Combatting Anxiety: Tools, Techniques, and Humor with Joslyn Justi

Joslyn Justi  0:00

There are also healthy levels of anxiety. It can keep us on our toes, it can keep us alert and it can be very helpful.

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Kira Yakubov  0:07

The content provided in this episode is intended for informational and educational purposes only. Our conversations are meant to create understanding and awareness around mental health topics, but they are by no means comprehensive, or individualized evaluations or treatment. Stay safe and take care of your mental health enjoy the podcast

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Kira Yakubov  0:33

Hi, I’m Kira Yakubov, Licensed Marriage and Family Therapist and founder of Heal Your Roots Wellness practice. Every episode, we talk with a professional from the mental health field to learn more about their approaches and specialties, and also their journey of becoming a therapist. In this podcast, we’ll uncover a deeper look at the world of therapy from new perspectives. You’ll meet the therapist of Heal Your Roots Wellness practice, and trusted colleagues from the community tackling mental well being or your go to Network for practical and professional insight in mental health. Subscribe for new episode releases every other Wednesday.

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Kira Yakubov  1:09

Welcome back to another episode. I’m so excited to have Joslyn Justi back for a third episode. She’s a Licensed Marriage and Family Therapist that Heal Your Roots Wellness, and I clinical supervisor in training. Jocelyn, thank you so much for being on with us today.

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Joslyn Justi  1:30

Yes, Kira. Thank you. I’m so happy to be back. And I’m really excited to give our listeners a lot of tips and information today.

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Anxiety is normal and healthy

Kira Yakubov  1:37

Yeah, me too. Awesome. So I know today we’re going to spend majority of our time really diving into different anxiety disorders, what they look like some of the differences, the symptoms, and really give audience members tips and coping strategies to really help them navigate through this process.

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Joslyn Justi  1:56

It’s a lot of information. And I know it can be overwhelming for people sometimes. And I think sometimes people often get confused with different anxiety disorders, because there’s a lot of common themes. So I’m really differentiate those for listeners today.

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Kira Yakubov  2:12

Absolutely. And I know that’s one of your specialties is working with individuals and couples with anxiety disorders, and particularly OCD, which is something I’m not very familiar with. So I’m really excited to hear more insight and depth from you on that as well.

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Joslyn Justi  2:25

Yeah, it’s something that I’ve recently just became very interested in and has become a new passion for me exploring how OCD in the brain works, and how it can disrupt our lives or relationships or work. So I’m really excited to talk about it today.

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Kira Yakubov  2:43

Awesome. So I just want to preface with anxiety is normal, right? Like we all experience it. And there’s normal daily anxiety that every person goes through. And it’s very vital for us to experience anxiety, or like it serves a function for us. And I think some of the normal day to day things, right? There’s a very clear trigger. Like, for example, if you know, or starting a new job, or it’s the first day of school tomorrow, or maybe we’re going on a first date, right? Like it’s natural and normal for us to feel kind of anxious, a little uneasy and worry about that. And that anxiety is something that everyone experiences pretty much across the board. And so I wanted to differentiate normal and common anxiety from anxiety disorders for people.

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Joslyn Justi  3:31

Sure, and most people honestly, and generally speaking, don’t meet criteria for a lot of anxiety disorders. You know, usually it’s an adjustment disorder if there’s a situation or circumstance and there are also healthy levels of anxiety, it can keep us on our toes, it can keep us alert, and it can be very helpful sometimes. However, what I have found the differentiation there is when someone has been experiencing constants symptoms and excessive worry, which is one of the cornerstones for generalized anxiety disorder, it needs to be lasting at least six months or more. And if someone’s coming to me saying, I’ve tried this, I’ve tried that. I am excessively worrying about XYZ on a daily basis for six months, that’s when they’re going to be meeting more of a criteria for generalized anxiety, or panic disorder, OCD. So the timing is very important. And it’s like you said, it’s important to normalize anxiety too. We all have it, I have it sometimes, you know, it’s completely normal. And we need to validate that for people. So they’re not overthinking Oh, I’m sick, something’s wrong with me. Because most times, it’s just situations or circumstances. So that timing that six month timing, I think is very important for people to know.

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The difference between anxiety attacks and panic attacks

Kira Yakubov  4:45

Absolutely. And I think a big piece of it as well is that typically when there’s like a normal level of anxiety or just like the general kind that people experience all the time is that when the trigger or when the situation is done That level of stress it leaves, right like it’s no longer present it subsides versus Generalized Anxiety Disorder, or panic or maybe OCD that stays with us, like you said, an excessive amount of time. And there’s almost irrational or an over exaggeration of the experience internally, in proportion to the actual situation, right. So we want to be able to kind of compare and what a reasonable or proportionate amount may look very different for a lot of people, but I think you’re saying the timeframe. And also if it doesn’t go away, or if it doesn’t lessen as the situation leaves, then that’s a pretty big trigger for us to recognize that, okay, there’s something deeper going on here for the person,

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Joslyn Justi  5:44

right, and it has to really cause significant impairment in many areas of our lives. For example, in our occupation, or in our personal life, if it’s causing such severe distress, then there is something a little deeper going on. And, again, the frequency, the intensity and the duration are all important factors to keep in mind too. One of the common factors when it comes to panic disorder, the person needs to have two unexpected Panic Disorders without any trigger anything happening over again, a period of three to six months. Because sometimes, you know, especially with COVID, for example, I saw an increase in anxiety. But again, a common theme, there was the unknown, we didn’t know what was happening, and it was uncertain. And sometimes our tolerance levels to discomfort, uncertainty play a huge role in anxiety.

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Kira Yakubov  6:35

Absolutely. And I think the important part for people to know the difference between like an anxiety attack versus a panic attack, is that anxiety attacks, there’s almost like a gradual build up. And it’s almost always surrounded by you know what the situation is, you know, what you’re getting anxious about. And there’s a build up, and you know, and you’re trying to move through it, and it can feel, you know, debilitating, but you can still understand what’s kind of happening to you, versus a panic attack. A lot of times for people, it may feel like they’re dying, or they’re having a heart attack. And it’s, it’s almost like an out of body experience where there’s a high level of almost terror, where you feel completely out of control. And the onset is almost immediate. So I think that’s a big differentiator for people who might be experiencing anxiety versus panic.

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Joslyn Justi  7:30

That’s a very common question I’ve gotten asked recently is the difference between anxiety attacks and panic attacks. And the way I also try to describe it is anxiety attacks, we like you said, we know what’s happening, the trigger is there. And it’s not so much a physiological response compared to the panic attack where you could have, you know, your heart racing, dry mouth, upset stomach, for example. And it completely comes out of nowhere, like there’s no trigger, nothing in your present moment is making this happen. So to me, that indicates also deeper, internalized stress, and things that we’re not dealing with, perhaps we suppress them. You know, sometimes I’ve noticed people who tend to avoid a lot or have an avoidant attachment style, can sometimes experience panic attacks, because a lot of things aren’t getting addressed. So when I treat panic attacks or panic disorder, I’m really getting to the underlying issues of what’s stressing you out and then working on stress management techniques. And once we get that stress under control, and again, self awareness, there is key. Yeah, a gradual decrease, or the frequency or the intensity decreases.

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Kira Yakubov  8:41

Yeah, and I can see, there’s going to be a lot more frustration and avoiding a lot of maybe social events because there isn’t a clear trigger, or there isn’t a clear link to why someone might be experiencing this, which could feel even scarier, right, like we have no control over this versus people who may have anxiety disorder, or anxiety, panic attacks is, you know, what is kind of triggering you or you know, the circumstances of the situation. And we’re more likely to avoid them, or isolate, like that’s an active decision, because we know there’s like a cause and effect versus really not knowing what’s happening.

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Joslyn Justi  9:18

And it’s really kind of a probability issue too, because people are prone to that social anxiety, OCD, even ADHD, we have this interpretation or almost this confirmation bias like, well, I don’t want to go because I am not comfortable with the unknown, or I don’t know what’s going to happen. Feeding that thought process in the brain even more. So. A little education for people is, is an  overactive amygdala and cortex is what is feeding these thoughts. And so what do we know that we can say, Okay, I’m interpreting this a certain type of way. If I feed into it, then the worry is going to be even more extreme. But if I change my interpretation a little bit, I can say, you know, instead of, I need to know what’s going to happen, I can’t tolerate the unknown, what we can maybe say is something like, you know, I need this opportunity to learn how to tolerate uncomfortable situations. So again, you hear the difference, we’re saying, like, I need the opportunity to be heard, because again, the probability that something may happen is relatively low. You know, it could be high, but we still don’t know for sure. And that’s something that we really work with a lot is trying to get people to open themselves up to the possibility that their initial confirmation bias thoughts may not be accurate. So therefore, because we don’t want to hold people back or for or hold themselves back from.

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How discomfort tolerance opens the window of tolerance

Kira Yakubov  10:50

Absolutely. I love that you say that because it’s really challenging our thoughts and being more realistic and having more of an open mind of all the scenarios that could happen, right? I say, and I’ve struggled with anxiety, especially social anxiety a lot in my life is that we imagine the worst case scenario in our mind, and then we feel it in our body. And then we imagine what that’s going to be like to move through that right? I don’t want to feel that discomfort. I already felt what it’s like in my body. I’m good. Yep, right, versus being like, Okay, that’s a possibility. It could happen, right? It’s not zero chance it could happen. And is there something just as likely or more likely to happen that either nothing bad will happen? Or I’ll actually have a good time or a positive experience? And what will that feel like in my body, so at least allow ourselves to see and understand different options. And I think a big part is feeling it in our body is like, kind of like visualizing, and grounding ourselves in those senses as well.

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Joslyn Justi  11:55

Absolutely. And it’s learning how to trust yourself a little bit more instead of trusting logical thoughts that have possibly prevented you from enjoying life or having certain experiences. So one of the things I really try to normalize and validate for people is look for the most tiny baby step opportunities you possibly can. And then work from there, because sometimes people want to jump to, oh, I need to go to this huge concert, but I’m tired of being around a ton of people. Okay, well, maybe just start by going to a coffee shop, maybe just start by having somebody over your house, gauge how you build your tolerance, you know, and again, change the way we approach anxiety, rather than like, trying to say no, don’t be anxious, don’t be anxious, because that just makes us more anxious.

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Kira Yakubov  12:46

Sure. It never works to say, don’t feel this feeling. If it was that easy, we wouldn’t be feeling it right. If there was a switch,

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Joslyn Justi  12:53

we’d be out of a job if I told people Hey, cool, they’re all better. And it’s just on the brain so powerful. And once we develop those thoughts and strengthen those thoughts in the brain, that’s what’s telling us is our reality. Yeah, when again, we’re just strengthening unhelpful thought processes,

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Kira Yakubov  13:14

for sure. And I like how you said, kind of exposing ourselves slowly to some of these things. Right. So it’s building that window of tolerance. Yes. So I think there’s different levels between discomfort, a comfort zone and like dangerous, right? Like, we don’t want to put ourselves in dangerous situations that are super risky, just for the sake of, you know, pushing ourselves that’s not the point. And, you know, sometimes we want to be in a level of comfort so that we can sooth their nervous system, but we don’t always want to stay in the comfort zone, because then we don’t necessarily grow, we isolate, like you’re saying we prevent ourselves from experiencing more. So it’s really kind of playing and testing with the discomfort tolerance window. Like pushing it a little bit further and further and seeing okay, this was really uncomfortable. It wasn’t a great feeling. But I’m not hurt. I’m still safe. I managed through it. Like that’s a really big deal that I even did this thing. Let me see if I can keep doing the same thing until it feels pretty normal, and then extend that window some more.

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The importance of identifying and addressing OCD behaviors

Joslyn Justi  14:18

Exactly. And I love that you brought that up because that’s one of the main treatments with OCD is the exposure prevention therapy. So you expose yourself to a triggering stimuli, and you gauge you rate on a scale how discomfort or comfortable and so we can use those numbers as a tangible treatment plan to say okay, this is where you’re at when you expose yourself to this stimuli. Let’s do it again in a week and see where you are with the same exact stimuli. So, exposure again in theory over time, should decrease the level of discomfort and increase your sense of self increase your confidence, increase your ability to withstand being uncomfortable because like you said, you’re not in any physical danger, we are not putting clients in any type of unsafe situation. Like I said, my exposure stimuli is very small baby steps. For example, I had a client who was diagnosed with OCD. And we work together for a long time, like couple years. And this person got to a point where they were able to identify not calling somebody to get validation for an obsessive thought. And when they realized this, it offered so much positive reinforcement to them. And it gave them this increasingly sense of self and feeling proud of themselves that they sat with it on their own, and they did not reach out to somebody else. And it was such a pivotal moment. Again, it was something so small, but it like it was so significant, it was a huge progress. And that was the catalyst to decreasing symptoms. And again, it’s, it’s all about the client and them doing all of the work. And us pointing that out, like, hey, yeah, we gave you this suggestion, but you did do the work. And that that helps people immensely. And it’s really awesome to see it happen in sessions too,

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Kira Yakubov  16:15

for sure. I mean, it’s super rewarding, like, you’re saying it sounds small, right, or trivial, but the meaning behind that, and how impactful that is, like that person now gained this level of confidence, and self reliance, that may have not been present before to ease some of that stress and anxiety. Yeah, and I think a big part of individuals feeling super anxious, particularly in relationships is this constant need for reassurance and control that it then becomes projecting onto others, and it becomes everyone else’s responsibility or job to ease their anxiety. Which, yes, sometimes we need that support. And we need that validation. Because we’re social beings, right? We need other people. And that can’t be our only source of self soothing, or being able to decrease anxiety, because then we give all give away all our control, and then we feel helpless. And that’s the worst place we really want to be as a feeling of helplessness.

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Joslyn Justi  17:18

Well, exactly. And you’re talking about too the difference between enabling a behavior and being a supportive spouse or partner. Yeah. So sometimes with either OCD, anxiety, ADHD, a lot of times it interferes with a couple system, communicating conflict resolution, being able to talk through something a lot of misinterpretation happens there.

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Kira Yakubov  17:39

So much, yea

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Joslyn Justi  17:40

And a lot of people will tend to either withdraw or they react, and depending on the level of that reactivity, or withdraw, can cause a lot of tension build resentment over time. And so we have to do a lot of reframing with that like, instead of a couple of say, a couple, someone that has OCD and the other partner doesn’t. One tip is okay, let’s identify the OCD behaviors, let’s, let’s identify their traits, their characteristics, let’s point them out. So that way, the spouse is not enabling them, or being a quote unquote, parent to them, and, you know, they can be supportive and say, No, hey, we discussed this, this is an opportunity for you to build your tolerance, I can be here to support you. But this is something that I need you to cope with, and utilize, like any type of, you know, coping tool that they may have learned prior. But again, we’re building resiliency here at the same time, and that’s a big component in this in treating anxiety disorders is resiliency.

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Kira Yakubov  18:42

Absolutely, and having that back and forth understanding, because I think sometimes when individuals are in the throes of anxiety, right, where it’s, it’s really it can be really debilitating, and it can feel all consuming, well, then we can be really stuck in our own experience of the anxiety and not recognize what it may be like for a partner, a family member, a friend, a co worker even Right, right. And so it’s recognizing, like, Yeah, I’m having this experience, it’s very uncomfortable. And this other person is here, and why aren’t they doing the things that I need them to do, but that other person also has their own experience, and they may or may not know how to support you, and it’s not necessarily their job to make this feeling go away for you.

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Joslyn Justi  19:27

Not at all. And that’s something that I’m pretty blunt and direct about in my sessions with couples particularly is it is not your partner’s job to parent you. It is not their job to be responsible for your own mental well being. Big difference between offering support and validate or offering reassurance when they need it. Sure. But we have to, the individual, you know, we have to work on ourselves before we can work on the relationship. And one thing I’ll suggest to, let’s say partners without the OCD or without the anxiety disorder, is really trying to refrain from blaming language. Like, or it is always causing us to get into fights or your OCD is causing us to, you know, not enjoy life. While instead of that, you know, maybe using an I statement, like, I see you’re struggling, you know, what can we do to make this experience better? How can we work together as a team? Again, you hear people hear the difference between you’re doing this, that causes ffensive right away, but back it up and say, I see you’re struggling, I see you’re having a hard time, right? You love this person, this is your best friend. And I know it can be frustrating. But that’s where I think individual and couples therapy can be extremely beneficial to create knowledge to offer education and be like, Hey, this isn’t them just, you know, being annoying, or, you know, wanting to fight for no reason at all, let’s get a handle on this first and go from there.

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The importance of individual therapy for couples

Kira Yakubov  20:50

Absolutely. And that’s why I think it’s so important is because even though in couples therapy, you’re kind of working with each individual, you can’t spend the whole session on helping one person cope, right, it’s how is this couple managing this and navigating this together. And so that individual therapy is going to be so crucial to have way more time to process, find insight, find awareness, and develop coping skills that you can bring to the relationship or to the couples therapy, like, Hey, these are the things I’ve been working on, I’m really trying, it’s not going to be perfect, you’re not going to get it right every time. But like, let me know when you see that I’m not doing it or help me or pointed out when maybe if I’m doing it right, or if I’m not doing it the best way, it’s directly keeping your partner accountable too

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Joslyn Justi  21:36

and that and again, just pointing out positive progress, Hey, I saw you were struggling. But I also saw you working through it. And I really appreciate that. And the other part is saying like acknowledging that appreciation, and just being very mindful that their partner is also just as important. Even if I’m the OCD, they don’t have anxiety at all, there’s still stress, right? And we So stress management comes into play. So I might tell a couple, hey, I know this, you have OCD, and you don’t. But let’s talk about stress management, because I’m sure that impacts the both of you. And then both of them use that together. And they positively reinforced that together, that makes progress honestly, so much more quick.

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Kira Yakubov  22:19

Absolutely.

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Joslyn Justi  22:20

Now, again, it’s not an easy progress process at all. It’s time consuming. I tell people that at the beginning, you know, we’re trying to rewire the brain, that [takes] lot of mental effort and can be exhausting. So that’s where a lot of self care strategies come into play also,

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Kira Yakubov  22:37

and even with that, right, there’s a lot of repetition that has to happen. And a lot of reinforcement of particular behaviors over and over again, with the reaction being a positive one as well, that to help us rewire that too. Because I think a lot of times when an individual is anxious, the reaction of their partner can also stop them from being honest. Or it can stop them from being more forthcoming or doing particular behaviors, you know, based on maybe the way they were raised or their family environment when someone made a mistake, right? So it’s also understanding the way that you react or speak to your friend or family or partner who may be more sensitive to that,

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Joslyn Justi  23:20

right

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Kira Yakubov  23:20

can also kind of enable them from being honest and open with you. When they have anxiety.

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Joslyn Justi  23:27

Absolutely. It’s it’s voice tone, it’s like you said family of origin plays a huge role in this, you know, how did you learn to manage conflict or anxiety or talk about emotions growing up, which is a big thing we talk about at couples therapy, and it really does increase a person’s insight and awareness and can also have people be more sympathetic towards each other. Again, it’s it’s tough to do that it’s tough to rewire the brain, you know, but I mean, it’s definitely doable, if you take accountability, if they have a willingness to want to work on the relationship. And if they genuinely want the relationship, those are the three things whenever people check those boxes. That’s why therapy also being the most productive and the most successful,

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Kira Yakubov  24:09

because both people have to be in it

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Joslyn Justi  24:11

Exactly. But I do see a lot of like the OCD and ADHD have have sometimes been some of the biggest barriers in a romantic system. You know, that the worry, it’s time consuming, people get flustered easily. I think that’s something we have to be mindful of when working with couples is just the intensity of where they’re at.

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Kira Yakubov  24:33

And so I wanted to ask you, if you can kind of dive a little bit deeper into OCD, but also what Pure O is in OCD? Because, you know, I’ve been seeing more of that and that it’s, you know, from my understanding and from some of my training, I don’t have a bunch of experience with individuals with OCD, but that there’s usually a behavioral component that goes with intrusive thoughts when the versus kind of the pure Oh, is just that there’s the interest Some thoughts but we don’t necessarily see the external behavior. Is that right? Or if you can kind of dive more into that.

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Joslyn Justi  25:05

So a lot of newer research has indicated that with Pure O or like OCD, it’s not just obsessions. And it’s not just compulsions, they’re kind of go hand in hand. Right. compulsions are not simply just behaviors anymore. We can have compulsions about thoughts. So the two are intertwined together like this. So with Pure-O, I think the obsession really is an overactive amygdala and an overactive cortex, which again, like this is for our listeners, this is something that you can look up on the OCD website, or you can look at this book called Rewire the OCD Brain by Catherine Pittman and William Young great book. It gives a lot of really good examples of how to rewire our thoughts, but also gives a lot of education. So when it comes to Pure O and obsessions, again, I look at have these been so intrusive in your life, that they have caused significant impairment and disruption to your activities of daily living? If so, let’s take a closer look of what that means.

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Joslyn Justi  26:12

However,

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Kira Yakubov  26:20

Yea,

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Joslyn Justi  26:13

let’s say it’s a circumstance, right? Someone just lost someone, for example, you know, and they’re having a very hard time and they might be obsessing over the past history. I don’t think that’s Pure O or OCD. I think that’s a circumstance.

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Kira Yakubov  26:20

Okay.

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Joslyn Justi  26:23

But it does become this just unexpected excessive time consuming worry, and the inability to get unstuck. So we’ll call this sticky thoughts is and ruminating thoughts. Perfectionism, for example, is a big one that I hear a lot. People if they can’t, like, they’re so perfect at work, for example, but they may be late to a meeting or a party because they have to prepare for so long for this. So again, that’s causing severe impairment in their life.

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Differences between OCD and generalized anxiety

Kira Yakubov  27:00

Okay. Yeah. Cause I wasn’t sure exactly of the difference with the Pure O, because I feel like it’s, it’s tough. And this is why it’s really important for individuals to have very specialized therapists or practitioners with OCD, if that’s something they’re struggling with, because so many symptoms can overlap with generalized anxiety, that it may be hard to tease out and I feel like the treatment is going to look different.

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Joslyn Justi  27:24

My treatment for OCD, there is overlapping treatment plans for OCD and Anxiety. But when it comes to OCD, specifically, it’s way more of the exposure prevention therapy and exposing us and learning about those ruminating thoughts a lot. And then with generalized anxiety, it’s it’s excessive worry, but it’s not time consuming. So again, this might be redundant, but I can’t emphasize enough that time consuming is a differentiating factor with OCD compared to generalized anxiety and panic disorder. So we have to identify those obsessive thoughts and see what’s feeding them. First and foremost, you know, kind of also like changing the interpretation, like I was mentioning earlier, and then identifying the theme, is it perfectionism? Is it uncertainty? Is it fear? Is it you know, contamination, what it because that differs from generalized anxiety, those those themes in my experience,

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Kira Yakubov  28:24

and I think with at least how I like to work with individuals or couples who have generalized anxiety or social anxiety, right is really finding more of that insight, first, of kind of going back in time to seeing when else did you feel this way? When else did you get these messages or these beliefs around these circumstances or these situations? And kind of finding those links? And understanding that because it happened before does not necessarily mean that this is the same now. Right? And your interpretation, right is, how can I interpret this differently? What is the likelihood, right? Am I just assuming, because a lot of the time, we’re going to be assuming, then creating a narrative then believing the narrative and then behaving based on the narrative when the other person or other situation, no clue that that was an experience you had until you checked in with them.

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Joslyn Justi  29:18

Exactly. So I think a big difference there is what again, with anxiety and OCD is that with the anxiety, the Insight is a little bit better. And sometimes insight with OCD, at least at the beginning, from what I’ve seen, like beginning treatment, I should say, Insight is sometimes poor to fair, generally speaking, again, not all the time, but it depends on where a person is in their life and in their treatment. If they’re at the very beginning stages of treatment. They’re not sure if it’s OCD, they’re not sure if it’s anxiety. Yeah, I asked how long this has been impacting their life for and again, what has it where has it caused the most distress? If they say sometimes I’m I just have sort of test anxiety, but I get pretty good grades. Well, that’s a pretty lackadaisical response. That indicates to me, they’re not too worried about it. They’re just aware, there’s a little bit of anxiety. Now, sure, that comes to me, and I can’t take a test, I have failed this. So many times, I have sat there and thought about the same question over and over again. And I was unable to think about anything else for let’s say, two hours, if that’s what, that’s how long the tests were to take. That’s a differentiating factor to me like, Okay, that’s a sticky thought you were unable to get unstuck from that, compared to some ad, you might be, you might experience more of like, like you said, like a body sensation for a little bit. But it was as much distress as someone sitting taking a test for two hours not being able to focus on any other word, except the first word they read in the sentence.

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Kira Yakubov  30:51

So that intensity and severity, duration frequency like this is for audience members like this is how therapists and practitioners kind of assess and look through these things is, How frequently does it happen? What’s the intensity level, the severity, and the duration of how long that lasts for right, because those are really big, important factors of being able to assess which the assessment is important for the fact that we need to now figure out the best treatment plan for you specifically, not just to give somebody a label, right, I actually don’t actually care about the label, I care more about what’s happening and how we can help you.

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Joslyn Justi  31:27

Exactly. And to be honest, OCD a lot more rare than people realize, like meeting the diagnostic criteria for Obsessive Compulsive Disorder, it is not as common as Adjustment Disorder with Anxiety. So a lot of the times it does get a little concerning with social media kind of throwing out a lot of, well, if you meet this, if you have, you know, xy and z, then you have this disorder. And that’s scary, you know, that’s really scary for people. So it’s so good for us to come in educate and normalize a lot of behaviors. Of course, like if there is a diagnosis and OCD diagnosis, it is helpful, like you said, to have a treatment plan moving forward, and how to treat them because like I said, the exposure prevention therapy is what I would use for OCD, but not necessarily generalized or panic disorder, or even like ADHD, for that, for that matter.

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Kira Yakubov  32:21

And so I did want to spend a little bit of time giving audience members like concrete coping skills or techniques that they can use for these different whether it’s disorders or the struggles and symptoms that they’re going through that maybe you like to use and that I use with clients as well.

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Joslyn Justi  32:38

Yeah, I would say for for panic disorder, I start with normalizing what’s happening, not panicking. When you know, something like know your body of what’s happening, like are your palms getting sweaty? for example, is your heart starting to race? Are you getting nauseous, you know, okay, if that’s happening, remain remain calm. Be still, walk to the sink, walk to your bathroom, splash some cold water on your face, put ice cube on the back of your neck. That can help calm the nervous system and tell yourself, I know what’s happening right now I’m having a panic attack. And again, slowing your inner dialogue has been very helpful. Because oftentimes, when something scary is happening to us, the mind starts to race a million miles an hour. So have to be very careful and cognizant of, hey, let’s slow it down. Let’s imagine something slow, like a turtle, for example. And I’ve mentioned this to clients like it’s, no, it’s kind of funny. But if we can visualize something slow, the mind is telling the body it’s okay to calm back down. There’s no immediate danger. So that’s where I, that’s where I start is self soothing techniques, calming the heart rate, because your heart rate is going to start to increase with a panic attack. Because like you said earlier, it can mimic a heart attack, which is really terrifying. I’ve had a panic attack before. And it does help me to coach people through it a lot easier after having her because I definitely saw that increase, I think after the pandemic, and people not knowing what was going on with them. Right. So yeah, that fear of the unknown was a whole other layer to exasperating the panic and causing it to last longer than it should, because we can decrease a panic attack within you can start having it and it can be over in 60 seconds, or over in two hours. The duration varies a lot. But as long as you start to think slow, control your heart rate, breathe, again, you put ice on your forehead or on the back of your neck that can be extreme that cold temperature. Cool to reset the nervous system and offer soothing to the body.

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How can you send the message to your body that you’re safe?

Kira Yakubov  34:53

Yeah, I love that. So I like to let clients know it’s basically the same right is that when When our body has these symptoms, where it feels unsafe, right, and when we feel unsafe, when our nervous system feels unsafe, a lot of the time, we don’t have the capacity to challenge our thoughts. So the first and most important thing that you can do is how can I send the message to my body that I am safe, that I am okay, and that I can just be present, right? So so you’re saying slowing down, having something cold, breathing, especially for a panic attack, I’ve had them too, it is not a good time, like you literally cannot breathe, which is horrifying within itself. And so it’s literally just focusing on I need to catch my breath, I need to slow my breath. And I need to count my breath. That is your only job is to focus on calming down your nervous system enough where you feel safe. Yeah. And then from there, once you feel safe, and you’ve calmed down, then you can kind of process then you can kind of challenge some of those thoughts after the fact. Right? I don’t like to let clients go into that first, because you’re just kind of amping up the anxiety.

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Joslyn Justi  36:09

Yeah, right. We have, we have to get physiological symptoms under control before we can start emotionally processing. Because we’re so terrified, and they’re in that fight or flight position in the body is telling us that we’re in danger. It’s gonna just exasperate things. And we’re like, Well, how does that make you feel? Like, I’m never going to tell somebody that was? No. Like,

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Kira Yakubov  36:30

I’m horrified. What do you think?

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Joslyn Justi  36:32

So I love what you said, like get the symptoms under control first and process after because a lot of times people will come and they’re like, I don’t even know what triggered me. It literally came out of nowhere. But that gives us a really great opportunity for self discovery. When people ask me, I don’t know, I’m not sure. Who will let’s use that as a great moment to like, discover, like, what’s beneath the surface?

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Kira Yakubov  36:55

Mm hmm. And that is I love that, because that’s what I like to ask clients when they come in with anxiety or depression is how do you know you’re experiencing it? Which may sound silly, because like, I’m always in it. But how do you know that? Right? Like, what are all the symptoms? What are the thoughts? What are you feeling in your body? So that you become more aware and knowledgeable of your personal experience so that next time it happens, like, oh, okay, I’m starting to feel anxious. This is typically what happens. Now I can kind of assess my environment or my internal thoughts, what are associated with this experience, right now that I can then process later and go back to?

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Joslyn Justi  37:36

Well, exactly, and you’re slowing it down. To me, that’s been some of the most helpful things that I’ve received feedback from clients lately is being mindful and aware of what’s happening and just taking the slow route. And you can come up with your own internal dialogue, but like, literally slowing, the way you talk to yourself, because if you when you start talking that way, you can feel the body starting to slow down. Because when we’re talking fast the body is like playing catch up with that.

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How to establish a calm state before you’re anxious?

Kira Yakubov  38:08

Yeah, I like that, because it kind of pairs with the rest of our sensations, right? Because it’s kind of controlling if I kind of pull this lever than this lever will kind of change appropriately or react appropriately to this. Right, right. So going through all our senses. So sometimes, like even myself, or some clients, like okay, I know I have anxiety, I recognize what’s happening, I understand what the triggers are, I still feel uneasy, right. So it’s like having the awareness is phenomenal. It’s the first step, but then it’s like, and now what? which can feel frustrating too. So I like to have them before they’re even anxious, right? like when they’re already in a calm state is to establish a place in their mind of somewhere they may have already been or that they can create is where is an environment that you feel the most safe and calm and at ease and I want you to visualize it. And through the visualization, I want you to hear the sounds, I want you to smell what’s going on around you. I want to I want you to experience the sensations and feelings on your body and against your body. And if you’re eating or tasting anything, I want you to fully immerse yourself in this super calm, peaceful state that you can then pull to later as a way to self soothe yourself anywhere, anytime without anybody. Because I think it’s powerful for people to have that that they can pull from anytime it feels like you’re less out of control and more aware of what you can do for yourself.

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Joslyn Justi  39:41

Well, it’s so soothing even like as you were describing and taking that step by step it felt so soothing, like hearing you go from Hey, what are you smelling? What are you seeing? And for our listener, basically we’re describing like guided imagery. That can just be such a great visual and a great relaxation and Soothing tool, like you said, Think of any peaceful environment that you possibly can, or use your imagination, you’re changing the way you interpret something. And, you know, to kind of fall back on what you said earlier was you’re also discussing reality testing, and the kind of testing the reality of your own thoughts, right. And sometimes when we ask, Well, how do you know that something bad’s gonna happen? You’re assuming at the end of the day, and that assumption can be a dangerous game. We all understand that sin. But it really is just getting to a conscious place to be ready to make that decision. Because sometimes people what I have learned in my experience is people get comfortable in anxiety, they get comfortable in a depressive state, even Yeah, it’s familiar territory. And the fear pops in because they’re afraid to get better. What happens if I have a setback? Again, do you hear like, the what ifs, what-if is a common factor with anxiety disorders, even depression. So again, if we can change the way we interpret things, we can catch that What if we don’t have to feed it. Easier said than done for all the listeners really understand that, but I wouldn’t say those things if I haven’t seen the work

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Kira Yakubov  41:16

for sure. And I think that’s such an important feature is that what you mentioned is getting comfortable in the anxiety and almost holding on to it because I think this happens a lot too in treatment is that someone will progress and they will get better. And there’ll be this kind of signal like okay, like things are working pretty well, we can probably see each other less. And then all of a sudden, it’s like, oh oh, and more comes back, or they start unconsciously sabotaging things around them.  Because we’re scared of change, right? Like, it may sound counterintuitive, like, oh, I want to get better. Why would I do that to myself? But it’s, it’s thinking like, what is the function of that? Right? So like, if, if I change that I can no longer rely on certain things. And if I fall back on some of those things, then, like you said, what could happen? Or I’m not going to have the same supports? Or I don’t know who I’m going to be? Or what am I going to spend my time thinking about? Or maybe that’s part of my identity. So now how do I show up in the world, if I’m not an anxious person, and everyone around me kind of caters to that a little bit.

Perfectionism is an illusion

Joslyn Justi  42:29

And that’s, and that’s a lot, right? spiraling around in our brains on like on a daily basis, what if this happens, you know, if I get better, and then I slip up, or this or that, what I’m like, I’ll tell clients, I expect that to happen. Because means at the end of the day, it is not going to be perfect. In terms of mental health. In my clinical opinion. Perfectionism is an illusion. And I truly believe that from a mental health perspective, I know we can perfect math problem, for example, would brains not perfect, we have to make mistakes in order to grow in order to learn. But a big theme there is also inviting the concept of accepting that and what that acceptance piece might look like. Because once we accept the fact that we can make mistakes, and we can tolerate making mistakes, then again, we’re changing the way we interpret it or approach a situation. And I think it can offer us new experiences, new mindset, takes a lot of work to get there. Don’t get me wrong. I have seen people get to that acceptance piece. And it has been a significant change. Again, there’s always going to be setbacks. But it’s our therapists and normalize those setbacks, because they continue to be proactive in their mental health, they continue to call out and make an appointment, let’s say if they had a setback, and they’re willing to process it in session. That’s a huge difference to me. And in that in and of itself, I think is very significant progress, too.

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Kira Yakubov  44:01

Of course, and I think, especially with perfectionism, when you say that is it’s interesting, I almost love working with clients who have perfectionism, because it’s not about the actual thing being perfect, right? Like, what are we avoiding happening by you being perfect, right? Is it the identity or sense of being a failure? Is that how other people are going to view you? And if they view you that way, what does that mean? What are the negative consequences to this? Right? Like, I think people focus on just the act or just the the purpose of what they’re trying to do to be perfect, and not really processing and thinking about like, if I’m not then what happens? like what is it that I’m really scared of or trying to avoid? That if I were to just face that, process that and work through that and accept that this part because it’s a lot of work to be perfect, and we never get there. Right? So it is a constant struggle. It is a constant uphill battle that we will never win, right. And I think people know they’ll never win, but they’re still going to strive because at least they feel like they’re working towards it. Right and avoiding that feeling of whether it’s a failure or the relationship or, you know, someone thinking a particular way about them. So it’s, it’s huge to have that normalized. And, like, I kind of love the family dynamic of it, it kind of pulls back is like, who in your life? What situation made you feel like you had to be this way?

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Joslyn Justi  45:27

Is this a generational learned behavior? You know, did your parents put a lot of pressure on you as a kid to perform, for example, and learned to again, perform at a certain type of level in adulthood? What did you learn about how to interact with individuals, romantic partners, for example, but the perfectionism is probably one of the most common traits that I see a lot with OCD. Because, again, another huge theme is that fear of being judged fear of being disliked fear of being uncomfortable experiencing guilt or shame. And again, the tolerance is so low that even the thought of making a mistake can send people into a downward spiral. And it kept them from going after that interview that they’ve been wanting for a long time. It might prevent them from hanging out with some friends or, you know, going on a date, for example, because again, it’s the fear dictating this. So I tried to frame it and ask people, What is it that we’re listening so much to the fear aspect, and that’s what I’m very, very curious about. I’m been working with that for a while now trying to understand that a lot more of how fear is dictating our our conscious.

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Kira Yakubov  46:42

Yeah. And I feel like fear and shame and guilt, just like lay at the surface, like at the bottom of the ocean, right. And they’re just like, such an unconscious, huge influence on a lot of the things we do that we don’t even recognize half the time until we take a step back to be like, I’m actually terrified of all of these things happening.

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Joslyn Justi  47:03

I think about what it’s like to even admit that to ourselves. Yeah, that can be in and of itself a huge step, when we can admit that it’s fear kind of dictating this. But then a good Another good tool to use is sometimes using a cost benefit analysis. And ask someone, okay, if fear is present, what are the benefits to letting go of that fear? And and let’s say reaching out for that job, give me the benefits, and then I’ll ask them, give me the cons. What are the reaching out to that job? While I might not get it, and that might make me feel like even more of a failure? We don’t know that for sure, though. You know, so let’s, let’s maybe challenge that and do a little bit more reality testing there, or a little bit more cognitive restructuring there. Yeah, you could get turned down. But that doesn’t mean you can’t move on and try something else. Because that’s building resiliency. That’s building tolerance, that’s building bravery and courage to step out of your comfort zone and say, Okay, I accept that I did not get that job. But you know, what, I am qualified. And I know I have the skill set. And I can do this a lot of positive reinforcement and a lot of like, positive self talk. It’s not the answer to every thing. But it can go a long way.

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Accepting our limitations and letting go

Kira Yakubov  48:23

For sure. And I think that’s, it’s so huge. And I like how you bring them both to the surface, because they’re both real, right? Like all of these features are real and do exist, when it’s, I think it’s also having people recognize that the amount of time we spend worrying that something bad will happen, and our limited ability to handle that situation is so disproportionate to what is actually happening, right, the chances are much lower, and our ability to overcome and are much higher. So I think pointing that out for people and building that acceptance and confidence that like, Okay, this is a very real factor, this bad thing or, you know, negative thing may happen. And if it were to happen, how can I feel confident in myself to move forward anyway? so that that’s not the factor or the barrier, the holding back from even trying

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Joslyn Justi  49:20

Right? It like I love that use the word, that barrier. Because that’s what I have found, like, what is holding you back like, and even with couples, I’m like, what is the barrier happening here that’s causing, let’s say, a disconnect between the two of you? What’s there, and that’s a great place to start exploring and finding those maladaptive functions that are just serving this horrible purpose within a friendship of family. So I think I just think it’s very important to be mindful of how we approach things, what we tell ourselves the inner dialogue, and also learning to accept our limitations. and using those limitations, though, to our advantage, if we know, if we know the brain’s limitations, we can totally use that to our advantage.

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Kira Yakubov  50:10

Absolutely. I love that. And as you were talking about that something came up for me, especially for couples with, like barriers or maladaptive kind of behaviors, is I think that even when we have these coping skills that maladaptive for audience members, like, you’ve figured out a way to cope with it, but it’s not necessarily healthy or helpful, but it’s a way that you learn to function and move through it, because you needed it at a certain point is that it’s also a grieving process to release that particular coping mechanism. So you can invite a new one. And I think that’s really tough, too, is I have to release this thing I’ve been relying on for so long, even though I know it’s not helping and it’s actually hurting when when it feels scary, because it served a function before. So it’s grieving that and allowing yourself to invite in new ways of interpreting situations or interacting with yourself or other people. So I love that you mentioned that because that just like came up for me, and I just wanted to share it.

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Joslyn Justi  51:10

Awesome. No, I never thought of it in a sense of grief and loss, when we’re losing the way we typically do things. And to be able to incorporate something new, of course, there’s going to be some resistance, right? Why is that piece of resistance, because it’s going to happen, I expect it to happen. But being able to incorporate, Hey, it’s okay, to be defensive, or to feel a certain type of way, when you’re no longer reacting, how you typically would, you’re changing, you’re doing something different. And that might feel defeating, sometimes, it might not feel like this person is gonna get one over on me, if I, you know, don’t stand up for myself for screaming. That can be hard. But again, did the pros outweigh the cons in that scenario, that’s where I just I love that benefits and cost analysis coping mechanism, because again, you can see it, you can write it down, it’s a great visual aid for those visual learners. And again, when you’re writing stuff down, and you’re reading it, your brain is remembering it more, and it’s comprehending it double compared to just once,

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Kira Yakubov  52:16

for sure, or even just reading it as like the physical act of you writing it. That’s why journaling is so powerful too is that you can your everything is connected for you to get that, that message across and engrained a lot more longer, a lot more permanently.

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Joslyn Justi  52:31

Absolutely. And it sticks. And I think couples can see that when things stick. And when they’re practicing together. And they’re giving each other the benefit of the doubt, can go a long way when trying to change behaviors within your system that can go a long way with your partner being more willing to change when they see that you’re helping them along the way and giving them that like, okay, you know what, you might have messed up a little bit. But here’s a little bit of grace at the end of the day.

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Kira Yakubov  52:59

And you know what’s interesting, so I’ve had couples where they’ve gone from really high intense arguments to, like high intense, it’s drawn out so much energy is spent to having a really respectful and productive conversation that doesn’t last very long because they get to the point. And one or both partners kind of feel like uneasy about it. And so I’ll ask like, why does this feel strange? And like, I don’t know, like, usually I can get all this energy, this pent up anger. And now it’s like, oh, you validated my feeling. That’s it? What am I supposed to do with all this energy now? So it’s funny that even healthy change, when we still have to recognize that something different means that we have, there’s a cost, right, we have to release something in order to receive something.

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Joslyn Justi  53:46

Because I think too, we can sometimes get so used to the chaos. Chaos just becomes second nature to us, sometimes, you know, whether we’re aware of it or not. And, again, it’s a safe space. It’s a comfortable space. It’s familiar territory. So when a couple does get to that, that point of, oh, we’re having a nice, we’re actually talking to each other and not screaming and yelling at each other. It just feels weird. But it’s good weird at the end of the day, right? Well, I like to differentiate between good weird, bad, weird. And it’s a nice way to kind of incorporate humor into the sessions a little bit and make light of some things because we don’t always want it to be this heavy, drawn out emotional conversation. That’s exhausting. And you know, I think that that piece of humor with anxiety, OCD, depression, couples therapy, can can go a long way. And sometimes we can even make fun of the symptoms. If we can, this internal dialogue that oh, this is being, we can name it. We can make fun of it. We can tease it. Sometimes it can decrease it in its power over us in a sense.

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Bringing humor into therapy sessions

Kira Yakubov  54:56

Yeah, humor is such a huge, huge tool, and it’s very healing and I love bringing humor into session. And I think that’s kind of why we jive well, too, is that like, if you can’t laugh at or you can’t find the silliness or lightness in it, everything’s going to feel heavy. Yes. It’s so hard to do anything in life when everything constantly feels heavy. Like in the moment, it might suck, but like, can we? Can we talk about that story after the fact that laugh at like, How absurd that was? Or like, Oh, my God, I couldn’t believe I did that again. Right, like, so it’s bringing that humor. So I love that you bring that up, too, because I think that’s such a huge piece in any relationship

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Joslyn Justi  55:35

Absolutely. If we can’t laugh at certain things, like even myself, as a therapist, I might say something silly or fumble my words. And I’ll just laugh at myself in session. And I think it just humanizes us a little bit. And it really, in my experience has made clients feel more comfortable. And I make mistakes too. I’m your therapist, but I also make mistakes. And guess what? It’s okay. I’m still here. I’m still doing my job. And I hope that shows that you can do the same. And yeah, okay, and laugh at that mistake and move along, learn from it, grow from it.

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Kira Yakubov  56:09

Love it. Love these little tidbits, those are great quotes. Great quotes, happy to talk. I could talk to you about this and like generally anything for hours. But I know we’ve definitely come closer to an end. So I really want to thank you so much for your time for sharing your insight and knowledge with us. I hope the listeners got a lot of great information. So Joslyn, thank you so much for being on with us today.

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Joslyn Justi  56:32

Absolutely. Kira, thank you so much as always for having me on here. And for our listeners, especially those with OCD. If you want to check out the book, Rewire my OCD Brain, it’s a really great resource to have. There’s a lot of great coping tools education in there. So check it out. It’s a great book and I hope everyone’s well and enjoyed this episode.

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Kira Yakubov  56:53

Awesome. And just so listeners know if you want to work with Joslyn, whether individually or as a couple she’s accepting new clients right now in Pennsylvania and Delaware. So you can head over to our website, HealYourRootsWellness.com schedule a consultation and we hope to hear from you soon. Thanks so much, everybody.

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Joslyn Justi  57:09

Thank you