep you updated on The Yunger Games. And basically, it’s a narrative device to explain that. 

Within the world of therapy, there are different types of therapists. You and I, we love CBT. We’ll bang the drum for that. We feel that there’s not enough ERP out there that certainly isn’t, particularly with the evidence and the points towards it and mountains of evidence. But other therapists may not feel the same. So, when people come to work at CBT School and they realize that Dumbledore, aka Kim Quinlan, is like, “No, we do ERP here; we’ve got to get down and dirty and do the horrible work,” they’re like, “That’s not conducive to the softer step-back approach that I’ve trained in, in my modality.”

Kimberley: Yeah. I’m always so happy that they just are honest with me. I remember as an intern at OCD Center in Los Angeles very clearly saying, “Are you okay talking about really very sexual, very, very graphic topics?” He listed off. Like, “Here is what you’re going to need to be able to talk about very clearly with a very straight face. You can’t have a wincing look on your face when you talk about intrusive, violent sexual thoughts. You’re going to have to be up for the game.” And I think that was a big thing for me. But what I think is really cool about your book, and you see now I’m bringing it back to your book, is it doesn’t mean the voice isn’t in your head sometimes questioning you. As I was reading it, I’m like, there is an imposter in therapists all the time saying, like you said, the critic that’s like, “You don’t know what you’re doing. You’re a failure. You’re a flake. You’re a complete fraud. You haven’t got it together. Maybe you haven’t even worked on the thing yourself yet.” That’s going to be there.

Joshua: Yeah, and I still get that. I can’t speak for you. But I think what makes a good therapist is a therapist who self-doubts. You don’t want to go and see a therapist who thinks that they’ve got it all worked out. That’s a red flag in itself. A good therapist is one that always wants to improve and uses that doubt and anxiety to make themselves a better therapist. Don’t get me wrong, I’m pretty confident in my ability to be a therapist now, but there are challenges.

In the book, the voices that come up, there’s 13 of them. One of them is escapist, which is, “I just want to get the hell out of you,” or “Maybe I want to get rid of this client. I’m not equipped for it.” And then the other voices come in and they’re like, “But maybe this is just you being critical,” or “The evidence suggests that actually you are trained for this,” and navigating that doubt, the anxiety that your therapist has. And I think it’s a beautiful thing. 

A lot of therapists are very harsh on themselves, but I think it’s a gift to have that inner critic. Because if you stand there like one of these therapists, and these therapists do exist, unfortunately, I have completed all my training. I know everything inside out. My word is gospel. I worked out what the problem was with this person within 10 minutes. You don’t want to talk to that person. What a close-minded moron. And there’s a judgmental voice from a therapist.

Kimberley: No, but I think that’s informed.

Joshua: So, it celebrates the vulnerability. You want a therapist who’s not got everything worked out. Absolutely. I do anyway.

Kimberley: Yeah, for sure. I’m wondering, how often have you had to work through your own shit in the room with a client? Meaning—I’ll give you a personal example—the very first time I ever experienced derealization for myself was with a client, and I was sitting across from them. They were just talking, and all of a sudden, I had this shift, like everything wasn’t real. Their head looked enormous and their body looked tiny. Like they were this tiny little bobbly head thing on the couch. And I knew what was happening. Thankfully, I knew what it was like. I knew what it was. Otherwise, I probably would have panicked, but I had to spend the rest of the session being as level and mindful as I could as I watched their head just bubble around in this disproportionate way. I got through it. I can say confidently I think I pulled it off really well, but it was hard. And I left the session being like, “What the heck just happened?” Has there been any experiences for you like that?

Joshua: Yeah, all the time. I mean, first of all, I’d question if you did have derealization. I was your client with a giant head and a tiny body. I was like, “What’s going on here?” There wasn’t derealization. That’s my body, Kim.

Kimberley: No, that’s just how I look, Kimberley. 

Joshua: It’s just how I look. 

Kimberley: “Stop judging.”

Joshua: But in general, no, it’s true. And again, one of the voices in my book, And How Does That Make You Feel?, it’s called trigger because therapists, they have to give a lot of themselves and they’re living a life and have had stuff in their past. One of the voices is trigger. One of the things I get asked a lot is, I don’t know about you, Kim, “If you’ve had anxiety, how can you work with it all day?” I’m like, “Because I’m all right with it. It’s okay now.” Sometimes it creeps in, though, if I’m tired or have not slept well. There’s stress in my personal life that you can’t avoid. Maybe I’ve not eaten too well. Maybe it’s just ongoing things. Sometimes trigger can happen, and it can be a stress-induced trigger or it could be a literal trigger from a traumatic event. 

So, in the book, I explain when people bring grief and death, that sometimes makes me feel vulnerable because of my own experiences with grief and death. No spoilers, but the book throughout, one of the themes is why I became a therapist. Not only because of my passion for anxiety disorders and to be self-righteous around other therapists, train different modalities, but also because it’s a very grief-informed decision to want to help people. 

And there’s several traumatic stories. One traumatic story around grief, that trigger, the voice of trigger will come up. So, a client could be talking about their life, like, “I’ve lost this person; I’m going to talk about it.” And of all these 13 voices around the table, what your therapist is thinking, trigger then shouts loudest. It goes, “Ah, trigger.” There’s some pain that you’ve not felt for a while and I’ve got to navigate it. You navigated the derealization, the dissociation. You’ve got to navigate it somehow by pulling on the other voices. And not only do therapists do this, but people do this as well sometimes, whether you’ve got to be professional or you don’t want to turn up to your friend’s birthday and just listen to trigger and anxiety and start crying all over your friend’s birthday cake. You might do. It’s quite funny, but not funny. 

Kimberley: I was going to say, what’s wrong with that? 

Joshua: Have you done it again? I thought you stopped that. 

Kimberley: Yeah. You haven’t done that? 

Joshua: It’s part of the interview at CBT School. You need to do really hard, tricky things. Go to your best friend’s birthday and make it all about you. 

Kimberley: Exactly.

Joshua: But yeah, it’s one of those. It crops up. The book’s funny a lot, but it’s good. It takes some really serious turns, and it shows you a lot of stuff can creep in and how I deal with it as a therapist. And I’m sure you related to it as well, Kim, because we do the same job, but you just do it in a sunnier climate.

SEEING CLIENTS IN PUBLIC 

Kimberley: Right. What I can say, and this will be the last thing that I point out, is you also address the awkwardness of being a therapist, seeing your clients in public and the awkwardness of that, or the, “Oh crap, I know this person from somewhere.” Again, no trigger. I don’t want to give the fun parts of the book, but as a therapist, particularly as someone who does exposure therapy, I might go across the road and take a client to have coffee because they’ve got to do exposures. We very often do see people, our clients, our friends in our work. How much does that impact the work that you do?

Joshua: If you ever bump into your therapist, just know that you have all the power there. Your therapist is squirming inside, “I don’t know what I’m doing. I don’t know. Do I completely blank this person?” But then I look like a dick. “Do I give a subtle nod? Oh, you’re breaking confidentiality. They’re out with loved ones.” It’s up to you. You can put your therapist out of their misery by just saying, “Hey, Kim.” “Hey, Josh.” And then I will say hi back because that shows that you’re okay with that. 

There is a very extreme shocking version of this story, of this incident in the book where, when I’m at my lowest, I do bump into a previous client. On a night out, when I’m off my face on alcohol. Oh, if you want to find out more about that... Media training’s really paid off. Get him on the hip. 

Kimberley: I didn’t want to give it all away, and you just did.

Joshua: No, no, not giving any more away. A media training woman said, “Entice them, then leave it, because then they’re more likely to read it.” So, I have listened to that media woman because my previous tactic of just begging and screaming into a camera doesn’t work. It’s like...

Kimberley: But going back exactly—going back, we are squirming. I think that is true that there is a squirm factor there when you see clients, and it happens quite regularly for me. But I think I’ve come to overcome that by really disclosing ahead of time. Like if I see you outside, you’re in the place of power, you decide what to do, and I’ll just follow your suit. It’s a squirm factor, though.

Joshua: See, that’s clever, good therapy stuff because you do it all part of the contracting and stuff. Actually, I told all my clients this is okay. But also, when you’re a new therapist or sometimes you forget, you’re like, “Oh no.” I used to run a music night in Manchester as part thing I did on the side. Enjoy it, love music, I was the host. One week I was on holiday, so a friend organized all the lineup of people to come down. Headline Act was a band name. Went along, and when I’m there, I’m having fun. I’ve got whiskey in my hand. I’m walking around telling irreverent, horrible jokes. No one in there would guess I was a therapist because I’m having fun and I’m entitled to a life outside the therapy room. 

What I didn’t know was that the Headline Act was a current client, and they’d just arrived dead late. They didn’t know, and they walked on stage, and I looked. It’s something that they’ve gone on publicly to talk about, so this is why I’m saying it now. I got permission to use it because they said it publicly on the radio and stuff like that. And we just looked at each other. It was like, “Oh my God.” And I stood there with this. I was like, “Oh my God.” And I’ve said all this bad language and cracking jokes, roasting people in the audience, my friends usually. And it’s like, yeah, I was squirming. 

So, at this point, I did just pretend I didn’t know them because it was the best I could do. And they got me out of trouble. They were obviously confident in performance mode. And they got onto mic and was like, “Can you believe that guy is my therapist?” And I was like, “What?” I was like, “Wow.” And then he said some really lovely things. And it wasn’t really awkward in therapy. If anything, it was quite something we laughed about in therapy afterwards, and it contributed to it. But yeah, the horror I felt. Oh, I felt sick, and oh. I don’t want to think about it.

FINAL CONCLUSIONS

Kimberley: I want to be respectful of time. Of course, before you share this all about you and where people can get a hold of you and learn about your book, is there anything you want to say final point about what it’s like to actually be an anxiety therapist?

Joshua: It’s the best job in the world for me. It’s the best job in the world. All my friends and family go, “I don’t care how you can do that.” I love it. I get to have the most human conversations with people without judgment. You mentioned before about intrusive thoughts. I’ve got the magic guitar in this room, and we make songs about horrible intrusive thoughts. There was one the other day about kicking babies down the stairs. You can’t say that out loud. Yes, we do in here, to the three chords of the guitar I only know, particularly postpartum mothers. 

Kimberley: You told me we couldn’t sing today. 

Joshua: No, I’m not singing.

Kimberley: I wanted to sing today, and now you’re telling me we can’t sing.

Joshua: I don’t think it’s going to be Christmas number one—a three-chord banger about harming loved ones or sexual intrusive thoughts—but you never know. Yeah, it’s the most beautiful job.

Kimberley: I am known to sing intrusive thoughts to happy birthday songs.

Joshua: That’s a good one. I have to close my window though in my office because I do get scared that people walk past and like, “Wow, that’s a very disturbed man.” No, he’s not. I’m confident in the powers of ERP and how it can help.

Kimberley: You are. I love it. Josh, tell us where we can hear more about your book and learn more about you.

Joshua: I’m Joshua Fletcher, also known as AnxietyJosh on social media and stuff. The book is called And How Does That Make You Feel?: Everything You (N)ever Wanted to Know About Therapy. It follows the stories of the four client case studies, obviously highly scrambled and anonymized, and gone through a rigorous ethical process there. So, don’t be like, “He’s talking about his clients.” No, that’s not what the book’s about. It’s about appearing in behind the therapy room door. It’s out in the US before the UK, which is here. I don’t know if anyone’s watching or whatever, but there it is. And it’s also been commissioned to be a television show for major streaming services. We don’t know which one yet, but it’s exciting. 

Go get yourself a copy. It should be in your bookstore. Get it at Barnes & Noble and all the other US ones. And I think you’ll really enjoy it. So, it’s a really lovely endorsement. Kim has also said it’s really good, and Kim is harsh. So, if Kim says it’s good, then it’s going to be good. And I hope you really enjoy it and pass it on to a loved one who doesn’t have anxiety, and you’ll find that, “Oh, I actually learned quite a lot there whilst laughing and being captivated by the absolute bananas behind-the-scenes life of being a therapist.”

Kimberley: Yeah, I love it. Josh, the way that you present it, if I was scared to go to therapy, I think it would make me less scared. I think it would make me feel like this is something I could do.

Joshua: And that’s the best compliment I can receive, because that’s why I wrote the book. So, thank you so much.

Kimberley: Yeah. So fun to have you. Thanks for being here.

Joshua: Thanks, Kim.

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 overcoming depression and with my patients in CBT, but some kind of mindfulness practice. It might be journaling, it could be a gratitude practice, it could be preferably some kind of meditation. Often, what I will encourage my clients to do is just listen to a guided meditation, even if you don’t really follow along exactly. But you’re just learning about these concepts. You’re learning about the tools. You’re getting curious about them if that’s all you can do. Or if you want, you could even go more into reading a book about mindfulness, starting to learn about these ideas and concepts because they will, again, help you to have a better relationship with your thoughts and your feelings. 

Another morning routine I want you to maybe consider here is to have some type of nutritious breakfast, something that supports your mental health. We want to keep an eye out for excessive sugar, not that there’s anything wrong with sugar, but it can cause us to have another energy dump, and we want to have something that will improve our energy. With depression, usually, we don’t have much energy at all. So, whatever tastes yummy, even if nothing feels yummy, but there’s something that maybe slightly sounds good, have that. If it’s something that you enjoy or have good memories about, or if it’s anything at all, I’m happy just for you to eat anything at all if it’s not something that you’ve been doing. 

Let’s now move over to work-day or daytime strategies or routines. The first thing I want you to consider here throughout the day is setting realistic daily goals and priorities. We have a course at CBT School called Optimum Time Management, and one of the core concepts of that course, which teaches people how to manage their time better, is we talk about first prioritizing what’s most important. 

If you have depression, believe it or not, one of the most important things you can do to prioritize in your daily schedule is pleasure. And I know when you have depression, sometimes nothing feels pleasurable. But it’s so important that you prioritize and schedule your pleasure first. Where in the day can you make sure that you do something enjoyable, even if it’s this enjoyable, even if nothing is enjoyable, but you used to find it enjoyable? We want to prioritize your self-care, prioritize your eating, having a shower, brushing your teeth. If nothing else gets done that day, that’s okay. But we want to prioritize them depending on what’s important to you. 

Now, if you’re someone who’s depressed because you’re so overwhelmed with everything that you have to do—again, we talk about this in the time management course—we want to really look at the day and look at the schedule and say, “Is this schedule nurturing a mental health benefit to me? Is it maybe time for me to reprioritize and take things off my schedule so I can get my mental health back up to the optimum level?” 

I have had to do this so many times in the last few years, especially as I have suffered a chronic illness, really separate like an hour to really look at the calendar and say, “Are these things I’m doing actually helping me?” Sometimes I found I was doing things for the sake of doing them to check them off the list, but I was getting no mental benefit from them. No real value benefit from them either. 

Another daytime strategy you can use is a technique or a tool called the Pomodoro Technique or the Pomodoro Method. This is where we set a timer for a very short period of time and we go and we do the goal and we focus on the thing for a short period of time. So, an example might be I might set a timer for 15 minutes, and all I’m going to do during that 15 minutes is write email. If 15 minutes is too much for you, let’s say maybe you need to tidy up your dishes, you might set a timer for 45 seconds and just get done with what you can for 45 seconds and then take a short break. Then you set the timer again. All I have to do is 45 seconds or a minute and a half or three minutes or five minutes, whatever is right for you, and put your attention on just getting that short Pomodoro little bout done. 

This can be very helpful to maintain focus. It can be very helpful to maintain the stress of that activity, especially if it’s an activity that you’re dreading. And so, do consider the Pomodoro technique. You can download free apps that have a Pomodoro timer that will set you in little increments. It was actually, first, I think, created for exercise. So, it sets it like 45 minutes on, 20 seconds off, 45 seconds on. And so, you can do that with whatever task you’re trying to get done as well. 

Another daytime routine I want you to consider is getting some kind of natural light or going outdoors. There is so much research to show that going outside, even if it’s for three minutes, and taking in the green of the earth or the dirt under your feet, really getting in touch and grounding with some kind of nature, or being in the sunlight, can significantly improve mood. So, consider that as well. And again, I’m going to mention, make sure you eat lunch. Eat something that boosts your mood and boosts your energy levels. 

Now let’s talk about evening or wind-down routines for depression or practices. Now, number one, one of the things that we often do the most, which we really need to be better about, and this is me too, is doing some kind of digital detox in the evenings. Try your hardest to limit screen time before bed because we know screens before bed actually disturb our sleep. We also know that often we spend hours, hours of our day scrolling on social media. And even though that might feel pleasurable, it actually removes us from engaging in hobbies and things that actually make us feel good about ourselves. 

One of the best ways to feel good about who you are and to feel accomplished is to be learning something or mastering something. I don’t care if it’s something that you’re starting and you’re terrible at. We have a lot of research that even moving and practicing a skill will improve and boost your mood so much more than an hour of sitting and watching funny TikTok videos. 

Now, again, if all you want to do is that for right now, that’s fine. Maybe spend five minutes doing some hobby or task—something that you enjoy or used to enjoy—that you feel like you’re getting better at. Maybe you learn Spanish, you learn to crochet, you learn to knit, you do paint by number. It doesn’t matter what it is. Just pick something and work at something besides looking at a screen, especially in the evenings. 

Another evening routine I want you to consider is some kind of relaxation technique for depression—reading, take a bath, maybe do again some stretching or some light yoga, maybe dance to one song. Anything you can do to, again, move your body. Again, we have so much research to show that moving your body gently, especially in the evening, can help with mood. 

Another thing here is to find a comfortable sleep routine and bedtime routine. So, if you can, again, go back to your scheduling, and if you’re not good at this—we do have that online course for time management—create a nighttime routine that feels yummy in your bones. Maybe it’s reading a book, a lovely warm blanket, the pillow you love, a scent—sometimes an oil diffuser would be lovely for you. Dim the lights, close the blinds, create a nice, warm, cozy nook where you can then ease into your sleep. 

Overall, weekly activities and routines that you may want to consider for your mental wellness include again finding hobbies. It doesn’t have to be grand. You don’t have to sign up for a marathon. You don’t have to become an amazing artist. You can just pick something that you suck at. That’s okay. 

I always tell my patients to do paint by number. It requires very little mental energy, but you do have this cool thing that you did at the end that you can gift somebody, or you can even scrap it at the end, it doesn’t matter. Put it up on your wall—anything to get you out of your head and out of the mood piece—and really get into your body, moving your hands and thinking about focusing on other things. 

One of the most important things that you can do to help boost mood and decrease depression is to find a community of like-minded people. The social interaction and improving and maintaining connections between people are going to be so important. In fact, in some countries, the treatment per se for depression, no matter how depressed somebody is, the community go and get them, bring them out, they have a party for them, they cook for them, they surround them, they dance with them. And that’s how those communities and tribes help people get through depression. And we in our Western world have forgotten this beautiful, important piece of community and being a part of a big community family. 

Now, if you have struggled with this and it’s been difficult, I encourage you to reach out to support groups. There are so many ways—meet-up groups, local charities, volunteering, maybe finding again a hobby, but a place where you go and you’re with other people, even just doing that. You don’t have to spend a lot of time, but being around people. Even though when you’re depressed, I know it doesn’t feel like that’s a helpful thing. We do know that it does connect those neural pathways in our brain and does help with the management and maintenance of depression recovery. 

Now, what do we do, and how can we maintain these routines on the really tough days? When it comes to handling the tough days, I understand it can feel overwhelming. All of this can feel like so, so much. But what I’m going to encourage you to do is keep it really simple. Just doing your basic functioning is all that’s required on those really tough days. It doesn’t matter if you don’t get all the things done on your list. Be compassionate, be gentle, encourage yourself, look at the things you did do instead of the things you didn’t get to do, and also seek support. Reach out to your mental health professional or a support group or your medical doctor or family or a friend or a neighbor if you’re really needing support. 

There will be hard days. Depression is not linear. Recovery for depression is not linear. It’s up and down. There will be hard days. So, be as gentle as you can. Keep it as simple and as basic as you can. Do one thing at a time. Try not to focus at the whole day and all the things you have to do. That’s going to help you feel less overwhelmed and, again, help you get through one thing a day. 

Let me do a quick recap. The importance of routine is huge. Routines are going to be probably one of the most important parts of your long-term recovery, besides, of course, treatment and medication. It will help you to get through the hard and stressful days and will also allow you to slowly make steps into the life that you want, and often, because we have depression, depression can take away the life that we want. So, that routine can help you slowly build up to the things that you want to do and get back to the life that you do really value. 

I encourage you all to play around with this. Remember, look at the routine you have already, and maybe add one thing for now. Take what works for you, but if some of the things I mentioned today, don’t leave them. Please don’t feel judged or embarrassed if some of these aren’t really working for you. We have to look at what works for us and be very gentle with ourselves with that as well.

I hope this has been helpful. The routines have really saved me in my mental health. And so, I hope it helps you just as much as it’s helped me. 

Have a great day, and I’ll see you guys next week.

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.

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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 ride out that urge to scratch the itch. So, paying attention to. If you zoom in on the itch, what happens?  What happens when you zoom out? What else can you pay attention to? 

And so when someone learns that process, that is on such a micro level. I often tell patients it’s like a one-pound weight.

Kimberley: Yes.

Joanna: And then what are some two-pound weights that people can use? So then, for many people, it’s their phone. So, it’s perhaps not checking notifications that come in right away. They begin to practice in low-distress situations because I want people to get confident that they know how to zoom in, they know how to zoom out. They know if they’re feeling a sensation, the more that they pay attention to it, the worse it’s going to feel. And so, where else can they put their awareness? What else can they be doing? 

And once they get the hang of it, we introduce more and more distress. So then, it might be their phone, then it might be them intentionally calling up a thought. And we work up that way with adding in, very gradually, more distress or more discomfort. Exercise is a great way, especially if it’s not married to anxiety, to get people interacting with it differently.

Kimberley: Yeah. We use this all the time with anxiety disorders. It’s a different language because we talk about an ERP hierarchy, or your exposure menu, and so forth. But I love that in the book, it’s not just specific to that. It could be like you talked about. It’s for those who have depression. It’s those who have grief. It’s those who have eating disorders. It’s those who have anger. I will even say the concept of distress tolerance to me is so interesting because there’s so many areas of my life where I can practice it. Like my urgency to nag my kids another time to get out the door in time, and I have to catch like, “You don’t need to say it the third time.” Can you tolerate your own discomfort about the time it’s taking them to get out the door? And I think that when we have that attitudinal shift, it’s so helpful.

Joanna: Yes. I find parenting as one of the hardest places for me, but it was also a reminder like the more I keep my mouth shut, the better.

Kimberley: Yeah. And I think that’s really where I was talking before. I found parenting to be quite a triggering process as my kids have gotten older, but so many opportunities for my own personal growth using this exact scenario. Like your fear might come up, and instead of engaging in that fear, I’m actually just going to let it be there and feel it and parent according to my values or act according to my values. And I’ve truly found this to be such a valuable tool.

Joanna: Yes. And I have found what’s been really interesting, when my kids were at home, that was where my distress was. Now that the two of the three are out of the house, my distress is when we’re all together and everyone have a good time. And so, it morphs, because what I tell myself and my perception and the urgency, it changes. It’s still so difficult with them, but it changes based on what’s happening.

Kimberley: Yeah. And I think this is an opportunity for everyone, too. How much do you feel that awareness piece is important in being aware that you are triggered? For the folks listening, of course, you’re on the Your Anxiety Toolkit podcast. Most are listening because they have anxiety. Do you encourage them to be aware of other areas? They can be practicing this. 

Joanna: Yes.

Kimberley: Can you talk to me about that?

Joanna: 100%, because I feel like -- what is that metaphor about the onion? It’s like the layers of an onion. So, people will come, and they’ll think it’s about their anxiety. But this is really about any uncomfortable feeling or uncomfortable sensation. And so. It may be that they’re bored or vulnerable or embarrassed or something else. So, once someone learns how to allow those feelings and do what is important to them or what they need to do while they feel it, then yes, I want them to go and notice where else in their life this is showing up.

Kimberley: Talk to me specifically about how in real-time, because I know that’s what listeners are going to ask. 

Joanna: Of course.

Kimberley: I have this scary thing I want to be able to do, but I don’t want to do it because I’m scared, and I don’t want to feel scared. How might someone practice tolerating their distress in real-time?

Joanna: I’m going to answer two ways. One, I would say that might be something to scale. Sometimes people want to do the thing because doing the thing is like the goal or the sexy thing, but if it’s outside of their window of tolerance, they may not be able to do it. So, it depends on what they want to do. So, I might say, as just a preface, this might be something that people should consider scaling. 

Kimberley: Gradual, you mean?

Joanna: Yes. So, for instance, they want to go to the gym, but they’re scared of fainting on the treadmill or something. Pretty common for what we see. It would be like, scale it back. So it might be going to the parking lot. It might be taking a tour. It might be going and standing on the treadmill. It might be walking on the treadmill. But we have to put it in smaller pieces. 

In the moment that we’re doing something that is difficult, first, we have to notice if we’re starting to grip. I use this “if we’re starting to grip” something. If we’re starting to zoom in on what we don’t like, if we’re starting to zoom in on a sensation we don’t like, a thought we don’t like, a feeling we don’t like, I want people to notice that and you get better at noticing it faster. 

The first thing is you got to notice it, that it’s happening, because that’s going to make it worse. So, you want to be able to notice it. You want to be able to loosen your grip on it. So, that might be finding out what else is going on in my surroundings. So, I’m on the treadmill, I’m walking maybe at a faster pace, and I’m noticing that my heart rate is going up, and I’m starting to zoom into that. What else am I noticing, or what else am I hearing? What else do I see? What else is going on around me? Can we make something else a louder voice?

And so, every time that my brain wants to go back to heart focus, it’s like, no, no. It’s taking it back to something else that’s going on. And it helps to connect with why is this important to do? So, as I’m continuing to say, “I’m okay. I am safe. I’m listening. I’m focusing on my music, and I’m looking out the window," This is really important to do because my health is important. My recovery is important. It becomes that you’re connecting to something that’s important, and the focus is not on what we don’t like because that’s going to make it bigger and stronger.

Kimberley: Right. As you’re doing that, as we’ve already mentioned, someone might be having those can’t thoughts, like I can’t handle it, even if it’s within their window of tolerance, right? It’s reasonable, and it’s an appropriate exposure. How might they manage this ongoing “You can’t do this, this is too hard, it’s too much, you can’t handle it” kind of thinking?

Joanna: I like “This may suck, and I can do it.”

Kimberley: It’s funny. I will tell you, it’s hilarious. In the very beginning of the book, you make some comments about the catchphrases and how you hate them, and so forth. I always laugh because we have a catchphrase over here, but it’s so similar to that in that we always talk about, like it’s a beautiful day to do hard things. And that seems to be so hopeful for people, but I do think sometimes we do get fed, like over positive ways. You have a negative thought, so we respond very positively, right? And so, I like “This is going to suck, and I’m going to do it anyway.”

Joanna: Yes. So you’re acknowledging this may suck, especially if you’re deconditioned, especially if you’re scared. It may suck AND—I always tell people not the BUT—AND I can do it. Even in 30-second increments. So, if someone is like, “I can’t, I cant,” I’ll say, “You can do anything for 30 seconds.” So then we pile on 30 seconds.

Kimberley: Yeah. And that’s such an important piece of it too, which is just taking a temporary mindset of we can just do this for a little tiny bit and then a little tiny bit and then a little tiny bit. 

Joanna: Yes, I love that. I love that.

Kimberley: Why do we do this? What’s the draw? Sell me on why someone wants to do this work.

Joanna: To do...?

Kimberley: Distress tolerance. We talk about this all the time. Why do we want to widen our distress tolerance?

Joanna: Oh my goodness. Oh my gosh. I think once you realize all the little areas that may be impacting one’s life, it just blows your mind. But in a practical sense, people can stay stuck. When people are stuck. This is often a piece. It’s absolutely not the whole reason people are stuck, but this is such a piece of why people get stuck. And so I think for anyone that might feel stuck, perhaps they want a different job or they want to show up differently as a parent or they feel like they are people-pleasers, or they’re having trouble dating because they get super controlling. It can show up in any area of one’s life.

Kimberley: Yeah. For me, the selling point on why I want to do it is because it’s like a muscle—if I don’t continue to grow this muscle, everything feels more and more scary.

Joanna: Oh, sure. Yeah, hundred percent.

Kimberley: The more I go into this mindset of “You can’t handle it and it’s too much, it’s too scary” things start to feel more scary. The world starts to feel more unsafe, whereas that attitude shift, there’s a self-trust that comes with it for me. I trust that I can handle things. Whereas if I’m in the mindset of “I can’t,” I have no self-trust. I don’t trust that I can handle scary things, and then I’m constantly hypervigilant, thinking when the next scary thing's going to happen.

Joanna: Right. Another reason to also practice doing it, if you never challenge it, you don’t get the learning that you can do it.

Kimberley: Yeah. There’s such empowerment with this work.

Joanna: Yes. And you don’t have to do big, scary things. You don’t have to jump out of an airplane to do it or pose naked, because I see that on Instagram now, people who are conquering their fears by doing these. Very Instagram-worthy tasks, which could be very scary. We can do it, just like you say, with not nagging our kids, by choosing what I want to make for dinner versus making so many dinners because I am so scared that I can’t handle it if my kids are upset with me.

Kimberley: Right. And for those who have anxiety, I think from the work I do with my patients is this idea of being uncertain feels intolerable. That feeling. You’re talking about these real-life examples. And for those who are listening with anxiety, I get it. That feeling of uncertainty feels intolerable, but again, that idea of widening your tolerance or increasing your ability to tolerate it in 10-second increments can stop you from engaging in compulsions that can make your disorder worse or avoiding which can make your disorder worse. Do you have any thoughts on that?

Joanna: I 100% agree with you. I always say, let’s demote intolerable to uncomfortable. Because I feel sometimes like I have to know I can’t stand it, I’m crawling out of my skin. But if I’m then able to get some distance from it, that’s the urgency of anxiety.

Kimberley: Yeah. It’s such beautiful work.

Joanna: Yes, and especially the more people do, they’re able to say, “You know what? I can do things.” It may feel intolerable. That diffusion, it may feel intolerable. It’s probably uncomfortable. So, what is the smallest next step I can take in this situation to do what I need to do and not make it worse? That’s a big thing of mine—not making a situation worse.

Kimberley: Yes. And that’s where the do-nothing comes in.

Joanna: Yes. That’s the paradoxical part. 

Kimberley: Yeah. Is there any area of this that you feel like we haven’t covered that’s important to you, that would be an important piece of this work that someone may consider as they’re doing this work on their own?

Joanna: I think and I know that you are a big proponent of this too. I think it’s very hard to do this work without some mindful awareness practice. And I talk about it in the book. It’s just such an enhancer. It enhances treatment, but it also enhances our daily life. So, I can’t say strongly enough that it is so important for us to be able to notice this pattern when we are saying, “Oh my gosh, I can’t take this,” or “I can’t do this.” And then the behavior and to think about what’s the function of me avoiding. But if we’re going so fast and our gas pedal is always to the floor, we don’t have the opportunity to notice.

Kimberley: Yeah, the mindfulness piece is so huge. And even, like you’re saying, the mindfulness piece of the awareness but also the non-judgment in mindfulness. As you’re doing the hard thing, as you’re tolerating distress, you’re not sitting there going, “This sucks and I hate it.” I mean, you’re saying like it will suck, and that's, I think, validating. It validates you, but not staying in “This is the worst, and I hate it, and I shouldn’t be here.” That’s when that suffering does really show up. 

Joanna: Yes. The situation may suck. It doesn’t mean I suck. That was a hard lesson to learn. The situation may, but I don’t have to pour gas on it by saying, “How long is it going to last? Oh my gosh, this feeling’s never going to end. Do I still feel it? Oh my gosh, do I still feel it as much?” All the things that I’m prone to do or my clients are prone to do that extend the suffering.

Kimberley: Make it worse.

Joanna: Yeah, exactly.

Kimberley: It’s a great question, actually. And I often will talk with my patients about it, in the moment, when they’re in distress. Sometimes writing it down, like what can we do that would make this worse? What can we do that will make this better? And sometimes that is doing nothing at all. And you do talk about that in the book.

Joanna: Yeah.

Kimberley: The forward and the backward. 

Joanna: The choice points. Yes.

Kimberley: Can you share just a little bit about that?

Joanna: It’s a concept from ACT (Acceptance and Commitment Therapy) that says, when we have a behavior, a behavior can either move us toward or forward what’s meaningful in our values or can move us away from it. And so, as we’re thinking about doing whatever the hard thing maybe or it may not even be a hard thing; it just may be something you don’t want to do. Thinking about what your why is, what’s the forward move? Why is it meaningful to you? What do you stand to get? What’s on the other side? Because most of us are well versed, and if we give in, that’s an away move. And we have to be able to do this non-judgmentally because some days it’s just not in us, and that’s totally fine. But I want people to be honest with themselves and non-judgmental about whatever decisions they make. But it does help to have a reason that moves us forward.

Kimberley: Absolutely. I think that’s such an important piece of the work. Again, that’s the selling point of why we would want to be uncomfortable. There’s a goal or a why that gets us there.

Joanna: Yeah. And it’s amazing how much pain we will put up with. I mean, think about all the things people like—waxing and some of these exercise classes. It’s amazing because it’s important to someone.

Kimberley: Exactly. And I think that’s a great point too, which is we do tolerate distress every day when we really are clear on what we want. And I think sometimes we have these things like I can’t handle it, but you might even ask like, what are some harder things that I’ve actually tolerated in my lifetime?

Joanna: Yes, exactly because there’s a lot of things you’re so right that we do that are uncomfortable, but it’s worth it because, for whatever reason, it’s worth it.

Kimberley: Yeah, I love this. I have loved chatting with you. I know I’ve asked you this already, but is there any final words you want to share before we learn more about you and where people can get in touch with you?

Joanna: I just want people to know that anybody can do this. It may be that it’s just creating the right scale—a small enough step forward—but anybody can work on this. There are so many areas and ways in which we can strengthen this muscle. And so there is hope. No one is broken. It may be that people just don’t know the next best move.

Kimberley: I love that. Thank you. Where can people hear more about you and get in touch with you?

Joanna: My website is JoannaHardis.com and my Instagram is the same thing, @JoannaHardis. And excitingly, the book just came out in audio yesterday. 

Kimberley: Congratulations. 

Joanna: Thank you. Thank you. 

Kimberley: That’s wonderful. And we can get the book wherever books are sold. 

Joanna: Wherever books are sold, yes.

Kimberley: I really do encourage people to buy it. I think it’s a book you could pick up and read once a year, and I think that there’s messages. You know what I’m saying? There are some books where you could just revisit and take something from, so I would really encourage people to buy the book and just dabble in the many concepts that you share.

Joanna: Wonderful. Thank you.

Kimberley: Yeah. Thank you so much for being on the show. This is such a concept and a topic that I’m really passionate about, and for myself too. I think it’s something I’ll be working on until I’m 99, I think.

Joanna: Me too. I’m with you right there.

Kimberley: There’s always an opportunity where I’m like, “Oh okay. There’s another opportunity for me to grow. All right, let’s get on board. Let’s go back to the school.” So, I think it’s really wonderful. Thank you so much for being here.

Joanna: Thank you so much for having me.

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 talking to a female colleague. Like we all do, we all look around the room and we try and think of something to say, but my eyes just landed on the chest, like just an innocent look. I’m like, “Oh my God, why did I do that? I don’t want to disrespect this person in front of me. I treat her as an equal. I treat everyone the same way. I don’t want to feel like she’s being disrespected.” So I heavily maintained eye contact after that. Throughout that conversation, it was fine. It was normal, nothing different. But after that, it really latched onto me big time. The rumination was massive. It was like, you’ve got to make sure you’re giving every single female colleague now eye contact. You have to do it because you know otherwise what stigma you could get. And that went on for months and years, and it progressed to men as well a couple of years later. It felt like my mind can’t function anymore.

I remember again I was sitting next to my friend, who was having a game on the PlayStation. And then I just looked at his lap, just for no reason, just looked at his lap, and he said, “Ooh, I feel cold and want to go and change.” I instantly thought, “Oh my God, is it because he thought I might have stared that I creeped him out?” And then it just seriously latched onto me big time.

As we all know, with this as well, when we think of the pink elephant allergy, it’s like when we don’t think of the pink elephant, what do we do? And that’s what it was very much like with this.

I remember when it started to get really bad, my eyes would die and embarrass somebody part places. It was like the more anxious I felt about not wanting to do it, the more it happened, where me and my good friend, Carol Edwards, call it a tick with the eye movement. So like Tourette, let’s say, when you get really nervous, I don’t know if this is all true. When someone’s really nervous, maybe they might laugh involuntarily, like from the Joker movie, or like someone swearing out loud. This is the same thing with eye movement. Every time I was talking to a colleague face-to-face to face, I was giving them eye contact, my mind would be saying to me, “Don’t look there, don’t look there, don’t look there,” and unfortunately think it would happen. That tick would happen. It would land where I wouldn’t want it to land.

It was very embarrassing because eventually it did get noticed. I remember seeing female colleagues covering their hi vis tops, like across their arms. Men would cover their crotches. They would literally cross their legs very blatantly in front of me. Then I could start to hear gossip. This is when it got really bad, because I really heard the stigma from this. No one confronted me by the way of this face-to-face, but I could hear it crystal clear. They were calling me all sorts, like deviant or creep or a perv. “Have you seen his eyes? Have you seen him looking and does that weird things with his eyes? He checks everyone out.”

It was really soul-destroying because my compulsion was to get away from everyone. I would literally hide across a room. Where no one else was around, I would hide in the cubicles because it was the only place where I wasn’t triggered. It got bad again. It went to my family, my friends, everyone around me. It didn’t happen with children, but it happened with every adult. It was horrendous.

I reached out to therapy. Luckily, I did get in contact with a CBT therapist, but it was talk therapy. But it’s better than nothing. I will absolutely take that. She was amazing. I can’t credit my therapist enough. She was awesome. If this person, maybe this is like grace, you’re amazing, so thank you for that. She was really there for me. It was someone I could really talk to, and it can help me and understand as best as she could.

She did, I believe, further research into what I had. And then that’s when I finally got diagnosed that I had OCD. I never knew this was OCD, and everything else made sense, like, “Oh, this is why I was going through all those things before. It all now makes concrete sense what I was going through.”

Then I looked up the Facebook group called Peripheral Vision/Visual Tourettic OCD. That was a game-changer for me. I finally knew that I wasn’t alone because, with this, you really think you’re alone, and you are not. There are thousands of people with this, or even more. That was truly validating. I was like, “Thank God I’m not the only one.”

But the problem is, I didn’t really talk in that group at first because I thought if other people saw me writing in that group, it’s going to really kill my reputation big time. That would be like the final nail in the coffin. Even though it was a private group, no one could do that. But I didn’t still trust it that much at that time.

I was doing ERP, and I thought great because I’ve researched ERP. I knew that it’s effective. Obviously, it’s the gold standard. But for me, unfortunately, I think I was doing it where I was white-knuckling through exposures. Also, when I was hearing at work, still going back to my most triggering place, ERP, unfortunately, wasn’t working for me because I wasn’t healing. It was like I was going through the trigger constantly. My mind was just so overwhelmed. I didn’t have time to heal.

I remember I eventually self-isolated in my room. I didn’t go anywhere. I locked myself away because I thought I just couldn’t cope anymore. It was a really dark moment. I remember crying. It was just like despair. I was like, “What’s happening to me? Why is all this happening to me?”

Later on, I did have the choice at work. I thought, I can either go through the stillest, hellacious process or I can choose to go on sick leave and give my chance to heal and recover. That’s why I did. And that was the best decision I ever made. I recommend that to anyone who’s going through OCD severely. You always have a choice. You always have a choice. Never pressure yourself or think you’re weak or anything like that, because that’s not the case. You are a warrior. When you’re going through things like this, you are the most strongest person in the world. It takes a lot of courage to confront those demons every single day to never ever doubt yourself with that. You are a strong, amazing individual.

When I did that, again, I could heal. It took me two weeks. Unfortunately, my therapy ended. I only had 10 sessions, but I had to wait another three months for further therapy in person, so I thought, “Oh, at least I do eventually get therapy in person. That’s amazing.”

And then the best thing happened to me. I found the IOCDF community. Everything changed. The IOCDF is amazing. The best community, in my opinion, the world for OCD. My god, I remember when I first went on Ethan’s livestream with Community Conversations. I reached out to Ethan, and he sent me links for OCD-UK. I think OCD Action as well. That was really cool of him and great, and I super appreciate that, and you knew straight away because I remember watching this video with Jonathan Grayson, who is also an amazing guy and therapist, talking about this. I was like, again, this is all that I have.

And then after that, I reached out to Chris Trondsen as the expert. What Chris said was so game-changing to me because he’s gone through this as well and has overcome it. He’s overcome so many severe themes of OCD. I’m like, “This guy is amazing. He is an absolute rock star. Literally like a true champion.” For someone to go through as much as he has and to be where he is today, I can’t ask for any more inspirement from that. It’s just incredible. He gave some advice as well in that livestream when we were talking because I reached out and said, how did you overcome this? He said, “With the staring OCD, well, I basically told myself, while I’m staring, well, I might as well stare anyway.” And that clicked with me because I’m thinking he’s basically saying that he just didn’t give it value anymore. I’m like, “That’s what I’ve been doing all this time. I’ve given so much value, so much importance. That’s why it keeps happening to me.” I’m like, “Okay, I can maybe try and work with this.”

Then I started connecting with Katie O'Dunne, who is also amazing. She was the first person I actually did hear about self-compassion. I’m like, “Yes, why didn’t I learn about this early in my life? Self-compassion is amazing. I need to know all about this.” It makes so much sense. Why’d I keep beating myself up when I treat a friend, like when I talked to myself about this? No, I wouldn’t. I just watched Katie’s streams and watched her videos and Instagram. It was just an eye-opener for me. I was like, “Wow, she’s talking about, like, bring it on mindset as well with this.” When you’re about to face the brave thing, just say, “Bring it on. Just bring on," like The Rock says. "Just bring it. I just love that.

That’s what I did. That’s what I started doing. I connected as well with my friend, Carol Edwards, who is also a former therapist and is the author of many books. One of them was Address Staring OCD. If anyone’s going through this as well, I really recommend that book. Carol is an amazing, amazing person. Such an intelligent woman. When I met Carol, it was like the first time in my life. I was like, “Wow, I’m actually talking to someone who’s got the same theme as me, and a lot of other themes I’ve gone through, she has as well.” We just totally got each other. I was like, “Finally, I’m validated. I can talk to someone who gets it truly.” And that really helped, let’s say, when I started to learn about value-based exposures.

I remember, again, Katie, Elizabeth McIngvale, Ethan, and Chris. I was like, “Yeah, I mean, I’m going to do it that way,” because I just did ERP before I was white-knuckling. I never thought of doing it in a value-based way. So I thought, okay, well, what is OCD taking away that I enjoy most doing? That’s what I did. I created a hierarchy, or like even in my mind. I thought, well, the cinema, restaurants, coffee shops, going to concerts, eventually going on holiday again, seeing my friends, family is most probably most important. I started doing baby steps.

I remember as well, I asked Chris and Liz, how do I open up to this to my family? Because I’ve got to a point where I just can’t hide behind a mask anymore. I need someone else to know who’s really close to me. Chris gave me some amazing advice, and Liz, and they said that if you show documents, articles, videos about this, long as they have a great understanding of mental health and OCD, you should be okay. And that’s what I did. They know I had OCD. I’ve told them I had OCD, but not the theme I had.

When I showed them documents and videos, it was so nerve-racking, I won’t lie. But it was the best thing I ever did because then, when they watched that, they came to me and said, “Why didn’t you tell us about this before? I thought you wouldn’t understand or grasp this.” I know OCD awareness in the UK is not the best, especially with this theme. But they said, “No, after watching that, we’re on your team; we will support you. We are here for you. We will do exposures with you.” And they gave me a massive hug afterwards. I was like, “Oh my God, this is the best scenario for me ever,” because then I can really amplify my recovery. This is where it started really kicking on for me now.

Everything I’ve learned, again, from those videos, watching with the streams from IOCDF, I’ve incorporated. Basically, when I was going to go to the cinema at first, I know that the cinema is basically darkness. When you walk through there, no one’s really going to notice you. Yeah, they might see you in their peripheral vision, but they’re going to be more like concentrating on that movie than me. That was my mindset. I was like, “Well, if I was like the other person and I didn’t have VTO and the other person did, would I be more concentrated on them or the movie?” And for me, it would be obviously the movie. Why would I else? Unless they were doing something really vigorous or dancing in front of me, I’m not going to look. And that’s my mindset.

The deep anxiety was there, I will be honest. It was about 80 percent. But I had my value because I was going to watch a film that I really wanted to watch. I’m a big Marvel fan. It was Black Panther Wakanda, and I really enjoyed that. It was a long movie as well. I went with my friend. We got on very, very well. For me as well, with this trigger, I get triggered when people can move as well next to me. I’m very hyper-vigilant with this. That can include me with the peripheral as well. But even though my eyes say they died, it was, okay, instead of beating myself up, I can tell myself this is OCD. I know what this is. It doesn’t define me. I’m going to enjoy watching this movie as much as I can and give myself that compassion to do so.

After that moment, I was like, “Wow, even though I was still triggered, I enjoyed it. I wasn’t just wanting to get out of there. I enjoyed being there.” And that was starting to be a turning point for me because then I went to places like KFC. I miss KFC. I love my chicken bucket. I won’t lie with that. That was a big value. You got to love the chicken bucket folks. Oh, it was great. Well, I had my parents around me so that they know I was pretty anxious still. But I was there. I was enjoying my chicken again. I was like, “I miss this so much.”

And then the best thing is, as far as I remember, when I left that restaurant, they said to me, “We’re so proud of you.” And that helps so much because when you’re hearing feedback like that, it just gives you a huge pat on the back. It’s like, yeah, I’ve just done a big, scary thing. I could have been caught. I could have been ridiculed. I could have been made fun of. People may have gossiped about me, but I took that leap of faith because I knew it’s better than keep isolating, where in my room, being in prison, not living a life. I deserve to live a life. I deserve to do that. I’m a human being. I deserve to be a part of human society.

After that, my recovery started to progress. I went to my friend Carol to more coffee shops. We started talking about advocacy, powerful stuff, because when you have another reason on a why to recover, that’s a huge one. When you can inspire and empower others to recover, it gives you so much more of a purpose to do it because you want to be like that role model, that champion for the people. It really gives you a great motive to keep going forward with that and that motivation.

And then I went to restaurants with my family for the first time in years, instead of making excuses, instead of compulsion. People would still walk by me in my peripheral, but I had the mindset, like Kate said, “You know what? Just bring it on. Just bring it.” I went in there. I know I was still pretty anxious, and I sat on my phone, and I’m going to tell myself using mindfulness this time that I’m going to enjoy the smell of the food coming in. I’m going to enjoy the conversation with my family instead of thinking of, let’s say, the worst-case scenario. The same with a waiter or waitress coming by. I’m just going to have my order. And again, yeah, my eyes die, they spit in my food—who knows? But I’m going to take that leap of faith because, again, it’s worth it to do this. It is my why to get my life back. That’s why I did it.

Again, I enjoyed that meal, and I enjoyed talking to my family. It was probably the first time in years where I wasn’t proper triggered. I was like, that was my aha moment right there. The first time in years where my eyes didn’t die or anything. I just enjoyed being in a normal situation. It was so great to feel that. So validating.

Kimberley: So the more triggered you were, the harder it was to not stare? Is that how it was?

Matthew: Yes. The more triggered I was going down that rabbit hole, the more, let’s say, it would happen because my eyes would die, like up and down. It would be quite frantic, up and down, up and down. Everyone’s not the same. Everyone’s different with this. But that’s what mine would be like. That’s why I would call it a tick in that sense. But when we feel calm, obviously, and the rumination is not there, or let’s say, the trigger, then it’s got no reason to happen or be very rare when it does. It’s like retraining. I learned to retrain my mind in that sense to incorporate that into doing these exposures.

Again, that’s what was great about opening up to my family. I could practice that at home because then, when I’m sitting with my family, I’d still be triggered to a degree, but they know what I have. They’re not going to judge me or reject me, or anything like that. So my brain healed naturally. The more I sat next to my family, I could bring that with, say, the public again and not feel that trigger. I could feel at ease instead of feeling constantly on edge.

Again, going to coffee shops late, looking around the room, like you say so amazingly, Kim, using your five senses. I did that, like looking around, looking at billboards, smelling the coffee again, enjoying the taste of it, enjoying the conversation, enjoying the surroundings where I am instead of focusing on the prime fear. And that’s what really helped brought me back to the present. Being in the here and the now. And that was monumental. Such a huge tool, and I recommend that to everyone. Mindfulness is very, very powerful for doing, let’s say, your exposures and to maintain recovery. It’s just a game-changer. I can’t recommend that enough.

One of my biggest milestones with recovery when I hit it, the first time again in years, I went to a live rock concert full of 10,000 people. There would be no way a year prior that would I go.

Kimberley: What rock concert? I have to know.

Matthew: Oh, I went to Hollywood Vampires.

Kimberley: Oh, how wonderful! That must have been such an efficient, like, it felt like you crossed a massive marathon finish line to get that thing done.

Matthew: Oh, yeah, it was. It was huge to see, like I say, Alice Cooper, Johnny Depp, and I think—I can’t remember this—Joe Perry from Aerosmith. I can’t remember the drummer’s name, I apologize, but it was great. You know what? I rocked out. I told myself, “I’ve come this far in my journey, I’m going to rock out. I’m going to enjoy myself. I don’t care, let’s say, where my eyes may go, and that’s telling OCD, though. I’m just going to be there in the moment and enjoy rocking out.” And that’s exactly what I did. I rocked out big time. I remember even the lead singer from the prior band pointing at me and waving. I would have been so triggered by that before, but now we’re back in the game, the rock on sign, and it was great.

Kimberley: There’s so much joy in that too, right? You were so willing to be triggered that you rocked out. That’s how willing we were to do that work. It’s so cool, this story.

Matthew: Yeah. The funny part is, well, the guy next to me actually spilled beer all over himself. That would have been so triggering against me before, like somebody’s embarrassing body part places. Whereas this time I just laughed it off and I had a joke with him, and he got the beer. It was like a normal situation—nothing weird or anything. His wife, I remember looking at my peripheral, was just cross-legged. But hey, that’s just a relaxing position like anyone else would do. That’s what I told myself. It’s not because of me thinking, “Oh, he’s a weirdo or a creep.” It’s because she’s just being relaxed and comfortable. That’s just retraining my mind out, and again, refocusing back to the concert and again, rocking out to Alice Cooper, which was amazing.

I really enjoyed it. I just thought it’s just incredible from where I was a year ago without seeing-- got to a point where I set myself, I heard the worst stigma imaginable to go to the other aspect, the whole end of the other tunnel, the light of the tunnel, and enjoy myself and being free. I love what Elizabeth McIngvale says about that, freedom over function. And that’s exactly at that point where that’s where I was. I’m very lucky to this day. That’s why I’ve maintained it.

Sometimes I still do get triggered, but it’s okay because I know it’s OCD. We all know there’s no cure, but we can keep it in remission. We can live a happy life regardless. We just use the tools that we’ve learned. Again, for me, values-based exposure in that way was game-changing. Self-compassion was game-changing.

I forgot to mention my intrusive thoughts with sexual images as well with this, which was very stressing. But when I had those images more and more, it’s basically what I learned again from Katie. I was like, “Yeah, you know what? Bring it on. Bring it on. Let’s see. Turn it up. Turn it up. Crank it up.” Eventually, the images stopped because I wasn’t giving fear factor to it. I was going to put the opposite of basically giving it the talk-to-the-hand analogy, and that worked so well.

I see OCD as well from Harry Potter. I see OCD as the boggart, where when you come from the boggart, it’s going to come to your most scariest thing. But you have that power of choice right there and then to cast the spell and say ridiculous, as it says in the Harry Potter movies, and it will transform into something silly or something that you can transform yourself with compassion and love. An OCD can’t touch you with that. It can’t. It becomes powerless. That’s why I love that scene from that film.

Patrick McGrath says it so well with the Pennywise analogy. The more fear we feed the beast or the monster, the more stronger it becomes. But when we learn to give ourselves self-compassion and love and, again, using mindfulness and value and knowing who we authentically are, truly, it can do nothing. It becomes powerless. It can stay in the backseat, it might try and rear its ugly head again, but you have the more and the power in the world to bring it back, and you can be firmly in that driver’s wheel.

Kimberley: So good. How long did it take you, this process? Was it a short period of time, or did these value-based exposures take some time?

Matthew: Yeah, at first, it took some time to master it, if that makes sense. Again, I was going to start going to more coffee shops with my friend Carol or my family. It did take time. I was still feeling it to a degree, but probably about after a month, it started to really click. And then overall, it took me about-- I started really doing this in December, January time. I went to that concert in July. So about, yeah, six, seven months.

Kimberley: Amazing. Were there any stages where there were blips in the road, bumps on the road? What were they like for you?

Matthew: Yeah. I mean, my eyes did that sometimes. Also, like I said, when I started to do exposures, where I’d walk by myself around town places, it could be very nerve-wracking. I could think I’m walking behind someone that all the might think I’m a stalker and things like that because of the staring. That was hard.

Again, I gave myself the compassion and told myself that it’s just OCD. It doesn’t define who I am. I know what this monster is, even though it’s trying its very best to put me down that rabbit hole. Yeah, that person might turn around and say something, or even look. I have the choice again to smile back, or I can even wave at them if I wanted to do so. It just shows that you really have all the power or choice to just throw some back into OCD space every single time.

Self-compassion was a huge thing that helped smooth out those bumps. Same with mindfulness. When I was getting dissociated, even when I was still getting dissociated, getting really triggered, I would use the mindfulness approach. For example, when I was sitting in pubs, and that was a value to me as well, sometimes that would happen. But I would then use the tools of mindfulness. And that really, really helped collect myself being present back in the here and the now and enjoying what’s in front of me, like having a beer, having something to eat, talking to my friend, instead of thinking like, are they going to see me staring at them weirdly? Or my eyes met out someone, and I don’t know, the waitress might kick me out or something like that. Instead of thinking all those thoughts, I just stay present.

The thing is with this as well, it’s like when you walk down places, people don’t even look at you really anyway. They just go about their business, like we all do. It’s just remembering that and keeping that mindfulness aspect. You can look around where you are, like buildings, trees, the ocean, whatever you like, and you can take that in and relearn. Feel the wind around you. If it’s an ice wind, obviously, that’s freezing right now. The smells—anything, anything if it’s a nice smell, or even if it’s a bad smell. Anything that use your senses that can just bring you back and feel again that peace, something you enjoy, surround yourself with.

Again, when I was seeing my friend Carol, the town I went to called Beverley, it’s a beautiful town, very English. It is just a nice place. That’s what I was doing—looking at the scenery around where I was instead of focusing on my worst worries.

Kimberley: This is so cool. It’s all the tools that we talk about, right? And you’ve put them into practice. Maybe you can tell me if I’m wrong or right about this, but it sounds like you were all in with these skills too. You weren’t messing around. You were ready for recovery. Is that true? Or did you have times where you weren’t all in?

Matthew: Yeah, there were times where I wasn’t all in. I suppose when I was-- I also like to ask yourself with me if I feel unworthy. That is still, I know it’s different to staring OCD and I’m still trying to tackle that sometimes, and that can be difficult. But again, I use the same tools. But with, like I say, doing exposures with VTO, I would say I was all in because I know that if I didn’t, it’s going to be hard to reclaim my life back. I have a choice to act and use the tools that I know that’s going to work because I’ve seen Chris do it. It’s like, “Well, I can do it. I’ve seen Carol do it. That means I can do it. So I’m going to do it.”

That’s what gave me the belief and inspiration to go all in. Because again, reach out to the community with the support. If it was a hard time, I’d reach out. The community are massive. The connection they have and, again, the empowerment and the belief they can give you and the encouragement is just, oh, it’s amazing. It’s game-changing. It can just light you up straight off the bar when you need it most, and then you can go out and face that big scary thing. You can do it. You can overcome it because other people have. That means you can do it. It’s absolutely possible. Having that warrior mindset, as some of my groups—the warrior badass mindset—like to call it, you absolutely go in there with that and you can do it. You can absolutely do it.

Kimberley: I know you’ve shared with me a little bit privately, but can you tell us now what your big agenda is, what your big goal is right now, and the work you’re doing? Because it’s really exciting.

Matthew: Sure, I’d be glad to do it. I am now officially a professional peer support worker. If anyone would love to reach out to me, I am here. It’s my biggest passion. I love it. It’s like the ultimate reward in a career. When you can help someone in their journey and recovery and even empower each other, inspire, motivate, and help with strategies that’s worked for you, you can pass on them tools to someone else who really needs it or is still going through the process where it’s quite sticky with OCD. There’s nothing more rewarding than that. Because for me, when I was at my most severe, when I was in my darkest, darkest place, it felt like a void. I felt like just walking through a blizzard of nothing. Having someone there to speak to who gets it, who truly gets it, and who can be really authentically there for you to really say, “You can do this. I’m going to do it with you. Let’s do it. Like really, let’s do it. Bring it on, let’s do it. Let’s kick this thing’s butt,” it’s huge. You really lay the smackdown on OCD. It’s just massive.

For me, if I had that when I was going through it, again, I had a great therapist, but if I had a peer support worker, if I was aware that they were around—I wasn’t, unfortunately, at that time—I probably would have reached out because it’s a huge tool. It’s amazing. Even if you’re just to connect with someone in general and just have a talk, it can make all the difference. One conversation, I believe, can change everything in that moment of what that person’s darkness may be. So I’m super, super excited with that.

Kimberley: Very, very exciting. Of course, at the end, I’ll have everyone and you give us links on how to get to you. Just so people know what peer support counseling is or peer support is, do they need to have a therapist? Who’s on the team? What is it that they need in order to start peer support?

Matthew: Yeah. I mean, you could have a therapist. I mean, I know peer support workers do work with therapists. I know Chrissie Hodges. I’ve listened to her podcast, and she does that. I think it may be the same with Shannon Shy as well. I’m not too sure. I think as well to the person, what they’re going through, if they would want to at first reach out to a peer support worker that they know truly understands them, that can be great. That peer support like myself can then help them find a therapist. That’s going to really help them with their theme—or not just their theme—an OCD specialist who gets it, who’s going to give them the right treatment. That can be really, really beneficial.

Kimberley: I know that we’ve worked with a lot of peer support, well, some peer support providers, and it was really good because for the people, let’s say, we have set them up with exposures and they’re struggling to do it in their own time, the peer support counselor has been so helpful at encouraging them and reminding them of the tools that they had already learned in therapy.

I think you’re right. I think knowing you’re not alone and knowing someone’s done it, and I think it’s also just nice to have someone who’s just a few steps ahead of you, that can be very, very inspiring for somebody.

Matthew: Absolutely. Again, having a peer support work with a therapist, that’s amazing. Because again, for recovery, that’s just going to amplify massively. It’s like having an infinite gauntlet on your hand against OCD. It’s got no chance down the long run. It’s incredibly powerful. I love that. Again, like you said, Kim, it’s like when someone, let’s say, they know that has reached that mountain top of recovery, and that they look at that and thinking, “Well, I want to do the same thing. I know it would be great to connect with that person,” even learn from them, or again, just to have that connection can make a huge, huge difference to know that they can open up to other people.

Again, for me, it’s climbing up that other mountain top with someone else from the start, but to know I’ve got the experience, I get to climb that mountain top with them.

Kimberley: Yeah, so powerful. Before we finish up, will you tell us where people can get ahold of you if they want to learn more? And also, if there’s anything that you feel we could have covered today that we didn’t, like a main last point that you want to make.

Matthew: Sure. People can reach out to me, and I’m going to try and remember my tags. My Instagram tag is matt_bannister27. I think my Facebook is Matthew.Bannister.92, if you just type in Matthew Bannister. It would be in the show notes as well. You can reach out to me on there. I am at the moment going to create a website, so I will fill more onto that later as well. My email is matt3ban@hotmail.com, which is probably the best way to reach out to me.

Kimberley: Amazing. Anything else you want to mention before we finish up?

Matthew: Everyone listening, no matter what darkness you’re going through, no matter what OCD is putting in your way, you can overcome it. You can do it. As you say brilliantly as well, Kim, it’s a beautiful day to do hard things. You can make that as every day because you can do the hard things. You can do it. You can overcome it, even though sometimes you might think it’s impossible or that it’s too much. You can do it, you can get there. Even if it takes baby steps, you’re allowed to give yourself that compassion and grace to do so. It doesn’t matter how long it takes. Like Keith Smith says so well: “It’s not a sprint; it’s a marathon.” When you reach that finish line, and you will, it’s the most premium feeling. You will all get there. You will all absolutely get there if you’re going through it.

Oh, Kim, I think you’re on mute.

Kimberley: I’m sorry. Thank you so much for being on. For the listeners, I actually haven’t heard your story until right now too, so this is exciting for me to hear it, and I feel so inspired. I love the most that you’ve taken little bits of advice and encouragement from some of the people I love the most on this planet. Ethan Smith, Liz McIngvale, Chris Trondsen, Katie O’Dunne. These are people who I learn from because they’re doing the work as well. I love that you’ve somehow bottled all of their wisdom in one thing and brought it today, which I’m just so grateful for. Thank you so much.

Matthew: You’re welcome. Again, they’re just heroes to me, and yourself as well. Thank you for everything you do as well for the community. You’re amazing.

Kimberley: Thank you. Thank you so much for being here.

Matthew: Anytime.

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 mental health disorder shows up. We can’t always control our triggers. Sometimes if we haven’t slept well or there’s a lot of change in our life, we could have more anxiety. So, it’s going to ebb and flow. 

So, when we have this fixed mindset of like, it has to be perfect, there has to be absolutely no bumps on the road, no turbulence, we’re going to set ourselves up for failure because the day we have a hard day, we want to completely shut down.

So I really believe, in this case, the solution is thinking bigger. If you’re thinking day to day, sometimes if you’re too in it, you’re dealing with depression, you’re really feeling bad, you skipped school because you have a presentation, social anxiety is acting up. You think bigger picture. Why am I here? Why am I doing this? Why have I sought out treatment? Listen to this podcast. What am I trying to accomplish? 

SOLUTION #2: KNOW YOUR WHY

I know for me in my own recovery, knowing my why was so important. There were certain things in my life that I found important to achieve, and I kept that as the figurative carrot in front of the mule to get me to go. So, that way, if I had a rough day, I thought bigger picture. What do I need to do today to make sure that I meet my goals? And so, I believe everybody needs to know their why. 

Now, it doesn’t have to be grandiose. Some people want to build a school and teach kids in underprivileged countries. Amazing why. But other people are sometimes like, “I just want to be able to make my own choices today and not feel like I base them out of anxiety.” There’s no right or wrong why, but if you can know what beacon you’re going to, it really helps you get through those hard days. 

What about for you? When we talk about this, what comes up for you?

Kimberley: Well, I think that for me personally, the why is a really important mindset shift because often I can get to this sort of, like you said, perfectionistic why. Like, the goal is to have no anxiety, or the goal is to have no bad days. We see on social media these very relaxed people who just seem to go with the flow, and that’s your goal. But I have to often with myself do a little reality check and go, “Okay, are you doing recovery to get there? Because that goal might be setting you up for constant disappointment and failure. That mightn’t be your genetic makeup.” 

I’m never going to be like the go-with-the-flow Kimberley. That’s just not who I am. But if I can instead shift it to the why of like, what do I value? What are the things I want to be able to do despite having anxiety in my life? Or, despite having a hard day, like you said, how do I want that to look? And once I can get to that imagery, then I have a really clear picture. So, when I do have a bad day, it doesn’t feel so defeating, like what’s the point I give up, because the goal was realistic.

Chris: For me, a big part of my why in recovery, once I started getting into a place where I was managing the disorders I was dealing with—OCD, body dysmorphic disorder, I had a lot of generalized anxiety, and major depressive disorder—I was like, “I need to give back. There’s not people my age talking about this. There’s not enough treatment providers.” There was somewhere, like in the middle of my treatment, that I was like, “I don’t know how I’m going to advocate. I don’t know what that’s going to look like, but I have to give back.”

And so, on those hard days when I would normally want to just like, “Well, I don’t care that it’s noon, I’m shutting it down, I’m going into my bed, I’m just going to sleep the rest of the day,” reminding myself like there’s people out there suffering that can’t find providers, that can’t find treatment, may not even know they have these disorders. I have to be one of the voices in the community that really advocates and gets people education and resources. And so, I didn’t let myself get in bed. I looked at the day as quarters. Okay, the morning and the afternoon’s a little rough, but I still have evening and night. Let me turn it around. I have to go because I have this big goal, this ambitious dream. I really want to do it. So that bigger why kept me just on track to push through hard days.

ROADBLOCK #3: YOU RUN OUT OF STAMINA

Kimberley: Amazing. I love that so much. All right. The third roadblock that we see is that people run out of stamina. I actually think this is one that really ties into what we were just talking about. Imagine we’re running a marathon. If you’re sprinting for the first 20 miles, you probably won’t finish the race. Or even if you sprint the first two miles, you probably won’t finish the marathon. 

One of the things is—and actually, I’ll go straight to the strategy and the thing we want you to practice—we have to learn to pace ourselves throughout recovery. As I said, if you sprint the first few miles, you will fall flat on your face. You’re already dealing with so much. As you said, having a mental health struggle is the most exhausting thing that I’ve ever been through. It requires such of your attention. It requires such restraint from not engaging in it and doing the treatment and using the tools. It’s a lot of work, and I encourage and congratulate anyone who’s trying. The fact that you’re trying and you’re experimenting with what works and what doesn't, and you’re following your homework of your clinician or the workbook that you’ve used—that's huge. But pacing yourself is so important. So, what might that look like?

Often, people, students of mine from CBT School, will say, “I go all out. I do a whole day of exposures and I practice response prevention, and I just go so hard that the next day I am wiped. I can’t get out of bed. I don’t want to do it anymore. It was way too much. I flooded myself with anxiety.” So, that’s one way I think that it shows up. I’ll often say, “Okay, let’s not beat yourself up for that.” We’ll just use that as data that that pace didn’t work. We want to find a rhythm and a pace that allow you to recover. It’s sort of like this teeter-totter. We call it in Australia a seesaw. You want to do the work, but not to the degree where you faceplant down on the concrete. We want to find that balance. 

I know for me, when I was recovering from postural orthostatic tachycardic syndrome, which is a chronic illness that I had, it was so hard because the steps to recovery was exercise, but it was like literally walking to the corner and back first, and then walking half a block, and then walking three-quarters of a block, and then having my husband pick me up, then walking one block. And that’s all I was able to do without completely faceplanting the next day, literally and figuratively. 

My mind kept saying to me, “You should be able to go faster. Everybody else is going faster. Everyone else can walk a mile or a block. So you should be able to.” And so, I would push myself too hard, and then I’d have to start all over again because I was comparing myself to someone who was not in my position. 

SOLUTION #3: PACE YOURSELF

So, try to find a pace that works for you, and do not compare your pace with me or Chris or someone in your support group, or someone you see on social media. You have to find and test a pace that works for you. Do you have any thoughts, Chris?

Chris: Yeah. I would say in this one, and you alluded to it, that comparison, that is going to get you in this roadblock because you’re going to be looking to your left and your right. Why is that person my age working and I’m not? It’s not always comparing yourself. Sometimes, like you said, it is people in your support group. It’s people that you see advocating for the disorder you may have. But sometimes people even look at celebrities or they’ll look at friends from college, and can I do that? The comparison never motivates you, it never boosts you; it just makes you feel less than. That’s why one of my favorite quotes is, “Chase the dream, not the competition.” It’s really finding a timeline that works best for you. 

I get why people have this roadblock. As somebody who’s lived through multiple mental health disorder diagnoses, it’s like, once we find the treatment, we want to escalate to the finish line, and we’ll push ourselves in treatment sometimes too much. And then we have one of those days where we can’t even get out of bed because we’re just beat up, we’re exhausted, and it’s counterproductive. 

I wanted to add one thing too. The recovery part may not even be what you’re doing with your clinician in a session that you are not pacing yourself with. My biggest pacing problem was after recovery, not that the disorders magically went away, they were in remission, I was working on doing great, but it was like, I went to martial arts, tennis, learned Spanish, started volunteering at an animal shelter, went back to school, got a job, started dating. It was so much. Because I felt like I was behind, I needed to push myself. 

The problem that started to happen was I was focusing less on the enjoyable process of dating or getting a job, or going back to school. I was so fixated on the finish line. “I need to be there, I need to be there. What’s next? What’s next?” I got burnt out from that, and I was not enjoying anything I was doing. 

So, I would say even after you’re managing your disorder, be careful about not pacing yourself, even in that recovery process of getting back into the lifestyle that you want.

Kimberley: Yeah, absolutely. I would add too, just as a side point, anyone who is managing a mental health issue or an anxiety disorder, we do also have to fill our cup with the things that fill our hearts. I know that sounds very cliche and silly, but in order to pace ourselves and to have the motivation and to use the skills, we do have to find a balance of not just doing all the hard things, but making sure you schedule time to rest and eat and drink and see friends if that fills your cup, or read if that fills your cup. So, I think it’s also finding a rhythm and a balance of the things that fill your cup and identifying that, yes, recovery is hard. It will deplete your stores of energy. So, finding things that fill that cup for you is important.  

Chris: Well, you just made a good point too. In my recovery, all those things you mentioned, I thought of those as like weakness, like I just wasted an hour reading. Sometimes even with friends. That one, not as much, because I saw value in friendship. But if I just watched a movie or relaxed, or even just hung out with friends, it felt like a waste. I’m like, “How dare I am behind everybody else? I should be working. I should be this. I should move up.” A lot of should statements, a lot of perfectionist expectations of myself. 

So, the goal for me or the treatment for me wasn’t to then go to the other extreme and just give up everything; it was really to ask myself, like you said, how can I fill my cup in ways that are important and see value and getting a breakfast burrito with a friend and talking for three hours and not thinking like, “Oh, I should have been this because I got to get my degree.” I’m glad that you brought that up. I always think of like we’re overflowing our cup with mental health conditions. We have to be able to have those offsets that drain the cup so we have a healthy balance. So, a great point.

ROADBLOCK #4: NOT OWNING YOUR RECOVERY

Kimberley: I agree. So important. Would you tell us about owning your recovery? Because you have a really great story with this.

Chris: Yeah. People ask me all the time how I got better. A lot of people with body dysmorphic disorder struggle to get better. Obviously, we know that with obsessive-compulsive disorder, major depressive disorder, et cetera. So, a lot of people will ask sometimes, and I always say to them, if I had to come up with one thing, it was because I made my mental health recovery number one. I felt that it was like the platform that I was building my whole life on. I’m so bad with the-- what is it? The house, the-- I’m not a builder. 

Kimberley: Like the foundation.

Chris: Thank you. Clearly, I’m not going to be making tools tomorrow or making things with tools. But yeah, like a house has to have a nice foundation. You would never build a house on a rocky side of the mountain. And so, I had to give up a lot, like most of us do, as we start to get worse. I became housebound and I dropped out of college, and I gave up a job. I was working in the entertainment industry, and I really enjoyed it. I was going to film school, and I was happy. I had to give all that up because I couldn’t even leave my house because of the disorder. 

SOLUTION #5: MAKE YOUR RECOVERY THE MOST IMPORTANT THING

So, when I was going to treatment and I was really starting to see it work, I was clear to that finish line of what I needed to do. So I made it the most important thing. It wasn’t just me; it was my support system. My treatment was about a four-hour round trip from my house, so my mom and I would meet up every day. We drive up to LA. I go to my OCD therapist, and I’d go to my psychiatrist and then my BDD therapist and support group, and then come home. There’s times I was exhausted, I wanted to give up, I was over it, but I never ever, ever put it to number two or three. I almost had this top three list in my head, and number one was always my recovery. My mom too, I mean, when she talks, she’ll always say it's the most important thing. If my job was going to fire me because I couldn’t come in because I had to take my kid on Wednesdays to treatment, I was going to get fired and find a new job. We just had to make this important.  

As I was getting better, there were certain opportunities that came back to me from my jobs or from school. My therapist and I and my mom just decided, “Let’s hold off on this. Let’s really, really put effort into the treatment. You’re doing so well.” One of the things that I see all the time, my mom and I run a very successful family and loved ones group. A lot of times, the parents aren’t really making it the priority for their kids or the kids, or the people with the disorders aren’t really making it a priority. It’s totally understandable if there’s things like finances and things, barriers. But that’s not what I’m talking about. I’m talking about when people have access to those things, they’re just not owning it. Sometimes they’re not owning it because they’re not taking it seriously or not making it important. Or other times, people are expecting someone else to get them better. 

I loved having a team. I didn’t have a big team. I came from nothing. It was a very small team. I probably needed residential or something bigger. I only really had my mom’s support, but we all leaned on each other. But I always knew it was me in the driver’s seat. At the end of the day, my therapist couldn’t save me, my mom couldn’t save me, they couldn’t come to my house and pull me out of bed or do an exposure for me, or have me go out in public during the daytime because of BDD. I had to be the one to do it. I could lean on them as support systems and therapists are there for, but at the end of the day, it was my choice. I had to do it. When my head hit the pillow, I had to make sure that I did everything I possibly could that day to recover. 

When I took ownership, it actually gave me freedom. I wasn’t waiting for someone to come along. I wasn’t focusing on other things. I made it priority number one. I truly believe that that was the thing that got me better. Once again, didn’t have a lot of resources, leaned a lot on self-help books and stuff because I needed a higher level of care, but there was none and we couldn’t afford it. I don’t want anyone to hear this podcast and think, “Well, I can’t find treatment in my area.” That’s not what I’m saying. I’m just saying, whatever you have access to, own it, make it a priority, and definitely be in that leader’s seat because that’s going to be what’s going to get you better.

Kimberley: Yeah, for sure. I think too when I used to work as a personal trainer, I would say to them, “You can come to training once a week, but that once a week isn’t going to be what crosses you across that finish line.” You know what I mean? It is the work you do in the other 23 hours of that day and the other seven days of the week. I think that is true. If you’re doing and you’re dabbling in treatment, but it’s not the main priority, that is a big reason that can hold you back. I think it’s hard because it’s not fair that you have to make it priority number one, but it’s so necessary that you do. 

I really want to be compassionate and empathize with how unfair it is that you have to make this thing a priority when you see other people, again, making their social life their priority or their hobby their priority. It sucks. But this mindset shift, this recalibration of this has to be at the top. When it gets to being at the top, I do notice, as a clinician, that’s when people really soar in their recovery.

Chris: Yeah. We had a very honest conversation with my BDD therapist, my OCD therapist, and my psychiatrist, and they’re like, “You need a higher level of care. We understand you can’t afford it. There’s also a lot of waiting lists.” They’re like, “You’re really going to have to put in the work in between sessions. You’re supposed to be in therapy every day.” We just couldn’t. All we can afford is once a week. They said, “Look, when you’re not in our session, you need to be the one.” 

So, for instance, with depression, my psychiatrist is like, “Okay, you’re obviously taking the medication, but you need to get up at the same time every day. Open up all your blinds, go upstairs, eat breakfast on the balcony, get ready, leave the house from nine to five.” I didn’t have a job. “But you need to be out of the house. You need to be in nature. You need to do all these things.” I never wanted to, but I did it. Or with my OCD and BDD recovery, I didn’t want to go out in public. I felt like it looked horrendous. I felt like people were judging me, but I did. Instead of going to the grocery store at 2:00 in the morning, I was going at noon. When everyone’s there for OCD, it was like, I didn’t want to sit in public places. I didn’t want to be around people that I felt I could potentially harm. 

My point is like every single day, I was doing work, I was tracking it, I was keeping track, and I had to do that because I needed to do that in order to get better based on the setup that I had. 

I do want to also say a caveat. I always have the biggest empathy for people or sympathy for people that are a CEO of a company or like a parent and have a lot of children, or it’s like you’re busy working all day and you’re trying to balance stuff. I mean, the only good thing that came from being housebound is I didn’t have a lot of responsibilities. I didn’t have a family. I wasn’t running a company. I wasn’t working. So, I did have the free time to do the treatment. So, I have such sympathy for people that are parents or working at a company, or trying to start their own small business and trying to do treatment too. But I promise you, you don’t have to put your recovery first forever. Really dive into it, get to that place where you’re really, really stable. It’ll still be a priority, but then you will be a better parent, a better employee, a better friend once you’ve really got your mental health to a level that you can start to support others. You may need to support yourself first, like the analogy with a mask on the plane.

ROADBLOCK #5: YOU HAVE A FIXED MINDSET

Kimberley: Agreed. That’s such an important point. All right, we’re moving on to roadblock number five. This is yours again, Chris. Tell us about the importance of specific mindsets, particularly a fixed mindset being the biggest roadblock.

Chris: One of the things that makes me the most sad about people having a mental health condition because of how insidious they are is it starts to have people lose their sense of identity. It has them start to almost re-identify who they are, and it becomes a very fixed mindset. So, if you have social anxiety or social phobia, it’s like, “Oh, I’m somebody that’s not good around people. I say embarrassing things. I never know what kind of conversation to lead with. I should probably just not be around people.” Or, let’s say generalized anxiety. “Deadlines really caused me too much strain. I can’t really go back to school.” BDD. “I’m an unattractive person. Nobody wants to date me. I’m unlovable.”  

We get into these fixed mindsets and we start to identify with them, and inevitably, that person’s life becomes smaller and smaller and smaller. So, the more they identify with it, the more that they become isolated from others, and they have this very fixed mindset.

I think of like OCD, for instance, isn’t really about guidelines; it’s all about rules. This is how things are supposed to be. What happens is when I work with a client specifically, somebody that’s pretty severe, it’s trying to get them to see the value in treatment and to even tap into their own personal values is really difficult. It’s like, “Treatment doesn’t work. I’ve tried all the medications. I don’t know what I’m going to do. I’m just not somebody that can get better.”

SOLUTION #5: GROWTH MINDSET

What I tell clients instead is, “Let’s be open. Let’s be curious. Let’s move into a growth mindset. Let’s focus on learning, obtaining education, being open to new concepts. Look, when you were younger and the OCD didn’t really attack you, or when you were younger and you didn’t deal with social anxiety, you were having friends, you had birthday parties, you were going to school, and everything. Maybe that’s the real you, and it’s not that you lost it. You just have this disorder that’s blocked you from it.” And so, when clients become open and curious and willing to learn, willing to try new things, and to get out of their comfort zone, that’s where the growth really happens. 

If you’re listening to this podcast or watching it right now and you’re determined like, “This isn’t working; nothing can help me,” that fixed mindset is never something that’s going to get you from where you are to where you want to be. You have to have that growth, that learning, that trying new things, expanding. 

I always tell clients, “If you try something with your therapist and it doesn’t work, awesome. That’s one other thing that doesn’t work. Move on to something else.” That openness. What I always love after treatment is people are like, “I am social. I do love to be around people. I am somebody who likes animals. I just was avoiding animals because of harm thoughts.” People start to get back into who they really are as soon as they start to be more open to recovery.

Kimberley: Yeah, for sure. The biggest fixed mindset thought that I hear is, “I can’t handle it.” That thought alone gets in the way of recovery so many times. We go to do an exposure, “I can’t handle this.” Or, “What if I have a panic attack? I cannot handle panic attacks.” It’s so fixed. So I often agree with you. I will often say, this work, this mental health work, or this human work that we do is shifting the way we see ourselves and life as an experiment. We always have these black-and-white beliefs like “I can’t handle this” or “I can’t do this. I can’t get in an elevator. I can’t speak public speaking,” or whatever it might be. But let’s be curious. Like you said, let’s use it as an experiment. Let’s try, and we’ll see. Maybe it doesn’t go great. That’s okay, like you said, but then we know we have data, and then we have information on what got in the way, and we have some information. 

I think that even just being able to identify when you’re in a fixed mindset can be all you need just to be like, “Oh, okay, I’m having a very black-and-white fixed mindset.” Learning how to laugh and giggle at the way our brain just gets so determined and black-and-white, like you can’t do this, as you said, I think is so important because, like you said, once you get to recovery, then you go on to live your life and actually do the things that you dream, the dream that you’re talking about. It might be you want to get a master’s degree or you might want to go for a job, or you want to go on a date. You’re going to be able to use that strong mindset for any situation in life. It applies to anything that you’re going to conquer. 

I always say to clients, if you’ve done treatment for mental health, you are so much more prepared than every student in college because they haven’t gone through, they haven’t had to learn those skills.

Chris: Yeah, no, exactly. I remember like my open mindset was one of the assets I had in recovery. I remember going to therapy and being like, “I’m just going to listen. These people clearly know what they’re doing. They’ve helped people like me. Why would it be any different?” And I was open. I can see the difference with clients that have a more growth mindset. They come in, they’re scared. They’re worried. They’ve been doing something for 10, 15, 16 years, and they’re like, “Why is this guy going to tell me to try to do different things or to think different or have different thinking patterns?” But they’re open. I always see those people hit that finish line first. It’s the clients that come and shut down. The family system has been supporting this like learned helplessness. Nobody really wants to rock the boat. Everything shut down and closed. It’s like prying it open, as most of the work. And then we finally get to the work, but we could have gotten there quicker. Everybody’s at their own pace, but I really hope that people hear this, though, are focused on that openness.

You were talking about like people thinking they can’t handle it. The other thing I hear sometimes is people just don’t think they deserve it. “I just don’t even deserve to get better.” You do. You do. That’s what I love about my job the most. Everybody that comes into my office, and I’m like, “You deserve a better life than you’re living. Whatever it is you want to do. You want to be a vet. How many animals are you going to save just by getting into being a vet? You got to do it.” My heart breaks a little bit when people have been dealing with mental health for long enough that they start to believe they don’t even deserve to get better. 

SOLUTION #6: IT’S A BEAUTIFUL DAY TO DO HARD THINGS

Kimberley: I love that. So, we had five roadblocks, and we’ve covered it, but we promised six strategies. I want to be the one to deliver the last one, which everyone who listens already knows what I’m going to say, but I’m going to say it for the sake that it’s so important for your recovery, which is, it’s a beautiful day to do hard things. It is so important that you shift, as we talked about in the roadblock number one, you shift your mindset away from “I can’t do hard things” to “It’s okay to do hard things.” It doesn’t mean you’ve failed. Life can be hard. 

I say to all my patients, life is 50/50 for everybody. It’s 50% easy and 50% hard. I think some people have it harder than others. But the ones who seem to do really well and have that grit and that survivor’s mindset are the ones who aren’t destroyed by the day when it is hard. They’re willing to do the hard thing. They’re okay to march into uncertainty. They’re willing to do the hard thing for the payoff. They’re willing to take a short-term discomfort for the long-term relief or the long-term payout. I think that mindset can change the game for people, particularly if you think of it like a marathon. Like, I just have to be able to finish this marathon, I’m going to do the hard thing, and think of it that way. There’ll be hills, there’ll be valleys, there’ll be times where you want to give up, but can I just do one hard thing and then the next hard thing, and then the next hard thing? Do you have any thoughts on that?

Chris: I’m glad that this is the message that you put out there. I’d say, obviously, when I think of Kim Quinlan as a friend, I think of other things and all the fun we’ve had together. But as a colleague, I always think of both. Obviously, self-compassion. But this idea of it’s a beautiful day to do hard things, I like it because we’ve always talked about doing hard things as this negative thing before you came along, and by adding this idea of it’s a beautiful day.

When I look at all the hard things I did in my own recovery, or I see clients do hard things, there’s this feeling of accomplishment, there’s this feeling of growth, there’s this feeling of greatness that we get. Just like you were saying, beyond the mental health conditions that I dealt with, when I start getting into real life after the mental health conditions now are more in recovery, every time I choose to do hard things, there’s always such a good payoff.

I was convinced I would never be able to get through school and get a degree and become a licensed therapist because I struggled with school with my perfectionism. It was difficult for me to get back in there and to humble myself and say, “Hey, you may flop and fail.” But now I’m a licensed therapist because of that willingness to do hard things. 

I could give a plethora of examples, but I want people to hear that doing hard things is your way of saying, “I believe in myself. I trust myself that I can accomplish things, and I’m going to tap into my support system if I need to, but I am determined, determined, determined to push myself to a level that I may not think I can.” I love when clients do that, and they always come in, they’re like, “I’m so proud of myself, I can’t wait to tell you what I did this weekend.” I love that. So, always remember hard things come with beautiful, beautiful, beautiful outcomes and accomplishments.

Kimberley: Yeah. I think the empowerment piece, when clients do scary, hard things, or they feel their hard feelings, or they do an exposure, they’ll often come in and be like, “I felt like I could do anything. I had no idea about the empowerment that comes from doing hard things.” I think we’ve been trained to think that if we just avoid it, we then will feel confident and strong, but it’s actually the opposite. The most empowered you’ll ever feel is right after you’ve done a really, really hard thing, even if it doesn’t go perfectly.

Chris: Yeah, and so much learning comes out of it. That’s why I always tell clients too, going back to one of our first roadblocks, beating yourself up prevents the learning. Let’s say you try something and it doesn’t go well. I was talking to a colleague of ours who I really, really like. She was telling me how her first treatment center failed. Now she’s doing really well for herself down in San Diego. She’s like, “I just didn’t know things, and I just did things wrong, and I learned from it, and now I’m doing well.” 

It’s like, whenever we look at something not going the way we’d like as an opportunity to learn and collect data, it just makes us that much better when we try it the other time. A lot of times these anxiety disorders were originally before treatment, hopefully trying to find ways to avoid our way through life—tough words—and trying to figure out, like, how can I always be small and avoid and still get to where I want to be?

When people hear this from your podcast—it’s a beautiful day to do hard things—I hope that they recognize that you don’t have to live an avoidant lifestyle, an isolated lifestyle anymore. Really challenging yourself and doing hard things is actually going to be so rewarding. It’s incredible what outcomes come with it.

Kimberley: Amazing. Well, Chris, thank you so much for doing this with me again. We finally stamped it into the podcast, which makes me so happy. Tell us where people can hear about you, get in contact with you, and learn more about what you do.

Chris: I am really active in the International OCD Foundation. I’m one of their board members. I also am one of their lead advocates, just meeting as somebody with the disorder. I speak on it. Then I lead some of their special interest groups. The Body Dysmorphic Disorder Special Interest Group is one of them, but I lead about four of them. One of their affiliates, OCD Southern California, I am Vice President of OCD SoCal and a board member. We do a lot of events here locally that Kim is part of, but also some virtual events that you could be a part of.

And then, as a clinician, I’m a licensed clinician in Costa Mesa, California. I currently work at The Gateway Institute. You can find me either by email at my name, which is never easy to spell. So, ChrisTrondsen@GatewayOCD.com, or the best thing is on social media, whether it’s Instagram, Facebook, or X, I guess we’re calling it now. Just @christrondsen. You could DM me. I always like to hear from people and get people’s support, and anything I can do to support people. I always love it.

Kimberley: Oh my gosh, you’re such a light in the community, truly. A light of hope and a light of wisdom and knowledge. I want to say, because I don’t tell you this enough as your friend and as your colleague, thank you, thank you for the hope that you put out there and the information you put out there. It is so incredibly helpful for people. So, thank you.

Chris: I appreciate that. I forgot to say one thing real quick. Every first, third, and fourth Wednesday of the month at 9 a.m. Pacific Standard Time on the IOCDF, all of their platforms, including iocdf.org/live, I do a free live stream with Dr. Liz McIngvale from Texas, and we have great guests like Kim Quinlan on, so please listen. But thank you for saying that. I always try to put as much of myself in the community, and you never know if people are receiving it well.

I want to throw the same thing to you. I mean, this podcast has been incredible for so many. I always play some of this stuff for my clients. A lot of clients are looking for podcasts. So, thanks for all that you do. I’m really excited about this episode because I think it’s something that we touch so many people. So, now to share it on a bigger scale, I’m excited about it. But thank you for your kind words. You’re amazing. It’s all mutual.

Kimberley: Thank you. You’re welcome back anytime.

Chris: And we’re going to get Greek food soon. It’s funny [inaudible] I’m telling you. It’s life-changing. Thanks, Kim. Listen to other episodes.

Kimberley: Thank you.

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 OCD. 

If you have generalized anxiety or panic disorder, we have a step-by-step process for how you can do that. It’s called overcoming anxiety and panic. 

If you have depression, we actually have a whole comprehensive course for depression as well on how you can face the depression, how you can undo the way that depression has you avoiding things and procrastinating, and how it’s demotivating you. That course is there for you as well at CBT School. 

If you’re someone who struggles with mental compulsions, we actually have a free six-part mental compulsion series here on Your Anxiety Toolkit. It’s completely free. I’ll leave the links for that in the show notes below. But that will help you walk through it with six amazing clinicians from around the world, like the best ones that we can get, talking specifically about different ways to manage mental compulsions. But it does involve a lot of the tools we’ve already talked about—a lot of mindfulness, a lot of facing your fear, a lot of willingness, a lot of awareness. These are things that you can be using specifically to interrupt those safety behaviors.

Now, another tool (Tool #5) is distress tolerance, because as you face your fear, you’re going to have some uncomfortable feelings. Distress tolerance is an opportunity for you to lean into that discomfort a little more. It’s very skill-based. Let me give you a couple of ideas. 

BEGINNERS MIND

Number one would be this idea of a beginner’s mind. Usually, when we’re uncomfortable, our natural human instinct is to get out of here. Like, “Let’s go. I don’t want to be here. I don’t want to feel it. Let’s run away.” Another instinct is to fight. Like, “Oh, I want to wrestle with it.” 

Beginner’s mind is the opposite of that. It’s the practice of being curious. We actually have a whole podcast episode on beginner’s mind. Think of it like you’re a baby. I always say, imagine you’re like one or two and you hand the baby a set of keys. Now, if you handed a set of keys to an adult, they’d be like, “Yeah, that’s keys.” They wouldn’t really stop to look at the keys. But if you give it to the baby, they’re so curious, they’re so open-minded, and they look at the keys like I’ve never seen these. They’re shiny, but they’re hard, but they’re bumpy. They have these round things. What do you do with them? I’ll put them in my mouth. What do they taste like? What do they feel like? They’re so willing to see these keys as if it’s the first time they’ve ever seen them because it's the first time they’ve ever seen them. 

As adults, we have to practice being curious, just like that. When we’re uncomfortable, we can be curious instead of nonjudgmental and go, “Okay, let’s be curious about this. What does it feel like? I wonder what it’s like if I’m willing to feel it. How long does it last? Can I let it be there? I wonder what will happen if I let it be there and go and do this or face the fear.” Let’s be curious instead of having a fixed mindset of, “I can’t feel this. I can’t handle it. I don’t want to,” and so forth. Beginner’s mind is very important in helping you relearn the perceived stress or the perceived danger of a certain thing. 

Another really important distress tolerance skill is radical acceptance. Radical acceptance is a sort of badass response to fear and emotions by going, “Bring it. Let’s have it. It’s here. There’s nothing I can do. Trying to stop it only makes things worse. And so I’m committed to radically accepting it being here.” Then you can go on to use other tools like your values and willingness, ERP, CBT, and any of those. You can use any of those skills. But you’re coming from a place of just radically accepting that it’s there. 

UNCERTAINTY

Another distress tolerance skill is to be uncertain on purpose. “Bring it on.” If you have anxiety, you’re going to have uncertainty anyway. Bring it on. Let’s let it be there. Let’s make another relationship with uncertainty—one that’s not stressful and one where it’s like, I’m allowing it to be there. I actually have some mastery over it because I’ve practiced letting it be there before, and I tolerated it then, and I’m sure I’ll tolerate it again. 

Remember here, you have gotten through 100% of the hard things in your life. You can do it again, and each time we can make this 1% improvement in how skillful we are in response to it.

SELF-KINDNESS AND SELF-COMPASSION

The next category that we had in the audit was kindness. We talked about questions such as, how do you treat yourself throughout the day? How kind are you? Do you punish yourself for having emotional struggles? And of course, you guys know this is number six, which is self-compassion. We know that self-punishment doesn’t work. In fact, it makes us feel worse. 

Self-compassion is the practice of making you a safe place to have any emotion, any discomfort, have any thought, have any anxiety. You’re willing to have them all, and you’re going to promise yourself and commit to yourself that you’ll be gentle with yourself no matter what. That’s the work. 

Truly, so many of you have said that you’ve been working on that, and you’ve actually made huge strides in that area. We have so much content on Your Anxiety Toolkit on self-compassion. I’d encourage you to go back and listen to any of those. This year I’m going to really heavily emphasize this work, but I really want you to really consider creating a safe place for you to have any emotion, any intrusive thought, any feeling, any discomfort at all, any pain, so that you know that you’re always in a safe place to have those feelings. 

MINDSET 

The last category of the audit that we did last week was on mindset. We asked questions like, how willing are you to experience these emotional struggles? When you wake up, what’s the thing you think? Do you think, “Oh no, I can’t handle it, this is going to be terrible, I hope I don’t have any anxiety today, I hope my emotions don’t come or I hope I don’t have any thoughts”? Or do you have a more positive outlook of the day? 

Now, we already talked about willingness. It was one of the first tools that we used. But here, I want you to consider the idea of being positive. Now, I’m not saying positive like, “Oh no, my bad things won’t happen,” or “No, I’m not a bad person, and my fears won’t come true.” That’s not what I’m talking about being positive. I’m talking about remind yourself of your strengths. That is a tool. 

Being complementary and positive is a tool that we don’t use enough. We spend all the time thinking about the worst-case scenario, and we very rarely take time to really think, “I’m actually pretty strong. I’ve actually handled a lot. I’m actually very, very resilient.” Is it possible that you do that too? What can we do to get you to see yourself the way I see you? 

Often, I’ll say to clients, “Oh my gosh, you’re doing so well.” And they’ll be like, “Oh, I kind of am, you’re right.” Or I’ll say, “Wow, look at how you got through that really hard thing.” And they’re like, “No, it’s not a big deal; everyone can do it.” But I’m like, “No, you did that.” 

CELEBRATE YOUR WINS 

Please practice being positive towards yourself, having positive regard for yourself, celebrating your wins, thinking positive about your strengths, not just focusing on your weaknesses. 

Now Tool #8, we all know. I say it every single week, which is it’s a beautiful day to do hard things. When we wake up and we think, “Oh no, I don’t want bad things to happen,” we become a victim. What we want to do is we want to stand up and say, “Today is a really beautiful day to do really freaking hard things, and I’m going to practice doing those.”

I want you to think of #8 as a motto, a mantra that you can take with you everywhere. “It is a beautiful day to do hard things.” We don’t need perfect conditions to do hard things either. We don’t need motivation to do hard things. Sometimes we just have to do them, whether we’re motivated or not. And then we see the benefit. We don’t have to wait until you have the right thought, the right feeling, or the right situation. 

Often, I’ll catch myself like, “Oh, I had a little bit of an argument with my husband. No, I’m not going to do hard things today.” No, that’s the day to go do the hard thing. Do it because it’s what brings you closest to your recovery. It brings you closest to the goals that you have. 

TIME MANAGEMENT

Now, Tool #9 is time management. When you wake up in the morning, if dread is the first thing on your mind, time management will help. We have a whole course on CBTSchool.com on time management, and what it is about is teaching you a few core things.

Number one, schedule your recovery homework first because it has to be the priority. It has to be. Secondly, schedule fun time first. Don’t schedule work. Don’t schedule your chores. Make sure you’re prioritizing these things because recovery requires rest, it requires fun, it requires lightness and brightness, and fulfillment. Doing these hard things takes up a lot of energy, so any way you can, even if it’s for two minutes, manage your time so that you have set in your calendar, set a reminder, the time where you’re going to do the things that you need to do to get your recovery on its way. Prioritize it. 

We have a whole course called Time Management for Optimum Mental Health. You can get it at CBTSchool.com, and it really outlines how you can do this and how you can practice prioritizing these things, which brings us to Tool #10, which is find a community of people who are doing the same things as you. 

I get it, everyone on Instagram looks like they’re having a jolly time and their life is easy. The truth is, no, they’re not. Find the people who are also struggling with similar adversity. You could go to CBT School Campus, which is a Facebook group we have. On social media, there are so many amazing advocates sharing what it’s like to be doing this work. Come on over and follow me on Instagram at Your Anxiety Toolkit, where I talk a lot about this all the time. There is a community of people who make the most gorgeous comments and are so supportive and encouraging.

FIND COMMUNITY

Find a community, because if you feel like you’re the only one who’s struggling, it makes it really, really hard. Just know that you’re not alone and that other people are going through hard things. They might not be going through exactly what you’re going through, but this community is filled with millions of listeners. There are other people who are struggling too, so try to find them. Use them as accountability buddies. Touch base with them. 

My best friend and I meet once a week, fire the phone, and check in. How are you doing? What are you doing well with? How are you doing with the goals you set for last week? Try to find someone, if you can, who can be your accountability buddy. If not, maybe ask a loved one or a friend who might be willing to do that. 

There are the 10 tools that I want you to have in your toolkit. You’re not going to use them all the time. You’re not even going to be good at them. I’m even willing to say you’re going to suck at using them, and that is okay. I suck at using these sometimes too. This is not about perfection; this is about pausing, looking at the problem, asking yourself, which of these tools would be most helpful right now? And be curious. Again, use your beginner’s mind. Be curious about trying them, experimenting, giving yourself a lot of celebration in the fact that you tried. 

Again, this doesn’t have to be perfect. We make 1% improvements over here. That’s all I’m looking for—a 1% improvement. Is there something you can do today that will get you 1% closer to your recovery goal? If that is possible, go for it. Give it your best. You will not regret it. I’ve never once had someone regret moving towards their recovery. In fact, I’ve only seen people say, “I’m so grateful I did it.” Even though it might have been late, it’s never too late. 

All right. Have a wonderful day. I know you can do this. I cannot wait for this year. I have so many things I want to talk to you about. 

Have a wonderful day, and I’ll see you next week.

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 

1. General Perspective 

2. Safety Behaviors 

3. Safety 

4. 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 happen next. How are you carrying this in your body? 

If you had an eating disorder, it might be, “I’m tensing my stomach and pulling it in and trying to not eat and trying to suppress hunger and thirst.” If that’s happening, okay, let’s document. If you’re having panic, are you squinting, pushing away thoughts, trying to avoid a sensation in your body? We want to get to know what is happening with our bodies.

A patient of mine a couple of weeks ago said, “I just hold my breath all day. I really do. I probably take half the breath that someone without anxiety takes.” Write it down if you notice that’s what you’re doing in your body. Again, not your fault; we’re just here to look at the data. 

The next category of safety behaviors is, how often do you seek reassurance per day? How often do you consult with Google to reduce your anxiety? How often do you ask family and friends questions about your fear to get a sense of certainty or to reduce your anxiety? 

Sometimes this can be tricky. You might even just mention a topic to notice their facial expression to see how they respond, or you might report to them something that happened to see if they’re alarmed so that you then know whether you should be alarmed and engage in some behavior, worrying, ruminating, and so forth. 

How often are you trying to get to the bottom of anxiety and you’re noticing that it’s repetitive, and over and over again, you’re getting stuck in these rabbit holes of Googling or asking friends and families, often asking them questions they don’t even know the answer to? 

Often, our family members, because they love us, will give us an answer based on probability, but they actually don’t know. And therefore, your brain-- you’re very smart. I know this because all my clients with anxiety often in depression are. You’re very smart. You know they don’t know the answer, so your brain doesn’t compute it as a real certainty anyway. Your brain is going to immediately go, “Well, how do they know? They probably don’t know any better than I do,” and it’s going to want more and more questions to be asked. How often do you seek reassurance per day, or how much of the day do you spend seeking reassurance? 

And then the last safety behavior here is physical behaviors. This is more common for folks with OCD, phobias, or health anxiety. What physical behaviors do you engage in? Meaning, do you rearrange things? Do you move things? Do you check things? Do you turn things on and off? Lock doors, unlock doors, lock them again. How much are you engaging in physical behaviors to reduce your anxiety? 

Again, I will also say this is very true for generalized anxiety. Often, people with generalized anxiety disorder spend a lot of time just engaging in this high-level functioning of checking boxes, getting things done, always being the busiest person in the room. And while yes, that does get rewarded by our society because, “Oh, look at them go, they’re getting all the things done,” they’re doing it to avoid or remove discomfort or uncertainty. So we want to get a thorough documentation of all of those things. Again, do not beat yourself up if it’s a long list. Those will help us next week when we talk about tools. 

KINDNESS AND SAFETY 

We move on now to the third category, which is kindness and safety. And now we’re talking about how do you respond to yourself and your experience of anxiety. We also talked about this through the lens of safety. Safety is when you’re feeling uncomfortable, you’re having an emotion such as anxiety, grief, sadness, dread, anger. When you have those emotions, is your brain and body a safe place to allow those emotions to exist, or is it an unsafe place in that you push it away, judge yourself, tell it shouldn’t be there, rid it out, get rid of it, banish it, avoid it, abandon it, all the things? 

Question #1: How do you treat yourself throughout the day? Out of 10, how kind are you to yourself? Really think about it. How do you treat yourself? 

If you thought objectively about yourself as a friend, would you want yourself as a friend around? Probably not. Maybe you’ve been listening to Your Anxiety Toolkit for some time and you’ve already really developed these skills, but really, really honestly, how kind are you to yourself? If you were another friend, would you invite yourself over? Probably not because you wouldn’t invite a friend over who’s like, “What is wrong with you? You’re crazy. You shouldn’t be doing that. You’re so silly. Why are you spending all this time? You’re lazy. You’re dumb. You’re stupid for asking these questions.” So really think about that. 

The second question is, do you punish yourself for having these emotional struggles? And if so, how? Do you blame yourself? Do you shame yourself? Do you engage in a lot of guilt behavior, guilting yourself for these behaviors? Do you withhold pleasure from yourself? 

I’ve had so many clients tell me that they will not allow themselves to have the nice toilet paper, and they get themselves the scratchy, one-ply toilet paper because of their intrusive thoughts or because they’re depressed and they don’t check the boxes that their friends on Instagram have checked. Therefore, they don’t deserve the nice shampoo, or they don’t deserve nice sheets, or they don’t deserve to rest. They basically punish themselves for their emotional struggles, and we don’t want to do that. 

I know you know this already, but we want to know specifically. Do an inventory. Give yourself some days here to really do a thorough audit of what’s going on in your life. You might find that you don’t eat or you eat foods that aren’t delicious. One thing in my eating disorder recovery was, let’s really try to eat foods that are genuinely delicious. And if it’s not delicious, don’t eat it. Well, of course, if you need to eat and you need to function and you don’t have great options, that’s fine. Just eat for the sake of nourishment. But if you’re at a restaurant, eat the thing that’s delicious. Are you engaging in not allowing yourself to have those pleasurable things?

The last question in the area of kindness and safety is, what specifically do you say to yourself when things get hard? What specifically do you say to yourself? 

Often, people say, “No, I’m really kind to myself. I’m really good. I work out.” But then, when things get hard, everything goes down the drain. They start beating themselves up. When they don’t win at work or they don’t get a good grade or when they’re having a bad anxiety or depression day, that’s when they start beating themselves up. What do you say to yourself specifically when things get hard or when things get painful? Write it down. 

MINDSET

All right. We’re moving into the last section, which is mindset, because remember, we’re looking at 2024. We’re looking at the next six months, three months, or one month, and we’re really looking at how can we supercharge your recovery. 

Here’s the question: How willing are you to experience these emotional struggles in your body? Out of 10, how willing are you? 

Most of my patients report like a four, five, and a six, which is still great. I’m happy with that. It’s better than one, two, and three. And if you’re at a one, two, and three, it’s okay. We can start somewhere. Okay? What I’m looking for when I’m with my patients or when I’m with myself is a solid eight, nine, and 10 of willingness. 

Of all the things that I push the most, how willing are you to actually have your emotional discomfort? Often, people are like, “I don’t want it. I’m in too much pain. I’ve had too much pain, Kimberley. Don’t even ask me to. You don’t even understand. I’ve been in pain for years,” and I get it. What we do resist persists. So we want to first ask ourselves, how willing are we to allow this discomfort to be in our body, this emotion to be in our body, or this thought to be present in our awareness? 

The last question here is, when you wake up, what is your mindset about tackling the day? Do you wake up and go, “Oh no, God, I don’t want this,” or do you wake up and go, “No, no, no, no. Please, no anxiety today. Please, no thoughts today. Please, no depression today. Please, let this be a good day,” or do you wake up and say, “This will be a bad day”? Just take note of it. You’re not wrong for any of them, but we want to get a little bit of a temperature check on how you start the day. 

Now, one thing to know, often these thoughts are automatic. You don’t have control of them. Again, I’m not here to say they’re wrong, but what we will talk about next week is ways in which you can change how you respond to some of those automatic negative thoughts, or even your intrusive thoughts, and really look at how we can create a mindset for you. 

Let me give you just a quick rundown before we move forward. 

Number one, we will be doing tools next week, and I’ll be going deep into that. And that will be the focus of mine for 2024. My biggest focus for 2024 is really doubling down on making sure you guys know what the tools are in your toolkit and which ones work for you, and you get to work from that. 

Then I’m actually recording another podcast with Chris Trondsen, where we talk about common mindset roadblocks when it comes to recovery, and we will be giving you strategies there as well. Stick around for that. If you are listening to playbacks here, make sure you listen to all three episodes of this, because I think it will be so important now that you’ve done an inventory and you know what’s going on. 

All right. That’s that. That is your mental health audit. Write it all down. Give yourself plenty of love. Congratulate and celebrate the fact that you did this hard thing, and I will see you next week to talk about the tools you need—the specific tools in your anxiety toolbelt—to help you go and live a life where anxiety is not in charge, not in the driver’s seat, and where you live according to your values, what is important to you. Anxiety and emotions do not get to make your decisions, and that’s my goal for you. 

Have a great day. As always, I always say it’s a beautiful day to do hard things. You did a hard thing today. Thank you for sticking with me. This is not fun work. I get it. But it is important work, and you do deserve to get this really out on paper so that we can get you going in the direction that you want to go. 

As always too, take what you need, leave the rest. If some of these questions don’t really fly for you or they’re very triggering, just do the best you can. I don’t ever want people to feel like what I’m saying is the rule and you have to do it. 

Take what you need. Leave the rest, and I’ll see you next week. Have a good one, everyone.

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 traumatic experiences range from 70% to 90% of the population, and most of us will experience something at some point in our lives that would need that definition—that strict definition of a trauma. Yet, only about 6 to 7% of people will be diagnosed with PTSD at some point in their lives. So there’s this huge discrepancy here. 

There are lots of factors, and of course, we don’t have this perfectly nailed down where we can exactly predict, “Okay, this person is going to be fine. This person is going to have PTSD.” It’s really an interaction of lots of factors. But we know that there are some things that can either provide a buffering effect against PTSD or have the opposite effect, where they might put somebody at greater risk. 

One of the biggest things that’s come up in research is social support or the lack thereof, so that when people have really great social support after their trauma, whether it’s after a sexual assault or they’ve come home from combat, that can really buffer against the likelihood of developing PTSD. The reverse is true as well when people don’t have social support. We saw this, for example, after the Vietnam War, where a lot of veterans came home and really were mistreated by a lot of people. Unfortunately, that’s a risk factor for developing PTSD. 

But there are other things too, like coping. Not necessarily using one particular coping skill, but rather having a variety of coping strategies that somebody can use flexibly, even something like humor. We see this as a resilience factor. Obviously, there are times when using humor can serve as a distraction or avoidance, and there are times when it can be really adaptive too.

Obviously, of course, genetics that people may have a predisposition in general towards having mental health concerns. Sex, we know that people assigned female at birth have a higher likelihood of developing PTSD after trauma. 

And then there are things that may be specific to the experience itself, so the type of trauma. Sexual assault is unfortunately a really big risk factor for developing PTSD, whereas there are other trauma types where fewer people go on to develop PTSD from those. 

And then there’s something that we call peritraumatic fear, and that just means the fear that you were experiencing at the time that the event was happening. In the moment that the trauma was happening to me, how scared was I? How much did I feel like I might lose my life? People who experience more of that fear at the time of the event are more likely to go on and develop PTSD. 

But it’s pretty interesting too, because, as with everything, there isn’t just this binary, like you either have it or you don’t have it. I want to normalize this too for anyone who might be listening and maybe has recently experienced something really horrible and is struggling with some of these symptoms that we talked about. It doesn’t necessarily mean that you have PTSD or that you’re going to continue to have PTSD. 

Most people, about 50 to 65%, will experience mild to moderate post-traumatic stress symptoms after the event that will just gradually go away on their own. We call that a resilience trajectory. We also have about 10 to 15% of people who have what we call a recovery trajectory, where maybe right away they did have a spike in post-traumatic stress symptoms, right away in that first month or so. But after a year, again, it’s resolved itself. 

And then we have two trajectories that go on to describe people who will have PTSD. That would be a chronic trajectory where somebody would have this elevation in symptoms after the trauma that persists. That’s usually about 15 to 20% of people. And then less likely is what we call a delayed trajectory. This is about only 5 to 10% of people who may have had really mild symptoms right away or perhaps no symptoms at all. And then, after about six to 12 months, it might just all of a sudden skyrocket for whatever reason.

IT IS OCD OR AM I IN DENIAL? 

Kimberley: Right. So interesting. I was actually wondering what you often hear about people who, especially as someone who treats OCD and anxiety disorders, often questioning whether there was a trauma they had forgotten. Like, did I repress or am I in denial of a trauma? What can you share statistically about that?

Caitlin: Yeah, that’s a really great question. It’s definitely more of a controversial topic in the field, not because people don’t have the experience of having these recovered memories, but rather because of what we know about how memory works and how fragile it can be, that as clinicians, we have to be really careful that we’re not, in our efforts to help someone, inadvertently constructing a false memory. 

I would say that most of the time, this delayed trajectory of PTSD symptoms is less so about the person not remembering the event, but more so like they just have continued on with their life and are probably suppressing, avoiding, and doing all sorts of things that are maybe keeping it at bay temporarily. And then there may be, in a lot of cases, some big life event that may bring it up, or perhaps another traumatic experience or something like that.

WHAT IF I HAVE REPEATED TRAUMAS? 

Kimberley: Yeah. I was going to ask that as well, as I was wondering. Let’s say you’ve been through a trauma. You recovered on that trajectory you talked about. Are you more likely to then go on to have PTSD if you repeat different events, or do we not have research to back that up?

Caitlin: That’s a great question. I’m not sure specifically about, depending on which trajectory you were initially on, how that increases the likelihood later on. I can say that repeated exposure to trauma in general is associated with a greater likelihood of PTSD. I would say that, probably regardless of how quickly your symptoms onset, if at all initially, experiencing more and more trauma is going to increase the likelihood of PTSD.

WHO CAN DIAGNOSE PTSD AND TRAUMA? 

Kimberley: Right. Amazing. Thank you for sharing that. I know that was very in-depth, but I think it helps us to really understand the complexity and the way that it can play out. 

Who can make these diagnoses? I know, as I mentioned to you before, even my daughter has said she found herself on some magazine website that was having her do some online tests to determine whether there was trauma. It seems to be everywhere, these online tests. Can you get diagnosed through an online test? Would you recommend that or not? Who can we trust to make these diagnoses?

Caitlin: That’s a great question. I would not recommend using something like an online test or even a self-report questionnaire to help you figure out if you have PTSD. Now, it can give you a sense of the specific areas that I might be struggling with that I could then share with a licensed provider, who can then make the diagnosis. But if you were to just find a quiz online and take it, and it says you have PTSD, that would not be something that we would consider to be valid or reliable in any way. 

I would recommend talking with a psychologist, a psychiatrist, any sort of general practitioner, an MD, or maybe even someone’s primary care physician. Definitely, if you can get in touch with a licensed provider who specializes in PTSD and can really be sure that that’s what’s going on for you. 

Now, TikTok and all these things exist out there. As with anything on the internet, it can be used for good and it can also be very harmful. I think it just comes down to gathering information that may be helpful but then passing it on to someone who can sift through the misinformation and give you a clearer answer.

Kimberley: Yeah. Thank you for that. I think, as someone myself who’s had their own mental journey, I do remember during different phases of my own recovery where our brains just don’t make sense. I had an eating disorder—a very bad eating disorder—and my brain just couldn’t see clearly in some areas, and me being so frustrated with that. I know lots of people with, let’s say, panic disorder feel the same way or health anxiety, their condition feels so confusing and makes no sense that in the moment of being grief-stricken by this and also very confused, it’s pretty easy to start wondering, “Could this have been a trauma or is this PTSD? This doesn’t make sense. Why am I having this mental health issue?” Especially if it’s not something that was genetically set up in your family. I’m wondering if you can speak to the listeners who may have dabbled in thinking maybe there is a trauma, a big T, a little T, or PTSD. Can you speak to how someone might navigate that?

Caitlin: Most definitely. I’ll validate too that it’s really complex. We use the DSM to help us understand these different diagnoses, but there’s so much overlap. Panic disorder—obviously, panic attacks are the hallmark feature of panic disorder, but people can have panic attacks in PTSD as well. People with eating disorders might have issues with their self-image and their self-esteem. That can happen in PTSD as well, as I mentioned, even with mood disorders. There are symptoms in PTSD that sure look and sound a lot like depression. 

If it feels confusing, “Well, wait a minute, I have this symptom. What does it belong to? What does it mean?” We do really have this very imperfect and overlapping classification system that we use. That being said, it’s a legit question to ask if somebody feels like, as you were saying, “I’ve been struggling with these symptoms, but it really feels like there’s something more here.” 

When we diagnose PTSD, we go through all of the 20 symptoms, some of which I referenced earlier. For each symptom, we’ll ask about when that symptom started for the person relative to trauma and whether or not it’s related to trauma in some sort of way, if there’s some content there to work with. 

For example, somebody maybe wasn’t having any issues with their mood whatsoever, and then they experienced trauma, and all of a sudden, it was just really hard for them to get out of bed. Well, that could potentially be a symptom of PTSD because it started after the trauma. 

One thing that I hear a lot, because unfortunately, childhood trauma is really common, when I ask folks about this, they’ll say, “I don’t know. The trauma happened when I was so young that I don’t even remember who I was before this person that I am now, who’s really struggling.” In that case, people usually have a pretty good insight into this. Like, do you think that this is related in any way? Or maybe, if you have any recollection, you had a little bit of this experience and this symptom initially, and it got worse after the trauma. That, again, could potentially indicate that that’s a symptom of PTSD. 

I would say for those folks who are listening, who are struggling with things like panic attacks, difficulty with eating, mood, whatever it might be, even OCD, which we talked about recently, really checking in with yourself about how and if those symptoms are related to your trauma. If they are, then find someone that you trust that you can talk to about it. Hopefully, a therapist who can help you piece this apart. 

It could still be maybe the disorder you thought it was, maybe it is panic disorder, maybe it is OCD, maybe it is an eating disorder that’s still informed by trauma in some way or impacted in some way, which would be important to be able to process in treatment. Or it could just be PTSD entirely. And then that would be really important to know because that would significantly change what the treatment approach would be.

Kimberley: Yeah. It’s so true of so many disorders. You could have social anxiety and panic attacks because of social anxiety, and a mental health professional will help you to determine what’s the primary, like, “Oh, you have social anxiety and social interactions are causing you to have panic,” and that can sort of help. I think as clinicians, we’re constantly ruling out disorders using our professional hat to do that. I think you’re right. Speak to a professional and have them do our assessment to help you pass that apart. Because I think in general, any mental health disorder will make you feel like something doesn’t feel right, and that’s the nature of any disorder. 

Caitlin: Right. The good news, too, is that, within reason, some of the treatment techniques that we have can be used more broadly. Interoceptive exposures, we can use that for people who have panic disorder, just people who struggle with panic attacks, or maybe people who have OCD or GAD and just feel really sensitive to those sensations in their body that suggest that they might be anxious. Same thing with behavioral activation. We use that for depression, and that can really easily be added to any treatment, whether it’s treatment for PTSD or something else. You’re exactly right, getting clarity on what’s going on for folks, and then what are some of these techniques that might be most helpful for these symptoms?

PTSD AND TRAUMA TREATMENT 

Kimberley: Yeah. Thank you. You perfectly segue this into the next question, which is, can you describe the treatment or give us names of the treatment for this comparison of trauma versus PTSD? Are they the same treatments? Does it matter whether it’s a big T trauma or a little T trauma? Can you give us some idea of the treatments for these struggles?

Caitlin: Definitely. Most of the evidence-based treatments that exist are specifically for PTSD. Obviously, they touch on trauma, of course, as the reason why somebody has PTSD and where all of these symptoms stem from. But there aren’t as many treatments that are, let’s say, specifically for trauma, at least not in terms of a standardized way of working through that. If somebody’s experienced trauma and they don’t have PTSD, and let’s say they don’t have any diagnoses, but they are still impacted by this experience, just doing behavioral therapy or whatever treatment feels like a good fit for what somebody is trying to work through might be sufficient. And then we have these evidence-based treatments that have been shown to really target PTSD symptoms and help reduce them.

A few years back, I think it was 2017, the American Psychological Association reviewed all of the research on PTSD treatments. They reviewed it using lots of different criteria for what it means to feel better after treatment beyond just reducing PTSD symptoms, but also looking at other things too, like mood and suicidality and things like that. They essentially created this list of treatments that they rank orders in different tiers, depending on how effective they were shown to be. 

In the top tier are four treatments. There’s cognitive behavioral therapy just broadly, cognitive therapy also broadly, and then the two specialized treatments are prolonged exposure (PE) and cognitive processing therapy or CPT. I can talk a little bit more about those two if you’d like. 

In the second tier are things like acceptance and commitment therapy, EMDR—these treatments that people may have used themselves and have found really effective, and they are effective. They’re just maybe a little bit less effective for fewer people, if that makes any sense. It’s not to say that EMDR doesn’t work, but rather that there’s just more of an evidence base for things like PE and CPT.

DIFFERENCE BETWEEN PTSD AND TRAUMA TREATMENTS 

Kimberley: Great. To speak to those two top-tier treatments, can you compare and contrast them for someone just so that they feel they understand the difference?

Caitlin: Yeah. If I had a whiteboard, I would just draw out the CBT triangle, but hopefully, folks listening know that in the CBT triangle, you have your emotions, your behaviors, and your thoughts, and all these things are constantly interacting with one another. We could say, just on a really simplified level, that when we are seeking treatment for PTSD, we want our emotions to be different. We want to feel less emotionally impacted by the trauma that we’ve experienced.

PE and CPT are both under the umbrella of cognitive behavioral therapy, so they both use that triangle. They just get at it a different way. PE starts with the behaviors, knowing that the thoughts and emotions come along for the ride. CPT starts with the thoughts, knowing that the behaviors and the emotions come along for the ride. 

Now, they’re both extremely effective at reducing PTSD symptoms. They’ve done head-to-head comparisons. They’re both great. You’re not going to find one that’s significantly better than another, but you might find one that feels like a better fit for what you’re currently struggling with. 

Cognitive processing therapy, again, starting with the thoughts, cognitive processing, basically involves-- I almost think of this as looking at our thoughts and our beliefs about things and examining them from different lenses. I always picture plucking an apple from a tree. Like, okay, this is a belief that I developed from my trauma. This was really adaptive for me at the time because this belief told me that I can’t trust anyone and I have to always watch my back. Boy, did that help me when I was in combat and I was always watching my back and making sure I was safe. But as I look at it from these different angles, I might realize, well, I’m not in combat anymore, and I’m living in a pretty safe environment with safe people. So maybe this belief doesn’t really serve me anymore. 

You work with your therapist to identify what we call stuck points, which are these really deep-seated beliefs that somebody has about themselves, other people, or the world that either developed from trauma or were reinforced by trauma, because sometimes people will say, “Well, I’ve never trusted people. I’ve always been in an environment where things weren’t safe.” And then there we go, the trauma happened, and it just proved me right. Cognitive processing therapy helps people work through these stuck points and come up with alternative perspectives on these thoughts. 

Prolonged exposure is a lot more similar to what I imagine lots of the folks listening may have done with exposure therapy generally, or exposure and response prevention for OCD. Again, we’re starting with the behavior, knowing that if we target the behavior first, that’s going to change our cognitions, and it’s going to change our emotions. 

PE involves two different types of exposure. The first one being in vivo exposure, which is really similar to just any sort of ERP exposure where you expose yourself to something in the environment that triggers a thought about the trauma or some sort of emotional reaction. You do those over and over again until they feel like no big deal to you, you feel really awesome about yourself, and you can conquer the world because you can. 

And with your therapist, you do an imaginal exposure, which is where, in a really safe environment, you talk through the experience of your trauma and what happened to you. You do this actually in a unique way to really engage with that memory because, as we talked about, that internal avoidance is so common in people with PTSD. This imaginal exposure would be describing the experience in the present tense, painting a picture as though it was a film that was playing out right in front of our eyes, and really digging into the details of, what am I feeling in the moment that this trauma is happening? What am I hearing? What am I sensing? And doing that imaginal exposure, again, with your therapist in a really safe space until it doesn’t have an impact on you anymore. 

I always say this to people when they start PE with me: I know that this may sound nuts right now. But a lot of people who do PE will get to a point where they’ll look at me and say, “I’m so bored telling this story again. I’ve told this story so many times. It doesn’t even bring up this emotional response for me anymore.” That feels really unlikely for people who are just starting out in treatment and are so impacted by this memory, and they do everything in their power to avoid it. But people can and very much do get to a place where they feel like they’ve conquered this memory and it doesn’t control them anymore. 

That’s how PE and CPT work. Again, they both eventually target the same thing. It’s just sort of, which route do you go?

COMPLIMENTARY PTSD TREATMENTS 

Kimberley: Right. Amazing. Thank you. From my experience too, and actually, this is a question, not a statement—my experience, some people who I’m close with or clients who have been through PTSD treatment also then had to develop some coping skills, mindfulness skills, compassion skills, or maybe sometimes even DBT skills to get them across the finish line. Has that been your experience? What is your feedback from a more scientific perspective?

Caitlin: Yeah, it really depends on the person. There are also combinations of these treatments. There’s a combined DBT and PE protocol out there for folks who do need a little bit more of those skills. Some people do feel like they would benefit from having some of these coping skills, maybe upfront or throughout the course of treatment. But they’ve also done research where they’ve started with that skill-building before they go into PE or CPT, compared to people who go right in. Actually, what they often find is that starting with skill building, sometimes it’s just colluding with avoidance, and it just lengthens the amount of time that somebody needs before they start to feel better. 

I’m glad you asked this question because it’s so common for people with PTSD to feel like, “I can’t. I can’t do this thing. I can’t feel this thing. I can’t talk about this thing.” And they really can. Sometimes if we allow people to really challenge those “I can’t” beliefs, then they’ll realize, “I really thought that I was going to need all this extra support or I was going to need this or this, and I was able to just move right through this treatment.”

Now, of course, again, that’s not the case for everyone. There are some folks who maybe have much more severe PTSD, maybe have some different comorbidities like personality disorders or something else where it might be helpful to involve some of that, or people who had really chronic exposure to, say, childhood trauma. But far and away, people are often much better able to jump right into some of these treatments than they think they are.

HOW TO FIND A PTSD TRAUMA THERAPIST 

Kimberley: Thank you for sharing that. I think that’s super helpful for us to feel hopeful at the end. One more question before you tell us about you and some of the amazing things that you’re doing. Where might people go? As we know, with OCD and health anxiety, we want a specialist to be helping us, ideally. I’ve noticed as a consumer that everybody and their Psychology Today platform says they treat trauma. I’m wondering how we might pass through that and find treatment providers who are skilled in this area. How might they find a trained professional?

Caitlin: I’m glad you mentioned that about Psychology Today. That’s the advice that I give people when they’re using Psychology Today, or really any sort of platform. If this person is saying that they treat everything under the sun, then it’s probably not a person that you want to link up with for something really specialized because it’s-- what is the saying? “Jack of all trades, master of none.” And I start to get suspicious even that this person even does evidence-based treatment for trauma and PTSD when they’ve listed a thousand things. It’s definitely a red flag to consider for those who are listening and maybe have had this experience. 

In terms of finding a therapist, if folks are interested in PE or CPT, there’s actually directories of therapists who’ve been trained and certified in those modalities. You can find them on-- I’m trying to think of the exact website. If you Google “Prolonged Exposure providers,” something will come up, I believe it’s through Penn. You can do the same for cognitive processing therapy. If you Google, I think it’s like “CPT provider roster,” you’ll get a whole list of providers as well.

Now, just because somebody isn’t on there doesn’t mean that they haven’t been trained in these things. There’s just a certification process that some people go through, and then they can get added to this list. If your provider says, “I’m trained in PE, I’m trained in CPT,” I would probably trust that person that, for one thing, they even know what those things are, and I’d be willing to give them a shot.

Also, and I know we mentioned this on the last episode too, for anyone listening who might have PTSD and OCD, I’ve compiled a list of providers on my website—providers who are trained to treat both OCD and PTSD. I have that broken down by state and then a couple of international providers as well. My website is www.cmpinciotti.com. 

In terms of broad resources beyond finding a provider, there are lots of organizations that have put out some really great content about PTSD—videos, handouts, blogs, articles, all sorts of things. I think the biggest place that I send people is the National Center for PTSD. This is technically run through the Veterans Administration, but anyone can use these resources. They’re not only for veterans. It’s very, very helpful. I’d recommend people who want more information to go there. 

You can also find things on the Anxiety and Depression Association of America, the National Institute of Mental Health, the National Alliance on Mental Illness, and so on. And then, of course, I mentioned the Trauma and PTSD in OCD Special Interest Group that I co-chair, that folks can sign up for that too, and we send out materials through there as well.

Kimberley: Amazing. I am so grateful for you because I think we’ve covered so much in a way that feels pretty easily digestible, helps put things in perspective, and hopefully answers a lot of questions that people may be having but didn’t feel brave enough to ask. Where can people find out more about you? You’ve already listed your website. Is there any other thing you want to tell us about the work that you’re doing so that we can support you?

Caitlin: On my website, in addition to the treatment provider directory, I also have some handouts and worksheets. Again, these are specific to co-occurring OCD and PTSD. That might be helpful for some folks. I also usually list on there different studies that are ongoing. I have two right now that are ongoing that I can-- oh, actually, I have three—I lied to you when I said two—that people can participate in if they’re interested. There’s one study that we’ll be wrapping up at the end of December. That’s about OCD and trauma. People can email OCDTraumaStudy@bcm.edu for more information. We also have a study that’s specific to LGBTQIA+ people with OCD that also covers some things related to trauma and minority stress in that study. If folks are interested in participating in that, they can email me at PrideOCD@bcm.edu. 

And the last one, and I’ll plug this one the most, that if folks are like, “Well, I want to participate in a study, but I don’t know which of those,” or “I only really have a few minutes of my time,” we have a really, really brief survey, and we’re trying to get a representation of folks with OCD from all over the country. For anyone who’s listening and who has OCD and is willing to participate, it’s a 10-minute survey. You can email me at NationalOCDSurvey@bcm.edu. All of these cover the topic of trauma and PTSD within them as well.

Kimberley: Thank you. I’m so grateful for you. You’ve come on twice in one month, and I can’t thank you enough. I do value your time, but I so value as well your expertise in this area and your kindness in discussing some really difficult topics. Thank you.

Caitlin: No, I appreciate it. Thanks for having me on. I hope that folks who are listening can feel a little bit more hopeful about what the future can hold for them.

PTSD & TRAUMA LINKS AND RESOURCES 

Find a PE provider: https://www.med.upenn.edu/ctsa/find_pe_therapist.html

Find a CPT provider: https://cptforptsd.com/cpt-provider-roster/

For educational resources on PTSD: https://www.ptsd.va.gov/

To participate in a brief, 10-minute national survey on OCD: NationalOCDSurvey@bcm.edu

To participate in the OCD/Trauma Overlap Study (closing at the end of December): OCDTraumaStudy@bcm.eduTo participate in a study for LGBTQIA+ people with OCD: PrideOCD@bcm.edu