Is Exposure Therapy Traumatizing? (Episode 180)

Drew Linsalata 0:02

Are exposures traumatizing? Even therapists who will say, I know that exposure is the best way for this. It makes them uncomfortable because they see your discomfort as possibly traumatizing you.

Josh Fletcher 0:18

Evoking fear, you know, that comes with an abundance of feelings and emotions. I don't find many CBT, third-wave CBT therapists using the word trauma that much, um, unless it's very kind of obvious and specific.

Drew Linsalata 0:34

It's incumbent upon the clinician to recognize this person is bringing some other things in here, and we might have to delay that because we have to address some other issues, or we can't just do the exposure the way it would be designed for somebody who doesn't bring those issues.

Josh Fletcher 0:46

Don't just assume, like Drew said, discomfort is traumatized. Welcome to Disorder. This is episode 180180. Uh, entitled, Are Exposures Traumatizing? I'm Joshua Fletcher, also known as Anxiety Josh, and I'm a psychotherapist who specializes in anxiety and anxiety disorders. Can't believe it's 180 episodes. And I'm really excited to talk about today's subject. I'm joined by my esteemed co-host, who is named Yeah, all the way from across the pond.

Drew Linsalata 1:22

I'm Drew Linsolata. I am a therapist in New York who specializes in treating anxiety and anxiety disorders. And I also cannot believe we have done this 179 times already. Like it doesn't seem that long, right? It's weird.

Josh Fletcher 1:34

No, it's a wonderful, wonderful part of the week. And we always seem to come up with usually questions from the community, emailed in or people in the community app. And today we decided this is a good question. Yeah, are exposures traumatizing? You know, and I think it's a really good question. But I think before we delve into it, should we listen to um I'm looking forward to hearing some of the did it anyways that you've got today?

Drew Linsalata 1:56

Yeah, 100%. I have a couple of good queued up, so let's do this one.

SPEAKER_01 2:01

Hi, Josh and Drew from Canada. I wanted to send my first voice Did It Anyway, because I'm really proud of myself. I just completed kind of a top of my exposure hierarchy, which is being away from my safe person without easy access to them for a long period of time. And so just recently, my husband got a new job and had to travel for work for three nights in a city several hours away. A year ago, honestly, I would have dragged the kids and gone with him. I just couldn't have imagined being that far for that long without him. For the time I was determined to do it, and honestly, it was totally fine. I don't think I was more anxious than I generally am. And it really just proved to myself that I can handle hard things, I can do, I can handle hard emotions, and so can everybody listening. Um one thing that really helped me was the reframe of refusing to save myself from this emotion because I know that anxiety is totally safe. And so trying to tell myself, you know, I'm not gonna save myself from this. I can experience this has really helped me. Yeah. So feeling great. Wanted to send this in. Thank you for all you do.

Josh Fletcher 3:36

Yeah, that's awesome. Well done. Uh top of your exposure hierarchy, and you did it uh really well. And also the anticipatory anxiety, guess that you wouldn't cope, and you did, and a very compassionate reframe to yourself as well. I don't need to save myself, I've got this.

Drew Linsalata 3:54

Yeah, very good. Which means she didn't. Like it's the reframe is uh informs the action, so that would tell me this person said, No, no, I'm not going to do the saving thing, and then didn't, and learned from that experience, hey, I could do that. As it turns out, that's true. I don't have to save myself from myself. So well done. Thanks for sharing.

Josh Fletcher 4:12

Well done. I don't have to save myself from myself. Powerful line in this community. Um, traumatizing. Are exposures traumatizing? Now, if you're not sure what an exposure is, uh obviously something that we speak about a lot in this podcast, but an exposure is when we basically either an intentional exposure or we purposely make ourselves anxious so we can rewire the anxious brain and teach the anxious brain that this uncertainty is okay with the long-term aim of bringing anxiety down. It's to teach ourselves that places or sensations or things are safe, uh, when we know rationally they're safe. And it's done. It's it's it's a proven uh approach to rewiring the brain. Um and obviously we've heard we have a magic button on this show called uh the amygdala, which is it there we got it?

Drew Linsalata 5:02

Yeah, it's right here. It's Craig the Critic. Oh, that was the wrong button. This button.

Josh Fletcher 5:05

Well, amygdala. Yeah, whatever. There we go. So top top end top end professional podcast. We're in that mode this morning. Yeah, and the yeah, and the amygdala can only be rewired when it's activated when you're scared. And so that's kind of the the core tenet of exposure therapy. It's doing things, purposely being scared to rewire the brain and show it that you can tolerate it. But obviously, if we're purposely, you know, um evoking fear, you know, that comes with an abundance of feelings and emotions, you know. And so some people, you know, you know, if you scare me too much, that's quite traumatizing. And that could be a word to use to describe it. We'll look at the little nuance of that topic today, particularly in the world with the in a world where the word trauma is, in my opinion as a therapist, heavily overused and misinterpreted. But we'll have a look at that topic today. What are your thoughts, Drew?

Drew Linsalata 6:00

Um, I agree with everything you said there. And I agree also with the fact that the word trauma is overused. I think whether you're listening because you're struggling with anxiety or you're listening because you are also a therapist, this is a hot topic among therapists. And one of the most interesting things that I learned in the last few years is when you look at therapy literature, counseling literature, and you want because people always say, how come it's so hard to find people like you and Josh, anxiety specialist, OCD specialist? It's that. It's the belief that exposure is trauma. And even therapists and this has been studied, but this is not a secret, you can all look it up. Even therapists who will say, I know that exposure is the best way for this it makes them uh uncomfortable because they see your discomfort as possibly traumatizing you. So they instantly jump to that's trauma, and I cannot traumatize my clients, and so they won't. They will not engage in exposure-based treatments. In fact, when you look at the discomfort levels, this is one of the more interesting interesting things too, and I'll get off it, was when you looked at the discomfort levels of you know a diad, a therapist, and a client who's doing the exposure, the therapist reported higher subjective levels of distress during the exposure than the actual client did. So that that like I'm traumatizing my client is a very common narrative. If you if anything that isn't grounded, regulated, calmed to the present is seen as a problem. No, the therapists aren't supposed to support that state, we're supposed to fix that state, and that's just not true in our context.

SPEAKER_03 7:37

Yeah, it's interesting.

Josh Fletcher 7:38

So look, a lot of therapists go into the the profession um because they want to help people feel better. And we're saying, unlike Drew and I, who are raging sadists who really get joy off your pain and suffering. But in general, it's like you do, we get into this profession to help people to feel better, but we're not in the business as anxiety therapists to play whack-a-mole with symptoms and pretend, you know, really the problem is we fear and misinterpret anxiety and the symptoms in this community, anyway. And in order to get through it, rather than wasting all our time trying to find all the quick fixes, hacks, and pushing feelings away, actually looking at what the brain's doing and stuff that we've known for years and years and years, is that you know, we're teaching the brain and the threat response that these things are actually okay. Uh, hence the birth of things like willful tolerance or surrender, or even back to Dr. Claire Weeks, you know, which is you know, floating. Yeah you're floating through stuff, you're not resisting, you're doing these things uh because it works, you know, and that does require you to have to be with very high levels of discomfort. But a lot of narratives and different modalities of therapy. It's very I don't find many CBT, third wave CBT therapists using the word trauma that much, um, unless it's very kind of obvious and specific. So there'll be people listening here and still that have been through trauma, PTSD, stuff like that, where actually that you know that something so bad's happened to them that you know they get flashbacks and they and they and they withdraw uh and there's very specific triggers and stuff. Um, and that does require some intervention, you know, and there's some empirical based stuff there. I'm sure um but uh but even at the core of that requires some kind of exposure. Right, right.

Drew Linsalata 9:34

I I think it's so important to recognize that, you know, could an exposure re-traumatize somebody? Yeah, sure. But it is incumbent upon the clinician to know you don't show up and then you know, session one, halfway through session one in Josh's practice, you're out there doing, you know, exposure. It doesn't work that way. So it's incumbent upon the clinician to recognize this person has ha is bringing some other things in here, and we might have to delay that because we have to address some other issues, or we can't just do the exposure the way it would be designed for somebody who doesn't bring those issues in. So it's really a case-by-case basis, and it requires somebody who understands that and and it will adapt in each individual circumstance. And it's in a way, the the conversation is is of exposure trauma or trauma or re-traumatizing sometimes based on the the the view of exposure that it's just feel the fear and do it anyway, do it scared. Like yeah, it gets so watered down on social media, and then uh I'm just gonna say we have people who are not trained and qualified on how to do that, offering coaches, you know, workshops and mentorships that are just just tell you to go do the exposure without ever knowing you or sitting in a room with you. And yeah, that could be dangerous at times. So is it possible? Yes, but it's incumbent upon us to know that before we put you into the exposures. That's part of our job, it's what we do.

Josh Fletcher 10:52

Yeah. Someone in the studio audience put it really, really um succinctly, and I completely agree with it. Um they've said, I think that maybe it can be easy to fall into more extremes of two camps. You know, the first camp is we don't need to worry about past trauma at all, we should only care about the current moment. Uh, which a lot of kind of it may come across in this podcast, of course, because we don't know you individually. You know, we look at the principles of desensitizing. And then the other camp is that but past trauma is the fundamental cause of why you're anxious, and if we can resolve that, you're cured. Um, absolutely. And I think what we should do is look meet in the middle because one both both one of them on on their own isn't helpful. You know, oh, it doesn't matter if you've what what trauma you've been through, just go and do this. No, that needs to be part of your formulation, you know. Actually, okay, you are scared to go outside or you are scared to leave the home, but then let's look at why. As a therapist, I look at where stuff like trauma and things come in. I look at how hurdles to exposure are created. Yeah, what are your barriers and hurdles? And sometimes trauma can be a part of that too, but it's different on a case-by-case basis. But I'm not gonna sit there for 20, 30 hours and charge clients for 30 hours where we just go through trauma over and over again with the hope that that eradicates a phobia of you know, driving, going outside, panic attacks, stuff like that. No, you just gotta have a bit of both. So, yeah, thanks for summarizing that audience member.

Drew Linsalata 12:28

I think we sometimes underestimate humans somehow, too, because you know, there there is really a lot of data also that says so many people will will suffer what would be considered possibly traumatizing events. Every human life involves crisis moments that could potentially be traumatizing. There's a difference in crisis and trauma, but very few people actually go on to develop PTSD. Like we know this. It's not a we have just so much data on this. But somehow it's almost become conceptualized as anytime you experience a very difficult or powerful emotion or a difficult internal experience, that that discomfort must somehow equal trauma. Like it's automatic, it's almost automatic that that will be.

Josh Fletcher 13:11

But it's overused as well, isn't it? In in social media, everything, my trauma, this and my trauma, that.

SPEAKER_05 13:17

Yeah.

Josh Fletcher 13:17

And don't get me wrong, like I don't want to tell people how to describe their experiences. No. If you found something traumatizing, you found it traumatizing. But I also reiterate on this podcast that the power of semantics are so important when it comes to therapy. If you're going to say things like, you know, I I can't do this because of my trauma, okay. Well, let's have a look at what that is. You know, no, I can't leave the house to go to the supermarket because of my trauma. I'm like, well, why?

SPEAKER_05 13:45

Right.

Josh Fletcher 13:45

And I would challenge that, you know. But if it's like, you know what, I can't I can't get into a relationship at the moment because of my trauma, um it's too soon. All right, okay. You know, you don't throw in exposures at that, you know, or maybe a kind of find out thing might happen. Yeah, but in general, no. And so when we're looking at desensitizing, uh are exposures traumatizing. And all I would offer as uh as advice on in this podcast is that don't just assume dislike Drew said, discomfort is traumatizing. You're allowed to describe something as traumatizing, but be careful it's not influenced by what the modern take is on traumatizing. Yeah, uh something that we have that that that we have to um get rid of, suppress, or avoid. You know, I've been I I've I've I've willingly gone into events in my life where they have been traumatizing, they didn't break me as such, you know. And I think just the goal isn't to optimize and be a perfectionist and get rid of trauma and avoid things because of trauma. When we encourage you to do exposures, yeah, we're doing things willingly that are scary, yeah. Um in general, but but you know, and here's the here's here's the kicker. You're in if you use AI, here's the kicker. Um you're doing it there to show that you're that you're not broken. Yeah, you know, you're to to lower anxiety in the long run. Um and so yeah, it's a nuanced one. And it for me, but I'm only sharing my personal opinion here. When someone says I'm a trauma expert, I genuinely don't don't I don't know what that means. I I don't know what that means. Yeah. I what I don't know what the official training is on trauma. I don't, I don't I don't know.

Drew Linsalata 15:32

Yeah. Again, well you made a really good point. Only in the end you get to decide whether you have been traumatized. Your therapist does not, your coach does not, and an influencer on social media does not. Only you get to decide. Generally speaking, uh, you have crisis and then you have trauma, like in a crisis moment, which everybody has, my ability to cope is temporarily overwhelmed. Okay, that's a crisis moment. We all have those. The trauma moment is when I never really fully regain that ability, and that moment is never I never find a meaningful narrative. It never gets written into my my book, if you will, like stored as an event. So it stays with me and it leaves a mark, and I don't understand why I have I'm things that remind me of that are problems. But generally speaking, it's because I've been through an event that was genuinely dangerous. It was threatening to me or a loved one, or I watched somebody being threatened, or my my family or my property was threatened. Like, yeah. And when we encounter that, then you don't just throw somebody out into the supermarket on day one to have them panic in the frozen food food aisle because those experiences can really matter. But being uncomfortable and even being afraid, and by the way, being afraid to panic again doesn't automatically equal the panic was traumatizing. Everybody that develops panic disorder, for instance, is afraid to panic again. But that doesn't mean that the panic was traumatizing, they just don't want to repeat it because they they think it's unhandleable, and we're trying to learn that it isn't.

Josh Fletcher 16:57

Yeah, it's so weird, isn't it? I would describe my first ever panic attack, the the one that got me into the sensitivity state. I would probably describe that as traumatizing as a feeling. It felt traumatizing. Yeah, I would agree.

Drew Linsalata 17:12

Yeah, yeah, yeah.

Josh Fletcher 17:13

It would that was a traumatizing experience.

Drew Linsalata 17:15

Right.

Josh Fletcher 17:15

But thankfully, I didn't come away going, well, that's my trauma I need to resolve. That would have kept me there a long time. Yeah. Or that was a traumatizing experience. You know, uh I didn't ended up in AE and all this was wrong with me. So frightened, so scared, couldn't eat, couldn't sleep for days and days and days, didn't leave the house. Yeah, that was a traumatizing experience. Does it mean I have trauma? Semantics are very important. I would say no. You know, actually, it was a result of a lot of accumulated stress and trauma. And that's just why we use the stress jug. And so you go through the stress jug. But there's some approaches in therapy and some approaches to to anxiety, whether it's therapists, coaches, online books, whatever, that you can't resolve your anxiety until you resolve your trauma. And I that's something that's it's a bit simplistic for me that, and I don't agree with it at all. Yeah.

Drew Linsalata 18:13

And we don't the data doesn't seem to support that. Like, you know, it doesn't we just just don't see it. That like I know you are in vet and again, everybody has it is invested. Listen, we every every therapist gets in, you know, in a way, personally invested in the methodologies they they feel are most effective. So I don't fault anybody for that, but it it kind of becomes the whole, I don't know, it's it's the hammer and nail thing. Like if all I have is a hammer, then everything looks like a nail. But so, and and I always make the argument that if you are heavily invested in healing narratives and modalities and trauma and everything is trauma, and there must be grounding and soothing and protecting and fencing, then it's really hard to put your brain around the idea like, no, no, we we we find the triggers and then we use them to intentionally trigger people so they learn resiliency and capacity and they don't have to be afraid of their own bodies and minds anymore. Just the same way that for us, but uh I find that the trauma narrative will come rushing into anxiety disorders. But I really don't know any anxiety disorder specialists like us who go rushing into trauma treatment to say exposure, exposure, exposure, float, accept and and let time pass.

Josh Fletcher 19:18

No, no, no.

Drew Linsalata 19:19

It seems to be a one-way gate for some reason where you don't go running into other people's trauma therapies and insist that they must be doing exposures and that the trauma doesn't matter. But the trauma narrator will often show up and say, no, it it belongs in everything, which isn't true.

SPEAKER_03 19:33

Yeah, yeah, absolutely. Um the same audience, really good, really good point as well.

Josh Fletcher 19:39

Like uh I think part of the problem here is that PTSD uh and the concomitant experience of it is absolutely a real thing, yes, which is meaningful practices and methodologies for treatment. Yes, it does. If you have PTSD, it has methodologies for treatment, uh, but it can be misinterpreted or misconstrued based on the current cultural trends for people to overuse and misuse the terminology, which it has done, you know. So it's the birth of things like complex PTSD, which yes, you know, you if you want to use that, and I know phys uh physicians and therapists that use complex PTSD, and yeah, I've used it probably a couple of times in in my practice. Um, but with that become comes like a vague, you start to open up stuff there, like it's vague, how can we put our fingers on it, etc.? And then it becomes part of cultural terminology, you know. Um, so look at the, for example, neurodivergence now. I I'm a he's a bit ADHD or he's a bit OCD and stuff like that, where we use these new phrases that come up and then they they're kind of watered down to kind of way take away the seriousness of how it can be and how it's just kind of a shared experience. Yeah, and I think the word that's kind of happened with the word trauma and stuff. So when yes, okay, you're gonna do an exposure now, and we've built up to it and we're ready and we're all we've done our kind of safe guy, we've done our risk assessment, whatever. You know, let's go, let's go and do something that we know is safe but will make us feel scared. Yeah, you it's gonna feel really uncomfortable and really scary. If you want to describe it as traumatizing, you can. I'd suggest not, but you know, let's kind of have a go and see what happens. But that word is very it it evokes a lot of defensive feelings in in this field, that's why it's very difficult, diff difficult to talk about. I will now because I don't, you know, I I believe in kind of just talking about I've got a you know pe stake in this in this topic. But it's a bit like just be careful that it isn't your threat response and your personality isn't hijacking it to convince you to avoid things just in case.

Drew Linsalata 21:50

One of the big differences, I think, also is when there is a traumatic or traumatizing event that is still with you now, and we okay, we're gonna call that trauma PTSD CP. PTSD, I don't care what you call it. That is an event that generally what are the parameters we tend to identify that with? Like it was an imminent threat to my life, my safety, my health, my property in some instances, or someone I love, my loved ones, or I just witness other people who were in an imminent threat or did lose their lives. Like, yeah, those are those things that tend to be you know that that could be traumatizing. It was and I had no control over it and I didn't ask for it, but it was genuinely dangerous. Like there was something going on there that was genuinely threatening, whether it's psychological health, whatever. And so when you're going to treat that, yes, we are learning that like the memory of that when you get all worked up or you get triggered or there's a flashback or you are feeling a certain kind of way because you have been reminded of that, it's still the thing in the past that's creating the problem. Whereas in our context, it's the feeling itself. There was never an actual danger. Now, there might be an interpretation that it was danger, but we're trying to explain, no, no, you just became afraid of the sensations, but they're not dangerous. So there's a little bit different that there is a and it's important, I think. That's why exposure and anxiety disorders is not I do not would not say it's traumatizing, uh because we're we're actually trying to help you understand that you were not actually in danger. Whereas in trauma treatment, no, no, you really were compassionate witness, like first thing, right? Yeah, that really happened to you. And it was in fact a true danger. So yeah, we don't just run back at it. Does that make sense? There's a fine line there.

Josh Fletcher 23:30

Absolutely. Yeah. Absolutely. And if you've just been through multiple horrendous things, yeah, you need time to withdraw, to rest, to be compassionate, to nurture yourself. Yeah, it's not all about that. Um, but you know, the title of this episode is Is Exposure Traumatizing? Um, when it's done with consideration, and when we formulated the problem, actually, you know what? I'm all right. I just I'm just a bit afraid of losing control behind the wheel because I'm scared of panic.

SPEAKER_05 23:58

Right.

Josh Fletcher 23:58

Then then we go do it, you know. Whereas, you know what, I've had years of absolute carnage and been in an abusive relationship. I've lost someone, I'm grieving, I've moved, my life's upside down. All right, okay. Well, let's sit and talk about that for a bit and let's get a bit of a sense of self back first before we do any of that stuff. Right. You know, because maybe that is just a bit too much too soon.

Drew Linsalata 24:18

Well, because in those situations, the fight, flight, freeze, fawn response really is indicative of something is going on. Like uh it fires off because I've lived through all that carnage, like you just said, and we have to take that into account.

Josh Fletcher 24:29

So Yeah, absolutely. Would you like a did it anyway? I've got a few written ones here. Sure. Um here's one. I'm going to start from the bottom. Um, I don't know if they said we could use their name, uh, so I'm not going to assume. Uh Hydrew and Josh, I have a Did It Anyway that I'm proud to share with you. Yesterday was my first day back from one-year maternity leave. I'm a young mum and I've hardly left the house due to agrophobia and anxiety. I suffer with daily DPDR, OCD, existential health, death anxiety, that kind of fun stuff. I was so terrified whilst getting ready for work, I was very close to not going and saying I can't do it and staying in my safe space. But I didn't. I went into work, which is a busy place for the first time in a year. I stayed for my whole shift, no break, no texting my boyfriend for reassurance, and no hiding in the toilet. Sure, I had thoughts the whole shift about mortality and how I never want to die and thinking I would faint or randomly die, but I kept serving my customers and I did it anyway.

SPEAKER_03 25:35

Thank you for everything you guys do. Oh, that's awesome.

Josh Fletcher 25:42

That's so cool. It's such a real life one, that as well. Don't get me wrong, we like the extravagant ones, you know, that, but that was such a really good real life one that we can all uh relate to. Well done uh uh for doing that. Um I also like the bit where he says, um, you know, I'm as I'm serving customers for the whole shift about mortality and how I never want to die. Work a few shifts at KFC like I did, and suddenly those thoughts are welcoming. That's a good point, right? There is an escape. There is an escape. Yeah, get out of there quick. Sudden suddenly these thoughts are comforting.

Drew Linsalata 26:23

I love that that did anyway, also speaks to the thing that we hear all the time you know in our community or in our audience. Oh, this isn't a big deal, but no, no, everything is a big deal. So, like these ordinary everyday life, just standard. Yeah, that's as big a deal as the oh, I went on a flight to Japan. Yeah, that's big, but this is equally big. There's no small did it anyways. Just remember that, guys.

Josh Fletcher 26:43

Oh, it's excellent. It's really good.

Drew Linsalata 26:44

Yeah, yeah, with the 100%. Uh okay. So how do we address that? The is exposure trap. I would ask you when a client shows up in your practice and they're worried, like uh because some people do ask us, you know, hey, I did this, did it anyway, it's really awesome. But like, how much is too much? We we get common questions like how much is overdoing it, how much is too much? Am I going to traumatize myself with my exposures? How how would you answer the question?

Josh Fletcher 27:10

I would say uh it depends what you mean by trauma, because it doesn't really have a definition in our field. You know, is this exposure going to cause PTSD? No. You know, well it depends. If you know, if I run into uh uh you know, if I dive into a pool of hungry piranhas because I'm afraid to dive in a pool of hungry piranhas, then yeah, that exposure probably will lead to PTSD. Yeah, but we don't do that, you know. Um is me being afraid of panic and sensations that are already happening in my body in safe places that have been evaluated, and me exposing myself to those uh situations uh traumatizing. I would say no, I would argue actually that the discomfort in the long term is more traumatizing than it is in the short term, having acute feelings. Yeah, obviously, some some therapists might fight beyond that, but it's it's fine. I have a lightsaber.

Drew Linsalata 28:06

Yeah. Yeah, I that's a great answer. I that would that really good answer. And because I think is it too much? Will it traumatize me? Well, what you know, remember that the exposure isn't just just do it anyway, just do it scared, feel the fear and do it anyway. Like push through, hang on. It's not that. We want to make sure that you're doing an exposure with an intention. You know why you're doing it, you stay connected to that, you understand what the lesson is supposed to be, and you have the ability to be kind to yourself and recognize, no, no, I chose to be very uncomfortable. What did I just learn from that? I think they tend to be a little bit more likely to, I never want to do that again. If you if you stop at the do it while do it scared, and that's the only explanation, the oversimplified explanation. And then you are scared and you hate it and you don't want to do it again, that lends itself to that interpretation, like, oh, I traumatized myself and now I don't want to do it again. Well, you clearly don't want to do it again because it's scary, but you know, yeah, we have to go into it with the right it's back to words though, isn't it?

Josh Fletcher 29:02

It's about the the narrative that you create for yourself. Yeah. Um I I went through and that traumatized me. Well, whereas I would often say, Well, I went and did that and it made me feel scared, and I don't want to feel scared again. It's different though. Like, take this for example. I'll get clients to come to me with driving anxiety. I'm like, okay, um, when did this start? You know, I'm not gonna be like, oh, you've got driving anxiety, get behind the wheel, be like, when did this start? What happened? Uh and some people most people are driving anxiety, it's they either had a panic attack or they had a panic attack. Nothing to do with driving, but their world's got a bit smaller and smaller and they're afraid of losing control. But then sometimes, you know, this is why you have to have these formulations stuff. Sometimes you get someone who who's in a car accident. And actually, when I put my hands on the wheel, I get flashbacks of that moment, and I feel really disrupted. I don't feel there. Uh and and and I'd be like, all right, oh, okay. Well, if you're getting flashbacks and it's in your dreams, and you're really kind of feeling that traumatic visceral response, then we deal with that first. That's when you do things like EMDR and you do like trauma-informed specialist therapy, and before you know, it's safe to go behind the wheel. Most people in this community probably haven't got that, or they've probably been in a car accident, but you know, that's they don't have PTSD as a result of it. It's just, oh, right, okay, I was in, you know, I know that that can happen, so therefore I get really anxious. Um, but in general, that's just an example of kind of yeah, right. There has to be some kind of level of exposure to everything, but it's a bit nuanced to how you approach it. For the vast majority of people who listen to this and have driving anxiety, it you're exposing yourself to the panic whilst driving. Right. You know, and and that's the difference.

Drew Linsalata 30:52

Yeah. And this is also why we do graduated exposures and we build fear ladders and exposure hierarchies. Like we don't just throw you, don't just start with the hardest thing. Although I do sometimes see people want to do that. Like, no, no, no, I'm gonna kick its ass once and for all. And I remember one person in particular from sort of back in the day who decided, no, no, I I'm not doing it. I'm not that kind of person. And it was, I'm gonna get in the car by myself and white knuckle a four-hour drive to another city. And and it expectedly didn't go that well. Like, you know, managed to get there, managed to get back, declared victory, but the very next day was right back to where it was. So the reason why we use like that graduated approach is not because we're afraid to traumatize you by going to the top, but we want you to have a good outcome in the beginning to start to build that momentum and be able to learn the lessons.

Josh Fletcher 31:40

Yeah. Yeah. Do us do it scared. You know, here's the thing. And again, a lot of people with anxiety disorders, and then it becomes a thing. Um, someone in the audience says, I feel like I'm going to give my give myself PTSD by having to have my operation that I'm so scared of. But but no, it doesn't work like that. You're gonna just do something scary. If anything, the opposite's gonna happen. You're gonna come through your operation and you're gonna be like, Wow, I can't believe how well I coped. Yeah, my anticipatory anxiety told me I'm gonna get PTSD, I'm not gonna cope. See what happens in the situation. You're like, oh wow, I actually thought, you know, yeah, I did better than I thought. And how often every did it anyway you hear on this podcast, there is this anticipation that it's gonna suck and they're gonna fail, and yet when they come out the other end, they do really, really well. Of course, your doubt and critic will tell you you're the exception and that you can't handle that. You know, you'll be you'll crumble and you're you're made of biscuits. No, absolutely not. And some people is talking about white knuckling. Well, if you have to white knuckle, you have to white knuckle. Yeah, it's all good. Rather you do it and white knuckle than not at all. So very, very good.

Drew Linsalata 32:47

And most people will, I mean, most human beings will tend to white knuckle their way through difficult experiences that come up, you know. Yeah, I have to have surgery, I'm really nervous, I'm really scared. Like, sure, like I'm gonna kind of white knuckle through that. It's not a thing you do every day, but I don't, you know, I sometimes I think people are get a little unrealistic or a little unkind to themselves and thinking I I should just know that the surgery is totally safe. There's nothing to worry about, it's just anxiety, and then I will calm down and just happily skip into the OR that day. No, nobody does that. Yeah, yeah, yeah.

Josh Fletcher 33:18

No one's doing that. It's okay to be scared. Um absolutely. Uh, do you want another dinner anyway? I've got I've got some more in here. Yeah, bring it up. Rather than us ranting on. Yeah. Um to to break up there might be some trauma-informed therapists here screaming at the podcast, but let's just break it up a little bit. Uh, here's one. Uh it's a Manchester one this. Okay, this is from Rachel. It's okay to use my name. Hi both. I wanted to share a massive did it anyway for me. I've been struggling with health anxiety and panic after having my first panic attack back in August. I've been working hard to practice all the tools you have shared, but I have missed out on a lot of things over the last several months due to all this anxiety. Well, this weekend I went to see the bands corn and architects in Manchester on Halloween. Awesome. I had all the scary thoughts and the build-up to up to it, but I did it anyway. I went to karaoke afterwards and stayed out till 4 a.m. I bet it was the one in Chinatown I have sometimes found in there myself. I remember an episode you did saying you wanted to see someone who went to them in the mosh pits and heavy crowds. Well, here you go. Thank you for all the work and support. Love it.

Drew Linsalata 34:34

Oh, that's so great. Coming through with the mosh pit request. Yeah.

Josh Fletcher 34:39

Well done. Yeah. I love it. You didn't even have to go into the mosh pit, but you you did. Yeah. I love that. Yeah. That's amazing. Well done. Um, I was out on Halloween, Drew. I was dressed as Jon Snow from Game of Thrones. Were you? Yeah, yeah. Yeah, I enjoyed it. I I enjoyed it. Was there a moshit? No, there wasn't a mosh pit. Oh, I'm disappointed. But a good example though. Like I I feel I'm shaken, I'm having panic attacks. You know, if I throw myself in a mosh pit, I could traumatize myself.

Drew Linsalata 35:10

Yeah. It would seem like the craziest suggestion, right? Uh uh, you know, I I have panic attacks sometime. A mosh pit, you you can't go to that. Well, evidently you can. Who knew, right? So, you know, we understandably this, and we say this stuff all the time, this is so counterintuitive. It doesn't make common sense at face value to say, oh, I'm struggling with panic attacks and I'm afraid to leave the house or whatever's going on. It's conventional wisdom for any, even a friend of yours would say, like, oh, well, we gotta, you know, let's try to calm you down and like, oh, we don't want that, we can't be triggering that, don't be going to the mosh pit. So the stuff that we talk about in this podcast and what we do professionally, it makes no common sense. How many times are you in a session and think to yourself, if someone was looking in my window right now, hearing this conversation, they would send me to jail, right? Like, because it sounds so ridiculous when you're cheering for the trigger and like, no, it's okay, stay with it. Don't don't save yourself and you're rooting for the person. It doesn't make any sense. I I get it. Yeah, I understand the the the trauma narrative. I really do in some in some ways.

Josh Fletcher 36:11

You can use the word trauma if you want. I'd encourage you not. I'm not gonna tell you how and not to describe stuff and things like that. I can just personally think as a therapist, just personally, I'm telling you what the abject truth is. I just think it's personal to just simplify the language a bit. Anxiety disorders want you to embellish and flourish and inflate narratives. Yeah, think about it in all your stuff that you say. I I spiraled, it worst, I did this, I had extreme panic, I did all that, I'm traumatized. It often falls under the same um umbrella. Whereas honestly, it things feel more manageable when you simplify actually what's happening with with easier uh words. Yeah, honestly, just like I'm going to walk to the restaurant and have an adrenaline rush. It's gonna feel uncomfortable, but I'm doing it to teach my brain that I can handle the adrenaline rush. Yeah, that's way more accurate than talking about tornadoing and hurricane and doing that and heads exploding in extreme panic. No, great for a creative writing project, but let's you know, let's kind of do that. And that personally helped me. Yeah, you know, but it's up to you. I can't tell you what how you want to describe your experience to describe your experiences. What I can tell you though is that the trauma industry is a money-making uh industry. And if you look at the statistics on books and stuff and conferences around trauma and things like that, yeah, lots and lots and lots of people attend, lots and lots and lots of money spent, but no outcomes. I don't see any data on outcomes. Yeah. Interesting, right?

Drew Linsalata 37:40

Yeah, I the language, you're right, everybody gets to use their own language. One of the words that I think is most feeds into the trauma is, you know, the exposures traumatizing narrative is the word almost. I've had somebody literally say to me, How would how would that not be traumatizing? I almost passed out while I was driving. It's my favorite anxiety word, almost. I almost passed out. That's trauma.

Josh Fletcher 38:03

Felt like right.

Drew Linsalata 38:04

Like tell me what tell me explain that. How do you know you almost passed out? What did you do to prevent the passing out? Oh, I got I I got my water. I a good thing I had my water with you. Like, was that magic water? Water kept you from passing out. So you know, I it I almost passed out. I almost made a scene at my, you know, at my my sister's wedding. Like that's traumatizing. Almost no, because your narrative is faulty right from the beginning. You didn't almost anything, it just felt very, very uncomfortable. So I mean, listen, a tough topic, but I I I think you'd have we'd hard pressed to have us agree with the blanket statement that exposure is traumatizing or re-traumatizing. You know what? If the exposure is re-traumatizing, because there's already trauma, that's on that's on the therapist in my world. Yeah. Yeah. You should know that before you send the person out there.

Josh Fletcher 38:51

So for the too long, don't you know for the too long, don't listen. Too long, don't listen. It's uh I think exposure is always necessary at some point. It's just when that point is there, and after cons due consideration and formulating, and when you're ready and stuff like that. But yeah, that it's always there at some point. If you're ready to dive in, you're ready to dive in. The exposure itself is not is uncomfortable and scary, but it doesn't mean it's traumatizing as such. Yeah, but I'm not gonna take away your words, you can use whatever you want. Um have we got another audio today?

Drew Linsalata 39:28

We actually do, and I figure we should play it because it's very values-driven.

SPEAKER_00 39:33

Hi, Drew and Josh. My did it anyway is that I've been so sensitized ever since coming off of my uh anxiety medication. And my health anxiety, death anxiety, OCD, everything has been so bad, so hard, especially ever since our first um IVF embryo transfer ended in a chemical pregnancy. Over the summer, I've had all kinds of physical symptoms, like a freeze response. Uh ended up needing to get on a beta blocker because my PVC burden went up, etc. Anyway, I just had my fourth IVF egg retrieval today. Um, never thought that we would have to do another round, but here we are. And I am so proud of myself because I was so afraid to have the anesthetic, especially with this kind of new heart issue, um, etc. And I was really scared. Um, even the doctors were reassuring me the whole time, but I'm really proud of myself because I did it anyway. And yeah, you can use my name. Thank you so much for your podcast. I found it a couple weeks ago. It's helped tremendously. You guys are awesome.

Drew Linsalata 40:52

Had to crank up the applause on that one.

Josh Fletcher 40:55

Yeah, that's that's wonderful. Well done. Yeah, just have sincere well done from us at disordered. We we uh that's a good one. Yeah, and they're all good, but that's you know, that's brilliant.

Drew Linsalata 41:04

Yeah, I always love it when it's you know, I did a scary thing because it was very important to me to do that. Well, that's that's the those are the best ones, right? So I kind of get it.

Josh Fletcher 41:13

I did a scary thing because it was important to me to do that. Yeah, values driven. Uh we like that. Um, anything else to talk about about this? Our exposure's traumatizing.

Drew Linsalata 41:24

Um I mean, we could probably go on for another two hours, but I don't think anybody wants to hear that.

Josh Fletcher 41:28

No, we can leave it there. We can leave it there. I I want to leave, I want to leave one one more dinner anyway, because I I I wrote down three and I couldn't decide which one. There's a little short one. Um, and again, there's lots of death anxiety OCD. Uh, what ones on this today's podcast? Which is great. If anyone of you have death anxiety and OCD and stuff like that, that's you know, don't let it get in the way of stuff. Um, hi Josh and Drew. This is from Tessa. I have a did it anyway. I recently became resensitized with the focus being health anxiety. I had a trip to Scotland coming up to go to up to go up to Comic Con. I was really anxious about getting sick whilst away. But I still went and took anxiety along for the trip. Craig the critic was in the in my ear a bit as I Googled a couple of times. Briefly, he was telling me that I was a failure. But I'm still really proud of myself for doing it and had a great time. Love the podcast.

Drew Linsalata 42:23

Oh, love it. Short and sweet.

Josh Fletcher 42:26

I wonder what you dressed as. Uh, did you dress up to go to Comic Con? That would that would be fun.

Drew Linsalata 42:31

That always seems like a fun thing. I've never been to one of those. I should go.

Josh Fletcher 42:35

You no cosplaying. Oh, come on. I've never been to it. You look like a great Thor. I will take that into consideration. Or yeah, or not to appropriate, but probably Luigi. From Mario Kart.

Drew Linsalata 42:51

That is so good. It's me, Luigi. Uh, it's in my blood, I guess. Um, Thor seems much more fun than Luigi, but I don't know, maybe I'm wrong. How's your hand at plumbing? I might know my way around a pipe here and there. So maybe a little wrench in my hand, be all good to go. Love it. Uh anyway, well done today. And I mean, but there's a lot to talk about in this, but I think we can wrap it up here. What do you say?

Josh Fletcher 43:15

Yeah, we'll be back every Friday. If you want to be part of the studio audience, you can do and be part of the disordered community. We do monthly round tables and workshops, and we've got did it anyway threads where you can share your own and ask questions and things. Um, uh, and it's just a little space you want to. Uh, if you want to listen to the disorder, read the disordered guide to health anxiety that's available on Amazon. Um, if you want to follow us on social media, Anxiety Josh, the anxious truth, and what else? We've also got previous books and stuff like that if you want to delve, or you can just crack on and live your life and not listen to us compulsively. It's completely up to you.

Drew Linsalata 43:54

I would suggest that option. Well, we'll see you next week, guys. Thanks for hanging out.