Welcome to nevertheless, you persisted.
I'm your host Sadie, every Friday.
I post interviews about mental health, dialectical behavioral
therapy and Teenage life. These episodes break down my
mental health Journey. Teach skills to help you cope
with life and showcase, testimonials from teens, just
like you whether you've struggled yourself or just want
to improve your mental Fitness, this podcast is your inspiration
to live a life you love and keep persisting.
Hello everyone and welcome back to another episode of she
persisted today. We're talking all about anxiety
and exposure therapy. P.
This episode is one that I've been wanting to do for a really
long time because exposure therapy and coping with anxiety
and OCD was a huge part of my treatment and I feel like it's
applicable to so many people. So in this episode I'm going to
walk you through how to assess if discomfort and anxiety is
Justified or not justified. If it's not justified, how you
can use, exposure therapy to decrease your discomfort in
certain situations whether it's social anxiety, generalized,
anxiety, OCD Etc. And I go through all the tips
and tricks that I use to what I did in therapy.
Different ways you can apply this with your life and also
give some book recommendations around social anxiety and OCD.
So, without further Ado, let's get into it.
Okay, so diving into this anxiety.
Disorders is a class of psychological diagnosis and
beneath that is actually OCD which before I did treatment, I
never knew. I thought it was a whole class
of its own, but OCD is actually an anxiety disorder and to
explain to anyone who's unfamiliar what OCD is it stands
for obsessive compulsive. Disorder.
And so the experience of OCD can be divided into two different
components. One is obsessions, and the other
is compulsions. So obsessions, can often be
described as intrusive thoughts? That enter your mind, you can't
get rid of it causes immense distress to try and get rid of
them. And oftentimes, they're pretty
disturbing on they can be very overwhelming and again,
anxiety-provoking. So I remember when I was
struggling pretty severely with OCD, I would be sitting in a
room or at dinner with my family and I I have these thoughts that
someone was going to come to the door and break in and hurt.
Everyone around me or someone would come in and start acting
crazy and trying again, hurt me or my family.
I struggled a lot with the idea that I would do something that I
couldn't control. Like, I'd want example that I've
heard a lot in different books that I've read about OCD is like
you're standing in church and you're worried, you're going to
stand up and start screaming your head off and it's not a
logical thought, it doesn't make sense.
I didn't implant that thought myself and yet it's in my head
and it's distressing to get out. So obsessive thoughts again,
just to give a little bit more clarification here.
It's intrusive worries that people, including yourself, will
get hurt or injured really constant, overwhelming,
awareness of your bodily Sensations.
Whether it's blinking breathing, moving, all of that kind of
stuff and also things about your life and your relationship.
Like, maybe you think someone's going to betray you, you think
someone's lying to you these thoughts that again, you're not
necessarily creating yourself. There's not like a logical
step-by-step. You're like, okay, I saw this
person lie to me. And then I also have this other
part of an interaction that didn't add up.
Therefore I think they're going to betray me.
It's like you're sitting there. You're having a cup of coffee,
bam. You think that they're going to
betray you for no reason. So the second half of OCD
compulsions. So these compulsions are often
associated with the obsessive thoughts.
You have the obsessive thought, someone's going to come in the
door, so to calm that, thought and make it.
Ok, in my mind, I might engage in a compulsion whether that's
tapping, something a certain number of times, keeping
something in a certain, Order that makes sense to me, moving
things in a certain way, it's behaviors that are decreasing
that anxiety. And within your head makes
logical sense to decrease the threat that you've for back of a
lack of a better word to say it made up.
So I think one of the most common things that people think
of, when I think of OCD is cleaning and cleanliness so
something that can characterize OCD is super raw and red Hanson
Knuckles from over, washing your hands cleaning disinfecting your
house obsessively, having things Organized in certain obsessive
way. So really things relating to
checking contamination symmetry ordering and even thinking
thinking something, a certain number of times, ordering your
thoughts in a certain way, repetition.
And many of these things are habits that many of us engage
in, especially with covid, we're washing our hands more.
We're cleaning. Our houses, does that mean you
have OCD? No?
So what makes someone qualify for OCD?
And of course, this is not a diagnosis, talk to your doctor.
If this is Becoming concerning to you.
And but a typical rule of thumb is that your obsessions and
compulsions are taking up more than an hour of your day.
They're not within your control. So when you try and stop a
compulsion, you try and stop a thought and you can't get it to
go away. It's not an enjoyable act to
engage and it causes distress and discomfort to have to do
something over and over again, or have a thought over and over
again. And it starts to interfere with
your life. Just like I talked about on the
podcast before, depression and anxiety, interfering with your
quality of life, your relationships, your activities,
same thing with CD. So that's a pretty basic
overview of OCD. I do want to touch on anxiety
disorders as well. Because exposure therapy has
also been clinically proven to help anxiety as well.
Anxiety, disorders are immense feelings of fear and dread that
aren't necessarily Justified given the situation.
It's intense worries that take up significant amounts of your
day and it gets to the point where it interferes with your
quality of life and your ability to function.
Whether that's attending school extreme avoidance panic attacks.
All of That kind of stuff. So one really effective way to
treat both anxiety and OCD something called, exposure
therapy. This week's episode is sponsored
by teen counseling. I cannot tell you guys.
How many DM's texts emails? I get from teens parents, even
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Whether that's improving your mental health, during the
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So you can go to teen counseling.com.
She persisted again that stink. Counseling.com says she
persisted to get started today. So, before we dive into, exactly
how you can practice exposure therapy, I want to talk about,
why exposure therapy is effective.
So, when we go through this, kind of pattern of an exposure
to threat and then we have anxiety, and then we engage in a
behavior, There's an actual flow chart of sorts that goes with
experience anxiety. First, you experience a trigger,
maybe you have a thought that causes a lot of distress, maybe
you see someone that you have anxiety about talking to, maybe
you have an upcoming presentation and the teachers
like, Sadie. You're up.
Let's go. That is your trigger and in
response to that if it's a distressing thing, you
experience anxiety. So when you experience this
anxiety, a lot of the times. What we do is we revert to a
safety Behavior. If you're giving a presentation
maybe that's safety behavior is. I gotta go to the bathroom,
going to have to do it later. If it's seeing someone that, you
know, that you're uncomfortable about confronting running away,
turning to the opposite side of the street, and not approaching
them, if it's a thought in your head, it's avoiding that thought
and pretending like, it didn't happen and not addressing the It
caused. So when you experience this
safety behavior, and when you engage in that sometime, you'll
go back up to the trigger, you go to the bathroom.
But you could back to the classroom, they're like, oh we
waited for you time, for your presentation and you're right
back where you started. But a lot of the time that
anxiety is more intense than it initially was after you engage
in that, safety Behavior. Whatever it is, you do get
short-term relief that anxiety goes down.
You feel a deep breath. You feel those anxiety symptoms
going away, but you again have that long-term issue of
associating side. It with whatever the thing is,
whether it's a presentation, a person you're avoiding
confrontation with or problematic thought.
So when you have that short-term relief, you just really end up
using that safety Behavior. As a crutch.
You keep going back. There you go.
Back to the short-term relief. But you have that long-term
problem, and over and over again.
You're confronted with that anxiety.
So, if that's a cycle of anxiety and you just keep getting back
to this trigger, the safety Behavior, or this overall
distress. How do you avoid that?
And that's where exposure therapy comes in.
When you think about Yourself to anxiety and initially your
distress is going to be really high, but as you're sitting in
that discomfort and you're exposed to that stimuli over
time, it does decrease and eventually it will completely go
away. And that's the goal of exposure
therapy is repeated, small exposures to the thing, causing
you discomfort. So, your overall distress and
anxiety decreases. When you experience that
trigger, then you don't get to the anxiety state.
You don't engage in the safety behavior and you're no longer
creating that long-term problem. So what were using exposure for
is emotion regulation. Ation because when we are
confronted with anxiety, we have two options, we either change
the environment, whether that's ignoring everything getting out
of the situation or we change our response to it.
We go back and we expose yourself in small ways to this
source of anxiety. We go back and we decrease our
distress related to this thing and so what this does is it
Alters our capacity to experience a problematic
environment and this is extremely powerful and can
really be used in any situation that causes anxiety or
discomfort. So this sounds like the most fun
enjoyable, worst possible thing you could do to someone with
anxiety and I completely agree with that, it's miserable, it's
not enjoyable and it works. So the idea of exposure therapy
is that you take something that causes you fear and anxiety and
discomfort and you expose yourself to that thread and
small little bits at a time. So, if you're terrified of
flying, you would slowly. But surely expose yourself to
the experience of flying until you felt comfortable enough.
Enough to get on a plane. So what that would look like,
would be sitting down. Maybe it's in a therapy session,
maybe it's with someone, you trust, maybe it's by yourself in
mentally walking through the process of getting to the
airport checking your bags walking through security getting
to your gate getting on the plane taking off, being on the
plane. What are you going to do?
What is it? Looks like outside the window,
who is around you and get going into great detail of this
experience in your mind. Once you get to the point where
that is no longer causing you a man.
Discomfort and Rapid breathing and the symptoms anxiety,
anxiety, like sweating, increased, heart rate, all of
this kind of stuff. You would move to the next step.
Maybe that's even packing for a trip and putting yourself
through that experience of packing, everything you need,
loading your bags up to the car after that.
Maybe it's driving by the airport.
Another thing that you can do is mimic the physiological symptoms
of anxiety. So, I don't know about you, but
if you struggle with a panic attack before you kind of really
get scared of. That experience is miserable.
It feels kind of like You're going to die.
You're not in control and you just, you can't breathe,
everything's overwhelming. The world is crashing all around
you. That's scary.
So, if you can expose yourself to what it feels like, when your
heart rate increases, when you have shortness of breath, when
it feels like things are overwhelming.
The next time those symptoms, come upon you.
You're like, okay, I got this. I felt this before.
I know how to cope with this. I know how to decrease my
anxiety. Navigate this situation and be
effective to the point where I can manage to cope through this.
Ways you can do this, have a paper bag breathing in and out
through that paper bag, again, kind of mimicking that feeling
of being out of breath. Another way is to get a straw
and breathe through a straw that limits your ability to intake
air and you get that feeling of a shortness of breath.
Going for a run doing push-ups things that get your heart rate
elevated and give you the same physiological experience of
anxiety or panic attack. It's another thing that can
expose you to that experience. So, again, like I just talked
about with the plane People what?
These are are three different types of exposure therapy
imaginative, which was imagining, you're going through
the plane. Imagining you're driving to the
airport Etc. Introspective, which is
recreating those physiological symptoms of anxiety that you
experience when you get on the plane and in Vivo which is
driving to the airport. Packing, your back, actually
getting on a flight. And so these are three different
ways you can do exposure therapy.
And when we think about why people like horror movies or
roller coasters and things like that, they're exposing
themselves to You're in a way that's manageable and you can
cope through it while still having that adrenaline kind of
approaching it from the same way here.
But you're doing it, not for the adrenaline butts that you know,
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your first order. So, another really important
thing to know about exposure therapy.
If your fear is getting in a car crash, you're not going to go
and get in a minor car. Crash two kind of Be okay with
that fear, you're not putting yourself in any danger, you're
not harming yourself in any way. Your safety is not being put at
risk. If you're, if you're is a car
accident, you would start by imagining yourself getting in
the car. You would go through what the
drive would be. Like, what you see outside your
window, what it physically. Feels like to be in the car.
Next up, you go sit in the car with the door open.
Then you would sit in the car with the door closed.
Then you would drive around with someone else driving the car and
you and the backseat slowly but surely Work up to driving
normally, but you don't get to the point where you're actually
putting yourself In Harm's Way and experiencing that fear,
whatever that is. So when I was doing exposure
therapy at McClain, there was a couple exercises that I used to
do a lot in sessions. One of them was related to a
fear of contamination and feeling dirty and not clean and
really, really, really just need to get rid of whatever that
threat was. So, what I would do and the
sounds horrible, even if you're just a germaphobe and you don't
necessarily have OCD, I'm gonna rub my hands on the ground and I
would sit there in the session for at verse 30 seconds, you
work up to a minute, maybe it's five minutes, maybe it's 10
minutes and I would just sit there with my hands covered in
dirt. From whatever Grime was on the
floor and I would resist the urge to go and wash my hands.
Scrub it off and feel clean again.
Another exercise that I would do a lot was I had a really, really
big problem with tapping in certain numbers.
So what I would do is instead of tapping three times which was
considered a good number for me, I would tap two times and I
would delay that third tap as long as possible, I would go
maybe 30 seconds at first and then I would elongate that to a
minute then it was five minutes. And by the time I was mastering
this ability to resist Compulsion.
My therapist would say, hey, go as long as possible for after
the session and not engage in this compulsion.
Another thing that I'd struggled with and still struggle with to
this day is hair-pulling. And and so for that, it would be
like, okay, I have an awareness of this compulsion and this urge
to pull out a hair. I'm not going to engage with
that. I'm not going to engage in that
compulsion. I'm going to be aware that, that
is a compulsion I have, but I'm going to wait 30 more seconds,
I'm going to wait. One more minute.
I'm going to wait, five more minutes.
I'm going to wait 10 more minutes and kind of sit in that
discomfort for as long as possible, until I absolutely had
to engage in the urge. So using exposure therapy in
your daily life. There's kind of two ways.
You can approach this, you can do exposure therapy from a
preventative perspective. Like, I just talked about in my
therapy sessions, where I was decreasing.
My distress that came from touching dirty things from not
tapping. A certain number of times from
not pulling out a hair, or you can do exposure therapy when you
are in an emotionally distressed space, and sometimes you were in
such a state of panic distress. Being overwhelmed, whatever it
is but the thought of actually going towards that threat is
absolutely miserable and not possible for you in that moment.
That's fine. You use a stop scale, you use
coping skills, you do deep breathing you go on a walk, you
going to run you do the tips Cal, I'll link the episode in
the description for how to do those skills.
But if you're having some anxiety about doing a
presentation, exposing yourself to that fear and going, and
giving the presentation despite having apprehension about doing
it in the future decreases that anxiety.
If you avoid it, completely the next I'm you go together
presentation in class. The, that feeling of anxiety
will be doubled if not triple, if not exponentially larger.
Whereas when you expose yourself to whatever that quote unquote
threat is, that isn't actually impacting your emotional or
physical safety your anxiety in the long run decreases.
So this is where I kind of want to segue into using exposure
therapy in a social sense. So when I was in treatment, we
did this thing, every Friday I called exposure to exposure
group. And I hated this group, with my
whole being, we alternated between activities.
We did to expose herself Special therapy.
One thing that we used to do is karaoke.
I'm a terrible singer. It's why you've never heard me
sing on the podcast. But I am terrible at singing.
It gives me anxiety to sing in front of people that I don't
know. I get really insecure about my
music taste and think, I'll be judged and forever Outcast.
And I just hate karaoke, even if I'm like not picking out the
song, Still anxiety. And so the exercise that we
would do, is every single person would pick a karaoke song.
Go up and do karaoke and at the end you would get a sticker.
So there's this reinforcement. Mint and you weren't a Therapy
Group. You are in a safe space with a
therapist and support and it still caused me so much anxiety.
I remember this one time. I talked to one of my friends
into doing it with me, so she went up with me.
I didn't even choose a real song.
I chose happy birthday. She was up there singing with me
and I was like, okay, I got this, I'm gonna go sing, happy
birthday, and I got to the front and I lip sync.
The whole thing to succeed, you have to sing like your, this is
the point of the group, and I just couldn't do it.
And we made small steps. We got up in front of the group,
we chose the song we did something.
But that just shows what it can be like to experience these
immense moments of anxiety and to expose yourself to what that
threat is. So that was one activity that we
would do. And if you struggle with getting
up in front of a group of people cheering music, whatever it is,
doing that kind of karaoke night with your friends or your family
member. It's a really good exercise to
kind of decrease your anxiety around that thing.
Another activity will that we did was called vulnerability
group, so you would think for the week, they'd be like, okay,
guys next week, Nobility group on Friday and you would think
for the week, what is a vulnerable story that I can
share and with this group? So you would come to the group
you would share something vulnerable by yourself.
Maybe it was a negative interaction, you had maybe it
was something. You felt a lot of guilt about.
Maybe it was something that caused you a lot of shame or
fear. Remember, one time I talked
about how ashamed I was about, how much suffering, I caused the
rest of the my family by struggling with depression and
anxiety. I had made my home life really
chaotic for my younger siblings, I Kind of displaced my family by
moving across the country to get help.
My parents were constantly going to therapy with me and working
in Family Therapy, and I just caused a lot, a lot of chaos and
that brought me so much, shame and guilt and in sadness as
well. And so that was something I
shared invulnerability group, and you would go into detail and
you would tell this story and everyone would go around and
share these things. And for a lot of people, if it
was something that really did Harbor, a lot of emotions, it
would cost a lot of anxiety and discomfort but You are exposing
yourself to that concept of being vulnerable.
And in the long run, when you were then building relationships
and building, strong connections, your ability to be
vulnerable and talk about things that brought up emotions was
improved. So there's one more activity
that we used to do and this was honestly, one of the funniest
ones, but we had these like little Bingo sheets and they
would cut them up into little squares.
And it was activities, like, go ask a stranger for their phone
number. Go, bargain and trade something,
Go sing a song in public. Go do ten Jumping Jacks in
front. Everything like silly things
that were not socially acceptable, push you out of your
comfort zone and were uncomfortable and we would go
into the cafeteria. This mental hospital.
We go up to these poor strangers who were visiting, probably
family members touring the place, maybe they worked there.
And we were these kids that were still getting treatment.
Would be like, can I bargain my lunch for your lunch and heroic?
What back is wrong with these kids?
Like what is going on. But, but it helped it helped to
expose yourself to that discomfort and understand what
it feels like to be socially. Not accepted in a sense, you are
putting yourself at risk for rejection and judgment and you
were okay with that. And so, those were the three
activities that we used to cycle through and do and all are very
applicable to normal life, to push yourself outside of your
comfort zone. Experience that anxiety, expose
yourself to those threats and then become more comfortable
with that experience in the long run.
So if you want to plan to use, exposure therapy, at some point
in the next week, in your life, whenever it is, here are the
steps that you can go through. The first thing you're going to
do is identify the trigger the queue.
Situation, whatever it is, that brings up that distress, and
that anxiety. And write that down.
Describe what it is. Next, you're going to ask
yourself. Is this a Justified anxiety or
not? If you're about to give a
presentation, you have some light butterflies, you're a
little bit nervous and apprehensive that's Justified,
you're going to be up in front of a lot of people, but if
you're having such severe anxiety that you can't breathe
in, you're about to cry. That's maybe not justified given
certain situation, and even if it is Justified given a history
based on certain presentations, it's not serving you effectively
within the school setting. So this is when you address your
exposure, what is your exposure? Look like whether it's
imaginative introspective or in Vivo.
So, kind of walk through that. What are different ways you can
expose yourself to the anxiety of going through that activity?
So you also want to revisit and see what that safety behavior is
that you're blocking. Maybe it's running out of the
classroom, maybe it's avoiding the presentation altogether,
maybe it's avoiding, whatever that threat is for long periods
of time and see what the healthy behavior is that you're creating
by avoiding. Other thing.
And lastly, what is the emotional response of exposing
yourself to this thing? Are you feeling proud of
yourself for being able to sit there and not be overwhelmed?
Are you feeling confident after giving this presentation and do
you want to reinforce this feeling?
If so you're going to keep exposing yourself to it, you're
going to keep working to get rid of these anxieties and fears and
discomforts. So, I also wanted to give a
couple resources around OCD and exposure therapy and things you
can read if you're interested in this topic or ADD.
If I with you and you want to learn more about it.
So one book that I read about OCD which was literally
phenomenal. And I've talked about it in
episodes before it was called brain lock, and I don't remember
who it's by, but I'll put it in today's show notes and there's
tons of case studies in this book of different individuals
who struggled with OCD and got treatment to improve their
obsessions and their compulsions.
And it talks about biologically what goes on when you're
experiencing OCD, how it really is a physiological disease and
not just kind of in your head going to approach coping with
obsessions and compulsions. Rewire those thought patterns,
so that you can recognize that this is not really a real
thought. And a real threat, it is an
obsession. It is a compulsion, Etc.
So that is one book, Brain lock. The other one, which totally
relates to vulnerability and social exposure.
Like we just talked about, is I thought it was just me but it
isn't by brene Brown. And that book is all about
perfectionism and really a lot about shame.
If you're not familiar with brene brown, she is a shame
researcher. And she's done tons, and tons,
and tons of work. But that's another really good
book about social anxiety, and fears and exposing yourself to
kind of that discomfort. So that's kind of all I got for
today. As far as exposure therapy, we
walked through how you can address a threat and decide if
what you're feeling is Justified or not justified.
And if it's not justified, how you can use exposure therapy to
decrease the discomfort around certain triggers, we talked
about different ways that you can do, exposure therapy,
whether it's introspective imaginative or in Vivo, we
talked about using exposure therapy for anxiety.
Disorders, general anxiety OCD and social anxiety.
And yeah, I think that's pretty much it.
So if you enjoyed this episode, be sure to leave a review.
Share it with a friend share on social media.
If you share yourself listening to this episode, I will give you
a shout out and repost on Instagram and actually resisted
podcast. Also, I am doing a crash course
to DBT series on Tick-Tock, so be sure to follow me on Tick,
Tock at she persisted podcast every day and posting three or
four videos and I'm Going from starting at the intro to DBT
what is DBT, what's a? Dialectic all the way through
every single skill and DBT. So be sure to follow along with
that great way to understand all the scales without literally
going to therapy and doing intensive treatment.
But anyone looking to be more effective in their life.
Whether it's being more mindful being more interpersonally
effective, you gotta watch this series.
I promise it's helpful. So thanks for listening.
I will see you next Friday.