March 12, 2025 • 36 mins
Send in a question or comment via text.
In this no-frills episode of The Anxious Truth, I'm tackling common questions about anxiety sent in by you, the listeners. No fancy production today - just real talk about real anxiety concerns.
We're diving into:
00:00 - Introduction
00:58 - Emetophobia (fear of vomiting) - what it is and how it's typically addressed
06:12 - Nocturnal panic attacks - why they're jarring and how to handle them
11:24 - Is focusing on breathing a distraction or helpful technique?
14:45 - The meta-problem of ruminating about rumination
18:20 - External sources of anxiety in our tumultuous world
22:06 - The fear of becoming suicidal against your will - a surprisingly common anxiety concern
27:40 - Why focusing on specific anxious thoughts misses the bigger picture
As someone who lived through panic disorder, agoraphobia, OCD, and depression, I'm sharing both professional and personal perspectives on these challenging issues. Remember - recovery isn't about eliminating specific fears but changing your relationship with your internal experiences altogether.
There are no magic solutions or quick fixes here, just practical guidance for the long-term journey of anxiety recovery. All sensations, thoughts, and emotions are permissible - even when they're uncomfortable.
For full show notes on this episode:
https://theanxioustruth.com/313
Support The Anxious Truth: If you find the podcast helpful and want to support my work, you can buy me a coffee. Other ways to support my work like buying a book or signing up for a low cost workshop can be found on my website. None of this is never required, but always appreciated!
Interested in doing therapy with me? For more information on working with me directly to overcome your anxiety, follow this link.
Disclaimer: The Anxious Truth is not therapy or a replacement for therapy. Listening to The Anxious Truth does not create a therapeutic relationship between you and the host or guests of the podcast. Information here is provided for psychoeducational purposes. As always, when you have questions about your own well-being, please consult your mental health and/or medical care providers. If you are having a mental health crisis, always reach out immediately for in-person help.
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Transcript
Episode Transcript
Available transcripts are automatically generated. Complete accuracy is not guaranteed.
Speaker 1 (00:00):
This week on the Anxious Truth, we're answering
common questions about anxietyand anxiety disorders sent in by
you guys, the audience.
Today we're going to talk aboutemetophobia.
We're going to talk aboutnocturnal panic attacks and
exposures related to that.
We're going to talk about howconcentrating on breathing when
you're anxious could be adistraction or maybe it isn't.
We're going to talk aboutruminating about ruminating.
(00:21):
We're going to talk aboutexternal sources of anxiety and
how you might deal with those.
We're going to talk about thefear of becoming suicidal
against your will, which isreally common in our community,
and then I'm going to have a fewwords about some specific
thoughts or symptoms that peoplealways want to ask about.
So thank you for the feedbackfrom the audience.
Let's get into it.
This is an absolutely noproduction, no frills episode of
(00:44):
the Anxious Truth.
In fact, if you're on theYouTube channel, you have a
still image.
Today there's no video.
It's just me.
I'm the only one that recordsand produces the Anxious Truth.
I don't have a production teamthat follows me around.
Sometimes my schedule is just alittle too much and I cannot
fit in recording and editingvideo.
So today it's me sittingoutside in the sun actually
recording into my phone with oneof my other microphones because
(01:06):
it's the first 60 degree day wehave on Long Island without 40
mile an hour wind that I'mtrying to take advantage.
So no intro, no music, a littlebit no frills, uh, and we're
going to get into questions fromthe audience.
Who is the one man show behindthe anxious truth?
That would be me.
I'm drew Linsalata.
I am the creator and host ofthis podcast.
I am a therapist pre-licensed,still practicing under
(01:26):
supervision in the state of NewYork.
I specialize in the treatmentof anxiety and anxiety disorders
.
I also suffered from variousforms of anxiety disorder OCD
and depression for many years ofmy life, on and off Better now.
Three-time author on this topicand educator and advocate
social media guy.
And, yeah, clearly a podcasthost, not just this podcast but
also Disordered.
That I do with my friend JoshFletcher in the UK.
(01:47):
You could find that one atdisorderedfm if you want more
resources.
And yeah, on the Anxious Truth,we talk about anxiety disorders
and the process of recoveryfrom those particular issues.
So if you've just stumbled uponthe podcast or the YouTube
channel today for the first time, welcome, glad you're here,
hope you find it helpful and, ofcourse, if you are a returning
listener or viewer, welcome back.
Thanks for spending some timewith me this week.
(02:10):
So this week we're going to takequestions from the audience,
some common questions thatpeople asked.
Many of these questions wererepeated and if you want to send
in a question, if you'relistening to this as a podcast
episode, you'll notice that inthe podcast description there's
always a link that says send ina question or comment via text.
Feel free to use it.
You can send me a text.
I will see it.
I will not see your name, Iwill not see your number.
(02:30):
I cannot text you back, Icannot share it.
You will not get spammed, it'stotally safe.
It's just a way for you tocommunicate comments and
questions to me by just clickinga link.
So if you have questions orcomments for me, feel free to
use that link and send them in.
Today we're going to cover, oh,five or six questions and then
sort of a general issue thatgets repeated again and again.
So let's get started withemetophobia.
(02:51):
What is emetophobia?
Emetophobia is the fear ofvomiting.
Now, nobody wants to vomit, butpeople who have emetophobia
will go to great lengths toprevent that from happening, are
always on the lookout for signsthat it might happen and it
becomes highly, highly, highlyimpactful.
And it's actually somethingthat we see quite common
alongside things like panicdisorder and agoraphobia.
(03:13):
When emetophobia is in the mixit definitely adds a wrinkle,
because anybody who's trying tolearn how to face their anxiety
or face or allow or tolerate oraccept, who is very fearful that
if they get too anxious theymight vomit because they have a
phobia of that.
This makes that approach reallydifficult.
So when there's emetophobia inthe mix we always have to
(03:35):
address that, and one listenersent in a question about
emetophobia and trying to helpher 16-year-old daughter.
This person actually said doyou think my book would be
appropriate for her at her ageor do you think it's more geared
toward adults?
While I have written three bookson the topic of anxiety and
anxiety recovery, I'm not surethat I would recommend any of
them for an emetophobic, andI'll tell you why.
(03:56):
First of all, if you're dealingwith a teenager that is
emetophobic, the rules fortreatment generally are the same
.
A therapist would approach thatthe same way.
When you're dealing with anadolescent, a teen or a child,
we're just looking atunderstanding that sometimes
that person isn't going toprocess the same way that an
adult does, because they'restill kind of growing up and
they're still sort of buildingtheir brain functions, which is
(04:18):
normal.
So we would just have to becognizant of what the person is
able to grasp and not grasp andhow they might process
differently than a fully grownand mature adult.
But otherwise the process oftreating emetophobia would be
the same.
The difficult thing aboutemetophobia, and why I say that,
while the book that I wrote,called the Anxious Truth, talks
about the principles that wouldbe applied in emetophobia
(04:40):
treatment, people who haveemetophobia tend to want
specificity.
They will not be able togeneralize from oh this is how
you deal with panic attacks, orthis is how you deal with
intrusive thoughts, or this ishow you deal with agoraphobia.
I can apply those rules to myemetophobia.
They won't get that, becausethey truly will carve out space
and say no, no, no.
But vomiting is in fact theworst possible outcome that any
(05:03):
sentient being could face onplanet Earth and they will stick
to those guns.
So that's why I don't think anyof my books would really be
terribly helpful.
You really want specificitythere.
But if you're dealing withemetophobia, the bad news is the
most empirically validatedtreatment is through exposure.
But I need to be clear aboutthat because this is something
we're probably going to talkabout on Disordered.
But no part of exposure foremetophobia would involve a
(05:30):
therapist intentionally tellingyou that you have to vomit.
Now this gets a little bitstrange, because each individual
emetophobe, each individualclient who's dealing with
emetophobia, may actually windup taking it that far, but
that's up to them.
They get to decide thatOfficial exposure treatment for
emetophobia does not include theclient must vomit.
It cannot be that way.
That would not be ethical inany way, shape or form.
(05:52):
And an emetophobe, just likeany other therapy client, has
full autonomy at all time andgets to decide their limits.
So while, yes, this is aboutchallenging the belief that
vomiting is an unacceptable,dangerous experience that will
break somebody and learning thatthrough exposure, usually to
things like words or stories orimages or sounds.
(06:14):
There's you guys all knowthere's a ton of animated, you
know, depictions of vomiting.
There's a ton of vomit scenesin movies and TV shows, there
are song lyrics, there arepassages in books.
We can use those sort of thingsas exposure and at some point
some people do choose to take itso far that like, okay, I got
myself a stomach virus and I'mgoing to let this happen because
(06:34):
you can't stop it anyway.
That's not the therapist'schoice.
So it's really important, whileyou do have to learn to face
that fear and use exposure-basedtherapies for emetophobia, none
of that would involve atherapist saying you have to go
vomit ever.
So just please keep that inmind.
Good question, I appreciate youwanting to support your
daughter in this challenge.
Emetophobia is really difficult.
(06:54):
It's really stubborn.
I do work with quite a numberof emetophobes in my practice.
Oddly, I'm the vomit guy in thepractice who saw that coming.
But they're also great peopleand they really do want to get
better.
So that's a little bit onemetophobia.
We're going to do anemetophobia episode on
Disordered Again.
That's at disorderedfm.
I have done emetophobiaepisodes on the Anxious Truth in
(07:16):
the past.
If you go to theanxioustruthcomand just search for the word,
you'll find those all A coupleof success stories that might be
helpful.
So the next question was sent inabout nocturnal panic attacks
and specifically exposures forthat, which is a really common
question, because nocturnalpanic attacks are really
difficult.
A nocturnal panic attack is apanic attack that just blows you
(07:36):
out of a dead sleep.
There's no specific trigger.
How can I be anxious?
I was sleeping.
I don't know why they happen.
It's certainly jarring becauseyou're in a dead sleep and next
thing you know you're wide awakeand you're in full blown panic.
It is not easy at all.
But the question this personsent in was my panic attacks
happen during my sleep.
I wake up usually after a firstsleep cycle already in a
(07:58):
heightened anxious state.
Most times lately I'm able torelax and attempt to accept.
Good job, it means you've beenpracticing.
I was wondering if we evertalked about this presentation
of panic before.
Yes, we did a nocturnal panicattacks episode on Disordered,
if you want to check out thatpodcast.
This person says it's sodisorienting waking up from
sleep into an attack, especiallywhen there's no obvious
precipitating trigger.
(08:18):
That is true.
It's hard to ground yourselfmindfully when you're in a
half-sleep state.
True, you're in a half-sleepstate and everything's a little
bit unusual in that moment.
That is also true.
I'm wondering if this issomething that you or other
listeners experience.
Yes, I did myself when I wasstruggling with panic disorder
and agoraphobia.
Many, many, many other listenersof this podcast in the anxiety
(08:39):
disorder community do in factexperience regular nocturnal
panic attacks.
For sure.
And this person says.
Are there any particularguidance for this scenario and
how to do exposure when youcan't control them when they
happen?
That's an excellent question.
So the bad news about nocturnalpanic attacks is that they're
really not different, while theyare certainly more disruptive
and jarring and maybe more scaryand shocking.
(09:02):
Right, there's a shock element,like I was dead asleep.
And now why am I gasping forair?
My heart is pounding and I'msweating.
I was just sleeping.
The principles are the same andwhile when you're awakened into
a state of extreme fear it canbe hard to remember what those
principles are, ultimately we'regoing to fall back on them
anyway.
It may mean that it takes you.
You're going to automaticallyfight against it and struggle it
(09:23):
and try to control it becauseyou're a little bit sleepy and
you're not really processing theway you normally would while
you are awake.
But at some point throughpractice, if you're practicing,
if you're practicing, you dostart to understand like oh wait
, I'm fighting this and now youhave to make that shift into
like I want to calm this downand use mindfulness and
grounding to instantly calm itor make it go away, but I have
(09:43):
to stop.
Stop doing that, I have to justride it out.
So while I know everybody wouldhope that there's some sort of
special thing you do fornocturnal panic attacks and it's
a reasonable question to askthe answer is no, there's kind
of not other than to justacknowledge that it is
definitely a more, moredifficult experience to go
through, which presents adifferent set of challenges,
makes it a little bit moredifficult to use an acceptance
(10:05):
or tolerance principles ormindful principles to work
through and you have to be kindto yourself because of that
extra challenge.
But at the same time you haveto recognize that like, oh, I
really do have to let that ride,even at night, when it's scary
and jarring and I don't know whyit happened and I'm just
disoriented.
We have to work through that.
People who have nocturnal panicattacks that practice that and
(10:29):
work through that do find thatultimately as a happy secondary
effect number one.
They lose the fear of nocturnalpanic attacks.
They're not nearly as impactfulas they once were and then when
that happens, the happysecondary effect is that they do
begin to decrease or disappearcompletely.
It's possible you will neverhave another nocturnal panic
attack in your life, or it'spossible that you might have
(10:50):
them now and then, but they justwon't be nearly as impactful.
As for exposures about nocturnalpanic attacks, there are none
right.
So people seem to think thatlike, oh, I have to do exposures
for everything.
Well, remember that exposure isreally part of exposure and
response prevention.
So an exposure is just thething we do to trigger a
situation where you want toengage in your safety or control
(11:12):
or avoidance responses.
So when you don't have to finda trigger because it just
happened, you woke up and you'rein a panic, congratulations,
you're in an exposureenvironment already, and now you
really just have to focus onthe RP, which is the response
prevention part.
I want to get my ice packs.
I want to, you know, go out andstand in the grass and wiggle
my toes.
I want to tap on my cheek.
I want to wake up my partner.
(11:33):
I want to do all these things.
But I really, once I recognizethose urges, I'm going to have
to try to ride this out.
I have to prevent thoseresponses so that I learned that
it's going to end anyway, eventhough it's really hard and
scary and uncomfortable.
That's what I had to do.
So don't worry so much aboutexposures for nocturnal panic
attacks.
I mean, if I was working withyou as a therapy client.
We might, because we get toknow each other and I get to
(11:55):
know your specifics.
We might find ways to work onexposures that are similar to
nocturnal panic attacks, but ingeneral, just know that when
you're having one, you're in anexposure at that point and now
you care about the RP part morethan anything else.
You don't have to do exposuresfor everything.
Sometimes life just puts you inthem and then you concentrate
on the RP part, as difficult asthat may be.
(12:17):
Patience, please, and be niceto yourself, because this is
hard work, right?
Say that all the time.
Say that all the time.
So let's move on to the nextquestion.
This is a question aboutconcentrating on breath.
Like, is that a distraction?
Is that wrong?
So this person asks do we notconcentrate on our breath when
we are feeling anxious to calmourselves?
Is that a distraction?
I've been taking a few minutes,you know, out during the day to
(12:39):
check in and take a few bellybreaths to calm my nervous
system.
I listened to all your podcastsall day long as I only just
found it.
Is that a source of distraction?
I work all day on my own andlive on my own.
So in my head a lot, and that'swhy I put a podcast on.
First of all, thank you forsending in the question.
It is an excellent, excellentquestion, because that whole
focus on the breath thing can bevery, very confusing.
There's two things that we careabout here.
(13:01):
So focusing on your breath isnever, in my theoretical
orientation, a thing that we doto directly control our anxiety
levels.
We're not ever trying tooperate directly on the anxiety
itself, because that becomeslike chasing your tail.
You wind up on a hamster wheelbecause you have to keep doing
it.
It doesn't really workconsistently and you don't learn
(13:21):
anything from that.
Anything from that.
But taking a few minutesthroughout the day, as this
person says, they do like everyonce in a while, take a breath,
take it.
You know I take a few minutes,I stop and I take a few belly
breaths.
That's actually a really goodstrategy.
But why are we doing that?
We're really looking forconcentrating on the breath as
an alternative to fightingagainst the experience that I'm
having.
(13:41):
So when we use like breathfocus and say, a mindful
meditation and acceptance or amindful awareness type practice,
we're only using the breathfocus because it's a way to back
away from the knee, jerkresistance and pushing against
the experience that we don'tlike regular breaks, if I can
(14:02):
determine that.
Oh, look at me struggling withmy own internal state, I'm
fighting it again, I'm resistingit.
Let me stop and take threeminutes to just focus on my
breath.
That's a good way to reset andback away from that resistance.
I wouldn't look at it.
I never look at it as breathingis a way that you regulate or
calm your nervous system.
Now I know this gets reallyconfusing because in other types
(14:25):
of therapies, for otherpresentations, like DBT, we
would use particularly measuredbreathing to try to help people
emotionally regulate, becausethey're not good at handling big
emotions.
That's true.
But in this situation andremember, this is a podcast
there's one of me and like150,000 of you I can't know the
specifics, so I can only giveyou general principles here
(14:48):
Taking a few minutes outthroughout the day, when you
notice that you're strugglingagainst your anxiety and trying
to control it and that's ampingyou up even more, let me stop,
reset, take a few breaths andstop fighting.
That's a great use ofconcentrating on the breath and,
honestly, that is primarily whyI would use concentrate on the
breath when anxious, but I thinkwe got to practice that even
(15:09):
when we're not anxious.
So it is not a way to run awayfrom the feelings.
It's not a way to forcibly ormanually turn the knobs and
buttons on your nervous system.
It's a way to back away fromfighting my anxiety Because,
remember, in our context anxietydisorders the biggest issue
that we have is that we areanxious about being anxious.
We're afraid because we'reafraid, so, but we are afraid
(15:32):
and we are anxious in thatmoment.
So learning to let it playitself out is the better overall
strategy.
That's what we always talkabout here.
I know it's a big topic, butthere's 300 other podcast
episodes and a bunch of booksabout this that you can learn
from.
You know, we're not usingbreath to get away from it or
control it.
We're using breath to give us achance to see how we are
fighting against it and tryingto control a thing that we're
(15:53):
never really able to controlthat well, and to get away from
that control and to start to letit play itself out.
So focus on the breath is agood way to is one technique we
might use to foster mindfulacceptance or willful tolerance,
or floating, or whatever youwant to call it.
Hopefully that helps.
It's not so much about directlytrying to calm or control your
nervous system.
Is it a distraction?
(16:15):
Yeah, it's a distraction, butthere's always an element of
distraction.
What's your intent?
I have to distract myself whenI'm anxious or I won't be able
to handle it.
We don't want that.
Does it distract you?
Ultimately, if you can focus onyour breath, it sure does, but
you can only be distracted ifyou're willing to take the
chance on being distracted.
So distraction, again,difficult, nuanced.
(16:36):
We did an episode ondistraction, on disorder, josh
and I did, where we talked aboutthis.
But no, I would not use itspecifically to distract or
control.
So good question.
Thank you so much.
Next question what do we have?
We have a couple more questionsto do, right, so let's do a
question about ruminating.
But this is a question aboutruminating, about ruminating,
(16:56):
and if they're ever, that's themost ruminating thing I've ever
heard.
Right, ruminating, aboutruminating.
But if this is you and you'rereally focused, you're thinking
about your thinking.
I'm ruminating about myruminating.
It's not just you, like.
A lot of people get trapped inthis loop.
So this this person sends in.
Hey there, I have a questionregarding exposures.
When you have some form ofhyper-awareness issues.
(17:17):
When I learned that ruminationand keeping an eye on it,
resistance or checking were thethings that make me suffer, I
then fear to do exactly thosethings.
So I won't go into the entirerest of the question, but what
this person is essentiallydescribing is I'm hyper aware of
what I'm thinking about.
And now I heard that, likeruminating is the thing that
actually is making me worse,because in a ruminative
(17:39):
presentation and this is mostprevalent in OCD and GAD,
although everybody with ananxiety disorder will ruminate
Ruminate is just perseverativethinking, like constant thinking
loops that you think are goodideas and then you think they're
bad ideas because you're makingyou feel even worse.
Why can't I turn my brain off?
That's rumination.
In this situation we become soaware that like, oh wait,
(18:02):
rumination is what I think is agood idea, but I actually have
to learn to break the habit ofrumination.
But now I'm going to ruminateon whether or not I am
ruminating and I think I'msupposed to ruminate on
ruminating.
The hyper awareness word in thisquestion is the main thing.
So a general principle herewould be if you are stuck in
that sort of meta anxiety thinglike meta thinking, thinking
(18:25):
about thinking, ruminating,about ruminating.
Your task here is to say Imight not pay attention.
What if I don't pay attentionto what I'm thinking about?
What if I let my brain thinkabout whatever it wants and I
acknowledge the process ofthinking, which is going to go
wherever it kind of wants if Ileave it alone, that's allowed.
This is really hard.
(18:46):
I cannot give you specificsteps on a podcast episode at
all, but that would be a generalprinciple.
We might also look at what if Isubstitute different activities.
Instead of sitting andspecifically thinking as my
primary activity, can I engagein another activity?
That will feel risky, it willfeel wrong, it will feel like I
shouldn't be doing that.
(19:06):
I'm supposed to beconcentrating on my thinking.
I'm supposed to be watching tomake sure I'm thinking the right
thing or not thinking the wrongthings, and I have to check my
rumination by ruminating on it.
Or I could try to do thiscrossword puzzle that I will
probably stink at because I'm ina really agitated state.
But I have to start to learnthat my brain is free to do
whatever it wants.
Like all the activity in mybrain is actually okay and
(19:28):
permissible.
So when you get stuck inruminating about ruminating or
thinking about thinking.
You have to fall back on theprinciple that I don't have to
evaluate my thinking.
I don't have to do that.
So any thought that I have isacceptable, it doesn't matter.
The process of thinking isorganic, it's natural, it just
happens.
All human brains make thoughtsall day long.
(19:49):
So first you have to stand onthat principle, like, oh wait a
minute.
My problem here is that I'vedeveloped this hyper awareness
based on the idea that if Iwatch my thinking, evaluate it
and control it, then I'll beable to think correctly.
And the answer to that is wrong, like that's what gets us stuck
.
So we'd be operating here onthe principle that I have to
(20:10):
start to learn through variousdifferent approaches and
techniques that I might come upwith, say with a therapist
working one-on-one.
I'd have to show myself throughexperience that, like I can let
my brain do whatever it wantsand I still turn out just fine.
So I know that isn't a greatanswer, because if you're stuck
in thinking about thinking orruminating about ruminating,
naturally your propensity willbe like but what do I do?
(20:31):
What are the steps?
And the answer is youexperiment with having no steps.
Like you don't have to controlyour thoughts.
You don't even have to watchthem, you can hear them.
Because you can't not hear them, you could acknowledge that
you're having them.
But you don't have to carefullywatch them, develop, evaluate
them, see if they're correct,try to change them.
Just acknowledge I am thinking.
I am thinking is a verypowerful tool we sometimes use
(20:54):
with people who are stuck inthat ruminating thing.
Forget what you're ruminatingabout, I am thinking, and
thinking is always allowed.
So that's a quick answer to acomplicated topic.
But also know that if you areruminating about ruminating or
thinking about thinking and youfeel stuck in that it's not just
you.
Just start from the premisethat, like, that doesn't serve
me any purpose at all.
(21:15):
I don't have to monitor andcontrol and evaluate my thoughts
because I don't have to try tomanually operate the levers and
knobs that come with thinking.
Also, the principle you canrely on is I can always choose
what thought to have.
I can never choose what thoughtto not have.
That's super important.
We'd have to start from thatlike on day one you get to
(21:36):
choose your thoughts, you don'tget to not choose your thoughts.
And we also have to be carefulbecause that can lead to
compulsive thought replacementLike, well, let me change that
thought.
I got to change that thought.
Nope, I had that thought.
Now what was I doing?
Instead of interacting onlywith the process of thinking,
what else can I interact with?
So hopefully that helps, atleast at a very broad, general,
50,000 foot view of the problem.
(21:57):
So now we'll do three more real, quick, external anxiety.
This person asked sent in thisparticular message.
Thanks for your work.
You're welcome.
I'm glad you find it helpful.
I'm interested in an episodeabout how anxiety is or is not
related to stressful externalevents and how we can live
through tumultuous andterrifying times without being
(22:18):
overwhelmed by anxiety.
Excellent, excellent question.
Thank you for sending it in.
Thank you for sending it in.
Many of us would agree.
I'm recording in March of 2025that the world just seems like a
strange place.
I don't care what your ideologyis Like.
Things feel completelytumultuous right now.
That's true, and human life ingeneral can often be tumultuous
Like human lives are full ofchallenges and disappointments
(22:39):
and big emotions and loss andall of those things.
So, yes, there are many, many,many external sources of anxiety
and stress in any human life,and sometimes collectively,
we're under even more stress.
Right, there are just moresources of this.
So start with the premise thatit's actually quite normal to
feel anxious when the world orthe universe or life is pressing
(23:02):
on you.
Like anxiety could beconsidered a stress response.
This is an indicator that I amunder stress of some kind.
My identity, my beliefs arebeing challenged, my safety is
being challenged.
There's things up ahead of methat I'm not sure I can meet.
I don't know how I'm going todeal with this particular
setback.
I'm having money problems,relationship problems, whatever.
There's a million externalsources of anxiety that can
(23:22):
trigger us.
That's okay.
There's no.
The difference between thedisordered anxiety person and
the regular anxious person isthat the regular anxious person
get anxious and focuses on whythey're anxious, which is, again
, I'm having a problem at work,or I can't seem to find a job,
or my relationship is breakingup, or I can't find a
(23:42):
relationship, whatever ithappens to be, or like the
politics of the world are notaligned with me.
These are the problems.
I feel anxious or stressed orafraid or upset because of those
things, so they can always makethat connection.
The disordered person is onlyworried about how they feel.
So, while there may be externalsources of anxiety that trigger
those feelings.
(24:03):
It quickly shifts from like ohmy goodness, the world is a mess
to the world is a mess and itmakes me feel, and I don't, I
can't feel this way.
That's the part we care about.
So general wellness advice thathas to do with self-care and
stress management and takingcare of yourself and feeding
your soul, and all those thingsapply when it comes to external
(24:23):
anxiety.
But more than anything else, wecare about the trap.
Externally generated anxiety isnormal.
Sometimes it's more normal andmore expected because of the
challenges in your particularlife or our collective lives.
But there's also a trap, whichis notice the time when you
morph from oh my goodness, theworld is out of control right
now Reasonable assertion to andthe problem is that I feel these
(24:46):
things.
That's where we start to wanderinto a counterproductive place.
If there's a way to address theexternal source of anxiety, we
want to try to do that.
If there's not a way to do that, or there are limited ways to
do that, well, it becomes alittle bit of a universal
acceptance problem.
These are the things that wehear through all the great
(25:06):
philosophies and faiths in theworld since we started recording
history in our thoughts likecontrol the things you can and
accept the things you can't is agood principle to go on here.
Except for a disordered anxiousperson, they will say no, that
doesn't count here, because theproblem is I need to control my
internal state and I should beable to do that, right?
No, not really.
(25:27):
So if you find that the worldis triggering you, a good
indicator that you havedisordered anxiety work to do
ahead of you is I quickly becomemore interested in how I feel
than why I feel that way.
So if you notice that it meansgenerally would indicate that
like oh, I'm still in asituation where I fear and
(25:49):
consider my internal stateunhandleable, unacceptable,
unsafe, whatever it happens tobe, and I have to work on
changing my relationship with myown internal fears and
anxieties.
I have to work on gettingbetter at being an anxious
person so that I could be a moreproductive anxious person when
the world outside of my skinpresses on me.
So hopefully that helps.
(26:09):
Another very common question inour community.
This is why we say anxiety is auniversal experience.
Disordered anxiety is not, butanxiety is a universal
experience, right?
So second to last question, thepenultimate question fear of
becoming suicidal against yourwill.
This is really important.
There is a difference betweenbeing suicidal and actively
(26:31):
planning to harm oneself or endone's existence and being afraid
that you might want to do thator might have those thoughts or
might become suicidal.
So this question is about a very, very common state among people
who have anxiety disorders,where a common theme is I'm
losing control of my thoughtsand my sometimes my bodily
(26:52):
responses.
Like I am no longer in controlof my thought.
My fear just comes, it justkeeps coming at me for no reason
I can't figure out.
I can't stop my thoughts, Ican't control my thoughts, and
then my body betrays me byshowing all these responses to
that that I hate.
They scare me so much and Ican't stop it from happening.
So I'm afraid that since Ican't control my thoughts, I
have found no way to control orstop thoughts.
What if I start to haveself-harm thoughts?
(27:14):
And then what if I can'tcontrol that?
And what if I can't control myresistance to that?
And so I actually do a thingthat I have no intention, no
plan and no desire to do, right?
So this person says I waswondering if you could do an
episode on how to overcome thefear of suicidal thoughts or
becoming suicidal.
Now, I did do an episode onthis, on the anxious truth.
Did we do it on Distorted?
(27:35):
I don't remember.
I have my friend Kim Quinlan on.
We talked about it a couple ofyears ago.
Did I have any personalexperience with this?
This person asks and yes, I did.
It was a huge fear for me.
While I was going through theworst of my anxiety disorder
presentations, I used to askpeople in my house to hide
things from me, like scissorsand knives.
Or my doctor would give me likea benzo prescription.
(27:57):
I wouldn't take it because Iwas too stupid and stubborn
that's just me and so I'd have abottle of benzo still hanging
around in my house that I wouldrefuse to take.
But I would ask to have thosehidden because I had no
intention of hurting myself.
But I was afraid that I mighthave that thought and not be
able to resist it For someunknown reason.
That seemed like a very realpossibility to me, but it isn't.
(28:19):
Nobody.
Nobody does that Like.
Thoughts are not impulses.
People with anxiety disordersworry that thoughts will somehow
become uncontrollable impulses,but that is simply not how
thoughts work.
Thoughts don't make you dothings.
In the context of an anxietydisorder.
Thoughts do not make you dothings that you don't want to do
, and so there's really nodifference between what if I
(28:40):
have suicidal thoughts and itbecomes suicidal against my will
?
And people with OCD who havepresentations like what if I
start screaming obscenities inchurch?
Or what if I can't controlmyself and I make a scene when
I'm in a parent teacher meeting,I just start screaming?
Or people who have panicdisorder who fear that the
problem will be they'll have apanic attack and it'll be so
overwhelming that they'll startscreaming and yelling and throw
(29:01):
themselves on the floor beggingfor help and make a big scene.
These are all the same question, even though I know that.
But what if I have suicidalthoughts?
Feels like a more importantquestion.
I promise it's really not.
Of course, if you do have activesuicidal ideation and you are
making plans to harm yourself, Igot to tell you just not only
legally, but just as a humanbeing please get help, but
(29:22):
worrying that you might thinkabout doing that or you might
have thoughts or you're.
You're afraid of the thoughtsand you don't really want to do
them, but you think they'regoing to make you do it anyway.
That's.
That's a very, very, verycommon, very disturbing and
scary experience, but that'sokay, that that's a little
different animal and people whodo the work that I do we see it
all the time.
All the time.
Every week I see that at leastfive, six times.
(29:44):
So very, very, very common.
It's okay.
To be worried about becomingsuicidal because you think it
will somehow make you do a thingyou have no intention of doing
Doesn't mean that you are goingto become suicidal or harm
yourself against your will.
Nobody does that.
It doesn't work that way.
Very good question, though, andI don't mind it being asked.
(30:06):
You'll notice that I didn'tgive you trigger warnings here
because we don't want to do that.
That would be the wrong messageLike oh, we got to be careful
about that word in this contextand if you're listening and you
want to come at me, you can feelfree to come at me.
Come at me.
(30:29):
You can feel free to come at me.
Oh, you should have had triggerwarnings.
The word was in the episode.
The problem is the peoplelistening to this episode are
the people who are harmed themost by trigger warnings about
words.
So, while I understand thatneed to try to be sensitive to
people who might be consumingcontent on social media or in
podcast apps or on YouTube thevery population that I am
addressing with these videos.
It's it's for them, verypopulation that I am addressing
with these videos.
It's for them.
And we don't help those peopleif we draw boundaries around
particular words because they'redisturbing, like that's a
driver of this problem.
(30:50):
So the word is okay.
I promise it's safe.
In fact, sometimes when peoplewith OCD who have self-harm
themes, we actually use thosewords intentionally as triggers
to start to address those things.
Right, excellent question, verycommon.
You're not weird if you worryabout that.
I used to worry about it too.
So let's finish with one moretopic, which is not really a
specific question or a topic.
(31:10):
It's a general thing.
Many of the messages that I gotand again, if you want to send
me a text message with a commentor a question, just follow the
link in the podcast description.
It's anonymous.
I can't text you back.
We don't sell your number oranything like that, just a way
to communicate with me.
Many of these comments andquestions that I get are about
specific things.
They usually look like can youtalk about the thought?
Dot, dot, dot.
Add a thought.
(31:30):
Can you talk about being afraidof dot dot dot.
Can you talk about a veryspecific circumstance or
situation?
One of the overarching rulesthat you have to kind of go by
when you listen to podcasts likethis or read my books or listen
to Disordered or follow anxietypeople on social media is that
you have to pay attention moreto the process.
The content of the thought thatscares you is not special,
(31:54):
because when you send me a textor an email or you're in my
comment section, you want to saybut what about when you think,
what about?
You're afraid of?
What about the thought about?
What you're basically asking iscan you give me some
information, can you do apodcast episode that will
convince me that that specificthought won't actually come true
or isn't real or isn't a dangerto me?
And that will never workbecause the process that creates
(32:14):
that fear will just morphusually into some other thing.
So if you've been listening fora long time or you interact with
people who have been listeningto this podcast or others like
it for any length of time, youwill notice in that sort of
support community and I use thatin air quotes people will talk
all the time about their currentfear.
It's very common to hear likewell, six months ago I was
really afraid of insanity, butnow, for some reason, now I'm
(32:36):
afraid of like somethinghappening to my kids.
Yeah, because it's the processthat we care about, right, so we
don't really want to get into aconstant long run of like.
Okay, let me answer a questionabout the fear that you might
scream in church.
Let me answer a question aboutthe fear that you might go
insane.
Let me talk about the fear ofyou know, being dizzy.
Like we don't address specificsymptoms and we don't address
(32:57):
specific thoughts.
It's not, in this context, oneone to many helping sort of
environment where I can barelyhelp because it's a one to many
environment.
We might get specific andpsycho education if we worked
one on one, but in thissituation you got to fall back
on the principle that it's notthe content of the thought.
And if what you really want toknow is I've heard six different
podcast episodes and watch 15videos about the fear of
(33:19):
insanity but hey, drew, can youdo an episode on that too?
Or another episode, because Iknow you've already done one or
two.
What you're really asking is I'mnot yet convinced that this
thought is safe.
So it's the process by whichyou get convinced that your own
thoughts are dangerous orthreats or inappropriate or need
to be controlled or stopped orbanished.
It's that process that we careabout, right, so fall back on
(33:43):
that.
If you have a specific thoughtthat disturbs you or a specific
fear or an outcome, an anxious,anxiety-related outcome that you
think is very important and youwant to hear addressed and for
some reason, people like me justnever seem to talk about it
that much something must bewrong.
I need to hear about that.
Know that if you are afraid ofyour own thoughts or your own
emotions or the sensations thatyour body makes naturally when
(34:06):
it is disturbed or triggered orafraid, then you got to fall
back on these general principlesthat like wait a minute, I'm
afraid of my own body and mindand I don't have to fear that
because all the sensations arepermissible, they're all okay
even though they're reallydisturbing and scary, and every
thought and every emotion isalso permissible and safe, even
though I really hate them.
So that's why sometimes youwon't hear me answer questions
(34:28):
like hey, what about the fear of, sometimes, when they're very,
very common, widespread things?
But honestly, after 10 years ofpodcasting and 300 and somewhat
episodes.
I've probably talked about yoursymptom broadly.
You know, there's the cardiacstuff, there's the breathing
stuff.
There's the cardiac stuff,there's the breathing stuff,
there's the dizzy stuff, there'sthe choking stuff, there's the
falling down stuff, there's thelosing control stuff, there's
the insanity stuff.
We've all talked about thatmany, many times.
(34:48):
You can go back and listenagain if you want.
But remember, it's not aboutthe content of your thoughts,
it's the process by which youhave become afraid of your own
thoughts in your body that wereally care about.
So that's why I don't really getinto the specifics and if you
ask those type of questions andwe don't answer them, I'm sorry.
I know you really want me to,but this is this is the best
answer I could give you, atleast in the context of a
podcast or a YouTube channel,right?
(35:09):
So 35 minutes in, it's one ofthe longer episodes I've done in
a long time.
Luckily there's not a lot ofediting, because I'm just
sitting on my deck talking intoa microphone while I hear my dog
copper barking because he wantsto come out.
So I'm going to wrap it up.
We're not going to do music andall that stuff, I'm just going
to thank you for listening andfor your support of the Anxious
Truth.
I mean amazing.
I can't believe I've been doingthis for 10 years at this point
.
It's almost exactly 10 years atthis point, actually.
(35:31):
Now it's 11 years.
Oh, my goodness, I'm losingtrack of time and the only thing
I will say or Spotify or somepodcast platform where you can
rate and review and you like thepodcast positive feedback is
always welcome because it helpsmore people find the podcast and
I can sort of help more people,in the limited way that we can,
at a podcast or a YouTubechannel.
And if you're watching onYouTube which you're not, you're
(35:51):
listening this week and you dolike it, maybe like the video.
Leave a question or a commentif you want.
I try to read them and try toanswer the ones that I can.
And, yeah, maybe subscribe tothe channel or hit the
notification bell.
I am supposed to ask you all ofthose things, right?
Otherwise, what kind of likecontent creator am I?
Anyway, guys, thanks forlistening.
I hope these questions werehelpful.
I'll do another one of these,maybe twice a year, every six
(36:13):
months or so.
We'll do them.
Click on the text link in thepodcast description if you want
to send one in.
Thank you for listening.
Thank you for being brave andbeing nice to yourselves,
because if you're listening tothis podcast, you're at least
doing something nice foryourself by trying to learn
about the nature of the strugglethat is up against you right
now.
Give yourself credit for beingbrave because, even though you
don't like the way it has everfelt, you are in fact tolerating
(36:37):
and handling every anxiousthought, sensation and scary
emotion you've ever had.
Take that with you.
I will see you again in twoweeks for some other topic.
Thanks for listening.
This week on the Anxious Truth, we're answering
common questions about anxietyand anxiety disorders sent in by
you guys, the audience.
Today we're going to talk aboutemetophobia.
We're going to talk aboutnocturnal panic attacks and
exposures related to that.
We're going to talk about howconcentrating on breathing when
you're anxious could be adistraction or maybe it isn't.
We're going to talk aboutruminating about ruminating.
(00:21):
We're going to talk aboutexternal sources of anxiety and
how you might deal with those.
We're going to talk about thefear of becoming suicidal
against your will, which isreally common in our community,
and then I'm going to have a fewwords about some specific
thoughts or symptoms that peoplealways want to ask about.
So thank you for the feedbackfrom the audience.
Let's get into it.
This is an absolutely noproduction, no frills episode of
(00:44):
the Anxious Truth.
In fact, if you're on theYouTube channel, you have a
still image.
Today there's no video.
It's just me.
I'm the only one that recordsand produces the Anxious Truth.
I don't have a production teamthat follows me around.
Sometimes my schedule is just alittle too much and I cannot
fit in recording and editingvideo.
So today it's me sittingoutside in the sun actually
recording into my phone with oneof my other microphones because
(01:06):
it's the first 60 degree day wehave on Long Island without 40
mile an hour wind that I'mtrying to take advantage.
So no intro, no music, a littlebit no frills, uh, and we're
going to get into questions fromthe audience.
Who is the one man show behindthe anxious truth?
That would be me.
I'm drew Linsalata.
I am the creator and host ofthis podcast.
I am a therapist pre-licensed,still practicing under
(01:26):
supervision in the state of NewYork.
I specialize in the treatmentof anxiety and anxiety disorders
.
I also suffered from variousforms of anxiety disorder OCD
and depression for many years ofmy life, on and off Better now.
Three-time author on this topicand educator and advocate
social media guy.
And, yeah, clearly a podcasthost, not just this podcast but
also Disordered.
That I do with my friend JoshFletcher in the UK.
(01:47):
You could find that one atdisorderedfm if you want more
resources.
And yeah, on the Anxious Truth,we talk about anxiety disorders
and the process of recoveryfrom those particular issues.
So if you've just stumbled uponthe podcast or the YouTube
channel today for the first time, welcome, glad you're here,
hope you find it helpful and, ofcourse, if you are a returning
listener or viewer, welcome back.
Thanks for spending some timewith me this week.
(02:10):
So this week we're going to takequestions from the audience,
some common questions thatpeople asked.
Many of these questions wererepeated and if you want to send
in a question, if you'relistening to this as a podcast
episode, you'll notice that inthe podcast description there's
always a link that says send ina question or comment via text.
Feel free to use it.
You can send me a text.
I will see it.
I will not see your name, Iwill not see your number.
(02:30):
I cannot text you back, Icannot share it.
You will not get spammed, it'stotally safe.
It's just a way for you tocommunicate comments and
questions to me by just clickinga link.
So if you have questions orcomments for me, feel free to
use that link and send them in.
Today we're going to cover, oh,five or six questions and then
sort of a general issue thatgets repeated again and again.
So let's get started withemetophobia.
(02:51):
What is emetophobia?
Emetophobia is the fear ofvomiting.
Now, nobody wants to vomit, butpeople who have emetophobia
will go to great lengths toprevent that from happening, are
always on the lookout for signsthat it might happen and it
becomes highly, highly, highlyimpactful.
And it's actually somethingthat we see quite common
alongside things like panicdisorder and agoraphobia.
(03:13):
When emetophobia is in the mixit definitely adds a wrinkle,
because anybody who's trying tolearn how to face their anxiety
or face or allow or tolerate oraccept, who is very fearful that
if they get too anxious theymight vomit because they have a
phobia of that.
This makes that approach reallydifficult.
So when there's emetophobia inthe mix we always have to
(03:35):
address that, and one listenersent in a question about
emetophobia and trying to helpher 16-year-old daughter.
This person actually said doyou think my book would be
appropriate for her at her ageor do you think it's more geared
toward adults?
While I have written three bookson the topic of anxiety and
anxiety recovery, I'm not surethat I would recommend any of
them for an emetophobic, andI'll tell you why.
(03:56):
First of all, if you're dealingwith a teenager that is
emetophobic, the rules fortreatment generally are the same
.
A therapist would approach thatthe same way.
When you're dealing with anadolescent, a teen or a child,
we're just looking atunderstanding that sometimes
that person isn't going toprocess the same way that an
adult does, because they'restill kind of growing up and
they're still sort of buildingtheir brain functions, which is
(04:18):
normal.
So we would just have to becognizant of what the person is
able to grasp and not grasp andhow they might process
differently than a fully grownand mature adult.
But otherwise the process oftreating emetophobia would be
the same.
The difficult thing aboutemetophobia, and why I say that,
while the book that I wrote,called the Anxious Truth, talks
about the principles that wouldbe applied in emetophobia
(04:40):
treatment, people who haveemetophobia tend to want
specificity.
They will not be able togeneralize from oh this is how
you deal with panic attacks, orthis is how you deal with
intrusive thoughts, or this ishow you deal with agoraphobia.
I can apply those rules to myemetophobia.
They won't get that, becausethey truly will carve out space
and say no, no, no.
But vomiting is in fact theworst possible outcome that any
(05:03):
sentient being could face onplanet Earth and they will stick
to those guns.
So that's why I don't think anyof my books would really be
terribly helpful.
You really want specificitythere.
But if you're dealing withemetophobia, the bad news is the
most empirically validatedtreatment is through exposure.
But I need to be clear aboutthat because this is something
we're probably going to talkabout on Disordered.
But no part of exposure foremetophobia would involve a
(05:30):
therapist intentionally tellingyou that you have to vomit.
Now this gets a little bitstrange, because each individual
emetophobe, each individualclient who's dealing with
emetophobia, may actually windup taking it that far, but
that's up to them.
They get to decide thatOfficial exposure treatment for
emetophobia does not include theclient must vomit.
It cannot be that way.
That would not be ethical inany way, shape or form.
(05:52):
And an emetophobe, just likeany other therapy client, has
full autonomy at all time andgets to decide their limits.
So while, yes, this is aboutchallenging the belief that
vomiting is an unacceptable,dangerous experience that will
break somebody and learning thatthrough exposure, usually to
things like words or stories orimages or sounds.
(06:14):
There's you guys all knowthere's a ton of animated, you
know, depictions of vomiting.
There's a ton of vomit scenesin movies and TV shows, there
are song lyrics, there arepassages in books.
We can use those sort of thingsas exposure and at some point
some people do choose to take itso far that like, okay, I got
myself a stomach virus and I'mgoing to let this happen because
(06:34):
you can't stop it anyway.
That's not the therapist'schoice.
So it's really important, whileyou do have to learn to face
that fear and use exposure-basedtherapies for emetophobia, none
of that would involve atherapist saying you have to go
vomit ever.
So just please keep that inmind.
Good question, I appreciate youwanting to support your
daughter in this challenge.
Emetophobia is really difficult.
(06:54):
It's really stubborn.
I do work with quite a numberof emetophobes in my practice.
Oddly, I'm the vomit guy in thepractice who saw that coming.
But they're also great peopleand they really do want to get
better.
So that's a little bit onemetophobia.
We're going to do anemetophobia episode on
Disordered Again.
That's at disorderedfm.
I have done emetophobiaepisodes on the Anxious Truth in
(07:16):
the past.
If you go to theanxioustruthcomand just search for the word,
you'll find those all A coupleof success stories that might be
helpful.
So the next question was sent inabout nocturnal panic attacks
and specifically exposures forthat, which is a really common
question, because nocturnalpanic attacks are really
difficult.
A nocturnal panic attack is apanic attack that just blows you
(07:36):
out of a dead sleep.
There's no specific trigger.
How can I be anxious?
I was sleeping.
I don't know why they happen.
It's certainly jarring becauseyou're in a dead sleep and next
thing you know you're wide awakeand you're in full blown panic.
It is not easy at all.
But the question this personsent in was my panic attacks
happen during my sleep.
I wake up usually after a firstsleep cycle already in a
(07:58):
heightened anxious state.
Most times lately I'm able torelax and attempt to accept.
Good job, it means you've beenpracticing.
I was wondering if we evertalked about this presentation
of panic before.
Yes, we did a nocturnal panicattacks episode on Disordered,
if you want to check out thatpodcast.
This person says it's sodisorienting waking up from
sleep into an attack, especiallywhen there's no obvious
precipitating trigger.
(08:18):
That is true.
It's hard to ground yourselfmindfully when you're in a
half-sleep state.
True, you're in a half-sleepstate and everything's a little
bit unusual in that moment.
That is also true.
I'm wondering if this issomething that you or other
listeners experience.
Yes, I did myself when I wasstruggling with panic disorder
and agoraphobia.
Many, many, many other listenersof this podcast in the anxiety
(08:39):
disorder community do in factexperience regular nocturnal
panic attacks.
For sure.
And this person says.
Are there any particularguidance for this scenario and
how to do exposure when youcan't control them when they
happen?
That's an excellent question.
So the bad news about nocturnalpanic attacks is that they're
really not different, while theyare certainly more disruptive
and jarring and maybe more scaryand shocking.
(09:02):
Right, there's a shock element,like I was dead asleep.
And now why am I gasping forair?
My heart is pounding and I'msweating.
I was just sleeping.
The principles are the same andwhile when you're awakened into
a state of extreme fear it canbe hard to remember what those
principles are, ultimately we'regoing to fall back on them
anyway.
It may mean that it takes you.
You're going to automaticallyfight against it and struggle it
(09:23):
and try to control it becauseyou're a little bit sleepy and
you're not really processing theway you normally would while
you are awake.
But at some point throughpractice, if you're practicing,
if you're practicing, you dostart to understand like oh wait
, I'm fighting this and now youhave to make that shift into
like I want to calm this downand use mindfulness and
grounding to instantly calm itor make it go away, but I have
(09:43):
to stop.
Stop doing that, I have to justride it out.
So while I know everybody wouldhope that there's some sort of
special thing you do fornocturnal panic attacks and it's
a reasonable question to askthe answer is no, there's kind
of not other than to justacknowledge that it is
definitely a more, moredifficult experience to go
through, which presents adifferent set of challenges,
makes it a little bit moredifficult to use an acceptance
(10:05):
or tolerance principles ormindful principles to work
through and you have to be kindto yourself because of that
extra challenge.
But at the same time you haveto recognize that like, oh, I
really do have to let that ride,even at night, when it's scary
and jarring and I don't know whyit happened and I'm just
disoriented.
We have to work through that.
People who have nocturnal panicattacks that practice that and
(10:29):
work through that do find thatultimately as a happy secondary
effect number one.
They lose the fear of nocturnalpanic attacks.
They're not nearly as impactfulas they once were and then when
that happens, the happysecondary effect is that they do
begin to decrease or disappearcompletely.
It's possible you will neverhave another nocturnal panic
attack in your life, or it'spossible that you might have
(10:50):
them now and then, but they justwon't be nearly as impactful.
As for exposures about nocturnalpanic attacks, there are none
right.
So people seem to think thatlike, oh, I have to do exposures
for everything.
Well, remember that exposure isreally part of exposure and
response prevention.
So an exposure is just thething we do to trigger a
situation where you want toengage in your safety or control
(11:12):
or avoidance responses.
So when you don't have to finda trigger because it just
happened, you woke up and you'rein a panic, congratulations,
you're in an exposureenvironment already, and now you
really just have to focus onthe RP, which is the response
prevention part.
I want to get my ice packs.
I want to, you know, go out andstand in the grass and wiggle
my toes.
I want to tap on my cheek.
I want to wake up my partner.
(11:33):
I want to do all these things.
But I really, once I recognizethose urges, I'm going to have
to try to ride this out.
I have to prevent thoseresponses so that I learned that
it's going to end anyway, eventhough it's really hard and
scary and uncomfortable.
That's what I had to do.
So don't worry so much aboutexposures for nocturnal panic
attacks.
I mean, if I was working withyou as a therapy client.
We might, because we get toknow each other and I get to
(11:55):
know your specifics.
We might find ways to work onexposures that are similar to
nocturnal panic attacks, but ingeneral, just know that when
you're having one, you're in anexposure at that point and now
you care about the RP part morethan anything else.
You don't have to do exposuresfor everything.
Sometimes life just puts you inthem and then you concentrate
on the RP part, as difficult asthat may be.
(12:17):
Patience, please, and be niceto yourself, because this is
hard work, right?
Say that all the time.
Say that all the time.
So let's move on to the nextquestion.
This is a question aboutconcentrating on breath.
Like, is that a distraction?
Is that wrong?
So this person asks do we notconcentrate on our breath when
we are feeling anxious to calmourselves?
Is that a distraction?
I've been taking a few minutes,you know, out during the day to
(12:39):
check in and take a few bellybreaths to calm my nervous
system.
I listened to all your podcastsall day long as I only just
found it.
Is that a source of distraction?
I work all day on my own andlive on my own.
So in my head a lot, and that'swhy I put a podcast on.
First of all, thank you forsending in the question.
It is an excellent, excellentquestion, because that whole
focus on the breath thing can bevery, very confusing.
There's two things that we careabout here.
(13:01):
So focusing on your breath isnever, in my theoretical
orientation, a thing that we doto directly control our anxiety
levels.
We're not ever trying tooperate directly on the anxiety
itself, because that becomeslike chasing your tail.
You wind up on a hamster wheelbecause you have to keep doing
it.
It doesn't really workconsistently and you don't learn
(13:21):
anything from that.
Anything from that.
But taking a few minutesthroughout the day, as this
person says, they do like everyonce in a while, take a breath,
take it.
You know I take a few minutes,I stop and I take a few belly
breaths.
That's actually a really goodstrategy.
But why are we doing that?
We're really looking forconcentrating on the breath as
an alternative to fightingagainst the experience that I'm
having.
(13:41):
So when we use like breathfocus and say, a mindful
meditation and acceptance or amindful awareness type practice,
we're only using the breathfocus because it's a way to back
away from the knee, jerkresistance and pushing against
the experience that we don'tlike regular breaks, if I can
(14:02):
determine that.
Oh, look at me struggling withmy own internal state, I'm
fighting it again, I'm resistingit.
Let me stop and take threeminutes to just focus on my
breath.
That's a good way to reset andback away from that resistance.
I wouldn't look at it.
I never look at it as breathingis a way that you regulate or
calm your nervous system.
Now I know this gets reallyconfusing because in other types
(14:25):
of therapies, for otherpresentations, like DBT, we
would use particularly measuredbreathing to try to help people
emotionally regulate, becausethey're not good at handling big
emotions.
That's true.
But in this situation andremember, this is a podcast
there's one of me and like150,000 of you I can't know the
specifics, so I can only giveyou general principles here
(14:48):
Taking a few minutes outthroughout the day, when you
notice that you're strugglingagainst your anxiety and trying
to control it and that's ampingyou up even more, let me stop,
reset, take a few breaths andstop fighting.
That's a great use ofconcentrating on the breath and,
honestly, that is primarily whyI would use concentrate on the
breath when anxious, but I thinkwe got to practice that even
(15:09):
when we're not anxious.
So it is not a way to run awayfrom the feelings.
It's not a way to forcibly ormanually turn the knobs and
buttons on your nervous system.
It's a way to back away fromfighting my anxiety Because,
remember, in our context anxietydisorders the biggest issue
that we have is that we areanxious about being anxious.
We're afraid because we'reafraid, so, but we are afraid
(15:32):
and we are anxious in thatmoment.
So learning to let it playitself out is the better overall
strategy.
That's what we always talkabout here.
I know it's a big topic, butthere's 300 other podcast
episodes and a bunch of booksabout this that you can learn
from.
You know, we're not usingbreath to get away from it or
control it.
We're using breath to give us achance to see how we are
fighting against it and tryingto control a thing that we're
(15:53):
never really able to controlthat well, and to get away from
that control and to start to letit play itself out.
So focus on the breath is agood way to is one technique we
might use to foster mindfulacceptance or willful tolerance,
or floating, or whatever youwant to call it.
Hopefully that helps.
It's not so much about directlytrying to calm or control your
nervous system.
Is it a distraction?
(16:15):
Yeah, it's a distraction, butthere's always an element of
distraction.
What's your intent?
I have to distract myself whenI'm anxious or I won't be able
to handle it.
We don't want that.
Does it distract you?
Ultimately, if you can focus onyour breath, it sure does, but
you can only be distracted ifyou're willing to take the
chance on being distracted.
So distraction, again,difficult, nuanced.
(16:36):
We did an episode ondistraction, on disorder, josh
and I did, where we talked aboutthis.
But no, I would not use itspecifically to distract or
control.
So good question.
Thank you so much.
Next question what do we have?
We have a couple more questionsto do, right, so let's do a
question about ruminating.
But this is a question aboutruminating, about ruminating,
(16:56):
and if they're ever, that's themost ruminating thing I've ever
heard.
Right, ruminating, aboutruminating.
But if this is you and you'rereally focused, you're thinking
about your thinking.
I'm ruminating about myruminating.
It's not just you, like.
A lot of people get trapped inthis loop.
So this this person sends in.
Hey there, I have a questionregarding exposures.
When you have some form ofhyper-awareness issues.
(17:17):
When I learned that ruminationand keeping an eye on it,
resistance or checking were thethings that make me suffer, I
then fear to do exactly thosethings.
So I won't go into the entirerest of the question, but what
this person is essentiallydescribing is I'm hyper aware of
what I'm thinking about.
And now I heard that, likeruminating is the thing that
actually is making me worse,because in a ruminative
(17:39):
presentation and this is mostprevalent in OCD and GAD,
although everybody with ananxiety disorder will ruminate
Ruminate is just perseverativethinking, like constant thinking
loops that you think are goodideas and then you think they're
bad ideas because you're makingyou feel even worse.
Why can't I turn my brain off?
That's rumination.
In this situation we become soaware that like, oh wait,
(18:02):
rumination is what I think is agood idea, but I actually have
to learn to break the habit ofrumination.
But now I'm going to ruminateon whether or not I am
ruminating and I think I'msupposed to ruminate on
ruminating.
The hyper awareness word in thisquestion is the main thing.
So a general principle herewould be if you are stuck in
that sort of meta anxiety thinglike meta thinking, thinking
(18:25):
about thinking, ruminating,about ruminating.
Your task here is to say Imight not pay attention.
What if I don't pay attentionto what I'm thinking about?
What if I let my brain thinkabout whatever it wants and I
acknowledge the process ofthinking, which is going to go
wherever it kind of wants if Ileave it alone, that's allowed.
This is really hard.
(18:46):
I cannot give you specificsteps on a podcast episode at
all, but that would be a generalprinciple.
We might also look at what if Isubstitute different activities.
Instead of sitting andspecifically thinking as my
primary activity, can I engagein another activity?
That will feel risky, it willfeel wrong, it will feel like I
shouldn't be doing that.
(19:06):
I'm supposed to beconcentrating on my thinking.
I'm supposed to be watching tomake sure I'm thinking the right
thing or not thinking the wrongthings, and I have to check my
rumination by ruminating on it.
Or I could try to do thiscrossword puzzle that I will
probably stink at because I'm ina really agitated state.
But I have to start to learnthat my brain is free to do
whatever it wants.
Like all the activity in mybrain is actually okay and
(19:28):
permissible.
So when you get stuck inruminating about ruminating or
thinking about thinking.
You have to fall back on theprinciple that I don't have to
evaluate my thinking.
I don't have to do that.
So any thought that I have isacceptable, it doesn't matter.
The process of thinking isorganic, it's natural, it just
happens.
All human brains make thoughtsall day long.
(19:49):
So first you have to stand onthat principle, like, oh wait a
minute.
My problem here is that I'vedeveloped this hyper awareness
based on the idea that if Iwatch my thinking, evaluate it
and control it, then I'll beable to think correctly.
And the answer to that is wrong, like that's what gets us stuck
.
So we'd be operating here onthe principle that I have to
(20:10):
start to learn through variousdifferent approaches and
techniques that I might come upwith, say with a therapist
working one-on-one.
I'd have to show myself throughexperience that, like I can let
my brain do whatever it wantsand I still turn out just fine.
So I know that isn't a greatanswer, because if you're stuck
in thinking about thinking orruminating about ruminating,
naturally your propensity willbe like but what do I do?
(20:31):
What are the steps?
And the answer is youexperiment with having no steps.
Like you don't have to controlyour thoughts.
You don't even have to watchthem, you can hear them.
Because you can't not hear them, you could acknowledge that
you're having them.
But you don't have to carefullywatch them, develop, evaluate
them, see if they're correct,try to change them.
Just acknowledge I am thinking.
I am thinking is a verypowerful tool we sometimes use
(20:54):
with people who are stuck inthat ruminating thing.
Forget what you're ruminatingabout, I am thinking, and
thinking is always allowed.
So that's a quick answer to acomplicated topic.
But also know that if you areruminating about ruminating or
thinking about thinking and youfeel stuck in that it's not just
you.
Just start from the premisethat, like, that doesn't serve
me any purpose at all.
(21:15):
I don't have to monitor andcontrol and evaluate my thoughts
because I don't have to try tomanually operate the levers and
knobs that come with thinking.
Also, the principle you canrely on is I can always choose
what thought to have.
I can never choose what thoughtto not have.
That's super important.
We'd have to start from thatlike on day one you get to
(21:36):
choose your thoughts, you don'tget to not choose your thoughts.
And we also have to be carefulbecause that can lead to
compulsive thought replacementLike, well, let me change that
thought.
I got to change that thought.
Nope, I had that thought.
Now what was I doing?
Instead of interacting onlywith the process of thinking,
what else can I interact with?
So hopefully that helps, atleast at a very broad, general,
50,000 foot view of the problem.
(21:57):
So now we'll do three more real, quick, external anxiety.
This person asked sent in thisparticular message.
Thanks for your work.
You're welcome.
I'm glad you find it helpful.
I'm interested in an episodeabout how anxiety is or is not
related to stressful externalevents and how we can live
through tumultuous andterrifying times without being
(22:18):
overwhelmed by anxiety.
Excellent, excellent question.
Thank you for sending it in.
Thank you for sending it in.
Many of us would agree.
I'm recording in March of 2025that the world just seems like a
strange place.
I don't care what your ideologyis Like.
Things feel completelytumultuous right now.
That's true, and human life ingeneral can often be tumultuous
Like human lives are full ofchallenges and disappointments
(22:39):
and big emotions and loss andall of those things.
So, yes, there are many, many,many external sources of anxiety
and stress in any human life,and sometimes collectively,
we're under even more stress.
Right, there are just moresources of this.
So start with the premise thatit's actually quite normal to
feel anxious when the world orthe universe or life is pressing
(23:02):
on you.
Like anxiety could beconsidered a stress response.
This is an indicator that I amunder stress of some kind.
My identity, my beliefs arebeing challenged, my safety is
being challenged.
There's things up ahead of methat I'm not sure I can meet.
I don't know how I'm going todeal with this particular
setback.
I'm having money problems,relationship problems, whatever.
There's a million externalsources of anxiety that can
(23:22):
trigger us.
That's okay.
There's no.
The difference between thedisordered anxiety person and
the regular anxious person isthat the regular anxious person
get anxious and focuses on whythey're anxious, which is, again
, I'm having a problem at work,or I can't seem to find a job,
or my relationship is breakingup, or I can't find a
(23:42):
relationship, whatever ithappens to be, or like the
politics of the world are notaligned with me.
These are the problems.
I feel anxious or stressed orafraid or upset because of those
things, so they can always makethat connection.
The disordered person is onlyworried about how they feel.
So, while there may be externalsources of anxiety that trigger
those feelings.
(24:03):
It quickly shifts from like ohmy goodness, the world is a mess
to the world is a mess and itmakes me feel, and I don't, I
can't feel this way.
That's the part we care about.
So general wellness advice thathas to do with self-care and
stress management and takingcare of yourself and feeding
your soul, and all those thingsapply when it comes to external
(24:23):
anxiety.
But more than anything else, wecare about the trap.
Externally generated anxiety isnormal.
Sometimes it's more normal andmore expected because of the
challenges in your particularlife or our collective lives.
But there's also a trap, whichis notice the time when you
morph from oh my goodness, theworld is out of control right
now Reasonable assertion to andthe problem is that I feel these
(24:46):
things.
That's where we start to wanderinto a counterproductive place.
If there's a way to address theexternal source of anxiety, we
want to try to do that.
If there's not a way to do that, or there are limited ways to
do that, well, it becomes alittle bit of a universal
acceptance problem.
These are the things that wehear through all the great
(25:06):
philosophies and faiths in theworld since we started recording
history in our thoughts likecontrol the things you can and
accept the things you can't is agood principle to go on here.
Except for a disordered anxiousperson, they will say no, that
doesn't count here, because theproblem is I need to control my
internal state and I should beable to do that, right?
No, not really.
(25:27):
So if you find that the worldis triggering you, a good
indicator that you havedisordered anxiety work to do
ahead of you is I quickly becomemore interested in how I feel
than why I feel that way.
So if you notice that it meansgenerally would indicate that
like oh, I'm still in asituation where I fear and
(25:49):
consider my internal stateunhandleable, unacceptable,
unsafe, whatever it happens tobe, and I have to work on
changing my relationship with myown internal fears and
anxieties.
I have to work on gettingbetter at being an anxious
person so that I could be a moreproductive anxious person when
the world outside of my skinpresses on me.
So hopefully that helps.
(26:09):
Another very common question inour community.
This is why we say anxiety is auniversal experience.
Disordered anxiety is not, butanxiety is a universal
experience, right?
So second to last question, thepenultimate question fear of
becoming suicidal against yourwill.
This is really important.
There is a difference betweenbeing suicidal and actively
(26:31):
planning to harm oneself or endone's existence and being afraid
that you might want to do thator might have those thoughts or
might become suicidal.
So this question is about a very, very common state among people
who have anxiety disorders,where a common theme is I'm
losing control of my thoughtsand my sometimes my bodily
(26:52):
responses.
Like I am no longer in controlof my thought.
My fear just comes, it justkeeps coming at me for no reason
I can't figure out.
I can't stop my thoughts, Ican't control my thoughts, and
then my body betrays me byshowing all these responses to
that that I hate.
They scare me so much and Ican't stop it from happening.
So I'm afraid that since Ican't control my thoughts, I
have found no way to control orstop thoughts.
What if I start to haveself-harm thoughts?
(27:14):
And then what if I can'tcontrol that?
And what if I can't control myresistance to that?
And so I actually do a thingthat I have no intention, no
plan and no desire to do, right?
So this person says I waswondering if you could do an
episode on how to overcome thefear of suicidal thoughts or
becoming suicidal.
Now, I did do an episode onthis, on the anxious truth.
Did we do it on Distorted?
(27:35):
I don't remember.
I have my friend Kim Quinlan on.
We talked about it a couple ofyears ago.
Did I have any personalexperience with this?
This person asks and yes, I did.
It was a huge fear for me.
While I was going through theworst of my anxiety disorder
presentations, I used to askpeople in my house to hide
things from me, like scissorsand knives.
Or my doctor would give me likea benzo prescription.
(27:57):
I wouldn't take it because Iwas too stupid and stubborn
that's just me and so I'd have abottle of benzo still hanging
around in my house that I wouldrefuse to take.
But I would ask to have thosehidden because I had no
intention of hurting myself.
But I was afraid that I mighthave that thought and not be
able to resist it For someunknown reason.
That seemed like a very realpossibility to me, but it isn't.
(28:19):
Nobody.
Nobody does that Like.
Thoughts are not impulses.
People with anxiety disordersworry that thoughts will somehow
become uncontrollable impulses,but that is simply not how
thoughts work.
Thoughts don't make you dothings.
In the context of an anxietydisorder.
Thoughts do not make you dothings that you don't want to do
, and so there's really nodifference between what if I
(28:40):
have suicidal thoughts and itbecomes suicidal against my will
?
And people with OCD who havepresentations like what if I
start screaming obscenities inchurch?
Or what if I can't controlmyself and I make a scene when
I'm in a parent teacher meeting,I just start screaming?
Or people who have panicdisorder who fear that the
problem will be they'll have apanic attack and it'll be so
overwhelming that they'll startscreaming and yelling and throw
(29:01):
themselves on the floor beggingfor help and make a big scene.
These are all the same question, even though I know that.
But what if I have suicidalthoughts?
Feels like a more importantquestion.
I promise it's really not.
Of course, if you do have activesuicidal ideation and you are
making plans to harm yourself, Igot to tell you just not only
legally, but just as a humanbeing please get help, but
(29:22):
worrying that you might thinkabout doing that or you might
have thoughts or you're.
You're afraid of the thoughtsand you don't really want to do
them, but you think they'regoing to make you do it anyway.
That's.
That's a very, very, verycommon, very disturbing and
scary experience, but that'sokay, that that's a little
different animal and people whodo the work that I do we see it
all the time.
All the time.
Every week I see that at leastfive, six times.
(29:44):
So very, very, very common.
It's okay.
To be worried about becomingsuicidal because you think it
will somehow make you do a thingyou have no intention of doing
Doesn't mean that you are goingto become suicidal or harm
yourself against your will.
Nobody does that.
It doesn't work that way.
Very good question, though, andI don't mind it being asked.
(30:06):
You'll notice that I didn'tgive you trigger warnings here
because we don't want to do that.
That would be the wrong messageLike oh, we got to be careful
about that word in this contextand if you're listening and you
want to come at me, you can feelfree to come at me.
Come at me.
(30:29):
You can feel free to come at me.
Oh, you should have had triggerwarnings.
The word was in the episode.
The problem is the peoplelistening to this episode are
the people who are harmed themost by trigger warnings about
words.
So, while I understand thatneed to try to be sensitive to
people who might be consumingcontent on social media or in
podcast apps or on YouTube thevery population that I am
addressing with these videos.
It's it's for them, verypopulation that I am addressing
with these videos.
It's for them.
And we don't help those peopleif we draw boundaries around
particular words because they'redisturbing, like that's a
driver of this problem.
(30:50):
So the word is okay.
I promise it's safe.
In fact, sometimes when peoplewith OCD who have self-harm
themes, we actually use thosewords intentionally as triggers
to start to address those things.
Right, excellent question, verycommon.
You're not weird if you worryabout that.
I used to worry about it too.
So let's finish with one moretopic, which is not really a
specific question or a topic.
(31:10):
It's a general thing.
Many of the messages that I gotand again, if you want to send
me a text message with a commentor a question, just follow the
link in the podcast description.
It's anonymous.
I can't text you back.
We don't sell your number oranything like that, just a way
to communicate with me.
Many of these comments andquestions that I get are about
specific things.
They usually look like can youtalk about the thought?
Dot, dot, dot.
Add a thought.
(31:30):
Can you talk about being afraidof dot dot dot.
Can you talk about a veryspecific circumstance or
situation?
One of the overarching rulesthat you have to kind of go by
when you listen to podcasts likethis or read my books or listen
to Disordered or follow anxietypeople on social media is that
you have to pay attention moreto the process.
The content of the thought thatscares you is not special,
(31:54):
because when you send me a textor an email or you're in my
comment section, you want to saybut what about when you think,
what about?
You're afraid of?
What about the thought about?
What you're basically asking iscan you give me some
information, can you do apodcast episode that will
convince me that that specificthought won't actually come true
or isn't real or isn't a dangerto me?
And that will never workbecause the process that creates
(32:14):
that fear will just morphusually into some other thing.
So if you've been listening fora long time or you interact with
people who have been listeningto this podcast or others like
it for any length of time, youwill notice in that sort of
support community and I use thatin air quotes people will talk
all the time about their currentfear.
It's very common to hear likewell, six months ago I was
really afraid of insanity, butnow, for some reason, now I'm
(32:36):
afraid of like somethinghappening to my kids.
Yeah, because it's the processthat we care about, right, so we
don't really want to get into aconstant long run of like.
Okay, let me answer a questionabout the fear that you might
scream in church.
Let me answer a question aboutthe fear that you might go
insane.
Let me talk about the fear ofyou know, being dizzy.
Like we don't address specificsymptoms and we don't address
(32:57):
specific thoughts.
It's not, in this context, oneone to many helping sort of
environment where I can barelyhelp because it's a one to many
environment.
We might get specific andpsycho education if we worked
one on one, but in thissituation you got to fall back
on the principle that it's notthe content of the thought.
And if what you really want toknow is I've heard six different
podcast episodes and watch 15videos about the fear of
(33:19):
insanity but hey, drew, can youdo an episode on that too?
Or another episode, because Iknow you've already done one or
two.
What you're really asking is I'mnot yet convinced that this
thought is safe.
So it's the process by whichyou get convinced that your own
thoughts are dangerous orthreats or inappropriate or need
to be controlled or stopped orbanished.
It's that process that we careabout, right, so fall back on
(33:43):
that.
If you have a specific thoughtthat disturbs you or a specific
fear or an outcome, an anxious,anxiety-related outcome that you
think is very important and youwant to hear addressed and for
some reason, people like me justnever seem to talk about it
that much something must bewrong.
I need to hear about that.
Know that if you are afraid ofyour own thoughts or your own
emotions or the sensations thatyour body makes naturally when
(34:06):
it is disturbed or triggered orafraid, then you got to fall
back on these general principlesthat like wait a minute, I'm
afraid of my own body and mindand I don't have to fear that
because all the sensations arepermissible, they're all okay
even though they're reallydisturbing and scary, and every
thought and every emotion isalso permissible and safe, even
though I really hate them.
So that's why sometimes youwon't hear me answer questions
(34:28):
like hey, what about the fear of, sometimes, when they're very,
very common, widespread things?
But honestly, after 10 years ofpodcasting and 300 and somewhat
episodes.
I've probably talked about yoursymptom broadly.
You know, there's the cardiacstuff, there's the breathing
stuff.
There's the cardiac stuff,there's the breathing stuff,
there's the dizzy stuff, there'sthe choking stuff, there's the
falling down stuff, there's thelosing control stuff, there's
the insanity stuff.
We've all talked about thatmany, many times.
(34:48):
You can go back and listenagain if you want.
But remember, it's not aboutthe content of your thoughts,
it's the process by which youhave become afraid of your own
thoughts in your body that wereally care about.
So that's why I don't really getinto the specifics and if you
ask those type of questions andwe don't answer them, I'm sorry.
I know you really want me to,but this is this is the best
answer I could give you, atleast in the context of a
podcast or a YouTube channel,right?
(35:09):
So 35 minutes in, it's one ofthe longer episodes I've done in
a long time.
Luckily there's not a lot ofediting, because I'm just
sitting on my deck talking intoa microphone while I hear my dog
copper barking because he wantsto come out.
So I'm going to wrap it up.
We're not going to do music andall that stuff, I'm just going
to thank you for listening andfor your support of the Anxious
Truth.
I mean amazing.
I can't believe I've been doingthis for 10 years at this point
.
It's almost exactly 10 years atthis point, actually.
(35:31):
Now it's 11 years.
Oh, my goodness, I'm losingtrack of time and the only thing
I will say or Spotify or somepodcast platform where you can
rate and review and you like thepodcast positive feedback is
always welcome because it helpsmore people find the podcast and
I can sort of help more people,in the limited way that we can,
at a podcast or a YouTubechannel.
And if you're watching onYouTube which you're not, you're
(35:51):
listening this week and you dolike it, maybe like the video.
Leave a question or a commentif you want.
I try to read them and try toanswer the ones that I can.
And, yeah, maybe subscribe tothe channel or hit the
notification bell.
I am supposed to ask you all ofthose things, right?
Otherwise, what kind of likecontent creator am I?
Anyway, guys, thanks forlistening.
I hope these questions werehelpful.
I'll do another one of these,maybe twice a year, every six
(36:13):
months or so.
We'll do them.
Click on the text link in thepodcast description if you want
to send one in.
Thank you for listening.
Thank you for being brave andbeing nice to yourselves,
because if you're listening tothis podcast, you're at least
doing something nice foryourself by trying to learn
about the nature of the strugglethat is up against you right
now.
Give yourself credit for beingbrave because, even though you
don't like the way it has everfelt, you are in fact tolerating
(36:37):
and handling every anxiousthought, sensation and scary
emotion you've ever had.
Take that with you.
I will see you again in twoweeks for some other topic.
Thanks for listening.
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