What Does Anxiety Therapy Look Like? (Episode 45)

SPEAKER_01 0:01

Hi, Josh and Drew. My name is Daniela, and I am from Newmarket, Ontario. You can use my name. First off, I want to say thank you for all of the information and resources that you provide in your podcast. It is extremely helpful. I am an anxiety sufferer now for many years. I was just wondering if you could do an episode almost mimicking what a therapy session would look like when you are addressing anxiety, OCD worries. It's really hard to kind of get past that bullcrap meter in your mind and addressing those core beliefs and those core fears.

SPEAKER_04 0:48

Welcome to Disordered. This is episode 45 entitled What Does an Anxiety Therapy Session Look Like? Or What Does Anxiety Therapy Look Like? I am Drew Linsolata. I am a therapist in training in the U.S. in the state of New York, specializing in anxiety and anxiety disorders. I am an author and a podcaster on this topic and a former sufferer of anxiety and depression myself for many years.

SPEAKER_02 1:08

And I'm Joshua Fletcher, also known as Anxiety Josh. I'm a psychotherapist based in Manchester in the UK, author, content creator, and co-host of this podcast.

SPEAKER_04 1:19

Welcome back.

SPEAKER_02 1:21

That's a really good question. What does anxiety therapy look like? There's many different kinds of types of therapy, but we thought we're going to open this episode today by demonstrating what I would do as a therapist. I'm trained in CBT and humanistic counseling. And when I yeah, we're going to demonstrate what we do now. If Drew, would you like to be the client today?

SPEAKER_04 1:46

I will totally be the client. And by the way, it's Academy Award season. So those of you who have connections, please submit this performance for the consideration of the Academy. It's going to be good.

SPEAKER_02 1:57

We're both going to be kind of performing. I'll try and not say jokes and stay and stay enroll. That's good. Yeah, why not? What better way than to model? Uh we'll just do it five minutes, maybe ten. Yep. Uh uh, and show you what anxiety therapy looks like. Why not?

SPEAKER_04 2:12

Yeah, I'm just gonna be 2005 Drew coming to my therapist, Josh.

SPEAKER_02 2:16

Okay, no worries. That sounds brilliant. Yep. So what we'll do is we will conduct the session after the sound of the eagle. When the eagle cries, we are in character. Okay. You ready, Drew?

SPEAKER_04 2:30

I yeah, that's how every session should start.

SPEAKER_02 2:35

Welcome, Drew. Um, come in, feel free to sit down. Um, choose a seat. I don't mind where I sit, but you can sit wherever you like. Cool. Thanks. I appreciate that. Uh thanks for coming today. Um, obviously, I know you explained a bit on the phone and over email, but um, yeah, how are you feeling today? What's what's happening?

SPEAKER_04 2:56

Uh how am I feeling today? I'm on the edge of panic right now. It was really hard to even get here. And you're only like 10 minutes from me, so I'm struggling.

SPEAKER_02 3:05

Really?

SPEAKER_04 3:06

Yeah. Oh, what does that feel like? Uh how's how's it present? Um, well, I feel like I can't get a deep enough breath, and you look like you're about a million miles away from you right now, and I'm having a hard time hearing anything, and my heart is pounding, and I feel like I I'm right at the edge of just like I gotta get up and run out of this place because I hate this.

SPEAKER_02 3:28

Okay, well, it sounds like uh anxieties are very high at the moment. Just know you're okay. You know, if you need to take a moment out, you can do, you know, I'm not gonna stop you or run after you. Um, but that that's okay. Um what you need to realize is that your body's currently in the threat response, but I'm pretty sure the longer you sit here, uh you'll realize it it will start to calm down. Also, you know, it's your first time here in a therapy room, you're gonna be a bit anxious, and that's okay. Yeah, you know. Yeah, yeah.

SPEAKER_04 4:01

Okay, I appreciate that.

SPEAKER_02 4:03

Uh okay. Well I like to demystify anxiety first. We try and put it if we when we get it on paper, it becomes a little less scary. I'd like to split it into three thoughts, feelings, and sensations. Um, you know it's an anxious thought when it begins with what if. So tell me some of your and if you don't mind, I'll write it down and we can make it on this piece of paper together. Tell me some of your what if thoughts. Just give me a second.

SPEAKER_04 4:35

Everything just feels so much right now, like I I want to call for help. Okay. What did tell me the question again? The question again.

SPEAKER_02 4:45

Yeah, so the question is what are these what-if thoughts now just flowing through your mind? They're just thoughts, but I know they feel very real and intense.

SPEAKER_04 4:52

But uh the loudest one right now is something is what if something is really wrong with me? And it oh, it feels really like something is really wrong with me right now.

SPEAKER_02 5:04

Okay.

SPEAKER_04 5:04

Yeah. Is this new? No. This has been going on for a while, and that's why I'm here, clearly.

SPEAKER_02 5:12

Okay, yeah. So it's a thought you've had before and a feeling you've had before.

SPEAKER_04 5:15

Yeah.

SPEAKER_02 5:16

Um, has anything wrong ever happened as a result of it?

SPEAKER_04 5:19

No, no, and and this I think what's makes it harder is right now I just feel like I want to jump out of my skin and and go to a hospital or something, but I know that I don't have to, and that this makes this really hard because I know that there's nothing wrong. So no, nothing's ever actually happened, but then it feels like, well, what if this time? You know.

SPEAKER_02 5:37

What if this is the exception? Yeah. Uh well, I'd wager it's not, you know. So there's good, there's a one that we can write down there straight away. What if something really bad is gonna happen right now? Yeah. Any others are popping?

SPEAKER_04 5:51

Um, it's not so much what if, but it's like uh maybe like scenarios are playing in my head. Like, does this guy know how to do CPR? I mean, I'm not gonna, you know, I I didn't want to ask you that, but like, does he have a defibrillator or like how far is the hospital from here? That's what's going through my head right now.

SPEAKER_02 6:10

So a lot of people with anxiety and panic will often worry about uh their heart. So it sounds like what if my heart explodes, yeah, stops. Yeah, yeah. Uh that's not happened so far in this therapist, uh, in this therapist office, but and I'm again I'd wager it's not gonna happen now. Uh well done, by the way, for engaging. And that was very difficult to concentrate.

SPEAKER_03 6:30

Yeah.

SPEAKER_02 6:30

Uh so I'm gonna write that one down too. So what if something bad's gonna happen? What if it's something to do with my body? Uh good start. Well done. Um, any other what ifs?

SPEAKER_04 6:40

Um, I mean, you know, what if this takes what if I can't calm down this session? Like, I really want to do something good here today, and I feel like I don't want to spend the whole hour just freaking out and wanting to like, you know, dial 911. So, like, what if this takes too long to get through?

SPEAKER_02 6:59

Even if you did, I think that's a a good session. At the moment, you've come in here at a new place, and you explained to me before and over the phone that you've you find it very intense outside of your safe zones. You're done really well to be here, and actually, you're doing some really hard work right now, which is great. Also, I always like to reassure people, particularly people who are panicking and they're anxious, is that that adrenaline can't last. You know, I almost guarantee you by the end of the session, you won't feel as anxious. You might feel a bit shaken and tired, and still might be some latent anxiety, but it won't feel as intense as it is now. Um, and I'm gonna go out on a whim there, you know. I've not been wrong yet with people panicking in here, but you know, obviously your brain's probably thinking, but what if I'm the exception to the rule?

SPEAKER_04 7:50

Yeah, it's exactly right. Like it's it's almost like you know me or something. Like, yes, this is exactly what it's still like. All I care about right now is if something happened to me, you would you could do something about that, right? Like you could call for help and all that.

SPEAKER_02 8:04

Yeah, I mean, if there was actually an emergency, I would, but I don't see an emergency here. I just see you and your body going through a very normal thing. It doesn't feel normal in here though, does it? But it it will do because you're even the threat response is engaged. You don't really need to do anything other than to concentrate on what we're doing.

SPEAKER_04 8:22

Yeah. And answering that question was really silly because after it comes out of my mouth, I know, like, why did I ask that? Why did I ask that question? I know I don't have to ask that question.

SPEAKER_02 8:30

I don't think it's silly, and but it's nice to vocalize it, you know, and but actually, yeah, I I'm vocalizing a thought, and that's okay. Okay, so we've done the thoughts. This next part is the feelings. Tell me about how it feels. You mean like physically how it feels?

SPEAKER_04 8:46

Yeah, you can if you like. Um, yeah, my heart is pounding, and I I can feel like when you see that little jump that I did, that's a skipped heartbeat. Like those freak me out, and you know, having a lot of those right now, and just feeling like I can't get a deep enough breath and feeling a little bit dizzy. Not really, I don't know. It's not dizzy. I don't know what it is. It feels like I'm on a boat, even though I'm sitting here on the sofa. And it's just a feeling of agitation. My fingers are tingly a little because I think I'm over breathing and I I know enough to know that, but it's just a lot. Like my body is just way up here right now.

SPEAKER_02 9:20

Okay. Yeah. It will come down, it will, and it's okay. I know you the fingers are tingling, your heart's palpitating. It's just getting it's just processing all that adrenaline. And I reassure you that adrenaline will start to come down, and it always does, doesn't it? How many times have you panicked? You know, it always it always peaks and troughs and it will start to come down again. So you're okay, and we will start to notice that as the session goes on. So those feelings, and then oh, the last part of anxiety usually ask is sensations, but you've already described a few. Yeah, so it's a bit like you know, the tingly feelings. Anything anything else?

SPEAKER_04 9:56

No, I mean I could go on and tell you everything that's happening in my body right now, but it we would be here for two hours.

SPEAKER_02 10:02

Okay, so discomfort.

SPEAKER_04 10:04

Yes, I'm uncomfortable, I'm afraid.

SPEAKER_02 10:06

Well, I like that. It's uncomfortable. I'm uncomfortable and I'm afraid. Yeah, I don't like that you're uncomfortable and afraid, but I like that you can label that and see that, and I think that's uh really good. Yeah, this is really common. I bet you're you know, and even though it happens over and over again, I bet you feel doubtful. I feel I doubt my safety here, even though it's happened hundreds of times. I'm yeah, filled with a feeling of doubt.

SPEAKER_04 10:31

Yeah, that definitely that. Yes, this has happened to me so many times, and I know that it's gonna pass, but it every time it happens, it still feels like it's not gonna pass or that something is really wrong.

SPEAKER_02 10:40

Yeah, that feeling of doubt is very normal right now, and it will pass on its own. It's supposed to, you know, it's it's a part of our brains that just kicks off when it senses danger because when we doubt as humans, we give it our attention and we stay hyper-alert, like a mere cat, you know. Uh it's probably why you can't find it difficult to focus, yeah. Why you can't have your usual daydreamy thoughts. It's okay, and everything you have listed so far is okay, and it will start to calm down. Isn't there something I could do to make it stop right now? No, all we do is show it, and I'll explain to this more as therapy goes on. Um, but what all we can do is show it that it's okay, threat response, you're not needed right here. Uh, and all you need to do is concentrate on this conversation and just work on grounding yourself in this room. You know, that's okay. We don't there's no magic technique I'm necessarily using here. I you look very healthy to me. Yeah, yeah, you're a bit uncomfortable and you're fidgety, but you're there's nothing going wrong from from what from what I can see. And I do this all day as a job, so you know, you're okay. You're just in that anxious state. That's a good point. Uh uh in here, um uh I for how you're presenting so far, I usually use uh cognitive behavioral therapy, which is CBT. Uh have you heard of that before? I've heard of that, yeah. Yeah, so what I like to do with CBT initially, uh particularly with the panicky feelings, so there'll be none of this talking about childhood and things like that yet. There may be a time for that during our time together, but for now, we're just gonna focus on the here and now because it sounds like there's this sense of immediacy.

SPEAKER_04 12:28

All I care about is the here and now, dude. Yes. Exactly.

SPEAKER_02 12:32

So we're not gonna bother with all that and you know, looking at all the reasons why you know all these things happened in the past. This is just a here and now thing, and that's what we're gonna look at. Okay, so yeah, I'm gonna we're gonna use CBT. We've already started it, we've already started to formulate a picture here, you know. Uh I'm gonna circle you this around your thoughts, feelings, sensations, you know. That's all that's happening. I'm just gonna put a big circle around that, label it anxiety, you know. And but the problem is everyone has these sensations, but what I'm hearing, Drew, is that you are perhaps fearing this anxiety.

SPEAKER_04 13:08

Oh, yeah. Yeah, I don't want this to happen ever again. If you could give me some magic thing right now that would make it never happen again, I would give you a million dollars.

SPEAKER_02 13:17

Yeah, yeah. And we feel no one likes to be anxious. But people with this kind of presentation and this kind of you know, don't be afraid of the word disorder, but like sometimes we people with panic disorder or any anxiety disorder, uh what they tend to do is not only fear the feelings, but they seem to misinterpret it. And I think I've noticed even that as you've come into the room. You seem very uh healthy and here, but we're misinterpreting this urgency. And that's something that we work with in CBT as well.

SPEAKER_04 13:53

Yeah, that sounds right. That sounds very right. I know it's not, there's nothing wrong, but yet it feels like it is. I'm actually starting to calm down a little bit now already. Great. What did you do? I'm just getting tired, like my body's getting worn out.

SPEAKER_02 14:09

But but also notice where's your attention been during this um state of urgency?

SPEAKER_04 14:15

You uh um that's a really good question. I would say in the last couple of minutes when you started talking about CBT, for some reason you caught my attention and I've been a little bit more I feel like I hear you clearly, and I don't know if that makes any sense at all, but like you kind of got me a little bit there, and so I've been a little more interested in what you have to say, and that's why I think maybe I'm starting to feel a little better. I don't know. I get out of my head a little bit.

SPEAKER_02 14:36

You've been listening to everything I've said since you've come in, and your attention's been on me. And that's something really important that we'll that we'll tap into as these sessions go on. Okay. Uh when you've panicked at home and when and things like that, where's your attention been?

SPEAKER_04 14:51

Oh, entirely on every sensation in my body and all the thoughts, and I'm trying to talk myself out of it 100% on me. It's like you're wrestling with it a little bit. Yeah, it's tiring, man. It's really tiring. Yeah, yeah.

SPEAKER_02 15:04

Well done. Well done for doing that. Uh, I'll also talk to you a bit about the other modalities that uh that I work with in here, but for now I think we should just sit and kind of celebrate your first anxious exposure, and I'll tell you about anxious exposures shortly. All right. Thanks, Drew.

SPEAKER_04 15:20

Thanks, Josh.

SPEAKER_02 15:29

Also, oh scene! Also, I I forgot to mention that your dress sense is a symptom of an anxiety disorder.

SPEAKER_04 15:40

Is it a symptom of panic disorder to dress like you're 18 forever? I don't I don't think I can work with you.

SPEAKER_02 15:46

I don't think I'm a professional man. I I don't want to look at that every week. No movies, please. I mean, I don't know how we did there, but keep it in. Um, let's put the uh we deserve a round of applause. Oh, we do, let's see.

SPEAKER_04 16:02

You work really good, man. I would hire you as my therapist.

SPEAKER_02 16:06

It was alright. It was just kind of going with it as well. It's hard to take you seriously because I talked to you all the time. Uh yeah, also Craig the critics, like, the hell was that? Uh, but that's just a little insight into how I would initially work with a client, or maybe a more conventional CBT therapist. Um, what you've got to remember is that if you're seeking therapy for anxiety, the modality is very important.

SPEAKER_03 16:33

Yeah.

SPEAKER_02 16:33

Uh particularly if you have an anxiety disorder and OCD. Drew, what do I mean by modality?

SPEAKER_04 16:40

Modality is the way you would treat it, right? So modality is just a fancy word for treatment type. Like if you, you know, if you have a sinus infection, the modality of treatment might be a ZPAC antibiotics or whatever. People know that stuff. So in therapy, the modality of treatment might be psychoanalytic. We're going to talk about your past and your childhood. It might be, you know, cognitive behavioral. We're going to talk about your beliefs and your ideas and your thoughts and exposure and all that stuff. So it's just the way you treat it. That's what modality is. And there's a lot of different ways that a therapist will approach this. Yeah. Yeah. It's like a style.

SPEAKER_02 17:13

So you you mentioned psychodynamic. So a lot of people who haven't been to therapy before, you know, they may picture this old, yeah, traditional um version of therapy where they have to lie on a sofa thought association. Yeah. You know, tell me the first word that comes to your head when you think of your mother. Yeah. Uh yeah, no, that's I mean, obviously psychodynamic exists. Uh, I don't recommend it for anxiety disorders. In fact, I heavily uh uh heavily advise do not do psychodynamic for anxiety disorders. Uh it's just my opinion as a therapist, but yep, um, it's usually the it's a very digging style of therapy where there's an underpinning meaning for for things. And don't get me wrong, that exists in certain things in life, but a lot of anxiety disorders are like what we said in our role play, which is I fear the sensations and and I'm misinterpreting the threat response. Uh, how we got there, maybe there's a there's a role to play. But as Drew says in an analogy that you used years ago, which is you know, firefighters want to get to the house and put out the flames first, they don't turn up and be like, I wonder what caused this.

SPEAKER_04 18:22

After maybe they do. Afterwards, yeah. Afterwards, maybe. You know, it's funny because doing that little roleplay that we did, I was trying to connect to what it felt like back then. I think I did okay with it. I mean, it was really vivid memories, right? So I think in that situation, when when you were like, What are you focused on? And I was, you know, I'm focused on me right now. This is a here and now question. Like uh, if somebody and I did, I remember I I have no ill will with this person, but I did see a therapist for two sessions, and she was clearly psychodynamic in her orientation. I know that now. And all I cared about was, all right, I'll talk about this stuff with you, but does that mean that you're gonna come up with something that will make me calm down? So people in the in the grips of disordered anxiety really just want, they're on fire. They need to put the fire out right now. So if you're gonna go into digging or just traditional talk type therapy, a lot of times our goal is off base there. Does that mean today we're gonna come up with something, some epiphany that will make me calm down for the next week? And no, generally not. So that's what makes it very ineffective, you know, for this whole thing.

SPEAKER_02 19:22

And it's a lot of digging and detective work, but for me, it was actually very, very unhelpful for my when I was back when I was had an anxiety disorder, because I it culminated this belief that I could find a miracle thought to make all the suffering go away. So if I sit there and go through the deepest echelons of my memories and find why I feel this way, even though it was just a panic attack that happened on a Tuesday afternoon because I was super stressed and going through a very stressful time in my life, uh, that was just adding to rumination. So, in my experience as a kind of an expert in this topic, um, stuff like psychodynamic, um, and also another modality that I'm trained in is person-centered, which is which is I love, but it's a type of therapy where you go where the therapist doesn't really say much. You know, they they allow you to have the space, and it's a very powerful form of therapy. I think every therapist should be trained in it. Um, but again, if you're going there with OCD and intrusive thoughts and the therapist is go, you know, is kind of reflecting back to you, um, trying to be in your frame of reference and things like that. It's it's comforting to be seen and it's comforting to have that space and respect. But sometimes, particularly with anxiety disorders, we kind of want a little bit of guidance, and that's why, again, in the role play, when someone came in, I use the CBT psychoeducation style um approach to be like, okay, well, let's learn what's happening in our bodies, and that's something that CBT, third wave CBT as well. So it's things like acceptance and commitment therapy. Yeah, uh, I'm not sure if metacognitive therapy is third wave, but it's it's it's it's of the same ilk. It is of the same ilk.

SPEAKER_04 21:06

Interesting, the MCT people really seem to want to differentiate themselves from CBA.

SPEAKER_02 21:09

Oh, yeah, they all want to start a cult and be whatever, as as do all modality purists. But in general, yeah, uh, I mean, there's lots of similarities in that. And they'll say, no, no, there's not as well, there is. I can literally just get a pen out and cycle the set similarities in Becky and Third Wave and that. But anyway, uh, yeah, so when you're seeking out a therapist, it's important to actually look at the kind of modality that they are trained in.

SPEAKER_04 21:35

I think it's important to recognize too that uh my other podcast, The Anxious Truth, one of my pop more popular episodes is why doesn't my therapist talk about it like this? People will ask me, like, why don't I have a therapist and they don't talk about anxiety like you do? Well, sometimes it's just so when Josh says like you should really look at what the therapist's modality is or what their theoretical orientation is, that's what's being drilled into me. You you have to have a theoretical orientation. Now, you could be an integrative therapist, which means I'm going to take pieces of different types of modalities and theories and apply them depending on the context, which I think makes perfect sense. That's what I would do for sure. But it's important to because the therapist, at least here in the States, the way that they train us is whatever your theoretical orientation is fine as long as it's an orientation. So if you want to treat panic disorder with adult therapy, you know you guys can Google that if you want, but you can if you really want to. There's no law that says you're not allowed to do that. But it's good to know what the person believes about and anxiety. What you know, I'm having recurring panic attacks, I'm afraid to leave my house. What do you think that is is a good question to ask a potential therapist.

SPEAKER_02 22:38

Yeah.

SPEAKER_04 22:38

Yeah. I mean doubt they would be reluctant to diagnose you in an initial call, of course, and they'll be careful, but well I believe that there's some unhealed pain is one answer. I believe that your brain has learned some unhealthy habits is an answer you might get from someone like Josh or me. That's a different answer. And that's to me that's the answer I needed back then.

SPEAKER_02 23:05

Yeah yeah I mean my panic disorder came from an accumulation of loads of stress trauma and grief. But knowing that and exploring that was not helping my current situation. I just wanted to stop feeling scared rather than readdressing traumatic stuff. I did go back and readdress those things. Interestingly I have I have had gestalt therapy which is the which is a school of thought that looks at you as different parts of your human uh you as a human and I did something called the empty chair technique from gestalt therapy where for my grief so because I'm very cynical miserable guy and I was addressing my grief and my gestalt therapist asked me to picture an empty chair and say well what would you imagine this person who uh who you lost imagine they were sat there like no just go with it suspend your disbelief what would you say to them yeah man I was really really powerful you know like wow you know but I wasn't going there from panic disorder at the time I was okay with that I'd stopped fearing fear. Yep I understood what was happening with my body so that equipped me to do powerful emotional work like that because yes anxiety came up when I do things like that but that was a different stage of therapy that I was in and that helped me process my grief.

SPEAKER_04 24:36

The therapist I worked with the most oh I'm sorry Josh I stepped on you. No no you carry on uh the therapist that I worked with the most and she was not an anxiety specialist. So she was uh you know I would love to say her name because uh she she was really great for me even though she was not an anxiety specialist she said right away well this isn't what I specialize but she also had a background as a um an acute care nurse and she said if someone comes into the ER and they're bleeding the very first thing we have to do is stop the bleeding and like you're bleeding you need to stop the bleeding and then maybe there's a wound that needs to be you know fixed and I can maybe help you with that but the bleeding has to stop first. That was such a that stuck with me from the day she said that. Yeah first we stopped the bleeding and I'm like you know what and I I respect her so much because she said this isn't really my bailiwick and she recommended a few people and I said well I think I could do it on my own and she supported me while I did exposures on my own and she cheered for me even though that's not what she does.

SPEAKER_02 25:28

And uh that that's really that's really that's really interesting isn't it because you don't if a lot of people listening to this podcast will be equipped with a lot of the information because if you're you're up to episode 45 with us you'll know a lot about what's happening. Yeah so yeah I never thought about that so if you find a good therapist you connect with and they're gonna be your cheerleader for a while and they're on board with you doing exposures and things like that and you want to park digging through the deep stuff first and you want to go do exposure that's super powerful.

SPEAKER_04 26:02

And she was smart enough to know enough about it where she would help me with little you know refocusing things in session and how did it go and how did it you know what where was your struggle and she didn't give me exposure she didn't do CBT with me but she was so super supportive and it worked which I think leads us to the whole like that theory that says all therapy works.

SPEAKER_02 26:21

What do you think about all therapy works um no I think a lot of therapy it has to be right so you know here's the shame as plug in in my latest book I talk about anxiety therapy. So if this is a topic that interests you you will love this book. And Drew helped me actually write a chapter about what does good therapy look like um and that includes you know in order to have good therapy then the whole concept of kind of bad therapy has to exist. And good therapy is a match of a connection with your therapist um and a matching modality to help. So for example when I had OCD and this is a big one for the OCD crowd if you're if you're an OCD person and a lot of your compulsions are rumination and seeking reassurance you could go to a really kind wonderful empathetic therapist who's perhaps drained in person centered or someone who's uh analytical and wants to dig deeper behind the thoughts but if these thoughts are just attempts to seek reassurance compulsively for intrusive thoughts you'll end you know you can end up going being there for months just going round and round and round and actually it's not helpful therapy because the therapist then becomes a source of reassurance giving yeah and we know and we that's one step away from the willful tolerance of uncertainty and we almost can kind of facilitate a reliance. There's actual research on that to show that conventional talking therapy for OCD and intrusive thoughts can be harmful. Also it it kind of can add to rumination. So when you're sat there reflecting on thoughts like what if I don't check all the plugs before I go to sleep what if I jump off this bridge that could be misinterpreted by a therapist from a different school of thought. Yeah. So someone who's into kind of symbolism maybe you're you know a Jungian therapist or whatever you're like oh I wonder why my client wants to jump off this bridge. You don't the client doesn't want to jump off the bridge they're just having an intrusive thought you know and and that's that's how I treat it. You know obviously you do your safeguarding and stuff and like check that this person yeah but you know 99% of the time these are people with OCD going I don't want to jump off the bridge but I well what if I do you know and around around around you go. Yeah and so whereas if you go to someone trained in CBT and particularly in exposure response prevention they hear that stuff all the time and they'll go okay well let's have a look let's let's let's see here this is then they include psychoeducation and then okay this is this is kind of what we have to do.

SPEAKER_04 29:01

Yeah and I think um so the all therapy works thing is yeah that's based on the idea that the therapeutic alliance your relationship with your therapist based on trust and respect and acceptance is critically important. So no matter what the modality is but I agree with Josh it can't you gotta have both of those things. So you can have a CBT anxiety expert and if you don't make a connection with that person that could wind up being quote bad therapy or maybe not so terribly effective. So there's a lot of different things that go into this but we are always making these claims based on data. So when we say that we're you know the things you hear us talk about are better or more effective it's just because of a lot of research when you can sit down and say well here's a hundred patients that present with agoraphobia for instance and some went through this therapy some went through CBT and these are the outcomes and CBT these type of therapies cognitive behavioral in nature win every time you know when you look at symptom reduction and the improvement of quality of life and re-engagement with life and then maybe other things come into play. That's why all therapy works yeah if it's the right therapy and you are connected with a therapist you just have a connection with and you can trust and they accept you and they support you.

SPEAKER_02 30:10

I think it helps because anxiety disorders can be measured. So if you've gone to CBT particular in the UK if you go to NHS CBT therapy I'm not knocking CBT therapists here. I'm knocking system you often rush through six sessions 30 minutes spend 10 minutes filling out a form the CAD seven how depressed were you how hopeless did you feel or how anxious did you feel and things like that and you circle one to five whatever it is um yeah that is data that can be used a lot of other therapy um therapists quite rightly get upset with that because you can't quantify other levels of therapy like I couldn't quantify you know personal growth and maturity on a chart you know I I couldn't quantify like almost like yeah just kind of self-development you can't really quantify that or just becoming just growing as a person you know I don't think you can there's no metric necessarily for that and that was for the therapist that I did afterwards.

SPEAKER_04 31:12

Yeah and but yeah I think the other criticism of that that data driven thing that folks like us claim is and and it's a valid criticism I'm 100% with this your anxiety disorder doesn't exist as a in a vacuum like all I have is the symptoms of panic. That's not true. You're a whole person you've lived an entire life up to that point. So that's where other therapists will look and say well what is it this person is only a walking collection of measurable anxiety symptoms? Of course not so when you start to see other issues you know in my experience start to bleed in is like okay well folks like Josh and I will have you do exposures. That's a difficult thing to do. So if your sense of self-efficacy because of your past experiences or your upbringing is really low, you may have challenges in terms of implementing these recovery strategies. And that's when other modalities would start to dovetail in for sure and things to look at so good.

SPEAKER_02 32:00

So yeah uh here's some helpful questions you can ask then if you're seeking therapy and finding a therapist uh the number one one would be is that are you anxiety disorder informed? Do you understand what panic disorder and OCD that's a big one you know and that's still one even I ask now you know it's helpful not always but you know are you anxiety disorder? Do you know how that presents you know and you can even ask them before you even have your session you know like can you just tell me a bit about what you know about panic disorder uh and they'll tell you or they won't and that's good. That's for me is step one.

SPEAKER_04 32:37

What would you ask Drew I would probably ask the same question for sure. I this is tough because you don't want to like credential shop necessarily but I would probably ask you know like can you give me an idea of what training you've gone through or what organizations you belong to those aren't the don't don't tell you everything about a therapist but a therapist who's a member of the Anxiety and depression association of America is much, much more likely anxiety disorder informed. So if they can say oh yeah I belong to the ADAA or I belong to the IOCDF you're like okay that makes sense I've done training on acceptance commitment therapy and multiple years of training at CBT that's great. You know yeah yeah and that's good.

SPEAKER_02 33:19

In the UK it's a bit trickier particular OCD as well um you you've got to find the you might have to do a bit of Google hunting here and just finding a therapist who is trained in ERP exposure response prevention. Yeah uh the they do exist in UK but you always find them in like a rural village in Warwickshire and you're honestly like one of the best there is someone I know she's brilliant she just lives in a rural she has no idea that she's like gold dust yeah she's just like oh yeah I'm just trained in it's something I'm passionate about. You know she's not you know running her mouth on social media like you and I. She's just quite content living a living a life down uh down there. But you can find them yeah you might have to do a bit of clever Google searching to find them.

SPEAKER_04 34:03

You know I think it's funny about that if I can chime in for a second one of the interesting things is I think it's hard to find people who specialize in this stuff because there's nothing glamorous about this kind of therapy. It doesn't lend itself to big social media mic drops. Except for you and I drew well you know that's the devastating good looks and the charm clearly but yeah I know I almost said it with a straight face. But I think in the end it's really hard it's that's why uh you know if you follow Josh and I on social media there's a very big difference. I'm not saying better or worse. It's just we have a hard time attracting those like million likes, you know, on a real because the best information and the best trained clinicians I think the you know who the best therapist on YouTube is for anxiety? Someone you've never heard of who's literally shooting their videos on a 2009 iPhone from a unknown office in Milwaukee somewhere. Yeah yeah and probably that's the best anxiety therapist on YouTube. They just we don't attract big followings we're not flamboyant there's no mic dropped it's not glamorous we don't talk about the usual things so it can be hard to find this person. Interesting I'm looking at an email from a therapist that had reached out to me about maybe being on the podcast she's a fellow of the Association of contextual behavioral science. I'm like that per this is a person who knows what they're talking about. You're never good it's find that person. Good luck. You know yeah but that's what I'm talking about.

SPEAKER_02 35:22

That's good. But yeah like I said the connection with the therapist is what really matters. But if you're someone who struggles with Craig the critic is he here today he is here. It's Craig the critic is always here that usually exists outside of an anxiety disorder. So you it may even go to someone to someone to talk about your self-esteem why you're very self-critical you know and maybe explore that and we'll do an episode on self-esteem because I love talking about conditions of worth and rejection stuff. I think it's great. So these are the people that maybe will do the exposures but then beat themselves up when they don't do it right and they're angry at themselves because they're anxious they criticize themselves for being you know they think they're failing or bad parent or whatever it's good to even take that to throw to a therapist and be like you know I am working through an anxiety disorder at the moment and I'm pretty well informed on it but I really want to explore why I'm such an ass to myself that would that's a I always had you know advocate doing that too. And another note as well before we play some answer some questions and play a cool dinner anyway um is that if you have symptoms of PTSD so you're someone who you know often has flashbacks um instantly fawns uh you know you know you've got OCD uh not OCD PTSD when you have the kind of acute anxiety you feel like you're back in the moment you have obvious triggers you have night terrors these kind of things uh there's some really good stuff find a trauma trained therapist who's particularly trained in EMDR because that has some good evidence behind it uh and just be a bit picky with trauma therapists because lots of people call themselves trauma therapists um but look for the do go looking for the credentials if you do struggle with BTSD that's very important yeah we could probably do an episode on like what if there's more than one thing because you can wind up you know people will say well do I do the trauma first or do they do the anxiety first don't know like it depends on your particular situation you might have do it all at the same time you might do it in sequence you might have the same therapist you might have multiple therapists it's hard to really say so this could be a this is choppy waters for people to navigate what does anxiety therapy look like how do I find a therapist we'll do more episodes in this for sure. Can we have a celebration did it anyway?

SPEAKER_04 37:38

We love these did it anyways please send them into disorder.fm uh we love hearing them yeah let's do it um let's read a did it anyway and then we'll do an audio one I have one to read it's been pretty good uh this person did not give us permission to use their name but uh this person wrote in and said I've been listening for about six months now and I just want to say how much you guys have helped me. Well I'm I'm glad um I've had anxiety partly caused by emetophobia since 2021 and used to spend months and months trying to Google how to end a panic attack which they put in quotes chewing on gum to distract myself running away from panic but then I found you guys and the idea of non-resistant to anxiety. Now I go to university in a big city. I haven't used any safety behaviors in over a year and I have traveled hundreds of miles. My big did anyway was last month when I traveled three hours away by myself to meet a hero of mine and listen to him do a speech. By now anxiety is becoming increasingly normalized and is no longer catastrophized. Honestly you guys are great keep it up very good big round of applause for that yes well done that's brilliant yeah well done yeah yeah I love anxiety is increasingly becoming normalized and no longer catastrophized best part of that one. So good that's what you're looking for um should we do an audio one?

SPEAKER_00 38:49

Yeah let's do an audio damage let's do it here we go hello Drew and Josh um first off I just want to say thank you for creating such an awesome podcast uh I just wanted to come on here and share my win a big win of mine uh so when I first fell into the anxiety cycle I was so bewildered that I unfortunately had to quit my job just because I didn't know what was wrong with me. After being unemployed for a couple of months as I've been on my recovery journey I felt like my next or a big step in my journey would be to go back to work. I just want to share that I was able to finally put in the effort and get a job and I just finished my first week of work and I couldn't be more proud of myself um been having lots of what if thoughts you know like what if I get a panic attack at work what if I can't handle it what if things become too overwhelming what if I get depression while I'm working you know just so many what if thoughts but I've just been accepting them and just going along with it and I wouldn't necessarily say I'm 100% recovered but this is definitely me rolling up my sleeves, taking my life back one step at a time and yeah I hope this serves as some sort of hope or inspiration for others that's a good one.

SPEAKER_02 40:17

Yep. I know that was sent in about five months ago uh because we we went through them and so thank you for sending that in and we hope that wherever you're on what you're doing now you're keeping it up well done buddy absolutely um we have any questions uh we I've got a few good nice questions I think we might save them for the next episode though because I'm just aware of the time of this this episode but yeah I'll definitely include them in the next one.

SPEAKER_03 40:41

Sounds good.

SPEAKER_02 40:42

But yeah thank you for tuning in today thank you for pre-ordering um and how does that make you feel if you've pre-ordered and emailed me with a question I will get back to you. I've had a few that's come in and it takes me a a little while to read them but I will send you an audio answer back and thanking you and stuff like that. Thank you to all those that have done that already um really excited for this and so yeah if you want to do it and pre-order it give us a shout. If not keep tuning in and thank you for your attention. Yeah we'll see you again in the next one we'll do more on this for sure we can talk about this for hours.

SPEAKER_04 41:14

See you guys next time