July 5, 2023 • 57 mins
In this insightful and empowering episode of Heal Your Roots Podcast, we welcome back the esteemed mental health expert, Joslyn Justi. In our heartfelt discussion, we delve into the often misunderstood realms of anxiety and Obsessive-Compulsive Disorder (OCD). Joslyn sheds light on the normalcy of experiencing anxiety, helping listeners differentiate it from anxiety disorders, and clarifying the common misconceptions between anxiety attacks and panic attacks.
We discuss the discomfort tolerance window, explaining how an overactive amygdala and cortex can fuel anxiety. Joslyn shares useful techniques for challenging these anxious thoughts and explains the role of exposure prevention therapy in treating OCD. Listen in to hear about a client’s journey through OCD diagnosis and treatment, including the importance of identifying OCD behaviors, building resiliency, and avoiding blaming language.
We explore the differences between OCD, Pure-O OCD, and generalized anxiety, emphasizing that OCD is rarer than many people believe. Gain insight into calming techniques for panic attacks and methods to send messages of safety to your body, and learn about the importance of self-care and stress management in maintaining mental health.
Joslyn tackles the topic of perfectionism, calling it an illusion in mental health and detailing its common occurrence in OCD patients. We discuss accepting limitations and the process of releasing coping mechanisms. We also touch on the benefits of journaling for couples and the powerful role humor can play in therapy sessions.
Don't miss out on this comprehensive guide to managing and understanding anxiety disorders, filled with practical tips, compassionate advice, and an empathetic approach to healing. Learn how to navigate your mental health journey with resilience and humor, and embrace a more informed, accepting mindset.
Check out the rest of the Heal Your Roots Podcast episodes at our website.
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Episode Transcript
Available transcripts are automatically generated. Complete accuracy is not guaranteed.
(00:00):
There are also healthy levels ofanxiety. It can keep us on our
(00:04):
toes, it can keep us alert andit can be very helpful.
The content provided in thisepisode is intended for
informational and educationalpurposes only. Our conversations
are meant to createunderstanding and awareness
around mental health topics, butthey are by no means
comprehensive, or individualizedevaluations or treatment. Stay
(00:25):
safe and take care of yourmental health enjoy the podcast
Hi, I'm Kira Yakubov, LicensedMarriage and Family Therapist
and founder of Heal Your RootsWellness practice. Every
episode, we talk with aprofessional from the mental
health field to learn more abouttheir approaches and
(00:46):
specialties, and also theirjourney of becoming a therapist.
In this podcast, we'll uncover adeeper look at the world of
therapy from new perspectives.
You'll meet the therapist ofHeal Your Roots Wellness
practice, and trusted colleaguesfrom the community tackling
mental well being or your go toNetwork for practical and
professional insight in mentalhealth. Subscribe for new
episode releases every otherWelcome back to another episode.
(01:09):
I'm so excited to have JoslynWednesday.
Justi back for a third episode.
She's a Licensed Marriage andFamily Therapist that Heal Your
Roots Wellness, and I clinicalsupervisor in training. Jocelyn,
thank you so much for being onwith us today.
(01:30):
Yes, Kira. Thank you. I'm sohappy to be back. And I'm really
excited to give our listeners alot of tips and information
today.
Yeah, me too. Awesome. So I knowtoday we're going to spend
majority of our time reallydiving into different anxiety
disorders, what they look likesome of the differences, the
symptoms, and really giveaudience members tips and coping
(01:53):
strategies to really help themnavigate through this process.
It's a lot of information. And Iknow it can be overwhelming for
people sometimes. And I thinksometimes people often get
confused with different anxietydisorders, because there's a lot
of common themes. So I'm reallydifferentiate those for
listeners today.
Absolutely. And I know that'sone of your specialties is
(02:14):
working with individuals andcouples with anxiety disorders,
and particularly OCD, which issomething I'm not very familiar
with. So I'm really excited tohear more insight and depth from
you on that as well.
Yeah, it's something that I'verecently just became very
interested in and has become anew passion for me exploring how
OCD in the brain works, and howit can disrupt our lives or
(02:38):
relationships or work. So I'mreally excited to talk about it
today.
Awesome. So I just want topreface with anxiety is normal,
right? Like we all experienceit. And there's normal daily
anxiety that every person goesthrough. And it's very vital for
us to experience anxiety, orlike it serves a function for
(02:59):
us. And I think some of thenormal day to day things, right?
There's a very clear trigger.
Like, for example, if you know,or starting a new job, or it's
the first day of schooltomorrow, or maybe we're going
on a first date, right? Likeit's natural and normal for us
to feel kind of anxious, alittle uneasy and worry about
that. And that anxiety issomething that everyone
(03:20):
experiences pretty much acrossthe board. And so I wanted to
differentiate normal and commonanxiety from anxiety disorders
for people.
Sure, and most people honestly,and generally speaking, don't
meet criteria for a lot ofanxiety disorders. You know,
usually it's an adjustmentdisorder if there's a situation
(03:42):
or circumstance and there arealso healthy levels of anxiety,
it can keep us on our toes, itcan keep us alert, and it can be
very helpful sometimes. However,what I have found the
differentiation there is whensomeone has been experiencing
constants symptoms and excessiveworry, which is one of the
cornerstones for generalizedanxiety disorder, it needs to be
(04:04):
lasting at least six months ormore. And if someone's coming to
me saying, I've tried this, I'vetried that. I am excessively
worrying about XYZ on a dailybasis for six months, that's
when they're going to be meetingmore of a criteria for
generalized anxiety, or panicdisorder, OCD. So the timing is
very important. And it's likeyou said, it's important to
(04:25):
normalize anxiety too. We allhave it, I have it sometimes,
you know, it's completelynormal. And we need to validate
that for people. So they're notoverthinking Oh, I'm sick,
something's wrong with me.
Because most times, it's justsituations or circumstances. So
that timing that six monthtiming, I think is very
important for people to know.
(04:45):
Absolutely. And I think a bigpiece of it as well is that
typically when there's like anormal level of anxiety or just
like the general kind thatpeople experience all the time
is that when the trigger or whenthe situation is done That level
of stress it leaves, right likeit's no longer present it
subsides versus GeneralizedAnxiety Disorder, or panic or
(05:08):
maybe OCD that stays with us,like you said, an excessive
amount of time. And there'salmost irrational or an over
exaggeration of the experienceinternally, in proportion to the
actual situation, right. So wewant to be able to kind of
compare and what a reasonable orproportionate amount may look
(05:28):
very different for a lot ofpeople, but I think you're
saying the timeframe. And alsoif it doesn't go away, or if it
doesn't lessen as the situationleaves, then that's a pretty big
trigger for us to recognizethat, okay, there's something
deeper going on here for theperson,
right, and it has to reallycause significant impairment in
(05:48):
many areas of our lives. Forexample, in our occupation, or
in our personal life, if it'scausing such severe distress,
then there is something a littledeeper going on. And, again, the
frequency, the intensity and theduration are all important
factors to keep in mind too. Oneof the common factors when it
comes to panic disorder, theperson needs to have two
(06:11):
unexpected Panic Disorderswithout any trigger anything
happening over again, a periodof three to six months. Because
sometimes, you know, especiallywith COVID, for example, I saw
an increase in anxiety. Butagain, a common theme, there was
the unknown, we didn't know whatwas happening, and it was
uncertain. And sometimes ourtolerance levels to discomfort,
(06:32):
uncertainty play a huge role inanxiety.
Absolutely. And I think theimportant part for people to
know the difference between likean anxiety attack versus a panic
attack, is that anxiety attacks,there's almost like a gradual
build up. And it's almost alwayssurrounded by you know what the
situation is, you know, whatyou're getting anxious about.
(06:55):
And there's a build up, and youknow, and you're trying to move
through it, and it can feel, youknow, debilitating, but you can
still understand what's kind ofhappening to you, versus a panic
attack. A lot of times forpeople, it may feel like they're
dying, or they're having a heartattack. And it's, it's almost
like an out of body experiencewhere there's a high level of
(07:17):
almost terror, where you feelcompletely out of control. And
the onset is almost immediate.
So I think that's a bigdifferentiator for people who
might be experiencing anxietyversus panic.
That's a very common questionI've gotten asked recently is
the difference between anxietyattacks and panic attacks. And
the way I also try to describeit is anxiety attacks, we like
(07:40):
you said, we know what'shappening, the trigger is there.
And it's not so much aphysiological response compared
to the panic attack where youcould have, you know, your heart
racing, dry mouth, upsetstomach, for example. And it
completely comes out of nowhere,like there's no trigger, nothing
in your present moment is makingthis happen. So to me, that
(08:02):
indicates also deeper,internalized stress, and things
that we're not dealing with,perhaps we suppress them. You
know, sometimes I've noticedpeople who tend to avoid a lot
or have an avoidant attachmentstyle, can sometimes experience
panic attacks, because a lot ofthings aren't getting addressed.
So when I treat panic attacks orpanic disorder, I'm really
(08:24):
getting to the underlying issuesof what's stressing you out and
then working on stressmanagement techniques. And once
we get that stress undercontrol, and again, self
awareness, there is key. Yeah, agradual decrease, or the
frequency or the intensitydecreases.
Yeah, and I can see, there'sgoing to be a lot more
(08:45):
frustration and avoiding a lotof maybe social events because
there isn't a clear trigger, orthere isn't a clear link to why
someone might be experiencingthis, which could feel even
scarier, right, like we have nocontrol over this versus people
who may have anxiety disorder,or anxiety, panic attacks is,
you know, what is kind oftriggering you or you know, the
(09:06):
circumstances of the situation.
And we're more likely to avoidthem, or isolate, like that's an
active decision, because we knowthere's like a cause and effect
versus really not knowing what'shappening.
And it's really kind of aprobability issue too, because
people are prone to that socialanxiety, OCD, even ADHD, we have
(09:28):
this interpretation or almostthis confirmation bias like,
well, I don't want to go becauseI am not comfortable with the
unknown, or I don't know what'sgoing to happen. Feeding that
thought process in the braineven more. So. A little
education for people is, is anoveractive amygdala and cortex
is what is feeding thesethoughts. And so what do we know
(09:51):
that we can say, Okay, I'minterpreting this a certain type
of way. If I feed into it, thenthe worry is going to be even
more extreme. But if I change myinterpretation a little bit, I
can say, you know, instead of, Ineed to know what's going to
happen, I can't tolerate theunknown, what we can maybe say
is something like, you know, Ineed this opportunity to learn
(10:14):
how to tolerate uncomfortablesituations. So again, you hear
the difference, we're saying,like, I need the opportunity to
be heard, because again, theprobability that something may
happen is relatively low. Youknow, it could be high, but we
still don't know for sure. Andthat's something that we really
work with a lot is trying to getpeople to open themselves up to
(10:38):
the possibility that theirinitial confirmation bias
thoughts may not be accurate. Sotherefore, because we don't want
to hold people back or for orhold themselves back from.
Absolutely. I love that you saythat because it's really
challenging our thoughts andbeing more realistic and having
more of an open mind of all thescenarios that could happen,
(11:00):
right? I say, and I've struggledwith anxiety, especially social
anxiety a lot in my life is thatwe imagine the worst case
scenario in our mind, and thenwe feel it in our body. And then
we imagine what that's going tobe like to move through that
right? I don't want to feel thatdiscomfort. I already felt what
it's like in my body. I'm good.
Yep, right, versus being like,Okay, that's a possibility. It
(11:23):
could happen, right? It's notzero chance it could happen. And
is there something just aslikely or more likely to happen
that either nothing bad willhappen? Or I'll actually have a
good time or a positiveexperience? And what will that
feel like in my body, so atleast allow ourselves to see and
understand different options.
(11:46):
And I think a big part isfeeling it in our body is like,
kind of like visualizing, andgrounding ourselves in those
senses as well.
Absolutely. And it's learninghow to trust yourself a little
bit more instead of trustinglogical thoughts that have
possibly prevented you fromenjoying life or having certain
experiences. So one of thethings I really try to normalize
(12:10):
and validate for people is lookfor the most tiny baby step
opportunities you possibly can.
And then work from there,because sometimes people want to
jump to, oh, I need to go tothis huge concert, but I'm tired
of being around a ton of people.
Okay, well, maybe just start bygoing to a coffee shop, maybe
just start by having somebodyover your house, gauge how you
(12:34):
build your tolerance, you know,and again, change the way we
approach anxiety, rather thanlike, trying to say no, don't be
anxious, don't be anxious,because that just makes us more
anxious.
Sure. It never works to say,don't feel this feeling. If it
was that easy, we wouldn't befeeling it right. If there was a
switch,we'd be out of a job if I told
people Hey, cool, they're allbetter. And it's just on the
(12:58):
brain so powerful. And once wedevelop those thoughts and
strengthen those thoughts in thebrain, that's what's telling us
is our reality. Yeah, whenagain, we're just strengthening
unhelpful thought processes,for sure. And I like how you
said, kind of exposing ourselvesslowly to some of these things.
Right. So it's building thatwindow of tolerance. Yes. So I
(13:21):
think there's different levelsbetween discomfort, a comfort
zone and like dangerous, right?
Like, we don't want to putourselves in dangerous
situations that are super risky,just for the sake of, you know,
pushing ourselves that's not thepoint. And, you know, sometimes
we want to be in a level ofcomfort so that we can sooth
their nervous system, but wedon't always want to stay in the
(13:44):
comfort zone, because then wedon't necessarily grow, we
isolate, like you're saying weprevent ourselves from
experiencing more. So it'sreally kind of playing and
testing with the discomforttolerance window. Like pushing
it a little bit further andfurther and seeing okay, this
was really uncomfortable. Itwasn't a great feeling. But I'm
(14:05):
not hurt. I'm still safe. Imanaged through it. Like that's
a really big deal that I evendid this thing. Let me see if I
can keep doing the same thinguntil it feels pretty normal,
and then extend that window somemore.
Exactly. And I love that youbrought that up because that's
one of the main treatments withOCD is the exposure prevention
therapy. So you expose yourselfto a triggering stimuli, and you
(14:29):
gauge you rate on a scale howdiscomfort or comfortable and so
we can use those numbers as atangible treatment plan to say
okay, this is where you're atwhen you expose yourself to this
stimuli. Let's do it again in aweek and see where you are with
the same exact stimuli. So,exposure again in theory over
(14:49):
time, should decrease the levelof discomfort and increase your
sense of self increase yourconfidence, increase your
ability to withstand beinguncomfortable because like you
said, you're not in any physicaldanger, we are not putting
clients in any type of unsafesituation. Like I said, my
exposure stimuli is very smallbaby steps. For example, I had a
(15:14):
client who was diagnosed withOCD. And we work together for a
long time, like couple years.
And this person got to a pointwhere they were able to identify
not calling somebody to getvalidation for an obsessive
thought. And when they realizedthis, it offered so much
positive reinforcement to them.
(15:34):
And it gave them thisincreasingly sense of self and
feeling proud of themselves thatthey sat with it on their own,
and they did not reach out tosomebody else. And it was such a
pivotal moment. Again, it wassomething so small, but it like
it was so significant, it was ahuge progress. And that was the
(15:56):
catalyst to decreasing symptoms.
And again, it's, it's all aboutthe client and them doing all of
the work. And us pointing thatout, like, hey, yeah, we gave
you this suggestion, but you diddo the work. And that that helps
people immensely. And it'sreally awesome to see it happen
in sessions too,for sure. I mean, it's super
rewarding, like, you're sayingit sounds small, right, or
(16:18):
trivial, but the meaning behindthat, and how impactful that is,
like that person now gained thislevel of confidence, and self
reliance, that may have not beenpresent before to ease some of
that stress and anxiety. Yeah,and I think a big part of
individuals feeling superanxious, particularly in
(16:38):
relationships is this constantneed for reassurance and control
that it then becomes projectingonto others, and it becomes
everyone else's responsibilityor job to ease their anxiety.
Which, yes, sometimes we needthat support. And we need that
validation. Because we're socialbeings, right? We need other
(17:01):
people. And that can't be ouronly source of self soothing, or
being able to decrease anxiety,because then we give all give
away all our control, and thenwe feel helpless. And that's the
worst place we really want to beas a feeling of helplessness.
Well, exactly. And you'retalking about too the difference
between enabling a behavior andbeing a supportive spouse or
(17:24):
partner. Yeah. So sometimes witheither OCD, anxiety, ADHD, a lot
of times it interferes with acouple system, communicating
conflict resolution, being ableto talk through something a lot
of misinterpretation happensthere.
So much, yeaAnd a lot of people will tend to
either withdraw or they react,and depending on the level of
(17:44):
that reactivity, or withdraw,can cause a lot of tension build
resentment over time. And so wehave to do a lot of reframing
with that like, instead of acouple of say, a couple, someone
that has OCD and the otherpartner doesn't. One tip is
okay, let's identify the OCDbehaviors, let's, let's identify
their traits, theircharacteristics, let's point
(18:06):
them out. So that way, thespouse is not enabling them, or
being a quote unquote, parent tothem, and, you know, they can be
supportive and say, No, hey, wediscussed this, this is an
opportunity for you to buildyour tolerance, I can be here to
support you. But this issomething that I need you to
(18:26):
cope with, and utilize, like anytype of, you know, coping tool
that they may have learnedprior. But again, we're building
resiliency here at the sametime, and that's a big component
in this in treating anxietydisorders is resiliency.
Absolutely, and having that backand forth understanding, because
(18:47):
I think sometimes whenindividuals are in the throes of
anxiety, right, where it's, it'sreally it can be really
debilitating, and it can feelall consuming, well, then we can
be really stuck in our ownexperience of the anxiety and
not recognize what it may belike for a partner, a family
member, a friend, a co workereven Right, right. And so it's
(19:08):
recognizing, like, Yeah, I'mhaving this experience, it's
very uncomfortable. And thisother person is here, and why
aren't they doing the thingsthat I need them to do, but that
other person also has their ownexperience, and they may or may
not know how to support you, andit's not necessarily their job
to make this feeling go away foryou.
Not at all. And that's somethingthat I'm pretty blunt and direct
(19:29):
about in my sessions withcouples particularly is it is
not your partner's job to parentyou. It is not their job to be
responsible for your own mentalwell being. Big difference
between offering support andvalidate or offering reassurance
when they need it. Sure. But wehave to, the individual, you
know, we have to work onourselves before we can work on
(19:50):
the relationship. And one thingI'll suggest to, let's say
partners without the OCD orwithout the anxiety disorder, is
really trying to refrain fromblaming language. Like, or it is
always causing us to get intofights or your OCD is causing us
to, you know, not enjoy life.
While instead of that, you know,maybe using an I statement,
like, I see you're struggling,you know, what can we do to make
(20:11):
this experience better? How canwe work together as a team?
Again, you hear people hear thedifference between you're doing
this, that causes ffensive rightaway, but back it up and say, I
see you're struggling, I seeyou're having a hard time,
right? You love this person,this is your best friend. And I
know it can be frustrating. Butthat's where I think individual
(20:33):
and couples therapy can beextremely beneficial to create
knowledge to offer education andbe like, Hey, this isn't them
just, you know, being annoying,or, you know, wanting to fight
for no reason at all, let's geta handle on this first and go
from there.
Absolutely. And that's why Ithink it's so important is
because even though in couplestherapy, you're kind of working
(20:55):
with each individual, you can'tspend the whole session on
helping one person cope, right,it's how is this couple managing
this and navigating thistogether. And so that individual
therapy is going to be socrucial to have way more time to
process, find insight, findawareness, and develop coping
skills that you can bring to therelationship or to the couples
(21:18):
therapy, like, Hey, these arethe things I've been working on,
I'm really trying, it's notgoing to be perfect, you're not
going to get it right everytime. But like, let me know when
you see that I'm not doing it orhelp me or pointed out when
maybe if I'm doing it right, orif I'm not doing it the best
way, it's directly keeping yourpartner accountable too
and that and again, justpointing out positive progress,
(21:40):
Hey, I saw you were struggling.
But I also saw you workingthrough it. And I really
appreciate that. And the otherpart is saying like
acknowledging that appreciation,and just being very mindful that
their partner is also just asimportant. Even if I'm the OCD,
they don't have anxiety at all,there's still stress, right? And
we So stress management comesinto play. So I might tell a
(22:02):
couple, hey, I know this, youhave OCD, and you don't. But
let's talk about stressmanagement, because I'm sure
that impacts the both of you.
And then both of them use thattogether. And they positively
reinforced that together, thatmakes progress honestly, so much
more quick.
Absolutely.
Now, again, it's not an easyprogress process at all. It's
(22:24):
time consuming. I tell peoplethat at the beginning, you know,
we're trying to rewire thebrain, that [takes] lot of
mental effort and can beexhausting. So that's where a
lot of self care strategies comeinto play also,
and even with that, right,there's a lot of repetition that
has to happen. And a lot ofreinforcement of particular
(22:44):
behaviors over and over again,with the reaction being a
positive one as well, that tohelp us rewire that too. Because
I think a lot of times when anindividual is anxious, the
reaction of their partner canalso stop them from being
honest. Or it can stop them frombeing more forthcoming or doing
particular behaviors, you know,based on maybe the way they were
(23:07):
raised or their familyenvironment when someone made a
mistake, right? So it's alsounderstanding the way that you
react or speak to your friend orfamily or partner who may be
more sensitive to that, rightcan also kind of enable them
from being honest and open withyou. When they have anxiety.
Absolutely. It's it's voicetone, it's like you said family
(23:31):
of origin plays a huge role inthis, you know, how did you
learn to manage conflict oranxiety or talk about emotions
growing up, which is a big thingwe talk about at couples
therapy, and it really doesincrease a person's insight and
awareness and can also havepeople be more sympathetic
towards each other. Again, it'sit's tough to do that it's tough
to rewire the brain, you know,but I mean, it's definitely
(23:52):
doable, if you takeaccountability, if they have a
willingness to want to work onthe relationship. And if they
genuinely want the relationship,those are the three things
whenever people check thoseboxes. That's why therapy also
being the most productive andthe most successful,
because both people have to bein it
Exactly. But I do see a lot oflike the OCD and ADHD have have
(24:17):
sometimes been some of thebiggest barriers in a romantic
system. You know, that theworry, it's time consuming,
people get flustered easily. Ithink that's something we have
to be mindful of when workingwith couples is just the
intensity of where they're at.
And so I wanted to ask you, ifyou can kind of dive a little
bit deeper into OCD, but alsowhat Pure O is in OCD? Because,
(24:41):
you know, I've been seeing moreof that and that it's, you know,
from my understanding and fromsome of my training, I don't
have a bunch of experience withindividuals with OCD, but that
there's usually a behavioralcomponent that goes with
intrusive thoughts when theversus kind of the pure Oh, is
just that there's the interestSome thoughts but we don't
necessarily see the externalbehavior. Is that right? Or if
(25:03):
you can kind of dive more intothat.
So a lot of newer research hasindicated that with Pure O or
like OCD, it's not justobsessions. And it's not just
compulsions, they're kind of gohand in hand. Right. compulsions
are not simply just behaviorsanymore. We can have compulsions
about thoughts. So the two areintertwined together like this.
(25:27):
So with Pure-O, I think theobsession really is an
overactive amygdala and anoveractive cortex, which again,
like this is for our listeners,this is something that you can
look up on the OCD website, oryou can look at this book called
Rewire the OCD Brain byCatherine Pittman and William
(25:49):
Young great book. It gives a lotof really good examples of how
to rewire our thoughts, but alsogives a lot of education. So
when it comes to Pure O andobsessions, again, I look at
have these been so intrusive inyour life, that they have caused
significant impairment anddisruption to your activities of
daily living? If so, let's takea closer look of what that
(26:12):
means.
However,let's say it's a circumstance,
right? Someone just lostsomeone, for example, you know,
and they're having a very hardOkay.
time and they might be obsessingover the past history. I don't
Yea,But it does become this just
unexpected excessive timethink that's Pure O or OCD. I
think that's a circumstance.
(26:33):
consuming worry, and theinability to get unstuck. So
we'll call this sticky thoughtsis and ruminating thoughts.
Perfectionism, for example, is abig one that I hear a lot.
People if they can't, like,they're so perfect at work, for
example, but they may be late toa meeting or a party because
(26:54):
they have to prepare for so longfor this. So again, that's
causing severe impairment intheir life.
Okay. Yeah. Cause I wasn't sureexactly of the difference with
the Pure O, because I feel likeit's, it's tough. And this is
why it's really important forindividuals to have very
specialized therapists orpractitioners with OCD, if
that's something they'restruggling with, because so many
(27:16):
symptoms can overlap withgeneralized anxiety, that it may
be hard to tease out and I feellike the treatment is going to
look different.
My treatment for OCD, there isoverlapping treatment plans for
OCD and Anxiety. But when itcomes to OCD, specifically, it's
way more of the exposureprevention therapy and exposing
(27:37):
us and learning about thoseruminating thoughts a lot. And
then with generalized anxiety,it's it's excessive worry, but
it's not time consuming. Soagain, this might be redundant,
but I can't emphasize enoughthat time consuming is a
differentiating factor with OCDcompared to generalized anxiety
(27:58):
and panic disorder. So we haveto identify those obsessive
thoughts and see what's feedingthem. First and foremost, you
know, kind of also like changingthe interpretation, like I was
mentioning earlier, and thenidentifying the theme, is it
perfectionism? Is ituncertainty? Is it fear? Is it
you know, contamination, what itbecause that differs from
(28:21):
generalized anxiety, those thosethemes in my experience,
and I think with at least how Ilike to work with individuals or
couples who have generalizedanxiety or social anxiety, right
is really finding more of thatinsight, first, of kind of going
back in time to seeing when elsedid you feel this way? When else
did you get these messages orthese beliefs around these
(28:43):
circumstances or thesesituations? And kind of finding
those links? And understandingthat because it happened before
does not necessarily mean thatthis is the same now. Right? And
your interpretation, right is,how can I interpret this
differently? What is thelikelihood, right? Am I just
assuming, because a lot of thetime, we're going to be
(29:04):
assuming, then creating anarrative then believing the
narrative and then behavingbased on the narrative when the
other person or other situation,no clue that that was an
experience you had until youchecked in with them.
Exactly. So I think a bigdifference there is what again,
with anxiety and OCD is thatwith the anxiety, the Insight is
(29:27):
a little bit better. Andsometimes insight with OCD, at
least at the beginning, fromwhat I've seen, like beginning
treatment, I should say, Insightis sometimes poor to fair,
generally speaking, again, notall the time, but it depends on
where a person is in their lifeand in their treatment. If
they're at the very beginningstages of treatment. They're not
(29:47):
sure if it's OCD, they're notsure if it's anxiety. Yeah, I
asked how long this has beenimpacting their life for and
again, what has it where has itcaused the most distress? If
they say sometimes I'm I justhave sort of test anxiety, but I
get pretty good grades. Well,that's a pretty lackadaisical
response. That indicates to me,they're not too worried about
(30:09):
it. They're just aware, there'sa little bit of anxiety. Now,
sure, that comes to me, and Ican't take a test, I have failed
this. So many times, I have satthere and thought about the same
question over and over again.
And I was unable to think aboutanything else for let's say, two
hours, if that's what, that'show long the tests were to take.
That's a differentiating factorto me like, Okay, that's a
(30:30):
sticky thought you were unableto get unstuck from that,
compared to some ad, you mightbe, you might experience more of
like, like you said, like a bodysensation for a little bit. But
it was as much distress assomeone sitting taking a test
for two hours not being able tofocus on any other word, except
the first word they read in thesentence.
(30:51):
So that intensity and severity,duration frequency like this is
for audience members like thisis how therapists and
practitioners kind of assess andlook through these things is,
How frequently does it happen?
What's the intensity level, theseverity, and the duration of
how long that lasts for right,because those are really big,
important factors of being ableto assess which the assessment
(31:11):
is important for the fact thatwe need to now figure out the
best treatment plan for youspecifically, not just to give
somebody a label, right, Iactually don't actually care
about the label, I care moreabout what's happening and how
we can help you.
Exactly. And to be honest, OCD alot more rare than people
realize, like meeting thediagnostic criteria for
(31:34):
Obsessive Compulsive Disorder,it is not as common as
Adjustment Disorder withAnxiety. So a lot of the times
it does get a little concerningwith social media kind of
throwing out a lot of, well, ifyou meet this, if you have, you
know, xy and z, then you havethis disorder. And that's scary,
(31:54):
you know, that's really scaryfor people. So it's so good for
us to come in educate andnormalize a lot of behaviors. Of
course, like if there is adiagnosis and OCD diagnosis, it
is helpful, like you said, tohave a treatment plan moving
forward, and how to treat thembecause like I said, the
exposure prevention therapy iswhat I would use for OCD, but
(32:15):
not necessarily generalized orpanic disorder, or even like
ADHD, for that, for that matter.
And so I did want to spend alittle bit of time giving
audience members like concretecoping skills or techniques that
they can use for these differentwhether it's disorders or the
struggles and symptoms thatthey're going through that maybe
you like to use and that I usewith clients as well.
(32:38):
Yeah, I would say for for panicdisorder, I start with
normalizing what's happening,not panicking. When you know,
something like know your body ofwhat's happening, like are your
palms getting sweaty? forexample, is your heart starting
to race? Are you gettingnauseous, you know, okay, if
that's happening, remain remaincalm. Be still, walk to the
(33:02):
sink, walk to your bathroom,splash some cold water on your
face, put ice cube on the backof your neck. That can help calm
the nervous system and tellyourself, I know what's
happening right now I'm having apanic attack. And again, slowing
your inner dialogue has beenvery helpful. Because
oftentimes, when something scaryis happening to us, the mind
(33:24):
starts to race a million milesan hour. So have to be very
careful and cognizant of, hey,let's slow it down. Let's
imagine something slow, like aturtle, for example. And I've
mentioned this to clients likeit's, no, it's kind of funny.
But if we can visualizesomething slow, the mind is
(33:44):
telling the body it's okay tocalm back down. There's no
immediate danger. So that'swhere I, that's where I start is
self soothing techniques,calming the heart rate, because
your heart rate is going tostart to increase with a panic
attack. Because like you saidearlier, it can mimic a heart
attack, which is reallyterrifying. I've had a panic
(34:04):
attack before. And it does helpme to coach people through it a
lot easier after having herbecause I definitely saw that
increase, I think after thepandemic, and people not knowing
what was going on with them.
Right. So yeah, that fear of theunknown was a whole other layer
to exasperating the panic andcausing it to last longer than
it should, because we candecrease a panic attack within
(34:27):
you can start having it and itcan be over in 60 seconds, or
over in two hours. The durationvaries a lot. But as long as you
start to think slow, controlyour heart rate, breathe, again,
you put ice on your forehead oron the back of your neck that
can be extreme that coldtemperature. Cool to reset the
nervous system and offersoothing to the body.
(34:53):
Yeah, I love that. So I like tolet clients know it's basically
the same right is that when Whenour body has these symptoms,
where it feels unsafe, right,and when we feel unsafe, when
our nervous system feels unsafe,a lot of the time, we don't have
the capacity to challenge ourthoughts. So the first and most
(35:15):
important thing that you can dois how can I send the message to
my body that I am safe, that Iam okay, and that I can just be
present, right? So so you'resaying slowing down, having
something cold, breathing,especially for a panic attack,
I've had them too, it is not agood time, like you literally
cannot breathe, which ishorrifying within itself. And so
(35:39):
it's literally just focusing onI need to catch my breath, I
need to slow my breath. And Ineed to count my breath. That is
your only job is to focus oncalming down your nervous system
enough where you feel safe.
Yeah. And then from there, onceyou feel safe, and you've calmed
down, then you can kind ofprocess then you can kind of
challenge some of those thoughtsafter the fact. Right? I don't
(36:00):
like to let clients go into thatfirst, because you're just kind
of amping up the anxiety.
Yeah, right. We have, we have toget physiological symptoms under
control before we can startemotionally processing. Because
we're so terrified, and they'rein that fight or flight position
in the body is telling us thatwe're in danger. It's gonna just
(36:22):
exasperate things. And we'relike, Well, how does that make
you feel? Like, I'm never goingto tell somebody that was? No.
Like, I'm horrified. What do youthink?
So I love what you said, likeget the symptoms under control
first and process after becausea lot of times people will come
and they're like, I don't evenknow what triggered me. It
literally came out of nowhere.
But that gives us a really greatopportunity for self discovery.
(36:45):
When people ask me, I don'tknow, I'm not sure. Who will
let's use that as a great momentto like, discover, like, what's
beneath the surface?
Mm hmm. And that is I love that,because that's what I like to
ask clients when they come inwith anxiety or depression is
how do you know you'reexperiencing it? Which may sound
silly, because like, I'm alwaysin it. But how do you know that?
(37:08):
Right? Like, what are all thesymptoms? What are the thoughts?
What are you feeling in yourbody? So that you become more
aware and knowledgeable of yourpersonal experience so that next
time it happens, like, oh, okay,I'm starting to feel anxious.
This is typically what happens.
Now I can kind of assess myenvironment or my internal
thoughts, what are associatedwith this experience, right now
(37:30):
that I can then process laterandgo back to?
Well, exactly, and you'reslowing it down. To me, that's
been some of the most helpfulthings that I've received
feedback from clients lately isbeing mindful and aware of
what's happening and just takingthe slow route. And you can come
(37:51):
up with your own internaldialogue, but like, literally
slowing, the way you talk toyourself, because if you when
you start talking that way, youcan feel the body starting to
slow down. Because when we'retalking fast the body is like
playing catch up with that.
Yeah, I like that, because itkind of pairs with the rest of
(38:12):
our sensations, right? Becauseit's kind of controlling if I
kind of pull this lever thanthis lever will kind of change
appropriately or reactappropriately to this. Right,
right. So going through all oursenses. So sometimes, like even
myself, or some clients, likeokay, I know I have anxiety, I
recognize what's happening, Iunderstand what the triggers
are, I still feel uneasy, right.
So it's like having theawareness is phenomenal. It's
(38:36):
the first step, but then it'slike, and now what? which can
feel frustrating too. So I liketo have them before they're even
anxious, right? like whenthey're already in a calm state
is to establish a place in theirmind of somewhere they may have
already been or that they cancreate is where is an
environment that you feel themost safe and calm and at ease
(38:58):
and I want you to visualize it.
And through the visualization, Iwant you to hear the sounds, I
want you to smell what's goingon around you. I want to I want
you to experience the sensationsand feelings on your body and
against your body. And if you'reeating or tasting anything, I
want you to fully immerseyourself in this super calm,
(39:21):
peaceful state that you can thenpull to later as a way to self
soothe yourself anywhere,anytime without anybody. Because
I think it's powerful for peopleto have that that they can pull
from anytime it feels likeyou're less out of control and
more aware of what you can dofor yourself.
(39:41):
Well, it's so soothing even likeas you were describing and
taking that step by step it feltso soothing, like hearing you go
from Hey, what are you smelling?
What are you seeing? And for ourlistener, basically we're
describing like guided imagery.
That can just be such a greatvisual and a great relaxation
and Soothing tool, like yousaid, Think of any peaceful
(40:02):
environment that you possiblycan, or use your imagination,
you're changing the way youinterpret something. And, you
know, to kind of fall back onwhat you said earlier was you're
also discussing reality testing,and the kind of testing the
reality of your own thoughts,right. And sometimes when we
ask, Well, how do you know thatsomething bad's gonna happen?
(40:24):
You're assuming at the end ofthe day, and that assumption can
be a dangerous game. We allunderstand that sin. But it
really is just getting to aconscious place to be ready to
make that decision. Becausesometimes people what I have
learned in my experience ispeople get comfortable in
anxiety, they get comfortable ina depressive state, even Yeah,
(40:48):
it's familiar territory. And thefear pops in because they're
afraid to get better. Whathappens if I have a setback?
Again, do you hear like, thewhat ifs, what-if is a common
factor with anxiety disorders,even depression. So again, if we
can change the way we interpretthings, we can catch that What
if we don't have to feed it.
Easier said than done for allthe listeners really understand
(41:10):
that, but I wouldn't say thosethings if I haven't seen the
workfor sure. And I think that's
such an important feature isthat what you mentioned is
getting comfortable in theanxiety and almost holding on to
it because I think this happensa lot too in treatment is that
someone will progress and theywill get better. And there'll be
(41:33):
this kind of signal like okay,like things are working pretty
well, we can probably see eachother less. And then all of a
sudden, it's like, oh oh, andmore comes back, or they start
unconsciously sabotaging thingsaround them. Because we're
scared of change, right? Like,it may sound counterintuitive,
(41:53):
like, oh, I want to get better.
Why would I do that to myself?
But it's, it's thinking like,what is the function of that?
Right? So like, if, if I changethat I can no longer rely on
certain things. And if I fallback on some of those things,
then, like you said, what couldhappen? Or I'm not going to have
the same supports? Or I don'tknow who I'm going to be? Or
(42:15):
what am I going to spend my timethinking about? Or maybe that's
part of my identity. So now howdo I show up in the world, if
I'm not an anxious person, andeveryone around me kind of
caters to that a little bit.
And that's, and that's a lot,right? spiraling around in our
brains on like on a daily basis,what if this happens, you know,
(42:36):
if I get better, and then I slipup, or this or that, what I'm
like, I'll tell clients, Iexpect that to happen. Because
means at the end of the day, itis not going to be perfect. In
terms of mental health. In myclinical opinion. Perfectionism
is an illusion. And I trulybelieve that from a mental
health perspective, I know wecan perfect math problem, for
(42:58):
example, would brains notperfect, we have to make
mistakes in order to grow inorder to learn. But a big theme
there is also inviting theconcept of accepting that and
what that acceptance piece mightlook like. Because once we
accept the fact that we can makemistakes, and we can tolerate
(43:19):
making mistakes, then again,we're changing the way we
interpret it or approach asituation. And I think it can
offer us new experiences, newmindset, takes a lot of work to
get there. Don't get me wrong. Ihave seen people get to that
acceptance piece. And it hasbeen a significant change.
Again, there's always going tobe setbacks. But it's our
(43:42):
therapists and normalize thosesetbacks, because they continue
to be proactive in their mentalhealth, they continue to call
out and make an appointment,let's say if they had a setback,
and they're willing to processit in session. That's a huge
difference to me. And in that inand of itself, I think is very
significant progress, too.
Of course, and I think,especially with perfectionism,
(44:03):
when you say that is it'sinteresting, I almost love
working with clients who haveperfectionism, because it's not
about the actual thing beingperfect, right? Like, what are
we avoiding happening by youbeing perfect, right? Is it the
identity or sense of being afailure? Is that how other
people are going to view you?
And if they view you that way,what does that mean? What are
(44:24):
the negative consequences tothis? Right? Like, I think
people focus on just the act orjust the the purpose of what
they're trying to do to beperfect, and not really
processing and thinking aboutlike, if I'm not then what
happens? like what is it thatI'm really scared of or trying
to avoid? That if I were to justface that, process that and work
(44:45):
through that and accept thatthis part because it's a lot of
work to be perfect, and we neverget there. Right? So it is a
constant struggle. It is aconstant uphill battle that we
will never win, right. And Ithink people know they'll never
win, but they're still going tostrive because at least they
feel like they're workingtowards it. Right and avoiding
(45:07):
that feeling of whether it's afailure or the relationship or,
you know, someone thinking aparticular way about them. So
it's, it's huge to have thatnormalized. And, like, I kind of
love the family dynamic of it,it kind of pulls back is like,
who in your life? What situationmade you feel like you had to be
this way?
Is this a generational learnedbehavior? You know, did your
(45:30):
parents put a lot of pressure onyou as a kid to perform, for
example, and learned to again,perform at a certain type of
level in adulthood? What did youlearn about how to interact with
individuals, romantic partners,for example, but the
perfectionism is probably one ofthe most common traits that I
see a lot with OCD. Because,again, another huge theme is
(45:54):
that fear of being judged fearof being disliked fear of being
uncomfortable experiencing guiltor shame. And again, the
tolerance is so low that eventhe thought of making a mistake
can send people into a downwardspiral. And it kept them from
going after that interview thatthey've been wanting for a long
(46:14):
time. It might prevent them fromhanging out with some friends
or, you know, going on a date,for example, because again, it's
the fear dictating this. So Itried to frame it and ask
people, What is it that we'relistening so much to the fear
aspect, and that's what I'mvery, very curious about. I'm
been working with that for awhile now trying to understand
(46:38):
that a lot more of how fear isdictating our our conscious.
Yeah. And I feel like fear andshame and guilt, just like lay
at the surface, like at thebottom of the ocean, right. And
they're just like, such anunconscious, huge influence on a
lot of the things we do that wedon't even recognize half the
(46:58):
time until we take a step backto be like, I'm actually
terrified of all of these thingshappening.
I think about what it's like toeven admit that to ourselves.
Yeah, that can be in and ofitself a huge step, when we can
admit that it's fear kind ofdictating this. But then a good
Another good tool to use issometimes using a cost benefit
(47:21):
analysis. And ask someone, okay,if fear is present, what are the
benefits to letting go of thatfear? And and let's say reaching
out for that job, give me thebenefits, and then I'll ask
them, give me the cons. What arethe reaching out to that job?
While I might not get it, andthat might make me feel like
(47:42):
even more of a failure? We don'tknow that for sure, though. You
know, so let's, let's maybechallenge that and do a little
bit more reality testing there,or a little bit more cognitive
restructuring there. Yeah, youcould get turned down. But that
doesn't mean you can't move onand try something else. Because
that's building resiliency.
That's building tolerance,that's building bravery and
(48:03):
courage to step out of yourcomfort zone and say, Okay, I
accept that I did not get thatjob. But you know, what, I am
qualified. And I know I have theskill set. And I can do this a
lot of positive reinforcementand a lot of like, positive self
talk. It's not the answer toevery thing. But it can go a
long way.
For sure. And I think that's,it's so huge. And I like how you
(48:27):
bring them both to the surface,because they're both real,
right? Like all of thesefeatures are real and do exist,
when it's, I think it's alsohaving people recognize that the
amount of time we spend worryingthat something bad will happen,
and our limited ability tohandle that situation is so
(48:50):
disproportionate to what isactually happening, right, the
chances are much lower, and ourability to overcome and are much
higher. So I think pointing thatout for people and building that
acceptance and confidence thatlike, Okay, this is a very real
factor, this bad thing or, youknow, negative thing may happen.
(49:10):
And if it were to happen, howcan I feel confident in myself
to move forward anyway? so thatthat's not the factor or the
barrier, the holding back fromeven trying
Right? It like I love that usethe word, that barrier. Because
that's what I have found, like,what is holding you back like,
and even with couples, I'm like,what is the barrier happening
(49:30):
here that's causing, let's say,a disconnect between the two of
you? What's there, and that's agreat place to start exploring
and finding those maladaptivefunctions that are just serving
this horrible purpose within afriendship of family. So I think
I just think it's very importantto be mindful of how we approach
(49:52):
things, what we tell ourselvesthe inner dialogue, and also
learning to accept ourlimitations. and using those
limitations, though, to ouradvantage, if we know, if we
know the brain's limitations, wecan totally use that to our
advantage.
Absolutely. I love that. And asyou were talking about that
(50:13):
something came up for me,especially for couples with,
like barriers or maladaptivekind of behaviors, is I think
that even when we have thesecoping skills that maladaptive
for audience members, like,you've figured out a way to cope
with it, but it's notnecessarily healthy or helpful,
but it's a way that you learn tofunction and move through it,
because you needed it at acertain point is that it's also
(50:36):
a grieving process to releasethat particular coping
mechanism. So you can invite anew one. And I think that's
really tough, too, is I have torelease this thing I've been
relying on for so long, eventhough I know it's not helping
and it's actually hurting whenwhen it feels scary, because it
served a function before. Soit's grieving that and allowing
(50:58):
yourself to invite in new waysof interpreting situations or
interacting with yourself orother people. So I love that you
mentioned that because that justlike came up for me, and I just
wanted to share it.
Awesome. No, I never thought ofit in a sense of grief and loss,
when we're losing the way wetypically do things. And to be
able to incorporate somethingnew, of course, there's going to
(51:21):
be some resistance, right? Whyis that piece of resistance,
because it's going to happen, Iexpect it to happen. But being
able to incorporate, Hey, it'sokay, to be defensive, or to
feel a certain type of way, whenyou're no longer reacting, how
you typically would, you'rechanging, you're doing something
different. And that might feeldefeating, sometimes, it might
(51:43):
not feel like this person isgonna get one over on me, if I,
you know, don't stand up formyself for screaming. That can
be hard. But again, did the prosoutweigh the cons in that
scenario, that's where I just Ilove that benefits and cost
analysis coping mechanism,because again, you can see it,
you can write it down, it's agreat visual aid for those
(52:06):
visual learners. And again, whenyou're writing stuff down, and
you're reading it, your brain isremembering it more, and it's
comprehending it double comparedto just once,
for sure, or even just readingit as like the physical act of
you writing it. That's whyjournaling is so powerful too is
that you can your everything isconnected for you to get that,
that message across andengrained a lot more longer, a
(52:29):
lot more permanently.
Absolutely. And it sticks. And Ithink couples can see that when
things stick. And when they'repracticing together. And they're
giving each other the benefit ofthe doubt, can go a long way
when trying to change behaviorswithin your system that can go a
long way with your partner beingmore willing to change when they
(52:51):
see that you're helping themalong the way and giving them
that like, okay, you know what,you might have messed up a
little bit. But here's a littlebit of grace at the end of the
And you know what's interesting,so I've had couples where day.
they've gone from really highintense arguments to, like high
intense, it's drawn out so muchenergy is spent to having a
(53:12):
really respectful and productiveconversation that doesn't last
very long because they get tothe point. And one or both
partners kind of feel likeuneasy about it. And so I'll ask
like, why does this feelstrange? And like, I don't know,
like, usually I can get all thisenergy, this pent up anger. And
now it's like, oh, you validatedmy feeling. That's it? What am I
(53:33):
supposed to do with all thisenergy now? So it's funny that
even healthy change, when westill have to recognize that
something different means thatwe have, there's a cost, right,
we have to release something inorder to receive something.
Because I think too, we cansometimes get so used to the
chaos. Chaos just becomes secondnature to us, sometimes, you
know, whether we're aware of itor not. And, again, it's a safe
(53:57):
space. It's a comfortable space.
It's familiar territory. So whena couple does get to that, that
point of, oh, we're having anice, we're actually talking to
each other and not screaming andyelling at each other. It just
feels weird. But it's good weirdat the end of the day, right?
Well, I like to differentiatebetween good weird, bad, weird.
And it's a nice way to kind ofincorporate humor into the
(54:20):
sessions a little bit and makelight of some things because we
don't always want it to be thisheavy, drawn out emotional
conversation. That's exhausting.
And you know, I think that thatpiece of humor with anxiety,
OCD, depression, couplestherapy, can can go a long way.
(54:41):
And sometimes we can even makefun of the symptoms. If we can,
this internal dialogue that oh,this is being, we can name it.
We can make fun of it. We cantease it. Sometimes it can
decrease it in its power over usin a sense.
Yeah, humor is such a huge, hugetool, and it's very healing and
(55:01):
I love bringing humor intosession. And I think that's kind
of why we jive well, too, isthat like, if you can't laugh at
or you can't find the sillinessor lightness in it, everything's
going to feel heavy. Yes. It'sso hard to do anything in life
when everything constantly feelsheavy. Like in the moment, it
might suck, but like, can we?
Can we talk about that storyafter the fact that laugh at
(55:21):
like, How absurd that was? Orlike, Oh, my God, I couldn't
believe I did that again. Right,like, so it's bringing that
humor. So I love that you bringthat up, too, because I think
that's such a huge piece in anyrelationship
Absolutely. If we can't laugh atcertain things, like even
myself, as a therapist, I mightsay something silly or fumble my
(55:42):
words. And I'll just laugh atmyself in session. And I think
it just humanizes us a littlebit. And it really, in my
experience has made clients feelmore comfortable. And I make
mistakes too. I'm yourtherapist, but I also make
mistakes. And guess what? It'sokay. I'm still here. I'm still
doing my job. And I hope thatshows that you can do the same.
(56:03):
And yeah, okay, and laugh atthat mistake and move along,
learn from it, grow from it.
Love it. Love these littletidbits, those are great quotes.
Great quotes, happy to talk. Icould talk to you about this and
like generally anything forhours. But I know we've
definitely come closer to anend. So I really want to thank
you so much for your time forsharing your insight and
(56:25):
knowledge with us. I hope thelisteners got a lot of great
information. So Joslyn, thankyou so much for being on with us
today.
Absolutely. Kira, thank you somuch as always for having me on
here. And for our listeners,especially those with OCD. If
you want to check out the book,Rewire my OCD Brain, it's a
really great resource to have.
There's a lot of great copingtools education in there. So
(56:46):
check it out. It's a great bookand I hope everyone's well and
enjoyed this episode.
Awesome. And just so listenersknow if you want to work with
Joslyn, whether individually oras a couple she's accepting new
clients right now inPennsylvania and Delaware. So
you can head over to ourwebsite,
HealYourRootsWellness.comschedule a consultation and we
(57:07):
hope to hear from you soon.
Thanks so much, everybody.
Thank you
There are also healthy levels ofanxiety. It can keep us on our
(00:04):
toes, it can keep us alert andit can be very helpful.
The content provided in thisepisode is intended for
informational and educationalpurposes only. Our conversations
are meant to createunderstanding and awareness
around mental health topics, butthey are by no means
comprehensive, or individualizedevaluations or treatment. Stay
(00:25):
safe and take care of yourmental health enjoy the podcast
Hi, I'm Kira Yakubov, LicensedMarriage and Family Therapist
and founder of Heal Your RootsWellness practice. Every
episode, we talk with aprofessional from the mental
health field to learn more abouttheir approaches and
(00:46):
specialties, and also theirjourney of becoming a therapist.
In this podcast, we'll uncover adeeper look at the world of
therapy from new perspectives.
You'll meet the therapist ofHeal Your Roots Wellness
practice, and trusted colleaguesfrom the community tackling
mental well being or your go toNetwork for practical and
professional insight in mentalhealth. Subscribe for new
episode releases every otherWelcome back to another episode.
(01:09):
I'm so excited to have JoslynWednesday.
Justi back for a third episode.
She's a Licensed Marriage andFamily Therapist that Heal Your
Roots Wellness, and I clinicalsupervisor in training. Jocelyn,
thank you so much for being onwith us today.
(01:30):
Yes, Kira. Thank you. I'm sohappy to be back. And I'm really
excited to give our listeners alot of tips and information
today.
Yeah, me too. Awesome. So I knowtoday we're going to spend
majority of our time reallydiving into different anxiety
disorders, what they look likesome of the differences, the
symptoms, and really giveaudience members tips and coping
(01:53):
strategies to really help themnavigate through this process.
It's a lot of information. And Iknow it can be overwhelming for
people sometimes. And I thinksometimes people often get
confused with different anxietydisorders, because there's a lot
of common themes. So I'm reallydifferentiate those for
listeners today.
Absolutely. And I know that'sone of your specialties is
(02:14):
working with individuals andcouples with anxiety disorders,
and particularly OCD, which issomething I'm not very familiar
with. So I'm really excited tohear more insight and depth from
you on that as well.
Yeah, it's something that I'verecently just became very
interested in and has become anew passion for me exploring how
OCD in the brain works, and howit can disrupt our lives or
(02:38):
relationships or work. So I'mreally excited to talk about it
today.
Awesome. So I just want topreface with anxiety is normal,
right? Like we all experienceit. And there's normal daily
anxiety that every person goesthrough. And it's very vital for
us to experience anxiety, orlike it serves a function for
(02:59):
us. And I think some of thenormal day to day things, right?
There's a very clear trigger.
Like, for example, if you know,or starting a new job, or it's
the first day of schooltomorrow, or maybe we're going
on a first date, right? Likeit's natural and normal for us
to feel kind of anxious, alittle uneasy and worry about
that. And that anxiety issomething that everyone
(03:20):
experiences pretty much acrossthe board. And so I wanted to
differentiate normal and commonanxiety from anxiety disorders
for people.
Sure, and most people honestly,and generally speaking, don't
meet criteria for a lot ofanxiety disorders. You know,
usually it's an adjustmentdisorder if there's a situation
(03:42):
or circumstance and there arealso healthy levels of anxiety,
it can keep us on our toes, itcan keep us alert, and it can be
very helpful sometimes. However,what I have found the
differentiation there is whensomeone has been experiencing
constants symptoms and excessiveworry, which is one of the
cornerstones for generalizedanxiety disorder, it needs to be
(04:04):
lasting at least six months ormore. And if someone's coming to
me saying, I've tried this, I'vetried that. I am excessively
worrying about XYZ on a dailybasis for six months, that's
when they're going to be meetingmore of a criteria for
generalized anxiety, or panicdisorder, OCD. So the timing is
very important. And it's likeyou said, it's important to
(04:25):
normalize anxiety too. We allhave it, I have it sometimes,
you know, it's completelynormal. And we need to validate
that for people. So they're notoverthinking Oh, I'm sick,
something's wrong with me.
Because most times, it's justsituations or circumstances. So
that timing that six monthtiming, I think is very
important for people to know.
(04:45):
Absolutely. And I think a bigpiece of it as well is that
typically when there's like anormal level of anxiety or just
like the general kind thatpeople experience all the time
is that when the trigger or whenthe situation is done That level
of stress it leaves, right likeit's no longer present it
subsides versus GeneralizedAnxiety Disorder, or panic or
(05:08):
maybe OCD that stays with us,like you said, an excessive
amount of time. And there'salmost irrational or an over
exaggeration of the experienceinternally, in proportion to the
actual situation, right. So wewant to be able to kind of
compare and what a reasonable orproportionate amount may look
(05:28):
very different for a lot ofpeople, but I think you're
saying the timeframe. And alsoif it doesn't go away, or if it
doesn't lessen as the situationleaves, then that's a pretty big
trigger for us to recognizethat, okay, there's something
deeper going on here for theperson,
right, and it has to reallycause significant impairment in
(05:48):
many areas of our lives. Forexample, in our occupation, or
in our personal life, if it'scausing such severe distress,
then there is something a littledeeper going on. And, again, the
frequency, the intensity and theduration are all important
factors to keep in mind too. Oneof the common factors when it
comes to panic disorder, theperson needs to have two
(06:11):
unexpected Panic Disorderswithout any trigger anything
happening over again, a periodof three to six months. Because
sometimes, you know, especiallywith COVID, for example, I saw
an increase in anxiety. Butagain, a common theme, there was
the unknown, we didn't know whatwas happening, and it was
uncertain. And sometimes ourtolerance levels to discomfort,
(06:32):
uncertainty play a huge role inanxiety.
Absolutely. And I think theimportant part for people to
know the difference between likean anxiety attack versus a panic
attack, is that anxiety attacks,there's almost like a gradual
build up. And it's almost alwayssurrounded by you know what the
situation is, you know, whatyou're getting anxious about.
(06:55):
And there's a build up, and youknow, and you're trying to move
through it, and it can feel, youknow, debilitating, but you can
still understand what's kind ofhappening to you, versus a panic
attack. A lot of times forpeople, it may feel like they're
dying, or they're having a heartattack. And it's, it's almost
like an out of body experiencewhere there's a high level of
(07:17):
almost terror, where you feelcompletely out of control. And
the onset is almost immediate.
So I think that's a bigdifferentiator for people who
might be experiencing anxietyversus panic.
That's a very common questionI've gotten asked recently is
the difference between anxietyattacks and panic attacks. And
the way I also try to describeit is anxiety attacks, we like
(07:40):
you said, we know what'shappening, the trigger is there.
And it's not so much aphysiological response compared
to the panic attack where youcould have, you know, your heart
racing, dry mouth, upsetstomach, for example. And it
completely comes out of nowhere,like there's no trigger, nothing
in your present moment is makingthis happen. So to me, that
(08:02):
indicates also deeper,internalized stress, and things
that we're not dealing with,perhaps we suppress them. You
know, sometimes I've noticedpeople who tend to avoid a lot
or have an avoidant attachmentstyle, can sometimes experience
panic attacks, because a lot ofthings aren't getting addressed.
So when I treat panic attacks orpanic disorder, I'm really
(08:24):
getting to the underlying issuesof what's stressing you out and
then working on stressmanagement techniques. And once
we get that stress undercontrol, and again, self
awareness, there is key. Yeah, agradual decrease, or the
frequency or the intensitydecreases.
Yeah, and I can see, there'sgoing to be a lot more
(08:45):
frustration and avoiding a lotof maybe social events because
there isn't a clear trigger, orthere isn't a clear link to why
someone might be experiencingthis, which could feel even
scarier, right, like we have nocontrol over this versus people
who may have anxiety disorder,or anxiety, panic attacks is,
you know, what is kind oftriggering you or you know, the
(09:06):
circumstances of the situation.
And we're more likely to avoidthem, or isolate, like that's an
active decision, because we knowthere's like a cause and effect
versus really not knowing what'shappening.
And it's really kind of aprobability issue too, because
people are prone to that socialanxiety, OCD, even ADHD, we have
(09:28):
this interpretation or almostthis confirmation bias like,
well, I don't want to go becauseI am not comfortable with the
unknown, or I don't know what'sgoing to happen. Feeding that
thought process in the braineven more. So. A little
education for people is, is anoveractive amygdala and cortex
is what is feeding thesethoughts. And so what do we know
(09:51):
that we can say, Okay, I'minterpreting this a certain type
of way. If I feed into it, thenthe worry is going to be even
more extreme. But if I change myinterpretation a little bit, I
can say, you know, instead of, Ineed to know what's going to
happen, I can't tolerate theunknown, what we can maybe say
is something like, you know, Ineed this opportunity to learn
(10:14):
how to tolerate uncomfortablesituations. So again, you hear
the difference, we're saying,like, I need the opportunity to
be heard, because again, theprobability that something may
happen is relatively low. Youknow, it could be high, but we
still don't know for sure. Andthat's something that we really
work with a lot is trying to getpeople to open themselves up to
(10:38):
the possibility that theirinitial confirmation bias
thoughts may not be accurate. Sotherefore, because we don't want
to hold people back or for orhold themselves back from.
Absolutely. I love that you saythat because it's really
challenging our thoughts andbeing more realistic and having
more of an open mind of all thescenarios that could happen,
(11:00):
right? I say, and I've struggledwith anxiety, especially social
anxiety a lot in my life is thatwe imagine the worst case
scenario in our mind, and thenwe feel it in our body. And then
we imagine what that's going tobe like to move through that
right? I don't want to feel thatdiscomfort. I already felt what
it's like in my body. I'm good.
Yep, right, versus being like,Okay, that's a possibility. It
(11:23):
could happen, right? It's notzero chance it could happen. And
is there something just aslikely or more likely to happen
that either nothing bad willhappen? Or I'll actually have a
good time or a positiveexperience? And what will that
feel like in my body, so atleast allow ourselves to see and
understand different options.
(11:46):
And I think a big part isfeeling it in our body is like,
kind of like visualizing, andgrounding ourselves in those
senses as well.
Absolutely. And it's learninghow to trust yourself a little
bit more instead of trustinglogical thoughts that have
possibly prevented you fromenjoying life or having certain
experiences. So one of thethings I really try to normalize
(12:10):
and validate for people is lookfor the most tiny baby step
opportunities you possibly can.
And then work from there,because sometimes people want to
jump to, oh, I need to go tothis huge concert, but I'm tired
of being around a ton of people.
Okay, well, maybe just start bygoing to a coffee shop, maybe
just start by having somebodyover your house, gauge how you
(12:34):
build your tolerance, you know,and again, change the way we
approach anxiety, rather thanlike, trying to say no, don't be
anxious, don't be anxious,because that just makes us more
anxious.
Sure. It never works to say,don't feel this feeling. If it
was that easy, we wouldn't befeeling it right. If there was a
switch,we'd be out of a job if I told
people Hey, cool, they're allbetter. And it's just on the
(12:58):
brain so powerful. And once wedevelop those thoughts and
strengthen those thoughts in thebrain, that's what's telling us
is our reality. Yeah, whenagain, we're just strengthening
unhelpful thought processes,for sure. And I like how you
said, kind of exposing ourselvesslowly to some of these things.
Right. So it's building thatwindow of tolerance. Yes. So I
(13:21):
think there's different levelsbetween discomfort, a comfort
zone and like dangerous, right?
Like, we don't want to putourselves in dangerous
situations that are super risky,just for the sake of, you know,
pushing ourselves that's not thepoint. And, you know, sometimes
we want to be in a level ofcomfort so that we can sooth
their nervous system, but wedon't always want to stay in the
(13:44):
comfort zone, because then wedon't necessarily grow, we
isolate, like you're saying weprevent ourselves from
experiencing more. So it'sreally kind of playing and
testing with the discomforttolerance window. Like pushing
it a little bit further andfurther and seeing okay, this
was really uncomfortable. Itwasn't a great feeling. But I'm
(14:05):
not hurt. I'm still safe. Imanaged through it. Like that's
a really big deal that I evendid this thing. Let me see if I
can keep doing the same thinguntil it feels pretty normal,
and then extend that window somemore.
Exactly. And I love that youbrought that up because that's
one of the main treatments withOCD is the exposure prevention
therapy. So you expose yourselfto a triggering stimuli, and you
(14:29):
gauge you rate on a scale howdiscomfort or comfortable and so
we can use those numbers as atangible treatment plan to say
okay, this is where you're atwhen you expose yourself to this
stimuli. Let's do it again in aweek and see where you are with
the same exact stimuli. So,exposure again in theory over
(14:49):
time, should decrease the levelof discomfort and increase your
sense of self increase yourconfidence, increase your
ability to withstand beinguncomfortable because like you
said, you're not in any physicaldanger, we are not putting
clients in any type of unsafesituation. Like I said, my
exposure stimuli is very smallbaby steps. For example, I had a
(15:14):
client who was diagnosed withOCD. And we work together for a
long time, like couple years.
And this person got to a pointwhere they were able to identify
not calling somebody to getvalidation for an obsessive
thought. And when they realizedthis, it offered so much
positive reinforcement to them.
(15:34):
And it gave them thisincreasingly sense of self and
feeling proud of themselves thatthey sat with it on their own,
and they did not reach out tosomebody else. And it was such a
pivotal moment. Again, it wassomething so small, but it like
it was so significant, it was ahuge progress. And that was the
(15:56):
catalyst to decreasing symptoms.
And again, it's, it's all aboutthe client and them doing all of
the work. And us pointing thatout, like, hey, yeah, we gave
you this suggestion, but you diddo the work. And that that helps
people immensely. And it'sreally awesome to see it happen
in sessions too,for sure. I mean, it's super
rewarding, like, you're sayingit sounds small, right, or
(16:18):
trivial, but the meaning behindthat, and how impactful that is,
like that person now gained thislevel of confidence, and self
reliance, that may have not beenpresent before to ease some of
that stress and anxiety. Yeah,and I think a big part of
individuals feeling superanxious, particularly in
(16:38):
relationships is this constantneed for reassurance and control
that it then becomes projectingonto others, and it becomes
everyone else's responsibilityor job to ease their anxiety.
Which, yes, sometimes we needthat support. And we need that
validation. Because we're socialbeings, right? We need other
(17:01):
people. And that can't be ouronly source of self soothing, or
being able to decrease anxiety,because then we give all give
away all our control, and thenwe feel helpless. And that's the
worst place we really want to beas a feeling of helplessness.
Well, exactly. And you'retalking about too the difference
between enabling a behavior andbeing a supportive spouse or
(17:24):
partner. Yeah. So sometimes witheither OCD, anxiety, ADHD, a lot
of times it interferes with acouple system, communicating
conflict resolution, being ableto talk through something a lot
of misinterpretation happensthere.
So much, yeaAnd a lot of people will tend to
either withdraw or they react,and depending on the level of
(17:44):
that reactivity, or withdraw,can cause a lot of tension build
resentment over time. And so wehave to do a lot of reframing
with that like, instead of acouple of say, a couple, someone
that has OCD and the otherpartner doesn't. One tip is
okay, let's identify the OCDbehaviors, let's, let's identify
their traits, theircharacteristics, let's point
(18:06):
them out. So that way, thespouse is not enabling them, or
being a quote unquote, parent tothem, and, you know, they can be
supportive and say, No, hey, wediscussed this, this is an
opportunity for you to buildyour tolerance, I can be here to
support you. But this issomething that I need you to
(18:26):
cope with, and utilize, like anytype of, you know, coping tool
that they may have learnedprior. But again, we're building
resiliency here at the sametime, and that's a big component
in this in treating anxietydisorders is resiliency.
Absolutely, and having that backand forth understanding, because
(18:47):
I think sometimes whenindividuals are in the throes of
anxiety, right, where it's, it'sreally it can be really
debilitating, and it can feelall consuming, well, then we can
be really stuck in our ownexperience of the anxiety and
not recognize what it may belike for a partner, a family
member, a friend, a co workereven Right, right. And so it's
(19:08):
recognizing, like, Yeah, I'mhaving this experience, it's
very uncomfortable. And thisother person is here, and why
aren't they doing the thingsthat I need them to do, but that
other person also has their ownexperience, and they may or may
not know how to support you, andit's not necessarily their job
to make this feeling go away foryou.
Not at all. And that's somethingthat I'm pretty blunt and direct
(19:29):
about in my sessions withcouples particularly is it is
not your partner's job to parentyou. It is not their job to be
responsible for your own mentalwell being. Big difference
between offering support andvalidate or offering reassurance
when they need it. Sure. But wehave to, the individual, you
know, we have to work onourselves before we can work on
(19:50):
the relationship. And one thingI'll suggest to, let's say
partners without the OCD orwithout the anxiety disorder, is
really trying to refrain fromblaming language. Like, or it is
always causing us to get intofights or your OCD is causing us
to, you know, not enjoy life.
While instead of that, you know,maybe using an I statement,
like, I see you're struggling,you know, what can we do to make
(20:11):
this experience better? How canwe work together as a team?
Again, you hear people hear thedifference between you're doing
this, that causes ffensive rightaway, but back it up and say, I
see you're struggling, I seeyou're having a hard time,
right? You love this person,this is your best friend. And I
know it can be frustrating. Butthat's where I think individual
(20:33):
and couples therapy can beextremely beneficial to create
knowledge to offer education andbe like, Hey, this isn't them
just, you know, being annoying,or, you know, wanting to fight
for no reason at all, let's geta handle on this first and go
from there.
Absolutely. And that's why Ithink it's so important is
because even though in couplestherapy, you're kind of working
(20:55):
with each individual, you can'tspend the whole session on
helping one person cope, right,it's how is this couple managing
this and navigating thistogether. And so that individual
therapy is going to be socrucial to have way more time to
process, find insight, findawareness, and develop coping
skills that you can bring to therelationship or to the couples
(21:18):
therapy, like, Hey, these arethe things I've been working on,
I'm really trying, it's notgoing to be perfect, you're not
going to get it right everytime. But like, let me know when
you see that I'm not doing it orhelp me or pointed out when
maybe if I'm doing it right, orif I'm not doing it the best
way, it's directly keeping yourpartner accountable too
and that and again, justpointing out positive progress,
(21:40):
Hey, I saw you were struggling.
But I also saw you workingthrough it. And I really
appreciate that. And the otherpart is saying like
acknowledging that appreciation,and just being very mindful that
their partner is also just asimportant. Even if I'm the OCD,
they don't have anxiety at all,there's still stress, right? And
we So stress management comesinto play. So I might tell a
(22:02):
couple, hey, I know this, youhave OCD, and you don't. But
let's talk about stressmanagement, because I'm sure
that impacts the both of you.
And then both of them use thattogether. And they positively
reinforced that together, thatmakes progress honestly, so much
more quick.
Absolutely.
Now, again, it's not an easyprogress process at all. It's
(22:24):
time consuming. I tell peoplethat at the beginning, you know,
we're trying to rewire thebrain, that [takes] lot of
mental effort and can beexhausting. So that's where a
lot of self care strategies comeinto play also,
and even with that, right,there's a lot of repetition that
has to happen. And a lot ofreinforcement of particular
(22:44):
behaviors over and over again,with the reaction being a
positive one as well, that tohelp us rewire that too. Because
I think a lot of times when anindividual is anxious, the
reaction of their partner canalso stop them from being
honest. Or it can stop them frombeing more forthcoming or doing
particular behaviors, you know,based on maybe the way they were
(23:07):
raised or their familyenvironment when someone made a
mistake, right? So it's alsounderstanding the way that you
react or speak to your friend orfamily or partner who may be
more sensitive to that, rightcan also kind of enable them
from being honest and open withyou. When they have anxiety.
Absolutely. It's it's voicetone, it's like you said family
(23:31):
of origin plays a huge role inthis, you know, how did you
learn to manage conflict oranxiety or talk about emotions
growing up, which is a big thingwe talk about at couples
therapy, and it really doesincrease a person's insight and
awareness and can also havepeople be more sympathetic
towards each other. Again, it'sit's tough to do that it's tough
to rewire the brain, you know,but I mean, it's definitely
(23:52):
doable, if you takeaccountability, if they have a
willingness to want to work onthe relationship. And if they
genuinely want the relationship,those are the three things
whenever people check thoseboxes. That's why therapy also
being the most productive andthe most successful,
because both people have to bein it
Exactly. But I do see a lot oflike the OCD and ADHD have have
(24:17):
sometimes been some of thebiggest barriers in a romantic
system. You know, that theworry, it's time consuming,
people get flustered easily. Ithink that's something we have
to be mindful of when workingwith couples is just the
intensity of where they're at.
And so I wanted to ask you, ifyou can kind of dive a little
bit deeper into OCD, but alsowhat Pure O is in OCD? Because,
(24:41):
you know, I've been seeing moreof that and that it's, you know,
from my understanding and fromsome of my training, I don't
have a bunch of experience withindividuals with OCD, but that
there's usually a behavioralcomponent that goes with
intrusive thoughts when theversus kind of the pure Oh, is
just that there's the interestSome thoughts but we don't
necessarily see the externalbehavior. Is that right? Or if
(25:03):
you can kind of dive more intothat.
So a lot of newer research hasindicated that with Pure O or
like OCD, it's not justobsessions. And it's not just
compulsions, they're kind of gohand in hand. Right. compulsions
are not simply just behaviorsanymore. We can have compulsions
about thoughts. So the two areintertwined together like this.
(25:27):
So with Pure-O, I think theobsession really is an
overactive amygdala and anoveractive cortex, which again,
like this is for our listeners,this is something that you can
look up on the OCD website, oryou can look at this book called
Rewire the OCD Brain byCatherine Pittman and William
(25:49):
Young great book. It gives a lotof really good examples of how
to rewire our thoughts, but alsogives a lot of education. So
when it comes to Pure O andobsessions, again, I look at
have these been so intrusive inyour life, that they have caused
significant impairment anddisruption to your activities of
daily living? If so, let's takea closer look of what that
(26:12):
means.
However,let's say it's a circumstance,
right? Someone just lostsomeone, for example, you know,
and they're having a very hardOkay.
time and they might be obsessingover the past history. I don't
Yea,But it does become this just
unexpected excessive timethink that's Pure O or OCD. I
think that's a circumstance.
(26:33):
consuming worry, and theinability to get unstuck. So
we'll call this sticky thoughtsis and ruminating thoughts.
Perfectionism, for example, is abig one that I hear a lot.
People if they can't, like,they're so perfect at work, for
example, but they may be late toa meeting or a party because
(26:54):
they have to prepare for so longfor this. So again, that's
causing severe impairment intheir life.
Okay. Yeah. Cause I wasn't sureexactly of the difference with
the Pure O, because I feel likeit's, it's tough. And this is
why it's really important forindividuals to have very
specialized therapists orpractitioners with OCD, if
that's something they'restruggling with, because so many
(27:16):
symptoms can overlap withgeneralized anxiety, that it may
be hard to tease out and I feellike the treatment is going to
look different.
My treatment for OCD, there isoverlapping treatment plans for
OCD and Anxiety. But when itcomes to OCD, specifically, it's
way more of the exposureprevention therapy and exposing
(27:37):
us and learning about thoseruminating thoughts a lot. And
then with generalized anxiety,it's it's excessive worry, but
it's not time consuming. Soagain, this might be redundant,
but I can't emphasize enoughthat time consuming is a
differentiating factor with OCDcompared to generalized anxiety
(27:58):
and panic disorder. So we haveto identify those obsessive
thoughts and see what's feedingthem. First and foremost, you
know, kind of also like changingthe interpretation, like I was
mentioning earlier, and thenidentifying the theme, is it
perfectionism? Is ituncertainty? Is it fear? Is it
you know, contamination, what itbecause that differs from
(28:21):
generalized anxiety, those thosethemes in my experience,
and I think with at least how Ilike to work with individuals or
couples who have generalizedanxiety or social anxiety, right
is really finding more of thatinsight, first, of kind of going
back in time to seeing when elsedid you feel this way? When else
did you get these messages orthese beliefs around these
(28:43):
circumstances or thesesituations? And kind of finding
those links? And understandingthat because it happened before
does not necessarily mean thatthis is the same now. Right? And
your interpretation, right is,how can I interpret this
differently? What is thelikelihood, right? Am I just
assuming, because a lot of thetime, we're going to be
(29:04):
assuming, then creating anarrative then believing the
narrative and then behavingbased on the narrative when the
other person or other situation,no clue that that was an
experience you had until youchecked in with them.
Exactly. So I think a bigdifference there is what again,
with anxiety and OCD is thatwith the anxiety, the Insight is
(29:27):
a little bit better. Andsometimes insight with OCD, at
least at the beginning, fromwhat I've seen, like beginning
treatment, I should say, Insightis sometimes poor to fair,
generally speaking, again, notall the time, but it depends on
where a person is in their lifeand in their treatment. If
they're at the very beginningstages of treatment. They're not
(29:47):
sure if it's OCD, they're notsure if it's anxiety. Yeah, I
asked how long this has beenimpacting their life for and
again, what has it where has itcaused the most distress? If
they say sometimes I'm I justhave sort of test anxiety, but I
get pretty good grades. Well,that's a pretty lackadaisical
response. That indicates to me,they're not too worried about
(30:09):
it. They're just aware, there'sa little bit of anxiety. Now,
sure, that comes to me, and Ican't take a test, I have failed
this. So many times, I have satthere and thought about the same
question over and over again.
And I was unable to think aboutanything else for let's say, two
hours, if that's what, that'show long the tests were to take.
That's a differentiating factorto me like, Okay, that's a
(30:30):
sticky thought you were unableto get unstuck from that,
compared to some ad, you mightbe, you might experience more of
like, like you said, like a bodysensation for a little bit. But
it was as much distress assomeone sitting taking a test
for two hours not being able tofocus on any other word, except
the first word they read in thesentence.
(30:51):
So that intensity and severity,duration frequency like this is
for audience members like thisis how therapists and
practitioners kind of assess andlook through these things is,
How frequently does it happen?
What's the intensity level, theseverity, and the duration of
how long that lasts for right,because those are really big,
important factors of being ableto assess which the assessment
(31:11):
is important for the fact thatwe need to now figure out the
best treatment plan for youspecifically, not just to give
somebody a label, right, Iactually don't actually care
about the label, I care moreabout what's happening and how
we can help you.
Exactly. And to be honest, OCD alot more rare than people
realize, like meeting thediagnostic criteria for
(31:34):
Obsessive Compulsive Disorder,it is not as common as
Adjustment Disorder withAnxiety. So a lot of the times
it does get a little concerningwith social media kind of
throwing out a lot of, well, ifyou meet this, if you have, you
know, xy and z, then you havethis disorder. And that's scary,
(31:54):
you know, that's really scaryfor people. So it's so good for
us to come in educate andnormalize a lot of behaviors. Of
course, like if there is adiagnosis and OCD diagnosis, it
is helpful, like you said, tohave a treatment plan moving
forward, and how to treat thembecause like I said, the
exposure prevention therapy iswhat I would use for OCD, but
(32:15):
not necessarily generalized orpanic disorder, or even like
ADHD, for that, for that matter.
And so I did want to spend alittle bit of time giving
audience members like concretecoping skills or techniques that
they can use for these differentwhether it's disorders or the
struggles and symptoms thatthey're going through that maybe
you like to use and that I usewith clients as well.
(32:38):
Yeah, I would say for for panicdisorder, I start with
normalizing what's happening,not panicking. When you know,
something like know your body ofwhat's happening, like are your
palms getting sweaty? forexample, is your heart starting
to race? Are you gettingnauseous, you know, okay, if
that's happening, remain remaincalm. Be still, walk to the
(33:02):
sink, walk to your bathroom,splash some cold water on your
face, put ice cube on the backof your neck. That can help calm
the nervous system and tellyourself, I know what's
happening right now I'm having apanic attack. And again, slowing
your inner dialogue has beenvery helpful. Because
oftentimes, when something scaryis happening to us, the mind
(33:24):
starts to race a million milesan hour. So have to be very
careful and cognizant of, hey,let's slow it down. Let's
imagine something slow, like aturtle, for example. And I've
mentioned this to clients likeit's, no, it's kind of funny.
But if we can visualizesomething slow, the mind is
(33:44):
telling the body it's okay tocalm back down. There's no
immediate danger. So that'swhere I, that's where I start is
self soothing techniques,calming the heart rate, because
your heart rate is going tostart to increase with a panic
attack. Because like you saidearlier, it can mimic a heart
attack, which is reallyterrifying. I've had a panic
(34:04):
attack before. And it does helpme to coach people through it a
lot easier after having herbecause I definitely saw that
increase, I think after thepandemic, and people not knowing
what was going on with them.
Right. So yeah, that fear of theunknown was a whole other layer
to exasperating the panic andcausing it to last longer than
it should, because we candecrease a panic attack within
(34:27):
you can start having it and itcan be over in 60 seconds, or
over in two hours. The durationvaries a lot. But as long as you
start to think slow, controlyour heart rate, breathe, again,
you put ice on your forehead oron the back of your neck that
can be extreme that coldtemperature. Cool to reset the
nervous system and offersoothing to the body.
(34:53):
Yeah, I love that. So I like tolet clients know it's basically
the same right is that when Whenour body has these symptoms,
where it feels unsafe, right,and when we feel unsafe, when
our nervous system feels unsafe,a lot of the time, we don't have
the capacity to challenge ourthoughts. So the first and most
(35:15):
important thing that you can dois how can I send the message to
my body that I am safe, that Iam okay, and that I can just be
present, right? So so you'resaying slowing down, having
something cold, breathing,especially for a panic attack,
I've had them too, it is not agood time, like you literally
cannot breathe, which ishorrifying within itself. And so
(35:39):
it's literally just focusing onI need to catch my breath, I
need to slow my breath. And Ineed to count my breath. That is
your only job is to focus oncalming down your nervous system
enough where you feel safe.
Yeah. And then from there, onceyou feel safe, and you've calmed
down, then you can kind ofprocess then you can kind of
challenge some of those thoughtsafter the fact. Right? I don't
(36:00):
like to let clients go into thatfirst, because you're just kind
of amping up the anxiety.
Yeah, right. We have, we have toget physiological symptoms under
control before we can startemotionally processing. Because
we're so terrified, and they'rein that fight or flight position
in the body is telling us thatwe're in danger. It's gonna just
(36:22):
exasperate things. And we'relike, Well, how does that make
you feel? Like, I'm never goingto tell somebody that was? No.
Like, I'm horrified. What do youthink?
So I love what you said, likeget the symptoms under control
first and process after becausea lot of times people will come
and they're like, I don't evenknow what triggered me. It
literally came out of nowhere.
But that gives us a really greatopportunity for self discovery.
(36:45):
When people ask me, I don'tknow, I'm not sure. Who will
let's use that as a great momentto like, discover, like, what's
beneath the surface?
Mm hmm. And that is I love that,because that's what I like to
ask clients when they come inwith anxiety or depression is
how do you know you'reexperiencing it? Which may sound
silly, because like, I'm alwaysin it. But how do you know that?
(37:08):
Right? Like, what are all thesymptoms? What are the thoughts?
What are you feeling in yourbody? So that you become more
aware and knowledgeable of yourpersonal experience so that next
time it happens, like, oh, okay,I'm starting to feel anxious.
This is typically what happens.
Now I can kind of assess myenvironment or my internal
thoughts, what are associatedwith this experience, right now
(37:30):
that I can then process laterandgo back to?
Well, exactly, and you'reslowing it down. To me, that's
been some of the most helpfulthings that I've received
feedback from clients lately isbeing mindful and aware of
what's happening and just takingthe slow route. And you can come
(37:51):
up with your own internaldialogue, but like, literally
slowing, the way you talk toyourself, because if you when
you start talking that way, youcan feel the body starting to
slow down. Because when we'retalking fast the body is like
playing catch up with that.
Yeah, I like that, because itkind of pairs with the rest of
(38:12):
our sensations, right? Becauseit's kind of controlling if I
kind of pull this lever thanthis lever will kind of change
appropriately or reactappropriately to this. Right,
right. So going through all oursenses. So sometimes, like even
myself, or some clients, likeokay, I know I have anxiety, I
recognize what's happening, Iunderstand what the triggers
are, I still feel uneasy, right.
So it's like having theawareness is phenomenal. It's
(38:36):
the first step, but then it'slike, and now what? which can
feel frustrating too. So I liketo have them before they're even
anxious, right? like whenthey're already in a calm state
is to establish a place in theirmind of somewhere they may have
already been or that they cancreate is where is an
environment that you feel themost safe and calm and at ease
(38:58):
and I want you to visualize it.
And through the visualization, Iwant you to hear the sounds, I
want you to smell what's goingon around you. I want to I want
you to experience the sensationsand feelings on your body and
against your body. And if you'reeating or tasting anything, I
want you to fully immerseyourself in this super calm,
(39:21):
peaceful state that you can thenpull to later as a way to self
soothe yourself anywhere,anytime without anybody. Because
I think it's powerful for peopleto have that that they can pull
from anytime it feels likeyou're less out of control and
more aware of what you can dofor yourself.
(39:41):
Well, it's so soothing even likeas you were describing and
taking that step by step it feltso soothing, like hearing you go
from Hey, what are you smelling?
What are you seeing? And for ourlistener, basically we're
describing like guided imagery.
That can just be such a greatvisual and a great relaxation
and Soothing tool, like yousaid, Think of any peaceful
(40:02):
environment that you possiblycan, or use your imagination,
you're changing the way youinterpret something. And, you
know, to kind of fall back onwhat you said earlier was you're
also discussing reality testing,and the kind of testing the
reality of your own thoughts,right. And sometimes when we
ask, Well, how do you know thatsomething bad's gonna happen?
(40:24):
You're assuming at the end ofthe day, and that assumption can
be a dangerous game. We allunderstand that sin. But it
really is just getting to aconscious place to be ready to
make that decision. Becausesometimes people what I have
learned in my experience ispeople get comfortable in
anxiety, they get comfortable ina depressive state, even Yeah,
(40:48):
it's familiar territory. And thefear pops in because they're
afraid to get better. Whathappens if I have a setback?
Again, do you hear like, thewhat ifs, what-if is a common
factor with anxiety disorders,even depression. So again, if we
can change the way we interpretthings, we can catch that What
if we don't have to feed it.
Easier said than done for allthe listeners really understand
(41:10):
that, but I wouldn't say thosethings if I haven't seen the
workfor sure. And I think that's
such an important feature isthat what you mentioned is
getting comfortable in theanxiety and almost holding on to
it because I think this happensa lot too in treatment is that
someone will progress and theywill get better. And there'll be
(41:33):
this kind of signal like okay,like things are working pretty
well, we can probably see eachother less. And then all of a
sudden, it's like, oh oh, andmore comes back, or they start
unconsciously sabotaging thingsaround them. Because we're
scared of change, right? Like,it may sound counterintuitive,
(41:53):
like, oh, I want to get better.
Why would I do that to myself?
But it's, it's thinking like,what is the function of that?
Right? So like, if, if I changethat I can no longer rely on
certain things. And if I fallback on some of those things,
then, like you said, what couldhappen? Or I'm not going to have
the same supports? Or I don'tknow who I'm going to be? Or
(42:15):
what am I going to spend my timethinking about? Or maybe that's
part of my identity. So now howdo I show up in the world, if
I'm not an anxious person, andeveryone around me kind of
caters to that a little bit.
And that's, and that's a lot,right? spiraling around in our
brains on like on a daily basis,what if this happens, you know,
(42:36):
if I get better, and then I slipup, or this or that, what I'm
like, I'll tell clients, Iexpect that to happen. Because
means at the end of the day, itis not going to be perfect. In
terms of mental health. In myclinical opinion. Perfectionism
is an illusion. And I trulybelieve that from a mental
health perspective, I know wecan perfect math problem, for
(42:58):
example, would brains notperfect, we have to make
mistakes in order to grow inorder to learn. But a big theme
there is also inviting theconcept of accepting that and
what that acceptance piece mightlook like. Because once we
accept the fact that we can makemistakes, and we can tolerate
(43:19):
making mistakes, then again,we're changing the way we
interpret it or approach asituation. And I think it can
offer us new experiences, newmindset, takes a lot of work to
get there. Don't get me wrong. Ihave seen people get to that
acceptance piece. And it hasbeen a significant change.
Again, there's always going tobe setbacks. But it's our
(43:42):
therapists and normalize thosesetbacks, because they continue
to be proactive in their mentalhealth, they continue to call
out and make an appointment,let's say if they had a setback,
and they're willing to processit in session. That's a huge
difference to me. And in that inand of itself, I think is very
significant progress, too.
Of course, and I think,especially with perfectionism,
(44:03):
when you say that is it'sinteresting, I almost love
working with clients who haveperfectionism, because it's not
about the actual thing beingperfect, right? Like, what are
we avoiding happening by youbeing perfect, right? Is it the
identity or sense of being afailure? Is that how other
people are going to view you?
And if they view you that way,what does that mean? What are
(44:24):
the negative consequences tothis? Right? Like, I think
people focus on just the act orjust the the purpose of what
they're trying to do to beperfect, and not really
processing and thinking aboutlike, if I'm not then what
happens? like what is it thatI'm really scared of or trying
to avoid? That if I were to justface that, process that and work
(44:45):
through that and accept thatthis part because it's a lot of
work to be perfect, and we neverget there. Right? So it is a
constant struggle. It is aconstant uphill battle that we
will never win, right. And Ithink people know they'll never
win, but they're still going tostrive because at least they
feel like they're workingtowards it. Right and avoiding
(45:07):
that feeling of whether it's afailure or the relationship or,
you know, someone thinking aparticular way about them. So
it's, it's huge to have thatnormalized. And, like, I kind of
love the family dynamic of it,it kind of pulls back is like,
who in your life? What situationmade you feel like you had to be
this way?
Is this a generational learnedbehavior? You know, did your
(45:30):
parents put a lot of pressure onyou as a kid to perform, for
example, and learned to again,perform at a certain type of
level in adulthood? What did youlearn about how to interact with
individuals, romantic partners,for example, but the
perfectionism is probably one ofthe most common traits that I
see a lot with OCD. Because,again, another huge theme is
(45:54):
that fear of being judged fearof being disliked fear of being
uncomfortable experiencing guiltor shame. And again, the
tolerance is so low that eventhe thought of making a mistake
can send people into a downwardspiral. And it kept them from
going after that interview thatthey've been wanting for a long
(46:14):
time. It might prevent them fromhanging out with some friends
or, you know, going on a date,for example, because again, it's
the fear dictating this. So Itried to frame it and ask
people, What is it that we'relistening so much to the fear
aspect, and that's what I'mvery, very curious about. I'm
been working with that for awhile now trying to understand
(46:38):
that a lot more of how fear isdictating our our conscious.
Yeah. And I feel like fear andshame and guilt, just like lay
at the surface, like at thebottom of the ocean, right. And
they're just like, such anunconscious, huge influence on a
lot of the things we do that wedon't even recognize half the
(46:58):
time until we take a step backto be like, I'm actually
terrified of all of these thingshappening.
I think about what it's like toeven admit that to ourselves.
Yeah, that can be in and ofitself a huge step, when we can
admit that it's fear kind ofdictating this. But then a good
Another good tool to use issometimes using a cost benefit
(47:21):
analysis. And ask someone, okay,if fear is present, what are the
benefits to letting go of thatfear? And and let's say reaching
out for that job, give me thebenefits, and then I'll ask
them, give me the cons. What arethe reaching out to that job?
While I might not get it, andthat might make me feel like
(47:42):
even more of a failure? We don'tknow that for sure, though. You
know, so let's, let's maybechallenge that and do a little
bit more reality testing there,or a little bit more cognitive
restructuring there. Yeah, youcould get turned down. But that
doesn't mean you can't move onand try something else. Because
that's building resiliency.
That's building tolerance,that's building bravery and
(48:03):
courage to step out of yourcomfort zone and say, Okay, I
accept that I did not get thatjob. But you know, what, I am
qualified. And I know I have theskill set. And I can do this a
lot of positive reinforcementand a lot of like, positive self
talk. It's not the answer toevery thing. But it can go a
long way.
For sure. And I think that's,it's so huge. And I like how you
(48:27):
bring them both to the surface,because they're both real,
right? Like all of thesefeatures are real and do exist,
when it's, I think it's alsohaving people recognize that the
amount of time we spend worryingthat something bad will happen,
and our limited ability tohandle that situation is so
(48:50):
disproportionate to what isactually happening, right, the
chances are much lower, and ourability to overcome and are much
higher. So I think pointing thatout for people and building that
acceptance and confidence thatlike, Okay, this is a very real
factor, this bad thing or, youknow, negative thing may happen.
(49:10):
And if it were to happen, howcan I feel confident in myself
to move forward anyway? so thatthat's not the factor or the
barrier, the holding back fromeven trying
Right? It like I love that usethe word, that barrier. Because
that's what I have found, like,what is holding you back like,
and even with couples, I'm like,what is the barrier happening
(49:30):
here that's causing, let's say,a disconnect between the two of
you? What's there, and that's agreat place to start exploring
and finding those maladaptivefunctions that are just serving
this horrible purpose within afriendship of family. So I think
I just think it's very importantto be mindful of how we approach
(49:52):
things, what we tell ourselvesthe inner dialogue, and also
learning to accept ourlimitations. and using those
limitations, though, to ouradvantage, if we know, if we
know the brain's limitations, wecan totally use that to our
advantage.
Absolutely. I love that. And asyou were talking about that
(50:13):
something came up for me,especially for couples with,
like barriers or maladaptivekind of behaviors, is I think
that even when we have thesecoping skills that maladaptive
for audience members, like,you've figured out a way to cope
with it, but it's notnecessarily healthy or helpful,
but it's a way that you learn tofunction and move through it,
because you needed it at acertain point is that it's also
(50:36):
a grieving process to releasethat particular coping
mechanism. So you can invite anew one. And I think that's
really tough, too, is I have torelease this thing I've been
relying on for so long, eventhough I know it's not helping
and it's actually hurting whenwhen it feels scary, because it
served a function before. Soit's grieving that and allowing
(50:58):
yourself to invite in new waysof interpreting situations or
interacting with yourself orother people. So I love that you
mentioned that because that justlike came up for me, and I just
wanted to share it.
Awesome. No, I never thought ofit in a sense of grief and loss,
when we're losing the way wetypically do things. And to be
able to incorporate somethingnew, of course, there's going to
(51:21):
be some resistance, right? Whyis that piece of resistance,
because it's going to happen, Iexpect it to happen. But being
able to incorporate, Hey, it'sokay, to be defensive, or to
feel a certain type of way, whenyou're no longer reacting, how
you typically would, you'rechanging, you're doing something
different. And that might feeldefeating, sometimes, it might
(51:43):
not feel like this person isgonna get one over on me, if I,
you know, don't stand up formyself for screaming. That can
be hard. But again, did the prosoutweigh the cons in that
scenario, that's where I just Ilove that benefits and cost
analysis coping mechanism,because again, you can see it,
you can write it down, it's agreat visual aid for those
(52:06):
visual learners. And again, whenyou're writing stuff down, and
you're reading it, your brain isremembering it more, and it's
comprehending it double comparedto just once,
for sure, or even just readingit as like the physical act of
you writing it. That's whyjournaling is so powerful too is
that you can your everything isconnected for you to get that,
that message across andengrained a lot more longer, a
(52:29):
lot more permanently.
Absolutely. And it sticks. And Ithink couples can see that when
things stick. And when they'repracticing together. And they're
giving each other the benefit ofthe doubt, can go a long way
when trying to change behaviorswithin your system that can go a
long way with your partner beingmore willing to change when they
(52:51):
see that you're helping themalong the way and giving them
that like, okay, you know what,you might have messed up a
little bit. But here's a littlebit of grace at the end of the
And you know what's interesting,so I've had couples where day.
they've gone from really highintense arguments to, like high
intense, it's drawn out so muchenergy is spent to having a
(53:12):
really respectful and productiveconversation that doesn't last
very long because they get tothe point. And one or both
partners kind of feel likeuneasy about it. And so I'll ask
like, why does this feelstrange? And like, I don't know,
like, usually I can get all thisenergy, this pent up anger. And
now it's like, oh, you validatedmy feeling. That's it? What am I
(53:33):
supposed to do with all thisenergy now? So it's funny that
even healthy change, when westill have to recognize that
something different means thatwe have, there's a cost, right,
we have to release something inorder to receive something.
Because I think too, we cansometimes get so used to the
chaos. Chaos just becomes secondnature to us, sometimes, you
know, whether we're aware of itor not. And, again, it's a safe
(53:57):
space. It's a comfortable space.
It's familiar territory. So whena couple does get to that, that
point of, oh, we're having anice, we're actually talking to
each other and not screaming andyelling at each other. It just
feels weird. But it's good weirdat the end of the day, right?
Well, I like to differentiatebetween good weird, bad, weird.
And it's a nice way to kind ofincorporate humor into the
(54:20):
sessions a little bit and makelight of some things because we
don't always want it to be thisheavy, drawn out emotional
conversation. That's exhausting.
And you know, I think that thatpiece of humor with anxiety,
OCD, depression, couplestherapy, can can go a long way.
(54:41):
And sometimes we can even makefun of the symptoms. If we can,
this internal dialogue that oh,this is being, we can name it.
We can make fun of it. We cantease it. Sometimes it can
decrease it in its power over usin a sense.
Yeah, humor is such a huge, hugetool, and it's very healing and
(55:01):
I love bringing humor intosession. And I think that's kind
of why we jive well, too, isthat like, if you can't laugh at
or you can't find the sillinessor lightness in it, everything's
going to feel heavy. Yes. It'sso hard to do anything in life
when everything constantly feelsheavy. Like in the moment, it
might suck, but like, can we?
Can we talk about that storyafter the fact that laugh at
(55:21):
like, How absurd that was? Orlike, Oh, my God, I couldn't
believe I did that again. Right,like, so it's bringing that
humor. So I love that you bringthat up, too, because I think
that's such a huge piece in anyrelationship
Absolutely. If we can't laugh atcertain things, like even
myself, as a therapist, I mightsay something silly or fumble my
(55:42):
words. And I'll just laugh atmyself in session. And I think
it just humanizes us a littlebit. And it really, in my
experience has made clients feelmore comfortable. And I make
mistakes too. I'm yourtherapist, but I also make
mistakes. And guess what? It'sokay. I'm still here. I'm still
doing my job. And I hope thatshows that you can do the same.
(56:03):
And yeah, okay, and laugh atthat mistake and move along,
learn from it, grow from it.
Love it. Love these littletidbits, those are great quotes.
Great quotes, happy to talk. Icould talk to you about this and
like generally anything forhours. But I know we've
definitely come closer to anend. So I really want to thank
you so much for your time forsharing your insight and
(56:25):
knowledge with us. I hope thelisteners got a lot of great
information. So Joslyn, thankyou so much for being on with us
today.
Absolutely. Kira, thank you somuch as always for having me on
here. And for our listeners,especially those with OCD. If
you want to check out the book,Rewire my OCD Brain, it's a
really great resource to have.
There's a lot of great copingtools education in there. So
(56:46):
check it out. It's a great bookand I hope everyone's well and
enjoyed this episode.
Awesome. And just so listenersknow if you want to work with
Joslyn, whether individually oras a couple she's accepting new
clients right now inPennsylvania and Delaware. So
you can head over to ourwebsite,
HealYourRootsWellness.comschedule a consultation and we
(57:07):
hope to hear from you soon.
Thanks so much, everybody.
Thank you
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