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Welcome to she persisted I'm 
your host Sadie Saxton a 19 year

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old from the Bay Area studying 
psychology at the University of 

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Pennsylvania. 
She persisted is the Teen Mental

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Health podcast made for 
teenagers by a team in each 

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episode. 
I'll bring you authentic 

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accessible and relatable 
conversations about every aspect

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of mental Wellness. 
You can expect evidence-based, 

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Tina, proof resources, coping 
skills, including lots of DBT, 

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insights and education. 
In each piece of content, you 

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consume, she persisted It offers
you a safe space to feel 

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validated and understood in your
struggle. 

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While encouraging you to take 
ownership of your journey and 

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build your life worth living. 
So, let's dive in this week on. 

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She persisted, when we avoid 
things that make us anxious, 

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they could exponentially worse, 
the anxiety. 

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The fear of the avoidance builds
over time, and then it's even 

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more challenging to overcome 
that anxiety. 

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If you're like, I have some 
anxiety, but it's not 

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debilitating. 
Go use exposure therapy right 

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now because you're going to 
avoid all of the pain and 

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suffering that comes We avoid 
our emotions, and they amplify 

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and intensity. 
Hello, hello, and welcome back 

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to she persisted. 
If you're new here, my name is 

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Sadie. 
I am a sophomore at the 

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University of Pennsylvania. 
Studying psychology, I started 

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she persisted after a year and a
half of intensive treatment at a

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residential program at a 
therapeutic boarding school. 

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And today, we're pulling from a 
lot of what I learned in those 

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early days of treatment. 
So we're talking about OCD and 

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we're talking about exposure 
therapy, we're talking about 

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anxiety, I really do see 
exposure therapy as the Nick, do

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the solution to any type of 
avoidance anxiety, emotional 

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version, whatever you want to 
call it, whenever those feelings

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come up for me, I'm like, okay, 
it's time for some exposure and 

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I know that that is what is 
going to help lessen. 

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Those feelings decrease, the 
intensity. 

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And it's been a long time since 
I've done a dedicated episode on

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exposure therapy. 
The last time that I did an 

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exposure therapy episode was 
episode 56, guys. 

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That is almost 100 episodes ago.
I'm sure no one was listening at

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that point, that's listening 
now, and Feel like I discuss 

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exposure therapy pretty 
frequently on the podcast so it 

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felt like it was time to do a 
deep dive to give you a really 

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educational overview on what is 
exposure therapy. 

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How can you use it? 
How can you implement it in your

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life and what I do on a routine 
basis to use, exposure therapy 

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to decrease anxiety, avoidance, 
Etc. 

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So when I first came across 
exposure therapy, it was in a 

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therapeutic group. 
We had group therapy all the 

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timer residential every single 
day. 

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And one of the groups that we 
had on Friday is, was called 

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Bossier to exposure. 
So you're doing exposure therapy

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to the idea of exposure therapy 
and practicing. 

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This idea of exposing ourselves 
to things that made us anxious 

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or working through the hierarchy
of exposure. 

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And then we would translate it 
to other things in our life. 

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I love the name of that group, 
still to this day and so we 

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alternated, what we would do in 
the exposure to exposure group, 

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some weeks we would learn about 
how exposure therapy works, what

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the exposure hierarchy is, which
we'll get into, don't worry some

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weeks. 
We did something called Group 

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where you would share something 
that required vulnerability, 

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whether it was an emotion, 
you're navigating thought you 

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had something really personal 
that you wouldn't share with 

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most people. 
And that really no one in that 

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Therapy. 
Group knew about you. 

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So anxiety-provoking, as you can
imagine, we did karaoke Group, 

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which was my worst nightmare to 
this day. 

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I could probably use some 
exposure therapy around doing 

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karaoke, because I am the worst 
singer. 

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I'm fully aware that I've known 
musical talents, I've accepted 

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it, I've moved on with my life 
singing in front of people, 

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gives me so much anxiety, 
because I No, I'm bad at. 

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It's not like, oh my God, I 
don't want to sing like, no, I'm

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bad. 
Like your ears will bleed. 

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So avoiding were avoiding. 
I need to do exposure therapy on

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that. 
So we would do karaoke, we do 

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this educational piece, we would
do vulnerability group, and then

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we would also do this thing 
where we was almost like a game 

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where you would draw tasks. 
It wasn't out of a hat, but you 

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would choose a task out of a bag
or something. 

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They were cut up in little 
strips of paper and it would be 

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tasks. 
That would typically Some sort 

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of anxiety. 
And so we would go to the 

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cafeteria McClain and we would 
try and barter with people. 

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So we go to these poor people 
that really probably visiting a 

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family member or doing something
on campus getting a test done 

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that. 
Can we trade? 

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You are food that we bought at 
the cafeteria for your food at 

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the cafeteria. 
These people were public, who 

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let these patients out, what the
heck is going on, but it was 

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really great for social anxiety.
So there was other things, like 

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go up and start a conversation 
with someone ask for someone's 

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phone number random, things like
that. 

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At that cause social anxiety, if
you're socially anxious. 

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And so you would go into the 
community. 

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This little little campus at 
McLean Hospital and do these 

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tasks to provoke some anxiety. 
But then cope with it, work 

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through it and increase your 
emotional resilience to social 

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anxiety and anxiety in general. 
So that was my introduction to 

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exposure therapy. 
And we're going to do a little 

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mini version of those learnings 
that I gained during my time at 

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McLain. 
And then we're going to talk 

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about ways that I have applied 
it on my old life. 

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If you Like I am someone that's 
anxious. 

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I don't know where to start. 
Those are some good ways. 

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Practice, being vulnerable with 
someone practice doing something

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like karaoke, or you have to go 
out of your way to do something 

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that's uncomfortable. 
Like, again, I have to go back 

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to how much anxiety. 
This gave me, like, I would, 

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almost refused to sing, Happy 
Birthday. 

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I mean, one of my friends stand 
up with me, there was a full 

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YouTube thing. 
I think I lip-sync, like, I 

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hated this with every ounce of 
my being, but you gotta overcome

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that anxiety and then the other 
one doing things in social 

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situations. 
Chelation that you wouldn't 

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normally do, especially when 
you're never going to see those 

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people. 
Again is a really great way to 

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overcome that social anxiety. 
Okay? 

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So first thing we've talked 
about, is what you can use 

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exposure therapy for. 
I am someone that likes to do 

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this holistic approach to 
emotion. 

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So whenever I explaining zaidi 
and depression to people that 

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haven't experienced before, 
like, imagine you are fearful, 

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but it's on an extreme 
overwhelming scale that is 

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impacting or everyday 
functioning. 

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So that's on the same Spectrum. 
Like fear and anxiety, both can 

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be explained in terms. 
These basic emotions that we all

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experience, like, fear and 
apprehension. 

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So the same thing is true for 
exposure therapy. 

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It has been clinically proven to
be really effective for OCD 

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social anxiety. 
Generalized, anxiety disorder. 

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These really extreme 
overwhelming, versions of 

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rumination, intrusive, thoughts,
extreme, emotional intensity. 

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And it also works for these 
smaller scale instances of 

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anxiety. 
Overwhelm apprehension, Etc. 

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So, it's almost spectrum and If 
you're like, well, I have some 

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anxiety, but like I definitely 
don't need OCD treatment. 

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If that is a barrier for you, 
trying this, whenever that kind 

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of emotional resistance comes 
up, I always like to say, all 

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that that means is that there's 
a greater chance that this will 

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work for you. 
There's a greater chance. 

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This will be effective because 
it is clinically proven to work 

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within populations that are 
debilitated by their OCD or 

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social anxiety. 
It's also going to work for that

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fear. 
You have about giving that big 

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presentation coming up or making
new friends. 

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So basically Therapy is used for
phobias. 

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It's used for generalized 
anxiety, social anxiety, 

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avoidance OCD, all of these 
different things and the idea 

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with all of this diagnosis is 
that there's some amount of fear

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and that fear is leading to 
avoidance. 

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And so whether that's a 
situation, an object and 

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activity, thought and emotion, 
Etc. 

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There's fear there and then 
there's a void ends. 

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And when we avoid things, that 
make us anxious, they could 

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exponentially worse, the 
anxiety, the fear of the 

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avoidance builds over time and 
then it's even more challenging.

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Challenging to overcome that 
anxiety. 

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So again, just like I mentioned 
where if you're like I have some

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anxiety but it's not 
debilitating. 

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Go use exposure therapy right 
now because you're going to 

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avoid all of the pain and 
suffering that comes when we 

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avoid our emotions and they 
amplify and intensity. 

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What's also really cool is that 
the most effective treatment for

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OCD is exposure and response, 
prevention therapy. 

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So, what we're going to talk 
about with this, this key 

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principle of exposure therapy is
what is used in clinical 

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settings to treat OCD. 
So we know it works, we know 

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it's Active for this CBT cycle 
of our thoughts, influence our 

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emotions influence, our 
behaviors, and then it all 

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repeats. 
And so that shows up in phobias,

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that shows up in anxiety, it 
shows up in OCD, and so exposure

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therapy works across the board. 
So, we do want to give the 

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caveat in the disclaimer, that 
if you are anxiety is becoming 

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debilitating. 
It's interfering with your 

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quality of life. 
It's interfering with your 

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relationships. 
Your ability to show up for work

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school, Etc, and it's been going
on for a long time. 

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It can be really emotionally 
unsafe to do, exposure therapy, 

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and that's why people. 
We'll go to therapy. 

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They get support. 
I did a lot of exposure therapy 

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with help of therapist for a 
long period of time. 

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I still will write exposure 
hierarchies with a therapist. 

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So if you're like, this feels 
really overwhelming the thought 

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of even thinking about this 
thing. 

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I'm avoiding is debilitating 
work with therapists, have them 

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help you out with the exposure 
therapy process. 

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And there are therapists that 
specialize specifically in 

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anxiety, OCD and exposure. 
So go find a clinician that 

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specializes in that area and 
they will help walk you through 

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this. 
Step by step, this is more. 

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Or if you are feeling anxiety 
avoidance Etc and you think you 

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can overcome it, but you're not 
exactly sure. 

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How or there are smaller levels 
of anxiety that you'd like to 

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work throughout this is for you.
But if it's completely 

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debilitating overwhelming, 
impacting every aspect of your 

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life, definitely work with a 
clinician because if you are not

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able to successfully cope with 
the emotions that come up or the

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thoughts are too overwhelming or
it leads you to avoid more again

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the anxiety, just amplifies and 
then it's even more challenging 

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to work through. 
Through those emotions. 

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So we don't want to try it, 
exposure therapy, then get cold 

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feet back out and then we're 
even more anxious than we were 

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when we started, that would be 
really productive. 

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If you think that might happen 
work with a therapist that will 

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help you through it, they will 
help you make the most amazing 

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exposure hierarchy and support 
you through it. 

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But I feel like I think I got 
this. 

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I just need help understanding 
how this works. 

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This is for you. 
So the first thing going to talk

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about is the CBT cycle in CBT, 
there is this amazing triangle 

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Circle. 
However you want to describe it 

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where we understand that our 
That's impact our feelings and 

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they impact our behaviors and 
just keeps going in a cycle. 

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So if you wake up and you're 
like, I am feeling depressed and

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then you don't get out of bed 
and then your thoughts are, like

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I have nothing going for me, I'm
so unmotivated. 

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I hate everything about life and
then you feel worse about 

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yourself and then you don't get 
out of bed for longer, then you 

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avoid your responsibilities. 
You can see how that cycle 

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continues to go in a loop and 
make the situation worse. 

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If you interject at one point, 
whether it's your behavior, your

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thoughts are your feelings? 
You are able. 

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To adjust the rest of the cycle.
So one skill that we've talked 

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about a lot in the podcast is 
opposite actions. 

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The idea is that you take the 
opposite of what you're feeling.

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And so if you are feeling 
depressed and you would like to 

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avoid all of your friends and 
family members, you don't want 

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to do anything. 
You want to stay in bed, you 

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want to avoid your 
responsibilities or can do the 

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exact opposite. 
So you go to coffee with a 

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friend, maybe go to class, maybe
you call someone and say, I'm 

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really not feeling great today. 
Can we go hang out spend time 

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together? 
I really just need to get out of

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my own head, that behavior is 
then going to impact your 

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thoughts, which How they had a 
loop? 

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Like I'm nothing going for me. 
Everything sucks. 

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This is terrible. 
This is overwhelming. 

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And of course, the feelings of 
feeling depressed, unmotivated, 

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overwhelmed, Etc. 
So exposure therapy is building 

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off of that idea where when we 
adjust the behavior or we adjust

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the thought, or we adjust the 
feeling and we'll get through 

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that. 
When we talk about an exposure 

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hierarchy, which one of those, 
you are kind of inserting 

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yourself into you, are able to 
break the cycle of the really 

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intense anxiety, the 
overwhelming thoughts and the 

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Sure, of avoidance. 
So, what is exposure therapy? 

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The basic idea of exposure 
therapy is that you are exposing

250
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yourself to the thing. 
That is causing anxiety, fear 

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Etc, and a small safe doable 
way. 

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You are slowly building yourself
up to the thing that makes you 

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so anxious. 
And so overwhelmed. 

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And as you build Mastery over 
those thoughts, those behaviors 

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those things that are making you
anxious as you get more 

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effective with your ability to 
cope with the emotions that 

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arise. 
Is to shift the thoughts, you're

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having, you're able to overcome 
the anxiety, the phobia, the 

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thought pattern, Etc. 
There are four types of exposure

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therapy. 
I originally learned three of 

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what we're getting a little 
technologically savvy nowadays. 

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So, the first is in Vivo 
exposure. 

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So, you are directly immersing 
yourself in the thing that is 

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making you anxious. 
So if you are scared of being in

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public, you are struggling with 
leaving your home, you are 

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struggling with going out 
socializing with others in Vivo.

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Oh, exposure would be leaving 
your home and going outside into

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the world. 
Imaginal exposure is when you 

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are mentally going through the 
process of doing the thing that 

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makes you anxious. 
So even though you're still in 

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your house, you are closing your
eyes, you're almost meditating 

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and you are visualizing yourself
leaving the front door. 

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Locking the door, getting in the
car, driving to a coffee shop. 

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00:12:50,000 --> 00:12:52,700
Placing your order talking to 
someone, getting your coffee, 

275
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sitting there for 30 minutes, 
and if you really, truly are 

276
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very anxious about something. 
Going through that mental 

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process, will bring up a Sighs. 
Your heart rate will probably 

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00:13:01,700 --> 00:13:03,700
increase you'll be breathing a 
bit more rapidly. 

279
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It is an overwhelming experience
to expose yourself even mentally

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to that thing that is making you
anxious. 

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This is also used with people 
that struggle PTSD or how to 

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traumatic experience, doing that
imaginal exposure to the thing 

283
00:13:17,100 --> 00:13:19,700
that is causing all of those 
intense emotions is also 

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something that is done in a 
clinical setting. 

285
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The second to last one is called
interoceptive exposure. 

286
00:13:24,700 --> 00:13:27,200
I'm sure I'm saying that wrong. 
But the idea here is that you 

287
00:13:27,200 --> 00:13:32,700
are exposing yourself to the 
Magical experience of anxiety. 

288
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Because if you've ever had a 
panic attack, you know, that one

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00:13:34,800 --> 00:13:37,400
of the most overwhelming parts 
of that experience is like, I 

290
00:13:37,400 --> 00:13:40,100
can't breathe, my thoughts, were
going insanely fast. 

291
00:13:40,100 --> 00:13:42,400
My heart rate is going so 
quickly, like, am I physically, 

292
00:13:42,400 --> 00:13:44,200
okay, is something wrong? 
What's going on? 

293
00:13:44,200 --> 00:13:47,500
And so that can, sometimes 
almost become a trigger and 

294
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itself for more anxiety because 
you're like, I don't wanna have 

295
00:13:50,000 --> 00:13:52,300
another panic attack. 
This is my worst nightmare to be

296
00:13:52,300 --> 00:13:54,500
this anxious. 
And so, once your heart rate 

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00:13:54,500 --> 00:13:57,100
starts increasing, once your 
breathing is more rapid, you get

298
00:13:57,100 --> 00:13:59,600
more anxious because of those 
physical symptoms. 

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00:14:00,000 --> 00:14:01,900
We're doing at Aricept of 
exposure. 

300
00:14:01,900 --> 00:14:06,600
You are kind of getting yourself
in the physiological space of a 

301
00:14:06,600 --> 00:14:09,000
panic attack. 
So maybe you're doing some, some

302
00:14:09,000 --> 00:14:11,600
Sprints, and you are sitting 
with the increased heart rate, 

303
00:14:11,600 --> 00:14:13,800
increased breathing rate that 
similar to what you experience 

304
00:14:13,800 --> 00:14:16,100
when you have anxiety. 
Maybe you're breathing through a

305
00:14:16,100 --> 00:14:17,200
straw. 
So, you know what? 

306
00:14:17,200 --> 00:14:19,700
It feels like to have shallow 
breaths and not fully be able to

307
00:14:19,700 --> 00:14:23,100
catch your breath. 
Maybe you are going through the 

308
00:14:23,100 --> 00:14:25,500
similar thought, patterns, that 
sometimes come up when you are 

309
00:14:25,500 --> 00:14:28,800
having social anxiety or worried
about leaving the house, right? 

310
00:14:28,900 --> 00:14:31,700
So that's of exposure. 
You're exposing yourself to the 

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00:14:31,708 --> 00:14:36,000
experience of being anxious. 
And as we talked about how an 

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00:14:36,000 --> 00:14:39,200
exposure hierarchy and going 
through that exposure process 

313
00:14:39,200 --> 00:14:42,500
works, you are again building 
Mastery over your ability to 

314
00:14:42,500 --> 00:14:46,000
cope with the situation. 
The last, I think this is the 

315
00:14:46,000 --> 00:14:48,000
newest version of exposure 
therapy is. 

316
00:14:48,000 --> 00:14:51,300
You can use Virtual Reality, so 
you're like fancy-schmancy. 

317
00:14:51,300 --> 00:14:53,900
You have a whole VR headset. 
Maybe you're like, okay, I'm 

318
00:14:53,900 --> 00:14:56,700
scared of leaving the house. 
I'm going to have someone else 

319
00:14:56,900 --> 00:14:59,200
film a VR experience in me, 
leaving the house and then I'm 

320
00:14:59,200 --> 00:15:00,900
going to watch that. 
Of course it's going to make you

321
00:15:00,908 --> 00:15:02,600
anxious because it feels like 
you're really going through that

322
00:15:02,600 --> 00:15:05,000
experience. 
But a great example here is if 

323
00:15:05,000 --> 00:15:09,500
you're afraid of flying, maybe 
you are going to watch a vlog of

324
00:15:09,500 --> 00:15:12,100
someone going to the airport and
going through security and 

325
00:15:12,100 --> 00:15:14,400
boarding the plane. 
And on the plane, that will 

326
00:15:14,400 --> 00:15:16,800
probably bring up some anxiety. 
So, to work through that, in 

327
00:15:16,800 --> 00:15:19,900
that safe environment and that 
less intense version of anxiety 

328
00:15:19,900 --> 00:15:23,300
can be super effective. 
So those are the four types of 

329
00:15:23,300 --> 00:15:26,500
exposure therapy. 
And, again, underlying theme. 

330
00:15:26,500 --> 00:15:28,900
There is that you are exposing 
yourself to the thing that's 

331
00:15:28,900 --> 00:15:32,500
making you anxious. 
Us in a small manageable way, 

332
00:15:32,500 --> 00:15:34,800
that is still slightly, pushing 
you outside of your comfort 

333
00:15:34,800 --> 00:15:37,500
zone. 
You are effectively coping with 

334
00:15:37,500 --> 00:15:39,500
the emotions and thoughts that 
arise. 

335
00:15:39,500 --> 00:15:41,900
And you are working your way 
through it, and you were doing 

336
00:15:41,900 --> 00:15:44,400
the opposite of what you want to
do, which is a void and run 

337
00:15:44,400 --> 00:15:46,400
away. 
Today's episode is brought to 

338
00:15:46,400 --> 00:15:48,400
you by teen counseling. 
If you haven't heard of teen 

339
00:15:48,400 --> 00:15:51,200
counseling, it is better helps 
branch of online therapy 

340
00:15:51,200 --> 00:15:54,900
specifically for teenagers. 
They've over 14,000 licensed 

341
00:15:54,900 --> 00:15:58,400
therapist within their Network 
and they help you work on things

342
00:15:58,400 --> 00:16:02,000
like anxiety, depression. 
Relationships trauma so many 

343
00:16:02,000 --> 00:16:05,600
things that people go to therapy
to get support with the great 

344
00:16:05,600 --> 00:16:08,000
thing about Teen counseling is 
that they offer different levels

345
00:16:08,000 --> 00:16:10,000
of support. 
So they offer text talk and 

346
00:16:10,000 --> 00:16:11,900
video counseling. 
So depending on what level of 

347
00:16:11,900 --> 00:16:14,300
support you're looking for they 
will meet you right where you're

348
00:16:14,300 --> 00:16:17,500
at and you are also able to do 
this all from your home. 

349
00:16:17,500 --> 00:16:19,800
So you don't have to deal with 
things like local waiting list 

350
00:16:19,800 --> 00:16:23,200
for providers trying to get a 
referral from your primary care 

351
00:16:23,200 --> 00:16:26,200
doctor, Etc. 
You can just go straight to teen

352
00:16:26,200 --> 00:16:28,500
counseling.com. 
Says she persisted, you'll fill 

353
00:16:28,500 --> 00:16:29,800
out a survey about what you're 
hoping? 

354
00:16:29,900 --> 00:16:32,600
You to work on and you'll be 
matched with a therapist that 

355
00:16:32,600 --> 00:16:35,800
specializes in that area and can
help meet your needs. 

356
00:16:35,900 --> 00:16:38,500
And there you go. 
You're in therapy if started the

357
00:16:38,500 --> 00:16:41,200
process and if things don't work
out, it's super easy to switch 

358
00:16:41,200 --> 00:16:43,600
your therapist. 
If you are under 18 they do ask 

359
00:16:43,600 --> 00:16:47,000
for a parents email to provide 
consent, not of your information

360
00:16:47,000 --> 00:16:49,500
is shared HIPAA is totally 
intact. 

361
00:16:49,600 --> 00:16:52,200
Everything you talked about and 
focus on in therapy as between 

362
00:16:52,200 --> 00:16:54,000
you and your therapist. 
So don't worry about that. 

363
00:16:54,000 --> 00:16:57,100
I tried it myself. 
I checked it for you guys, but 

364
00:16:57,100 --> 00:16:59,400
that's how it works. 
So if you want to check out teen

365
00:16:59,400 --> 00:17:02,200
counseling, Can got a teen 
counseling.com says she 

366
00:17:02,200 --> 00:17:03,800
persisted. 
The link will be in the show 

367
00:17:03,800 --> 00:17:06,700
notes and start therapy or 
continue on your therapy Journey

368
00:17:06,700 --> 00:17:09,200
today. 
So if you are doing exposure 

369
00:17:09,200 --> 00:17:11,099
therapy, the way that I would 
approach this in the way that 

370
00:17:11,099 --> 00:17:14,800
I've approached this in the past
is I would do an exposure 

371
00:17:14,800 --> 00:17:17,700
hierarchy. 
So what I would do is I would 

372
00:17:17,700 --> 00:17:20,599
write down the thing that I am 
most afraid of and most scared 

373
00:17:20,599 --> 00:17:22,500
of. 
So if it is public speaking or 

374
00:17:22,508 --> 00:17:26,200
going to say, my biggest fear 
that I am going to have to 

375
00:17:26,200 --> 00:17:28,200
navigate as I have to give a 
speech at the end of the 

376
00:17:28,208 --> 00:17:29,800
semester and I'm absolutely 
terrified. 

377
00:17:29,900 --> 00:17:32,800
If I dive so much anxiety. 
The idea of doing that makes me 

378
00:17:32,800 --> 00:17:35,700
want to like throw up faint 
runaway, drop out of college. 

379
00:17:35,800 --> 00:17:38,700
If that's your fear, that is 
going to be at the top of the 

380
00:17:38,700 --> 00:17:40,200
hierarchy. 
That's what we're working up 

381
00:17:40,200 --> 00:17:42,300
towards and you're going to work
yourself backwards. 

382
00:17:42,600 --> 00:17:45,000
You could say, like, what is one
step below? 

383
00:17:45,100 --> 00:17:48,400
Giving a speech, maybe it is 
being in the room, watching 

384
00:17:48,400 --> 00:17:51,000
other people, give their 
presentations and knowing that 

385
00:17:51,000 --> 00:17:52,900
you probably are going to be 
next. 

386
00:17:53,100 --> 00:17:56,000
So maybe you go and sit in on 
another lecture where people are

387
00:17:56,000 --> 00:17:59,100
giving presentations and you 
mental are like, okay, I'm ready

388
00:17:59,100 --> 00:18:01,100
to give my presentation. 
And let me pull up my slides. 

389
00:18:01,100 --> 00:18:04,900
Let me emotionally deal with 
this overwhelming experience and

390
00:18:04,900 --> 00:18:08,800
maybe below that is practicing 
giving a presentation to a 

391
00:18:08,800 --> 00:18:11,500
friend or two, you're going 
through the process. 

392
00:18:11,800 --> 00:18:15,100
You are saying everything that 
needs to happen, Etc. 

393
00:18:15,100 --> 00:18:17,200
And then below that, maybe 
you're giving the presentation 

394
00:18:17,200 --> 00:18:20,000
in an empty classroom before 
that. 

395
00:18:20,000 --> 00:18:22,200
Maybe you're prepping for the 
presentation, you're creating 

396
00:18:22,200 --> 00:18:25,100
your slides, you're preparing 
your speaker notes before that, 

397
00:18:25,100 --> 00:18:28,300
maybe you are watching someone 
else's presentation. 

398
00:18:28,500 --> 00:18:30,000
You are not mentally. 
Ali. 

399
00:18:30,000 --> 00:18:32,700
Like okay, my presentation is 
next but even just watching 

400
00:18:32,700 --> 00:18:35,300
someone else do it, can kind of 
bring up that anxiety. 

401
00:18:35,500 --> 00:18:38,000
So you're doing that in person 
then maybe it's watching a video

402
00:18:38,000 --> 00:18:39,900
of someone that is giving a 
presentation. 

403
00:18:39,900 --> 00:18:43,700
And the Very lowest freebie, 
almost if you will is mentally 

404
00:18:43,700 --> 00:18:46,300
going through the process of 
giving the presentation. 

405
00:18:46,300 --> 00:18:47,700
Again, this will be different 
for everyone. 

406
00:18:47,700 --> 00:18:51,100
It's so subjective, but you're 
going to make this hierarchy 

407
00:18:51,100 --> 00:18:54,500
that feels very doable to move 
from one step to the next. 

408
00:18:54,500 --> 00:18:57,300
You don't want to be like, okay,
one day I'm imagining I'm giving

409
00:18:57,300 --> 00:18:59,800
a presentation, the next one. 
I am. 

410
00:18:59,900 --> 00:19:02,000
Live podcast. 
Like that would be the worst way

411
00:19:02,000 --> 00:19:04,500
to structure your exposure 
hierarchy, because you're going 

412
00:19:04,500 --> 00:19:07,200
to get too anxious about the 
idea of giving a whole life 

413
00:19:07,200 --> 00:19:10,000
podcasts to an audience. 
You're going to avoid the 

414
00:19:10,000 --> 00:19:12,700
situation and the anxiety is 
going to amplify. 

415
00:19:12,800 --> 00:19:16,700
So what I would do is make this 
really comprehensive list and 

416
00:19:16,700 --> 00:19:18,700
you want to have these three 
things you can check off. 

417
00:19:18,700 --> 00:19:21,100
Yes, I did this or no, I didn't.
We don't want to be vague. 

418
00:19:21,100 --> 00:19:24,200
Like I'm going to expose myself 
to the feeling of being anxious.

419
00:19:24,300 --> 00:19:25,800
Do you want to be really 
specific? 

420
00:19:25,800 --> 00:19:29,000
Are you exposing yourself to the
physiological sensation of being

421
00:19:29,400 --> 00:19:32,800
like, Short of breath. 
Are you mentally going through 

422
00:19:32,800 --> 00:19:34,500
the thought process? 
That might come up, when you're 

423
00:19:34,500 --> 00:19:37,500
giving your presentation, are 
you imagining the worst possible

424
00:19:37,500 --> 00:19:39,400
scenario? 
That could happen and coping 

425
00:19:39,400 --> 00:19:41,300
through that worst-case scenario
in your head? 

426
00:19:41,900 --> 00:19:46,200
We're being very specific and we
again, it's a comprehensive list

427
00:19:46,200 --> 00:19:48,000
of like freebie. 
I can do that. 

428
00:19:48,000 --> 00:19:51,000
It'll make me a little bit 
anxious, but I got this to, oh 

429
00:19:51,000 --> 00:19:54,200
my gosh, this is the end goal 
and I'm very anxious about 

430
00:19:54,200 --> 00:19:58,500
navigating this experience. 
So once you have your exposure, 

431
00:19:58,500 --> 00:20:01,900
hierarchy is what Halt. 
You are going to begin the 

432
00:20:01,900 --> 00:20:06,800
process of doing these small 
exposure therapy steps. 

433
00:20:07,200 --> 00:20:10,900
And this is why it's great to 
work with a therapist because I 

434
00:20:10,900 --> 00:20:12,800
full accountability here. 
I've made multiple exposure 

435
00:20:12,800 --> 00:20:15,400
therapies for myself this year, 
whether it's like making new 

436
00:20:15,400 --> 00:20:17,800
friends or talking to people are
doing things that make me 

437
00:20:17,800 --> 00:20:19,800
anxious. 
There are my bullet journal. 

438
00:20:19,800 --> 00:20:21,700
They're written down. 
Have I done them? 

439
00:20:21,900 --> 00:20:24,300
Nope, I go back home and I see 
my therapist. 

440
00:20:24,300 --> 00:20:25,900
She's like house exposed to. 
There we go. 

441
00:20:25,900 --> 00:20:29,000
I'm like have a really dumb so 
this is why it's great to work 

442
00:20:29,000 --> 00:20:31,300
with the clinician or someone 
that can hold you accountable 

443
00:20:31,300 --> 00:20:33,300
and also be there to support you
throughout the process. 

444
00:20:33,300 --> 00:20:35,800
But it's totally possible to do 
by yourself. 

445
00:20:35,800 --> 00:20:38,700
Especially if it feels 
emotionally safe to do so, and 

446
00:20:38,700 --> 00:20:40,900
you can do things like having a 
friend hold you accountable. 

447
00:20:40,900 --> 00:20:42,900
So, maybe the thought of going 
to the gym is like, so 

448
00:20:42,900 --> 00:20:45,900
anxiety-provoking for you. 
So you asked a friend. 

449
00:20:45,900 --> 00:20:47,700
Hey, do you want to go walk on 
the treadmill with me? 

450
00:20:47,900 --> 00:20:51,000
It's a pretty low ball, like 
easier item or more like oh can 

451
00:20:51,000 --> 00:20:53,300
you go to the gym with me and 
get a smoothie, don't even work 

452
00:20:53,300 --> 00:20:54,900
out. 
Just go and get a smoothie or 

453
00:20:54,900 --> 00:20:57,700
maybe you're walking past the 
gym and you're like to a friend.

454
00:20:57,700 --> 00:20:58,900
Hi. 
Do you want to go on a walk? 

455
00:20:58,900 --> 00:21:00,500
We can go. 
However, and then you 

456
00:21:00,500 --> 00:21:04,000
strategically walk past the gym,
but you're going with a friend. 

457
00:21:04,000 --> 00:21:06,000
So they're there to hold you 
accountable and you're not 

458
00:21:06,000 --> 00:21:08,100
backing out, and avoiding the 
situation. 

459
00:21:08,100 --> 00:21:11,300
So, there's some ways to hold 
yourself accountable, but it can

460
00:21:11,300 --> 00:21:13,500
be very personal thing. 
You almost need, like, expose 

461
00:21:13,500 --> 00:21:16,300
yourself to the idea of being 
vulnerable and telling people 

462
00:21:16,300 --> 00:21:18,700
that you're anxious and you're 
trying to overcome this anxiety 

463
00:21:19,100 --> 00:21:21,200
that itself. 
You're exposing yourself to 

464
00:21:21,200 --> 00:21:24,800
those anxiety, shame. 
Whatever emotions. 

465
00:21:24,800 --> 00:21:27,200
Come up, can be intense. 
And so that also you're doing a 

466
00:21:27,208 --> 00:21:30,000
little bit of exposure therapy 
there, but now getting in to the

467
00:21:30,000 --> 00:21:32,300
details. 
So we have our exposure therapy.

468
00:21:32,300 --> 00:21:35,000
We have our first item. 
What you're going to do before 

469
00:21:35,000 --> 00:21:37,600
is we're going to really go 
above and beyond with coping 

470
00:21:37,600 --> 00:21:40,100
ahead. 
This is a DBT scale within the 

471
00:21:40,100 --> 00:21:42,300
ABC scale. 
So it's from the emotion 

472
00:21:42,300 --> 00:21:44,600
regulation, module. 
We're working to long-term 

473
00:21:44,600 --> 00:21:47,300
overcome and maintain our 
emotional stability. 

474
00:21:47,600 --> 00:21:50,700
So with the Copa head scale, we 
are planning exactly how we're 

475
00:21:50,708 --> 00:21:52,200
going to cope with the 
situation. 

476
00:21:52,700 --> 00:21:55,900
When you're coping ahead, you 
are describing the situation and

477
00:21:55,900 --> 00:21:58,000
as much detail as possible, 
we're not even doing the 

478
00:21:58,000 --> 00:21:59,700
imaginal part of it, but on a 
piece of paper. 

479
00:21:59,900 --> 00:22:01,800
Like I'm going to be imagining 
what? 

480
00:22:01,800 --> 00:22:04,800
It's like to expose myself to 
this anxiety. 

481
00:22:04,800 --> 00:22:08,600
So if we use the example of 
going to the gym with a friend, 

482
00:22:08,600 --> 00:22:11,700
that's what's making you anxious
but you're like big long-term 

483
00:22:11,700 --> 00:22:15,300
goal is to work out three days a
week. 

484
00:22:15,300 --> 00:22:17,900
So like going to the gym with a 
friend is maybe you in the 

485
00:22:17,900 --> 00:22:20,600
middle of the hierarchy like 
maybe first third. 

486
00:22:20,800 --> 00:22:23,800
So it's not quite like I'm just 
walking by the gym or I'm just 

487
00:22:23,800 --> 00:22:25,700
getting a smoothie. 
We've already done those things.

488
00:22:25,700 --> 00:22:27,700
We've conquered them. 
We've overcome the anxiety. 

489
00:22:27,700 --> 00:22:29,100
We didn't avoid them. 
We did it. 

490
00:22:29,100 --> 00:22:31,000
Amazing. 
Saying this is maybe a third or 

491
00:22:31,000 --> 00:22:33,400
fourth on the list. 
So you're like my friend and I 

492
00:22:33,400 --> 00:22:35,700
are going to go to the gym. 
I have someone there to support 

493
00:22:35,700 --> 00:22:37,000
me. 
We're just walking on the 

494
00:22:37,000 --> 00:22:38,200
treadmill. 
We're not going to do anything 

495
00:22:38,200 --> 00:22:39,400
crazy. 
We're not going to try to 

496
00:22:39,408 --> 00:22:42,100
navigate lifting weights or 
asking someone what workout are 

497
00:22:42,100 --> 00:22:43,100
you doing? 
Like none of that. 

498
00:22:43,100 --> 00:22:45,300
You're just gonna walk on the 
treadmill for 30 minutes and 

499
00:22:45,300 --> 00:22:47,200
then you're leaving. 
So you're going to describe the 

500
00:22:47,200 --> 00:22:49,200
situation, you're texting. 
Your friend, to make the 

501
00:22:49,200 --> 00:22:51,800
appointment to go to the gym. 
You are walking to the gym. 

502
00:22:51,800 --> 00:22:54,100
With your friend, you're 
probably feeling some anxiety, 

503
00:22:54,300 --> 00:22:57,500
you then, get to the gem pan. 
We have to swipe our cards and 

504
00:22:57,500 --> 00:22:59,600
so, you're swiping your card in.
Maybe you're filling up your 

505
00:22:59,600 --> 00:23:00,200
water. 
Bottle. 

506
00:23:00,200 --> 00:23:02,800
You're getting to the treadmill.
You're putting the treadmill on.

507
00:23:03,000 --> 00:23:04,600
What are you going to do on the 
treadmill? 

508
00:23:04,600 --> 00:23:06,800
Are you listening to music? 
Are you watching a show or you 

509
00:23:06,800 --> 00:23:08,800
talking to your friend? 
What are you doing? 

510
00:23:09,200 --> 00:23:14,000
And you're also going to 
describe what potential anxiety 

511
00:23:14,000 --> 00:23:16,100
might come up for you. 
Are you interests while you're 

512
00:23:16,100 --> 00:23:17,800
on the treadmill? 
Are you anxious before you enter

513
00:23:17,800 --> 00:23:19,900
the building? 
Like what are the pain points? 

514
00:23:20,100 --> 00:23:22,700
You're being super specific and 
you're also using the check the 

515
00:23:22,700 --> 00:23:26,100
facts scale here. 
So if you're like what's going 

516
00:23:26,100 --> 00:23:30,100
to make me most anxious is when 
I fall off the treadmill, On my 

517
00:23:30,100 --> 00:23:32,700
face in front of everyone and 
the whole gym laughs at me and 

518
00:23:32,700 --> 00:23:35,800
kicks me out and tells me that 
I'm never again allowed to go to

519
00:23:35,800 --> 00:23:37,800
the gym. 
We gotta check the facts are, 

520
00:23:38,000 --> 00:23:39,800
that's probably not going to 
happen. 

521
00:23:39,800 --> 00:23:42,400
Yes, you could fall off the 
treadmill but the most likely 

522
00:23:42,400 --> 00:23:44,000
course of events. 
If that happens, we won't. 

523
00:23:44,000 --> 00:23:45,400
We oh my gosh. 
Are you okay? 

524
00:23:45,400 --> 00:23:47,600
Like, can I help you? 
You're going to get back on the 

525
00:23:47,600 --> 00:23:48,800
treadmill. 
You're going to keep doing your 

526
00:23:48,800 --> 00:23:50,900
thing. 
No one is gonna ban you from the

527
00:23:50,900 --> 00:23:53,700
gym for the rest of your life. 
We're checking the facts. 

528
00:23:53,700 --> 00:23:57,200
We are writing down the possible
situations that might happen but

529
00:23:57,200 --> 00:24:01,300
we're also being realistic. 
You Also, again, listing the 

530
00:24:01,300 --> 00:24:03,900
emotions and the thoughts that 
might come up, that would lead 

531
00:24:03,900 --> 00:24:06,900
to the anxiety and that 
typically cause avoidance or you

532
00:24:06,900 --> 00:24:10,900
having like a thought pattern 
about not feeling like you are 

533
00:24:10,900 --> 00:24:14,100
active enough to be at the gym 
or is not going to the gym for 

534
00:24:14,100 --> 00:24:16,900
you associated with maybe body 
image like what body image, 

535
00:24:16,900 --> 00:24:19,500
thoughts are coming up for you 
and how do you cope with those? 

536
00:24:20,300 --> 00:24:23,000
So we're describing the 
situation, we're naming, the 

537
00:24:23,000 --> 00:24:26,000
events were naming, the emotions
were naming the thoughts, and 

538
00:24:26,000 --> 00:24:29,000
then you're going to decide what
coping skills you're going to 

539
00:24:29,000 --> 00:24:31,300
use. 
When so if I was going to the 

540
00:24:31,300 --> 00:24:33,500
gym, I would really lean on 
distraction. 

541
00:24:33,500 --> 00:24:37,500
I'd be like okay I know that I 
really have a lot of time to be 

542
00:24:37,500 --> 00:24:40,200
in my head and get overwhelmed 
once I'm on the treadmill. 

543
00:24:40,200 --> 00:24:42,900
So I'm going to scroll on Tech 
talk because that's super 

544
00:24:42,900 --> 00:24:45,100
engaging and it's really hard to
ruminate in your head when 

545
00:24:45,100 --> 00:24:47,000
you're watching Tech talks and 
people are dancing. 

546
00:24:47,000 --> 00:24:49,400
The sounds are going. 
The trend is happening. 

547
00:24:49,500 --> 00:24:51,200
So I know the second I get on 
the treadmill. 

548
00:24:51,200 --> 00:24:53,900
I'm going to scroll on Tick-Tock
and that's what I'm going to do 

549
00:24:53,900 --> 00:24:56,000
and at least in the short term 
that will distract me. 

550
00:24:56,300 --> 00:24:58,000
I'm also going to practice deep 
breathing. 

551
00:24:58,000 --> 00:24:59,600
I don't want to be totally out 
of breath while. 

552
00:24:59,800 --> 00:25:01,800
Can the treadmill. 
So I'm going to paste my 

553
00:25:01,800 --> 00:25:05,000
breathing with my walking. 
So these are some examples of 

554
00:25:05,000 --> 00:25:07,900
skills you would use. 
So, go through see what the most

555
00:25:07,900 --> 00:25:10,000
overwhelming things. 
That would happen in this 

556
00:25:10,000 --> 00:25:13,600
anxiety-provoking situation are 
and you're going to plan, what 

557
00:25:13,600 --> 00:25:15,500
coping skills, you are going to 
use. 

558
00:25:15,900 --> 00:25:17,900
And this, you're even going to 
mentally go through it. 

559
00:25:17,900 --> 00:25:20,200
So, again, this is a little bit 
more challenging with imaginal 

560
00:25:20,200 --> 00:25:22,600
exposure because you're planning
it, and then the anxiety 

561
00:25:22,600 --> 00:25:24,700
provoking situation is imagining
it. 

562
00:25:24,700 --> 00:25:27,300
But if you're doing something in
person, you're physically going 

563
00:25:27,300 --> 00:25:30,200
somewhere, and doing this 
activity that provokes, Anxiety.

564
00:25:30,200 --> 00:25:32,600
You're going to imagine yourself
doing it again. 

565
00:25:32,600 --> 00:25:36,000
Even exposure therapy is built 
into the DPT skill, cope ahead. 

566
00:25:36,300 --> 00:25:37,700
So, you're imagining yourself 
doing it. 

567
00:25:37,700 --> 00:25:40,100
You're imagining yourself coping
with the skills, you're 

568
00:25:40,100 --> 00:25:42,700
imagining rewiring, the thoughts
that are coming up, you're 

569
00:25:42,700 --> 00:25:45,000
imagining doing your 
distraction, doing your deep 

570
00:25:45,000 --> 00:25:49,200
breathing, getting through the 
situation effectively, and then 

571
00:25:49,200 --> 00:25:51,400
you always want to make sure 
that after these really intense,

572
00:25:51,400 --> 00:25:53,600
emotional situations, you're 
recharging. 

573
00:25:53,600 --> 00:25:56,100
You are doing some self-care. 
You're going to pick, okay? 

574
00:25:56,100 --> 00:25:59,500
Next week is my next item on the
exposure therapy hierarchy or 

575
00:25:59,500 --> 00:26:01,200
not. 
Let me bang out all 10 of these 

576
00:26:01,200 --> 00:26:03,400
exposures right at once we 
always want to get back to our 

577
00:26:03,400 --> 00:26:06,600
Baseline after being in the 
situation that is making us 

578
00:26:06,600 --> 00:26:09,300
anxious. 
So that's an example of how we 

579
00:26:09,300 --> 00:26:12,300
would use the Copa had scale and
then we actually go through the 

580
00:26:12,300 --> 00:26:14,300
motions. 
We actually do the thing. 

581
00:26:14,500 --> 00:26:18,200
So we do the skills that we 
plan, we were going to use, we 

582
00:26:18,200 --> 00:26:20,600
problem solve in the moment if 
we need to we're going to lean 

583
00:26:20,600 --> 00:26:22,800
on distress tolerance skills. 
If this is something that makes 

584
00:26:22,800 --> 00:26:26,000
you super anxious, but if you 
really do take the time to 

585
00:26:26,000 --> 00:26:29,100
properly, do a cope ahead and 
plan how you're going to cope 

586
00:26:29,100 --> 00:26:31,500
with this situation. 
Ation, what might come up? 

587
00:26:31,500 --> 00:26:33,700
What, exact coping skills? 
I'm going to use even write 

588
00:26:33,700 --> 00:26:35,400
yourself a list put on your 
notes app. 

589
00:26:35,400 --> 00:26:38,900
If I have a thought spiral about
body image, I am going to 

590
00:26:38,900 --> 00:26:41,000
distract with this thought 
instead of and say these 

591
00:26:41,000 --> 00:26:44,300
affirmations, if I start 
breathing really quickly because

592
00:26:44,300 --> 00:26:46,800
I'm getting anxious, I'm going 
to paste my breathing to my 

593
00:26:46,800 --> 00:26:48,800
walking. 
If my thoughts are just going 

594
00:26:48,800 --> 00:26:51,600
crazy, I'm an open Tick Tock and
scroll 45 minutes. 

595
00:26:51,600 --> 00:26:54,700
So if you truly do that process 
of outlining what skills, you're

596
00:26:54,700 --> 00:26:58,100
going to use and what triggers 
might come up, I don't 

597
00:26:58,100 --> 00:26:59,600
necessarily think you will have 
to do. 

598
00:26:59,800 --> 00:27:01,300
As much problem solving in the 
moment. 

599
00:27:01,300 --> 00:27:03,300
Because you've done that in 
advance, you've made it pretty 

600
00:27:03,300 --> 00:27:05,700
easy for yourself. 
You just have to do the thing. 

601
00:27:05,800 --> 00:27:09,100
We can't avoid avoidance is easy
but again it amplifies the 

602
00:27:09,100 --> 00:27:13,500
anxiety long-term. 
So once we have gone through the

603
00:27:13,500 --> 00:27:16,300
motions, we've done the thing 
that makes us anxious. 

604
00:27:16,300 --> 00:27:19,900
We've used our skills. 
We've overcome that anxiety in a

605
00:27:19,900 --> 00:27:22,800
way that is safe. 
That is not overwhelming, that's

606
00:27:22,800 --> 00:27:25,700
not causing us to avoid more. 
We can check that item off the 

607
00:27:25,708 --> 00:27:29,200
exposure therapy hierarchy. 
And as we keep moving up this 

608
00:27:29,200 --> 00:27:32,500
hierarchy, G over time, our 
level of fear or level of 

609
00:27:32,500 --> 00:27:35,600
avoidance, our level of anxiety 
will decrease. 

610
00:27:35,600 --> 00:27:39,100
This is the beauty of exposure 
therapy, every single time. 

611
00:27:39,100 --> 00:27:41,500
You check off this thing on your
hierarchy. 

612
00:27:41,500 --> 00:27:43,500
You are getting better. 
Using your coping skills. 

613
00:27:43,800 --> 00:27:46,800
You are getting better and 
navigating anxiety, thought, 

614
00:27:46,800 --> 00:27:51,100
patterns avoidance, whatever it 
is, and it gets easier with 

615
00:27:51,100 --> 00:27:52,500
time. 
Yes, you are continuing to 

616
00:27:52,500 --> 00:27:55,300
expose yourself to things that 
make you more anxious, but you 

617
00:27:55,300 --> 00:27:58,600
also have more practice using 
your skills in the moment and 

618
00:27:58,600 --> 00:28:00,800
coping with the That's making 
you anxious. 

619
00:28:01,100 --> 00:28:04,600
And so we just went through like
an extreme really comprehensive 

620
00:28:04,600 --> 00:28:07,300
way to cope with something that 
makes you super anxious will 

621
00:28:07,300 --> 00:28:10,700
probably be like a big phobia, 
or a big sense of avoidance, but

622
00:28:10,700 --> 00:28:12,500
you can also do this for smaller
things. 

623
00:28:12,500 --> 00:28:15,500
So if you're like, I get 
super-anxious being in a new 

624
00:28:15,500 --> 00:28:18,500
situation, I never am the first 
one introduced myself. 

625
00:28:18,500 --> 00:28:20,900
I'm always like kind of hanging 
back and letting other people do

626
00:28:20,900 --> 00:28:23,900
the talking, you're like, it's a
long-term goal for me to become 

627
00:28:23,900 --> 00:28:26,100
more comfortable in those 
situations. 

628
00:28:26,700 --> 00:28:29,100
Maybe that doesn't have a lot of
anxiety for you, but you know, 

629
00:28:29,100 --> 00:28:30,900
that easy. 
Our option is to avoid. 

630
00:28:30,900 --> 00:28:32,500
So you've just always done that 
in the past. 

631
00:28:32,500 --> 00:28:35,400
So maybe you would have like two
or three items on your exposure 

632
00:28:35,400 --> 00:28:38,900
hierarchy, like I'm going to go 
ahead and make conversation when

633
00:28:38,900 --> 00:28:40,400
I order my coffee at the coffee 
shop. 

634
00:28:40,400 --> 00:28:43,000
Next time, I'm going to pretend 
to ask someone for a phone 

635
00:28:43,000 --> 00:28:44,300
charger. 
Pretend like, oh my gosh, my 

636
00:28:44,300 --> 00:28:46,500
phone just died. 
What time is it something like 

637
00:28:46,500 --> 00:28:48,300
that? 
And then you work yourself up to

638
00:28:48,300 --> 00:28:50,500
being like, oh, hi, I'm Sadie. 
Nice to meet you. 

639
00:28:51,300 --> 00:28:53,400
So you don't have to do this, 
like, 12-step plan. 

640
00:28:53,400 --> 00:28:55,800
You're just doing that. 
When there's extreme avoidance, 

641
00:28:55,800 --> 00:29:00,500
there is a pattern of extreme 
anxiety and Avoidance. 

642
00:29:00,900 --> 00:29:04,800
So that is exposure therapy. 
And again, if you are feeling 

643
00:29:04,800 --> 00:29:08,100
the urge to avoid, if you are 
feeling anxiety, your little 

644
00:29:08,100 --> 00:29:11,200
like mental signals to be like, 
okay we gotta do some exposure 

645
00:29:11,200 --> 00:29:13,600
here because the more you lean 
into that anxiety and the more 

646
00:29:13,600 --> 00:29:16,300
you avoid, the more it will 
build with time. 

647
00:29:16,600 --> 00:29:19,600
So whether that is anxiety, 
let's go back to the beginning 

648
00:29:19,600 --> 00:29:21,700
of this episode, where we talked
about being vulnerable, maybe 

649
00:29:21,700 --> 00:29:24,500
it's social anxiety, maybe two 
things like doing karaoke in 

650
00:29:24,500 --> 00:29:27,500
front of other people. 
Maybe it's a phobia you have, 

651
00:29:27,500 --> 00:29:29,500
maybe it's a general, something 
you want to. 

652
00:29:29,600 --> 00:29:31,700
Oh, improve on. 
But you've been avoiding because

653
00:29:31,700 --> 00:29:34,600
it does bring up some anxiety. 
There's this whole spectrum of 

654
00:29:34,600 --> 00:29:37,900
things that cause anxiety and 
intense emotions, and you can 

655
00:29:37,900 --> 00:29:40,100
use exposure therapy across the 
board. 

656
00:29:40,200 --> 00:29:43,300
Just like a quick little recap 
exposure therapy in a nutshell. 

657
00:29:43,300 --> 00:29:46,500
You are identifying the thing 
that makes you anxious, whether 

658
00:29:46,500 --> 00:29:50,300
it's an activity, an 
interaction, a behavior, 

659
00:29:50,300 --> 00:29:52,700
whatever it is you're 
identifying that thing. 

660
00:29:52,900 --> 00:29:55,000
We were deciding whether you're 
going to do in Vivo just when 

661
00:29:55,000 --> 00:29:57,600
you're actually going and doing 
an action related to the thing 

662
00:29:57,600 --> 00:30:00,200
that's make you anxious. 
Whether you're Imagining 

663
00:30:00,200 --> 00:30:02,800
yourself doing that thing. 
Or when you are doing 

664
00:30:02,800 --> 00:30:05,300
interceptive, which is when you 
are exposing yourself to the 

665
00:30:05,308 --> 00:30:09,300
feelings of anxiety, you're 
going to make a hierarchy of 

666
00:30:09,300 --> 00:30:11,000
each. 
Stop is like, okay, a little bit

667
00:30:11,000 --> 00:30:12,700
out of my comfort zone, but I 
can do this. 

668
00:30:12,700 --> 00:30:14,200
You're starting with an easy 
item. 

669
00:30:14,200 --> 00:30:15,700
Let's make things easy for 
yourself. 

670
00:30:15,700 --> 00:30:17,200
Give yourself a freebie that 
you're like. 

671
00:30:17,200 --> 00:30:19,300
Yeah, I can do that. 
Let's get some momentum going. 

672
00:30:19,600 --> 00:30:22,000
And the last thing is the thing 
that you are most anxious about 

673
00:30:22,000 --> 00:30:24,300
and again when you're choosing 
your biggest thing, check the 

674
00:30:24,300 --> 00:30:25,700
facts. 
Like, if we go to the gym 

675
00:30:25,700 --> 00:30:27,800
example, you're like I am most 
anxious. 

676
00:30:27,800 --> 00:30:31,000
I have the biggest phobia 
falling off the I'd nail your 

677
00:30:31,200 --> 00:30:33,700
biggest thing that you're 
working up to is not going to be

678
00:30:33,700 --> 00:30:35,900
falling off the treadmill. 
Dealing with that anxiety. 

679
00:30:36,500 --> 00:30:37,800
It's probably not going to 
happen. 

680
00:30:37,800 --> 00:30:39,400
Sure. 
We like to be prepared for every

681
00:30:39,400 --> 00:30:41,500
worst-case scenario, but you 
don't really have to fall off 

682
00:30:41,500 --> 00:30:44,400
the treadmill that I'm so glad I
have the coping skills to deal 

683
00:30:44,400 --> 00:30:47,500
with this, in case this ever 
actually happens in my life, but

684
00:30:47,500 --> 00:30:49,800
like, going to the gym 
consistently and using the 

685
00:30:49,800 --> 00:30:52,900
treadmill would probably be your
highest item on the exposure 

686
00:30:52,900 --> 00:30:55,600
hierarchy. 
So, writing down the exposure 

687
00:30:55,600 --> 00:30:59,200
hierarchy, it's manageable it 
pushes outside of our comfort 

688
00:30:59,200 --> 00:31:02,700
zone but Still doable. 
We're checking things off with 

689
00:31:02,700 --> 00:31:06,000
each action, item, with each 
part of the exposure therapy, 

690
00:31:06,000 --> 00:31:08,300
hierarchy, or coping ahead. 
We're planning with coping 

691
00:31:08,300 --> 00:31:09,500
skills. 
We're going to use. 

692
00:31:09,500 --> 00:31:11,800
We're building Mastery over the 
thoughts, emotions and 

693
00:31:11,800 --> 00:31:14,100
behaviors. 
We are beginning to trust 

694
00:31:14,100 --> 00:31:16,100
ourselves because we know I can 
cope with this. 

695
00:31:16,100 --> 00:31:19,300
I got this. 
I've done this before and I can 

696
00:31:19,300 --> 00:31:21,500
get through this anxiety. 
And then you keep building 

697
00:31:21,500 --> 00:31:23,300
yourself all the way up to the 
thing that makes you most 

698
00:31:23,300 --> 00:31:26,700
anxious, you overcome that 
anxiety, you stop avoiding and 

699
00:31:26,700 --> 00:31:29,300
it's amazing. 
It really just is so effective 

700
00:31:29,300 --> 00:31:31,400
in. 
So many areas of life because 

701
00:31:31,400 --> 00:31:34,100
when we're not doing something a
lot of the times, it's emotional

702
00:31:34,100 --> 00:31:37,000
resistance, or anxiety, and 
exposure therapy is a great way 

703
00:31:37,000 --> 00:31:39,800
to combat that. 
So I know that was so much 

704
00:31:39,800 --> 00:31:42,200
information. 
I truly hope that made sense 

705
00:31:42,200 --> 00:31:45,800
because it can be a little bit 
overwhelming, it can be a lot. 

706
00:31:45,800 --> 00:31:48,900
Probably gives too much detail 
at some points and skeet over 

707
00:31:48,900 --> 00:31:51,000
some things at other points. 
But I'll leave links in the show

708
00:31:51,000 --> 00:31:55,000
notes about what is exposure 
therapy, how it works, all of 

709
00:31:55,000 --> 00:31:57,900
the things, but it's been one of
the greatest Tools in my tool 

710
00:31:57,900 --> 00:32:00,000
kit for me Mental Health. 
Eyes. 

711
00:32:00,000 --> 00:32:02,600
And so I hope it helps you now 
as well. 

712
00:32:02,600 --> 00:32:05,700
And again, if this feels really 
overwhelming and like too much, 

713
00:32:06,400 --> 00:32:09,800
make sure to Loop in a 
clinician, go to therapy, get 

714
00:32:09,800 --> 00:32:13,300
support, that is totally 100%. 
Okay, if you enjoyed this 

715
00:32:13,300 --> 00:32:16,100
episode of, she persisted, as 
always, make sure to leave a 

716
00:32:16,100 --> 00:32:17,800
review share with a friend or 
family member. 

717
00:32:17,800 --> 00:32:19,300
I can share on social media tag 
me. 

718
00:32:19,300 --> 00:32:21,500
I'll make sure we post give you 
a little shout-out. 

719
00:32:22,000 --> 00:32:25,800
I really, really hope this was 
helpful and I'll see you next 

720
00:32:25,800 --> 00:32:27,700
week. 
Thank you so much for listening 

721
00:32:27,700 --> 00:32:29,500
to this week's episode of 
jeepers. 

722
00:32:29,600 --> 00:32:32,200
Today if you enjoyed make sure 
to share with a friend or family

723
00:32:32,200 --> 00:32:35,100
member, it really helps out the 
podcast and if you haven't 

724
00:32:35,100 --> 00:32:38,500
already leave a review on Apple 
podcasts or Spotify, you can 

725
00:32:38,500 --> 00:32:41,800
also make sure to follow along 
at at she persisted podcast on 

726
00:32:41,800 --> 00:32:44,700
both Instagram and Tick-Tock and
check out all the bonus 

727
00:32:44,700 --> 00:32:47,600
resources content and 
information on my website. 

728
00:32:47,700 --> 00:32:51,000
She persisted podcast.com, 
thanks for supporting, keep 

729
00:32:51,000 --> 00:32:52,900
persisting and I'll see you next
week. 

730
00:32:29,600 --> 00:32:32,200
Today if you enjoyed make sure 
to share with a friend or family

731
00:32:32,200 --> 00:32:35,100
member, it really helps out the 
podcast and if you haven't 

732
00:32:35,100 --> 00:32:38,500
already leave a review on Apple 
podcasts or Spotify, you can 

733
00:32:38,500 --> 00:32:41,800
also make sure to follow along 
at at she persisted podcast on 

734
00:32:41,800 --> 00:32:44,700
both Instagram and Tick-Tock and
check out all the bonus 

735
00:32:44,700 --> 00:32:47,600
resources content and 
information on my website. 

736
00:32:47,700 --> 00:32:51,000
She persisted podcast.com, 
thanks for supporting, keep 

737
00:32:51,000 --> 00:32:52,900
persisting and I'll see you next
week.