0:00

Hey everybody, a really good episode for you

0:02

today. Very interesting question. I'm just doing one

0:04

question today, but it has some depth to

0:06

it. The primary purpose of

0:08

the question is to ask about agoraphobia,

0:10

which is essentially a fear of being

0:12

outside your house or outside your safe

0:14

space. But the person who

0:16

asks, I think has some errors

0:19

that are happening in their therapy. And I talk

0:21

about some of the mistakes that their therapist may

0:23

be making and how to correct those. And

0:25

we also talk about another layer of the

0:27

whole situation, which is that they have MS,

0:30

multiple sclerosis. So we talked about the

0:32

way that impacts the brain and how that can be

0:34

impacting the anxiety part as well. So

0:36

very deep stuff, but I think super

0:38

interesting. And I hope you

0:40

enjoy. This is the hardcore

0:42

self-help podcast. I'm

0:53

your host, Dr. Robert Duff. I'm a

0:56

clinical psychologist and a self-help author from

0:58

Southern California. My goal is to

1:00

make mental health content for real people, just like

1:02

you. And in this show,

1:04

I answer your questions or dive deep

1:06

into topics related to life, psychology, mental

1:08

health, relationships, and more. Please

1:10

be aware that sometimes I use some spicy

1:13

language and I also don't shy

1:15

away from sensitive topics, but I will try to

1:17

give you a content warning whenever it's relevant. So

1:20

if all this sounds good to you, let's get started.

1:22

All right, hello, friends of

1:24

all varieties. This is episode 395. Thank

1:27

you for joining me today. Don't forget, you

1:29

can get the show notes for this

1:31

episode at duffthepsych.com/episode 395. And

1:34

if you want to send me a question, now

1:36

is a great time to do so. You can use the contact form on

1:38

my website or email duffthepsychgetgmail.com.

1:42

Either one is good. I wanted to let you know

1:44

I am in the midst of going through sort

1:47

of my like career transition readjustment with

1:51

my day job stuff. So some

1:53

things may end up being in flux

1:55

a little bit in the coming weeks. I'm kind of

1:57

getting my official start in that. Me

2:00

first so you know if I end up

2:02

like disappearing for he a week and announced

2:05

or something you know gets kinda screw in

2:07

the interim just know it's because of that

2:09

and probably gonna third just sort of when

2:11

I tend to record and things of that

2:13

sort. I also have been putting some serious

2:16

or into whether I might be interested in

2:18

starting to do interviews on the show again.

2:20

If you're a long time listener you know

2:22

you know when a them. Not

2:24

when I started. Earlier in

2:27

the podcast I had guess on

2:29

all sorts of guess from therapists

2:31

talking about you know, trauma to

2:34

influencers to doctors talking about specific

2:36

treatments, etc. even people who have

2:38

been through specific treatments. So is

2:41

something that I did enjoy in

2:43

the past and it became very

2:45

very hard with my life and

2:48

kids and things like that to

2:50

find space and time and everything.

2:53

Events. But I'm feeling

2:55

like me, me now. I can get back

2:57

into it a little bit, but I'm wondering if

2:59

that would be interesting to you guys and so

3:01

have you been listening for a while? or

3:03

if you're new. Feel

3:06

free to shoot me any of your thoughts

3:08

about that through email or on social media

3:10

Anywhere Am just about the idea of potentially

3:12

getting back to doing interviews. I would still

3:15

be doing you know to in A and

3:17

Deep Dives and Sas. It would just be

3:19

in addition to those things. On

3:23

have to suffice to free the you know, shoot me

3:25

a message or email you have any opinions about it.

3:28

But yeah, isn't that? Let's go. Hadn't just get

3:31

into the ocean and a gun free today. Here

3:33

goes: It is a little bit longer, so bear with

3:36

me on this woman. It's a really good question though.

3:38

So it reads: had not enough. I've written

3:40

in before and you've been so helpful. I

3:43

have a question about my agoraphobia. I didn't

3:45

go off of it for about four years

3:47

now. I do not leave the house except

3:49

for it infusion at the doctor every four

3:51

weeks. I have M S which was. I've.

3:55

Been doing this for about ten years. I'm thirty

3:57

nine in able to do it as far as

3:59

leaving the. Otherwise, I can write in

4:01

the car, I don't drive anymore, I get

4:03

too anxious and I can walk outside to

4:05

get my Mil alone. My question is I've

4:08

been working on this problem for the last

4:10

three years I'm in therapy. I'm on anxiety

4:12

meds, been through many of them with no

4:14

help. Annecy, a psychiatrist. I've tried to go

4:16

into a store a few times but I

4:18

get panic and run out. My therapists wants

4:21

me to get to the door that leave,

4:23

then go a little further, may be inside,

4:25

then leave, etc. but I'm just to embarrass

4:27

when people see me do this. I really

4:29

thought one medication. Xanax would help the at least

4:31

go for a walk to my mom's house or

4:34

to my primary.for visits but I just can't seem

4:36

to do it. Is. There anything else

4:38

I can deal with. therapist is great.

4:40

it's more me that's the problem. not

4:42

doing my homework or maybe not trying

4:44

hard as I used to. I target

4:46

become too comfortable with my or phobia

4:48

as a thing and embarrassed to say.

4:51

How can I get motivated again? I did with my

4:53

boyfriend for thirteen years and he basically takes care of

4:55

me in doesn't push me but he does praised me

4:58

when I get the mail or go for a car

5:00

ride. I still horrible that I'm

5:02

this way. I was not before I developed

5:04

a lesion on my amid. They.

5:06

Wrote and mcgill up but I think the

5:08

mean the migdal up smelling question marks or

5:10

near it and became anxious overnight in it

5:13

has gone horribly worse since it started and

5:15

I had an M R I. Was

5:18

there any hope for my anxiety? since is

5:20

because something physical dc getting a much better

5:22

in of so any of us to be

5:24

appreciated. Think so much. Okay

5:27

yeah so a lot of stuff here obviously

5:30

bit longer question but i really like this

5:32

question so on and tell you know give

5:34

it its do it it's time and think

5:36

is reading it in in. Just.

5:38

Let everybody know you know to be

5:41

getting you said and you have a

5:43

question before and. It's. Toll the

5:45

okay if you want to write in

5:47

additional questions if you've written into the

5:49

show before and you wanna read another

5:51

one still free, you know I don't

5:53

really remember who has written why, so

5:55

I'm sure that authority answered multiple questions

5:57

for. The card. The

6:00

question rather than for Santana. So if that's

6:02

ever held you back for sending an additional

6:04

questions, let it rip. The free. Getting

6:08

to the question. I have talked

6:10

about the gore phobia fairly recently

6:12

on the show, but it's essentially

6:14

an anxiety disorder that involves fear

6:16

of being and places are situations

6:18

where escape may be difficult or

6:20

embarrassing or were help may not

6:22

be available to you if you

6:24

were to have a panic attack

6:26

or of medical A at So

6:28

is feeling of being stuck in

6:30

not having a good escape. Often

6:32

it is related to panic attacks.

6:34

Are you sexy? Group them diagnostic

6:36

li like panic. Disorder with Agoraphobia without

6:39

agoraphobia. But yeah we know that it

6:41

can be more than that. Now as

6:43

of Friday things are talk about that

6:45

but it is very linked to panic

6:48

because it's at same sort of thing

6:50

where think about the place where you

6:52

would not want have a panic attack

6:54

right? Some a refill exposed and vulnerable

6:57

in unsafe in that's basically the just

6:59

a foot or a phobia feels like

7:01

any can lead you to avoid a

7:03

lot of things and crowded are in

7:06

close spaces like a bus or. You

7:08

know, going into an unfamiliar house or store

7:10

On the other hand that avoidance my also

7:13

include wide open spaces, rates of your ass,

7:15

Silicon music festival or something like that. Where

7:17

this no place for youtube or it feels

7:19

like there's no place for you to escape.

7:21

same sort of feeling they're. Agoraphobia

7:25

can happen for a variety of reasons,

7:27

and he could definitely build up gradually,

7:29

but I think it's most often triggered

7:31

by something like a panic attack or

7:33

a physical issue or traumatic event. Something

7:35

that's a big and and activating event

7:37

that happens when you're out and. So

7:40

for example would say that you were out shopping and

7:43

you're by yourself over the holidays and you're at the

7:45

mall and then you had a panic attack and you

7:47

felt really really bad. He saw, yeah, everybody was looking

7:49

at you. He felt like you're going to lose your

7:51

mind. You didn't know what to do. You are sweating.

7:54

And you know either you got through

7:56

it barely or you had to run

7:58

an escape and. Rates. Of

8:01

blood say that happened in than ever. Since

8:03

then that circle of comfort in terms of

8:05

getting away from house cats are smaller and

8:07

smaller. I'm in. Same thing that happened was

8:09

he were walking around in the neighborhood, assaulted

8:12

by somebody or sexually harassing some sort of

8:14

way. Seems had a saying that my make

8:16

your comfort zone get smaller and smaller are

8:18

making us to be triggered by something unrelated

8:21

right? Like if there is a terror incident

8:23

or you lost a loved one in that

8:25

just really really hit you while you were

8:27

out and doing things while your own. Is

8:31

a lot of different things that can

8:33

lead to agoraphobia, but the crux of

8:35

it is avoidance. Rate. With agoraphobia,

8:37

you have this feeling of anxiety in

8:40

thread in these public scenarios where your

8:42

body is telling you that something ads

8:44

gonna happen. And then you

8:46

listen to on a you say oh

8:48

wow on the that inhabit would avoid

8:50

that. See you in

8:52

of avoiding scenarios where there may

8:54

very well not be any actual

8:56

danger. But. You listen to your breeze

8:59

Q telling you that there is danger. So

9:01

when you do that, when you take that

9:04

advice from your anxiety, it makes things

9:06

a stronger. You know, mention

9:08

a circle of comfort getting smaller and

9:10

smaller moment ago And that's actually something

9:12

that does happen here where you have

9:14

a vicious cycle where the anxiety leads

9:16

to avoidance. Which. Can make seems Id

9:18

worse went and leads to more avoidance in

9:21

Ceylon. Great! It's kind of like the flipside

9:23

what happens with depression where your house in

9:25

of low motivation or low energy and then

9:27

you start doing less and that makes you

9:29

more depressed which makes you less motivated and

9:31

so on and so on. So it's another

9:33

one of those shitty vicious cycles. Obviously,

9:36

I'm simplifying a bit. Here is a

9:38

lot more to agoraphobia than just what

9:41

I'm saying. You know, genetic factors and

9:43

social anxiety can also play components, but

9:45

I do want to emphasize the fact

9:47

that can really, really disrupt. it

9:50

can impact her ability to go to

9:52

school or go to work to get

9:54

appropriate medical care of it can make

9:56

it difficult to engage with ease outdoors,

10:00

socializing with other people. Most

10:03

people that have agoraphobia are very frustrated

10:05

with their limitations. It's not like they

10:07

want to be this way. It's limiting.

10:09

It's really hard. So,

10:11

you know, if you don't have agoraphobia or

10:13

you've never really encountered it, please pay attention

10:15

to the way that, you know, the person

10:17

who wrote in this question explain

10:20

their limitations. They don't leave the house except

10:22

for once a month for an infusion for

10:24

their MS. They can

10:26

get the mail alone. They can also ride in the car

10:28

with somebody else but not drive. That's

10:30

basically the extent of it. So,

10:33

you know, luckily we live in a world where there's still

10:35

a lot of life that you can live from

10:37

the confines of your home when it comes

10:39

to interacting with other people virtually, getting

10:42

things delivered, etc. But

10:44

regardless, this is a serious limitation that

10:46

just fundamentally changes the way that somebody

10:48

lives their life. So

10:52

all that said, it's worth taking seriously.

10:55

I want to go into the nuts and bolts

10:57

of things here but let's take a quick break

10:59

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Swords get into it was we're actually

12:23

asking am I did email to confirm

12:25

that you're already in my online course.

12:27

We do talk about exposure worked extensively

12:29

in there, so it may be worth

12:31

going back to have again for refresher

12:33

if it's been a little while. And

12:36

he do. You said that your therapist is great

12:38

which is awesome and who can be really hard

12:40

to find somebody that you trust? something that you

12:42

get along with some a that seems to understand

12:44

you. But. I'm

12:46

wondering if they really specialize in

12:48

anxiety disorders like this because I

12:51

hear some errors in their approach

12:53

and this is not a knock

12:55

on them, right? This is actually

12:57

one of the most common errors

12:59

that I see regarding exposure work,

13:01

but. Nevertheless, it is something that

13:03

you know I don't think is totally

13:06

correct. So the method of going to

13:08

the door of the grocery store and

13:10

you know sort of getting there are

13:12

touching it than leaving his accent Something

13:14

that may be more likely to make

13:16

your anxiety mass better. If

13:19

you think about it right, you know you're gonna

13:21

go to that door you're going. Are you going

13:23

to touch it? Or you're gonna get there in,

13:25

open it, and then exit in so you're building

13:27

up in your mind that. Anxiety, that

13:29

anticipation, the hallway, their anxieties. Raising your

13:32

body's telling you this is a bad

13:34

idea. You shouldn't do it happened. You

13:36

can be embarrassed. You're gonna see somebody

13:38

that you know Camilla do it. Whatever

13:41

in it builds and builds and builds

13:43

post. He

13:46

go it hasn't door and then what do you

13:48

do you put away he bought her coast. So.

13:52

that essentially reinforces the idea that there was

13:54

something dangerous about going to that or in

13:56

first place right because you don't stay there

13:58

you don't linger You get it done and

14:01

you run away. So that's building it up. And

14:03

in a certain way, you're giving that act of

14:05

getting to the door more credit than you need

14:07

to. Not to say it's not an

14:09

accomplishment, but it's building it up to be something more than

14:12

what it is. Another

14:15

issue here is that the

14:17

store going to the grocery store seems to be

14:20

way outside your mastery level with

14:22

agoraphobia, right? If you can't go

14:24

further than the mailbox in your own neighborhood, the store

14:26

is like going to ultra hard mode. So I don't

14:28

see that being a really good place for you to

14:30

be focusing right now. So

14:33

what should you do instead? The error

14:35

that I'm alluding to is duration, meaning

14:37

the length of it. Exposure

14:40

sessions, especially for agoraphobia, should be

14:42

prolonged. I'm talking like 30 minutes,

14:46

which is a long time, but there's a

14:48

reason for it, right? You don't want a

14:50

quick burst of anxiety followed by relief. You

14:53

need to give your body time to work

14:55

through the anxiety. You want it to start

14:57

to come down naturally and you need to

14:59

prove to your body that the danger that

15:02

you're imagining isn't real. It's not relevant. So

15:05

instead of doing that boom quick burst and

15:07

then followed by running away from it, you

15:09

need to sit with it and let it take its course.

15:13

An example, let's say that you have a cold

15:15

pool, right? A cold swimming pool and you jump

15:17

into it and then you immediately come up. Like,

15:20

okay, I'm done. Like technically,

15:22

yeah, you did the thing. Okay. So

15:26

you didn't get any better at tolerating the

15:29

cold pool, right? You didn't get any

15:31

better at tolerating it. So instead,

15:33

if you weighed your way in gradually and then

15:35

you stay in the pool for an extended period

15:37

of time, your body starts to acclimate

15:39

to it and you actually can

15:42

enjoy yourself in that pool eventually once you're

15:44

used to it. So same

15:46

thing here, right? We don't want that hit and back

15:48

off. We want to get used to it and get

15:50

better at it. There's

15:53

also a whole structured protocol for this. The

15:56

first thing you want to work on is

15:58

self-regulating strategies for your anxiety. coping

16:00

skills so that you can endure you

16:02

know a moderate amount of anxiety without

16:04

having to run away without having to

16:06

avoid and so learning those

16:08

fundamental skills whatever they might be for you

16:11

sets you up to succeed when you go

16:13

into this those exposure exercises right you're not

16:15

going in there without any tools. So

16:18

first you do that much like if you're

16:21

doing EMDR right you don't start with the

16:23

you know actual recollection of trauma you start

16:25

with the coping skills so that you can

16:27

handle that later on. So

16:30

after you get those skills and that

16:32

ability to self-regulate then you need to

16:34

consider what your starting point is and

16:36

if we're talking about a scale from 1 to

16:38

10 where 10 is the most severe anxiety we're

16:41

looking for say a 6 or so something that's

16:43

uncomfortable for sure and a challenge but

16:46

not impossible for you not totally unapproachable.

16:49

The grocery store for you sounds like probably a 9 or

16:51

a 10 which is why you're not even able to

16:53

do it. So let's say

16:56

that checking the mail is a

16:58

4 for you right on a 10 on a 0 or

17:00

1 to 10 scale it's a 4. So

17:02

that's manageable you're able to do it it's not the

17:04

most comfortable thing but you can. What

17:07

about walking around the block or walking

17:09

down the street and back? What

17:11

would that mean? You said that walking all

17:13

the way to your mom's house is too hard so that

17:15

would probably be 8 9 something

17:17

like that so maybe walking around

17:19

your block would be something like a

17:21

6 walking up and down the street 6

17:24

out of 10. If you find that

17:27

sweet spot then what you want to do is spend extended

17:29

periods of time doing that right don't treat it the

17:31

same way as what we were just talking about with

17:34

the door don't walk to the end and then run

17:36

back spend 20 to

17:38

30 minutes walking around the block and

17:40

it's not going to be comfortable but it will get

17:42

more comfortable right and that's gonna allow your body you're

17:45

gonna have to trust a little bit and that's gonna

17:47

allow your body to go through the natural progression of

17:49

things and then you

17:51

know you keep doing this and once you're able

17:53

to reliably reduce that anxiety by half

17:55

right if we're talking about that new miracle

17:58

value from the 6 down to 7 say

18:00

a three, halfway, you're not halfway, but

18:02

you know, throughout the duration of the exercise, then you're

18:04

ready to move on to the next step because that's

18:06

not a challenge for you anymore. So

18:09

it's gradual. And again, if you need a

18:11

step-by-step guide on this, including an example of

18:13

how you develop that hierarchy and that step-by-step

18:16

protocol with the values and stuff, check out

18:18

the online course. It's

18:21

kickingzydicourse.com. So

18:24

that's one thing, right? The duration. Another

18:26

common error that I see is frequency. And

18:29

this is the part where, you know, you really need to

18:31

show up. Now, you mentioned that you

18:33

feel like, per, this is your fault, like you're not

18:35

doing your homework. Yes

18:38

and no, right? Like, it does take commitment and

18:40

fall through on your part, but if

18:42

the task that you're trying to do is just too

18:44

challenging and you're not able to approach it, that's

18:46

not really on you, right? It's not your fault. Like, you

18:48

don't know how to do this stuff. That's where the experts

18:50

are supposed to come in. So

18:52

if you're able to find an approachable starting

18:54

point, then that does go on to

18:57

you a little bit to try to find some motivation

18:59

to push and keep pushing. And

19:01

what you're going to do is you're going to keep

19:03

doing that exposure as often as possible for those longer

19:05

durations that I mentioned before. So

19:08

let's say it's walking around the block 20 minutes per

19:10

day, almost every day of the week. That's

19:12

really what's going to get that needle to move, right? It's

19:14

going to be pretty shitty the first time. You

19:17

know, you're maybe able to do it, but it's uncomfortable. Maybe

19:19

you're going to stay at that six. And it's not going

19:21

to come down very much, but you keep

19:23

doing it and keep doing it. And eventually it's not going

19:25

to be as big of a deal for you. And then

19:27

you're ready to step it up a notch. You

19:31

also asked if you can get too comfortable

19:33

with your agoraphobia. Like,

19:35

I don't like that phrasing, you know, because it

19:37

makes you sound lazy and that's definitely not the

19:39

issue. But agoraphobia is

19:41

self-reinforcing, right? It is more comfortable

19:44

to be at home. It is

19:46

less exhausting and scary and just

19:49

doesn't put you through the wringer as much to stay home

19:51

instead of trying to do all these things. Everything

19:54

is difficult for you outside. So,

19:56

you know, yeah, it can be very tricky to

19:58

find the motivation to push against the this

20:01

when you're asking yourself to actively invite

20:03

discomfort into your life. So

20:05

I don't blame you for that. I don't blame you for

20:07

this at all. That's why it's a mental health disorder. It

20:10

sucks. But there is hope,

20:12

right? There's a different approach here. There are

20:14

different ideas and you're not hopeless. I

20:17

also want to point out you have a medical

20:19

aspect of this, right? And yours is actually a

20:21

really great example of how agoraphobia can start with

20:24

a physical trigger. Let

20:26

me briefly mention, you know, MS because not everybody

20:28

is totally aware of what it is. So

20:31

MS is multiple sclerosis and it's

20:33

an autoimmune disease that breaks

20:35

down and damages the what's called myelin

20:37

sheath, which is basically the fatty substance

20:39

on the outside of your neurons. And

20:42

that allows the nerve signal to travel more

20:44

efficiently, right? So that's the way that nerve

20:47

signals travel very quickly is because

20:49

that myelin sheath helps it kind of jump

20:51

from node to node. Don't need

20:53

to get that far into it. But basically, it helps

20:55

with the efficiency of how your neurons fire. So

20:58

with MS, the body, it's an autoimmune

21:00

disease that attacks that myelin and

21:03

that can cause all sorts of problems depending

21:05

on where the damage is. They call those

21:07

lesions, right? So wherever the lesions are, it

21:09

can cause muscle weakness. It can

21:11

cause vision problems, numbness, certainly

21:14

mental health things or memory things. It can

21:16

cause all sorts of different symptoms. So

21:20

what you're describing is that for you, your

21:22

brain MRI, so the brain scan showed a

21:24

lesion on your amygdala. That's

21:27

part of your deep brain,

21:29

your limbic system, which is

21:31

the part of your brain, the amygdala that is,

21:34

it's the part of your brain that's responsible for

21:36

initiating the fight or flight response. And

21:39

it's very closely tied to anxiety. I often call it

21:41

kind of the push button of anxiety. When

21:44

something is alarming, the amygdala goes, boom,

21:46

hey, there's danger here. And

21:48

it's up to the rest of your brain to figure out what to

21:50

do with that. So if

21:53

you have a lesion on your amygdala,

21:55

your body may be overreactive and oversensitive

21:57

to those anxiety cues. So

22:00

once this lesion developed, you probably started feeling

22:02

a lot more just generalized anxiety, which then

22:04

made it more difficult to stand being in

22:07

these public spaces, especially if

22:09

you already had, you know, an inkling of social

22:11

anxiety or any of those sort of genetic vulnerabilities

22:13

we were talking about. And

22:15

then from there, that cycle of avoidance

22:17

plays out until eventually it gets to

22:19

this point where we have full-blown agoraphobia.

22:23

Your question though was, can you do anything about this?

22:25

Since it's a physical issue? And the

22:28

answer is yes, absolutely. You definitely can.

22:31

You certainly are though at a bit of a disadvantage.

22:33

I'm not going to lie about that. If you do

22:35

have a lesion on your amygdala that's making you more

22:38

reactive, it puts you at a

22:40

disadvantage compared to people that don't have that. But

22:42

it certainly does not mean that you're hopeless. In

22:45

fact, even taking the agoraphobia out of it,

22:48

it may even be more essential

22:50

for you with this particular issue

22:52

to be engaging in things like

22:54

relaxation techniques, you know,

22:56

movement like yoga, meditation, other

22:58

types of physical activity. Even

23:01

things like neurofeedback do have some modest

23:03

research support for this. The

23:05

idea would be to, you know, work

23:07

on your relaxation response

23:09

and over time actually teach

23:11

your amygdala to be less

23:13

reactive. And you can do that.

23:16

You can decrease the reactivity of your amygdala. It's

23:19

been shown when you have something like

23:21

say PTSD or other forms of chronic

23:23

anxiety, your amygdala can actually grow in

23:25

size and become over reactive.

23:27

And the opposite can happen when you do

23:29

things like these interventions that I'm talking about.

23:33

You said that medications aren't very helpful. That's

23:35

somewhat common, right? You know, we're talking

23:38

about more than just generalized anxiety here.

23:40

So it can be really hard

23:42

to find medications that do the trick for

23:44

you, especially if it's, you know, it doesn't

23:46

matter how much sedation you have, you're still

23:48

going to run into these issues with the

23:50

agoraphobia. But there are other

23:52

avenues as well, like TMS, transcranial

23:55

magnetic stimulation that does have some

23:57

research support, ketamine, which can

23:59

be done. that home now so that's that's a

24:01

whole other ball game for you since you could do that

24:03

from home if you wanted to and

24:06

all of these are options to cope and

24:08

reduce that hyper reactivity of your amygdala but

24:11

really the biggest impact is going to come

24:14

from that exposure work that we've been discussing.

24:16

When it comes to your boyfriend that's

24:18

a tough one right on one hand it's nice to have

24:20

him be a safe person to just be a loved one

24:22

you know you don't want to get mad

24:24

at him because he's trying to push you too hard and so

24:26

to keep those things separate can be good. On

24:29

the other hand sometimes that can veer into kind

24:32

of enabling behavior where he's you know

24:34

not by any fault of him just

24:37

because he cares about you inadvertently reinforcing

24:39

your anxiety by helping you avoid

24:41

things. So what

24:43

I would suggest is start with the clinical

24:45

part right so first nail down a solid

24:48

plan for recovery that can be with your

24:50

therapist or you can find another specialist that

24:52

works more closely with anxiety disorders but

24:55

you're gonna want to develop that hierarchy, build

24:57

those coping skills, make a plan of attack

24:59

and then you can discuss this with your

25:01

boyfriend and you can be clear that

25:04

you know you don't need to be anything other

25:06

than my boyfriend I love you you don't need

25:08

to be my therapist you know these

25:10

are the goals that I'm looking at so maybe you

25:12

can give me a gentle nudge here and there and

25:14

remind me that this is what I'm working toward and

25:17

not be so quick to offer solutions and

25:19

things that just sort of save me from

25:21

the situation. You

25:23

know it's not gonna be perfect there's no perfect answer

25:25

here but I think that he could be a really

25:27

good team member obviously the praise is

25:30

great and I'm happy that you have somebody who

25:32

is such a solid person on your team but

25:34

if you do need him to be a little bit

25:36

less enabling it's totally okay to talk about that and

25:40

I think given the fact that he's you

25:42

know been here for the ride he's been

25:44

good to you he could actually be very

25:46

helpful and encouraging you and reminding you that

25:48

you're pursuing these exposure goals. So

25:51

I hope that these thoughts are helpful to

25:53

you I hope this isn't just pure review

25:55

even if it is some things you know kind

25:57

of get lost in translation so maybe this clears

26:00

it up a little bit. I do not want

26:02

you to give up hope. Even though this has been

26:04

a serious wrench thrown in your life, there's definitely a

26:07

possibility that you can have more freedom

26:09

to move about your life in the future. So

26:12

best of luck to you. Feel free to shoot

26:14

an email back if you have any questions about,

26:16

you know, terminology that I used or anything like

26:18

that, but best of luck. And

26:21

that's it guys. Just doing this one question today. Thank

26:23

you so much for listening. Take care of yourselves out

26:25

there and I'll see you for the next one. Thank

26:32

you so much for joining me in this episode.

26:34

If you would like to send a question or

26:36

a topic for a future episode, please email me

26:39

at depth of psych at email.com. If

26:41

you like my approach and would like to learn

26:43

more about my books, online course or other resources,

26:45

please head over to my website at depth of

26:47

psych.com. And lastly, it would mean

26:50

so much to me if you would leave a review

26:52

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26:54

share an episode with a friend. Until

26:56

next time, you got this.