How Do We Overcome Worry and Rumination? (Episode 142)

SPEAKER_01 0:01

Rumination. Some people call it overthinking, worry.

SPEAKER_00 0:04

It's the one symptoms that does show up across almost every condition.

SPEAKER_01 0:11

Somebody with panic disorder is going to ruminate and worry. They may have different content, but the process is going to look the same no matter where we look, right?

SPEAKER_00 0:18

All rumination is an attempt to not be uncertain.

SPEAKER_01 0:23

It's an attempt to avoid discomfort.

SPEAKER_00 0:25

The idea of having to make changes to get that thing you want, you don't have the energy for. You know, it feels productive to ruminate about it, but it actually isn't, as you know. We often ruminate, we're trying to whip ourselves or punish ourselves for it not going well. As if that's going to make you get the energy to make change.

SPEAKER_01 0:52

Welcome to Disordered. This is episode 142. Today we're going to talk about how rumination, overthinking, worry show up across different anxiety disorders in different contexts. I am Drew Linsolata, one half of Disordered. I'm a therapist that specializes in the treatment of anxiety and anxiety disorders in New York, former sufferer of the things we talk about on disordered, four-time author on the topic, social media guy, dude with cameras and microphones, advocate. You know the story.

SPEAKER_00 1:18

And I am joined by Me, not Josh. Oh my gosh, what a disappointment to everyone. My name is Kimberly Quinlan. I am an OCD and anxiety specialist in the state of California. Um, I'm a podcast host, I'm an author. Um, and just I'm just pretty much a human. Just a general human.

SPEAKER_01 1:38

Yeah, one of my favorite general humans, too. Thank you, Kim, for stepping into the breach. Josh is under the Manchester flu is going around, and he's got it. So I reached out and Kim was gracious enough to like, sure, send me a link. And here we are.

SPEAKER_00 1:51

Yeah. Yay, I'm so happy to see you.

SPEAKER_01 1:53

I'm guessing if you guys listen to disorder, you know who Kim is already. So we're gonna talk today about rumination, over some people call it overthinking, worry, whatever. Like meant that's a mental compulsion, and where it how it shows up in different sort of anxiety disorder presentations or different situations. What do you think? It varies pretty widely, doesn't it?

SPEAKER_00 2:13

It does. I've taken a particular interest into this topic because as my work as a therapist, it's the one, it's one of the one symptoms that does show up across almost every condition. Um, and the cool thing is, you know, like when you're you've got multiple things, maybe you've got depression and generalized anxiety, or you've got generalized anxiety and panic, like you sometimes feel like you've got to keep switching skills, but this is sort of like one thing that you can do, a sort of blanket like risk response to every time, which I think makes it easy for us. Like when we're overwhelmed and we've got so much going on, it's nice to just be grounded in some basic skills.

SPEAKER_01 2:56

Yeah, I agree with that. I think it does show up across all the different context, diagnoses, presentations. It is the one constant. And that confuses people sometimes, though. I mean, somebody with panic disorder is going to ruminate and worry. They may have different content than somebody with a particular OCD sub type or GAD, but the process is going to look the same no matter where we look, right?

SPEAKER_00 3:18

Yeah. Yeah. Even second, like if for folks with depression or secondary depression. So let's say their first primary condition is panic and agoraphobia. Often there is that secondary depression. And you can sort of switch from ruminating about, you know, what might happen, will I panic or not, into like this depressive rumination, just like flips into that. And you mightn't even notice that switch, but it is a switch from like fear of something happening to hopelessness about that thing happening. So yeah, it's it's a cool, it's a cool topic.

SPEAKER_01 3:55

Yeah, I did a video about that last week on my YouTube channel, the whole like anxiety that grows out of, I mean, depression that grows out of anxiety, and that's it. It's the time when you tip into hopelessness, and then you start to ruminate on hopeless themes, powerless themes, and this will never get better. So no matter where we look, and I think that probably says something about how human minds work, not just anxious minds, like all minds, we're always looking for a problem to solve. That's what your brain gets paid to do. So it will try to figure things out all the damn time, and it doesn't want to stop.

SPEAKER_00 4:26

Well, I think you just hit the nail on the head, which is I have found that all rumination is an attempt to not be uncertain.

SPEAKER_02 4:37

Yeah.

SPEAKER_00 4:37

Um, even depressive rumination. Like sometimes we go into there's no hope because the uncertainty on whether there's hope or not becomes too scary and unbearable that even we just move into being like, okay, fine, every everything's gonna suck and nothing's gonna get better. And so across like I had an eating disorder, it was the same with that. The uncertainty about what other people were thinking about your body, what your body would do and how it would react. Like it's the same for OCD. It's it's very much that. Um, and so once we know that we can have a different response to that uncertainty.

SPEAKER_01 5:16

Yeah, I agree. I would even expand that. It's an attempt to avoid uncertainty, it's an attempt to avoid discomfort, like any kind of discomfort. I can fix my discomfort by thinking. Um, yeah, and it's something we do no matter what. Let's talk about the uh the depression thing a little bit more because I think that's something we don't talk about. We don't talk a lot about it on disordered. I I'm sure you covered a little bit more on your podcast, but you know, it people will say, Yeah, but I have evidence. I actually have evidence, nothing works. I've been trying everything for so long to fix my anxiety, and nothing works. So this isn't just needless rumination or pointless rumination. I have evidence that says that nothing works for me. I'm just gonna be anxious and scared my whole life and like everything sucks.

SPEAKER_00 5:58

Yeah. So, so to back up, there are usually three themes that depression thrives on. Um, it's either hopelessness, helplessness, or worthlessness. Um, and some people have all three, some don't. And what you've really just shared is uh a degree of hopelessness or helplessness. Um again, I would be willing to say, yeah, even if you even if you do have evidence, that's still not evidence of the future. And so it really becomes because you have evidence, you feel like that takes away your chances. Like it's like a a gambling, like, oh, well, I have more proof here, so I shouldn't believe that. But it's it doesn't, it doesn't have any impact on whether you make a change or anything like that. So the rumination can be done for a couple of reasons. You can ruminate because you're scared. You're scared of that you won't get better, right? You can ruminate because the idea of, and this is true for a lot of folks with depression, the idea of having to make changes to get that thing you want, you don't have the energy for. Depression takes a lot of your energy away. It's it sends you it, there's a there lethargy that there's like a a deep heaviness that goes physiologically with depression. And so often people ruminate because the actual action into change they don't have the energy for, rightfully so. And so, you know, it's sort of it feels productive to ruminate about it, but it actually isn't, as you know. Um, and the last thing is we often will ruminate because we're trying to whip ourselves or punish ourselves for not it not going well, um, as if that's going to make you get the energy to make change. Like if I just beat myself up enough and ruminate enough on how terrible I am and how bad things will, well, that will propel me into change.

SPEAKER_01 8:07

So rumination. It's funny, rumination, overthinking, worry, they feel like good ideas. They feel like action, they feel like you're doing something. And you know, I always say, like, hey, well, what? I'm just never supposed to think about anything. No, that's clearly not the case. But in the absence of an associated action or behavioral activation, then rumination becomes kind of pointless because it's just the thing that happens inside your own head. Drawing conclusions, there's cognitive distortions there, but it does always feel like a good idea. Like, let me think about this and I will uh I'll figure it out if I think about it. Yeah.

SPEAKER_00 8:43

At the end of the day, all rumin like when I was just thinking about this on my way driving here to my office, is I have right now a lot of projects going on, and the list of things I need to do is astronomical. And what I've been what catching myself doing is when I go to open up my email and I go to look at my tasks, I'm picking the easiest one to do because it feels so productive. It feels so good to check something off a list, and I'm choosing the easiest. Um and the I'm not choosing the hard thing because the hard thing is hard. That's the same with rumination. We we want to problem solve, we want to find solutions, and we often will find our brain will find the thing to do that uses the least amount of energy, but has the least amount of benefit. And so often that's a a habit, a habit or a trap we find ourselves in is I'm gonna ruminate, it will feel like I'm being productive, or it'll feel like I'm making a change, or I feel like I'm like preparing myself for a movement. Like if I just think it through enough and you know, get but the problem there is there's very little in return in investment. And the biggest piece about rumination is it there's like a tax on rumination, which is it adds more exhaustion. Yeah, that's the tax on it, is you're exhausted, it is so hard to come out of a rumination spiral. Um, and that's why that can be so painful. So the the real work, and I talk a lot about this, is you are allowed to be a problem solver. I encourage it because there is a very clear difference between problem solving and rumination. They are two different things. So you there is, you know, you can be problem solving, which means you sit down and you're thinking, but you're coming up with active solutions, like actual, active, and then you're planning. Rumination, you won't leave with some plan. You won't leave with structure, you won't leave with clarity. You usually just leave with exhaustion, and that's how you tell the difference. What I encourage people to do, and and this is a little bit of a controversial thing because some people, you know, some talk therapists prescribe this and it ends up being just compulsive as they sort of assign worry time. And I'm always scared of like people, uh therapists who aren't super trained to like prescribe worry time. But if someone is ruminating, I will prescribe worry time. But it it is it is about three minutes or 10 minutes max. I'm not talking about 30 minutes. At 30 minutes, you're probably ruminating. Again, you'll know the difference. Are you coming up with clarity or are you coming up with exhaustion? That's how you'll tell.

SPEAKER_01 11:30

And what are you planning for? Problem solving, rumination versus problem solving. Problem solving is you're focused on an outcome of some kind. You're trying to come up with an action plan, you're trying to inform some sort of behavior. Rumination is an attempt to just solve a feeling, which yeah. I had somebody the other day said, like, after three hours, is it possible that my brain, she was just exhausted and wound up having to go to sleep? Like my brain just couldn't think anymore. Yeah, I know. It doesn't lead anywhere, even though it feels like a good idea. You know what I find so interesting about that too? Rumination in problem solving, we're using more nuanced, like metabolically expensive thinking. But it's it's a good investment. Like those calories are a good investment. In rumination, we tend to fall back to the cheap, metabolically cheapest thinking, which is just give me something familiar, easily accessible, that familiarity and availability heuristic kicks in. And like we draw terrible conclusions when we ruminate. Terrible.

SPEAKER_02 12:21

Yeah.

SPEAKER_01 12:22

So like if you really got nuanced about it and like challenged your own distortions and saw like the craziness that's going on in your own head, you could probably break the cycle, but it's not that easy. You can't just no, you can't just do that.

SPEAKER_00 12:33

No. I I have a course called the Rumination Reset. Um, and one of the worksheets is um the first question when you sit down to do worry time. The first question is, is this problem actually solvable? Because you cannot proceed into worry time if you haven't asked that question. So if I'm going to sit here and and okay, so let's say I'm following my instructions or Drew's instructions or Josh's instructions. Okay, we're gonna we're gonna be very um careful around worry time. We're not gonna prescribe just more rumination time. We're gonna sit down and we're gonna see if we can solve this problem. The first question, is it actually solvable? So if your fear is like, will I harm my baby or will I, you know, um embarrass myself at the event today, the if the first question is, is this actually solvable, it's not solvable. So we're not gonna, we're not that's not the that's we're not problem solving that. We're problem solving what can I actually um do to set myself up for success, right? So let's say I do have a presentation today, which I don't, but let's just say that the fear is what if I totally screw it up and ruin it. That is not a solvable thing, the what if. But what is solvable, what is within my control, um, how much I prepare. Sure. Right. Um, maybe even what would I do if I've I embarrassed myself? I can problem solve that for a very short period of time. I'm not moving into rumination of like, oh, and then what would happen and all that. I I can be very, I can be very boundried. And boundaries are important here where you've set yourself parameters of what you are allowed to touch and what you're not. Because it's the same with depression, it's the same with anything. If you don't, if you're when you're going in your day, you need to have at the very beginning of your day very clear boundaries on what you're going to allow yourself to indulge in and what you're not. And I talk about indulge, it is an indulgent behavior. Um, even though I'm not in any way, in any way saying that you like it and you want this at all, I let me explain it to me, is I indulge in rumination all the time. And I catch myself. And what the reason I call it indulging is you know that feeling when you sort of sink into it and and it feels like um it's a hard thing to explain, but it sucks, but it also feels good, right? Like it it it it feels like, oh I'm I'm gonna get yeah, I'm gonna get and it's the same for depression. Like it depression is awful, it's awful and so painful. But when we're going, yeah, things are gonna be so bad and everything sucks, like you feel like you're in some kind of um zone where you lose touch with reality and you're just in it and you're sort of stirring the pot of how bad things will be and how bad you are, and it's like it is, it's like stirring that pot.

SPEAKER_01 15:50

And there's something oddly soothing, which is something that surprised the hell out of me as I got into this work. That like self-deprecation and rumination and catastrophizing, there is something oddly soothing about that in some crazy paradoxical way. Yeah, and that's what makes it indulgent.

SPEAKER_00 16:04

I would not disagree with the word indulgent, you just I I just want to be really careful, even as I'm saying that, I like want to put the word back in my mouth, like because in no way would I ever want anyone listening to feel like um we have any judgment for it. Like, this is such a human thing that we do, right? Like, I I don't would never want anyone to feel judged or bad for it. Like, even yesterday I caught myself ruminating and I burst out laughing because it was so ridiculous. Um, and and my only response there is like, oh, can believe this is such a human experience that things are uncertain, things are scary. And so your natural default while you're making dinner for the family is to be like, get stuck in that thing.

SPEAKER_01 16:52

Let me abandon the dinner that I make and travel to some other scenario in my head. But that's what our brains get paid to do. I use that frame, that phrase a lot, and I know you guys are tired of hearing it, but but like, so it's very human to have that happen. Uh I want to go back to the worry about like I use worry appointments with my clients in a metacognitive frame. I want them to understand that this is not, you are not without agency here. So if you can say to yourself, that whole okay, what if I really screw up? What if I get on the plane and I really panic on the plane? Uh hang on. I think about that at 6 p.m. And right now it's only 11 a.m. So I'm gonna do that later. Yeah, if you can do that, um go ahead and park at 6 p.m. and go ahead, worry about it. I don't care. It shows you that you if you can postpone the worry, then you do have agency. So we we use it for metacognition. You I'm not telling you that you already know, but for people listening. I also add, if you're so I like your your opening salvo there is is this a solvable problem? Well, if it begins with the words what if, it is not because what if is actually not a question. What if you look at what if is just a statement? What what if I panic on the plane? Just change that and say, I'm terrified to panic on the plane. Okay, done. That's not a question. It's just say what you're afraid of, what you're allowed to be afraid of at. But yeah, if you run with what if, but what if, you're trying then you hear it as a question, then you try to answer it. That's not a question, that's just a statement of what you fear. So exactly.

SPEAKER_00 18:14

Exactly. And I think that awareness, you talk about metacognitive, that awareness of the difference is so important. Like if once you get the aware, I've and I've had a lot of students and clients say, I actually think of myself as a super high-functioning, problem solving, you know, successful person. And they're like, but I actually had no idea that there was a difference between rumination and problem solving. That that I actually the lines were so blurry that I could do some problem solving, but then two minutes, like if we tracked it, I problem solve, then I do two minutes of rumination, I go back to problem solving, then I do five minutes of rumination. Like they're flip-flopping in between. And that it we I actually love, I have for one client thinking of where they tracked it in minutes and they were like, damn, like that one hour was 47 minutes rumination. And all I needed was 13 minutes to solve that problem. But but and they had always scheduled, let's say they'd always scheduled in the morning, you know, an hour to respond to emails, realizing that the only replying to emails was taking 13 minutes, but the rest was like that. Oh, what if they think that? And what if they think that? And how am I that? Like it's it's a lot of work that's gets a lot of time that gets wasted.

SPEAKER_01 19:40

Yeah, we we started by saying, how does it appear across different contexts and presentations? I I find that in GAD, in generalized anxiety disorder, there's a lot of that. Like I am a high functioning type A, multitasking, smartest, fastest guy in the room. Like, this is what I do. This is my identity. Okay, but can you see where? Yeah, sometimes that that serves you well, but sometimes you try to use that tool when it is to no avail and it it is counterproductive, it makes you feel worse. But it's really hard to turn your back on a big chunk of the way you see yourself. That's an identity threat. But what am I going to become just a passive, like, I just don't solve any problems anymore? Things are fixable, not always. But some people don't understand when, like, my type A problem solving, multitasking, fast thinking, I take care of stuff. I think I see it also in parental identity. But I have to worry, I'm a mom. That's what mom, that's a job of a mom. So I will often invite a client to say, when we get done today, before I see you next week, I want you to worry as hard as you can about me. Because I know you we we like each other. So, and I'll tell you when we show up next week whether I felt that or not. Spoiler a lot, I won't feel a bit of it. Like no one will know but you. So there's identity, like sometimes your personal identity is driven, drives that worry and rumination in that presentation. So it's not so much safety necessarily, it's just I'm overvaluing the outcome of thinking as a tool automatically.

SPEAKER_00 21:06

Well, and you hit on something really important, which is our beliefs about rumination. So we have um we have a lot of negative beliefs about rumination. Negative meaning it's a problem, I don't like it. We have, but we actually have positive beliefs about rumination, like good moms worry. That's a positive belief about worry, right? It's it's saying there's a benefit that I'm a better mom because I work.

SPEAKER_01 21:33

Health is important. You're supposed to work.

SPEAKER_00 21:35

It's irresponsible if I don't, if I don't, right? That's a that's a positive belief about rumination. And so often as we're tracking this, so I usually often use these sort of rumination trackers. Um, often we'll asterisk when there is a positive belief that is giving us permission to keep ruminating. Um, because that's key, right? That's where you you Default into rumination because you usually have a positive belief about it. This will prepare me more. Often people will say if I ruminated about it ahead of time, that it will protect me from the pain I'll feel if that bad thing happened. There's a lot of positive beliefs we have about rumination that you have to dispel in order to break that sort of pattern. But the other thing I would say here is um, and I say this all the time, and people think it's so funny, and I don't really I I laugh when is I say, you know, when you think about therapists who educate, um, therapists are usually really professional and really like, you know, encouraging. And I immediately come in at the very beginning of the rumination reset with like, let's just get this out of the way. You are going to suck at like the same person. Like you are good, like, let's just get it out of the way. You're going to suck at this. Like, this is gonna be repetitious hard work because I think people think that you learn to do this once and then it should be easy. But this is life's work. The the management of rumination is a lifetime of work, right? So I'll I'll tell a silly story, which this is actually real time something I'm working through. So I um this is so silly. I um have had an eating disorder, and I have gone through recovery, and I've been 17 years recovered, and I have not weighed myself for 17 years, because a part of my recovery is to not give any benefit or any emphasis on weight. I just take care of my body, and that has been a crucial part of my eating disorder recovery. Well, I've recently joined this gym that I'm absolutely obsessed with, and they are putting us all through this eight-week fitness challenge. And a part of enrolling is you had to get weighed and you had to do this body fat composition test to start. And I said to them, I don't care about this. Like, I'm actually there for bone density, not for fat loss. Like, I'm trying to improve my bone density. And he said, Well, you don't have to do it, but if I said, because I haven't weighed myself in 14 years, and he said, You don't have to do it, but it sort of defeats the purpose of being a part of this eight-week challenge if you're not doing this thing. So I agreed to it. I was like, you know what? I'm gonna do this. Like I'm 17 years recovered. I'm let's test this. So yesterday I went in to get this body composition test, and I was shocked at this, what I learned, right? Not that there's nothing bad, and there's nothing bad, but it it's I you can't remember the last time I did such a thing, I was massively disordered. Yesterday afternoon, I was making dinner, and without my even knowing, I had stopped making dinner, walked over to the cupboard, gotten a bag of marshmallows, and put four of them in my mouth. Not that there's anything wrong with that. There's nothing wrong with that, but that was an old automatic that's 17 years ago behaviors that I used to do. Like, what? I thought I was so recovered, and I am. No, no, I'm not gonna go back to eating disorder behavior. But how is it that 17 years of practice and I am I all of a sudden? So the reason I tell that ridiculous story is this is life's work, your ability to manage. And as I was eating, I was ruminating. Like I was literally, I cracked up laughing. I was like, literally had marshmallows in my hand, like pause. You can imagine me like just staring at them, going, Kimberly, you're what are you doing? Like, put the marshmallows down. It's like 6 30 at night. What are you doing? But in my mind, I was going, oh my God, they I'm gonna have to like, do I have to go on a diet now? What would I even do on a diet? Like, and all of a sudden, all that stuff came back. So the reason I that was a very long story, I'm sorry, but it's just this is life's work. It's not a one and done. And it's okay that it's life work because once you manage this, I could catch it in four marshmallows in, and I caught it and I laughed, and then I was like, Oh, I know what to do.

SPEAKER_01 26:24

That's the difference, though. Remember, I'm fond of saying, and I don't know who who got Stephen Hayes, maybe I don't remember. He's like, There's no delete button. Your brain doesn't have a delete button, you can't erase the old stuff. It's why people will say to people like you and I all the time, like, you know, well, what do you mean you could have a panic attack today? I thought you were recovered. Yeah, but the difference is I will get triggered into like, oh my god, I'm dying. But I can catch that in like 10 seconds and then adjust and it passes. Yeah, it's Kimberly's awareness that never went away. But that's maintained though, that's constant work. Otherwise, you get split back in. It's really normal.

SPEAKER_00 26:59

That's the beauty. I'm so grateful for the thousands of reps I've done of this.

SPEAKER_01 27:04

Yeah.

SPEAKER_00 27:05

So that that was just a such a it was a joke. It literally was a joke. Like I feel like it was a constant. I know it was so ridiculous. And again, there's nothing wrong with marshmallows. It's it's just that that was a ruminative behavior of mine. I was like, I went to some food and I just started ruminating like crazy. Like, if you could see me on video, I was like just stuffing those things in my mouth until I was like full mouth of marshmallows. Like, wait.

SPEAKER_01 27:32

All you can do is then because you kill you can't speak with a mouthful of marshmallows. It has to be silent. Anybody, it's so easy for us to fall into the trap. And I think if rumination is a primary thing that you experience in whatever your problem is, whether it's panic disorder or OCD, whatever, like, yeah, and then people will call that a setback. But no, no, no, no. A setback is just when you get triggered enough to accidentally follow the old pathway and do that again. But as long as you can see it, if you can tell me that you're ruminating again, so it's a setback, then that's great. Then you have everything you need, right? Now we know it's okay. You're gonna you can handle it.

SPEAKER_00 28:09

Yeah. Yeah. But but the cool part about that too is I haven't had to deal with an eating disorder in 17 years, but I have had to deal with other mental health struggles. And the practice of of managing rumination with those conditions made it so that I could easily apply the exact same skill with the eating disorder stuff. Or I could, you know, if if social anxiety showed up, I could apply the exact same strategies for that. Like, you know, I could apply it across the board, right? Even within OCD, PTSD, any of those conditions have a rumination component. Um, and so that repetition and again and giving yourself permission to suck at it for a long time and just keep practicing is is again the best gift you can give yourself.

SPEAKER_01 28:59

I agree 100%. Like, where does that practice? For me, the practice comes in regular mindfulness practice. It's not calming, it's not soothing, it's not ohm, it's not a zen state. I just practice every day watching my gears turn so that I can tell. I can watch thoughts come up, I know what's going on. For me, a very common sort of ruminative reset is oh, wait a minute, I'm having an experience I don't like. And I'm I can't fix this experience. I don't have enough time to finish this project, and I'm resisting that, and it's making me think go faster, go faster. Like, wait, I gotta stop doing that. But that's just practice, practice, practice. It's okay if you get stuck back into rumination. You're gonna, you're just gonna.

SPEAKER_00 29:37

You are gonna we all do. Yeah, the goal isn't to to uh banish rumination, I think it's just catching it earlier and earlier and earlier as you do it. Um, and and and and I really want to encourage people that that is a possible thing, like that is an absolute attainable goal. Often people will say, Oh, I can stop checking the time or I can stop asking for reassurance, I could stop avoiding, but the rumination and the mental compulsions, nah, that's that's unachievable. That's something I'll never master. And I really want to say, like, absolutely not. If I I truly believe that a massive degree of our suffering when it comes to these conditions comes from the consequences of rumination. Because it's exhausting and it takes us away from being present. It takes us away from you know, smiling and being with your child or your loved one or doing the thing you love, because we can just get stuck with the loop.

SPEAKER_01 30:39

Well, so much of it is it's interesting because we always come back to certain themes. And and I think in rumination, process versus content is a key theme because you will get stuck on on the content of the thoughts, what you're ruminating about. And people will often think, yeah, but so how do I stop ruminating? I just need to I need to put that issue to bed, right? And then that'll kind of get stopped ruminating.

SPEAKER_00 31:01

Let me just solve it.

SPEAKER_01 31:03

No, that's not it. You you have to be focused on the process. You could ruminate about anything you want, but the process is always the same. I am overusing thinking as a solution. So it doesn't matter what the content is, your health, uh, you know, an OCD theme, whatever, like money problems down the road. Yeah, sure, you can make financial plans, but if you're looping and looping and looping, you are shoehorning thinking in as a solution to a problem that you can't solve with thinking or just can't solve at all. That's the hardest part. So for me, I often try and tell people, you know, they think if I could just answer the question, then I'll be okay. I can stop ruminating. No, no, no. You have to leave the question unanswered and learn to stop asking it if you can. You know, yeah. And that's fair.

SPEAKER_00 31:45

Well, ultimately, what ultimately exactly, but ultimately what they're saying is I just need to ruminate well enough so that I can stop ruminating. Right. Right. Which again, you're you're training the wrong muscle. Um, it this is a skill of being able to put something down, literally put it down, and it it's called attention control training, which is put put something down and learn to train your brain to have a new focal point of attention. I love this. I feel like as a therapist, I got trained into this by accident because let's say I was ruminating about something. Well, now I have a client. I have to focus on them. So at this top of the hour, let's say it's 10 o'clock, I let's say Jessica is my client or Gem, you know, Gemma or whatever.

SPEAKER_01 32:33

I'm your W client.

SPEAKER_00 32:34

Yeah, yeah, yeah. So Drew's my client is I I am going to, I have to be with you. So it doesn't matter what's going on in my life. I have to put that down and give you my attention. And that I think helped train me for this work of like that you have to learn to put things down. And that is hard. You as you do it, I always remember like, all right, I'm gonna have to be uncertain for this whole 50 minutes, right? I'm gonna have to be uncomfortable and I'm going to give Drew every ounce of my attention. And that helped prime my brain on attention control.

SPEAKER_01 33:09

Well, what the lesson and I I get that as a fellow therapist, although a new therapist compared to you, of course. But yeah, it's a thing, man. And like with that is a process that you could apply anytime on your well, I'll have to be uncomfortable. And then I've been there, like, oh boy, I don't really want to start this session, but I don't have a choice, so I'll just have to be uncomfortable. And guess what? The lesson that my brain can quickly latch on to because it's learned it over and over for many, many years, is oh, yeah, that's right. I don't have to fix feelings or create. I think the other problem that people try to solve is I want a feeling. I either want to get rid of this feeling, so I'll try to ruminate it away, or I really want to make a feeling. And like you can't, you cannot conjure that feeling. Oh well, I'll just have to pay attention to Kim while I'm uncomfortable. Let's see what happens. Yeah, yeah. So there's always it feels like risk taking and it feels like the wrong thing to do, or it violates your identity, or it doesn't make sense to me. Like I'm thinking so hard, but I can't seem to find a solution. So let me just think harder. I'll get it if I just think more.

SPEAKER_00 34:08

So this can also show up in relationships a lot. I know Valentine's right around the corner, is you know, a lot of people are ruminating, trying to solve what other people think. Yeah, right. Like, do they like me? Do you know they didn't reply fast enough in the text because I dated them? When do you like then you start ruminating? When should I reply? Is it weird to reply right after the date? You know, a lot of that is showing up. And and I think our society has encouraged us to try and solve relationships, like what other people are thinking and how they're feeling, and do they like me? And a lot of this is also letting uh letting go of this idea of trying to control how people think and feel about you, trying to like make sense of how people think and feel about you. That's a huge thing that's showing up on my channels a lot right now is uh how it shows up in relationships.

SPEAKER_01 35:07

Yeah. As if you can control the other person's or other people's thoughts, or like I I know I need to make sure that they're gonna be happy with me. Like, I don't care what you do, shorter feeding them tacos because that's automatic happy. We know that. Yes, yes, shorter, you know, you cannot make somebody happy. You cannot make them feel anyway. And often that's a hard sell when you throw that out there. Yeah, like clearly, you're that powerful. You can make you can make someone else happy or sad or whatever. Cool. Teach me how to do that one.

SPEAKER_00 35:35

And the same goes with anger. I always joke with my husband, like, I had the best argument with you in my brain today. Like, you know, I have I I'm playing out this argument. Like, you did this, and I know what he's gonna say. I don't even have to go to him for the argument because I know what he's gonna say. I'm like, I had the best argument with you in my head today. And that's funny and all, and I get it, him and I laugh. But to be honest, that's just rumination on anger.

SPEAKER_01 36:00

The shower arguments, you win every argument in the shower.

SPEAKER_00 36:04

I know, I know, and and and I'm right, and I have a point, and like I'm, you know, don't you dare cross me, but that that too is angry rumination, right? Rumination on anger.

SPEAKER_01 36:15

And does it actually change anything in the way you guys are actually interacting? No, it just only happens in your head. Always the hardest sell in this. It doesn't make your relationship better, it doesn't protect you, it's not predictive, it's not a virtue, it's none, it's none of those things. It is thinking horribly misapplied, and that is it. Yeah, but yeah, but what about but it but what if I do panic in church? Like, okay, that I just say I don't want to panic in church, but no rumination is gonna change that at all. In fact, in those presentations, the more you ruminate, the more likely you are to walk into that church at level seven out of ten, and you have no wiggle room, and then it might boil over. Well, I have blind practice a lot with the anticipatory state because that is a ruminative and worry state. Like, no, no, be uncomfortable at the thing that's happening in three days. Go ahead, just be uncomfortable, just bring it with you. And sure enough, they will almost always, once they get the hang of that, say, I don't know, the event wasn't that bad. Yeah, because you didn't walk out the door in near panic already.

SPEAKER_00 37:16

So you are the reducing rumination when it comes to anticipatory anxiety does actually help the event because you're not walking like again, think of it through the lens of if you stare at something for long enough, let's say you write your name on a whiteboard, if you stare at it for long enough, it starts to look really weird and distorted. And and you, you know, if you stare at a problem too much, you got to step away, otherwise things get a little weird. And that's the truth. If you've got an event coming up and you've looked at it from every angle and every bad thing that could happen, you know you're gonna be freaked out walking into that. You're not feeling more in control, you're you're absolutely terrified.

SPEAKER_01 37:58

Yeah. Rumination is a way, and where are we? 37 minutes, we'll wrap it up soon. But I I think I often use like a dartboard analogy. The scary moment is the bullseye. And while that might be the most important thing on the dartboard, it also occupies the smallest amount of space on the dartboard. So, like you're living in the outer rings. Jumping ahead into that bullseye makes no sense. You're trying to expand the bullseye, don't do that. Just save the scary part for the scary part. Yeah, it'd probably be scary, but save the scary moment for the scary moment. Rumination won't make it any better. Can't solve a future fear. You just can't do it. No.

SPEAKER_00 38:28

So you just say we'll feel it. Yeah, we'll see. I don't know.

SPEAKER_01 38:31

A shrug of the shoulders. Like, well, what happens if I like lose it? What am I gonna do? Can I get out to my car while somebody sell?

unknown 38:37

I don't know.

SPEAKER_01 38:38

I don't know. I guess you'll find out that day. Yeah. Very good. Very good. Should we maybe we'll answer a question or two? What do you think? You guys want to have like Tim answer questions about rumination? Let's do it. Um, I did find one. I'm gonna abbreviate it a little bit because a very long email. Um, this person says, I won't use her name, even though she said we could. It's okay. Um, for the past year I've been dealing with anxiety, panic, OCD, and dementophobia. That's the fear of losing one's sanity. Um DPDR, weird thoughts. They would have she would have thoughts like, what if I forgot my pants one day? And you might laugh, but like, hey, welcome to an anxious mind. Don't sweat.

SPEAKER_00 39:16

I immediately thought of that. Honey, where are my pants?

SPEAKER_01 39:19

Right, exactly. Anxious minds can make any thoughts they want. And so she says, Yeah, that you suffered from these things, tried some medication. That's fine. That's a solution for many people and is okay with that. Been on it for 20 years, kind of doing better, but got resensitized. Like stuff started coming back. I feel like I'm in constant states of worry and rumination. Uh so clouded, trying to survive all the thoughts and ruminating that I do indeed have forgetful moments. And it's really like something. I have to really think about this. So this person is asking for again, very content specific. I'm I'm ruminating over the the I'm having thoughts about thoughts. That's metacognition. I keep having thoughts, what if I'm losing my memory? What if I'm actually losing it? What if my sanity is unraveling? What if I'm suffering from some sort of dementia? And then she's getting stuck in ruminative loops about this. And she's wondering, like, how do I get better? I don't know, how do I, how do I overcome this? What do I do? No pressure, just solve this problem in three minutes, if you could, Kevin.

SPEAKER_00 40:20

No, I I I feel like I can give it a good outline at least. Um so, number one, you have a really great awareness of the problem. So that's wonderful. Um, so that's a huge start, and you understand that this is not helpful. So we're we're right on the track here. The second piece here is um once you've identified it, that your next work is to continue that awareness training by being aware of when it does show up in your day. But you have to have boundaries again on these are self-boundaries on are you going to be solving those problems? And and if not, what will you do instead? So the gold standard treatment for a lot of the conditions that you you talked about is exposure and response prevention, which means um it I always say it should be response prevention and exposure because response prevention is more important in this type of situation. Is yeah, is is you're doing a lot of this to try and reduce and remove the discomfort that you feel. Rightfully so, if those things happen, it would be scary. But for right now, they're just thoughts. They're thoughts about a scary thing happening. And the more you focus on them, the more your brain is gonna find more and more loopholes into how this may or may not be happening to you. So I would be focusing here a lot on that attention control and just having boundaries to start with on, oh, there are certain subjects that I am not allowed to touch. Like whether you're gonna lose your memory, that is something I I have that same fear as my dad has dementia. So now I'm like very aware when I forget things. Like, oh no, it's coming. And so I think it's sort of like from today from 7 a.m. to 7 p.m., whether or not I'm losing my memory is not, I'm not allowed to touch it with a 10-foot pole. So it my awareness is, oh, there's that, oh, I forgot, I forgot that appointment. Oh my gosh. Uh but we're not allowed to talk about or think about whether that means I have dementia or I'm losing my mind or so much, so forth. So some boundaries there are really important. Now, what you can then move into is having some exposure. Like you could be doing some exposure work. I encourage you to do that with a clinician where you do something, you know, that on purpose triggers your ex your fear, but not just to torment you. You're only doing that so you can further practice that response prevention. So you can further practice, you know, having that uncertainty and going about your day. But it is so important that you have really strong boundaries about what you will and will not touch. Now, what do you do? What do we do when we're uncertain? Right? A lot of this is what Drew's talked about and Josh talks about, which is being mindful and present, re-engaging. Attention control is re-engaging in the present moment so that you don't have to solve the future. So it's about what are you doing? What do you see? What do you hear? What who are you with? What's the project? And this is what's gonna happen. I always say you're gonna bring your attention to the present, then your brain's gonna take you away, then you're gonna bring yourself back to the present on like the type, the computer board in front of you, then your brain's gonna take you away, then you're gonna come back and you're gonna do that all day. Just it's just a matter of returning, returning, returning. If you go off track, that's actually not a problem at all. It's about then bringing yourself back to the present, whatever your focal point is, and being okay and non judgmental about how you're gonna have to do. That over and over again as you do the reps.

SPEAKER_01 44:03

Yeah, that's pretty much it. And the and every one of those returns is a rep, like being in the chain. And what do you learn in the end? You learn, like, oh, uh that getting hooked into that and spending an hour trying to find some sort of certainty or fix this terrible feeling I have was never needed. That didn't do anything. I could return to my life in front of me. I think there's two things I might add to that would be I always tell ask people, well, start with what you're feeling, which is this really disturbs me. Oh, yeah, I what's happening right now? Oh, I just had a thought. I realized they forgot a meeting. And oh, that triggers my fear. So I'm uncomfortable right now, or I'm really afraid right now. But what are my options? I could ruminate for three hours and go nowhere, or I can come back to the email I'm doing. One of the best things we ever heard on this podcast, we had um Sally Winston and Marty Sifon. And and Sally Winston said, People often ask, Well, then what do I do? And she goes, Well, whatever's next. What a great answer. Very practical answer. I don't know, you're making dinner. What are you doing? You're doing a workout, you're walking your dog, what are you doing? That come back to that. Yeah, yeah, yeah. But but this, no, no, no. There's no butt. There's like to walking the dog, thank you.

SPEAKER_00 45:06

Well, I think this is like if you're a gardener and you plant a seed, you don't get the fruit right away. And often that's we we really want immediate relief. And so I think it's important that as you're doing this returning, returning back to the present and getting tough track and returning, people get frustrated. Like, I'm not getting any relief here. But I always say, like, the work you do, the reps you do today is really to benefit the the two-week you. It it you'll get benefits as in the two weeks, but you're the work you're doing today is to benefit that two-week version of you or two-month version of you. So it's it's a little bit of a patience game as well. Like you can't plant a seed and expect fruit today. Um, it it takes a while to germinate and to come up. And you have to, we're willing to wait for those types of things, but this work is um it is the results and the the benefits happen, but you you just have to, again, just like bicep curls. I can't go and do 20 biceps calls today, curls today, and expect huge muscles. I I understand it's gonna take some time, and this takes some time.

SPEAKER_01 46:12

And I the sad part about it, too. That's sad. I mean, it's a good thing, but it's very anticlimactic. Like, how often do you hear people say, like, oh, I it's not like there's a big moment where suddenly the it lifts and the sun comes out and like, oh, look, I've stopped ruminating and I feel so great. Usually it's very like, and people will look in the rearview mirror and say, Oh, yeah, I guess I didn't get I didn't spend as much time on that as I used to. Like, oh, you didn't even really notice that. Yeah, I know it's like there's no parade. I wish there was, there should be, but just give it time and watch things change. And probably I spent a lot of time with clients trying to connect them back to like you would have led with that two months ago in a session, and now you just threw it in three quarters of the way through as like an anecdote. What oh yeah, look at that. Maybe it isn't bothering you as much. Yeah, well, you get the credit for that. You did that, so good job.

SPEAKER_00 47:00

Yeah, it it is anticlimactic, but I will also say, um I have had heard so many people say, Oh, like, you know, I talk about a lot of different mental health conditions and struggles. This seems to be the one that has the biggest return on investment.

SPEAKER_01 47:18

Bigger than the disorder, right?

SPEAKER_00 47:20

Yes, because now there are a lot of times people will be like, Kim, I've had clients or people or students write to me and say, I learned this skill because I needed to manage my OCD. But my daughter just got married and I was present for it. And otherwise I would have been doing like a generalized anxiety rumination about the flowers and all the things. But dude, I actually was there for that wedding. Like I actually was there. And so, yes, it's anticlimactic, but it does um the benefits do build on themselves until you get these like beautiful real life experiences that rumination would have taken you from.

SPEAKER_01 48:01

It directly changed the positive meta-belief. Like, oh wait, I know what this is, and people will often that's one of the most gratifying things. I'm sure you would agree with me. Like the person who says, Oh my god, this has expanded outside just my anxiety disorder. Like, I don't understand what's going on, but it's it's it's bleeding into the rest of my life. Yeah, I know. You're not just an anxiety disorder with legs, and this is a really common thing that drives rumination too. No, no, no. I want to be a ruminator in every other part of my life, like that's what I do, and it's good there. Here I want to learn to stop it. You can't do that, you cannot selectively like it's gonna bleed, but let it, it's a good thing to bleed.

SPEAKER_00 48:38

So, yeah, yeah, it's it's a skillful life, and once you have it, you can apply it to any area. Yeah, and and that's why I love this this work.

SPEAKER_01 48:48

Very cool. And I don't care whether you're talking about ERP, ACT, MCT, you are gonna find these principles. Want to go into philosophy and use Taoism or Buddhism, you're gonna find these principles. Want to rely on Christianity, you're gonna find these principles. There's a reason for that. And you know what I think is funny? We'll wrap it up with this. This is why people, this is why we it's a bad deal to be human. It's a great deal, but it's also a bad deal. We have legitimately had entire departments of humanity, like theologians and philosophers and mental health experts working on this for thousands of years, and we still can't take the advice. We will still get sucked in and think that we're doing a good thing. So, like, be nice to yourself, you're just human.

SPEAKER_00 49:27

Yeah, I know. I I actually last year had like a uh moment where I was like, okay, let's just reassess my goals here. And I was like, what's the real goal here? I was like, if we could just reduce suffering, like that would be an amazing mission. And I was like, well, what's the fastest way to help reduce suffering? It's reduce rumination.

SPEAKER_02 49:45

It's resistance, yeah.

SPEAKER_00 49:47

It it's one of the it's one of the best, fastest, not fastest, but like most impactful work you can do.

SPEAKER_01 49:55

I think it's it speaks to why John Kabadzin has earned the right to say whatever words he wants, clearly. It's all good. But when he starts to like go off and like dump thousands and thousands of words and wax poetic about like changing global consciousness and fixing all the problems, I kind of see why he does that. Right? Because it does feel like a very impactful thing to do. Anyway, yeah. Thank you, my friend. You know what's always cool about sitting on video with you, even though you guys aren't gonna see the video? I am waving my hands all over this room. I'm so animated, and I have not seen Kim's hands once. Yet here we are talking about the same stuff.

SPEAKER_00 50:28

I wonder what that means. Why?

SPEAKER_01 50:30

Oh, but there you go. Well, we'll collaborate on a reel. Clearly, this definitely means that that's a trauma response for one of us.

SPEAKER_00 50:37

Oh no, that's because I haven't had any celery juice recently in my my what am I my nervous, my nervous canal canals. Oh my god, my brain isn't even working. I don't even want to know.

SPEAKER_01 50:52

But yeah, it's 745 your time. I appreciate that.

SPEAKER_00 50:56

Your hands are moving around and mine are like you're like glued.

SPEAKER_01 50:59

I don't know what I was I literally had to thought, like my brain makes automatic thoughts. Where are Kim's hands right now? Are they crossed in front of her? Is they on her lap? They're just gently kept holding each other. And I'm just if you saw what was going on here, oh my god, it's crazy.

SPEAKER_00 51:12

I didn't even pick up on that.

SPEAKER_01 51:14

I don't know why that struck me, but thank you, my friend. I appreciate that. You should be like you could be the permanent third mic, once in a while, third mic on disorder.

SPEAKER_00 51:22

Yeah, you need some feminine energy here.

SPEAKER_01 51:24

You just said that you enjoy a good meltdown. How feminine is that? Come on.

SPEAKER_00 51:28

I do. I love it.

SPEAKER_01 51:29

You're as much a dude as the rest of us.

SPEAKER_00 51:31

I love my own meltdowns. I love clients' meltdowns. They're they're actually, I do genuinely love a good meltdown. You know what?

SPEAKER_01 51:38

There's always something to learn from them, I think, in the end.

SPEAKER_00 51:40

So oh, I feel like it's the most human interaction we have.

SPEAKER_01 51:44

Sometimes you just gotta let it out. Anyway, um, where can people find you? I'm gonna put all Kim's links in the description as if you don't already know her, but I'll put all the links in the show notes here. But where do you want people to look for you?

SPEAKER_00 51:55

Um, I have a podcast and a YouTube channel called Your Anxiety Toolkit. Um, and all of our courses are at cbtschool.com, CBT, cognitive behavioral therapy school.com. Um, and I have a private practice in Calabasas, California. We have six therapists under on my team where we help people with OCD and OCD related conditions.

SPEAKER_01 52:18

Very cool. I will put all those links in there and uh go check out Kim if you don't already.

SPEAKER_00 52:23

Yeah, thanks for having me.

SPEAKER_01 52:25

Thanks for coming in and pitching in. Appreciate it. Josh, Josh, he was better than you. Just saying if Josh is out. Josh is out, Kim. Hostile takeover. All right, guys. Josh is um if you want to participate in some way in the in disorder, just go to disorder.fm. You can send me a question. I did it anyway, whatever it is. Follow us on social media, anxiety Josh and the anxious truth. And of course, Kim is your anxiety toolkit. And uh, we'll see you next week with some other random topic. We're out of