 are. Today we are going to talk about what's the difference between like GAD, OCD, panic, agoraphobia. What's the difference between all those things? It's a good question. Maybe there is a difference. Maybe there isn't. Maybe the more similar as you think. I see my guest is in the green room. We have a green room here. We're very fancy. So I'm going to bring Jenna on in a second. You guys know Jenna Overbaugh. She's going to pop in and talk about this with me. Let me put the chat overlay up so you guys can talk to each other and so that we can see what's going on. We're going to do the usual, which is like will Jenna and I will blab for a little while and then we'll take some questions. And I'm sure Jenna will be thrilled to sit and answer them with me. So I'm not alone this time, which I'm really appreciating. And yeah, before we start, I'm going to go out on a limb here and do a thing that I rarely if ever do. I'm going to tell you about this thing, which was released today. This is a, let me put the overlay up on the screen. I'm going to use all my fancy tools here. So this is a workshop, this that I just got done creating when I took last week off from this, from live streaming and stuff. I was working on this sort of stuff. So this URL right below you, the anxioustruth.com slash panic is more information about that, especially if you are new to this and you are having recurrent panic attacks and you are trying everything and you don't know what's going on and you've never really heard this stuff before, which if you're in today's live stream, I'm guessing is probably not the case, but just in case, you can go check out the anxioustruth.com slash panic. It's a 90 minute workshop that's designed to explain it, take the mystery out of it and tell you why all the things you've been doing to make it haven't worked. So go check that if you will, especially if you're new. Oh, I'm going to need headphones because I need to be able to hear Jenna. So let's bring Jenna on right now. Hello, everybody, Bangladesh. What's going on? I'm so excited that I can see everybody chatting. This is so fun. This is fancy, man. We are not kidding around here. We got all the tools. This is really fancy. I know you say I have things to teach you, but I feel like you need to teach me that I've never, this is so fun. Jenna and I have decided that we are literally just stumbling through social media, like making stuff up as we go along. And maybe we are, that might be. Well, that's what happens when you just have fun. Like you're, I'm only ever just having fun and we're just figuring it out as we go. So this is so fun. Hi, everybody. I think so. So hello, everybody. Let us know. Clearly, everybody can hear us. So that's fine. So what I'll do is I usually will blab for a little while. I see somebody already picked up on that. Hello, blabbers. We have our honorary person from Twitter. I always have one viewer from Twitch. I'm always happy. I don't even know what Twitch is, honestly. I mean, I've heard of it before, but that's how far behind I am. I don't even know what Twitch is. My one Twitch viewer. And if we play our cards, right, we'll be able to stream to TikTok too at some point. I'm working on it, but anyway, you'll be able to see everybody's names, except if you're coming from the Facebook group. It just shows you Facebook user, but that's okay. If you have a question or whatever, just say your name if you're coming from the Facebook group so we know who it is. But we got, we're used to this by now. So Jenna, first of all, tell everybody who you are just in case they don't know who you are. So hi, everybody. I am Jenna. I'm a licensed counselor. I'm a licensed professional counselor. I live in Wisconsin, but I was born and raised near Pittsburgh. I just always knew from a really early age that I was just an anxious little kiddo trying to figure out the world. My earliest memories were, you know, being very nauseous before school. Oh my gosh, what do I sit with? Oh my gosh, what if the teacher calls on me? Oh my gosh, oh my gosh, what if, what if. But even from a very early age, I knew that I didn't like that. I didn't like for that entity to win whatever it was. So I just knew even when we were playing like heads up seven up, if anybody is like old enough to know what that game is, I would always be like, I'm going first. Like whatever would be anxiety for hoping for me, I always wanted to do that just to kind of show anxiety who was boss. Like I didn't want that entity to win. So just always kind of live my life that way, like trying to sit with the most challenging person at lunch, whatever that might have been. But then I went to college and I learned that that was actually a thing. It was actually a treatment. It was called exposure and response prevention. I started to learn about OCD, panic, anxiety, which is really cool because you never learn about that stuff, especially in like a basics like 101 course, right? So I was really, really lucky. But at that point, I was like, this is for me, like I wanted to be a therapist, but not the typical like, let's talk about it. Let's talk about how hard that is for you and like offer people a tissue. Like I was, I wanted to do something with them. I wanted to like, let's go, let's do this together. Come on, like believe in yourself and get them there. So from there, since 2008, I just went hard on studying exposure and response prevention and OCD and anxiety and panic as much as I possibly could. I went on to study it more in grad school, worked a lot with OCD there, worked at Johns Hopkins Hospital with kiddos and adolescents with OCD. And then I worked at Rogers, which is an OCD residential recovery unit for 10 years with kind of what you would imagine the most debilitating cases of anxiety in the world. And here I am. I've been on my own for a little bit, just kind of hanging out since COVID. Everyone kind of modernized, went online, had to figure out social media. And here we are. We're kind of figuring out how to teach people about these concepts in a way that's very widespread and, you know, has a really awesome impact. Because yeah, I believe OCD and anxiety and panic and all the things, right, like they can be so debilitating. And I know you know that, Drew. But they don't have to be like it's just this weird paradox to me that they can be so debilitating, but they're also so responsive to treatment. So that's what I want people to know that it doesn't have to be that way forever. And you can totally get on top of it no matter what it is that you're struggling with, whether it's GAD, OCD or panic or whatever. Yeah. Well, I'm glad you're here. Also, Jen, you're also whooped to win. So my whoop is convinced that I'm climbing a mountain right now. Yours is 98% recovery this morning. I'm like ready to go. That's not good. Jen at 98% recovery. We need to have to tone this down a little bit. But the thing that I love about Jenna is Jen is a little bit of a, well, I'm older. So you're a female version of me, I'm going to say that for sure. Because I came with that. So we've sound very similar. I think you guys are going to appreciate that. So let's get into today's topic. So on Friday in my subscriber live on Instagram, I talked about diagnostic labels. Like what's, you know, do they matter that much? People get really down. Oh, no, I might have OCD. I was diagnosed with GAD. What does that mean? I have another problem. Oh, no, no, no. And I have heard my friend Jenna here speak openly because she does that. Like this is what we do. And this is why I dig her so much about the idea that what's the difference in the end? Do we care that much about the difference? And then we talked about, yes, there is a value in diagnosis in terms of speaking common language and informing treatment. But is there really such a big difference between OCD, between GAD, between panic disorder in the end? No. So I could go on this topic forever of all the topics. This is probably one that's very near and dear to my heart. So when I started to learn about all these things, I started to have questions myself as we all do. And I'm sure you guys have all had it too, right? Like, well, what's the difference between OCD and anxiety? And you know, how do I know which is which? And how do I treat it? How do I respond to this symptom versus this symptom? And so we know that in the DSM, the diagnostic and statistical manual, which is guys, it's not the end-all-be-all. It is very kind of sloppily put together. People operate to create and organize the DSM. They operate in silos and they don't necessarily always talk to each other. It shouldn't be taken as the end-all-be-all. It's wrought with mistakes and room for improvement. But earlier in the DSM and the previous versions, OCD, GAD, generalizing anxiety disorder, panic, social anxiety and specific phobias, they were all lumped together under anxiety conditions, right? And I think that made sense for a lot of people. There's a lot of anxiety that's present in OCD. I think we can all relate to that, right? But because of some studies that have come out that suggested that there are some pieces of the brain, there are some parts of the brain or some structures in the brain that are more heavily implicated in OCD than GAD, they kind of took that and were like, okay, well, let's make OCD its own category in the DSM. But functionally, that doesn't mean anything as far as the nuances of what's going on and how we would approach it for treatment. The brains are so complicated, we have so much to learn, so I wish they wouldn't have made that decision. But anyway, so when it comes to generalizing anxiety disorder and OCD or panic, right? We're talking usually with GAD, we're thinking that person has a lot of anxiety around more real life concerns, right? Like more down to earth concerns, like bills, the state of the world, health, relationships, so on and so forth. Whereas with OCD, we're thinking that, you know, the technical terms for them are obsessions and compulsions. And I think in the past, right, we tended to believe that OCD was more of these outlandish fears, right? Like, I had the thought about it of a devil when I walked into a room, and I don't like that thought, so I have to go back and do it 12 times or something or until I see a good or until I can have it feel just right. Like that seems very, it's outlandish, right? Like it's not necessarily this like real life kind of down to earth thing for most people. But as we've started to learn more and more about OCD and like, you know, we're starting to relinquish this concept of subtypes, right? Like we're starting to realize that it's not just about contamination and fear of germs and needing to have things clean, it's not just these outlandish things. For instance, what about COVID, right? Like I worked with tons of people during COVID who definitely had, you know, like would definitely fall under like that slam dunk case of OCD. But that wasn't necessarily very outlandish anymore, right? Like we were in the midst of a pandemic. Relationship OCD, we have sexual orientation OCD, gender orientation OCD. These are no more, it's no longer just like these very obviously outlandish out of this world types of fears, right? And so I think as that has evolved, we're starting to be like, okay, well, where is the line drawn, right? And but at the end of the day, as a treatment provider, I don't care what someone is anxious about. Like at the end of the day, I don't care whether they're anxious about real life, like more down to earth types of things in GAD, for instance, I don't care whether they're more obsessively and compulsively responding to something out of anxiety, you know, about whether they're in the wrong relationship or contamination. And in panic, I don't care if you're anxious about the internal body signals that you are misinterpreting, right? Like I don't care what it is that you're anxious about. My job is to help you understand that a little bit better, and identify where you want to go. Like what are your goals? And what are the behaviors that are dysfunctionally impeding you from being able to achieve that, right? So in GAD, we call them safety behaviors. In OCD, we call them compulsions. They do the same exact thing. They reduce your anxiety that you feel from a thought and idea of worry and uncertainty. And same thing with panic, right? So it's all just semantics. It's all just semantics. Call it a compulsion, call it a safety behavior. I don't really care. But when we get, when we can go more abstractly and think more big picture and not get so lost in the weeds and not get so lost in the trees, we can realize like, hey, the function of these things are all exactly the same. The function of a compulsion is exactly the same as a function of a safety behavior in panic or in GAD. And, you know, they both reinforce that initial thought. They both reinforce that initial anxiety. The treatment, for me, is like, to someone who comes to me, again, I don't care what it is that they're anxious about. I treated the exact same way through evidence-based treatments with exposure and response prevention. I love ACT. So acceptance and commitment therapy. We'll do inter-receptives if we need to work on some panic stuff. But it's all the same. Like the function and the big picture of everything is the same to me because, again, I don't care what you're anxious about. That's not the content is irrelevant. Yeah. I think that's the main point right there. The content is irrelevant. And that is a thing that, over time, we've seen change, right? So if you go back 25 or 30 years in traditional or old school CBT, the content did matter. We're going to challenge the thoughts. We're going to show that they're irrational. We're going to fact-check them. We're going to keep records of them and let you check them against reality. But over time, when we've gotten to the point where we've said more and more, the royal way, I mean, clinically, that the content doesn't matter, the process matters, then these things do start to bleed together then. Because what's the difference between a checking compulsion and the need to continually engage in worry and rumination to try and find certainty? None. Right in the end. There's no, I would say there's no functional difference between worry, which we would normally say is a GAD-related behavior or a panic-related behavior and rumination. But both once all, or you're trying to figure something out, it requires this analytical effort, right? So there's no functional difference to me. And in the end, if you're going to work on that too, like so for somebody with GAD, we're going to work on like, hey, listen, you got to start to recognize your thinking habits and know that it's safe to disengage from rumination. Even though that feels so bad and you'll be really anxious to make your lunch while you leave that problem unsolved, this is what you have to do, which looks very similar to the person who does ERP work where they have to trigger themselves and not do the compulsion. 100%. And I think what people get stuck with is like, well, I think so many people are like confused about CBT versus ERP. And it's like cognitive behavioral therapy is a big umbrella term. And it's super, super vague. So cognitive behavioral therapy essentially means that your therapist or the intervention that you're doing or getting basically acknowledges the relationship among emotions, thoughts, and behaviors. And of course we do that. Like, of course, we all would venture to say that, yes, our behaviors influence our emotions and vice versa, so on and so forth. But ERP is CBT is so broad. CBT is so broad, it encompasses so many other like more specified interventions underneath that, like exposure and response prevention, like acceptance and commitment therapy, dialectical behavioral therapy is under there too. So while ERP is under that CBT umbrella, CBT does not necessarily equal ERP. And so what I'm fearful of, and it seems like that has happened in the chat, you know, sometimes people are going, and they're talking about things that I would want them to get ERP for. Like I want them to learn how to tolerate uncertainty because that's part of life. I want them to learn how to relinquish these, you know, dysfunctional, repetitive behaviors. I want them to learn how to problem solve instead of worrying and ruminating. But instead, unfortunately, they're probably going to get labeled as having generalized anxiety disorder because it's just like a catch all. And instead, they're going to get this very kind of like blanket recommendation for cognitive behavioral therapy, which that could be anything, right? Like that could be anything as long as the therapist recognizes the relationship between thoughts, behaviors, and emotions, you're getting CBT. But it doesn't mean that you're actually getting the evidence-based treatment that you need, right? You could be sitting there and a lot of things that people do that therapists do whenever they're just doing more like traditional CBT is they will do cognitive restructuring where they like actively take a person when they are actively anxious about something, whether that's the bills, their health, their relationship, whatever, job stress, and they will sit there and they will deconstruct that. Like a therapist is going to like deconstruct that in the moment and essentially reassure them. Essentially reassure them as to like why you don't need to worry that much. I never do that. I never, ever, ever, ever, ever do that with anybody. That's an old technique. That's an old school, like original CBT technique. Yeah. I don't like doing that. I think we can achieve the same thing more meaningfully and more impactually. What I do is I try to educate my people, my people, my clients. I try to educate my people about potential like thought traps that they can land themselves into, right? Like catastrophizing, probability, overestimation, black or white. But like when someone's anxious, I'm not going to sit there and actively deconstruct that with them. Yeah, argue with the fear. Let's sit down and prove why your fear isn't true. But for somebody that's dealing with OCD or GED or even panic disorder that leads to agoraphobia, no amount of reasoning that your fear is not true is ever going to be enough as anybody in the chat is going to attest. I've been trying to believe that a panic attack is safe forever in my head and I can't seem to believe it. This is why. I'm sure everyone in the chat, and it's happened to me before Drew, I'm sure it's happened to you, but we try to rationalize or logic our way out of these thoughts. We try to logic our way out of what our body is doing or I don't know, you're just having a weird day, right? It's fine, like there's nothing wrong with your heart or whatever. We try to just logic our way out of it and that might help really temporarily, but eventually these things you guys, we call it the doubt disorder. So it's the doubt disorder. It's the intolerance of uncertainty and these things all exist in your imagination and your imagination is way more expensive than anything that you could conjure up with logic. It doesn't just say by reality rules. Yeah, logic is only so expensive, right? Yeah. If you argue with your brain, it doesn't have to follow the rules. It can make up anything it wants anytime. So it's always going to come up with one more, but what if, right? Like, but what if this is the time, right? What if this is the time? But you've always been able to pay your bills before and you've been fine. You always find a way to figure it out. But what if I don't figure it out this time, right? Oh, they're not mad at you. Like they told you that they're not mad at you. They said that you're fine and that you didn't say anything offensive. Oh my gosh, but what if they're lying? Right? Like you're always going to have one more, but what if. And so my job is to teach people, again, I don't care what it is that you're anxious about, my job is to get you to tolerate that what if. So you don't have to continue to go back and fight with it. So yeah, so. But if you look at that and you apply it across the labels that like I have on the screen right now, GAT, OCD or Panic Disorder, for instance, and by the way, Panic Disorder and Agoraphobia, I'm going to kind of lump together because Agoraphobia is what grows out of Panic Disorder. So Agoraphobia isn't special. It's just Panic Disorder run amok. But in all of those cases, I'm going to tolerate the what if. So in OCD, I'm going to tolerate the possibility that I don't actually love my partner. Okay. And GAT, I'm going to tolerate the possibility that I might not, I might have made a huge mistake and that my family hates me because I said something wrong. In Panic Disorder and Agoraphobia, I'm going to tolerate the what if something is actually wrong with my body, even though it never has been. So see how it all starts to look the same in the end. Yeah. And I think that's, that's, I want you guys to like say in the chat, I'm like a big, like I want to hear you guys in the chat. So who, I'm sure so many people out there have been like, well, you know, at one point in my life, I had this subtype of OCD and then I had this OCD and then it kind of plays whack-a-mole, right? So it kind of plays whack-a-mole, like, and I've worked with people who literally feel like they're subtypes or whatever it is that they're anxious about, literally it changes like day to day, like sometimes multiple times in a day and it can feel like so many moving targets, right? But I try to get people to understand that it's actually not all of these moving targets. It's actually not what it feels like a bunch of moving targets. It's actually one target and that one target is down. That one target is you not being able to sit with uncertainty. I've worked with so many people too who, like, they're actively anxious about, say, their sexual orientation, right? Like, I just, I think I'm, I think I'm gay, but I just want to be 100% sure that I'm not actually straight or not actually bi or whatever, right? Like, just want to be 100% sure. And then like two years later, they'll be like, I can't even believe that I was so anxious about that. Like, that seems so stupid, but now they're anxious about this thing. And it's like, it just, it gets whatever happens to ruffle your feathers in the moment. Like whatever it is that you are not tolerating uncertainty about, that's where OCD and anxiety and panic or any of these things will fester. It's going to get you right. And that's why, like in my, and you guys know this all time, I don't talk about symptoms. We don't talk about symptoms in the Facebook group. Why? Because the symptom you are convinced today is the worst one. See me in six months. You'll have a new one. Yeah. And think about three months ago when you had one that was, what was definitely the worst one then and now it isn't now. Why is that? So it is, there is a lot of similarity here. And I think people get caught up and listen, I don't want to minimize OCD. We understand the severity of OCD. We understand that specialized treatment. But the more we get into this, the more we see that the specialized treatment looks exactly the same because you might say ERP for OCD, but all exposure is ERP. Because at the RP, the exposure is pointless. So maybe it looks a little bit different contextually from somebody who has panic disorder, somebody has OCD. But in the end, there's an E and an RP in all of it. It doesn't matter what you're working on. And again, I don't care what you call it, right? So another like semantic thing that just like drives me nuts is in generalized anxiety disorder, they call them behavioral experiments. There's no difference. Like behavioral experiment, like, yes, we're gonna, we're gonna, you know, educate you about all these cognitive distortions. And then we want you to go out into the world and, you know, challenge yourself, you know, put yourself in these anxiety-provoking situations without letting your cognitive distortions run amok. And I'm like, that is literally the same thing as an exposure with response prevention. Like, it's literally the same exact thing. Like, so a couple of the other arguments that I get are like, what just feels so different, right? Like that's because I would say that of like my majority audience, I lump them together, but not everyone else does. Right? I get a lot of people in the OCD community who feel like very protective. And I get it, right? Because I have OCD, like I've been diagnosed with OCD. I've also been diagnosed with generalized anxiety disorder in the past and didn't feel like it quite got it. So like, I get that piece of it. But I get so many people who are like, no, they are different. They just feel so different. And I'm like, since when do we give feelings any say, right? Like, everything that we talk about is like, you feel the way that you feel. And like, you can feel the way that you feel, and that's very valid. But your like narrative about that feeling is the problem, right? Like, so again, like, since when can we say that that's like a valid argument? Oh, well, they just feel different. It doesn't mean that that's legitimate. Like, we're constantly talking about how like, yeah, you feel like you're having a panic attack, or you feel like you're having a heart attack, but we're going to continue acting as though they're like, so since when do we start to, you know, use that as like a credible source of information. And I find it so interesting to that, you know, when we attack these sort of things, or you're working with your clients that have OCD, you're constantly going to do that part of it that says it doesn't matter how strong it feels. We can't rely on the strength of the feeling is not a prediction of its validity or its predictive power or the fact that it's a message or an omen. But yet we will come back to, but it feels so strong. So therefore we will use that feeling to judge that it's a special condition. But I'm telling you right now that somebody who is in the grips of the height of panic, a panic attack, is as afraid that they are going to have a psychotic break as the OCD sufferer is that they accidentally ran over a kid two miles back and they don't know it. So I would agree with you on all of these fronts. This, I mean, I knew we were going to, this was going to be an agreement fest. I knew that, but when I guessed you to come on. It's a really great, it's a good topic because people get stuck on like, well, I have this one versus that one. Oh, we have a second Twitch viewer. I'm all excited. But it is a good topic. So if you want to go into the chat, you want to go into the chat and we'll we'll see what people had going on. Yeah, let's do it. And can I say, I want to say one more nerdy thing. You can say all the nerdy things you want. That's what we're here for. Literally, I love this topic so much. I mean, Jenna says nerdy things. That's going to be on the bottom of the screen. Because I think like when I was in grad school, I always had these thoughts. Like, what the F is the difference between a safety behavior and a compulsion? Like, what is the difference? And like, it just never felt right. It like never felt like it made sense. But I was like, what do I know? What do I know? I'm just going to go with it, right? Like, I'm just going to go with it and da, da, da. But I feel like people are starting to catch on now. And so I feel like I finally found my voice and like I'm not the only one who thinks this. The best way that I have been able to describe the difference between generalized anxiety disorder and OCD is that generalized anxiety disorder kind of feels, and this is how this is my like interpretation of it myself. So hopefully it resonates with people. Generalized anxiety disorder feels like it feels like a thunderstorm in the background, like a rolling thunderstorm in the background. It's like not immediately threatening, but like it's always kind of there and like a very doomy thing. Like you feel like it's like something that is hot going to happen, right? But like it's not immediate threat. OCD feels like the lightning bolt, like the thunder clap. Like it feels very sudden and very like in your face, like very threatening right now. But they're both still storms, right? Like they're both still storms. Like I treat them the same way. Like when I hear rolling thunder, or if I see a clap of lightning outside, like I make sure that I get in my house, then I make sure the windows are shut. Like we do it the same. So like there might be some features that maybe are a little bit different, but not enough to warrant a massive difference in how we treat it. And the nerdy thing that I was going to say was that sometimes the argument I get for why they're different is, oh, exposure and response prevention isn't as effective in the research for generalized anxiety disorder as it is for OCD. Like when you look at the research for OCD and ERP, it's like, whoa, like more effective for OCD than any other treatment for any other disorder. So why not for GAD? Well, they've done research just to potentially indicate why. And that's because in generalized anxiety disorder, as the name implies, the triggers are more general. The triggers are more general. A lot of times people who have more GAD are like, well, I don't know. I'm just so anxious all the time. I'm just so anxious all the time. I don't really know why I'm just anxious all the time. Whereas with OCD, it can be like, I'm really nervous about not, like I don't like knives, right? Like I don't like scissors. I don't like sharp objects. I don't like driving. I don't like looking at kids. It can be very obvious. Well, if you know how treatment works, for exposure and response prevention, you know that you need to rely on the identification of triggers, right? Like as a treatment provider, we need to identify triggers. We need to know what your triggers are so that we can actually implement good exposures, right? So we can actually identify things that you need to go and do in your environment. And so you can imagine from a treatment perspective, right? Like if you don't have good triggers and you're not identifying specific triggers, like you might struggle to do in GAD, you're probably not going to have as effective or like as wow of a treatment plan. But that just goes to show that you need a really well-educated therapist who can be creative when it comes to hierarchy development and identifying these triggers, right? Like the problem isn't therefore that they're different. The problem is that we just have to be a little bit more creative in our hierarchy development and our development of exposure work. So what's my sub box? No, I agree with you. And I think in GAD, and it's interesting because I've just spent two and a half months neck deep in GAD and MCT, Metacognitive Therapy, which is fascinating shit. But in the end, it's all the same stuff. So we're going to make you aware of your propensity to pay really close attention to your thinking. And then we're going to work on behavioral experiments, if you will, in the GAD world that says, hey, you can do things while this rest has happened to this discomfort. Anyway, but I think in GAD, like you may have to look a little bit closer, but I think the triggers are right there. You just have to look for them. Yeah, you just have to be creative. Right, there's not as obvious as somebody with panic attacks or maybe with OCD, but the triggers are there and you can address them. So they're not all that different. But I like your idea of like, it's the rolling boil versus the spilling over. One, if we graph them, GAD might always look like this, whereas OCD and panic disorder might look more like that. But in the end, if you understand the nuance, the treatment's become very similar. Wow, it's the same. Yeah, I get it. And someone in the chat is saying, my doctor said I have agoraphobia, but I feel like I have a little bit of everything. You probably do, because again, this isn't a bunch of moving targets. This is one target. It's the intolerance of uncertainty and doubt, right? So if you're intolerant of uncertainty about, oh my gosh, what if I leave my house and I have a panic attack, you're probably not tolerating uncertainty in a lot of other areas, too. So yeah, and so that's what we need to fix, right? Like we can't just fix your fear of going outside. You know, we can certainly do that and you will extinguish your fear of going outside, but you're probably going to still be very intolerant of uncertainty in a lot of other areas. So we have to do exposures to you going outside and having these panic symptoms and being able to tolerate that in a way that's challenging but manageable. And we need to make sure that you are tolerating uncertainty of life, because again, it's part of life, to make sure that that's a really big focus of treatment. Otherwise, it's just going to go to somewhere else. We can't just like extinguish a fear. I think that's why though, if the treatment is done well, so that exposure that you're going to use, it's not just tolerance. It's not just habituation. It's the lesson is the process of tolerating that distress and working through it. So that the exposure that you do walking around your block because of your agoraphobia can be portable. For me, I was agoraphobic. I had panic disorder and I also spent a whole lot of time 100% obsessed with the idea that my food was tampered with and poisoned. But in the end, the same tools would have applied in all of those things. Does that make sense? So you should be able to use them in multiple ways. Let me put some stuff up on the screen so we'll take them in the order that they came. Perfect. So this one, how do you deal with the compulsions if they are mental? This is right up your alley. I love this. This is the best time of my life right here, like this whole discussion. So this, I will give this to you guys, right? So mental compulsions are going to feel a little bit trickier. And again, I'm like, I use compulsions the same as like say, it's all the same to me. So, you know, whether you have like GAD or panic or OCD, like I hope that you can resonate with what I say. So I get it. Mental compulsions, kind of non-observable compulsions are going to feel a little bit trickier and they do require a little bit more attention and expertise and kind of honing it on because it's not as observable. It's not observable, like say getting up physically from the couch and walking in the direction of the sink to wash your hands, right? Like that is very observable and kind of like a clear step by step process. When they're mental, it requires, I think I start first with just a lot of education about, I always tell people, you are not in control of the thoughts that pop up. You are in control of the thoughts that you conjure up. And so there's a difference between thoughts that just pop up into your head like, oh my gosh, what is, what's my heart rate doing? What does that mean? Usually a lot of the times it comes in the form of a question, not always, but a lot of times I feel like it comes in the form of a question for people. You can't help the thoughts that pop up. You can't help the urges that you have to like want to go back and like review a conversation. But you are 100% responsible for what you do after that. That first initial thought that comes in is instantaneous. It takes but a couple of milliseconds, right? It is another analogy that people have used in the past is like, you can't help a bird that flies onto your head, but you are responsible for whether or not it lays a nest. So my best analogy, just like super, super, or my best advice here is to really, truly try to recognize that they are habitual. These mental compulsions are habitual. They're not automatic. Automatic is like breathing. It's blinking. It's your heartbeat. These mental compulsions, they feel probably very hard to let go of because you may be justifying them. It may feel like, if I don't figure that out, I'm going to be irresponsible. If I don't figure that out, something bad will happen. You know, it's hard to sit with that uncertainty. I think of these questions like a complex math problem. And the number that I use is always the same, like 38 times 27, right? So 38 times 27. I want you all, when you have these, what if thoughts that come up? What about this? Or what if I said something offensive? Or what if I get fired? Or what if I have a panic attack when I'm out? I want you to think of it like a complex math problem, like 38 times 27. You can visualize that. You can have that thought be there, but it takes mental effort for you to actually figure that out. And it takes mental effort for you guys to try to figure out all of the things that it is that you try to figure out, right? Like, when am I going to die? Or, you know, am I going to get sick? Did I come into contact with someone who has COVID? Did I say something offensive? It takes effort to try to figure these things out. So the best thing that you can do, and it's obviously easier said than done, you want to make sure that you are sitting with that question, allowing that question to be there. And your only job is to not answer it. And of course, it won't be hard. You'll have more nagging, intrusive thoughts that come in, like, well, if you don't think about this, then you must not care, right? Like, what if something that happens because you didn't prepare for it? I'm treating that like an obsession too, and I'm not answering that question. And you continue living your life. Yeah. Good answer. It's just more nuanced. Yes. By the way, not this Wednesday's podcast, but next Wednesday's podcast is exactly that topic that it's habitual, not automatic. It's exactly that, the fact that we have a choice at some point. Let's put another one up. And this is going to be typical, and I think this will apply also to other people. I say, well, what about death anxiety, but what about, what about this? Okay, well, the same answer is going to apply. What about harm, OCD, and the fear of hurting? How could you possibly tolerate that thought? That's a special one, right? Yeah. So, and I love what you said, right? Like, none of these exists on a spectrum. Like, there's no one subtype or like, set of fears that's harder than the other. They're all relevant to the person, right? And we know that OCD and anxiety latches on to what it is that the person values. So, I used to struggle a lot with this, I have a five-year-old, and I used to be obsessive about whether he would die before me. Someone else with OCD probably wouldn't, doesn't ruffle their feathers because they're more worried about, I don't know, whether they said something offensive, right? It just, I don't care about that as much, right? So, it's wherever you're not tolerating uncertainty where your OCD will start to fester. So, how do you tolerate that thought? My answer to that is that you have no other choice, right? And like, the nicest way possible, right? Like, how has it been not tolerating that thought, right? Like, we have no choice. Like, when it came to use my personal example here, like, I, again, like, I would go hard on trying to figure out whether my son would die before me. And I was like, I was like, nuts enough to think that I somehow could figure that out. Like, no one else will be able to figure that out, but I just look a little bit further, I can figure it out. Like, I will be able to figure it out. And like, I thought that it was at the bottom of a Google search or something. I don't know. I just, I felt so strongly that I could figure that out. And then it just hit me like a slap in the face one day. Like, there's literally nothing that I could do to figure that out. Like, I could do all the doctor's tests. I could look into the future. You know, if like future Jenna, like herself, was presented to me and said, Eli will not die before you. You're fine. You can have a great life with him and you never have to prepare for that. I wouldn't believe it, right? That's right. Like, what I want doesn't exist. Even if he did, it wouldn't be enough for me anyway. So, I, like, so tall- You know what ACB would say? What about the many worlds interpretation? That's Jenna from one time or another one. I get that. Are you, how crazy are you? Like, are you that delusional that you just like can just like conjure that up? Like, what's the matter with you? You can't trust that. So, tolerating these thoughts doesn't mean that you like it, right? Like, I wouldn't say that I am tolerating the thought of my son dying. So, like, but I kind of am, right? Like, he's at school right now. I don't know with 100% certainty that he's alive. Right. So, it's not, I love that thought. I get hot even, like, thinking about it. Like, I'm sweating. I'm not loving it. I don't like it. I don't enjoy it. But I also know that I have to take bets in my life in order to live the life that I want to live. Like, he has to go to school. I have to work. Like, I have to work. You also take bets every day. You know, we take bets continuously all day long. All day long. Just some bets we determine are off limits. You can't take that bet. All day long. And all, like, all of you guys, like Stacy in the chat, Katelyn here, like, how do I tolerate uncertainty? How do I tolerate it? Right. Well, you do all that. Because then, in that situation, yeah, but what about the uncertainty about that? Okay, great. Yeah, yeah, harm, OCD, whatever. But I have the fear of a heart attack or stroke. I have the fear of death. Mine, especially, is different. It's all the same. It's all the same in the end. Which is, sounds like such a harsh, cold, cruel thing to say. I know that your fear of death seems incredibly important because isn't that the most important thing? How long are you going to be alive? Right? But what Janet is saying is perfect. We'll lay a little bit of personal experience. You went down the rabbit hole of trying to figure out if Eli was going to die before you. I went down the rabbit hole of trying to prove that there was, in fact, an afterlife. I was reading, like, voraciously, like a robot to try to find some spiritual thing that helped prove to me that I would continue and not just blink out of existence. And in the end, I had to come to the same realization, too. It was super uncomfortable. But I realized I am never going to answer this question. And this is doing me more harm than good. So I'm going to have to roll the dice and be really uncomfortable while I remind myself that I should live now instead of trying to figure that out. Yeah. And we took bets all the time. Like, Caitlin, Stacey, anyone who was like, how do I sit with you uncertainty? We take bets all the time. If you guys got in the car recently, you took the bet that you could have died on a fatal car accident. And I'm not saying that you, like, checked the box saying, like, I signed up for this. I tolerate the fact that I could die in a car accident. But I am saying that you probably didn't, like, you know, hardcore check the weather conditions or check your tires or, you know, pull everybody in your neighborhoods to make sure that they haven't been drinking, right? Like, you get in the car because to not take those bets is a horrible way to live. You have to be able to, you have to be able to live your life. You have, you're not willing to sign up for a life where you can't drive, right? Like, I'm not willing to sign up for a life where I'm planning my son's death and I can't enjoy him. So how do you tolerate that thought? You have no choice but to, right? Like, otherwise. And again, like, tolerating it doesn't mean that you agree with it. I think that's why people get stuck on it. Like, they think that if I'm agreeing with the thought or if I'm allowing that thought to be there and I'm not fighting it, it must mean that I like it. It must mean that I agree with it. And that's not true. It's just that I'm not gonna let you dictate my life anymore, right? Or that I think people also get confused and they think that tolerance means that their discomfort level goes down. That's not what that happens either. Like, that takes a while to have happened. So I think people feel like, but I can't tolerate it. So when you say, how do you not, I would add to that and say, what you're really asking is, how do I stop trying to, how do I stop trying to solve it and be safe from it and find safety from this thought? But in the end, you discover, I'm not getting any safety. So all of my resistance and my thinking and my digging and my Googling and my asking and my checking and my saving and bracing is literally performing zero function except making me feel worse. So when I stopped doing those things, now I am in tolerant zone, but I will feel unsafe in tolerant zone for a while. I think it's really important to point that out because people think, well, tolerance means that I feel better about it. No, no, no. You'll feel worse about it at first until you learn that, oh wait, it's okay. Look, nothing changed in life. And I didn't try to prove that I won't hurt somebody or that I won't die. Or I'm hearing a lot of, but what about, but what about the fear we're going to create? The same answer is going to apply over and over. Yeah, and so there's Jonathan Grayson. He is more in the OCD field, but Jonathan Grayson has this really wonderful concept of like the second best life. So OCD and anxiety and panic, it makes us want to chase this fantasy, right? Like this fantasy where you will find out whether there is an afterlife. Like this fantasy where I will figure out whether my son will die or not before me, right? Like we're all chasing for that fantasy, quite frankly, right? Like we're chasing that fantasy where we will never have a panic attack again. We're chasing that fantasy where we will never hurt anybody whatsoever. But that's all just a fantasy that doesn't exist. 100% certainty does not exist. You know, there will be anxiety. I can't promise anybody that there is an afterlife. I can't promise anybody that my son won't die before me. Like all of that is just a fantasy. And the sooner that we can, you know, recognize that and mourn that, right? Like there was a time where I had to literally mourn the fact that my son could die before me. Like that realization really, really sucked. But with that comes the ability to take a breath and like stop holding your breath where you can be like, okay, that was a fantasy. That was literally never going to happen no matter how hard I chased it. I can stop holding my breath now and now I can live my second best life. I can live my second best life where my son may or may not die before me but at least I'm not planning his death every day. Where there may or may not be an afterlife but at least I'm living mine, right? Like it's this second best life. Not to say that that can't still be freaking amazing. Like I'm super, super happy and I'm way happier now than I was when I was planning my son's death every day. But it's that fantasy, right? Like we're all chasing a fantasy that doesn't exist. And so I encourage all of you, like when you consider that like make space for yourself to mourn that. You know, Bethany is saying I've realized many times that I essentially wanted a perfect life with no problems. Mourn that sister, mourn that. Like allow yourself to be sad about that but that doesn't exist and that no matter what you will never have that. But then, you know, do what you can to live your second best life. For me and the death thing it was, I literally had to keep repeating to myself, one day I will die. And there was mourning in that because that's the acceptance of like none of this is going to stop it from happening. But my second best life, which is great, I dig that idea is I don't have to live like it's happening right now. Let me do the best I can until that day comes. I don't know when it's going to come, but let's assume it's not today and do the best we can. That's really great. This is what Jonathan Gray said. That's why he's Jonathan Gray saying that we're here. Yeah, Jonathan Gray said it's amazing. It's all like this. And again, like it's not like, womp, womp, second best life. It's like the second best life you can achieve. I would rather achieve a second best of something than keep fighting an unfightable fight to try to get something that was never going to happen anyway. Well, I think, yeah, that's 100% true. Let's take another one. These are all very similar. So we can't, we're going to take all of them, but how do you get over thinking the thoughts? They feel like they're going into your mind's eye. Like it feels very important. So this is where the, what would the exposure or the tolerance practice look like in this situation? So I want you to, I mean, our bodies and our brains are really, really smart, right? Like our brains are really, really smart, but they're also kind of dumb in some ways, right? Like I'm sure all of you have had that experience where you're watching a scary movie and it feels so real. Like the last scary movie that I watched was Smile. It was actually super creepy. It was a really good movie I thought. But it was like, I was like wanting to close my eyes and like I was bracing myself. Like obviously on some logical level, I know that that's not true, but it feels so real. I challenge all of you if you get like really stuck on like the feelings and the field and it feels so real. I challenge you to go a day or a therapy session or go through Drew's workshop and not use the word feel. Oh, I do that all the time. How many times, how many people show hands to the Facebook group? Have I said, have I answered your post and said, don't you're not allowed to say what it feels like? I do it with my clients all the time. I'm like, all right, I'm gonna have to break up. I'm gonna have to break this out and you're gonna be really pissy with me, but you're not allowed to use the word feel. Because it is not, we cannot allow that to be a legitimate argument. We can't allow it to be because our bodies feel things all the time. That don't make sense, right? And it's not the, like you can feel how you feel. The feeling is real, right? Especially with panic. I always am very careful to tell people like, I believe you that your heartbeat is racing. I believe you that you have this like pressure in your head. I believe you that you feel woozy. And that's fine. What is not necessarily true or accurate is the imagined narrative that you're making up about that feeling. And so we can only ever change our behaviors, right? Like we can only ever influence our behaviors. If we continue to come back to this argument, but that it feels so real. It feels so real. It feels so real. You are, you're, I mean, there's nothing quite more like spinning your wheels in the mud than that. Like you have to, and of course it feels real, right? Your brain doesn't know that you have OCD or anxiety or GAD or panic or whatever. Your brain only responds to how you react, right? So, you know, like your brain doesn't have an automatic filter of what's scary and what's not. There's some exceptions with that because of evolution, right? Like the majority of us are more scared of spiders than those who are not. But when it comes to this stuff, our brains don't know that we have OCD or anxiety. Our brains only know what's scary or not based on how we react. And so our brains are, you know, it's taking in, it's always like taking in and picking up what we're throwing down, right? So like if we act as though, you know, if we act as though, what would be, if we act as though driving is scary. Right. If we act as though driving is scary and we pull over to the side and we avoid driving and we're like, you know, asking other people to drive for us, our brains interpret that as, huh, this must be really scary. Yeah, I was right. I better panic on the highway. I was right. I'm gonna keep doing that. Yeah. And thank goodness you pulled over because otherwise something bad would have happened, right? Right, right. So of course it feels real. Like your body's, your brain's like only job is to keep you alive. And so it's gonna do anything that it can. And so when you suddenly, after hearing this amazing discussion by Jenna and Drew, and you decide to get your booty in the car because you want to challenge yourself, of course your brain is going to try to get you to stop because you've already given it so many memories of why driving is scary. And so it's going to do everything it can because it wants to keep you alive. It's going to turn out adrenaline and turn out norepinephrine to get you to stop driving. And so that's why it feels so real. But you have to just keep your eye on the prize. That feeling it can no longer be a legitimate argument. I love this too. But this argument, like that's such a great comment. Thank you so much, second Twitch person. Thanks for coming over to us. And thanks for such a great comment. Yeah. Try to. Yeah. OCD, when you take that away. If you eliminate that word and you no longer let that be an argument, OCD, I promise, just lost its biggest stake in the game. And I think the same would hold true for all of the disorders we're talking about. Same. Same thing holds true with panic disorder, which leads to goryphobia. Same it holds true with Gat. It's the same. And so in the end, it feels like, should you give me the stink eye? Yes, so Grace Bailey, he always has the best funniest comments too. I love it. He said before it was great. He's like, I drive cars with if he breaks for fun, but I was afraid of dying sitting on the sofa. So, you know, there's the bets thing. But I think it's huge. It's so crazy. I'm anxious about all the things that I should. Losing my car keys, whatever. Like I'll figure it out. I lost my credit card the other day. I'm like, I don't care. Like whatever, I'll figure it out. I drive my husband crazy because I'm sitting here worried about like, I don't know, like the most ridiculous stuff. But like when it actually comes to legitimately like anxiety-provoking things, I'm like, I don't care. But that feels like thing. And I think that speaks to tolerance and exposure and all those things too. And I say all the time, you guys have heard me say it a million times, when we do exposure, we only care what we did. We didn't care how it felt, which is so important because that's practice and allowing it to feel real, but not acting like it's real. It's really important there. And that holds true for- Sometimes it's helpful for people to just know that there's a word for that. It's called emotional reasoning. Yeah, right. If it feels so strong, it must be true. Yeah, so many times. I mean, and that's literally, it's called emotional reasoning. So, you know, we, it's a cognitive distortion. People with OCD and anxiety of any kind, I don't care what you're anxious about, they're more, they tend to believe that their feelings are the sole indicator and guider of truth. And the stronger the feeling, the more likely the truth. And like, if I feel guilty, that must mean that I did something bad. Well, not necessarily, right? Not necessarily. It's kind of crazy. But like it feels like is a good indicator, almost is another sneaky word that I hear all the time. I almost passed out. Well, how do you know you almost passed out? And what did you do that stopped you from passing out? Tell me how you almost, how, how did you avoid it? I don't know. Well, then how do you know you almost passed out? So there's almost, it felt like it felt as if I thought that, these are clues, right? Yeah, for sure. Yeah. Anyway, we'll kind of wrap it up here. We're at almost an hour. Most of the comments are very much the same. But what about this thought? What about that thought? The concepts here are the same. This is gonna stay on my YouTube channel. So you can come back and rewatch this a million times if you wanted to watch Jenna explain again and again and again. You have anything you want to add to at the end here, Jen? Before we go. No, I just love this final comment about like how emotional reasoning is like part of their culture. And I think that's the case for a lot of things too. Like a lot of us are like, you know, we rely on intuition and we rely on our gut feelings. Like there are just gonna be some things in our culture and in our, you know, modern day and age that don't fly with you. Like, and when you have, I mean, anyone, but when you have OCD and anxiety, especially, right? Like you got to take the fruit, spit out the seeds, right? Like you, not every single thing, you can't take every single thing and like apply it to you 100% because you are unique. And especially when you have OCD and anxiety and panic and whatever, right? Like not what works for other people might not necessarily work for you. And so when you get these, when you're bombarded with things that like follow your gut instinct and trust your intuition, like you literally have to, that's funny. Like when you have, when like everyone around you is telling you all these other things, just like bite, eat the fruit, spit out the seeds, like take what works for you and take what doesn't, but like totally normal, right? Like a lot of times like what works for us, like what works culturally or for other people in general, like doesn't always work for us and that's okay. So the last person I just wanna make, please take my question. We can't take all the questions. What I'm going to tell you, don't lose hope, is go to the anxioustruth.com and listen to the very first 15 episodes of my podcast and you can go on my website and search for crazy and you'll find fear of going crazy. There's a ton of information out there and you can't get the answer to this in one answer in a YouTube live. It's really important. So go hit the anxioustruth.com and search for all of the things you wanna search. I guarantee you, I probably answered the question a hundred times already. And hey Drew, people really like us together. Should we like maybe tease? We should make, yes, sure. Well go ahead, I'm gonna leave that up to you. It's your thing. She's all like, look at me being impish, impish. I'm so honored. So Drew had me on his podcast when I had literally like 2,000 followers. I was hiding in my old jobs, like back office because I just wanted to be on his podcast so bad and he really believed in me. So like I love Drew. I love Drew so much. He's like probably one of my favorite people like in this community. So we are going to, and we've heard this before from people that like people really like us together. I'm so glad that you guys think so too. We are going to do a workshop together at some point and it is going to be like the kick in the butt that you guys never knew that you needed. So you know, we tend to be like the best of tough love. Right? Like we tell you how it is but hopefully in a really empowering way where you guys can walk away feeling very capable where you guys can feel like you've got this and we're just going to be there or it's going to be an amazing workshop to just tell you like it is but in a way that's really powerful and really, you know, just make you feel like you're on top of the world. So, and it's going to be something we wanted you guys to have something that you could come back to as like a power up, as like a pick me up when you're maybe feeling down and it's going to be something that you guys can just use hopefully on an ongoing basis if you need to come back. So yeah, we're working on it, not too long from now probably within the next month or two we will be able to have some more details but we will be together soon and it's going to be so, so good. It'll be on Jenna's platform so you guys should if you're not following Jenna I'm guessing most of you are but follow her on Instagram and of course I'll share it when I do that. And so I have my panic attacks workshop is coming up in February 11th. I will share that on my website and email. I started sharing it today to check it out and there are resources there. And unfortunately the answer is there's really no good but you can't really contact me directly. It's not okay for me to try to do it one-on-one advice with people on the internet. Jenna would agree as a therapist that's not a thing that you're not allowed. You're not really allowed to do that. It's not safe. It's not ethical. So you can't do that. But go use all the resources. Anyway, Jen, thank you so much for coming. I appreciate it. A quick place for having me. Hope to see you guys again soon. This was really fun. Yeah, it was awesome. So again, we're going to end it now but you can always come back and watch on YouTube. It'll stay here, whatever. And we'll do more of these as we go. Thanks everybody. Let me awkwardly end the stream and then I'll