Anxiety Recovery and Metacognitive Therapy (Episode 71)

SPEAKER_05 0:02

So you've got your thoughts, your thinking, your cognition. Metacognition is your thinking about thinking. Get the thoughts, or like a pat a trail of thinking, and it's the thought that comes after that. Why can't I stop thinking about this? Why am I worrying about that? Why does this feel so important? It must be important. There are some examples of metacognition, our thinking about our thinking. Think whatever you want, but it's what meaning have you given to that thinking? Or, you know, why is it an issue that you're thinking that? Why is it an issue that you're thinking about your thinking? What does it seem will happen if you continue to do that? Which thinking processes are being given attention, are being given importance. Especially people who are really good at problem solving, you know, well, that's a skill that's helped you in so many areas of your life. So why not not why not with anxiety?

SPEAKER_02 0:53

Welcome to Disorder. This is episode 71 of the podcast. We are talking today about metacognitive therapy. I am Drew Lincolata, one of the co-hosts of Disordered. I am a therapist in training, specializing in anxiety and anxiety disorders in the US, a three-time author on the subject of anxiety and desired anxiety disorders, a former sufferer for many years of my life, a social media dude, an advocate, and all that good stuff. And with me as always is my co-host.

SPEAKER_04 1:16

Hi everyone, I'm Joshua Fletcher, also known as Anxiety Josh, social media. I'm a psychotherapist who specializes working with anxiety, anxiety disorders. Uh enjoy being the co-host of this podcast and author of the book, and how does that make you feel? And I've invited a guest on today's show, someone who I trained with at the University of Salford. I'm very pleased to announce our guest, Rihannan Wilcox. How are you doing, Rihanna?

SPEAKER_05 1:47

I'm good. I'm nervous, but good, thank you.

SPEAKER_04 1:50

Would you say it's something that you're doing anyway?

SPEAKER_05 1:53

It absolutely is. When you messaged me to come on, I was like, that is definitely my did it anyway. Um yeah, I think just talking and knowing other people are gonna hear it, I'm just like very nervous.

SPEAKER_02 2:07

It's okay, nobody's gonna hear this.

SPEAKER_05 2:08

That's fine. No, no one, no one even listens to the podcast, do they?

SPEAKER_04 2:12

They skip it and just go to the health anxiety episode.

SPEAKER_02 2:17

Marianan, why don't you tell us a little bit about yourself?

SPEAKER_05 2:20

Well, I feel like at the moment, as with when I spoke to you both early, I was thinking, what have what have I been doing recently? And looking after ducks is my main occupation at the moment. Um but yeah, I'm a psychotherapist specializing in working with anxiety. Um, I'm a CBT therapist and have recently trained in metacognitive therapy as well. So that's what I'm going to be talking about a bit more today.

SPEAKER_02 2:48

Cool. Yeah, our metacognitive therapy resident expert now.

SPEAKER_05 2:55

Expert.

SPEAKER_04 2:56

We like reading about metacognitive therapy. Uh, I find it fascinating. I've actually received some metacognitive therapy myself in the past. And yeah, it's really nice to get um a trusted therapist on as well. Uh she's a good egg. Uh to talk a bit more from the MCT side of things, uh, and just sort of the concepts uh that that that perhaps you might include when working with people with anxiety. So, what is metacognition, Rihanna?

SPEAKER_05 3:26

So metacognition um it refers to so you know, obviously you've got your thoughts, your thinking, your cognition. Metacognition is your thinking about thinking, essentially, or can be described as like afterthought. So you get the thoughts or like a patter trail of thinking, and it's it's the thought that comes after that. Um, so it could be why am I thinking about this? It could be um, you know, um, why can't I stop thinking about this? Uh why am I worrying about that? Why does this feel so important? It must be important. Um, you know, there are some examples of of metacognition our thinking about our thinking.

SPEAKER_02 4:07

What does this thought mean?

SPEAKER_05 4:08

Yeah, absolutely that one. What does this thought mean? Why am I having this thought? Um, which then can then lead to you know what what to do about it, which we hear that whole host of issues there.

SPEAKER_04 4:22

Yeah, we hear that a lot in our community. Um, we often get questions, don't we, Drew, as well, but like, I'm thinking about my thinking and then I'm overthinking about the thinking about the thinking. Or what am I supposed to think is what we hear quite a lot as well.

SPEAKER_01 4:37

Yeah.

unknown 4:38

Yeah.

SPEAKER_02 4:38

What am I what am I supposed to think? Might be one of the top 10 questions we get. What are you supposed to think? Yeah. So that they're not sure what they're supposed to be thinking, then whatever they do think, they're starting to evaluate whether or not that's the right thought to have.

SPEAKER_05 4:52

Yeah, yeah, absolutely. Yeah, so think whatever you want, but it's the, you know, what meaning have you given to that thinking, or you know, why is it an issue that you're thinking that why is it an issue that you're thinking about you thinking? You know, what what does it seem will happen if you continue to do that?

SPEAKER_04 5:09

Do you see that a lot with people with anxiety disorders and things?

SPEAKER_05 5:13

Yeah, absolutely. Yeah, I'd say I'd say very much, you know, everyone. I think everyone generally will think about their thinking, but when it comes to you know, anxiety disorders, it's it's usually about like if I if I continue to do this or I can't stop doing this, it's more about the uncontrollability of it. So I'm trying to not think about this thing and I keep thinking about this thing, you know, what whatever that might be. I'm continuing to worry, I'm continuing to ruminate, I'm continuing to threat monitor. These are things I'm told that I shouldn't be doing, and I can't stop doing that. Um that happens for pretty much anyone experiencing an anxiety disorder.

SPEAKER_02 5:57

Then we have that love-hate relationship that I know MCT talks about, where like I love thinking, it's the way I solve problems and fix things and keep myself safe. But then I hate that I can't stop thinking. I love it, I hate it, I love it, I hate it.

SPEAKER_05 6:10

Absolutely, yeah. Which I suppose is then the um what we call like positive meta-beliefs and negative meta-beliefs about thinking. Um, and it's good that you've just used the term thinking there. I think we use like worry and rumination a lot, and actually sometimes people aren't aware that because of the words worry and rumination, it's like, oh, well, I'm not really worried about that, or I'm not really ruminating on that. But you are trying to problem solve it, or you are trying to prepare, or you are trying to plan. So usually I'll say, How much are you thinking into it rather than worrying or ruminating?

SPEAKER_02 6:44

Um, it's interesting. Yeah, that's smart.

SPEAKER_05 6:48

Yeah, because sometimes it's subtle, isn't it? You know, if we think something's helpful, so I'm I'm just preparing myself, you know, I'm just thinking it through, probably emotionally preparing for like how am I going to feel doing that thing. Um, and actually that's that's engaging in that metacognitive process, but it seems helpful. And then you notice you're doing it a lot, and you think this is unhelpful, but then you're stuck in between of like, you know, part of you wants to see this helpful thing, part of you is like, I'm sick of continuing to think like this or continuing to be in this thinking pattern.

SPEAKER_02 7:20

Like when you initially said, like that you might hear people say, Well, no, I'm not I'm not worrying and ruminating. This isn't worrying and ruminating, or I'm not anxious about this until they are, because they they've been thinking, thinking, thinking for an hour or two about it, and now they're more anxious when than when they started.

SPEAKER_05 7:35

Yeah. So yeah. Absolutely. And especially when there's um thinking about recovery in itself, well, that will seem helpful. You know, I need to know how to recover, I need to know how to get there, you know. I'm just reading up on it, I'm just listening to podcasts and just, you know, um, and it's really helps my knowledge and and to know what to do. Um, and actually then you take away how much you already know and you know how how much you can put that into practice rather than just I suppose gain more knowledge, you know.

SPEAKER_04 8:12

Yeah, and I suppose it challenges the notion if I'm thinking about doing something, I'm I'm doing something about it.

SPEAKER_03 8:19

Yeah.

SPEAKER_04 8:20

I'm thinking about the problem and that feels like it's doing something about it. I used to do that a lot with my anxiety. Well, if I think and try to I I say to Drew, like try and find the miracle thought to make all my feelings go away, or to find the root cause of something, because a lot of narratives around mental health are if I find the root cause, I'll be fine. But actually, that's why I love metacognitive therapy and third wave CBT and stuff, is that actually what am I doing now that's contributing to why I feel so bad? And I think that for anxiety disorders, that's a massive one.

SPEAKER_02 8:57

Yeah, that would be a positive metacognitive belief, wouldn't it? A part, you know, if I'm thinking about if I'm reading about recovery and I'm thinking about it, and I'm asking questions and I'm talking about it, and I'm it's all going on a peer, I'm doing something. That's that's helpful, right?

SPEAKER_05 9:10

Yeah, if I think it's through, it'll help me solve problems. Um, you know, that that would be a positive meta-belief. And it's really hard to, especially people who are really good at problem solving, you know, well, that's a skill that's helped you in so many areas of your life. So why not not why not with anxiety?

SPEAKER_04 9:30

Yeah. Um when I was um reading about uh metacognitive therapy and stuff, my favorite concept of it is something called the CAS cognitive attentional syndrome. Really described me and my anxiety disorders to a T. Could you tell us more about what the CAS is?

SPEAKER_05 9:50

Yeah, so the CAS is the cognitive attentional syndrome, and essentially it's what which thinking processes are being given attention, are being given importance, and that's what's likely to continue and actually perpetuate the problem. So, um, so in terms of you know worrying about anxiety itself, so I'm continuing to feel anxiety, I'm continuing to think about anxiety. By worrying about it, you might be trying to again problem solve, it might seem like it's helpful, but actually by continuing to think about it, you you likely build in anticipation um and you're just adding importance to the subject. So in terms of attentional syndrome, it's that your attention is pulled to it. So a lot of your attention is on anxiety itself and and yourself and how you feel and what you think. Um, so it leads to a lot of self-focus as well.

SPEAKER_04 10:47

Which makes anxiety become more important than it needs to be.

SPEAKER_05 10:52

Yeah, yeah, absolutely.

SPEAKER_02 10:55

We hear that in people who will say, like, it's all I I I own all I can think about. It's I think about it all day long, I talk about it all day long, I read about it, it's all I can pay attention, it's all I care about right now.

SPEAKER_05 11:06

Yeah, yeah, and pay attention too. And whilst you're paying attention, you've got that inward attention much of the time, you're feeling less fulfilled in in other areas of your life, you know, and then there's that, you know, rather than that flexibility of attention, there's some inward focus, some reflection, there's some, you know, um outward attention, and that real kind of flexibility and fluidity of attention, it's very much fixed. And usually I find that people say, Well, I can't not focus inwards, so then they're trying their best to not do that, like I need to focus outwards, like you know, completely, and actually really want the flexibility of that rather than you know, I need all my attention to be outwards, because that's it's not realistic to do that as well.

SPEAKER_04 11:54

I like that flexibility. Can you tell us more about like the role of flexibility? Because Drew and I have mentioned it before on this podcast, like having that psychological flexibility. What kind of how do you look at that through like the lens of MCT?

SPEAKER_05 12:08

Well, I'd say, I mean, the nature of anxiety, you can, I suppose concepts like this can be taken as very all or nothing, um, which makes sense. You know, you thought it was once trying to be protective, it's like do that, you know, you you want something to be that this is the answer. Um, so with with attention, we can do the same. We can think, right, I need to stop ruminating, stop worrying, I need outward attention, I need to be mindful, you know, all these concepts that we hear of that are, you know, supposed to be helpful. Um, and then that can, like I say, push you to try and give all your focus outwards. And there needs to be that awareness that our attention should be flexible, it should be fluid. So that might be, you know, I'm going out for a walk and I'm gonna try and give try and have all my attention outwards. I'm not gonna worry, I'm not gonna ruminate, I'm not gonna threat monitor. And actually, in MCT, we'd look at um, well, a term called detached mindfulness, and the term mindfulness is quite misleading because it makes you think of, you know, the types of mindfulness that we all know, kind of more um meditation-driven. But detached mindfulness is about that outward attention with the awareness of what's going on in your mind, but kind of seeing it as processes rather than the content itself.

SPEAKER_04 13:28

So that's so cool.

SPEAKER_05 13:30

Yeah, so um I'm out on a walk and this keeps pulling my attention back in, it's kind of convincing me that it's important, and I'm gonna I'm carrying on on my walk. It's hard for me to focus on everything that's around me. Um, but I'm I'm gonna try and do that. I'm gonna try and you know, be more outwardly focused. But without beating yourself up about it, you know, oh I'm thinking about it again. That's okay, you know, just notice what's happening, keep on trying to shift your attention outwards. But it's it's different to mindfulness because you're not trying to focus on how your body feels, you're breathing, anything internally focused. You are trying to take notice of things outside of you, and every time you do that, you're signaling, you know, this thinking, it's not important.

SPEAKER_04 14:17

Yeah, it's that without judgment side of it as well. Because a lot of our listeners have got very loud this guy. It's Craig, the criteria, and they're usually people that are asking, like, what am I supposed to think? I keep checking, I'm annoyed that I'm checking on my anxiety. Um, I'm annoyed that I was happy, and through habit I've checked on my anxiety. What you're saying is actually sometimes your brain will just do that, yeah. But with the principles of detached mindfulness, which is a good good part of MCT, is that well, yeah, don't judge, like, yeah, your attention will be flexible. That's what your brain does. Yeah, stop trying to make it become rigid.

SPEAKER_05 15:04

Exactly, because trying to fix your attention outwards is it's a type of control, yeah, right, exactly.

SPEAKER_02 15:12

And that control-based strategy, not so good. Like old school.

SPEAKER_05 15:15

Not ideal, no, yeah. Um, it's like don't press the red button and then you just stare at it, or it's like trying to hold the door closed.

SPEAKER_03 15:24

Don't tell me not to press the button.

SPEAKER_05 15:26

Exactly. You know, don't tell me no.

SPEAKER_02 15:32

Don't tell them that's not gonna work out for us.

SPEAKER_05 15:36

Um, so yeah, it's trying to hold the door short, whether it's physical symptoms, it's emotions, it's it's thoughts or thinking, it's trying to hold the door shut on it rather than essentially stepping away from the door.

SPEAKER_02 15:47

Yeah, not gonna happen.

SPEAKER_04 15:49

Uh how much of about how much of MCT is about attention? Because the more I learn about anxiety disorders and stuff like that, and reflecting on my own recovery and things like that, honestly, the vast majority of it was about my attention. Don't get me wrong, the psychoeducation on top of it, understanding how my brain, my body, adrenaline, cortisol, why I felt the way I did. But look at the main uh part of my recovery was where my attention is going. What am I doing here? And using the different aspects of of of my brain, uh, the different mechanisms or the you know, fixation. I think in a way I was doing detached mindfulness without even realizing it. Um using my behaviour. How much is attention so and how you use it important in anxious recovery? And bear in mind Rihanna's worked very successfully with lots of anxious people. How much is um yeah, how much how much is the role of attention uh a part of that?

SPEAKER_05 16:51

I think in recent years I re I really do think that attention is is quite important, you know. I think coming from a you know, training in CBT, it wasn't really focused on as much as it is in MCT. Um, but in MCT, you know, rather than CBT thinking about thoughts, um, thoughts, emotions, behavior, physiology, MCT you'd think more about like thinking styles, attention and behaviour. And actually, if you can, if you feel more in control of being able to shift your attention, that's what can be really helpful. And like I say, having that flexibility of attention, if you can build that skill and be more aware of that, that can be much more helpful than trying to to I suppose do everything perfectly and do it right, and you know, what should I be thinking? What should I be doing? You know, this exposure, have I done it right because I'm still feeling like this afterwards? Like actually, my questions there would be, you know, where was your attention before doing that? Where was your attention whilst you were doing it? Where was your attention afterwards? And that really highlights, you know, was the worry and was there anticipation beforehand, was there threat monitoring during the exposure? And afterwards was the rumination of that didn't go well, you know, because that you know that that can happen a lot. You know, I was doing this thing, I was, you know, starting to get out to the supermarket every day. Sometimes it was feeling easier than there was a day, and it just felt really hard. And then the rumination after that will convince you, you know, you've completely gone backwards. Um, I'm not recovering anymore, I'm doing something wrong, I'm missing something, and then that can start off, you know. I need to find the thing that I'm missing that I'm doing wrong. I'll start researching that, I'll start looking into that, I'll start, you know, just scrolling through Instagram, seeing if anyone else has had this. And it's really noticing, well, there were worry elements beforehand, there were monitoring elements, and there was rumination, and all of that comes back to your attention.

SPEAKER_02 18:51

Isn't that thing where but the idea that you have to develop a flexibility of attention, that's like that's a built-in did it anyway, because now you're challenging that positive meta-belief that, like, no, no, no, this is a thing I'm supposed to pay attention to. It helps me to entirely focus on how I feel and what I'm thinking, right? Well, yeah, but I I'm so sure that I'm this close from our psychotic break, says the anxious person. And now Rihanna comes along and says, Yeah, but let's work on on getting some flexibility in your attention. What? What do I mean? Like, uh, why would I not pay full attention to this pending psychotic break? So, in a way, taking that risk or that leap of faith that like I can actually pay attention to other things at the same time feels like a ridiculous suggestion to anxious people.

SPEAKER_05 19:38

Yeah, absolutely, absolutely. And and I always acknowledge when working with people, you know, what I'm asking you to try out here, it could be hard. And it could be like me saying, just go and put the stove on and just put your hand on it, you know. Like I know that sometimes what I'm asking people to do, I think what can be really helpful is just using a little bit of postponement there. So rather than I'm not gonna think about this at all, I'm not gonna prepare or plan at all and trying to completely cut it out. Can you just plan for a shorter amount of time? Can you prepare for a shorter amount of time and just see how it goes? I'm asking you to do this thing, but I'm just saying, see how it goes. And I know that the nature of fear is like, see how it goes. I don't think so. You know, like that is very dangerous for me to do, and it feels completely irresponsible. Yeah. Um yeah, so I I suppose there's a way to work with that where we just build it up gradually rather than right, this is what I need to do. No preparing, you know, no planning, no problem solving. I'll just cut that out. I wouldn't ever suggest that anyone just does that in in one in that way.

SPEAKER_02 20:46

Um you can't anyway. No, I can we get I know I'm I'm being a little worried here, but this is where that you talked about process versus content. And I think that becomes super important because sometimes I'll tell clients that I'm working with, other people, that like I don't care if tomorrow you come in for your next session and you have a completely different fear. It doesn't matter. I only care about the process that created that and perpetuates it. Yeah, and they'll do the whole like, wait, wait, what what do you mean? Because the the content is super important to me, right? That's the risk, is that I'm walking away from the content of psychotic reference. And so we'll go back to that. How do you address that? Like, yeah, yeah, because you don't understand it's not we really want to look at the process of your thinking more than the the thoughts it's making, right?

SPEAKER_05 21:30

Yeah, yeah, absolutely. Yeah, so um I suppose if we were using like a cognitive behavioral approach, you you might you might look at the content a bit, and and actually I feel like there's a bit of an indirect metacognitive impact through that element of CBT because it's you know you might kind of prove that um or find evidence to say that that think that thought or that thinking process isn't accurate, and sometimes that can allow. You to see it as less important and therefore engage with it less. But through metacognitive therapy, just go in straight in there with that. You kind of you know what we can see that that's being judged as important. What processes does that start? Um, and how can we work on that directly to to reduce the importance of that and to change that metacognitive belief because if you can do that, it's so it's so generalized rather than there's this fear, there's this fear, there's this fear, and I need to work on them all separately. Actually, you start to see that I worked on this element of it, and now I'm starting to see that these fear, these this fear-led thinking, it's all starting to feel less important. I'm starting to give it less importance.

SPEAKER_04 22:46

I I remember when like to use an example of my own anxious recovery, where it was really helpful to look at the processes of what my brain was doing. So I was doing I was doing the tricky thing. So I was like, you know, let's say I had a fear of going crazy. Uh so I started my exposure therapy, I did things on the surface, and if to anyone observing, I would go out, leave the house, do all these things. But for me, I was having like compulsive attention inwards, constantly threat monitoring, constantly scanning, doing all that. And so whilst on the outside, I was doing good work. Oh, you know, yeah, anyone who gets out of the house or do it or challenges, these things are good. Yeah, but I hit a stumbling block in my recovery when I noticed that and it was almost it was so automatic as well. I had no awareness of it, but when I found the awareness, this constant scanning, monitoring, checking very internally, being able to step back, label that as a process, and be like, ah, I've noticed I'm doing that. Let's maybe not do that. That's why I always say like attention is so important. I was like, ah, actually, I'm gonna go to the same park again, and it is the same fear, but actually, what I'm gonna do up here with my attention is gonna be different, and that's when I started to really see huge jumps in in my recovery, yeah.

SPEAKER_05 24:09

Because by that, by labeling the process, you're allowing that detachment from the content of the thought.

SPEAKER_04 24:15

Yeah, same with OCD as well, and all the OCD heads listening. Yeah, sometimes everyone with OCDs, well, most people with OCDs have always like had varying themes. So, what does that tell you? When the theme changes, does the content really matter that much? So let's look at what's happening around it.

SPEAKER_05 24:34

Yeah, exactly, exactly. And who who decides what thoughts are important? You know, who decides what thinking is important? It's usually it's usually because it evokes something whether whether it's an emotion, a fear, and then well, that must be important, but we're you know, we're we're kind of judging that and monitoring it, and again, those thinking processes are coming in. And it's not that that's for a reason necessarily, it's not that we're saying, you know, we're kind of sieving through all our thoughts, like, oh, that one's important, that one's not. Um, but yeah, I suppose it's uh I've lost my train of thought here, but it's uh yeah, it's just we're there's something that we do with those thoughts and that thinking, we engage with it more, we give it more importance, we feel it's more harmful, but at the same time we feel like part of it might be helpful to think into this, and there's just that conflict of of engagement, you know. I don't want to think this, I don't want to keep going over this, feeling this, but I keep getting pulled back to it, which is you know one of the one of the main uh concepts in MCT is it is it's that that uncontrollability belief. If you feel that your thinking is uncontrollable, well that's gonna cause you know a lot of distress.

SPEAKER_02 25:58

Think harder to not think.

SPEAKER_05 26:01

Yeah. So you start to control more and you start to feel more distressed. And actually, we want to say, really let go of that that control.

SPEAKER_03 26:08

I mean, we let it do its thing. Yeah, just let it do its thing.

SPEAKER_05 26:13

That feels irresponsible. You know, I don't want to let it do its thing, but I don't want to, um, you know, I can't leave it alone. And actually, you you then I suppose that's always a point for me to think there's probably a lot of thought suppression going on here, and it might seem like it's not engaging in worry and rumination. And actually, then I might ask people to worry or ruminate on purpose and do more of it.

SPEAKER_02 26:38

Interesting. Um please worry and ruminate on purpose. Why? That's a good guy.

SPEAKER_05 26:45

Because that challenges to the negative belief, you know, if I continue to worry about this, it could become stuck. I could, you know, I might not ever be able to stop thinking about it, I could lose my mind, I could go crazy, um, I might not be able to cope. So, okay, well, let's let's maybe just try that out.

SPEAKER_03 27:02

Yeah, the exposure is to do it.

SPEAKER_05 27:05

Yeah, yeah.

SPEAKER_03 27:06

I love this. It's my favorite part of the day.

SPEAKER_05 27:09

And it seems it seems dangerous to do, it seems irresponsible to do. But you know, I'll be doing that in in session with clients and um, you know, supporting them through it, and they might worry or ruminate, yeah, on purpose or think about an intrusive thought, bring it to mind, and we we challenge those negative metacognitive beliefs because if you've got metacognitive beliefs that are saying, you know, if I continue to focus on this, something bad's gonna happen, then you're gonna continue to monitor that. So, how can you alter that belief so that you know it's safe to not monitor that anymore?

SPEAKER_04 27:45

Yeah, it's the resistance, it's finding where your resistance is, isn't it? Dropping it. And if your resistance is to do that because of the beliefs, uh fascinating.

SPEAKER_02 27:53

Uh interweave, they get so interlocked, though. I love this because for somebody who's really worried about negative thoughts, like I've I can't have negative thoughts, or my mood is starting to drop. I have to monitor my mood and my thoughts because they're terrified that they are going to spiral quickly into like a suicidal level depression.

SPEAKER_01 28:12

Yeah.

SPEAKER_02 28:13

For that, of course. But forget the content, they do a lot of mood and affect and thought monitoring. Uh you know, we might do like, okay, well, come on, let's tell me the whole story about what happens. You have a thought and you spiral into like institutionalized in a way from your family. Force them to confront that, but really it's no, no, no, it's safe to think about this. It's actually think safe to think about that. So it might be an imaginal exposure that actually does challenge some of that metacognitive belief at the same time, you know, it's all connected in ways.

SPEAKER_05 28:42

Yeah, and and people might predict, you know, if I start thinking about this, I won't stop. Or if I start thinking about this, I could think about it for hours. But actually, when you're thinking about something for hours, it's because you're trying to not think about it, then you're thinking about it, then you're trying to not, and then you're thinking about it. If you just let yourself think about it, it's only gonna go on for a short while and then it it's gonna become boring, repetitive, repeating the same things, or it kind of gets to a worst case scenario, and then we'll, well, that's it. That's the worst case scenario, you know, which which can be incredibly scary and distressing to think about. But when it's well, that's the worst case scenario, my thinking wasn't gonna go any further than that. Yeah, kind of a oh, like I don't I don't need to control this so much.

SPEAKER_02 29:23

You know what I find interesting about that? There are two, especially deep work, right? Like, we literally buy books to try to teach us to think consistently, and yet anxious people are worried that somehow that'll just happen. Like, if I'm not careful, I'll just get stuck thinking the same thing. But like the brain gets bored, it doesn't do that, can't right. Exactly. We're not designed to do that, so yeah, exactly.

SPEAKER_05 29:47

And and the brain would get bored. It's like, you know, if I keep on thinking about this thing and I'm kind of um there's no resistance to that, it would become uninterested and bored with it rather than uh oh, there's that thing that you shouldn't be thinking about. Again, it's that red button situation, don't think about that, and it it's there, you know. You are like I say, holding the door shut on it and monitoring your thoughts for you know, am I gonna start thinking about that?

SPEAKER_04 30:19

Um, I wanted to ask you something, Rihanna. Um, what when you mentioned thinking styles, what what does that mean?

SPEAKER_05 30:25

Yeah, so thinking styles that's um, you know, worry, rumination, uh threat monitoring. I'd say that I'd say that certain compulsions come into that as well. So it might be reviewing, it might be um kind of, yeah, it might be reviewing, it might be kind of going over a situation, neutralising thoughts. Um they would all be all be thinking styles. And I feel that sometimes we can really go the behavioural route with that. So, you know, what what are you avoiding, what are you acting cautiously with, um, and how can we work on that? But actually what kind of thinking styles are going on, like I say before, during and after these things. And and from an ERP perspective, I used to focus a lot on behavior and safety behaviours, and now it's so much more on on thinking styles and what thinking is going on, and how how can we apply that response prevention to to the thinking and how much time spent with that?

SPEAKER_04 31:24

Yeah, massive for me as well. Don't get me wrong, the exposures are are huge and and get putting yourself in the situation. But like I said before, it was what am I doing in the exposure that was so important for me, and it was actually realizing that what was making me more anxious was the threat monitoring during it, or we call it white, you know, white knuckling. It was white knuckling because I don't like it, and I need to keep my attention on this, I need to keep thinking about it because it's otherwise it's unsafe. Something awful could happen. I could humiliate myself, or a massive health issue could just suddenly arise. I need to my brain needs to be here right now to keep me safe. And actually, the best exposures were like, I'm just gonna practice. I know I'm all right, you know. I don't know for certain, but rolling the dice, rolling the pent a million gone, and and I'm looking and actually I'm gonna try and keep my attention external here. Yes, my attention will come inwards and will check, but that's where that flexibility comes in. That detached mindfulness is like yeah, it's impossible to keep my attention 100% external external. And what Rihanna's saying is if you try if that's your you know, if that's your goal, then good luck, that's not gonna help. Yeah, but noticing it come out and just always dragging, I always say to Drew, like that 51%, just bringing my attention back gently, because that's how I want to be in this situation, was so important for for my exposures anyway.

SPEAKER_02 32:55

Yeah. So when you get into that triggered state, you know, like, oh, how can I tell? You know, well, when you're when you notice that you're activated now, the question you'd have to ask yourself is just thinking about this and engaging in those processes and thinking styles that I believe are helpful for me, are they actually helping me or not? So like the decision is not so much centered on what I'm hearing, is not so much centered on am I going to have a psychotic break or a stroke? It's does thinking about it help me or hurt me? Well, my belief is that the thinking about it has always helped me. But if I really challenge that, oh no, it actually has been hurting me. So I'm gonna have to back away from that and see what happens. That's to see what happens as far, right?

SPEAKER_05 33:39

Let's just see what happens, yeah. Yeah. But like like Josh said about kind of you know, identifying the thinking process with that, it might be preventative. You know, if I keep on thinking this, if keep on monitoring it, that could prevent the thing that I think is going to happen, you know, the thing that I've that I fear happening. Um so it'd be, you know, I know that my brain is gonna try and suggest preventative methods. I know that my brain is going to try and, you know, get me involved in this or bring up something else that makes this situation in particular now feel even more important. There's something different about it, there's something new, um, the stakes are higher. So I need to prevent in this situation because this is where it's really gonna happen. Well, can you just put off thinking in a preventative way? Can you just put that off for even a few seconds? And you just notice that the urgency can start to the sense of urgency you might feel can start to drop at that point. And every time you do that, you sit in this isn't as important.

SPEAKER_04 34:39

So true. It's so true. That is so true. Yeah, put off the thinking about it for now because you're not solving it and you're actually teaching the brain that ultimately it's not as important as it should be. Don't get me wrong, it's important to me and my values to be able to do the scary thing again. Yeah, but I'm doing the scary thing in two weeks. Me thinking about it now is not helping, actually. Or I'm just putting putting it off a little bit though, each time signals to the brain that's not as important as you think it is. Uh so true. It resonates with me so personally as well in my own recovery.

SPEAKER_01 35:13

Yeah, yeah.

SPEAKER_02 35:14

It's interesting, you always got to come back to it. It's coming back to the process. Like what you're learning is that you're challenging the process of paying attention so closely to every thought and feeling you have. That process is not helping you. Not, oh, I'm proving that I'm not gonna have a stroke right now. No, no, I'm learning that that paying close attention to that thought isn't actually a thing, it doesn't have to happen. Yeah.

SPEAKER_05 35:37

And trying to decide which in which thoughts you should or shouldn't pay attention to. How do you decide that? It's like, well, this feels really important, so I should. And if you try and say it's not important, your brain's gonna come up with another reason of why it is. So don't even try and decide whether it's important or not. Just however important it is, can I still put off thinking about it for the next few seconds? Yes. Can I still put off thinking about it whilst I do this thing? And the answer will always be yes, because you you can get yourself through those few seconds, those few minutes of I'm I'm not gonna engage in that thinking. And your brain will pull you back to the thinking. You know, are you sure you don't need to prepare for that or prevent or or problem solve? Because this is really important, even if I do, not right now.

SPEAKER_02 36:23

I think we gotta ask one more question. It's like it's like always a million-dollar question. So people listening, like, yeah, yeah, this sounds all good. But is Rihanna saying that like I have to learn to ignore all my thoughts? None of my thoughts are important. And I'm sure you hear that. I gotta I'm sure you hear that every day. So no thought I ever have needs attention. Is that am I just gonna be a robot? That's not that's not yeah, yeah.

SPEAKER_05 36:45

Yeah, and I do I do hear that a lot, you know, and and again with thoughts, with feelings, with physiological changes, it's not that we're saying just ignore all of those things. It's you know, can can we just acknowledge that right now that feels really urgent? And once that urgent feeling has gone down, you know, does it does it now feel like it still needs some attention or or you know, do I need to do something about this? Um, and thinking about our cues, you know, you might think I'm hungry, you know, and thinking about being hungry, does that do much? Go in and getting some food, then you're you know, it's action-based problem solving, it's not thinking-based problem solving.

SPEAKER_02 37:23

Yeah, good point. Because very I mean, what I think one of the basic principles here is that there is very little thinking-based problem solving that we can actually do.

SPEAKER_04 37:34

Yeah, and unless it's and it's always thinking that leads to action-based. Yeah, right. That's exactly right. Yeah, yeah.

SPEAKER_02 37:42

I always try and tell people like it's not about learning to be a robot and just ignore every thought you have, it's about getting better or returning to a state where you can more accurately assess what needs your attention and what doesn't. You're not gonna suddenly, oh, I learned this technique and then I just I what if I miss something important because I learned to not pay attention? No, no, you're better at finding out what's really important.

SPEAKER_05 38:06

Yeah, and it's also becoming less involved in those thinking processes so your brain can do what it wants to do. You know, it wants to help, it wants to problem solve, it wants to work through things, and that problem solving will happen naturally. So if you know the answer to something or you know how to work through something, that'll come to you, you know. So, usually an example that's given is filling out a crossword. Um, so you get get to a question. I mean, I don't know how many people for that crosswords can't say I've done one recently, but filling out a crossword, you get to a question and you think, I know that, I know the answer to that, but it's just not coming to me. And if you stay on that question, you could just you keep thinking, why? Why can't I come up with this? Like I know the answer, it's on the tip of my tongue, I know the answer. And it's usually when you move on to the next thing that it comes to you, or 2 a.m. And you weren't actively doing anything, yeah.

SPEAKER_04 39:01

You weren't actively thinking, so true, yeah, so true. I remember, yeah.

SPEAKER_02 39:05

Yeah, yeah. When I was doing technical work, we would do those. I run into a roadblock because of sitting there for three hours working on this, trying to solve this problem. Like, I gotta come back to this later or tomorrow. And sure enough, like most of the time I would get it when I came back to it. Yeah, gotta get away from it for a little while.

SPEAKER_01 39:20

So yeah, yeah, very good.

SPEAKER_04 39:22

Thank you so much for coming on, Rihanna. We are gonna put you on the spot uh uh shortly, actually, before we go. But uh every episode of Disordered, we always celebrate uh a community. Um, we've got a written Did It Anyway here. I think Drew's gonna read out, and we've got an audio one with a question at the end. And because Drew and I are feeling lazy, we might get you to answer it.

SPEAKER_02 39:46

All right, so I will do this. Uh I will read this. We did not, I since first in the question sender internet or the did it anyway or did not say we can do the next, but did it anyway, or that's a thing now. Um, hi Drew Josh. Note the order. I am a tremendous fan of disordered. Why wouldn't you be? What with your wow, I'm really bad today. With your podcast and the help of Dr. Claire Weeks, I am firmly on the road to recovery. Three months ago, I was agoraphobic and couldn't do things like take my dog for a walk or climb the stairs of my own home with having a colossal panic attack. I love the language here. I was fed up with life passing me by and I was determined to claw my way back to living. I listened to all of your podcasts, read Dr. Weeks' books. I and as I've learned, I was mentally framing my anxiety all wrong. I was running from it, I started to practice what you taught me, and I slowly pushed myself out of my sight zone. I started going for walks with my dog again. The first couple of times I shook with fear and I was terrified that my jelly legs would give out. But I did it anyway. I listened to your podcast on these walks, and it started to keep the anxiety at bay. Then I slowly worked out of the fear until I was walking without any fear at all. I'm happy to say, was my favorite part, that I stopped using disordered as a crutch, and I am back to listening to music as I walk further and further from my house each day. But this is my best did it anyway moment. This past week I went on a family vacation to a golf and ski resort in northern Michigan. My family wanted to ride the chairlift to the top of the mountain. At first I told my family that I would wait for them at the bottom of the mountain. Heights, like many other things, are not my favorite. But my daughter is my voice of reason. I've explained everything I've learned about handling my anxiety so she can call me out on it. She did just that, and I recognized that I had to get on the anxiety train and take it with me all the way up that mountain. So I did it anyway. I was pleasantly surprised that I did not melt into a trembling puddle of mush, and my jelly legs never made an appearance. Three months ago, I could have never done this. Thank you so much from the bottom of my heart.

SPEAKER_04 41:38

Oh standing that, isn't it? Those it reminded me of this man.

unknown 41:45

But I'm not done yet.

SPEAKER_04 41:48

Oh, right. Just constantly, I'm not done yet. I'm gonna keep going, keep going. Well done. Let's start so far.

SPEAKER_02 41:53

And you know what? Good job, like not listening to the podcast to like be calm. Listen to music, it's fine.

SPEAKER_04 41:58

Yeah, don't listen to us compulsively, just listen to us for entertainment purposes.

SPEAKER_02 42:03

We are entertaining. Um, should we do our audio did it anyway and then make Rihanna ask a question before we unchain her from her desk? Yes, sounds great.

SPEAKER_00 42:11

I can't wait.

SPEAKER_02 42:12

I can't wait.

SPEAKER_00 42:14

Hi, Drew and Josh. This is Sophie. Um, you can use my name, but I have a did it anyways and also a question, I guess, the same comment. So a few years ago, um, I had really bad anxiety. I started listening to your podcast. Um, I did start taking medication, but I'd gotten to a point where life was back to normal, and I was I flew for the first time in almost 20 years, and I flew about 15 more times since then. So I've made a lot of progress uh in that regard, but I've recently had a pretty major setback, I guess, if you could call it that. And driving has become difficult again. I know that's something that's a pretty common feature, I guess. Well, I am driving, don't worry, it's free at the moment. But um, I guess my question would be how do you get over these setbacks that just seem to really uh feel more difficult than even the time before? Uh, and just what would your advice be to not feel like I've just gone backwards? Thanks. I appreciate you guys.

SPEAKER_02 43:27

Well, again, applause for flying. Did anyone for sure. Good job.

SPEAKER_04 43:32

Outstanding. I can't wait to put Rihanna on the spot. Hi, Rihanna, what do you do with the setback?

SPEAKER_05 43:38

I think I think it's important. And this is where here, you know, you don't need to ignore how you feel or your thoughts, or you you know, actually feeling frustrated at that, of course. You know, if something was getting easier and you're thinking, yeah, the work that I'm putting in, you know, I'm really starting to see this now. And then you have an experience where it's harder again. That's you're gonna feel really frustrated about that, so let that be there. And it it may be that you know, next time, next time you go out for a drive, you're likely gonna be thinking about that and predicting about that. Am I gonna feel as bad as it is last time? There's gonna be some anticipation there. So, just how how can you spend a little bit less time on that anticipation? You know, how can you get back to it, try and you know, build in some more drive in where you can. Um, but how can you spend less time thinking about how you're gonna feel when you do it? Because this time, you know, you you felt the way you did, and that that would have felt awful at the time. And it's not it's not that you need to just be okay with that, but how you know the the thinking about it beforehand or kind of um predicting that that might happen again, the engagement in that thinking beforehand is is going to increase anticipation. And I I suppose um yeah, I suppose it's like how how can you spend a little bit more time with that thinking each time you do it? And to me, that would that would be a type of response prevention in terms of the anticipatory thinking beforehand or the or the worry beforehand, and the rumination after that, and the rumination after, yeah, absolutely, because there might not seem to be much worry beforehand or or thinking it through beforehand, but what about after? You know, I I that's another time. Does this mean that you know I I won't ever feel comfortable driving again? You know, all these predictions are gonna come up and it's just labing, you know, what is my thinking trying to do here and how can I spend less time with it?

SPEAKER_04 45:38

Yeah, I that was for me when I've had setbacks in the past, it was the thinking, it was the annoyance. I I want to get back to where I was very quickly. How can I think to get there?

SPEAKER_05 45:49

Yeah, yeah, yeah. How can I think my way to that? Um, and we wish that we could think our way, you know, to um to feeling better, to something feeling easier. But it is it is the action and also just just being aware of what's going on in your thinking.

unknown 46:07

Yeah.

SPEAKER_02 46:08

Good answer.

SPEAKER_04 46:11

No, I think it's it's good. Go with compassion. Um, yeah, go easy on yourself, build up again. Remember, it's not the driving, it's just the uh a resensitization to the feeling itself. Yeah, it's not a new problem, it's not special. It's just the the the area or where it's presenting is different. You know, you can go on a plane 15 times, you can get behind the wheel of a car. It's not the car, it's not the plane, you just don't like the feeling. Go practice your willful tolerance with that feeling again. Um and like Rihanna said, don't try to use all your time thinking about it and and simmering in a broth of anticipatory anxiety.

SPEAKER_02 46:52

Yeah, or the evaluation after, I think, is the story that you tell yourself after, I think. It's a reaction after, like, oh, that was so hard. That way, what does that mean? Why couldn't I do it? Why was it hard this time? Well, it was. It just was.

SPEAKER_04 47:04

Yeah, just was.

SPEAKER_02 47:05

Yeah, it just was.

SPEAKER_04 47:06

It's okay. Thank you so much, Rihanna. Uh where can people are you on are you on the socials? Where can people find you?

SPEAKER_05 47:12

Um, so yeah, on Instagram at Rihanna Wilcox Therapy. Um, I'm only on Instagram, really.

SPEAKER_02 47:20

You are a wise woman.

SPEAKER_04 47:25

Yeah, Rihanna Wilcox Therapy. Uh, yeah, if you want to uh follow along, um, really uh thank you so much for joining us. It's been a privilege. It's nice to get good guests, and we always get good guests.

SPEAKER_02 47:38

If you guys want to know more about Rihanna or find her, you can go to disorder.fm slash seven one and I will have all your stuff there. You can find Rihanna that way too. Anyway, guys, thanks for hanging out. Thanks for listening. Got anything else, Josh? Are we good to go?

SPEAKER_04 47:51

I'm good to go. Thank you so much, guys.

SPEAKER_02 47:53

We will uh see you next week. We are out.