 Hey, what's up guys Drew here that anxiety guy calm once again, but except today I am joined by a special guest my new friend Kimberly Quinlan Kim is host of the anxiety toolkit podcast which just gets rave reviews from anybody. I ever heard that mentions it So Kim, thank you for taking the time To come on today. I really appreciate it. Of course. I'm happy to be here. Kimberly is an OCD specialist she's a therapist that's practicing in California here in the US of A and why don't you take a few seconds and give us an idea of where you're coming from and and what you do and and You know just kind of background and what's going on sure well I have the awesome job of being an OCD specialist or an anxiety specialist here in California I see clients in my private practice and Basically, what that means is I get to teach people how to face their fears Which is a wonderful job because even though it's scary for the person doing it they end up coming out on the other end so empowered and Feel like they finally got a grasp on how to manage their anxiety So there's the private practice piece and then I also have for those who don't have access to a therapist Which is a lot of people because unfortunately There are very few therapists who understand how to treat OCD I also have online programs for people who don't have access to therapy and that's more in the terms of Invited courses and OCD courses. Yeah, we talked about that a little bit and for you Unfortunately, we should probably address this right away Not being licensed outside of California You want to talk about that a little bit because I know you're gonna get contact that I know you well Well, and that was my dilemma. So like I said, I'm so blessed to work with the clients that I have but unfortunately I'm only legally allowed to treat people in California or within a country that allows me to treat them Basically, what that means is they're an unregulated Tele-therapy country now the problem with this is people were contacting me saying please I live in this state and I have to drive three hours To a therapist and even then they don't really get it and and please what can you do to help me? And I was feeling so sad because I literally had no place to turn them to like I couldn't even refer them to a Sort of good option. So that was the reason why I created the courses Which is basically the first five courses for sessions I would have with a client on teaching them what exposure therapy looks like what they need to be doing what they Need to be putting on make sense. Cool. Great story. Well, I'm happy that you took the time today Because as we talked about in our previous discussion a lot of the folks that are listening today that follow my podcast my videos into the Facebook group Are deal with some measure of OCD Usually the discussion centers around intrusive thoughts more so than those Compulsions that everybody hears about like handwashing and checking and things of that are counting But it's mainly intrusive thoughts and they often come along with that larger anxiety complex Panic disorder with or without agoraphobia Sometimes general anxiety disorder and it is a tremendous topic of discussion in my community But okay, so I understand if I'm afraid to drive the type of exposures I need to do to get back in the car and face my panic But how do I deal with these thoughts that won't turn off? And I think that's pretty much a bunch of people did ask in my Facebook group And if you're watching you're not in the group, I'll put a link in the description Go ahead and join everybody's welcome, but all the questions that were asked and I'm going to scroll while we do this Are almost all the same they're asking you about different thoughts Some people are focused on a fear of death. Some people are focused on a terrible accident. You understand They're all irrational and obsessive thoughts that people are having a hard time controlling So we'll we'll talk to about a few specific ones, but maybe we should talk about that in general And in my community we we deal a lot with with actually an australian dr. Claire weeks I don't know if you're familiar with Claire weeks and uh and her work Uh, but we we talk a lot about that stuff and that floating and facing and accepting and you know Kind of the basis of the exposure and facing the fear, but that doesn't necessarily apply Exactly when it comes to Cognitive behaviors like intrusive and obsessive thinking am I correct? Right, so the thing to first remember about OCD is no matter what the topic OCD has chosen We do treat them all the same And the way that we really in an easy way to understand OCD is that there's always it starts with what it will be either an intrusive thought Or an intrusive sensation It could be an intrusive Emotion right maybe guilt or shame or you know something like that Or in addition something that doesn't get it talked about a lot would be an intrusive urge Which would be this urge like you're going to do something dangerous So you're going to do lose control When you have that it's uncomfortable. Nobody likes it It's a horrible feeling and naturally our instinct is to run away from it Do something to make it go away to control it And what we want to do is we want to first really look at the concept around OCD and remember that The thought is not actually the problem. The problem is how we react to that thought I told you we speak the same language And so it's important for people to know often we get really caught up in like What does it mean about me if I'm having an intrusive thought about harming someone or or doing some terrible action or some very You know graphic thought What does that mean and the important thing is again as I said is to not focus on the content of your thoughts But instead to really look at how am I reacting to this thought? And how is that reaction actually cycling us back into the cycle to have more of those thoughts Not that it's anybody's fault or that you're you're causing them But it's it's true how we react to our experience can change how the brain reacts to it in the future Yeah I find that people are so when you're dealing with things like agoraphobia Where somebody develops a fear of being out of the house or even in a specific room in their house They're always afraid of how they're going to feel in that situation and those are easier They're often externalized even though we talk all the time about how it's really your reaction That's causing this. It's not the room or the supermarket. But when it's thoughts, I think it becomes harder because you cannot externalize You know, there's no outside influence there. This is things in my own head that I'm having a hard time dealing with You know and how do I deal with that? So You're I like the idea where it's the reaction to the thought But we have to go past the idea that you just have to and there's a lot of discussion about this Are you just supposed to accept them? Are you supposed to just let them be there? Am I supposed to distract myself? We have people who swear that meditation is the way to go with this so many different things But it's an active process, isn't it? This is not a sit back and just ignore them thing There's work to actually do isn't there absolutely, absolutely So I think the main thing to remember is metaphorically. It's how you greet the thought So if you let's say metaphorically a heart of your horrible neighbor comes to your door And you open the door and slam the door in its face Your neighbor's going to be a little upset with you or you know raise some some trouble It the same goes with intrusive thought So I think the first step is always to really address how you're greeting or welcoming this thought into your day So an important thing to remember here is an actual tool that we use in therapy It's actually derived from acceptance and commitment therapy Which is the the technique or tool of learning how to observe a thought Instead of fuse with a thought Right, so the work here is being able to notice Oh, I'm having a thought about I'm gonna like use triggering words But I'm having a thought about killing my husband Or I'm having a thought about that accident happening or if you have health anxiety It might be I'm having a thought about getting cancer and dying So it's first being able to observe and diffuse from those thoughts Again, that's sort of how you greet it That in and of itself can be enough for some people But if you're really stuck and let's say you've been dealing with this and you've been reacting to it for some time That probably won't be enough and you will need to engage in exposure and response prevention Which is a specific type of cognitive behavioral therapy All of what I'm talking about here is scientifically proven like none of this has been pulled out of my back pocket right And so exposure and response prevention to thoughts Would be around what we would write an imaginal or a script about that terrible thought coming true And then I would actually have you play around with it in creative ways So let's say if you were afraid of harming someone if you were my client And this is what I teach in the course as well is I would have you write this terrible Horrible story. I get you like it's horrible and I I want to always preface it with you know, this is not easy work I always make the joke with people is you should not want to see me If you want to see me. I'm doing something wrong, right? Because you're gonna make them do this hard Exactly in the kindest way possible. I I want you not to look forward to seeing me And so we would write those scripts But then let's say like I said if you had a fear of harming, I might have you walk around the streets with a pocket knife Right, or I might have you listen to fans of gunshots or I might have you You know, we can get really creative. This is why I love my job Like kind of statistic in a way and that we get to come up with very creative ways to have fun with fear And ultimately through that process You're basically showing fear that You're going to bring it on And you're showing fear that I'm going to stare you down and we're going to have the staring down contest, right? And I'm going to win Right. Yeah. Yeah, it's just the same that we talk about in dealing with a panic attack Same exact thing. So it's experiential learning when you when you stare it down and nothing actually happens You've taught your brain. Oh, I didn't have to fear that thought Right, or even if something does happen that you can handle it, right? Like even if you know, if you someone has a really bad fear of of having an accident You know, I'm not going to tell someone to purposely rear in somebody's car as an exposure But if for any reason they do it our work here with fear Isn't just about proving it won't happen. It's about proving that we can handle and master any emotion That rises when things get difficult Well, I think we I see two different things actually two or three different things that come up a lot And in the questions that were posted when I told people I would be talking to you Generally speaking health anxiety is huge. So the fear there is And the overriding question is no matter how many times the doctor tells me that I'm fine And the 50 different tests I've had and the 16 specialists have all told me I'm fine I still won't believe it. What do I do? There's that one And then there so there are rational or things that can actually happen. You can have a car accident. That's true You know, so you can get sick. It's possible. You can get sick But then there are also thoughts about completely irrational things that simply will not happen and people can't let go of those But I'm guessing that the the process is the same We often talk about learning to identify when those thoughts happen. Oh, this is one of those Now how do I greet it? Like you said, you know, how do I react to it? How do I interact with it? We talk about not getting into an internal dialogue with it because you you'll never win the argument What if what if always wins? So people the overriding question is how do I answer? What if what if always wins? But you could teach people how to not let what if when that's an actual skill that they can learn. I'm guessing Well, it's basically through the lens and the practice of being uncertain The only way to trump OCD is through uncertainty to be okay with uncertainty Because think it through and this is how tricky OCD is. So let's say you have health anxiety You go to the doctor. He says nothing is wrong. You're good And then you leave the office you have a short time period of relief And then as you're walking out of the office, you see someone else walk in who looks unwell and you go What if he missed something? Right, it's always one of you miss something Right, what if how and then you might go no no and then you might even have the MRI in your hand And you'd be like look here and you're do all you're doing is a reassurance seeking compulsion Right and even if you're holding it and you've got clear evidence in front of you I always sort of externalize OCD and make him into kind of a jokester I always tell my clients he literally sits back and he closes his arms and he goes. Are you sure? Right. Oh Right and and he can OCD and anxiety can pull out the are you sure card anytime And the own right and so the thing for us to work in is to lean in and be like, you know what? I actually don't I don't want to know anymore. I'm going to work at not knowing Yeah And then it can go on and on and on Yeah, and no you cannot overcome the I'm going to be uncertain card. That's the one thing that will get you through So the answer to the question is it's through the practice of uncertainty Now what I tell people in my office? In and in the courses as well is I want you to think of uncertainty like a very weak muscle in your body And the only way to strengthen it is by practicing it just like doing push-ups or bicep curl You can't expect uncertainty to work if you haven't practiced it a lot And so if you're faced with a problem or an or a Thought or a fear or a sensation or an urge you have to ask yourself Am I going to pick this up with my compulsive arm or am I going to pick this up with my uncertain? Whichever one you pick it up with is the one that will get stronger And and the goal here is to get an uncertainty arm that's so strong that it becomes the habit You know, we're very much habits of creatures of habit So if you're used to picking up things with a compulsion You you know in you know what it's like when you're anxious It's hard to think through things you can't think rationally your limbic brain winning So it's about the work here is working while you're anxious and while you're not anxious that's strengthening that uncertainty muscle And strengthening those the uncertainty muscle, which I really love actually like that concept When and we talk a lot of times in my community about I've actually said things like positive self-talk is bullshit In the middle of things because you can't argue with your limbic brain In the midst of it. So I'm guessing that when you are calm and rational you're doing a certain set of exercises and Those hopefully will become automatic behaviors so that when the shit hits the fan you automatically know what to do Is that I'm guessing that's what you would be teaching people It is it is I mean I mean that to a degree. So I agree with what you're saying, but I always always sort of Make a point in that the limbic part of our brain the anxious part of our brain that gets lit up when we have fear Is is built to prepare us to run That's what it's actually for So there will never be a day where you naturally want to be uncomfortable and naturally want to be You're always default to running away. That's just the human brain. Thank goodness. We're grateful for that part of the brain So but but the practice is with enough practice of being uncertain You will actually connect to the limbic brain with more of that upper higher part of the brain The more higher functioning part of the brain or the prefrontal cortex and that will step in sooner than what it would If you hadn't practiced that uncertainty So I I'm I'm just being picky with that because I don't want people to think that They'll one day always have that as being their normal response. That makes sense Yeah, that does make sense because then it's practice like anything else the more you do it the better you'll get at it But it's it's this is practice doing hard things and facing these thoughts and welcoming them Welcoming them in and people go down that road. They're trying to shut them out Let's talk for a second about distraction Like most people will find in just about any of the anxiety situations be they cognitive or overt like a panic attack If I get it they color or they use those little Devices I get on the phone. I talk to somebody they get out of their own head and suddenly everything seems to be better Which is great except what happens when you can't color So I don't know how does that play in in your practice and what you're teaching people And I would think with thoughts distraction is a huge strategy for I'm guessing many people They just want to distract or drown them out Sometimes you can't drown them out and what happens you're not actually building resiliency and skills if you just Run from them and distract. I'm guessing Right. Well the science behind this is a concept of what we call thought suppression So what we know in science is that if I put you in a room Um, and I put you a little on a table. This is the science experiment They did forgive me if you're you're proud know this already But if I put you in a room brought 15 people in and I said, okay, everyone gets their own desk for the next 15 minutes I want you to not think about white elephants Here's a button if you happen to accidentally think about white elephants, you have to press the button Right, so everyone sits there and does that and then the 15 minutes is over everyone leaves Then they bring the same 15 people in and say, okay for the next 15 minutes You can think about whatever you want if you want to think about white elephants You can if you have if you happen to think about it hit this button Which group thinks about the most white elephant? Yeah, the people that aren't supposed to Right, right exactly because the act of trying not to think about something is the action of thinking about it Correct, right. Yes. So thought suppression never works Never work Right. Um, and so we definitely don't want to do that now Distraction is a tool that is used in Dialectical behavioral therapy. That's mostly for people who have such strong emotions that they are self-harming suicidal Going to make very poor decisions for themselves and their health And so distraction has been a good tool for people who are really heightened But the problem was if even though with people with anxiety are technically very heightened The distraction ends up acting as a thought suppression, right? So it's not effective It's really confusing because people see people talking about destruction But it's actually this is where john hershfield a very good friend of mine Who's written a lot of books on ocd always says That's for them not for me, right Distraction is good for other people But not for the person or the brain with ocd right the same as as you go into a hospital There's always going to be like the antibacterial white Things that's good for everyone who doesn't have ocd, but if you have contamination, that's really not for you Right. Yeah, right. That makes sense. Yes. That actually so what we do is we practice Allowing the thought But you don't have to sit there and just think about the thought You can then engage in activities, but the thought comes with you So you might say something along the lines of high thought about killing people or whatever it is Yeah, I really need to go get the groceries Why don't you and I come and go get groceries together? And if you want to show up you can show up whenever you want I know that you've got a lot to say, but let's go get the groceries Let's go. Yeah Right. Yeah. So in other words, it's not that's a different reaction as opposed to oh, no, here it is Let me sit down and have a chat with it all day long. It's it's a slightly different thing Um, this balance between you're you're allowing it, but you're also not engaging with it the whole time It's sort of the metaphor of you can come but you can sit in the back seat You're not telling me where to drive. Yeah, exactly chat if you might and maybe I'll listen or maybe I won't We sometimes use the analogy of the infant screaming in your face or the toddler that really wants ice cream And every parent has done this you let them scream and ignore them That same thing that no matter how much it screams in your face. Just keep doing what you're doing Let it let it scream. Yeah, exactly So these are all really valuable things and and some I was just scrolling through some of the questions that came up And like I said, they're all along the same lines for the most part Very few people at least in my community seem to deal with actual physical compulsions Like checking or tapping or any of those things. It seems to all be cognitive So I think we've covered a lot of that To a sense But one of them came up and yes health anxiety is uncertainty Existential and death anxiety certainty like yes, we're all gonna go today is not that day or maybe it is who knows right but One person asked, uh, it's that whole be gentle to yourself thing and we talked about this in relation to overcoming panic disorder and agoraphobia Give yourself the space. How far should you go? A lot of times the gentle approach sometimes backfires and creates so much space In my head that I have this endless loop of ruminating So I think this is this the topic that comes up all the time when we're talking about physical exposures And that whole like, oh, I know it was hard. It's okay. Be kind to yourself like have a cup of tea You don't have to do it today. No, no, you do have to do it today So do the same rules kind of apply in your situation Like you don't get to take I always tell people there's no days off until you know that there's a day off Like there's no day off because you want a day off. You'll know when it's time for there There's no days off from this. So do you find that you're in the same boat with your clients or? Right. I really yes, absolutely. Not only my clients myself included like just the real um, I I had a really wonderful conversation with christa neff who is the Very very well known researcher in the in the area of self-compassion And the way that she frames it and the new research about that which is so awesome Is we've misunderstood self-compassion and self-care as only doing gentle slow Things like right about having a bath and candles and fair and cotton candies and backing away from challenge Yes, yes, but that is one component of self-compassion There are two and it's what they call it is the yin and the yang of self-compassion So the yin is that very maternal like how can I hold you in close to my heart kind of thing? Which is very important particularly given that intrusive thoughts usually come with a ton of shame right, but there's also the yang of self-compassion or self-care which is Doing the thing that will propel you to actually live the life you want The most the self-care isn't just sitting on the couch self-care is sometimes doing the really hard thing and you're doing it because you want long term happiness and joy and pleasure and and and wonderful experiences But the thing to remember is ERP and so all of the work I do must have both And I tell people it's a it's a flow So you you'll flow in and out of yin and yang and you'll do an exposure And then you'll be gentle and then you'll lean back in and then and so it's this flow that we have to get into But both needs to be there Often it's the you have to do the stuff when you most don't want to do the stuff That's the time to do it. So I would imagine the same rules apply in your sphere, which is great Um, we've been going for about 25 minutes. I don't want to go too much longer So I don't want to take up too much of your time and um, we can go for hours and hours on this I think but social anxiety also seems to have a big obsessive component. It appears Um with some of my people they they get obsessed with those things that feed into those feelings of rejection and inadequacy And I'm checking my phone eight zillion times to see if that person finally responded to my text Because if they don't I feel a certain way So do you find that there's a big connection there social anxiety comes Yeah, the the obsessive parts of social anxiety same rules apply. I'm guessing like you said same rules always apply The same rules apply. I think that the thing to remember with social anxiety is um, we actually do a small amount of cognitive therapy way less behavioral therapy um with um Then then icd treatment. Um, so sometimes we do sort of have to work through some often Um, ultimately errors in thinking around like, you know, that people will reject me if I'm sweating or so forth But think of that as one for me. It's one session. Maybe, you know with ocd I don't spend a ton of time correcting thoughts with people because that becomes a compulsion Um, so with social anxiety, we do sort of work through a couple of errors in thinking But then 100 we stare that fear down We you know, we walk across to the street where I have this awesome outdoor mall and we ask people for quarters and we You know, we ask to borrow pens and we give compliments and that's the work we do Yeah, which I'm guessing I know a few of the people that will be watching it sounds like their worst nightmare But but that's what you have to do do the things you don't want to do. Yeah. Yeah, this is so great So great, but um, do you have any So many people struggle for so long. They are not even aware what they have They don't know that these resources exist And let's talk for a second about how hard it is to find Not only an ocd specialist, which honestly, you're the first person that I've come across in my travels that That will say that you are an ocd specialist, which I really commend But just cognitive behavioral therapy and its variants in general So we're dealing with people many many times who have just been dealing with a general practitioner and a prescription pad or a psychiatrist and a prescription pad Or holistic medicine or all kinds of different things that for years on end So how would you find if you're in california? Somebody might be able to find you, but if you're somewhere else Resources, how do you go about finding this person? Absolutely. So the very first place to go is the international obsessive compulsive disorder foundation Um, you can go to i ocdf.org and what they have they have an a Directory of therapists who have training in erp but The thing is to remember for people and this is the main if you walk away with one message today this is The it's about the questions you ask Unfortunately the top by the time I see a client in my office. They're hopeless They've been told by multiple other therapists that I can help you I do cbt You know, and then I do I do I have there go through a year of therapy only to find out that that wasn't helpful And so the questions that you may want to ask the therapists on the intake are questions like do you know what erp is? Do you use exposure and response prevention? What is your training in exposure and response prevention if they don't know the answers to that right away? This is not good right now. There are I don't want to completely diss there are some therapists who let's say if you live in a State where there are one maybe two ocd therapists They might say I don't know what that is but let's you and I make sure we get resources And we'll go through this together given that I'm your only person. That's fine. There are workbooks that are very cheap There are resources like similar to what I've created that can help therapists become trained and therapists can become trained Through the iocdf and there's a certification there. Yeah, so make sure you ask the right questions That will save you tons of time Yeah, I was trying to remind people that in the end the therapist is working for you So you have to advocate for yourself and if you think those questions don't sound like the right answers And beware of the old. Oh, yeah, I I do anxiety. I have patients with anxiety. I'm sure you must hear too Yeah, yeah, I have patients with ocd too Right, right. It's like a very specialized thing to work on right It takes the average is seven to 14 years for someone with ocd to get the correct diagnosis and treatment That's horrendous. That's right. It's terrible So, you know, there's questions to ask and I'm so grateful that you know to be on here and help If anyone, you know has Yeah, just now in the early stages. Hopefully that gives them some resources to move to their great workbooks as well if you're You know, that's sort of more of what you're able to do or wanting to do Yeah, some people do like to work on their own if possible 30 seconds. Do you recommend it? I feel and what people are overcoming Things like panic disorder or phobia. I believe they they can often do it on their own If they have the right resources the workbooks they read they're in contact with people who are in the now ocd, can you tackle it on your own? Yes, absolutely. Yeah, is that going to be really hard? Yes. The problem is is that When you're in your own thoughts, it's hard to kind of call yourself out on your own bs, you know, I mean So it's harder, but it's doable people do it all the time and the cool thing is there are resources out there Like your podcasts and and and things like that that are support groups online support groups that can just help us along the way I'm a 100% believer that you can get better and live your best life I want to make sure I add that doesn't mean you won't have anxiety and that you won't have intrusive thoughts But you can live your best life That's why I want to make sure I say that because it's important to know But yes, I I have very much hope that people can get better and live their best life. That's great. Well Thank you so much for taking the time. I so appreciate it and maybe we'll get to do a few more of these at some point Any time give me your website is how do people get at you? So you can follow me on instagram. It's kimberley quinland. It's kimberley with an e k i m b l e y Or you can find me That's my australian Of word, um, but if you're interested in any of the online resources I have cbt school see cognitive behavioral therapy school.com. Yeah, it's great. I was on the site You have a lot of really good stuff there. So you guys check it out. All right. Thanks kim. I'll talk to you again soon All right. Thank you. I have to stop recording now the awkward part