 This week on the anxious truth, we're going to ask the hundred thousand dollar question Is there a secret sauce in recovery and it turns out there kind of is so let's go Hello everybody, welcome back to the anxious truth. This is podcast episode number 205 We're actually recording in February of 2022 even though I'm not really sure when you're going to be watching this If you are new to the podcast, I am drew linsellata creator and host of the anxious truth This is the podcast that covers all things anxiety and anxiety recovery related So if you're dealing with things like panic attacks or agoraphobia, this is the place for you And of course if you are a returning listener or viewer on YouTube pay YouTube then welcome back Glad you're here as always today We're gonna ask a an important question and that is is there a secret sauce in recovery Is there a secret ingredient? Is there sort of a golden thread that runs through recovery and as it turns out I kind of think there is and here's a spoiler alert It's the idea of being intolerant to any kind of distress So I was joined to for this week's podcast by my friend Joanna hardest Joanna is Spectacular she knows what she's doing. She is a working therapist specializing in OCD and anxiety disorders We ran into each other on Instagram about a year ago, and I highly respect her work. This is a conversation. We started over Messaging all about a month ago, and we decided hey, you know what? Let's continue the conversation for everybody to hear with the cameras and the microphones So that's what we talked about today. We talked about distress intolerance being possibly the secret sauce of recovery I think you guys are gonna kind of dig it and then I will show you the interview and then I'll come back and wrap it up As I always do but before we go I just want to give you a quick reminder That the anxious truth is more than just this podcast episode if you go to the anxious truth comm You will find three books about anxiety and anxiety recovery You're gonna find my free morning newsletter called the anxious morning And you're gonna find all the rest of the podcast episodes and links to all of my social media So avail yourself of all the resources you can find it all on my website, which is at the anxious truth comm So go check it out because it's all there and let's get on to the interview. Let me bring Joanna on I know you guys are gonna dig her and then I will come back at the end wrap it up Give you all her links and ways to get in touch with Joanna and follow her on social and yeah away We go for those of you guys I a little intro, you know I told you who Joanna is in the intro, but you want to give us the Rita's digest version What's your deal? So I'm in Cleveland, Ohio Midwest Representing and I'm a therapist and private practice specializing in OCD Primarily OCD, so that's 95% of my caseload and some anxiety disorders Yeah, and been a big fan of yours for a couple years So excited to be able to be on here Well, I'm glad you're here. It's awesome So I will put up all the Joanna's links and stuff at the end of the show and on the on the screen if we're on YouTube So you can guys can go find her and follow on Instagram really good You're always I love your content because it's always right on. Oh, thank you Sure, so today we're gonna talk about like the title of the episode is a little we were joking because we had to make it a Clickbaity title and the clickbait title is what's the special sauce and recovery? So because everything we talked about like kept coming back to this one thing and Go ahead. I'll give you the honors. You're the guest. What are we talking about today? You know what I think is part of the special sauce and it kind of it's kind of underlies so many anxiety disorders and other mental health challenges is distress tolerance and That's how you and I connected on one of your other question and answer because I posed the question to you about teaching distress tolerance skills Pre-exposure, yeah, but I really think helping people think about ways to strengthen Their distress tolerance and we can talk about what that is Is is such an important component of recovery? I It is it is totally doable and you know in the end We're joking a little bit about the secret sauce But the more I think about that it kind of really is in the end the secret sauce because I think we could take Almost all of this no matter what your variant is whether you're panic disorder your agoraphobic you have health anxiety Whatever it is distress intolerance is really the Problem in the end Yeah, I'm thinking scary things or I'm feeling scary things and I cannot tolerate it So I must find a way to stop it and get away from it, right, right And it bumps up against that other big concept an act of experiential avoidance Which is you know, you know that unwillingness to to Experience our internal our internal sensations and memories and urges and thoughts and feelings and sensations So we bump up against that and then disrupt distress tolerance is we perceive that we can't handle it Yeah, it's too much and I think I know in your practice you must hear it on the daily and we hear it in the community every Day, it's too much the fear is ultimately that it will be too much that might be physically too much emotionally too much Psychologically too much And by the way act being acceptance and commitment therapy for those watching playing along at home, right, right, right huge fan The more I learn about it the more I'm a huge fan of that Yeah, so let's talk about that for a second though experiential avoidance like we hear about avoidance all the time And why that's bad Let's kind of expound on that and how does that relate to this distress intolerance or distress tolerance secret sauce? Sure. Well, you know, I think we we avoid external things in life Because we want to avoid the internal things that they evoke So if we think about it, it's not, you know, we may avoid driving or we may avoid You know exercising because our heart rate gets too high or we may avoid We may say that that all of those external things are too much too scary to risky But what we're really trying to avoid is how they make us feel. Yeah, the reaction It's three. It's always the reaction or the interpretation and therefore the reaction Exactly the sensations or the memories or the thoughts and so the experiential avoidance is our unwillingness to even come into contact with that without trying to change it or Or, you know resisted or struggle with it or whatever it is Yeah, and that then that starts to build a life of its own So I avoid this thing and experiential avoidance could be an external experience or an internal experience, right? In the act world, we talked about internally experiencing, right? Internal, right We put the blame on external, but it's really Internal experience that gets us Exactly. Yeah, exactly. And so when we say somebody says well I'm afraid to drive on the highway, which is big in my population or my community It's not the highway or it's not the supermarket. It's not the school pickup line It's how you may feel in the school pickup line, right? How they're relating and reacting to what comes up for them When they're in the pickup line or when they're driving on the highway. Yeah, exactly Let's relate that to you know, I guess that the brunt of your practice, which is OCD related How would you relate that in that in that realm? Well, it's the same thing. They may you know, someone it's it's entirely the same thing So someone I mean someone may say well this you know, this counter or this whatever is to you know I can't possibly touch that. It's contaminated and it's you know, it's It's really, you know, the the fears that are gonna come up That they're trying to neutralize The head that they think that they're gonna, you know, and you know expose all of their loved ones to some horrible thing If they don't wash their hands that they might get sick themselves if they do So it's less about the counter and it's more about how they are reacting to all the thousand what if scenarios and The whoosh of feeling that's gonna come with it and that would go I mean clearly it's gonna go for that that's like contamination OCD which you're describing but even thought-based intrusive thoughts and Whatever pedophilia or sexual orientation. Sure the being straight or gay It's the what you think about that the fear that you attach around that thought Right, right and if you right and you you might think like, you know I can't possibly have this thought, you know, what if it's true and it comes with such intense feelings and such intense Sensations and you know for a lot of people they just believe like I can't you know If I don't know how long it's gonna last If I don't know if I'm gonna have a panic attack or not if I don't know if I'm gonna throw up or not like I can't possibly Ride this out. Yeah, so so much of that is and I think I talked about this a lot, too People who have health anxiety that's I we say that's an uncertainty intolerance problem more than anything else But uncertainty is just another form of distress So it all comes back to the inability to just to tolerate any distress I cannot have any of that it will be too much Right, right. Yeah, yeah, and the consequences of that too much the common ones. I'm going to snap and when I have a Psychotic break, I'm gonna go insane lose control die I'm sure you've heard right. Yeah. Yeah I'm like, you know what I find fascinating is that people will say, oh, well, I only do this in This one area of my life I Only really am intolerant in when it comes to driving on the highway or when it comes to my heartbeat But that's actually probably not true No, I don't think it is at all Right, but a lot of people think that it's only in this one area So when people start to actually Take a look at how they're interacting with things that are unpleasant In their broader in the broader scope of their life They see how they have to you know, how they struggle how they have to figure everything out how they have to How they you know something as benign as like word all you know Conversation without world I know it's everywhere on the last one that hasn't played it. Maybe no, maybe you haven't you know I play world but like you get frustrated So it's like why can't tolerate this frustration? So I'm just gonna like start over or I'm gonna bail because you can't possibly work through your frustration Yeah, which is really difficult place to be in the end, you know So what's interesting about that is so many different forms And again, it comes back to that avoidance and an internal level because it's gonna be too much I'm gonna snap and this is gonna happen. So Really in the end, how do we learn to be more? I think a lot of it is just an experience sometimes Like and and I love the old like no, it's just that part of my life because for me I've always found but is it really like if you really look at what you're doing on a day-to-day basis You can really start to ferret out all the little safety behaviors and avoidance and engineering that you do in your life to keep You safe from that distress. It's on a scale, of course So maybe you know that that really horrible intrusive thought or that that panic attack or the you know driving on the highway That's the top end of the scale But you probably have a ton of little avoidances all throughout your day You can practice with you can practice right, right? I like to get people Feeling it out in session So for instance, I often will have people say what is your least favorite stretch and They'll look at me like, you know, I'm crazy which is fine But I'll say what is your least favorite stretch and they'll tell me and then I'll say, okay Let's get in it right now and I want you to I want you to you know You know, give me a give me the stream of consciousness of what is happening in your head And so they'll get in the stretch and it's usually like some kind of hip thing or a straddle stretch And then they'll get to that point where they're must they're hitting the stretch and their muscles contract But because their muscles don't know is this safe or not? Yeah, and they'll say, you know, some version of oh, I hate this It hurts This sucks, you know, oh, this is why I don't stretch, you know, it's like it's like, you know One complain after another But and then I'll say okay, and so I'll say right do you what do you what do you see is happening in this like in this very moment? And they see like oh my gosh I'm resisting and then they can see how they're tensing up different parts of their body Sometimes they can see it what happens to their breath Yeah, and now I and now I say okay now what happens if we really work To show your body and to show whatever we're stretching that No, the stretch is fine like that, you know essentially coast is clear. Yeah, so you can use I love that So even though that's a physical thing. It's a perfect illustration of oh, no, no It's okay. You could stay in that stress even though it hurts a little bit for 30 seconds It's like and if we breathe into it Yeah, if we like really work on showing your body That no this is just uncomfortable, but it's not dangerous. It doesn't yeah might suck But you can do it what happens to your body and then they may say okay. Well, I got a little bit more range of motion Okay, that counts Exactly. Yeah. Yeah, that extra half an inch matters over time Exactly, and then I'll say okay, so what do you learn like what is what do you think? What was the point of that? I love when the people are like I have no clue what the point that was It's so interesting though because yeah, but I think that's an important thing that you bring up So like oh that was a cool exercise. Why did you make me do that? Because I'm still looking at that intolerance that when I'm scared of the thought or this particular thing that triggers my anxiety That's its own special Event that needs a special set of circumstances so often we get so clouded by that that we don't understand No, it's not special at all in any way. It's just another form of distress or uncertainty or discomfort. That's it Exactly connect up they can't connect the dots between that exercise and the panic disorder for instance Oh, yeah, and for people who can't who are such overthinkers who can't understand When we say you know the fear center of your brain you can't language out of it. You have to show your body This is why I dig you You know, thanks. So I dig you, you know, you have to show your body. We are showing. This is how we show Yeah, we lengthen breath. We relax the body. You know, we do all of those things So I think you know, which is a great great great Exercise to illustrate that that that issue, you know, leaning into it staying and breathing into it allowing it All of the things you hear us talk about, you know odd infinitum. I think in the end I want to go back for a second to That idea that it's not the only place that you're experiencing distress and tolerance it's probably sprinkled all throughout your life because I don't know if I that's been published yet in my morning was there a letter or it's coming But I talked about that like how can you practice letting go? It was a whole series on letting go that I think it's right and one of the things people say well, I don't know how to let go well you do if you start really small so You're not gonna let go in the midst of a level 10 panic attack if you don't practice letting go in little things like Joanna's little stretch analogy or Sit on the sofa in silence for 30 seconds when you think you can't possibly do it That's how you begin to learn So would you teach somebody to start to learn to be tolerant of distress in little bits finding those other areas in their life that You work on yes Yeah, I call a neutral stimuli Okay, find something neutral that The gym is a great place or if someone's exercising and they don't have health anxiety That's a that's another place Because that people that people can do it really well because you know if people and again It's harder with people with health anxiety So let me just put blood out there loud and clear but so many times when people are on the treadmill or the row or whatever They go on You hit a point where it gets difficult and They're and then all of a sudden they're ten stop and they're like I can't I can't push past this It hurts. I hate it and they get really tense and they're and And it's like okay. Well, why don't you try relaxing there? Why don't you try accepting that this is hard and try relaxing into it and just see if you can like push for 15 more seconds Yeah, which is great. I love neutral stimulus because it doesn't it's not necessarily directly related to the thing that you might be in the therapy room for Exactly Bring it there, right? Right, you know, I do a lot of that because I you know because I spend You know, I'm a powerlifter. So I'm real familiar with distress tolerance But you know, it just makes sense to me or your phone Here's a great one like your text thing dings like don't answer it That's so good. I use the analogy of go ahead and like make dinner without asking people what they want Right, that's a little thing that might not have anything to do directly with what you think your problem is But it introduces some uncertainty. It might trigger those feelings of what if I get it wrong, but okay? I can move those that's perfect, right don't apologize Don't apologize. It's another good one. Yeah, it's so interesting to where I think if you really look at it there and all of us I think it goes beyond people with anxiety disorders We all find ways to engineer some of that distress at little levels out of our life Partially because we just want to make our lives easier, which is true But then I think there's a lot of little stuff that we don't even realize we're doing Right, maybe avoid confrontation or keep things calm or because we think no no no I can't be in that situation Right, right. Yeah, and I'm always interested, you know to start a session I'm I'm I'm getting more in the habit of just asking people Okay, tell me over the week how you got better at feeling uncomfortable. Yeah That's because that's really what it's all about in the end Exactly. Yeah, you use two words before that like I just would give you this big fist bump We were in the same room which was relation and reaction Like everything is about building a new set of a new default reaction and building a new relation with this fear and the discomfort and the uncertainty and the vulnerability and all of the things So we could put that all under the umbrella of distress and here we are back to the secret sauce It's all about the ability or unwillingness to to tolerate any distress. Right, right Where does it come from do you think I mean I mean I think that everybody comes in a different place, of course But so much of that. I think sometimes is learned going in. I can't my emotions are too much conflict is too much Challenges are too much and then that comes right into the anxiety sphere. I just I can't handle anything I know I really wonder I really do wonder because Athletes I've got a fair number of college people adults who are college athletes And I don't know, you know, it's like chicken or the egg. I don't know but they have a Tremendous ability to tolerate distress Sometimes to their disadvantage like it's it's so high and they just kind of like put their head down and like the white knuckle through anything Which is not what we want. We don't want people to white knuckle But you know, I don't know. I don't know where this comes from. I don't know what's learned if it's biological I don't know Who knows really interesting It's funny because I wouldn't I that's 100 true now that you bring it up But there's both sides of that spectrum. There's people who feel like they have no There's no sense of competency in anything or the ability to tolerate in almost any part of life Forget just anxiety and then there's the other way I'm the run that was me. I'm the run it over guy I just run everything over I'm like, but I can't run this over and that was so problematic for me. I couldn't run it over So you want it that sweet spot in the middle? I guess is really where you try and wind up because that's where the lessons come Right exactly. Yeah All right. Well, there you go. Secret sauce Secret sauce stress intolerance. So what else can we say about this? I mean, what would you teach? I mean, you gave some great examples I think of the the exercises that you gave maybe of some of your clients What else would you tell people in terms of I think part of it is just the acceptance that like, oh I have to get better at being uncomfortable. That's hard to overcome sometimes and the less, you know, I think You know, I think and everyone comes to your work my work at a different place But I think there is utility before people jump to exposures To spend some time really working on flexing this muscle You know learning that you can you know, because with distress tolerance, it's often our our perception of what we can handle And so if we spend some time before we jump into exposures Learning, okay. How can I do this with neutral stimuli? How can I I need to I need to know that you know feelings are temporal They peak and pass I can urge surf and and then really have some practical ways just like you said not with your 10 stuff I think it might help build people's confidence I would agree with you 100% and the perception of their inability is more as greater always The perception is always I can't handle this when even when they even when people are actually in the middle of handling They will tell you I can't handle us. What was your handling it right now? I know right. That's always interesting. I have had a lot of people that seem to enjoy Little stuff like okay Tonight sleep with your phone in another room Which is not something they like to do like no, no, no, I need to have it with me What if somebody needs me would try try leaving it in the kitchen when you go into bed That is crazy. It sounds when you start to introduce those little habits people will say like oh my goodness I did not even know what I was doing and like that was so hard But like yeah, but you did it and now we can take that into the rest of the stuff you have to work on so Right Little things matter Exactly and just like I think you're the one who says like progress What did you say progress is process The product. Yeah, the process it is the process is the progress. Which is that's what you say. Yes. Yes. Yes True. So anything that they can do toward that end Yeah, anytime you can learn those lessons that are portable across all these circumstances So let's talk about it's it's good the process versus the outcome thing Which I think maybe in last week's podcast, I don't remember was it was so good Yeah, so but people you get focused on the outcome and then when you talk about like well No, you don't have to learn to not be anxious. You have to learn to get better at being anxious You're already afraid you got to get better at it now So that's always cool. But then some people misinterpret that is oh, so what you're telling me is recovery It's just to learn to live like this for the rest of my days Right. Well, how would you respond to that? Well, I mean ultimately it's like maybe That's hardcore That's hardcore. Look, that's the you got to get better at being unsure. I mean, I'm pretty confident that you won't but like I don't know. I'm not psychic Well, I guess but that's that thing where they're focused on the outcome like I know, right? Tell me when it all goes away. Okay, fine. Joanne. I'll no longer care Uh, yes, that's so good Right. So I wanted to tell someone that but that's But like the compulsion the resistance is in needing to know that One of the questions I'm sure you get ass all the time. I get ass all the time because of my own experience with anxiety How did you know when you were recovered? Well, first of all, I didn't wake up in morning and say, hey, I'm recovered Like it's I don't know what had happened But I one day woke up and discovered that it had happened And I always say, you know when you're recovered when you stop asking if you're recovered, which is Oh I feel like such a rat when I say that because it's like what a smart ass answer But there's truth in that and so in the end when we say like well You have to get better at learning to tolerate distress or discomfort or fear or uncertainty Not so that you can live in a blind panic or tortured by your thoughts for the rest of your natural life That's not what it is Like over time things do change But only when you embrace the process of it and that word maybe is an incredibly powerful word Yeah Yeah, so like I don't need a specific outcome because I'm okay with all outcomes. That's where you've got to get now No, I agree. I was trying to think when I knew I had a terrible phobia of flying and I think I knew um When I could fly and I still don't like it, but I can like read a book I can read a magazine Yeah You're not it doesn't become the most important thing in the room all the time anymore Right the thoughts are still there the thoughts are still there You know, I don't do the facapta stuff that I was doing The thoughts are there, but but you know, my awareness isn't something else Is an entire swath of the middle united states that just went What what was the cop? That's okay Anyway, where are we about 25 minutes? That's about as far as we like take these or else We fall off the cliff people don't have time to listen to really long podcasts But this was really good. So the secret sauce of recovery is probably You say distress tolerance. I say intolerance. What's the same thing? And we have to throw willingness. I really am such a hardcore believer that you got to be willing But that is distress tolerance like distress tolerance is our ability, but we have to be willing also Yeah, and I think you can't learn distress tolerance You can't work on a problem if you're not willing to be uncomfortable. So you're right willingness is probably the precursor to that I guess. Okay, good. Yes. Yeah, but what am I not willing to be? I'm not willing to be uncomfortable I'm not willing to be in distress. So That's like the the pad the like the the fried chicken and this is the sauce They're all right. I'm in I blame you Clearly copper wants fried chicken too if you hear my dog in the background He's chiming in as he's wanted to do some times in these podcast episodes. So, uh, anyway, this is a great conversation We have to do now. It's so fun You're welcome back anytime anytime you want. Oh, I can't wait. It's so fun Yeah, so I'll put everything up in the links at the end of the show. I'll come back and wrap it up But where can people find you generally join? Um, so on instagram, that's where I post mostly it's cbt.clie Cleveland always have to represent Cleveland not very many of us um and That's where you can find me and oh my website Joanna hardest calm There you go. If you're on youtube Up on the screen cbt.clie Look at that and Joanna hardest calm is my website very good So, uh, Joanna, thank you again for taking the time appreciate it. We'll do it again sometime real soon And uh, you guys stay tuned. I'll come back and wrap it up and give you all the places to go All right. See you guys in a bit. Well, that was pretty awesome or at least I thought so I hope you do too And uh, that's episode 205 of the anxious truth a little discussion with my friend Joanna hardest about the idea that The inability or unwillingness to tolerate distress kind of is the secret sauce in the golden thread of recovery So hopefully that was an enlightening conversation for you guys If you would like the full show notes in this episode you can go to my website at the anxious truth.com slash 205 and I will have Joanna's links there so you can get in touch with her And follow her on social if you're watching on youtube I'm going to put it up on the screen right now. She is on instagram at cbt.clie CBT in Cleveland Joanna's always represented for Cleveland So thanks again to Joanna for taking the time to come and talk to us today I really appreciate having her on and we'll definitely have her on again And that's it for episode 205. You know, it's over because music And this is afterglow by ben drake. You hear it every week on the podcast It has special meaning to both me and ben so you can go check out ben and his music at ben drake music.com You do go tell him I said hello Because he's a friend of mine and just a good guy If you are listening to this podcast on itunes or spotify or someplace where you can leave a rating or a review A five star rating would be awesome and a short review would be even better because it helps other people find the podcast Then we get to help even more people which is the white reason why I do this And of course if you're watching us on youtube then hit the subscribe button and like the video and comment I'm digging interacting with you guys on youtube now. So that's been great And that's it. Thank you for coming by as always Hopefully it has been helpful and educational and inspiring and all of those things I will be back next week as I always am and I will tell you as I always do That I don't know what I'm going to talk about because I truly don't But I will be here and we'll talk about something and remember as always. This is the way