Anxiety Unpacked

We are joined this morning with Noelle McCord Aquino, who is a psychotherapist who's been practicing for 30 years in Chicago. She specializes in, um, treatment of anxiety disorders and has actually developed a unique framework for understanding and treating anxiety. Anxiety. I am so excited to hear about this and share your model with our guests.

She also is a licensed continuing education sponsor and she trains mental health professionals and she teaches this models to therapists and uses it, uses it in her work with clients. She writes a blog called unpacking anxiety for psychology today. com and she is writing a book soon to be released about this model.

Beyond her professional experience, Noelle is a mother of a young adult son who lives with generalized anxiety and obsessive compulsive disorder for most of his life. So she's got a lot of experience in this whole world of anxiety and I can't wait to dive deep with this Noelle.

Hi. Thanks, Andrea.

Noelle, what, I think there's a lot of confusion that goes along with anxiety. Is anxiety a normal response to things that make you nervous? When does it become an issue? Can we start off with kind of a generalized overview of what anxiety is?

Absolutely. And that's a great question because anxiety is a normal emotion to have. There's no human being who doesn't experience anxiety. And it has a very important and useful purpose for us. It's, it's wired into our DNA and it is part of how we keep ourselves safe and keep ourselves alive. So if we just look at it from a very neurobiological perspective, um, There is a very primitive part of our brain.

It's called the amygdala, whose only job is to look for signs of danger. And when it detects danger, it automatically releases hormones into our system. And this is an automatic response that we cannot interrupt because if we truly are in danger, we don't want to interrupt it. We want it to do its job and it releases. hormones into our system, including epinephrine, which turns into adrenaline. And that really fuels our body to go into either fight or flight. So if we're in danger, we all talk about the fight, flight, or freeze response. And we need fuel for our body to either fight off danger or to flee from it. So we get an accelerated heart rate, which pumps blood more quickly to our extremities so that we get blood to them to fuel them to either fight or flee. Our breathing becomes more shallow so that we're also getting more oxygen to our limbs. Um, a bunch of other things that we associate with anxiety happens. Our digestion shuts down because it is considered a non essential function if we are in danger and our body is really trying to reserve all of our energy for our survival.

So all those digestive issues that people feel when they're anxious comes from this process. Um, our select lens get activated. Um, the flushing that can happen with anxiety or shaking is that excess energy that gets created that we may not be using. So all the symptoms of anxiety that we experience are directly related to this activation into fight, flight, or freeze response.

It's our sympathetic nervous system. And it's really important in lifesaving when we are in danger, um, where it becomes a problem is when that system gets activated when we are not in danger or it gets activated in a disproportionate way. So one of the things that I talk about is that the system that is really. Very sophisticated in many ways has one really significant flaw, and that is that it cannot tell the difference between a danger that's real and one that our mind perceives. And so as long as our mind perceives a danger, our body will respond exactly the way that it was designed to do. So for people who suffer from anxiety, meaning that it's a regular part of their life that they experience these, you know, sort of anxious responses or these persistent worries in situations where there is no danger. Um, that is because there are habitual ways that their mind is perceiving danger that doesn't exist.

Now is this a Learned behavior or is it something that's triggered by an imbalance in your system of some sort if they have an anxiety disorder?

Both. I mean, it could be either. I mean,

so, you know, I don't think anybody has the clear cut answer for each individual as to why a particular person has anxiety. There are a multitude of factors that we know go into it. One is biological. So some people's biology is just wired towards more anxiety. And I think about that for my son because I can. think back to him being a baby and see signs that, you know, he just liked to be held a lot. He needed a lot of soothing. So there are people who do come in with a biology that is, is more leaning towards anxiety. Um, there are environmental factors that can contribute to that. That can be the family environment that you're raised in.

So if you, um, and I mean, there's a multitude of circumstances that can create

anxiety. But if you grow up in chaos or, um, you know, unpredictable environments that can create anxiety. If you grow up with a parent who is anxious, you can absorb and learn those anxious behaviors. So it can become more of a learned and conditioned response. Um, if you are in situations where, um, There is trauma in your background, um, that does rightfully activate that fight or flight response. Um, and you don't get enough of the supportive elements that help. You to return to a state of calm. Um, that can also keep you in an activated state in a, in a long-term circumstance.

So there, there's a multitude of factors. There are societal factors. Also mean people who are, um, you know, people who grow, who are in more sort of marginalized, um, groups or disen disenfranchised groups. Environmentally, they're experience, you know, they're exposed to more cir circumstances that would activate anxiety.

So. Lots of factors that go into it. And I don't think that there's any one clear cut reason

why a person is, is anxious. And it's a good, you know, thing to be curious about and to explore for each person as to, you know, if they notice that they are anxious to be really curious about what are all the contributing factors for that.

Well, and then on the top of it, we all perceive things differently, too. So we look at things from a very different standpoint. So what may be a threat to somebody else or to somebody may not be a threat to somebody else. And so the response system is going to be a little different, right?

That's exactly right. So, you know, when we talk about, you know, when we talk about trauma and, and trauma is not always a part of anxiety, but it. It is often a factor in anxiety. You know, we define trauma as an event that is overwhelming to you. So what is overwhelming to you is not necessarily going to be overwhelming to somebody else.

And, and so there's definitely very individual, you know, aspect to that and, and sort of your own resilience and, you know, just sort of your own level of overwhelm with whatever the circumstances are.

Now, To make anxiety even more complex in the fact that it's one, it is a normal response to some situations, it can be an anxiety disorder, but then on top of it, there are multiple types of anxiety disorders. Is that correct?

There are, yes. I mean, so if we look at diagnosing anxiety disorders, there are a multiple, you know, there's generalized anxiety disorder, there's obsessive compulsive disorder, there's panic disorder. I mean, there, there's a number of different, you know, social anxiety disorder. There's a number of different, um, sort of categories or diagnoses for anxiety.

Okay. So let's talk a little bit. Now we're going to pivot to your model because I think that is kind of going to be the crux of what we talk about here. Why don't you lay out the baseline for your model and then I'll start digging in and 

Yeah, absolutely. Um, so I'll, I'll start with where it came from and you know, where, where it came from is when I started my career as a therapist, I found myself immediately drawn to working with clients with anxiety. And at the time didn't really know why, because I personally don't suffer from an anxiety disorder, though I certainly know what it is to be anxious.

I have plenty of experiences of that myself. And when I started out working with clients, I quickly felt, um, not sufficiently skilled in helping them with their anxiety. So I sought out a lot of training early in my career on, you know, different models and approaches to working with anxiety. And what I found was that everything that I studied was valuable and had something, you know, to offer in the treatment of anxiety. And everything that I studied address certain aspects of anxiety, but there wasn't any one thing that felt like if I just do this, this will work for all of my anxious clients. So I acquired a lot of different approaches and a lot of different skills for working with anxiety. And part of Part of where this came from was just me trying to figure out for myself, which things do I use for which clients to best help them. Um, at the same time I was working with many clients with anxiety and I was hearing these repeated themes and patterns and the way that they were talking about their anxiety. So even though these clients, the details of their anxiety were completely different, even though their life backgrounds were different, their life circumstances were different. Um, their stages of life were different. There would be these common phrases, ways of describing their anxiety that I just kept hearing repeated over and over again across many different clients.

And 

matter the type of anxiety, whether 

it did not matter. 

Okay. So it was more of the response system and

And the way that they were experiencing it and the way

that they talked about it.

And so I started listening, really noticing that and. How I started to make sense of that was I began to think about that. They really were describing three different types or at root causes of anxiety. So within this sort of large umbrella of anxiety, they were, I was realizing that they're really describing three different. nuances to it in three different presentations of anxiety. And the more that I thought about that and worked with that, the more this really kind of became, you know, more fleshed out and clear to me. And what I noticed about each of them was that each has their own characteristics that makes it different than the other two.

So there's like these three root causes, which is really the, the root of the foundation of the model.

Um, so each has unique manifestations that make them different from each other. Each has its own underlying need that's seeking to be expressed through the anxiety that's different from the other. The other two.

So understanding that sort of root need or that motivation of the anxiety is really important. Um, each

has 

I just want to, I want to pause on that because I think that that is kind of the key right here. As you said, each one of the nuances has a unique need that needs to come out and that's what differentiates it between the other two types of, Oh, interesting. Okay,

Yes, and it's one of the most important things to know because when you understand what the underlying need is, then the way that you address it, the interventions that you use are the ones that best are catered for

that underlying need. So that's where sort of all the different training I did came into is like pulling from the different models and applying the one, you know, applying different aspects to that underlying need and the ones that would best. you know, really resolve it or address it. Each has its own objection or the way that the anxiety fights to preserve itself when challenged, as it always does.

So understanding that is also really important because those objections become really compelling ways to keep you tethered to your anxiety. So if you can, anticipate them and learn how to look for them and understand what they are that helps you move through them more easily. Um, and then as I said, each has its own solutions.

Um, So 

piece of it real quick, is that the piece, if I understand, so my, my daughter has generalized anxiety and um, and so does my son actually, but you know, some of the things we've been taught, taught over the years is to talk back to that or to question that. So is that the piece, those objections then are the piece that maybe aren't, um, real or they, they're, they're inflated in some, in some ways or distorted.

So what you're talking about is some of the distorted beliefs that get attached to anxiety

and understanding those and being able to challenge them can be a really useful way of, you know, managing anxiety. The objections is actually the way that each of these three types of anxiety tries to stay in control.

So when you, you know, when you challenge the anxiety, um, it's the way that it sort of fights back and says, no, you actually really need me. And, um, and, and I can explain as we

kind of get into this a little bit more what those what those are, because they each have their own, own way of doing that.

Did you see Inside Out, the second one? And, and how anxiety like fights for it. That's what I picture. I picture. I mean, they did such a phenomenal job in that movie. I thought of explaining what it is and how she's trying to justify her experience in the body.

Yeah, and the movie was fantastic and it did such a good job of addressing so many things about anxiety and just emotions in general.

And, you know, it really took a very compassionate view of anxiety

and recognize that it was really trying to help her, which, you know, You know, that, that's a really important frame to always view anxiety through.

That even though it's very painful, even though it's not helping you, always being curious about how it thinks it's helping is, is really important because it does think it is helping you in some way.

Um, if you, and again, if you go back to why we have anxiety, it's to protect us and keep us safe and keep us alive.

So anytime it's painful. you're experiencing anxiety. There is some part of you that thinks that that the anxiety is serving a useful purpose for you and protecting you.

Okay. Let's go back to these, these, these three different ones and that I want to dive deep into at least one of them so I can understand exactly the, the, how the model was developed in.

Yeah. So I can go through all three and

just, you know, give you a high level view of each one. Um, so the first one I'll just name what the three are first and I'll go through them one at a time. So it's catastrophizing

control and distorted beliefs.

I'm writing these 

what I have found is that any anxiety a person is experiencing can be traced back to one of these three routes.

And a person may, you know, I'll give this model to clients when I'm working with them around anxiety. Okay. And 100 percent of the time they're able to tell me when I give them just sort of the overview of the model, they're able to tell me exactly where their anxiety comes from, because people do recognize their own patterns when, when they hear, hear each one described. And, you know, you can have just one of them and not the other two, or you may say, I have two of those, but not the third, or I do all three. So these can show up in any combination,

um, for for a person who experiences anxiety. So the first one is catastrophizing, and this is where we're in a current situation and we create a, you know, future oriented story of disaster, catastrophe that almost always begins with the words, what if, so our mind immediately jumps to a story and it is always a story, um, of something bad that's going to happen as some catastrophe or bad outcome. But then we relate to that story as if it's a Um, so I'm going to talk a little bit about what is happening or what is likely to happen, and we get really caught up in the story and feel like we have to worry about it, we have to problem solve for it, the story feels like it's very real, when in reality, it is just a story.

So, anything that. It begins with the words, what if, um, everything that follows what if is a story. So this is people who they wake up with a headache and think, what if this is a brain tumor and I have cancer? Or, uh, they call a friend and the friend doesn't call back and said, what if they're mad at me and they don't want to be my friend anymore? Um, or. Your boss speaks to you in sort of a short and impatient way, and you immediately think, I'm going to get fired. So it's jumping to those worst case scenarios and, um, and, and then sometimes sort of really getting stuck in them and feeling like this is something real that I do actually need to worry about.

Okay. And what's the objection then? Okay. Okay. Yeah. And that 

So, yeah, so when you're catastrophizing, if you do the reality testing with, you know, because what you were describing with, you know, what you might do with your daughter's reality testing, is this fear real? Is that really going to happen? The objection is that it will come back and say, but it could happen. And so if you try to reason with those, those catastrophe stories, the objection comes back and says, but it could happen. And because something seems possible, because it's a possibility, it feels like something that I need to worry about.

And, you know, of course, the reality is, is anything is possible.

And, you know, there's no end to the things that are possible.

And we can't possibly relate to every possible outcome as if it is something that we genuinely need to think about and worry about. and problem solve for. Um, so with the catastrophizing, a lot of the work that we want to do with that is, um, to learn to be with what is not what if, and really bring your attention back to what do you actually know?

What are the facts? What's the story that you're making up? Um, The underlying need or the root that is behind catastrophizing is our discomfort with uncertainty. Uh, the human mind does not like uncertainty and you know, the neuroscientists believe that, um, you know, At one time back when we were, you know, cave dwellers, um, in prehistoric times, uncertainty did mean danger. If you stepped out into the unknown, you might meet a human foe, you might meet a predator. And so you had to worry about all the unknowns and try to prepare for them.

Um, but in today's world, and I always preface this, There are people who do live in today's world where that is true,

where that is something that they actually do need, um, you know, to be mindful of. But many people live in this, you know, discomfort with uncertainty when there are no real dangers that they're facing, um, you know, attached to that.

Seems like maybe our mind or our nervous system didn't evolve like the rest of us did.

Exactly. You know, it's a part of, yes, it's a part of our nervous system that hasn't evolved as, you know, our society has evolved, as our culture has evolved, as, you know, human life has evolved.

Okay. How about control?

Control. So there is a couple of elements to control. And the first one is sort of like the big picture. Um, You know, what we know to be true about control is that in any situation, there are always going to be things that are in our control, and there will always be things that are not in our control. Things that are not in our control are what somebody else thinks, what somebody else feels, what somebody else is doing, why they're doing something that they're doing. And then there are things like acts of nature. Governmental decisions and actions, um, societal, you know, there's societal factors. I mean, there, there's a multitude of things that are not in our control. The things that are in our control is how I choose to respond. Um, I never will say that how we feel is in our control. We feel what we feel. How we choose to respond to our feelings is in our control. The choices that we make is in our control. What we think about is in our control. How we engage with our thoughts is in our control. So there's, there are always going to be things in our control and not in our control. So one element of this is that for some people who have a tendency to overly focus or overly attend to the things that are not in their control, They're going to be anxious when, when, you know, a lot of our energy, whether that's mental, physical, or emotional energy is devoted to the things that are not in our control, either trying to change things that we don't have the power to change.

Like what somebody else is doing or, um, you know, what they think about something or where we expend a lot of the energy around, well, why do they think that, or how do I get them to, you know, think differently or feel differently? Or focused on, like, this thing that happened is so unfair. When we get stuck in focusing on what's not in our control, we will feel disempowered, we'll feel powerless, we'll feel victimized. And these are all things that can lead to us feeling anxious, um, as well as depressed. So, on a, on a really sort of big picture level, part of this is, what do you attend to? The things that are in your control, or the things that are not in your control. Of course, we want to always bring our focus back to what's in our control, and just come to a place of acceptance around the things that are not. Um, acceptance not being that I like it, that I think it's okay, um, but just simply that I recognize that it's something I can't change. Um, so I'm going to put my focus on what I can't change, what is in my control or in my sphere of influence. Um, so that's the big picture, but there's a couple of other elements to this that are more specific.

Um, and I would say it starts out with sort of a baseline feeling or belief of I'm not okay or things are not going to be okay. And how a person comes to have that be their baseline is, is different for everyone. But if, if your fundamental feeling state and belief is I'm not, okay, things are not going to be okay. Then we develop ways of being in the world to try to create a sense of safety, trying to create a sense of security and trying to create a sense of comfort. And there's two primary ways that we do that. One is that we will try to control as much of our external environment as possible. And the unconscious belief behind that is if I know what to expect, if things happen the way that I think that they should, or I want them to, then I'll be okay. So there is a strong motivation to and compulsion really to try to control as much of your external environment as you possibly can. So this looks like people who have really rigid beliefs about how

things should be done. Um, believe that there's a right way to do things. Everything else is the wrong way. Um, You know, who, uh, tend to over research, over plan, and part of that is also like, I need to find the right, the perfect right choice, because if I don't, something bad will happen. So there's the, the default around that. It's like, I have to keep researching before I make this decision, because I might make the wrong decision. And then it won't be okay. Or, you know, not knowing, um, when they have prepared enough for something. So we see with this, like, a lot of, like, stress, overwhelm, really high functioning, successful, competent people,

but who have very rigid, uh, ways of, you know, being in the world. So that's

one 

hard to be around. And 

It can be Yeah.

it can be. And I also do a lot of work with couples. Um, so I do a lot of couples therapy and something else that I'm really wanting to develop and sort of teach other therapists about is sort of the anxious couple because this dynamic in couples is very powerful and, um, it really has an impact on, you know, intimate relationships when one person in the couple has anxiety that's rooted in control.

I can imagine. Yeah. We, we did. And, uh, what was interesting was, I don't know, I'm getting personal here, but early in our relationship, I thought he was. controlling. And then I realized it was not, yes, he was doing controlling things, but it wasn't that. It was based in this fear. And coming from that perspective, my own, of being able to see that with him, helped.

Change the dynamic of our relationship tremendously one. He was able to see it But two I was able to see it from a more empathetic standpoint rather than feeling attacked

Absolutely. Yeah, it's very often it is fear, though it doesn't look like fear.

And one of the things that I work on a lot with couples is for the person who is anxious, who does feel this need to have control over everything to start to be able to identify it as their anxiety and to talk about it in that way.

So that when, you know, they want. Uh, you know, something done a perfect particular way instead of saying, why are you doing it this way? You need to do it this way or why didn't you do it this way? It's I'm feeling uncomfortable because I'm feeling anxious about this. And, and, you know, to give a personal example of that for myself, I, I used to with my, my husband, when we were driving, um, I used to be a terrible like backseat driver, you know, in terms of like, Oh, you need to go this way or you need to go that way, which is, is that controlling anxiety. And, you know, that's annoying to be around and, um, can also be disruptive to the person who's driving. When I got more in touch with, I'm actually just feeling uncomfortable than being able to speak to, whether it's like, because like I'm uncomfortable with the speed or I'm uncomfortable with the way that, you know, they're driving, or I'm uncomfortable because I don't know where we're going.

Um, you know, being able to speak to it either before, or if I, you know, said something, you know, that, that was, wasn't helpful or kind being able to say like, Oh, I'm sorry. I was just uncomfortable. It does change things a lot.

It does we've actually turned to humor because we all I think we all have some of that response, right? But we've used humor a lot now that we see it Um, then I think we're, we're able to laugh at ourselves and laugh at each other. Um, I don't know whether or not that's healthy or not. 

Oh, that's the healthiest thing. Absolutely. No, that, you know, I always say that when couples get to the point where they can laugh about things that they used to fight about, that's how you know that you really have done the work on it. And, um, yeah, because, you know, laughter, being able to laugh and not take yourself seriously, um, you know, is, is really, um, it's, it's how you can be really connected to another person.

Yeah.

well, and we've all got our quirks I'll say and you know, whether or not, okay, so back, back to anxiety now, 

Yeah. So, okay. So that was 1, 1 boy that control manifests the other way that it manifests. So again, that underlying feeling state. I'm not okay. Things are not going to be okay.

1 way is trying to control your external environment. The other way we cope with that is by anticipating everything that could go wrong and making a plan for what you will do. If, and when that thing happens,

so this is. It's exhausting. That's exactly right. That's the word for it. Um, it's exhausting. It takes up so much energy, mental energy, emotional energy. It's catastrophizing, but then taking catastrophizing a step further and feeling like you need to make a plan for everything that you think about that could go wrong. It's exhausting and it's not helpful. And, you know, one of a couple of the reasons why control these control behaviors. On the surface, they sound like they make sense. You can understand why someone would think that this is useful,

but it's actually not useful. Neither of them are useful. 

So the problem with trying to control our external environment as a coping mechanism. Um, goes back to that first rule and principle of control, which is that there are always things that are not in our control. And actually, there's usually more things not in our control than what is in our control. So when, when we make our sense of well being dependent upon what's happening outside of us, and it looking the way that we want it to, or we think that we should, it thinks that it should, We're always going to fail.

That will never work. And, um, and the bigger problem with it is what I just said, which is that it does place our sense of well being on factors outside of us.

And really where our sense of well being needs to be is internal. So instead of I'm only okay if what's happening out here is okay, we need to shift that to no matter what's happening out here, I possess the internal and external resources that I need in order to be okay, in order for me to find my way to being okay. So a big problem with, with the control is how it externalizes the conditions under which we can be okay rather than internalizing them. Yes.

presented like that, ever, is that this need for control is putting the responsibility of being okay on your outs I mean, it makes sense, right, on your outside, but where you need to feel the most in control is inside.

That's right. That's right. And so this is why this is the problem ultimately with control is it, it, we need to move that sense of wellbeing internal. And as long as you're trying to control what's out there, you're placing your sense of wellbeing on what's out there. Um, so that's a huge, that's a huge problem with control.

The other part of it, you know, the, you know, a lot of people will argue, well, You know, anticipating what could go wrong and making plans that that's a good strategy, right? That helps because then you're prepared when things happen and the reality is no, you're actually not because none of us are fortune tellers and none of us can predict the future and what we can count on and what we we do know is that things will go wrong.

Problems will happen. Things will go, you know, will go wrong. Sometimes really, really bad things happen. And when they do, we have to figure out how to respond based on the facts that are available to us in that moment. And we'll never be able to accurately predict those things. Even if we can predict with some accuracy, you know, some broad stroke thing that might happen. We will never know the details and and our responses to the bad things that happen and the problems that happen has to be based on the facts and you know the information that's available to us at that time. So,

Curiously, on this, so if, if somebody is struggling with control and they're putting a plan in place, at the moment when something goes wrong and it doesn't, it takes a left or a right turn, does that person who's in control then have or experiencing control as a coping mechanism, whatever, I don't know how to word it.

When they, when, when they get to that point where they're in a situation that does not go as planned, then it really does, there's. I would imagine that their anxiety would then spike because they don't have that mechanism 

it's. You would think so. And it's really interesting. And you know, this is, I'm about to make a generality,

but I have found this to be largely true. It's really interesting because people who have anxiety in this control realm, they're always very competent, successful, capable people.

Okay.

And when things go wrong, they actually do fine.

They're able to. you know, sort of adjust and figure out what

to do and manage it. Where their anxiety comes in is that, is they're not like recognizing that about themselves and not trusting that about themselves

and believing I have to worry about all these things. And this actually gets into what the objection

is for people who have anxiety stemming from control. The objection is that the belief that it is my anxiety behaviors, these coping mechanisms that are the reason I'm successful, not me. So they believe that because they always are successful people, a hundred percent of the time. And they really believe that it's because of how detail oriented they are or, um, which is true,

you know, that that is true, but they think it's because of how much I think about things or how much I worry about things or how much I plan ahead for things or, and there's, I don't want to say there's no truth to that.

There's a little bit of truth to that. But what the real truth is, is that they are just capable people with, with a lot of skills and attributes and knowledge and experience and all of that. And that's what kicks in.

in whatever they show up and do. And so it, what I actually have found is that when things do go wrong, they're fine.

And, and we talk about, I often will talk about this with clients. It's like the things that they didn't plan for, they just manage. Um, but they don't have that internalized trust that it's actually me that is,

is handling all this. And they really believe that it's their anxiety behaviors that are the reason that they

Interesting. Oh, that's interesting. Okay. Um. Then the last one is distorted beliefs.

Beliefs. Yes. So distorted belief is when you believe something about yourself to be true that is in fact false. And we can have negatively and positively distorted beliefs, but when it comes to anxiety or depression, those distorted beliefs are always negative. So it is believing something negative about myself, That I believe that it is true when it is in fact false and these are often like core beliefs that we hold about ourselves as a person and that that shape not only how we see ourselves, how we feel, but also shape how we move through the world, interact with the world, interact with other people.

So, examples of some of those like core negative beliefs could be, I'm a failure. I'm unlovable. I'm broken. I'm fundamentally flawed. I'm an outsider. It's, you know, these, these really sort of core sense of who we are. as a person or in relationship to other people. And when we hold those beliefs about ourselves, I mean, again, obviously it affects the way that we feel, but there are always going to be behaviors that we engage in, in terms of interacting with other people or how we show up in the world that are designed to either compensate for those negative beliefs or to try to hide them. So an example that I often give is if a person's core belief is I'm unlovable, or I am fundamentally flawed. Um, they will have a tendency when they're in relationship with other people, they will have a tendency to be people pleasers, to say yes to everything that other people want them to do, to never ask for anything themselves, to never make their own needs known. They may even anticipate what other people need and Sort of try to meet those needs before they're even verbalized or asked for, because there's sort of this unconscious belief that if I'm unlovable and I'm fundamentally flawed, you would not want to be in relationship with me. So the way that I will make myself valuable to you is by the accommodating to you saying yes, being helpful. And then also the belief that, and there's no room for me to need or want anything because I see myself in such a, you know, sort of, flawed or unloved, lovable way. So, um, those distorted beliefs They lead to anxiety, they lead to depression. Um, people who have social anxiety, social anxiety is always based in a distorted belief, a belief that I'm awkward, I'm going to be viewed as stupid, I'm being judged. Um, so we, we always will see a distorted belief in social anxiety, but it can show up in, in other forms of anxiety as well. Right.

grade, I had a friend who, looking back on it, I, you know, see it was disruptive and why my parents were concerned. She would buy me everything. She would just buy me all of these things instead of just being with me and enjoying it and you know at the time You're like, oh, okay. Well, I have a new concert t shirt or whatever But it got to the point where it wasn't fun anymore because I didn't know her There was like this protective piece between her and I that she wouldn't let me know who she was

Exactly, because probably underneath that, and we don't know the

exact of that, but underneath that, we probably, you know, was probably like this belief that there was something so flawed or unlikable or unlovable about her that I can't let you see the real me, because if I did, you wouldn't like me, you wouldn't want to be my friend, and I'm going to buy all these things for you so that you want to be with me.

it's more conditional. They sees themselves as a condition that they're only loved because of X Y or Z You 

yeah, 

so the objection, well I guess the objection would be if I don't do these things you're not going to love me, or you're 

Well, the The objection that we see with distorted beliefs is, you know, if you understand that by definition, um, it, it's, you believe something to be true that's not. By its very definition, it means that something else actually is true about you. And very likely as you, you know, kind of go through life, you are going to get feedback from the world around you that tells you the truth of who you are that will come to you in the form of compliments.

It will come to you in the form of like, grades, um, performance evaluations at jobs. And the objection that's used by people who are, you know, whose anxiety stems from distorted belief is that they will find ways to reject, deflect, or invalidate that, you know, that feedback that comes from the external world that tells you the truth of who you are.

okay.

you know, we do that by like, if you get a compliment, you might, you might dismiss it by saying, well, they're just saying that to be nice. Or, you know, they say that they're, they say that to everybody. Um, or, I always use this example because it's, it's such a good example of what this looks like from a client, um, and I included it in the book. She, um, her distorted belief was, I'm a failure. So everything that happened in her life, she rewrote through this lens of, I'm a failure. And. She had been in graduate school several years before I had worked with her. She was at graduate in graduate school at an Ivy League caliber institution. And she told me that she was in therapy while she was in graduate school because she was constantly convinced she was about to fail out at any moment. And so one day I finally just asked her, so what kind of grades did you get in graduate school? And she said, well, I got all A's. And I asked her, So how did you convince yourself that you were going to fail out at any moment when you were getting A's? And she said, Well, everybody gets A's in graduate school. And of course, that's not true. And it certainly was not true at this institution. But that was the way, that was the objection in action. That was the way that she deflected that, you know, objective feedback so that she could preserve. That, you know, view of herself is failure. And I need to worry that I'm going to fail out at any moment.

I'm feeling very exposed right now, Noel.

And we all do

that. I mean, everybody knows what that is.

but I was thinking, you know, I mean, of all, I, you can see different parts again, getting back to the complexities of, um, of anxiety in general, right. Before it's a disorder is, As you're speaking through these things, I can speak of, I can think of specific situations in my own life where I have experienced and fallen into that bucket of either catastrophizing or, you know, having distorted beliefs.

Um, and what was the last one? Control. Control. And so, I think that's good because now I'm understanding where it's coming from and it becomes a challenge again where it's a disorder or an issue is when it takes over or is a continuous, um, cycle.

That's right. You know, all of these, you know, there's nobody who will hear these and, you know, say, I have no idea what you're talking

about. I mean, we all, you know, have experiences with all three of these. And, you know, that's just part of being human.

But where it does cross over into a disorder is when, you know, This is like predominantly ruling your life when, you know, it is interfering with your quality of life and, you know, where it really is sort of what takes over, um, you know, in most situations that you find yourself in.

What's great about this model, I think, is that for the person that maybe doesn't have it where it's taken over their life. They can understand it, they can apply it to their own situation, and then if they have a loved one or somebody that they work with or whatever, that they see these patterns and they can come from a little, a better place of empathy, at least, from, from that.

And then obviously the person that is experiencing these where it's disruptive to their life can also kind of Dig deeper in, into each one of those realms.

Yes, yes, and then they each have their, like I said, they each have their own solutions that tend to work better because, you know, it, if you can get at what that underlying need is with, with each one, um, you know, then you can really transform your experience and your relationship with anxiety in a way that is, that is not just addressing the symptoms of it, but really. Changing, you know, your entire relationship with it.

So now you, you mentioned you have a son that has OCD

and that's an anxiety disorder,

It is.

correct? Now how do these fit nicely within the, the OCD realm as well? Okay.

So OCD is sort of its own thing. And, you know, there can be aspects of this that apply to OCD, but when it comes to obsessive compulsive disorder, um, first of all, and this is, this is sort of more my, I'm not sure. you know, how scientifically based this is. I mean, I think there's a lot of science that backs this up, but other people may have a different perspective.

So

I'm sort of saying this is my perspective on obsessive compulsive disorder. I think there is a very strong biological component. Um, to OCD. I think that, you know, there is, there's definitely a strong component in terms of, like, the brain structure, the wiring of the brain that lends itself to OCD. And there are very specific patterns. that you see in OCD that are unique to OCD, which is why it is different than regular anxiety.

And when it comes to OCD, it's really important to understand that very specific pattern that always plays out in people with OCD, because you do need to, you do need to work with the pattern of OCD, which is different than the pattern of regular anxiety.

And I'm happy to talk about that, but I also like, you know, I could go off on a whole tangent

Well, and I could probably sit the whole day with you because this stuff fascinates me, so I won't get too deep into that, but that is interesting to know that, um, so there be, there may be anxiety disorders that aren't as cut and dry, like, like an OCD type of a thing.

Yeah, yeah, there's just a very clear pattern that plays out with OCD, and that's what you really have to work with is, is the pattern of how it just really reinforces itself.

So you came up with this model and you decided to write a book. Tell me a little bit about what somebody can expect with a book. When it comes out and then also if somebody identifies with this and wants to pursue this line of, um, therapy and understanding their own, um, anxiety disorders in, in, in a framework of the model that you presented, what they can do to move forward with it if they don't live in Chicago.

Yeah. So, um, I, the book is written. It's at the publisher. I don't know when it's It's going to be, I don't know when it's out in the world yet.

So, um, yeah, so we're still waiting on, on that. It's moving through the process and, uh, as a first time, you know, I guess author, I'm getting used to saying that, um,

I'm getting, It's it's, it's a very, it's a little uncomfortable.

It's like, it doesn't feel like an identity that, that I'm comfortable with yet, but

you know, I need to say it. So I get

comfortable with 

right. I'm excited to read it.

Thank you. Um, so what do you, what, what will people get from reading it? Um, the book is, um, it really, it focuses on this model and goes into detail about, um, each, each of those three root causes and what are different interventions that you can do within each of those root causes.

So the first, I would say third of the book or so is just some really like overview information about anxiety. There's a lot of, you know, sort of very general concepts and things to understand about anxiety that apply across the board. It doesn't matter which of the three. You know, root causes it comes from.

There are just like, I call them universal truths about anxiety. They're important to know. I address things like what the difference is between anxiety and intuition, because that's

often confusing for people. Um, you know, people often mistake their anxiety for intuition. Um, talk about the mind body connection and you know, that, cause a lot of the book does focus on. sort of how we think about things and, and intervening in that realm. But, you know, anxiety also is in our body and, um, we have to address the body part of it as well. So there's, there's a lot of just sort of like overview about anxiety that's in about the first third of the book. And then I kind of lay out in a bit more detail than we talked about here, the actual model.

And then the last. Probably half of the book is different interventions based on each of, you know, so within catastrophizing, you know, a number of interventions, um, for how you work with catastrophizing

within control, like how you work with control, and then also with distorted beliefs and throughout it all are, you know, client stories. sometimes my own stories, my son's stories to illustrate, um, you know, the concepts that we're talking about. So the stories is a really big part of it. I think that's what helps things feel relatable

and, you know, help you to see yourself in, you know, hearing about other people as well.

Absolutely. Well, it sounds like a great, um, actionable book, right, where you're understanding, but then you've also given them some helpful tips to be able to move forward and to put into place by themselves after reading the book. So that's great.

That's, that's my goal. Yeah. It's, it's to, to increase understanding and give you really a different way of understanding anxiety. Cause I think this is a different way and this is

really what led, you know, the PR the progression of it for me is I developed this just for myself and explained kind of where it came from and really came really from clients and listening to them and sort of hearing these themes and patterns. And as I use the framework for myself, like I felt more, you know, skilled as a therapist. I felt more empowered as a therapist. I could see that my clients were making more progress. So at some point I started sharing the model with clients. So I would start to say to them, let me tell you about how I think about anxiety and, and how I work with it. And When I would share it with people, you know, I already mentioned a hundred percent of the time people can tell me exactly where their anxiety comes from, which is so useful. It

just, you know, gets us on the same page of how we're going to work with this right away. But the other thing people started saying with things like, why has nobody ever told me this before? Or, I never thought about it that way before, but that makes so much sense. And, you know, then later after I've been working with people for a while, you know, I would hear from people who really had identified as having anxiety for most of their lives and had therapy before, which they found to be helpful and positive. Say, you know, say that like, They felt like they made more progress with their anxiety in, in working under this framework, which is what led me to think, well, maybe this is not going to just be helpful for maybe this, maybe this would help other therapists too. And, and so the next progression was I started training therapists in, in the Chicago area around doing this, using this model.

And then the next progression was writing the book in the hopes that, you know, it will be helpful to people because. I, I am really strongly motivated by my experience as a mother to a child who has really been impacted by anxiety and obsessive compulsive disorder. And, you know, I've had a front row view to the pain and challenges that he's faced and,

um, and his resilience, which is, you know, the other part of the story too, and, um, if this will help people. And, you know, to be able to understand their anxiety and move through it, um, in a, in a better way and find some peace with it. You know, I, I want to get that to as many people as I possibly can.

Oh, that's beautiful. That's beautiful. And you know, anxiety may be based in fear, however, the people that I know that suffer with anxiety are some of the bravest, strongest people that I know. They are facing their fears on a daily basis and those of us that don't struggle with it don't have to face them all, all the time and it's, it 

That, that's exactly right.

heart wrenching, but also

right.

they,

often think about, you know, sort of the, all the people who live with anxiety and persevere and succeed in spite of, and they're carrying the weight of this anxiety that the rest of us are not carrying. And,

you know, just really how strong and powerful that, that makes them, but also this wish that I have that it be easier

and lighter, and there be more ease with it all.

Um, and that's what I, I hope to help people get to.

Well, Noel, I really appreciate it. The name of your book is,

The working title at the moment is Anxiety Impact, Discover Your Type, and Recover Your Peace.

Oh, sorry. I interrupted that. So let's say it one more time so that I don't 

it.

sure, it's uh, Anxiety Impact, Discover Your Type, and Recover Your Peace.

How beautiful. When it comes out, make sure you let me know and I will let everybody else know that when it, when it comes out.

I will. Thank you.