 Okay. Hey guys, what's going on? Drew here, thatanxietyguide.com with me today is my friend Leslie Gustafson all the way from Colorado who has agreed to spend some time with us today and talk about the topic of anxiety disorders and sex and intimacy. Yes, Leslie? Yes, absolutely. So glad to be here. Yeah. Yeah. Thanks for taking the time. Really, really appreciate it. So I'll give you the 30 second version of where Leslie comes from. Leslie is a clinical psychologist, correct? Nope. I'm a licensed marriage and family therapist and a certified sex therapist. Okay. Good answer. So I screwed up right away. Strike one on Drew. Some people call me doctor, but it's not technically accurate. Yeah. Okay. No problem. So no problem. So Leslie comes from that background of therapy and you had mentioned to me in a previous chat that you had spent some time even treating anxiety disorders in the past. I still treat anxiety disorders because anxiety disorders are so prevalent and show up in my office all of the time. More specifically early on, I was doing only anxiety and depression and bipolar, but I work with couples a lot and also everybody walks in with everything. So yeah. Yeah. So it's good combo. So Leslie brings that to the table and that specialization in marriage and intimacy therapy and sex therapy and good. So one of the things that comes up a lot, one topic that comes up a lot in our discussion forum and around the podcast is the topic of how these anxiety issues, panic disorder, panic attacks, agoraphobia impact intimacy relationships and people's sex lives. So it appears to be a topic that many people have in their minds, not too many people for comfortable discussing. And I thought it would be worth spending 20, 30 minutes together kind of kicking it around. So I don't know if this is something that you see under, you know, as part of your daily travels or not, but I mean, it's a thing. It seems to be a real thing. Yeah. The struggle with anxiety and sexuality. Yes. Study in general, in general. Well, in general, definitely. And how it impacts relationships and intimacy and sex for sure. And I would say, I was talking on Instagram, I would say that I often run into over time when I'm working with a couple that the culprit, in fact, was anxiety that was getting in the way. And they couldn't move through it. And they thought it was a bunch of other things. But it was really once the anxiety got treated with kind of the standard cognitive behavioral and medication protocols that they were like, Oh my gosh, I'm, I'm so different now. That's amazing. And available for sex, which was when you're in really heightened state, you know, you and I have talked about it. Sex is the opposite of a heightened central nervous system and an anxious person. In fact, we can't even function sexually when we're anxious. Because we need to be relaxed. Yes. Come in with anxiety in the bedroom at any level, but some of it's more manageable. But when it's too high, you can't even settle in to connecting. That's true. And so I would say it's a culprit for many, many couples. A lot of times I see it more, I would, I see it a little bit more with women where it interrupts. Men often make use of the anxiety, if you will, in a stress kind of level. And then they kind of act it out and it just adds to their sexuality or they take their anxiety and put it into it. Women more often will get shut down by it and not be able to move forward. I think I've seen almost exactly that. And my evidence is purely anecdotal from people who are interacting with me, you know, around the podcast, but I see that exact thing. Women will basically say like, I've lost my libido. I've lost the desire. I can't connect with my husband or my partner. Whereas men will often say like, oh, that's a huge stress reducer for me. Yeah, like I still like it because it's positive for me. So it's so interesting. I get calming and I get calmed down from it. You're like, oh, yeah. So it's interesting. And I think the two things that I see more than anything else that we can kind of address is one is a physical thing. And a lot of people are afraid. They become afraid of intimacy and sex because those physiological responses, rapid heart rate, heavy breathing, perspiration, the whole nine yards, they mimic the same feelings of a panic attack or an anxiety spike. And so they have learned to associate those bad feelings with bad things and they want to avoid them. And it really kind of triggers them. So a tough one to deal with, I think, you know, we can kind of take that one and we'll move on to that whole connection thing later. But you know, we talk a lot that whole connection thing, that small detail, right? We, you know, we talk a lot on the podcast about desensitizing yourself to those symptoms using exposure techniques and intraceptive exposure and things like that. But we do run into a problem where people are, they're terrified of their own heartbeat. And so therefore they really are terrified to engage with their partner because of how it feels physically before they get to the good part. Yes. And there is, there is a kind of emotional regulation issue in that, which is to, you know, how we interpret it, right? So if my heart rate starts to race, and I think I'm going cuckoo or I'm having a heart attack, guess what happens to anxiety? It just escalates. Whereas if I'm starting to get wound up or feeling aroused sexually, and it's interpreted as like, yeah, you know, you're going to have a different reaction of with your anxiety. And so it's, it's so much what we do with that arousal when the things are starting to get heightened, how we interpret it and what we do with it. If it's seen as excitement or something positive or like, you know, this was what happens when I experience a big pleasure, then it's going to be a lot different than, oh my gosh, this is a scary thing that's happening in my body. So there is an issue with getting comfortable with our own experiences inside of ourselves and not panic over them. And that's no small task. It's not. Right. And I think with people who have anxiety disorders, what happens is it goes so high that they start to scatter and it's just too much. In my experience, when the anxiety gets tempered down through usually medications or really great anxiety management plan and cognitive behavioral mindfulness dialectical behavior therapy also helps. Yeah. And it doesn't get so skyrocketed. There's it's tempered down. So it never gets to that place of where you're feeling out of control because that's what people hate. Yeah, yeah. Or that feeling of the those cognitive distortions that say that a heart, a rapid heart rate must be dangerous. They've gotten into that groove that says this is a dangerous thing. So when we learn to no longer fear it even when it happens, it becomes like, okay, now I can put it into a proper context. This is a good thing in this situation now. Exactly. Yeah. Yeah. Or it's excitement or it's the energy that I need to make this thing happen. Yes. Feeling like it's for you and that you are going to be undone by it. And I think it just takes so much work. And for some people who are really struggling, these are folks who can't get in the car or can't get out of the house or can't go to work. And they're they're engineering an entire life to make sure that those sensations don't happen. Right. It becomes very, very difficult. So yeah, because, you know, you have to eventually tolerate more and more. Yes. Of more and more empowerment is the more we can slowly over time tolerate in our emotional experience, the stronger we become and the more we habituate to that. Yeah, more. Yeah, yeah, that acclimation. Yeah. So we talk often about using exposure techniques, I will admit to having a strong anti medication bias, but I'm just a technology guy. I have no I did not have the qualifications that you have. So I will say that upfront, we often steer the discussion away from that in certain aspects, you know, at least in my in my community, but that's okay. So we talk about doing that work to learn to acclimate to those sensations so that you no longer fear that. And I so anyway, that that's something that we try to get people gone. Yes. And there's clear evidence that we can actually rewire our brains when we create repetitions. And we we form new neural pathways by new strategies over time that strengthen us and lessen the anxiety. And we are more capable. I think I'm not biased in the direction against medication. It's not first order for me. But in such profound help for so many that sometimes it just it's a nice adjunct that has to be used to get people sometimes being able to do the things at all. Yeah, to just get it started. No, I do understand that absolutely. I know it's a somewhat controversial topic, even in the industry profession, not industry, you know, in industry, your question. Yeah. So, so I think, you know, the general advice we could probably I think we're sort of offering or I hear you say and you confirm or deny this is, you know, you work on everything. So people ask me all the time, like, how am I ever going to get back to being intimate with my partner? Well, you work on everything. You work on getting to the supermarket. And you work on getting in the car and driving on the highway. And then you'll be able, you'll be better able to get back to that that setting of intimacy. Does that make sense? It absolutely does. And when I work with people who have struggles in their intimate relationship, and it is anxiety based, or it doesn't even have to be, but the couple, it's gotten so negative. And everything that they're doing in the bedroom is no longer like they don't like it anymore. It's not positive. It's become a negative experience. We take everything in traditional sex therapy, we go way back to simple simple, which means when I have a couple, I basically send them home with an exercise that says, I want you guys to give each other hands and foot massages and talk. Okay. And monitor yourself. And if that becomes too anxiety provoking, then how can you come at the activity in a different way? That's very good. So that you keep things not negative and not scary. And so that you walk away from the experience and it was mutually pleasurable, mutually wanted, and you will do it again. Yes. And so when you start out really slow and add in, it's not near as threatening. What tends to be very threatening for people is the idea that I have to go out in there and I have to perform and we have to have an orgasm. And that's so pressure full. And there's so much demand in that, that that skyrockets their anxiety and they don't enter in at all. They just avoid. Yeah. And I think that that's the same as just about any avoidance that people are engaged in. You don't go from stuck on the sofa for six months to a trip to Paris. You have to build the small things first. You have to build it up and out of repetition. And when you have those positive experiences, it encourages you to try again. Yeah, exactly. Sometimes you start way back there and it is kind of a sexual desensitization because you're getting more and more and more comfortable. And if it ever becomes negative, then we take it back and become comfortable and connected again. Because once people aren't relaxing and enjoying the experience, then we need to pull in the reins a little bit. Because we want success because success breeds a want for more. Right, exactly. And that's that whole flooding thing we talk about sometimes. You don't want to do that because that can backfire. Yeah, that will backfire. On to flood. Yes, exactly. Through a flooding, there's also good evidence once you live through a flooding that you can and you will and you didn't have. Yeah, exactly. And sometimes it's super effective, but you usually got to have somebody like you really deepen that, managing that with you. So those are kind of nuts and bolts. But the other thing that comes up quite often is that connection. So when one partner is in the midst of a serious anxiety disorder, the other partner often becomes the sole source of safety, support, reassurance. That's exactly right. I can only get in the car with my husband or my wife. That person takes on such a role and is often, I'm not going to say required to understand, but becomes kind of the caretaker in a way. It really can shatter that other aspect, that romantic aspect of the relationship. It puts a stress on the whole relationship. And here's an interesting tidbit that when we experience ourselves as a caregiver or a nurturer in a chronic kind of way, our own sexual desire is likely to fall away, as is the passion that we experience towards our partner. So it's not a really great thing to get in too tightly of a dependent situation when you're feeling so needed. Yes. Which happens. Yes. And it feels like they are the safety and they are the reassurance I was talking to a gal this week, and this is happening with her boyfriend. He's like, wants to go away for the day. And she's just like, oh my gosh. And I'm like, wait a minute, you can survive a day. You were doing that before him. Yes. But he's such a sooth, and she's had a longstanding anxiety disorder, and he comes in as reassurance. I go, your strength is going to come not from that. It's going to come from those times when you did it by yourself, however little it was. And then you go, yes, I can by me. I didn't have to rely on someone else, because you don't have full confidence when you're relying on somebody else that you accomplished it. Yeah, that's exactly right. We say all the time, like, there is no such thing as a safe person. You're your own safe person. Try and get people to understand. Go uncomfortable. And I saw Instagram post, you can be safe and anxious at the same time. Absolutely you can. It doesn't feel good, but you're still safe. Yeah. And that's a core thing that keeps people stuck so often to that connection between being uncomfortable and being unsafe. They can't break that. You have to break that link. But yeah, that thing where just the relationship on a hole begins to suffer. My husband is telling me to just pull myself together. He's tired of this. It's been going on too long. He doesn't understand or she the other way. And it really like kind of puts a sledgehammer through the through the relationship. So sex is naturally going to suffer, I would think. Yes. So as the relationship is suffering and, you know, in and out of the out of the bedroom, that connection, that relationship, yeah, context is so critical to great intimacy. I often say, and sometimes I catch some heat from this and you'd mentioned, you know, that little bit of in your face, the reverent thing that I got going on, like when you take care of that, it's difficult. So you have a person suffering from an anxiety disorder instead of having requiring that their partner be the safe person, like you must understand, you must understand how hard this is, you must understand why it can't go to dinner or the movies, order family dinners or on vacation, understand why how hard this is. I often say they don't have to understand. They actually understand that you're safe. So use them as a role model. So it's that thing again, that if you take care of that thing, that problem, so many other things get to fall into place, I would think I would think I think what what when we're anxious, what we're looking for is some kind of joining or some kind of empathy, but not somebody should then rescue us because it's rescue us because it's the rescuing that is doing a disservice. Yeah, someone to have empathy for you, but then believe in you, rise up. Yes. And believes in your strength and doesn't infantilize you and believe that you're incapable or incompetent or can't get through this. That is not a message that serves the anxious person. No, it can feel cruel to hear somebody going, you know what, I can't do that. I can't be that one for you all of the time. They can be like, whoa, but they can have empathy for the plight, but then believe in the strength of the person with the anxiety. Well, because I think both people have a role, right? So the non-anxious person, if you will, can be empathetic and supportive and be a cheerleader, I think. Yes. As opposed to being an enabler or not an a, that's a bad word, I understand. Well, it almost, it's semantics. When somebody starts moving into that chronic caregiving, taking care of another, what happens is that it starts to build up resentment, it starts to build up hurt feelings. I don't have any in this relationship anymore that are independent from being a caregiver. It doesn't work. So do people to be, you know, developing their own strength, whatever their issues are, that's pro-relationship. And I think that's true. So then that person, that resentment begins to build up and it becomes a issue where, hey, look, if heaven forbid your partner develops some terrible disease, cancer or something horrible like that, nobody signed up for that, but that's almost different. It's out of the control. Whereas asking your wife to understand why you won't go to the supermarket or can't pick up the kids from school is a tall order. And so I always say that, you know, that your partner should become a cheerleader and a supporter, but you also have to acknowledge to them, like, I understand that you don't understand this. My fear is every bit as real as if you held the gun to my head, but I do understand there's no reason for it and I'm going to work on that. So please just cheer me on while I work on that. You have to accept responsibility for the irrationality of the behaviors in a way. So, and I always say, you know, when you start to improve that, hopefully everything, the relationship begins to improve along with it, you would hope. But I don't know if you've, you know, been able to coach people through that, I would hope so. Yeah, good. Very good. And, you know, anxiety is such a tricky thing because anxiety to one person is empowering and energy and anxiety to another is incapacitating. And it's not only just about, you know, levels of anxiety, but it's also about, you know, your history with anxiety and if it's done something to you that was negative, which is usually where the pairing happens, right? I'm in the car one day, I've always been a little bit anxious, but then I have this panic attack. So I'm no longer going to drive. Yeah, yeah, we're talking about that all the time. Unfortunately, like how our brains work. Yeah. Right. And you pull all the way back because you never want to have that happen again. Right, right. Because it only happened one time in your 20 years or whatever it was. It's so terrible that that's the way it works. It only takes one to develop the phobia. It only takes one and then it's like, I can't go in the car anymore and I don't need to get back in the car. Right, right. So, by bit, and you need to go farther and farther and farther. Correct. Well, it takes the one panic attack, but then it takes 150 repetitions of getting back in the car. It's cruel. It's cruel. It is. But our brains seem so plastic and so elastic, I mean, that you can do those habits. So I think you've been going for about 20 minutes. I don't want to take a whole lot of your time. Anything in particular that you wanted to add to this? Or I mean, I know it's a big topic. There's really no good. We can't give people they do this, this, this and this and you'll be fine. Unfortunately. All right. First and foremost, I always encourage the courageousness of getting help, getting help and taking up your own cause. If you're going to be better than this, then you're going to have to fight for your life to be better than this. And sometimes that means means reaching out to a qualified professional. Sometimes it means listening to a podcast. But if you're not where you want to be, then the work isn't done. And you need to keep fighting for yourself to get to a level where you're getting your functioning back and your life is what you want it to be. Hope, hope, hope never stops. But we have to seize the reins and do the work and do the effort. But we're the ones who end up reaping when we do. So I would say, you know, stay in the battle, get in the battle, be courageous enough to keep fighting for yourself and doing whatever it takes to get the help that you need to get to a better place. Excellent. That's really super good advice. I'm going to ask you one more question down that road. Then I'll let you go. When people do reach out for help from a qualified professional, which I really encourage all the time, there seems to be a huge amount of misunderstanding of what that's all about. So just going in and telling your therapist or your counselor how your week was and how it went without that action oriented approach seems to frustrate people. Like that's not working. I've been in therapy for a year and a half and I still can't get in the car. I'm still having intimacy problems. Can you address that sort of action oriented approach that I'm guessing you're taking with people? You send them home with homework, you have them? Oh, yeah, yeah, no. Yeah, there are assignments to do. And not all therapists are the same. They just are not all the same. And so you want to be looking for somebody who's qualified and specialized in working with anxiety disorders, cognitive behavioral therapy, or dialectical therapy, but they're probably psychoeducational as well, where they're teaching you things, but they're also, they know what they're doing around anxiety disorders. Yes, are really preferred treatments and research based treatments that have the best outcomes. And we're talking about them right here. Yeah. So if you're sitting there and someone is just listening to you or, you know, has an analytic, even a psychodynamic, long term kind of approach for your anxiety, you know, get a new therapist. Oh, thank you. Thank you. Where do you know that doesn't work? We're not talking about Freudian therapy here where you can talk and talk and talk and talk and then you just get well. No, you get well because there's an action oriented, you know, we've talked about the kinds of treatments that exposure and response prevention and cognitive behavioral shifting. And, you know, these are evidence based for people and they need to be, if they aren't, if they're, if their therapist is in there giving them helpful strategies and working with them in a proactive way, then that to me is a red flag for this camp of people. Right. Correct. For this particular situation. No, I understand that. Yeah. Always talking about that. I can tell you personally, I've spent years in therapy, I went and I told you this and I'll just be transparent. You know, I had a real anxiety and depression struggle in my 20s and I've done tons of therapy, but for me, it wasn't until I got the right kind of therapy that shifts happen because you can get really bright and you can get really insightful, but you're still hurting. Yeah. Excellent. That's you want to get through the thing so you can live the life that you long to live. Very good. Very good. Well, thank you so much. That's excellent, excellent advice. I so appreciate you taking the time. Where can we find you? You can find me everywhere. Pretty much. I see you everywhere. That's true. I'm everywhere on social media. My website is authentic and true.com. Probably one of the most exciting things going on right now is I have designed a subscription box for couples so that they don't have to date outside their house. They can date in their house and that is called the amazing intimacy box at the amazing intimacy box.com. And what it is, is essentially a date box with carved out experiences that are very positive with products that go with it. Very good. And that shows up every quarter so you can just, you know, I was tired of hearing couples say, we can't ever date. We can't ever date. We can't ever date. I'm like, I'm bringing it to you. Yes. Well, now you can. No excuses. Now you have no excuse to tell me to your doorstep. So that's great. I would encourage everybody to check out Leslie's stuff. I've seen Leslie now for the last year and a half on social media and authentic and true. Pretty much sums it up, I think. Very good. Very good. So thanks for taking the time. And feel free to reach out to me through social or direct messages if you have a specific question. I also have a Facebook group. If you're worried about cultivating more in your marriage, that's called the amazing intimacy tribe. So there's lots of ways to just make use of me and I'm here to help and support and give back what I know. Well, I'll put some links to all your stuff in the descriptions wherever you happen to be watching. And excellent. Thanks Leslie. Have an awesome day. Thank you so much. Take care.