Welcome to nevertheless, you persisted. I'm your host Sadie, every Friday. I post interviews about mental health, dialectical behavioral therapy and Teenage life. These episodes break down my mental health Journey. Teach skills to help you cope with life and showcase, testimonials from teens, just like you whether you've struggled yourself or just want to improve your mental Fitness, this podcast is your inspiration to live a life you love and keep persisting.
Hello everyone and welcome back to another episode of she persisted today. We're talking all about anxiety and exposure therapy. P. This episode is one that I've been wanting to do for a really long time because exposure therapy and coping with anxiety and OCD was a huge part of my treatment and I feel like it's applicable to so many people. So in this episode I'm going to walk you through how to assess if discomfort and anxiety is
Justified or not justified. If it's not justified, how you can use, exposure therapy to decrease your discomfort in certain situations whether it's social anxiety, generalized, anxiety, OCD Etc. And I go through all the tips and tricks that I use to what I did in therapy. Different ways you can apply this with your life and also give some book recommendations around social anxiety and OCD. So, without further Ado, let's get into it. Okay, so diving into this anxiety.
Disorders is a class of psychological diagnosis and beneath that is actually OCD which before I did treatment, I never knew. I thought it was a whole class of its own, but OCD is actually an anxiety disorder and to explain to anyone who's unfamiliar what OCD is it stands for obsessive compulsive. Disorder. And so the experience of OCD can be divided into two different components. One is obsessions, and the other is compulsions. So obsessions, can often be
described as intrusive thoughts? That enter your mind, you can't get rid of it causes immense distress to try and get rid of them. And oftentimes, they're pretty disturbing on they can be very overwhelming and again, anxiety-provoking. So I remember when I was struggling pretty severely with OCD, I would be sitting in a room or at dinner with my family and I I have these thoughts that someone was going to come to the door and break in and hurt.
Everyone around me or someone would come in and start acting crazy and trying again, hurt me or my family. I struggled a lot with the idea that I would do something that I couldn't control. Like, I'd want example that I've heard a lot in different books that I've read about OCD is like you're standing in church and you're worried, you're going to stand up and start screaming your head off and it's not a logical thought, it doesn't make sense.
I didn't implant that thought myself and yet it's in my head and it's distressing to get out. So obsessive thoughts again, just to give a little bit more clarification here. It's intrusive worries that people, including yourself, will get hurt or injured really constant, overwhelming, awareness of your bodily Sensations. Whether it's blinking breathing, moving, all of that kind of stuff and also things about your life and your relationship.
Like, maybe you think someone's going to betray you, you think someone's lying to you these thoughts that again, you're not necessarily creating yourself. There's not like a logical step-by-step. You're like, okay, I saw this person lie to me. And then I also have this other part of an interaction that didn't add up. Therefore I think they're going to betray me. It's like you're sitting there. You're having a cup of coffee, bam. You think that they're going to
betray you for no reason. So the second half of OCD compulsions. So these compulsions are often associated with the obsessive thoughts. You have the obsessive thought, someone's going to come in the door, so to calm that, thought and make it. Ok, in my mind, I might engage in a compulsion whether that's tapping, something a certain number of times, keeping something in a certain, Order that makes sense to me, moving things in a certain way, it's behaviors that are decreasing
that anxiety. And within your head makes logical sense to decrease the threat that you've for back of a lack of a better word to say it made up. So I think one of the most common things that people think of, when I think of OCD is cleaning and cleanliness so something that can characterize OCD is super raw and red Hanson Knuckles from over, washing your hands cleaning disinfecting your house obsessively, having things Organized in certain obsessive
way. So really things relating to checking contamination symmetry ordering and even thinking thinking something, a certain number of times, ordering your thoughts in a certain way, repetition. And many of these things are habits that many of us engage in, especially with covid, we're washing our hands more. We're cleaning. Our houses, does that mean you have OCD? No? So what makes someone qualify for OCD? And of course, this is not a diagnosis, talk to your doctor.
If this is Becoming concerning to you. And but a typical rule of thumb is that your obsessions and compulsions are taking up more than an hour of your day. They're not within your control. So when you try and stop a compulsion, you try and stop a thought and you can't get it to go away. It's not an enjoyable act to engage and it causes distress and discomfort to have to do something over and over again, or have a thought over and over again. And it starts to interfere with
your life. Just like I talked about on the podcast before, depression and anxiety, interfering with your quality of life, your relationships, your activities, same thing with CD. So that's a pretty basic overview of OCD. I do want to touch on anxiety disorders as well. Because exposure therapy has also been clinically proven to help anxiety as well. Anxiety, disorders are immense feelings of fear and dread that aren't necessarily Justified given the situation.
It's intense worries that take up significant amounts of your day and it gets to the point where it interferes with your quality of life and your ability to function. Whether that's attending school extreme avoidance panic attacks. All of That kind of stuff. So one really effective way to treat both anxiety and OCD something called, exposure therapy. This week's episode is sponsored by teen counseling. I cannot tell you guys.
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persisted to get started today. So, before we dive into, exactly how you can practice exposure therapy, I want to talk about, why exposure therapy is effective. So, when we go through this, kind of pattern of an exposure to threat and then we have anxiety, and then we engage in a behavior, There's an actual flow chart of sorts that goes with
experience anxiety. First, you experience a trigger, maybe you have a thought that causes a lot of distress, maybe you see someone that you have anxiety about talking to, maybe you have an upcoming presentation and the teachers like, Sadie. You're up. Let's go. That is your trigger and in response to that if it's a distressing thing, you experience anxiety. So when you experience this
anxiety, a lot of the times. What we do is we revert to a safety Behavior. If you're giving a presentation maybe that's safety behavior is. I gotta go to the bathroom, going to have to do it later. If it's seeing someone that, you know, that you're uncomfortable about confronting running away, turning to the opposite side of the street, and not approaching them, if it's a thought in your head, it's avoiding that thought and pretending like, it didn't happen and not addressing the It
caused. So when you experience this safety behavior, and when you engage in that sometime, you'll go back up to the trigger, you go to the bathroom. But you could back to the classroom, they're like, oh we waited for you time, for your presentation and you're right back where you started. But a lot of the time that anxiety is more intense than it initially was after you engage in that, safety Behavior. Whatever it is, you do get short-term relief that anxiety goes down.
You feel a deep breath. You feel those anxiety symptoms going away, but you again have that long-term issue of associating side. It with whatever the thing is, whether it's a presentation, a person you're avoiding confrontation with or problematic thought. So when you have that short-term relief, you just really end up using that safety Behavior. As a crutch. You keep going back. There you go. Back to the short-term relief. But you have that long-term problem, and over and over again.
You're confronted with that anxiety. So, if that's a cycle of anxiety and you just keep getting back to this trigger, the safety Behavior, or this overall distress. How do you avoid that? And that's where exposure therapy comes in. When you think about Yourself to anxiety and initially your distress is going to be really high, but as you're sitting in that discomfort and you're exposed to that stimuli over time, it does decrease and eventually it will completely go
away. And that's the goal of exposure therapy is repeated, small exposures to the thing, causing you discomfort. So, your overall distress and anxiety decreases. When you experience that trigger, then you don't get to the anxiety state. You don't engage in the safety behavior and you're no longer creating that long-term problem. So what were using exposure for
is emotion regulation. Ation because when we are confronted with anxiety, we have two options, we either change the environment, whether that's ignoring everything getting out of the situation or we change our response to it. We go back and we expose yourself in small ways to this
source of anxiety. We go back and we decrease our distress related to this thing and so what this does is it Alters our capacity to experience a problematic environment and this is extremely powerful and can really be used in any situation that causes anxiety or discomfort. So this sounds like the most fun enjoyable, worst possible thing you could do to someone with anxiety and I completely agree with that, it's miserable, it's
not enjoyable and it works. So the idea of exposure therapy is that you take something that causes you fear and anxiety and discomfort and you expose yourself to that thread and small little bits at a time. So, if you're terrified of flying, you would slowly. But surely expose yourself to the experience of flying until you felt comfortable enough. Enough to get on a plane. So what that would look like,
would be sitting down. Maybe it's in a therapy session, maybe it's with someone, you trust, maybe it's by yourself in mentally walking through the process of getting to the airport checking your bags walking through security getting to your gate getting on the plane taking off, being on the plane. What are you going to do? What is it? Looks like outside the window, who is around you and get going into great detail of this
experience in your mind. Once you get to the point where that is no longer causing you a man. Discomfort and Rapid breathing and the symptoms anxiety, anxiety, like sweating, increased, heart rate, all of this kind of stuff. You would move to the next step. Maybe that's even packing for a trip and putting yourself through that experience of packing, everything you need, loading your bags up to the car after that. Maybe it's driving by the airport.
Another thing that you can do is mimic the physiological symptoms of anxiety. So, I don't know about you, but if you struggle with a panic attack before you kind of really get scared of. That experience is miserable. It feels kind of like You're going to die. You're not in control and you just, you can't breathe, everything's overwhelming. The world is crashing all around you. That's scary.
So, if you can expose yourself to what it feels like, when your heart rate increases, when you have shortness of breath, when it feels like things are overwhelming. The next time those symptoms, come upon you. You're like, okay, I got this. I felt this before. I know how to cope with this. I know how to decrease my anxiety. Navigate this situation and be effective to the point where I can manage to cope through this.
Ways you can do this, have a paper bag breathing in and out through that paper bag, again, kind of mimicking that feeling of being out of breath. Another way is to get a straw and breathe through a straw that limits your ability to intake air and you get that feeling of a shortness of breath. Going for a run doing push-ups things that get your heart rate elevated and give you the same physiological experience of anxiety or panic attack. It's another thing that can
expose you to that experience. So, again, like I just talked about with the plane People what? These are are three different types of exposure therapy imaginative, which was imagining, you're going through the plane. Imagining you're driving to the airport Etc. Introspective, which is recreating those physiological symptoms of anxiety that you experience when you get on the plane and in Vivo which is driving to the airport. Packing, your back, actually
getting on a flight. And so these are three different ways you can do exposure therapy. And when we think about why people like horror movies or roller coasters and things like that, they're exposing themselves to You're in a way that's manageable and you can cope through it while still having that adrenaline kind of approaching it from the same way here. But you're doing it, not for the adrenaline butts that you know, how to cope. Effectively this week's episode
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and get in a minor car. Crash two kind of Be okay with that fear, you're not putting yourself in any danger, you're not harming yourself in any way. Your safety is not being put at risk. If you're, if you're is a car accident, you would start by imagining yourself getting in the car. You would go through what the drive would be. Like, what you see outside your window, what it physically. Feels like to be in the car. Next up, you go sit in the car with the door open.
Then you would sit in the car with the door closed. Then you would drive around with someone else driving the car and you and the backseat slowly but surely Work up to driving normally, but you don't get to the point where you're actually putting yourself In Harm's Way and experiencing that fear, whatever that is. So when I was doing exposure therapy at McClain, there was a couple exercises that I used to
do a lot in sessions. One of them was related to a fear of contamination and feeling dirty and not clean and really, really, really just need to get rid of whatever that
threat was. So, what I would do and the sounds horrible, even if you're just a germaphobe and you don't necessarily have OCD, I'm gonna rub my hands on the ground and I would sit there in the session for at verse 30 seconds, you work up to a minute, maybe it's five minutes, maybe it's 10 minutes and I would just sit there with my hands covered in dirt. From whatever Grime was on the floor and I would resist the urge to go and wash my hands. Scrub it off and feel clean again.
Another exercise that I would do a lot was I had a really, really big problem with tapping in certain numbers. So what I would do is instead of tapping three times which was considered a good number for me, I would tap two times and I would delay that third tap as long as possible, I would go maybe 30 seconds at first and then I would elongate that to a minute then it was five minutes. And by the time I was mastering this ability to resist Compulsion.
My therapist would say, hey, go as long as possible for after the session and not engage in this compulsion. Another thing that I'd struggled with and still struggle with to this day is hair-pulling. And and so for that, it would be like, okay, I have an awareness of this compulsion and this urge to pull out a hair. I'm not going to engage with that. I'm not going to engage in that compulsion. I'm going to be aware that, that is a compulsion I have, but I'm going to wait 30 more seconds,
I'm going to wait. One more minute. I'm going to wait, five more minutes. I'm going to wait 10 more minutes and kind of sit in that discomfort for as long as possible, until I absolutely had to engage in the urge. So using exposure therapy in your daily life. There's kind of two ways. You can approach this, you can do exposure therapy from a preventative perspective. Like, I just talked about in my therapy sessions, where I was decreasing.
My distress that came from touching dirty things from not tapping. A certain number of times from not pulling out a hair, or you can do exposure therapy when you are in an emotionally distressed space, and sometimes you were in such a state of panic distress. Being overwhelmed, whatever it is but the thought of actually going towards that threat is absolutely miserable and not possible for you in that moment.
That's fine. You use a stop scale, you use coping skills, you do deep breathing you go on a walk, you going to run you do the tips Cal, I'll link the episode in the description for how to do those skills. But if you're having some anxiety about doing a presentation, exposing yourself to that fear and going, and giving the presentation despite having apprehension about doing it in the future decreases that anxiety. If you avoid it, completely the next I'm you go together
presentation in class. The, that feeling of anxiety will be doubled if not triple, if not exponentially larger. Whereas when you expose yourself to whatever that quote unquote threat is, that isn't actually impacting your emotional or physical safety your anxiety in the long run decreases. So this is where I kind of want to segue into using exposure therapy in a social sense. So when I was in treatment, we did this thing, every Friday I called exposure to exposure
group. And I hated this group, with my whole being, we alternated between activities. We did to expose herself Special therapy. One thing that we used to do is karaoke. I'm a terrible singer. It's why you've never heard me sing on the podcast. But I am terrible at singing. It gives me anxiety to sing in front of people that I don't know. I get really insecure about my music taste and think, I'll be judged and forever Outcast. And I just hate karaoke, even if I'm like not picking out the
song, Still anxiety. And so the exercise that we would do, is every single person would pick a karaoke song. Go up and do karaoke and at the end you would get a sticker. So there's this reinforcement. Mint and you weren't a Therapy Group. You are in a safe space with a therapist and support and it still caused me so much anxiety. I remember this one time. I talked to one of my friends into doing it with me, so she went up with me. I didn't even choose a real song.
I chose happy birthday. She was up there singing with me and I was like, okay, I got this, I'm gonna go sing, happy birthday, and I got to the front and I lip sync. The whole thing to succeed, you have to sing like your, this is the point of the group, and I just couldn't do it. And we made small steps. We got up in front of the group, we chose the song we did something.
But that just shows what it can be like to experience these immense moments of anxiety and to expose yourself to what that threat is. So that was one activity that we would do. And if you struggle with getting up in front of a group of people cheering music, whatever it is, doing that kind of karaoke night with your friends or your family member. It's a really good exercise to kind of decrease your anxiety around that thing.
Another activity will that we did was called vulnerability group, so you would think for the week, they'd be like, okay, guys next week, Nobility group on Friday and you would think for the week, what is a vulnerable story that I can share and with this group? So you would come to the group you would share something vulnerable by yourself. Maybe it was a negative interaction, you had maybe it was something. You felt a lot of guilt about.
Maybe it was something that caused you a lot of shame or fear. Remember, one time I talked about how ashamed I was about, how much suffering, I caused the rest of the my family by struggling with depression and anxiety. I had made my home life really chaotic for my younger siblings, I Kind of displaced my family by moving across the country to get help.
My parents were constantly going to therapy with me and working in Family Therapy, and I just caused a lot, a lot of chaos and that brought me so much, shame and guilt and in sadness as well. And so that was something I shared invulnerability group, and you would go into detail and you would tell this story and everyone would go around and
share these things. And for a lot of people, if it was something that really did Harbor, a lot of emotions, it would cost a lot of anxiety and discomfort but You are exposing yourself to that concept of being vulnerable. And in the long run, when you were then building relationships and building, strong connections, your ability to be vulnerable and talk about things that brought up emotions was
improved. So there's one more activity that we used to do and this was honestly, one of the funniest ones, but we had these like little Bingo sheets and they would cut them up into little squares. And it was activities, like, go ask a stranger for their phone number. Go, bargain and trade something, Go sing a song in public. Go do ten Jumping Jacks in
front. Everything like silly things that were not socially acceptable, push you out of your comfort zone and were uncomfortable and we would go into the cafeteria. This mental hospital. We go up to these poor strangers who were visiting, probably family members touring the place, maybe they worked there. And we were these kids that were still getting treatment. Would be like, can I bargain my lunch for your lunch and heroic? What back is wrong with these kids?
Like what is going on. But, but it helped it helped to expose yourself to that discomfort and understand what it feels like to be socially. Not accepted in a sense, you are putting yourself at risk for rejection and judgment and you were okay with that. And so, those were the three activities that we used to cycle through and do and all are very applicable to normal life, to push yourself outside of your
comfort zone. Experience that anxiety, expose yourself to those threats and then become more comfortable with that experience in the long run. So if you want to plan to use, exposure therapy, at some point in the next week, in your life, whenever it is, here are the steps that you can go through. The first thing you're going to do is identify the trigger the queue. Situation, whatever it is, that brings up that distress, and that anxiety. And write that down.
Describe what it is. Next, you're going to ask yourself. Is this a Justified anxiety or not? If you're about to give a presentation, you have some light butterflies, you're a little bit nervous and apprehensive that's Justified, you're going to be up in front of a lot of people, but if you're having such severe anxiety that you can't breathe
in, you're about to cry. That's maybe not justified given certain situation, and even if it is Justified given a history based on certain presentations, it's not serving you effectively within the school setting. So this is when you address your exposure, what is your exposure? Look like whether it's imaginative introspective or in Vivo. So, kind of walk through that. What are different ways you can expose yourself to the anxiety of going through that activity?
So you also want to revisit and see what that safety behavior is that you're blocking. Maybe it's running out of the classroom, maybe it's avoiding the presentation altogether, maybe it's avoiding, whatever that threat is for long periods of time and see what the healthy behavior is that you're creating by avoiding. Other thing. And lastly, what is the emotional response of exposing
yourself to this thing? Are you feeling proud of yourself for being able to sit there and not be overwhelmed? Are you feeling confident after giving this presentation and do you want to reinforce this feeling? If so you're going to keep exposing yourself to it, you're going to keep working to get rid of these anxieties and fears and discomforts. So, I also wanted to give a couple resources around OCD and exposure therapy and things you can read if you're interested in this topic or ADD.
If I with you and you want to learn more about it. So one book that I read about OCD which was literally phenomenal. And I've talked about it in episodes before it was called brain lock, and I don't remember who it's by, but I'll put it in today's show notes and there's tons of case studies in this book of different individuals who struggled with OCD and got treatment to improve their obsessions and their compulsions.
And it talks about biologically what goes on when you're experiencing OCD, how it really is a physiological disease and not just kind of in your head going to approach coping with obsessions and compulsions. Rewire those thought patterns, so that you can recognize that this is not really a real thought. And a real threat, it is an obsession. It is a compulsion, Etc. So that is one book, Brain lock. The other one, which totally relates to vulnerability and social exposure.
Like we just talked about, is I thought it was just me but it isn't by brene Brown. And that book is all about perfectionism and really a lot about shame. If you're not familiar with brene brown, she is a shame researcher. And she's done tons, and tons, and tons of work. But that's another really good book about social anxiety, and fears and exposing yourself to kind of that discomfort. So that's kind of all I got for
today. As far as exposure therapy, we walked through how you can address a threat and decide if what you're feeling is Justified or not justified. And if it's not justified, how you can use exposure therapy to decrease the discomfort around certain triggers, we talked about different ways that you can do, exposure therapy, whether it's introspective imaginative or in Vivo, we talked about using exposure therapy for anxiety. Disorders, general anxiety OCD and social anxiety.
And yeah, I think that's pretty much it. So if you enjoyed this episode, be sure to leave a review. Share it with a friend share on social media. If you share yourself listening to this episode, I will give you a shout out and repost on Instagram and actually resisted podcast. Also, I am doing a crash course to DBT series on Tick-Tock, so be sure to follow me on Tick, Tock at she persisted podcast every day and posting three or four videos and I'm Going from starting at the intro to DBT
what is DBT, what's a? Dialectic all the way through every single skill and DBT. So be sure to follow along with that great way to understand all the scales without literally going to therapy and doing intensive treatment. But anyone looking to be more effective in their life. Whether it's being more mindful being more interpersonally effective, you gotta watch this series. I promise it's helpful. So thanks for listening. I will see you next Friday.