485 How to Win Against Anxiety (with Reid Willson)

Summary

Your Anxiety Toolkit – "How to Win Against Anxiety"

Episode 485 | Guest: Dr. Reid Wilson | May 13, 2026

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Episode Overview

In this engaging and deeply practical episode, host Kimberley Quinlan welcomes Dr. Reid Wilson, a renowned anxiety specialist best known for his innovative approaches to anxiety treatment. Drawing on decades of clinical expertise, Dr. Wilson challenges conventional methods (specifically, gradual exposure therapy) and offers a bold, empowering alternative: targeting the core beliefs that underlie anxiety and building an attitude of welcoming uncertainty and distress. Listeners are guided through Dr. Wilson's step-by-step philosophy of "hard and fast" change, practical self-talk interventions, and the key mindset shift—moving from "I can’t" to "I want this challenge."

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Key Discussion Points & Insights

Dr. Wilson's Approach to Anxiety

• Rejecting the Gradual Hierarchy:
  • Dr. Wilson differentiates his methods from standard Exposure and Response Prevention (ERP) approaches. Instead, he advocates jumping as high as possible on the exposure hierarchy when opportunities arise, to “take down the bully” (anxiety).
    • Quote:
      “If there's an opportunity for us to go as high up in the hierarchy as we can during a practice and take down the bully, well, there's a great deal of placebo that goes along with taking down the bully…I want to jump the hierarchy.” (03:00)
  • He likens effective change to moving a massive ship—requiring forceful, opposite action rather than slow, gentle nudges. (04:00)
• Target Beliefs, Not Just Situations:
  • Rather than tackling symptoms one by one, he aims at the overarching belief system driving the anxiety. Effective treatment equips clients with principles they can reuse when anxiety returns:
    • Quote:
      “If it's driving that specific event, it's probably driving others as well…there are far too many people with mental health problems in the world for us to have to be working one on one with individuals every time there's another breakthrough.” (05:10)

The Power of Resistance & The ‘Want It’ Mindset

• Reducing Resistance as Key:
  • Wilson insists that progress starts with minimizing resistance. Paradoxically, wanting anxiety—instead of resisting it—transforms the treatment process.
    • Quote:
      “Resistance is everything. If we can get resistance out of the way and then have them do what we tell…you will get stronger.” (06:45)
• “Want the Anxiety” as a Core Principle:
  • True change means not simply tolerating anxiety, but actively wanting the discomfort; this rewires neural pathways and undermines the disorder’s grip:
    • Quote:
      “I want to feel the uncertainty that I’m feeling right now at this moment…It’s the opposite of what the disorder needs me to be saying, that’s important.” (12:10)
  • The focus is on generic uncertainty, not the specific content of obsessions or fears—a theme revisited throughout the episode.
    • Analogy:
      Wilson likens OCD’s focus on content to the Wizard of Oz—if you look behind the curtain, you see it’s all about generic uncertainty, not the content itself. (11:45)

The Two Voices: Fear vs. Therapeutic Reason

• Distinguishing Voices:
  • Reid introduces the idea that everyone has a fearful, automatic voice and a therapeutic, rational voice. Successful treatment involves “stepping back” during anxiety and letting the therapeutic voice guide action.
    • Quote:
      “When the fearful side shows up, we need to help them step back in that moment with that therapeutic side and have another stance to invite themselves into.” (15:56)
  • Preparation is critical: rehearse what to say to yourself before anxiety triggers hit, since “your mind turns to mush” in the heat of the moment. (21:00)

Practical Application – Case Examples

• Health Anxiety:

  • When physical symptoms appear, practice labeling them as “noise” (not a meaningful signal). If reassurance from a doctor is needed, get it—otherwise, treat recurring symptoms as a fear response.
    • Quote:
      “Step back and label it. If I don’t step back, I’m not going to change anything.” (23:21)
  • Treat every intrusive thought as a practice opportunity, celebrating each return as a chance to get stronger:
    • Quote:
      “If the thought comes back...it’s another opportunity for me to practice my skills…treat it like, you know, let’s shift attitude…” (25:16)
  • Use simple, assertive self-talk—imagine setting boundaries with the disorder, much like saying “Bad dog!” to an unruly puppy. (27:00)

• Panic Disorder:

  • Orient clients to not just endure exposures, but to want them—to understand the principle behind them for genuine empowerment.
  • Use interoceptive exposures (e.g., spinning in a chair, breathing through a straw) to provoke sensations of panic, providing real-time insights that replace gradual, weeks-long desensitization.
    • Quote:
      “I don’t want to do exposure and response prevention for 12 weeks with somebody in order to have them...have the insight...Let’s have insight up front and then do the practice.” (34:35)

• Responding to “I Can’t” or Resistance:

  • Dr. Wilson neither argues nor pushes clients who say “I can’t”—he shifts the onus back to the client’s genuine willingness.
    • Quote:
      “If you don’t want to do the work, don’t do the work...if you want to get stronger, you have to want to do the hard stuff.” (35:40)
  • He asserts that the lifelong lesson is learning principle-driven action, not just fixing one isolated problem. (37:00)

The Attitude Toward Doubt and Uncertainty

• Aggressive Willingness:
  • Facing uncertainty and doubt head-on with a “bring it on” attitude is crucial:
    • Quote:
      “If I have to take what you’re dishing out, give me two servings and give them to me now...” (41:54)
  • Having a compelling outcome in mind helps endure discomfort—“If I have to go through this to get to that outcome, then I want to go through this.” (42:10)

Key Phrases and Memorable Moments

• Effective Self-Talk:
  • Keep in-the-moment mantras simple and meaningful: “I want my life back,” “None of my business,” “Chill.”
  • Host Kimberley asks Dr. Wilson for his favorite phrase—he affirms her slogan (“It’s a beautiful day to do hard things”) as sufficient and powerful. (44:11)
    • Quote:
      “It’s a beautiful day to do hard things…It represents what they have been learning with you…so I’m not into changing it.” (45:21)
• Transfer of Power:
  • Therapists initially “model being big,” but must teach clients to own and lead their own recovery:
    • Quote:
      “We want to shift that role and get you to be big and shrink down the disorder…If we’re doing our job, we’re going to transfer that to them so they learn to get big.” (27:39)

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Timestamps for Important Segments

• 00:23 – 05:00: Dr. Wilson’s philosophy: jump the exposure hierarchy, use “hard and fast” intervention.
• 05:10 – 10:00: Addressing beliefs; teaching principles not situational fixes; resistance as the treatment focus.
• 12:10 – 17:00: "Wanting" anxiety—how and why this shifts neural pathways and empowers clients.
• 20:00 – 23:00: The “two voices” concept; prepping self-talk before triggering events.
• 23:21 – 28:00: Applying principles to health anxiety; labeling thoughts as “noise”; practicing assertive, simple self-talk.
• 29:07 – 34:35: Panic disorder cases; practicing interoceptive exposure; fostering immediate insight.
• 35:35 – 37:00: Responding to client resistance; the lesson is “wanting,” not complying.
• 41:54 – 43:00: Aggressive approach to doubt; framing willingness as a competitive, high-stakes personal challenge.
• 44:11 – 45:21: Crafting and using effective self-talk phrases; affirmation of the mantra “It’s a beautiful day to do hard things.”

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Notable Quotes & Speaker Attribution

• “Let’s go after the belief system, alter at a big level, and then we’re going to be able to turn the ship much more easily.” — Dr. Reid Wilson (03:45)
• “What I want is for you to want to do that [big exposure]...I want you to want to, because you get what you’re about to do and what you’re trying to accomplish with that attitude.” — Dr. Reid Wilson (29:30)
• “I want to have that feeling in order to modify [the neural pathway]. Now, the interesting thing is by honestly wanting it, I am already influencing the neural pathway.” — Dr. Reid Wilson (12:56)
• “None of us...have any question about how much suffering is going on...so the attitude is much more aggressive.” — Dr. Reid Wilson (43:10)
• “If you don’t want to do the work, don’t do the work...If you want to get stronger, you have to want to do the hard stuff.” — Dr. Reid Wilson (35:40)
• “It’s a beautiful day to do hard things…It represents what they have been learning with you…so I’m not into changing it.” — Dr. Reid Wilson (45:21)

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Summary & Takeaways

• Dr. Wilson's core message: Long-term recovery hinges on changing your relationship to anxiety, adopting a proactive stance, and “wanting” the discomfort as a means to real change.
• Tools for listeners: Prepare short, powerful self-statements for tough moments; practice seeing all symptoms as practice opportunities; focus on principles, not content.
• Practical wisdom: "Wanting" uncertainty is the ultimate paradox—and the path to freedom.

Resource:
Dr. Wilson’s free self-help site: anxieties.com (46:02)

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A beautiful life is possible—even (or especially) when you’re doing hard things, on purpose, for the right reasons.

Transcript

[A]

All right, well, welcome. We are totally lucky today to have the most amazing guest, Reid Wilson. I am so thrilled to have you here with us. So welcome.

[B]

So thank you. Yeah.

[A]

Would you like. Would you like me to call you Dr. Wilson? How would you like me to.

[B]

No, Read is fine.

[A]

Reid is fine. Okay. So I know you have some incredible wisdom regarding how to approach anxiety. Everyone I know who has been treated by you or has heard you speak said they left feeling incredibly empowered, and that would be my biggest goal for today. So I really want to get your personal approach when you're with your clients, on why do we do the hard thing? We're always talking about it's a beautiful day to do hard things over here at cbc. So what's your approach? Why do we do the hard thing when it comes to anxiety?

[B]

Well, let's get it over with. You know, I do work differently than a lot of folks do, and I don't do exposure and response prevention, which makes me maybe weird or different. But, you know, I want to jump the hierarchy. If we can. If we can. If there's an opportunity for us to go as high up in the hierarchy as we can during a practice and take down the bully. Well, there's a great deal of placebo that goes along with taking down the bully. And if I, you know, go after the bully and I fail, well, what did you expect? I was, you know, doing a really tough thing, and so it's kind of a win, win. It's not. You don't. It's not as painful. But I think, you know, if we go all the way back to Sir Isaac Newton and his three laws of motion and inertia, what he talked to us about 355 years ago, which is still in place today in mathematics and physics and so forth, is that especially when you're talking about an object with big mass, you know, so with people we're working with, typically the mass is about my belief. You know, I can't do this. This is too dangerous. I could get my children sick if I don't wash my hands thoroughly and they're going to have salmonella. Beyond me, those things. So, you know, the bigger the mass, the more we have to use force with it. You in California, when the Highway 1 collapsed and you had these huge boulders up there, nobody came out with chisels to move all of that stuff. But I think part of what happens with us as therapists, at least, is that when we work with clients who are in a more difficult straight or are up against Some large mass. Their belief system is that we go more carefully with them, and that is not the most effective way to produce change. And that's what Sir Isaac Newton would say. He would say the most effective way is hard and fast. You have to come in and you have to pull or push in a direction that is opposite of where it's been going. So, you know, if you think about. I know you don't think about this, but, you know, you think about ships in a harbor. If you've got a big freight ship in a harbor, how do you turn it around? They have to turn those ships around on a dime. Well, what do they do? They put a tugboat on the bow and they put a tugboat on the stern and they go in opposite directions and they spin it right in place. And that is hard and fast. That's what we want to do is, you know, so much of this is run, I think, by belief systems that let's go after the belief system alter at a big level, and then we're going to be able to turn the ship much more easily. Not saying everybody's willing to do that, but that would be my objective. Okay, I'll stop talking for a minute.

[A]

No, I want you to talk. How do you move that ship? How do you do the hard and fast?

[B]

Well, you know, as I'm saying, we don't. I want to go up a level of abstraction, one or more levels of abstraction. I don't want to work with my client about a specific event that is in their way. I want to look at what's driving that specific event. Because if it's driving that specific event, it's probably driving others as well. The anxiety disorders and OCD tend to run the life cycle. And if we do a great job and finish up treatment with our clients and then they leave. But we've worked on one specific issue. When they have another breakthrough of symptoms and another issue rises up, they have to traipse back into our office and work with us again. And I just think that's. There are far too many people with mental health problems in the world for us to have to be working one on one with individuals. Every time there's another breakthrough. I want us to go up a level and impart that with them in a set of principles so that you know, when you're better, when you're stronger, the first thing you know, somewhere down the line, you're going to start dropping your skills because you don't need to pay attention to your skills. You're doing okay. Then you get hit again and you get knocked back because you don't have your skills in place. We want them to then kind of go back and brush those skills off and bring them back in place. So I go up at a higher level. And one of the main higher level issues is around resistance. And, you know, if, in many ways, resistance is everything. If we can get resistance out of the way and then have them do what we tell, you know, I'm, I'm bossy. I know I don't sound bossy, but I'm bossy. I'm, I'm going to tell, I'll tell you what to do. I don't mind telling you what to do. It's fine. Here. This is what to do. If you will do this, you will get stronger. I guarantee you you will get stronger. I'm not, you know, you're going to get better if you'll do these four things or whatever. I'm not saying you'll be best, but you can't help but be better because if you'll do these things, you'll be moving in a direction opposite of what the disorder requires of you. Anxiety disorders and OCD require the client to respond in a specific way. And if we can change our response to the symptoms, then we're going to start winning. You know, most of the symptoms and the fears that come are, they're unconsciously mediated. They, they happen spontaneously. We can't stop that. And I think that's part of what, you know, the mistake people make when they come into therapy is like, I've hired you to help me get rid of those symptoms. They're bad. I want them out of here. Please tell me how to do that. And this is paradoxical treatment. The whole idea of I want that gone is working in service of the disorder. And so if we can turn in that ship around is to go is for them to have we got to explain it to them. Give them, you know, again, I don't do exposure. The work I do has a lot more to do with insight. Now, that sounds like what, psychodynamic psychotherapy. But no, it's no. We're just like, how is the disorder dominating me? What does it do and what strategies is it using? And what strategies do I need to use in order to change things? Well, it's going to throw me these frightening thoughts and images or impulses. And that's not the end of it requires me to hate them, not want them, and need to push them away. So therefore, I'm going to do the Opposite of that. So, you know, I'm going to play big as an authority figure, and then I'm going to play small, which means, you know, I, I know these disorders. I know how to treat the disorders. I don't know you to my client. So I depend on you to help give you what you need. And so as I explain things, I'm constantly turning to my client and saying, does that make sense to you? What do you think about that? Tell me, you know, respond to what I've been saying. I got to keep them connected with what I'm imparting because I have no interest in them complying with an instruction. I want them to take this in and metabolize it and make it their own and have ownership with it. And so, you know, blah, blah, blah. I can keep talking. Do you want to ask me something?

[A]

Well, I, I, I love what you're saying. I, what I'm really curious is, every person I know who's seen you speak said they walked away with a new way of conceptualizing that they should want to have anxiety. Not should. That's a piece of the work that you do. So what is your, oh, you can say should.

[B]

You can say should about that. That's funny, because as you were formulating that I just wrote down on my paper, want it, in other words, that I wanted to talk about that, that was what was on my mind. I wanted to stop and take a breath and let you ask me that. And, But I think this is the core piece. I mean, again, one core piece. What I started with was resistance. Well, what is resistance? I don't want this. I don't want to do this. I don't. Right underneath that is, I don't understand this. You know, I have resistance because I don't see how that's going to work and so forth. So, of course, we as therapists need to be able to, you know, I often call this as persuasive therapy. My job is to change your mind as a client that it is what I want to do. Because the disorder has taken over your mind and has, you know, if you've got a client with OCD and fear of asbestos, you know, I want them to say, asbestos is none of my business. You're right, because asbestos has, although it's real. And I just spoke to somebody who is a contractor who's removing asbestos from a building, you know, construction in his work. So it does exist. But when you have OCD and you're caught up in asbestos, the disorder now owns that topic, right? And I got to get off that topic because there is nothing there for me. So, again, I have to get up above that topic and go, this has nothing to do with asbestos. Well, okay, well, what does it have to do with? Well, it has to do with uncertainty and the distress that comes from that uncertainty. That's what I want. And I argue this point often. You know, this is all I do every day. So I see people, since I'm a specialist, I see people who've seen other therapists, including therapists who've done exposure and response prevention, because that is the gold standard. And everybody does that. And I'm to do something other than that. But nonetheless, they come in and they go, oh, I. You know, I know about this uncertainty thing because, like, you know, I have around driving, if, you know, or locking the door. You know, my. My. I've worked with my therapist, and what I say is, maybe I locked the door, maybe I didn't lock the door. I can handle uncertainty. Now, to me, as a therapist, I think that's nuts to say. I just think it's totally wrong because maybe I locked the door, maybe I didn't lock the door is about content. It's about the topic. OCD for dogmatic ocd. We're not, but now we are. OCD has nothing to do with the topic. So for me as a therapist to train my client to say, maybe I locked the door, maybe I didn't, I can handle uncertainty. Keeps them stuck on the topic. So here I am, driving down the road, feeling a bump, wondering if I just ran someone over. Maybe I killed someone just then, maybe I didn't. I can handle uncertainty. I'm walking through the mall and I brush up against. I think maybe I'm not sure. That child, as she went by with her parents. Did I do that on purpose? Could I be? Am I a pedophile? Well, maybe I'm a pedophile. Maybe I'm not. I can. You see, it just seemed to me when you start looking at it, it's nuts. What I want, when we get back to want, is I want to feel the uncertainty that I'm feeling right now at this moment, Right? So I'm not like, oh, I want it later. I want to spend 45 minutes generating this feeling and sitting with it. Okay? I don't work like that. E. If we can work naturalistically with someone, that's what I want to do. Instead of sitting down for 45 minutes four days a week or whatever, and listening to something and trying to make myself as distressed as possible. I would rather step into a scene that tends to provoke my symptoms, knowing that my symptoms are going to come. And the reason I'm going to do that is I'm going to receive what's happening and learn to sit with it. Because it's about generic uncertainty, not specific uncertainty. And that is the piece that I'm constantly coming back to. People with these disorders have nothing to do with the topics. They need you to focus on the topics. Because it's like the wizard of Oz. If you look behind the curtain, there's just this old guy pulling these levers, and the levers are just about generic uncertainty. But if you discover that he's not going to dominate you anymore, so he's got to keep you down here looking at all these specific things. If I go up here and go, oh, it's all about uncertainty. I'm not treating my phobia of spiders or whatever. I'm not treating this obsession around this particular topic. I'm treating the disorder. And if I'm treating the disorder, it's only about uncertainty. I want that feeling. Why do I want that feeling? Well, it's the opposite of what the disorder needs me to be saying that's important. I want it because I have to experience it in order to modify it. We have to generate the neuropathway of fear that's connected with a specific circumstance to modify that pathway. So I want to have that feeling in order to modify. Now, the interesting thing is by want, honestly wanting it, I am not only wanting it because I want that neural pathway, but I am already influencing the neural pathway because my automatic response is, this is bad. I don't want it. So I want to bring that negative feeling up, and on the heels of that, bring in a positive feeling or an opposite feeling, which is what we're talking about now, of wanting, putting that on top of it, and I mean, you know, figuratively on top, not parallel to it, but above it. And so, you know, we go back to people having two voices, right? I've got the voice of fear, and then I have my therapeutic voice. And when they sit across from us in the office, typically the voice that's present is their therapeutic voice. They're trying to learn, understand, get what the strategies are and so forth. When they leave the office and go into the scene, the therapeutic voice is not the voice that shows up. It's the fearful side. And so when the fearful side shows up, we need to help them step back in that moment with that therapeutic side and have another stance to Invite themselves into. It's like, you know, oh, my God, here it is, stepping back, going, all right, now I'm facing. Here's what I need to be doing, right? So to literally be giving myself instructions in those moments. And they need to be very simple. Because as you and I know, when you are in a threatening situation, your mind turns to mush, and you don't want to be talking a lot to yourself, right? You want to understand all of that and then have a couple of little phrases that you say in the moment, right? If my client's, you know, feeling contaminated, wants to go over and wash her hands urgently, and she's trying to resist that, right? You know, she's trying to step back, she can say inside her head whatever she wants. But if she says something like, I want my life back, that's not an instruction that doesn't tell her what to do, but it is a message in the moment that is a manifestation of a principle of the treatment. So I'll wrap this little long soliloquy up to just say, we want to figure out what the strategy is. It's going to be based on principles. And then once we comprehend what those principles are, we bring them down to the moment. That's how I work moment by moment. I bring it down, down to the moment, to a self talk, really, that directs my action as I'm facing my threat. Laura, I'm quiet.

[A]

No, please don't apologize. I could listen to you all day, really.

[B]

So what do you think?

[A]

What's your response exactly? The message that I use with my clients as well, in terms of you don't need me. I know, but we really do. You have a message, and I love it. So talk me through your way of saying, okay, so you're in the moment. You know that you're being triggered. You know, it's not about the content. So you've caught that piece. You and your therapist have worked through that the biggest.

[B]

Okay, hold on, hold on. I gotta interrupt you around that. Because that's not really necessarily true, because I'm. Again, if we just think a little bit figuratively of two voices, I'm going to come in and operate as though the content is irrelevant, even though I'm feeling unsure whether it's relevant or not. Actually, both of those are going on at once, so I'm not going to know. And the interesting thing of trying to go to, I know this isn't important is actually not helpful because we're trying to sit with doubt. And so if I reassure myself over and over again. It's nothing about that. No, I'm fine. My hands are not clean. I'm sure there's not really the door, you know, whatever. So. Right. And so you have to do the work when you simultaneously feel doubt about whether it's the right work. That's the cunning nature of these disorders, which is they don't let you know. So I interrupted you, but I wanted to clarify that around knowing that the content is irrelevant.

[A]

I actually think you hit the question on the head in that. So we've practiced not engaging in that content. Right. So the biggest question that I get from listeners and followers and clients is if that feeling in that moment feels like I want to jump out of my skin. Whether it's a thought or it's physical panic. Right?

[B]

Yeah.

[A]

What is this conversation that you're talking about that you know, between these two?

[B]

Well, so first let's back up. If I, you know, obviously some of this stuff happens spontaneously. We don't know it's going to hit us and then it does. But to the degree either I am purposely stepping into a scene to do practice or I kind of know as I walk into this circumstance, you know, a party or whatever it may be, that I'm going to have trouble here. Step outside of that circumstance before I step in it. And let me get my head straight around this. Let me remind myself of what my intention is. Let me get my intention set. Okay, I'm going to go in here. I'm probably going to get provoked in this manner. This is how I want to respond to it. This is probably what's going to happen when I try to do that. You know, again, here's what I want to say, here's what I want to do. Get that set before you step in there. Because if you step in there again, you get hit so quickly by the symptoms that your mind turns to mush and you can't figure it out in time. So now you're asking this question, but you're going to have to give me a context of what kind of disorder are we talking about?

[A]

Well, I think here there's a big range. So I think you could answer it in any way that you feel comfortable or give a couple of examples.

[C]

Now, as you know, I have a private practice. I have six amazing therapists in Calabasas, California. However, we do not take insurance. Now, if you are looking for INS insurance covered OCD or BFRB treatment, I want to let you know about nocd. NOCD provides face to face live video sessions with specialized Licensed OCD therapists. Now, their therapists use exposure and response prevention. We know this is the gold standard for ocd. So you can be absolutely confirmed that you're in the right place there. And they have a clinically proven app that helps you see, stay connected to your therapist and others who have OCD between sessions. So you'll always feel supported. Now the cool thing is NOCD is available in all 50 US states and even internationally and they accept most insurance plans, making it affordable and accessible. We love that. Now, if you think you might have OCD or you're struggling to manage your symptoms, you can book a free call to just click the link in the show [e-mail] I am honored to partner with NOCD. I want to remind you that recovery is possible. Please do not forget that. Now big hugs and let's get back to the show.

[A]

So let's first start with health anxiety. You know, that's a common one. So they have a physical pain, right? Something has flared up or there's a sort of a miscellaneous symptom and they're stuck on that.

[B]

Okay. So, you know, a few things. One is, so I've got, you know, I've got health, severe health anxiety. I've got what we used to call hypochondriasis, which is more of a somatoform disorder. But I, the how I treat health anxiety is the same way I treat OCD because the content is irrelevant. So now if I, you know, I already know I'm prone to all this kind of stuff, but I wake up and all of a sudden I'm having a symptom I've never had before. Boy, I'm having this throbbing headache over my left ear. You know, is this something serious or isn't it? We're going to get thrown by novel experiences and so, you know, you're probably going to lose that one a little bit. And one of you know, if you have that concern, you got two choices. Either I am going to go get reassured by seeing my physician and who cares? You want to go see your physician, go see your physician. To me, I don't to do it, it's maybe cost you money or your physician's going to be going, honey, I've told you, you don't have any trouble. But if you are confused about a particular symptom and need reassurance, well then go ahead and get that. Now let's talk about symptoms that have been recurring. You have been reassured. You have decided that I want to do the treatment and the treatment is, this has nothing to do with an illness. This has to do with a fear response. Then when that occurs and I start obsessing about it, I need to step back and label it. If I don't step back, I'm not going to change anything. And so all I got to do is step back and go, oh, I'm doing it right. If I don't do that, then there's nothing else to do. So the first step is kind of step back. And then part of what I want to do is decide, is this a signal? Is this something I need to pay attention to, or is this noise? Well, I already know this is noise because this is my typical focus that I have. And so now I'm going to treat it as noise. Well, how are you going to do that? Well, I'm going to have the symptom and have an urge to, you know, worry about it and check it and be concerned, and I'm going to drop that. I'm going to let that go and turn away from it and bring my attention to something else. As the therapist, I don't care if 8 seconds later it comes back. That doesn't bother me. That's fine. How I shape it is I say if the thought comes back, because what we talked about is we're not in control of it popping back up. Why wouldn't it pop back up? It's the disorder. It needs to keep your attention. So it's going to pop back up, and I'm totally fine with it popping back up. I don't want to get frustrated about that. I'm not trying to get rid of it. If it pops up, it's another opportunity for me to practice my skills. So that's how I want to look at it. So we're talking about wanting it. So one of the responses I can have is, oh, good, there it is again. Oh, great. You know, sometimes I'll say to people, so imagine every time it pops up, I'm going to put a gold coin in your safety deposit box. Treat it like, you know, let's shift attitude, because again, you know, resistance and all that kind of stuff. The other big thing I push is shifting my attitude. So I've got an attitude of I'm looking for an opportunity to practice. Oh, good. Here's another opportunity. As though if I respond this way, Reid's putting a gold coin in my safety deposit box. I like that. And now I want to do that. So greet. I'm a. Greet it like that. That's great. And again, What I want to do is have a single transaction, whether I talk to the disorder or I talk to myself, right? So I can say, oh, thanks for scaring the heck out of me and see you later. And then I'm done and I turn away and I go do something else. Comes right back. Hey, nice. You really, like, you really want to talk to me now, don't you? Well, thanks for showing up. Goodbye. You know, over and over again. I'm just, you know, something like that, or I'm going to talk to myself. It's like, you know, you special people who are seeing this on video, you. If you were seeing my gestures, you'd see my hand coming up as like a stop sign. It's like, none of my business. Not going there. Not. Not now. Forget it. You know, something like that. And I just turn away sometimes because I was talking to somebody the other month around, I was doing a demonstration at a conference and he was feeling stuck. And I said, if you had a little puppy and the puppy is coming over right now and chewing on the leg of your chair, what would you say to him? And he said, well, I would say, please stop chewing on my chair. I said, you would not say that. You would say, stop, get back. Stop that. Right. So these disorders come in like ogres, controlling people, and you feel shrunk down and small. We want to shift that role and get you to be big and shrink down the disorder going, you know, like, bad dog. Not. Not going there. You and I, Kimberly, as the therapists need to be big first because we have to model for them how to get big. But if we're doing our job, we're going to transfer that to them so they learn to get big. So few ways to respond to this example of health anxiety, but you're going to see, whatever you do next, it's going to look a little similar to what we just talked about.

[A]

Exactly, exactly. And would you. I know you have books on panic. Do you do the same when it comes to. So we could do all that. We could sort of look at all the subtypes and apply that the same. But would you do the same for Panic in that respect?

[B]

Well, certainly, if I know I'm going to put myself in circumstances that might provoke my panic, I want to get oriented in the can. So if I'm going to go choose and do do the big stuff, I don't have to, with panic, go doing the top thing on my hierarchy. Necessarily. What I would. What I often say when I'm talking to therapists of Constructing. And I'll get back to panic. Constructing. What do you do in the session? Well, I want to talk and orient them in the session to such a degr that at the end of the session we will talk together about between now and when I see you next. How can you generate some degree of uncertainty about your theme, period? You know, especially initially with people, it's like, I don't care how much uncertainty you generate. You want me to go ahead and step in that elevator and provoke my panic in the elevator. Right? That's what you want me to do? No, I absolutely do not want you to do that. What I want is for you to want to do that. That's what I want as a therapist. I don't want you to comply. I want you to want to and want to, because you get what you're about to do and what you're trying to accomplish with that attitude. And so I want you to want to step in there. But if you got panic disorder, and that happens in claustrophobic circumstances, and then we can pick working on an elevator. Well, let's pick on working on an elevator. And if you only have to go up one floor to provoke your panic or thinking about it to provoke your panic, well, then let's do that. Do that for yourself. And then, you know, obviously we're educating them about everything, and they need to understand that the symptoms of panic are not the symptoms of having a stroke and so forth. That is what has to get ruled out. And if they're confused in any way about why am I having these symptoms, and maybe it's something physical, then they got to go get that ruled out, because we're not going to do anything helpful to anybody if they think the symptoms are dangerous. You know, I worked with a woman a while back who was like, she's having panic attacks on planes and various enclosed spaces because she's got more claustrophobia than anything. But her concern is, I'm afraid that I'm damaging my heart by the degree of distress that I'm having. And, you know, I'm trying to educate her about that. And she's going. And I said, you know, your heart's working well. This is what it's supposed to do in emergencies. And so her, because she's bright, you know, her response was, yeah, but that's the fight or flight response. You're supposed to either be fighting or running. But if I'm on the plane sitting there with this, I'm afraid I'm going to be damaging my heart. Well, again, she and I are going to go nowhere if that is her belief. And I, you know, I'm not going to argue with her about that. I said, go see your physician. You know, check that out. Because if you're right, and you're not. But if you're right, I literally said it like that, you know, if you're right, well, then, you know, you wouldn't. Why would you want to do what we're talking about? Just you stay off, don't fly anymore. You know, the world can get away with you not flying anymore. It's inconvenient for you. But. Right. And so. But however, by the end of that session, she did a practice around her heart and her heart was racing. I think we were breathing through my straw or I had a pillowcase over her head with duct tape or something provocative. And I was asking her how her number was, numbers were. And she said, well, about 50 out of 100 and my heart's beating pretty fast, but that's okay. What do you mean it's okay? You haven't even seen your doctor yet. Yes, I haven't, but you said so. Sometimes we as therapists don't want to start digging in to convince somebody. That's not my job. At some point you got to cut your losses and go, go figure that out. So again, to just summarize around panic disorder, you need to understand what the symptoms are going to be. And you've got to be able to go, I can handle this. I often use interoceptive exposure. So we bring people in the room and spin them in a chair or breathe through a cocktail straw or. It helps to be sadistic as a therapist, really to do some of that. It really does. And so fortunately for me, that comes easy. But I was working with a kid the other while and he was having panic attacks while he's doing sales presentations and he's in the medical equipment business. And so he was in another state doing the sales thing, and all of a sudden he had this full blown panic attack. And now he's lying on the ground and the physicians and nurses are over him and, you know, perfect place to have this occur. But after that happened, he stopped. He didn't, you know, he took leave and he stopped doing his presentations and was out. He was on medical leave for all of this. And so we've been working around with the interoceptive exposure. And I was trying to say I did a combination of having him hyperventilate and spinning him in a chair for a minute, and then I wanted him to pop up and walk over to the windows and just, you know, find out what happens. Well, you know, he did that and was disoriented, walked over the windows and then, you know, a light bulb went off just. Just like that for him, which is, oh, interesting. I felt just like you said, I felt awful. And you're going to feel awful when you hyperventilate for a while. You know, we're looking for difficult feel. He said, I just. I felt awful, but I walked, you know. But after about eight to ten seconds, that dissipated. You know, if I can manage the first 10 seconds, I think I'll be okay. So out of doing that little practice in the room with me that gave him this insight, which is what we're looking for. I don't want to do exposure and response prevention for 12 weeks with somebody in order to have them, 12 weeks from now, have the insight that they can not do their compulsion and their obsession will actually quiet. I don't want to do it that way. I want them to have. Why would we want to wait 12 weeks for insight? Let's have insight up front and then do the practice, you know, and do small little things to get that insight going on. So anyway, blah, blah, blah. Lots of things I can say about panic.

[A]

So I love it. So let me throw the most common resistance. Resistance that I see, which is I can't. I think it's sometimes code for I won't. But what are your thoughts on that?

[B]

You can't do it. Well, then, okay, well, what would you like from me? I'm not going to go, oh, yes, you can. I know you can. You're going to give yourself a chance. I'm not playing that role because if I play that role, that allows them to play the role of resistance. I don't care whether you do it or not. I don't care. I mean, I care about you, but I don't care. If you don't want to do the work, don't do the work. If you don't want to practice, don't practice. If you don't want to be in treatment, don't be in treatment. I don't care. What the corollary of that is, which I want you to understand, is if you want to get stronger, you have to want to do the hard stuff. But if you don't want to do it, say, I'm going to move. I can't to. I don't want to. I won't. Right. If you don't want to, then fine, you know, again, back to the initial response was, they say, I can't. I'm going. Okay. I'm shrugging my shoulders. Well, remind me again why you're here. What is it you want from me?

[A]

So I think it's beautiful because there are cases particularly I have this more with my younger clients where you are sort of talking them into doing exposure. But then you, like you said at the beginning, and please correct me if I'm getting this wrong from your.

[B]

Oh, I will.

[A]

Is you're not teaching them the lifelong lesson. You're just teaching them how to deal with that one thing. Right.

[B]

Oh, and so sure.

[A]

So you're teaching.

[B]

Let me just interrupt. To say what I. I'm. Yes, but there's a lot of things around that. So if we suggest an assignment to them, we're not. We're not saying, here's how to fix your problem. Again, I'm. I'm a cognitive therapist, so we do behavioral experiments. You know, you're saying this. I'm suggesting that let's see if we can construct some experiments to find out what is true here. This is not how you fix the disorder. This is what I am suggesting. We see if you can experiment between now and when I see you next and just see how it goes. Or, you know, sometimes we get people who are, you know, have relationship ocd. It's like, oh, I've got to figure out what, you know, is, is he the right man for me, should I marry him, Do I really love him, blah, blah, blah. So, you know, the disorder gets them. These are important questions, and that's how the disorders get them, which is I'm looking for as the disorder. I'm looking for your values so that I can manipulate you with your values. I love my children. I want to pick the right man to marry and so forth. So. So if we've got somebody who is obsessing regarding relationship ocd, should I or shouldn't I? So one of the things I will suggest is let's have a moratorium on trying to figure that out for two months. This is March. What do you think? That between March and May, we say, don't figure that out, and in May you can resurrect that again. Why are we doing that? In order to practice handling an obsession, you're confused whether this is an obsession or not. Let's make it an obsession. And the way we make it an obsession is by you saying, I am not addressing this topic for two months. Now, when you make that decision and we're throwing the symptom Cluster a bone. Because I'm not saying don't have that thought anymore. I'm saying for this designated period, then you can pick it up again. Once I make that decision decision and lock it in, then in those two months, every time the obsession comes up, is he right? For me, that is automatically an obsession. And my job is to go, oh, I'm doing it again. Drop it, move over here and do something else. So I have no idea what you asked me, but that's the answer.

[A]

I think you did answer it beautifully, which was, what do you do with the people who say, I can't.

[B]

Yeah, that's where we went from.

[A]

Okay, which is it? I mean, I think you said is. You just said don't, and I sort of was really looking at. You're teaching us as a community that the approach is I want. I want to have the anxiety, and therefore I will not. It's not up for discussion. Ultimately, would you agree?

[B]

The reason I'm saying I want the anxiety is because my therapist and I have worked out how I'm going to respond to it when it comes. So you got to. You can't start with I want it. You've got to start with, okay, I've got some things in place to manage these things. And then I want that. I've got to go towards. I want that. I want it first. And then I'm going to step forward with that attitude. It's all about attitude. And so, yeah, we're going to orient like that, and then let's get going. And I'm going to want to do it, which means I'm going to be confronting uncertainty. You know, I often say to people, does. Has anybody mentioned to you you have a mental health disorder? Let's treat the disorder. So as you go forward, of course you're not going to want to do this, and you got to also want to do that. We're not killing off the side of you that says, I don't want to do this. Everybody knows what that's like. You know, if you go on vacation for a week, if you're me, then on Sunday night, you start thinking, why am I still in practice? Couldn't I take some more time off? You know, because I've been out of the rhythm and I don't, you know, but then I straighten it out so I don't have to kill that voice off. You just have to have another voice that comes in that helps lead the discussion. That's the voice that needs to be the executive. Right. You got to have that top dog underdog has to be your executive voice versus the part of you who is frightened and vulnerable to the disorder.

[A]

I have two more questions. So I love that you're talking about doubt and allowing doubt as you go and that you need to have an attitude. With that attitude you have about doubt, is it just to make space for it? Because you have a really powerful attitude and a message. So what, what's your advice and how do you model that?

[B]

It's competitive. You know, I'm looking for this doubt. I want this doubt. Look, if I have to take what you're dishing out, give me two servings and give them to me now. I mean, that's your attitude too. Let's get going. You know, if I have to go through this to get, you know, I want to make sure my clients have an outcome picture that's important to them because this is difficult and just standing rawly facing my fear is very hard. I better have an outcome picture that helps pull me through that. I don't like this, but I want that outcome. And if I have to go through this to get to that outcome, then I want to go through this. If I can go around it, I'll go around it. But apparently I have to go through that. And so now if I have to go through it to get here, then I'm going to do that. And so we're stepping up and being more. This is an aggressive sport, it's not for the faint hearted here. And you know, again, there's a lot of people in our field who have come out of having OCD or an anxiety disorder and some of them get it and are pretty darn aggressive with people and other people haven't finished some of the work that I think they need to do with themselves. Pardon me if I'm talking about you, anyone here. But you know, which is that they are more delicate and careful and I absolutely want to have rapport with people and I'm not going to, you know, try to anyway pretend, you know, you know, suck it up and do it. I'm going to get rapport around what their suffering has been like. None of us who've been in this field for any length of time have any question about how much suffering is going on and let's get going. So the attitude is much more aggressive. And you know, where we started from, it's like it's this big mass, I gotta get going. Best way for me to produce change is hard and fast, not slow and careful.

[A]

I love it. Okay, last question. Really Easy. So we say here on the podcast, it's a beautiful day to do hard things. Would you put your brand on it? Would you change that to it's a beautiful day to want to do hard things. Like how would you reframe that?

[B]

I like, that's fine. It's a beautiful day to do hard things. Again, it's just like somebody saying, I want my life back. It manifests a point of view so I don't have to do a self talk that explains everything about what I am have to do. I'm looking to have a short, you know, I just talked to somebody this, this morning and where we got to the message he needs to say is he, he. His example is he's just retired and all of a sudden he's got all these to do lists and you know, he's back into I haven't accomplished. Oh my gosh, I've been retired for a week and look, I haven't done this, this and this. And. And he started going. Then I kind of stepped back, went like, where am I in a. You know, why do I, you know, Scott, you just need to chill out. Right. And so we truncated that back down to what could you say in the moment that represents that? And how about just saying chill because chill is it and that's enough. And so I think beautiful day to do hard work represents what they have been learning with you or what all of you have been learning together. So I'm not into changing it.

[A]

But what would yours be? That's what I want. I want your piece of it. What's your phrase that you say to you yourself or what? What's the thing that really empowers you?

[B]

It's a beautiful day to do hard work.

[A]

I thought you were going to say you've got to want to do hard things. I swear you're going to say that.

[B]

All right, well, if you want me to say that, I could say that

[A]

I love it. Thank you. I feel like that is exactly what people have been asking for is to really closer to understanding why. And that willingness piece that I think that you speak so beautifully to. So I'm so grateful for you coming on and sharing your knowledge with us.

[B]

Great. I will throw out that I have a website which is a free self help site called anxieties.com plural a, n x I e t I s dot com. And if you just go on the homepage there's probably 12 video clips, free clips that you can just watch and learn some things. And I've got a whole self help help program for all the anxiety disorders. People can walk through that again. You don't have to sign up for anything. You don't have to pay anything. It's there to for you to learn. So it's a resource for people if they want it.

[A]

We'll add that in the show notes and I can really say to everyone, please do go on that because the video content is brilliant and you really do a great job of addressing so many different areas of anxiety. So I'm so grateful for you offering those resources out. It's so good. And also I will link in the show notes the links to all of your books, your many, many books that are brilliant.

[B]

Okay.

[A]

Thank you again for all of your amazing work. It's incredible.

[B]

All right, see ya.

[C]

Please note that this podcast or any other resources from CBTSchool.com should not replace professional mental health care. If you feel you would benefit, please reach out to a provider in your area. Have a wonderful day and thank you for speaking supporting CBTSchool.com.