Your Anxiety Toolkit - Anxiety & OCD Strategies for Everyday Kimberley Quinlan, LMFT

Welcome back, everybody. I had a whole other topic planned to talk with you about today and I’ve had to basically bench it because I feel so compelled to talk to you about this topic, which is the topic of having fun. Now, you might be having a strong reaction to this and maybe there’s a bunch of people who didn’t listen because the idea of having fun feels so silly when you are anxious and depressed. It feels like a stupid idea, a ridiculous idea. But the last few weeks have taught me such valuable lessons about mental health. I talk about mental health all the time. That’s what I live and breathe pretty much. Sometimes when you have an experience—I keep saying it changes your DNA—I feel to a degree my DNA has been changed these last few weeks and let me share with you why. 







For those of you who follow me on social media, you will know that in the last couple of weeks, I made a very last-minute trip to the United Kingdom. What happened was pre-COVID, I had booked tickets to visit London for a work event, and COVID happened. I had a certain amount of time to use these tickets, and I actually had thought that those tickets had expired on December 30th of last year. And then one Friday morning, I woke up and checked my email and it said, “You have 18 days until you depart.” I’m thinking, 18 days to depart, where? I haven’t booked any tickets. Only to find out that my tickets were put on what’s called an “open hold,” which meant they had just put a date to a trip knowing that I would log in and reschedule it when I was ready. It turned out to be three years later. And then I logged on and saw I have 19 days to use my ticket. 


I went upstairs, I talked to my husband, and I said, “I have this ticket to the United Kingdom I’ve never been to. I would really love to go.” He said, “You should go. I think it would be really good for you. I’ll stay home with the kids. You go.” That was the plan. I was going to go, I was going to keep working, I was going to see my clients, but when I wasn’t working, I would go out and have British food and maybe go walk around London and maybe visit a castle or two. That was the plan. I was so excited. 


I happened to mention it to my sister-in-law who I love, and I said, “Ha-ha, you should come.” She said, “Oh! No, there’s no way I could come and I didn’t think anything of it.” And then the next morning I woke up, she had messaged me and said, “I’ve changed my mind. I’m coming.”


Now, there is a point to this story, which is, my first thought was, “Oh my gosh, that’s so exciting.” My second thought was, “Oh my gosh, that is scary,” because my sister-in-law is the most wonderful human being and she loves to have fun. What was shocking to me is I started to notice I was going to pump the brakes on fun. No, no, no, no, no, no. Oh my gosh. Now quickly, of course, I said, “Come, I’m so excited.” We went, but that response was so interesting to me. What it was, was my anxiety did not like the idea that we were going to go and let loose. My anxiety did not like that inhibitory piece, that amygdala deep in my brain was like, “Whoa, whoa, whoa, whoa, pump the brakes. This is going way too fast for me.” 


The reason I’m doing today’s episode is I bet you that’s what your brain does too. It wants to pump the brakes on fun and pleasure because it creates uncertainty and it creates vulnerability and it creates where things aren’t in control anymore. Letting go and having fun is hard when you have anxiety. Letting go and having fun is hard when you have depression. 


“Yes” Week

We went and we called the week “YES week.” Actually, I called it “YES week” because I knew this was an exposure I needed to do. We made an agreement that if one person wanted to do something, both of us had to say yes. If someone wanted to try a food, and my sister-in-law loves to try all the

Today, we’re going to talk about the 15 depression symptoms you may not know about. My hope is that it will help you, number one, understand your symptoms, and number two, get help faster. Let’s do this. Let’s get started. 





I hope you are well. I hope you are kind and gentle to yourself today. I hope you are taking moments to notice that the trees are changing, the leaves are changing, and spring is here. If you’re in the Northern Hemisphere, maybe the weather is changing. Also, if you’re in the southern hemisphere, my lovely friends in Australia, I just want to remind you to stop and take note of the weather. It can be one of the most mindful activities we engage in, and it can help us be grounded in the present instead of thinking forward, thinking backward, and ruminating on the past and the future. 


I hope you can take a minute. We can take a breath right here... and you can actually take in this present moment before we get started. 


Today, we’re talking about 15 depression symptoms you may not know about. As I said in the intro, my hope is that these symptoms help you understand what’s going on for you if you’re depressed or help you get help faster. 




Mnemonic For Depression Symptoms

Now, some of you may really have a good understanding of depression symptoms. Some of you may know the common ways that it shows up, so I will first address those just to make sure you’ve got a basic understanding of common depression symptoms. I’m going to actually give you a mnemonic for depression symptoms. I find it’s very helpful to have this on hand when I’m assessing my clients and my patients. It’s a really good check-in even for myself like, what’s going on? Could this be depression? Let’s go through this mnemonic for depression. 


D is for depressed mood. I think we all know about that one. That’s a very common Hollywood way of understanding people who are sad, feeling very down, and so forth. We mostly all know the D for depression. 


E is for energy loss and fatigue. In fact, I did a poll on Instagram. For those of you who don’t follow me, go ahead and follow me @youranxietytoolkit. I did a poll and I asked, what are the most painful parts of depression, and the most common response was complete fatigue, complete exhaustion, just overwhelming tiredness and energy loss. I think that that’s a really common one. It can be confusing because you’re like, “What’s going on?” It makes you feel like maybe there’s a medical condition going on, but often it is depression.


The P is for pleasure loss. Now, this is an important one that we look for in clinical work as we’re looking for. Is the person with depression completely at a loss and they’re not enjoying the things they used to? Are they struggling to get joy out of even the most joyful things that they used to find joyful? That’s a very common one. 


The R is for retardation or excitation. What we’re talking about there is moving very slowly, like a sloth pace or even just sitting there and staring and unable to move your body completely, inability to get motivated to move. Excitation is the other one, which is like you feel very jittery and you feel very on edge and so forth. 


The E is for eating changes such as appetite increase or decrease, or weight increase or decrease. Again, common symptoms for depression. 


The S is for sleep changes. It is very common for people with depression to either want to sleep or need to sleep all day, again, because of that energy loss. Or they lay awake for hours at night staring at the roof, unable to sleep, experiencing sleep anxiety, which can often then impact their sleep rhythm. They’re sleeping all day, staying awake all night, or vice versa, but in a very lethargic way. 


The next S is for suicidal thoughts or what we call suicidal ideation. These are thoughts of death, thoughts of dying, and sometimes pla

In this episode, we are talking about the emotional toll of OCD. 


Kim: Welcome back, everybody. This week is going to include three of some of my most favorite people on this entire planet. We have the amazing Chris Trondsen, Alegra Kastens, and Jessica Serber—all dear friends of mine—on the podcast. This is the first time I’ve done an episode with more than one guest. 





Now, this was actually a presentation that the four of us did at multiple IOCDF conferences. It was a highly requested topic. We were talking a lot about trauma and OCD, shame and OCD, the stigma of OCD, guilt and OCD, and the depression and grief that goes with OCD. After we presented it, it actually got accepted to multiple different conferences, so we all agreed, after doing it multiple times and having such an amazing turnout, that we should re-record the entire conversation and have it on the podcast.


I’m so grateful for the three of them. They all actually join me on Super Bowl Sunday—I might add—to record this episode. I am going to really encourage you to drop down into your vulnerable self and listen to what they have to say, and note the validation and acknowledgment that they give throughout the episode. It is a deep breath. That’s what this episode is. 


Before we get into this show, let me just remind you again that we are recording live the Overcoming Depression course this weekend. On March 11th, March 18th, and March 25th, at 9:00 AM Pacific Standard Time, I will be recording the Overcoming Depression course. I am doing it live this time. If you’re interested in coming on live as I record it, you can ask your questions, you can work along with me. There’ll be workbooks. I’ll be giving you a lot of strategies and a lot of tools to help you overcome depression. 


If you’re interested, go to CBTSchool.com/depression. We will be meeting again, three dates in March, starting tomorrow, the 11th of March, at 9:00 AM Pacific Time. You will need to sign up ahead of time. But if for any reason you miss one of them, you can watch the replay. The replays will be uploaded. You’ll have unlimited on-demand access to any of them. You’ll get to hear me answering people’s questions. This is the first time I’ve ever recorded a course live. I really felt it was so important to do it live because I knew people would have questions and I wanted to address them step by step in a manageable, bite-sized way. Again, CBTSchool.com/depression, and I will see you there. Let’s get over to this incredible episode. 


Again, thank you, Chris Trondsen. Thank you, Alegra Kastens. Thank you, Jessica Serber. It is an honor to call you my friend and my colleague. Enjoy everybody. 




Kim: Welcome. This has been long, long. I’ve been waiting so long to do this and I’m so thrilled. This is my first time having multiple guests at once. I have three amazing guests. I’m going to let them introduce themselves. Jessica, would you like to go first?


Jessica: I’m Jessica Serber. I’m a licensed marriage and family therapist, and I have a practice specializing in the treatment of OCD and related anxiety and obsessive-compulsive spectrum disorders in Los Angeles. I’m super passionate about working with OCD because my sister has OCD and I saw her get her life back through treatment. So, I have so much hope for everyone in this treatment process.


Kim: Fantastic. So happy to have you. Chris?


Chris: Hi everyone. My name is Chris Trondsen. I am also a licensed marriage family therapist here in Orange County, California at a private group practice. Besides being a therapist, I also have OCD myself and body dysmorphic disorder, both of which I specialize in treatment. Because of that, I’m passionate about advocacy. I am one of the lead advocates for the International OCD Foundation, as well as on their board and the board of OCD Southern California, as well as some leadership on so

I can barely hold in my excitement!


We have a three-day live event where I will teach a new course called Overcoming Depression. 







I have had all of this passion show up in my body after seeing loved ones and clients struggle and after you guys repeatedly asking for a course on depression.  


Our new online course called Overcoming Depression is finally here. 


I will record it live on March 11th, 18th and 25th from 9:00 a.m. to 10:30 a.m. 


If you are interested, please join me, and I will teach you LIVE, and you can ask all your questions.


NOTE: This course will not be considered therapy. Just like all of our courses, it will be educational. 


Overcoming Depression will be me teaching you the skills I teach my clients when it comes to Psychoeducation and strategies and tools to overcome depression.   


Head over to CBTSCHOOLcom/depression to sign up!  


I am so excited to have you guys join me live. 


Ask your questions in the question box. 

We will tackle not only your negative thinking but also your behaviors

your motivation

Self-compassion

Long-term recovery techniques 




 I'm so excited and hope to see you there.
SIGN UP at CBTschool.com/depression

OCD TREATMENT OPTIONS 


Today, we have Elizabeth McIngvale and we are talking all about different OCD treatment options. 


Elizabeth (Liz) McIngvale is the Director of the McLean OCDI Houston. She has an active clinical and research and leadership role there. McLean OCDI is a treatment center for people with OCD and she talks extensively about different OCD treatment options in this episode. She’s the perfect one to talk to in this episode about knowing when you need a higher level of care, particularly related to OCD. 





In this episode, we walk through the different levels of care from self-help all the way through to inpatient facilities. Elizabeth spoke so beautifully about how to know when you’re ready for the next step of care, what to look out for, what you should be interested in, and questions you should ask. This is such an important episode. I’m actually blown away that I haven’t addressed it yet, but I’m so grateful we got to talk about it today.




Elizabeth McIngvale is also a lecturer at Harvard Medical School. She treats obsessive-compulsive disorders, anxiety disorders. She’s got a special interest in mental health stigma and access to mental health care. It was actually such an educational episode and I felt like it actually made me a better supervisor to my staff and a better educator as well. You’re going to love this episode if you’re really wanting to understand and take the stigma out of increasing your care if that’s something that you need. 


That being said, I’m going to let you listen to Elizabeth’s amazing words, and I hope you enjoy this episode just as much as I did. Have a great day, everybody.


Kimberley Quinlan:  Well, welcome, Liz McIngvale. I'm so excited to have you on for two reasons. Number one, I really want to talk about giving people information about OCD treatment options, but I also understand that you can also bring in a personal experience here. Anytime, someone can share their personal experience, just lights me up. So thank you for being here.


Elizabeth McIngvale: Thank you for having me. I'm so excited to be here and yeah, I hope that both my personal but also professional kind of background in this arena might help guide. Some individuals who are kind of wondering what treatment do they need right now and and what does treatment for them look like


Kimberley Quinlan: Wonderful. Do you want to share a little bit about your history with OCD and your story as much as you want to share?


Elizabeth McIngvale: For sure. Yeah, I'll try to not take up too much time but you know, basically, I grew up here in Houston, Texas, where I'm from, and was diagnosed with OCD right around 12. I started showing lots of different symptoms prior on and off, but nothing that was disruptive nothing. That really would have warranted a diagnosis. I would do things like track the weather, or every time I read a book, I would start at page one because I didn't like the feeling if I picked up in between and things like that…


Elizabeth McIngvale: but nothing was really out of the norm normal in the sense that I was still doing okay. And academically you know, Relationship-wise and I was functioning well until I wasn't, you know, until my intrusive thoughts, got louder and the disruption became more and more severe. Here in Houston, we have the largest medical center in the world and we are known for our healthcare and so you would think access to good care would be really accessible, but unfortunately, it just wasn't and granted, this was a long time ago, almost 20 years ago but we really started searching for treatment here in Houston and, you know, I was lucky enough that pretty early on I got  a diagnosis and for most of us in the OCD world, we know that that's rare for it to happen that soon. So that was great. That was a huge blessing for me, however we couldn't find good treatment. Every provider would say things l

Depression is a liar. If you have depression, the chances are, it’s lying to you too. 


Depression is a very, very common mental health disorder, and it tends to be a very effective liar. My hope today is to get you to see the ways that it lies to you—the ways in which depression lies to you, and gets you to believe things that are not true. 





I believe that this part of depression, this component of managing depression is so important because the way in which depression lies to us, impacts how we see ourselves in the world, how we see the future, how we see other people, how we see our lives playing out. And that in and of itself can be devastating. 


Today, I want to talk about, number one, the ways in which depression lies to us and what we can do to manage that. Let’s get going. 


THEMES OF DEPRESSION


Before we start, let’s talk about the themes of depression. Now, the way it was trained to me is that there are three core themes of depression. The first one being hopelessness, the second one being helplessness, and the third being worthlessness. It will often target one, some, or all of these themes. Let’s go through those here and break it down. 




DEPRESSION LIES ABOUT THE FUTURE

This is where it can really make us feel very hopeless. Depression says your future won’t be good. You won’t amount to anything. You won’t be successful. You won’t have a relationship if that’s important to you. You won’t have kids if that’s important to you. It often will target the things that we deeply value and it’ll tell us you won’t get those things or you’ll be doing those things wrong. Or in some ways, something bad will happen. When it targets the future, that is often when we begin to feel very hopeless. When we think about the way the human brain works, our brain does things right now, even things it doesn’t want to do, knowing that it’ll get a benefit or a payoff or a wonderful, joyful result. But if your brain is telling you that the result is always going to be bad, that’s going to create an experience where you feel like there’s no point. What’s the point of doing this hard thing if my depression is telling me the future is going to be crummy anyway? What we want to do is get very skilled at catching it in its lies about the future. 


DEPRESSION LIES ABOUT THE PAST

Depression will tell you, you did something wrong. You’re terrible. That thing you did really ruined your life or ruined somebody else’s life, or is proof that you’re a bad person. Depression loves to ruminate on that specific event or an array of events. What we end up doing is cycling and gathering evidence. This is what depression does. It gathers evidence to back its point. What we end up doing is instead of seeing the event for what it is, which is both probably positive and negative, depression likes to magnify all of the things that you did wrong or that didn’t go well. And then it wants to disqualify the positive. Often patients of mine with depression will say, “Oh, I’m a terrible person. I did this terrible thing,” or “I made this terrible mistake or accident.” I’ll look and say, “Okay, but what about the other times where maybe you didn’t make a mistake and so forth?” They will disqualify that as if it means nothing to them. It does mean something to them, but often the way in fact depression functions is it keeps you looking at the negative. And that’s how you get stuck in that cycle of rumination on the negative—feeling worse and worse, feeling more shame, feeling more guilt, feeling more dread, feeling often numb because the depression is so, so strong. 


Now, this is where I’m going to offer to you to reframe things a little bit and look at helplessness. Depression will also tell us: “There is no one who can help you. There is no amount of support that can help you. You’re helpless.” Often when people come to me