 Hello, everybody. Welcome back. We are here again. I'm joined by my friends and fellow smart people, Lauren, Lauren and Kelly. I had a strange one and now I lost it. Anyway, welcome back. We're here for our usual once a month conversation about something related to anxiety and recovery. So why don't you guys introduce yourselves real quick? Let's do Lauren first. Nicely done. I'm Lauren Rosen. I am a licensed psychotherapist in several states, California, foremost among them. And I am the director of the Center for the Obsessive Mind. I do some advocacy work on Instagram and I co-host the purely OCD podcast with that one. There we go. And that's Kelly. I'm Frankie. She'll introduce herself now. Yes, I'm Kelly Frankie. I am a licensed marriage and family therapist or a psychotherapist. I don't know why I don't say that more often. It's so much easier to say. Co-host of purely OCD and on Instagram, which is how I met Drew. And I am the director at the Center for OCD. The end. The end. Drew, your turn. I'm Drew Linsalata, creator and host of the entry podcast. Not a therapist yet in the middle of my grad program. So I'll keep you all posted. But yeah, I have the privilege of doing this monthly with these two fine people. And today we're going to talk about that thing where like for some people you automatically take a struggle and turn it into a reason to beat yourself up publicly and or privately and what that's all about. Because it seems to be an actual thing. It does seem to be an actual thing. Yeah, sort of all the walk of shame and Game of Thrones where, uh, what's her face? I say it's been a while. So yeah, shame, shame, shame. Yeah. Yeah. Yeah. So what it would, we were actually, I had asked Drew a question about this right before we went live, but I wanted to hear his thoughts on here. So Drew, do you think people, do you think people are doing this sort of consciously? Do you think that it's like, I'm going to beat up on myself because that somehow, I don't know, alleviates me of some of the response, like the responsibility of, of doing the hard work where like I'm somehow, like it's easier if I'm somehow incapable. Yeah, it's a really good question. I think, I think it becomes a little bit automatic. I don't know if anybody necessarily chooses to do it other than the fact that my opinion here after seeing it happen so often is that it's a way to try to feel better. So if you're in the middle of the struggle, which feels terrible and it might feel like I'm not getting anywhere and this is going too slow and what if I never get better, the turning to sort of self-flagellation, I'm not going to get this. I'm weak. I can't do anything. I'm the worst. I know I did it wrong. I can't get it. Seems to be a way to sort of take the sting out of that a little bit temporarily. I'm not sure how that works, but it seems to be why people do it. It's a soothing thing to a certain extent. Well, yeah. Sorry, go ahead, Kelly. Does that make sense? Yeah, no. I mean, I think that we see that often. It's interesting because I don't know if I've seen it as a soothing thing, but I could be wrong. I could be missing it and maybe you guys have seen it more, but I see it as more of like that's just the way they think about themselves in general. The side effect is that they do get off the hook, but I don't think until they recognize that, hey, guess what? When we say I can't, that actually tells your brain that you can't and then you start believing that you can't and then you don't do the exposures. It's kind of like the side effect of it, but I could totally see where somebody could do that in a way that's intentional to try to alleviate their anxiety or get them off of the hook around their exposures. I've heard it described that way. It's a release to a certain extent. For instance, in a public forum like on social media, somebody will roll in with a story of what they might feel is failure or a struggle, and that story will be about how they can't get it. They just can't do it. There's something wrong with them. What am I doing wrong? I can't get it. They lead with that. That's not a question. It's a statement. I'm here to tell you all that I fail. Yeah, I'm treatment resistant. Yeah, and it's kind of a buffer. A little bit. I don't know if it's a, I will own the failure before you can call out my failure. Maybe it's that. I'm throwing stuff at you. No, no, you're right. That's a good point. Yeah. Yeah, I'll just say it before you can. Yeah, that's what I was thinking with the buffer thing is like if I can preempt it by acknowledging that I'm a failure and that I can never do anything right, then when I fail, it won't sting quite so much. It won't hurt quite so badly. Right, and I've been to all the other therapists. I've done all the treatment and nothing works, but then you sit down and you're like doing an assessment and you realize, oh, this person actually isn't doing the work. It's not because they can't. It's because they're not willing to. Yeah, or they will bail right away. It's difficult. Yeah, I get that. The other thing that I've seen it described as, and this does make sense to me, is it is in a way a sneaky bit of reassurance seeking. If I roll into my support group and start with I am the worst, I am a failure, human nature, people are going to say, oh, please, stop saying that, but you're great. We love you. So in a way, it's a way to almost hit the button and get the food pellet. Maybe some of that, maybe all of this. Yeah. Well, yeah. And I think that it often accompanies more depressive tendencies. Right. So it's usually when you have some sort of co-occurrence, that narrative of like, I'm not good enough. It often relies on other people to give you the feedback that that's not true. Like you develop this sort of over reliance on others giving you positive feedback. And that's so I can see you like what you're saying would like get the good feedback with the pellet. Certainly happening, but I'm with you guys both. I don't know that it's like a conscious thing. I think it's a pattern. It's like a behavioral pattern and this sort of learned helplessness that comes up because the alternative will often lead to such self-flagellation that it's super painful. Right. So say, you know what? I can do this, but I'm not willing to do this. Right. Or I haven't been willing to do this. So to own it. Yeah. To own it necessitates a degree of self-compassion and kindness that comes with it. That's it's not accessible for a lot of people. So like learning to say like, no, no, no, it's a choice. It's okay that you're making this choice. You don't need to beat the shit out of yourself for making this choice. But it is a choice. So is that the choice you want to continue to make or do you want to make another choice that framing it as it's not some sort of like personal failing if you make some choice? It's just also maybe not what you want. So it's a way to eliminate to not have to confront I tried and failed. It's just no, no, no, I'm not even capable. I'm just not capable of this. I'll start from that. Yeah. Yeah. It makes no sense to probably very complex, complex. But they also want to get better. So yeah. Yeah, that's the rock in a hard place. You want to get better. And at the same time, sometimes you're hanging on to this pattern of like, I'm no good. I'm weak. I can't get it. That's hard. That's really difficult. It's very hard. Slowly, usually. Yeah. A lot of cognitive work. So like Lauren was talking about that it's a co-occurrence usually with depression, and I totally agree. And when that happens, usually there's a lot of restructuring of thoughts. That's where I would go heavy with just cognitive restructuring and behavioral activation and getting mastery and feeling confident over smaller tasks that aren't related to OCD per se. Yeah. But yeah, I don't know any thoughts, Lauren. No, I think that that building competence is so important. And a lot of it is in session. I do some cognitive restructuring. I don't do a ton of it these days, but what I do is highlight for them when they do something well. Because the tendency is to sort of push that aside or not. There's this sort of selective abstraction or confirmation bias where all you're seeing is what you're not doing well. And you're filtering out everything that would suggest otherwise. So really trying to highlight like, oh, wow, look, you did that. How did you do that thing? As opposed to when they come in and it's like, well, I didn't do this this week. It's like, okay, well, what did you do just out of curiosity? Did you do any of it? And how did you manage to do that? And continuing to emphasize that helps to build a sense of self efficacy so that that narrative begins to slightly change about one's abilities. Which reminds me of narrative therapy, which is like, what's the exception? Tell me the exception of this story, the narrative of I'm not good enough. I can't do things. I'm a failure. How is it this week that you did it different? You were able to do that. And it might be something simple like, well, I did this. Interesting. Okay. So when you did that, what made the circumstance unique? Like, how did that happen? What happened that was different there? And how can we do that now in the work we're doing? And actually even giving them the power of like, how do you think we can do this differently? What's the way that we can make it so that we get rid of all potential barriers this week that got in the way last time, so we can give you a layup here? Yeah, I could see where that would be slow work sometimes. Sometimes, yeah. Yeah. So I could see where like, you might have somebody who normally might not have that tendency, but it is in a depressive state, develops that tendency, or then there's the person who just lives their entire life with that low sense of self-efficacy and lack of belief in their self. I think that makes it even harder to do the work we talk about here. Yeah, it does. Yeah, it becomes a recovery obstacle for sure. If you've been told that you're weak, if you're experienced, the people in your life, unfortunately have told you that, which is not cool. Yeah, whatever reason you comment on the process. Very much. Yeah, and I think that's where sometimes, and I know we don't talk about this stuff a lot, but sometimes people who come from that traumatic or abusive background, especially if it's their parents or somebody significant in their life, that can have an impact, which is something I know we tend to steer away from, like we're not digging for the root cause of your OCD or anxiety disorder, but those things can make the work of recovery more difficult. Absolutely. I was just talking to somebody about that this morning, yeah, that it's not every person that comes in that's really highly motivated to do treatment and believes in their ability to do it and has the support that they need right like these. We're looking at whole humans here with a variety of experiences and this element of this belief in you're not enoughness or in your incapacity or your helplessness is a huge barrier because if you don't believe that you can effectively change, how in the world are you going to do that? Every time that you make the smallest inch towards some sort of change, you're going to immediately discount it and that's the thing I will say in session, if somebody has this, one of the things that I like to bring like a mindful awareness to and model for them is like, oh, look, did you see how you just discounted that? Like I bet and I'll try and be playful with this like, I'll bet if I offer something else, you'll find another way to discount that. Let's test this hypothesis out and then I'll do it. And then it often happens and it's just, it's like, oh, that's interesting, right? Just to sort of bring a little bit more awareness to it and ability to watch it without being caught up in it. Yeah, that makes sense. It's funny, you can see that in session one on one, I can tell you from a lot of experience, you could literally see that in writing in very large like online support groups. Every day we get that in my Facebook group, somebody will roll in and just reel off this long list of wins and great accomplishments and such good work and end it with an interpretation that they are the worst. It was a complete failure and they don't know what to do. Right. You have to respond that way to like, wait a minute, look at, look at all these things. And sometimes I'll literally bullet point them, you did this, this, this, this, this. How did it end up as you're horrible? What happened there? Yeah, I think this is what we had talked about in the recovery conversation. What does recovery look like? Where we're talking about assigning people, like come back and tell me what you did good, right? Don't bury the lead as Lauren said, I believe she said, you buried the lead, right? You buried the stuff you did is like, let's lead with this, the good stuff. And then how about we frame it as what did, what can I do differently versus I didn't do it or this was really versus, yeah, this is really challenging. And maybe if I tweak this a little bit, it'll be more reasonable to accomplish. Yeah. So how do you get, you know, when you call it out, but when you point that out, I often hear like, I know you're right. I have this habit. This is what I do. I beat myself up. I speak poorly of myself. They only seem to know they're doing it sometimes after they do it. And you point it out, even though they've done it 10 times in two weeks, they'll do it again until you point it out. And they'll say, Oh yeah, I did it again. You're right. So like, how do you break somebody out of that? Cognitive restructuring. Yeah. I don't know. I mean, I guess for me, it's just like, if you're constant, if you're noticing you, I guess, mindfulness really, you notice you're feeling pain or discomfort or it's a cue that's like, Hey, are you talking bad to yourself? Okay, write it down and challenge that thought. And then eventually, after you've written it down enough times, it starts to slowly like, this is a long process. This person's been talking bad about themselves their entire life. So it's going to take time to unravel that mess and then start believing it, right? Yeah. What would Kelly say? What would what would Lauren tell me? Replacing the voice. Yeah. Yeah. Yeah. What would Lauren say now about this? Yeah. So funny that you say that like comes up all the time. You're so right. And I think it's both, right? Like the cognitive stuff and the mindfulness stuff, because where the cognitive stuff can turn into an internal debate that goes on and on about how like, like basically Bart, like not bartering, but like trying to prove to yourself that you are a good person, right? But after a while, it's like, just noticing like, Oh, I'm doing that thinking again. Do I want to continue doing that? And that's where meditation, I think has such a great leg up here is that, you know, it can support people in noticing when their mind wanders off into something or other and give them the opportunity to make a different choice. Yeah. That makes sense. Still hard. Always hard. Yeah. And you don't believe any of it. And you feel like it's, what's the point of any of this? Writing down my thoughts, meditating, because there's no instant fix and humans want an instant fix. Why don't I feel better? Why? Why is it not working? Well, give it some time. Give it a minute. Give it a minute. It's going to space and come back. Oh my goodness. That's exactly what I was thinking. That's so funny. Yep. I got it. I got to get to the airport because clearly we're just one day and they're a stupid standup movie. That's right. Yeah, I hear that. It's interesting, the writing down your thoughts like cognitive destruction, some of those old school exercises, thought challenging, in fact, checking it, all those things. I've heard people that say that, yeah, that helped me to a certain extent, but sometimes it made it worse because they wind up turning it into a, let me write down how terrible I am. Well, you know, this is what I felt all day long. So sometimes it's hard to instruct somebody to say, okay, well just simplify that journal exercise if you will. Felt this, did this. That's it. The entry felt this, did this. You can see them opposite each other and keep going back to see those things, but it's really hard. It's hard to get somebody out of that habit sometimes. Right. Because then they believe it and there's this loop, right? Like I believe it so that I'm off the hook or I believe it and now I'm more in the way of getting the help, depending on how we're looking at it, if it's intentional or not. Yeah. Yeah. Maude weighing in. Love it. Yeah. Sorry. Maude is usually my colleague's weighing in, so it's totally fine. She has a lot to say. Yeah. She has a lot to say. That's all right. So I think this is more of a problem. It's a problem for more people than we probably think. Absolutely. I suspect. Yeah, I suspect. And people who are struggling sometimes to get with this and do the work and make some consistent progress often are people who look like this. What's on the bottom of the screen? Like I'm beating myself up. I'm, you know, I got to tell you how much of a failure I am all the time. I'll preempt this, but I will own the failure. I will talk about the failure. So if that sounds like you and you're wondering why this is such a struggle or is taking a very long time, this could be one of those reasons. If that's your default. So true. It's such gradual work. It's so like chipping away one thought at a time, noticing, making different choices. And if you're not having a tremendous amount of patience with yourself, it can be, right? And especially if your propensity is already to beat up on yourself, that it's like, even internally, then the second that you get it wrong, it's like, oh, I'm doing that stupid thing again, where I beat up on myself when you're beating up on yourself or beating up on yourself. It's a mess. Happens in session all the time. I'm like, stop that. Did you hear yourself? Don't beat up on my clients. Oh, I like that though. That's I do that a lot. Yeah. Yeah. Because that takes that like negative voice and breaks it out. Like it's externalized narrative. So Oh, I see you sneak out with that now. I know I do it a lot. All right. So speaking of narrative therapy or different types of therapy, you see how at the bottom of the screen, I'm the only one without letters. Well, now I'm going to leverage that. I'm going to give it to you with a letter. Yeah. Oh, good to have no letters yet. Oh, yeah. I'm already letters, but right now no letter. So it's okay. So in this situation, I've had people ask me all the time and I'm going to ask your opinion on this professionally because you guys have the letters. So let's use them. Sometimes I hear people say, well, does this mean I need a different kind of therapist to help me with that work? Should I have a psychodynamic therapist for that? Should I have somebody who's, should I be in family therapy for that? Is there really an answer to that one way? There's really, I'm thinking there's no solid answer one way or the other. It's very individual. Oh boy. Take it. Take it. Take it. Take it. Take it. Take it. So I honestly, I mean, I think that that's a, it is, you're going to get a different answer depending on the therapist that you ask. I think that most people who treat OCD or anxiety disorders with CBT and ACT and ERP are going to have the ability to support people with depression, right? Because cognitive therapy began as a treatment for depression. So hopefully they have the skill set to support that because it's, you know, it's pretty common. But I also think, and I'm probably not the majority here, that there's room for a lot of different methods in supporting people with all sorts of disorders. So yeah, OCD is treated with ERP. Does that mean I never talk to my clients about their history? Absolutely not. Like, of course I'm going to, like, if I have a client who went through some sort of traumatic experience that informs their obsessions, even though it's not PTSD, like, one way that I can support them in accepting their feelings is to normalize and validate, like, of course you're having this experience and to provide and model compassion for them. So we get, I think, so rigid about, like, well, ERP is the answer. And I agree. Like, that's the evidence-based treatment. But the reality is that it's evidence-based from a bunch of very controlled studies. And these controlled studies don't include people with co-occurring disorders, which are, like, a lot of people. And they're, you know, these 12-week sessions and most people don't fit into that mold. They just don't. So I think we improvise, right? Our work is part art and part science. And we would be limiting ourselves substantially if we didn't take from all of these different theories that can be beneficial. Yep. So box descended. Sorry. Oh, that's a good answer. That's a great answer, I think. Oh, thanks. No, I mean, I totally agree. I get concerned a little bit in saying, okay, we need to segregate depression, because that's what we're talking about, and get you a different therapist that's not OCD, because then we have the, we open ourselves up to a much higher risk, in my opinion, for reassurance giving, for misunderstanding on the therapist, because they're not trained in OCD. So they might be just not opening themselves up about the content of their OCD, like if it's a taboo type of topic. Yeah, but I'm with you, Lauren. I think we can usually do it. If there's an eating disorder, if there's substance use, if there's PTSD, we likely will do adjunct treatment where that person is getting treatment for this, and they're doing OCD treatment for this. But other than that, I like to stay, I like to limit my risk. Yeah, that's fair. I think people that concentrate on the topics that we concentrate on, we often get that, like, well, those are the engineers, they're the robots, they're, I mean, I've heard, I'm hearing it all the time. And guessing in the therapeutic community, I was literally told like, Oh, yeah, those guys, they're the mechanics, you said, if you ever find somebody, I was literally, I was at my residency at school, and I was like, well, if you ever run into somebody like that, you send them to Drew, because that's what those guys do. Like it was, and we laughed, but yeah, you know, but in the end, there's also the idea of like, you might be practicing, you know, aim squarely at OCD or anxiety disorders and using those modalities. But there's that whole call Rogers thing that pretty much every therapist should be. Yes. Yeah. So that therapeutic alliance by itself, if you've got that support built in, right, should be able to support some of those things too, I think. So the answer is, don't know, should you get a suffer therapist don't know. It does, it does, because there's a lot about it, ERP therapist, too. Carl Rogers better be in the damn room with everybody. Hell, yeah. I mean, come on. And that's the thing, like, I think we get a bad rap is as evidence based treatment providers. But the reality is that should be an addition to whatever grounding in, I don't know, being a human. Yeah. We're just treating the most presenting problem is all. So sometimes that is our first line of business is let's just get to the OCD. I mean, obviously, we're building rapport always and reflecting and actively listening and validating. All that stuff's going to happen with us. Yeah, you think, right? How could it not in the end? And it's totally related to evidence based stuff, right? Like how does validating not promote acceptance, right? Like that's an acceptance of feelings is huge in evidence based treatment, especially with ACT. So yeah, I don't know. I think I also I'm a huge proponent for increased trans diagnostic sort of treatment modalities, right? Like ACT is used to treat a great many disorders. And I think if we had more clinicians and even in our educational system, who are being trained early on and like, okay, well, this is how this applies to this and this is how this applies to this, then we wouldn't need to be sending people off to see like 10 different treatment providers because there would be like a, I don't know. Yeah, central. Makes sense. And it's hard to do it with one person though. It is hard, but it's also really difficult to coordinate that in the ideal world. Yeah, we may have a team of two or three different therapists and a physician all working together so closely. And yeah, but that's also really hard to arrange sometimes. So I get it. But this wasn't a direction I didn't expect. I mean, I sent it in that direction. And I'm going to say I didn't expect it. Like I did that. Asked you guys a question. Always a plot twist. And then the surprise of what we're talking about when you answered my question. I appreciate that. I think there's no easy answer. So people watching are like, well, how do I stop eating myself up? And we always get to the end and say, thanks for hanging out for 26 minutes where we all want answered, but I feel like we're still in that. We always get there in the end. Well, it's a slow process. Let's put it that way. So be patient about it, whatever it may be, is like just self compassion, growth mindset. How can we do it differently? What can I do to get obstacles out of my way and slowly building that experience of I'm competent. And I deserve recovery. Every little step and move in a different direction adds up. It sure does. It sure does. And I think that the stop, can I throw one last thing in there? When we say like, how do I stop eating up on myself? I don't think it's that stopping is hard necessarily once you get the proper tools. Like when you understand mindfulness and meditate, like you know how to drop it. It's about not picking it back up again, right? Or like about witnessing as soon as you do. And then real and that practice, like Kelly was just saying, I'm going to consistently let it go, let it go, let it go, because it's not a one and done kind of a thing. Yeah, it makes sense. It's the repetitive nature. Every time you do it, you win. Right. Yeah. Love it. That was a good way to end it. I appreciate that. Yay. We got everybody up on the bottom of the screen. Kelly on Instagram is the OCD therapist. We have Lauren at the obsessive mind. And I don't even know where I am. You guys know where I am. I'm here. I'm at the.xsbtruth. He is. That's true. That is what it is. Anyway, thanks guys. Always, always great to enjoy doing these with you guys. But we'll do them. We'll do them again next month. We don't know what we're going to talk about, but if you have a question or you want to put it in the comments or suggest a topic, we'll certainly take it under advisement, as they say. Under advisement. I like it. That makes it sound very fancy. Make you uncomfortable. So anyway, all right, guys. Thanks for coming by and watching. I appreciate it. Follow these lovely humans. They will help you. See you. Adios. Bye.