Transcript
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Hello, today I have with me Megan McCutchen, lpc.
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Megan is a therapist specializing in perinatal mental health.
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You can connect with Megan at perinatalplacecom or MeganMcCutchencom.
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She also offers a birth bundle for pregnant moms and coaching for new moms.
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Megan is the mother of three and she is here today to talk about intrusive thoughts.
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Megan, thank you so much for joining me.
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Thanks for having me.
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I always love talking to you and so many things we have to talk about, oh so many, so little time.
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Yes, well, can you start off by explaining what intrusive thoughts are and what they mean?
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Yes, absolutely.
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Intrusive thoughts is something that I see really common in the perinatal period.
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It can happen during pregnancy and it can also happen postpartum.
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It's honestly one of the most frequent things that I see in the moms that come into my therapy or coaching practices for support.
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A lot of us know about postpartum depression.
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I don't think everyone is as familiar with postpartum anxiety.
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But the intrusive thoughts we actually technically call it postpartum OCD or perinatal OCD.
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I like to describe it as a flavor of perinatal anxiety.
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What intrusive thoughts are?
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They are just these pesky little thoughts, often scary, that pop into your brain throughout the day.
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For pregnant moms it often shows up as things like what if my baby's not safe?
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What if I miscarry?
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What if I eat something that harms the baby?
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What if I move in a way or exercise and do something that harms the baby?
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Then postpartum often shows up as, again, fear of harm to baby, like what if this isn't safe for baby?
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What if I accidentally drop baby?
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What if we're in the car and we get in a car accident?
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Things like that.
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The thing that's tough about it is that these are these intrusive, unwanted thoughts that just come into your brain when your brain tends to run a little more anxious.
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It's tough because it's things that can actually happen in some instances.
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It's not completely true that it's irrational.
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A lot of times with anxiety we talk about irrational fears.
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These are things that could happen, but the chances are very, very low For a lot of moms.
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The reason we call it OCD is because it has this obsessive quality to it where these thoughts just obsessively come into your mind, in your all day long obsessively thinking about them, or they pile on at a certain time of the day I think you and I were talking about sometimes for people that can come on in the evening.
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Sometimes there's certain times a day where your mind is more anxious and these thoughts just rapid fire start coming in.
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The compulsion part to the OCD is there's often a tendency to either seek reassurance or to avoid.
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I'll give a couple examples.
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I was working with a mom this week who had an obsessive fear around what if I didn't sterilize the bottles enough?
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What if these bottles that I'm using for my baby aren't safe, aren't clean, maybe somehow get salmonella or some sort of thing that upsets her system or is catastrophic?
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She was obsessing over this thought that the bottles weren't sterilized, the bottles weren't clean enough.
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The compulsion she was engaging in was just frantically searching the internet for any article that dismissed that fear.
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That said, it's a very low risk that anything will happen with unsterilized bottles.
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Then for some other moms it might look like what if I accidentally hurt my baby while I'm giving them a bath?
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These are these catastrophic thoughts.
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What if I accidentally drown my baby while I'm giving him a bath?
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They will sometimes avoid that situation to avoid the anxiety.
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They'll say, okay, let's get partnered to give the bath.
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I'm not going to do this.
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They'll want somebody else to be present.
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They'll really avoid doing things with the baby alone.
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What happens in those situations is it actually just serves to increase the anxiety, like that OCD cycle.
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There's this obsession over this fearful thought.
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There's the compulsion to either avoid it or seek reassurance from it.
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Then it just strengthens the thought and the thoughts just come more and more.
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What we actually want to be doing when we have these intrusive thoughts is just really sitting with them, sitting through them.
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I always tell moms it's really important to just acknowledge it for what it is.
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So just be able to say to yourself okay, this is an intrusive thought, this is a piece of postpartum anxiety, I know what.
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It is Really important for moms to know that thoughts do not equal reality.
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Just because you're having this thought doesn't mean it's going to be true, doesn't mean you're wishing anything to come true, doesn't mean you want to hurt your baby, nothing like that.
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So One of the exercises that I'll sometimes do with moms and listeners can do it here is okay, raise your right hand and then, as you have your hand in the hair, say I cannot possibly raise my right hand.
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There's no way I can raise my right hand.
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There's absolutely no way I can raise my right hand.
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Well, you're raising your right hand If you put your right hand up, as you said that.
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So that's just a little kind of example of thoughts do not equal reality.
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If you're literally raising your right hand and saying I cannot raise my right hand, those don't jive, and so that's just a good reminder that just because your brain thinks something doesn't make it true.
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So if you're thinking something like we might get in a car accident if I bring my baby in the car, that's just a thought, the actual chances of you actually getting in a car accident are very low.
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If you're driving safely, if you're following stop sign red lights driving the speed limit, it's actually a very low chance that that will happen.
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So really important to just remind yourself OK, this is an intrusive thought, this is just my anxiety and it doesn't mean that this thought is true.
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And so when you just sort of sit with it rather than avoid it or run away from it, it helps you to learn to tolerate the thought more, and then those thoughts gradually start to decrease.
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One of the analogies that I like to use with anxiety and, in particular, intrusive thoughts is kind of think of an ocean wave.
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And if you've ever been in the ocean and kind of like by the surf when the waves start getting bigger, you know that often the tendency is to run from the wave, to run to the shore and to run away from it.
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But there's a really big risk that it's going to actually catch you and you're going to get sort of tumbled over.
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So to really stay safe in those waves, you want to dive through it.
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When you dive through the wave it really can't knock you down, and so that's the same sort of concept with anxiety and with these intrusive thoughts.
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Think about just riding the wave of the anxiety, just acknowledging that it's there and just sort of like letting it be.
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When we try and run from it, when we try and resist it, it just grows stronger and has more of the potential to knock us off our feet.
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So, yeah, so these thoughts can be really scary for moms, but they are things that are treatable.
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They often do get better with time, just with some distance.
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We don't know exactly why postpartum anxiety or perinatal anxiety happens.
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We just know that it does, and what I like to say is that for anyone that runs a little on the anxious side, if they've had any form of anxiety before getting pregnant and having a baby, there's a really good chance that that anxiety is going to really skyrocket.
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That was sort of the case for me.
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Looking back, I'm like, oh yeah, I probably always was a little anxious, but not in a debilitating way and more just.
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You know, I was able to get stuff done, I was able to function with it, and then, after having a baby, that's when my anxiety really flared up, and for me it at first showed up as brain fog, confusion, just difficulty making decisions like this sort of need to constantly be busy, and at the time I really sort of dismissed it.
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It was with my second child.
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So I kind of told myself, oh, it's just, you know, adjusting to life with two babies.
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And it wasn't until it escalated and became more of this OCD type of thinking, these intrusive thoughts, that I realized like, oh, something's going on here.
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I started having the thought of I wonder if it would feel good to throw my baby down the staircase.
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I remember going into my doctor's office and she was really validating Because when I told her that she's like yep, I had an intrusive thought too.
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Mine was what if I throw my baby in this pot of chili I'm cooking?
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So sometimes it can be these like really sort of ridiculous things.
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But it makes moms feel so terrible because they look at themselves and they think, oh, my God, am I a terrible mom?
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Do I want to hurt my baby?
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Do I not love my baby?
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What is wrong with me that I'm thinking these terrible things?
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So there's nothing wrong with moms that are having these intrusive thoughts, no matter how awful they are.
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For some moms, unfortunately, it shows up in sexual ways.
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So there's sometimes moms that start obsessively thinking these intrusive thoughts of like what if I accidentally molest my baby while I'm changing the diaper?
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What if I can't save my baby from this world and a child predator harms them, so these can be really disturbing and disruptive thoughts for moms, kind of wondering why am I thinking this way?
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We don't know exactly why it happens again, but it is a part of postpartum anxiety and it's nothing to feel guilty about.
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It's just something to really recognize as okay.
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I'm having some symptoms of an anxiety disorder occurring and I can get help for it.
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Yeah, that's so.
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All of that is so interesting and validating, because I feel like I experienced the same thing postpartum and with my first pregnancy I didn't get treated because I didn't recognize it for what it was.
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I think that sometimes it can be a little sneaky because, like you said, it can seem like something that could happen and that maybe you could control, and so I found myself trying to just fix the situation instead of realizing that this was just something that was eating away at my time and making me super anxious.
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Yeah, no-transcript, I can't remember what all of mine were, but they were, I mean, and I guess I think that people when you say people that run on the side of anxious I just remember as a kid having intrusive thoughts like what if?
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I jump in front of this car, you know, and I would just be like that's weird.
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Why would I think that?
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You know?
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They just jump into your head and then they go away, but they just get more.
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I feel like intense and terrifying in postpartum, at least from my experience.
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Absolutely.
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That's so true.
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They get more intense, they can happen more frequently, and it's different when it's your own self and you have this intrusive thought.
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You know what if I jump in front of a car?
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What if I jump off of a balcony and you know you're not going to do it?
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But then, when it comes down to your child, it can be even more disturbing.
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And I think part of it is like sort of our biological wiring as mothers, as nurturers.
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It's sort of our instinct, our natural instinct to protect our child.
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That I always say just kind of goes a little haywire.
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It goes a little bit off the deep end, to the point where we're like over stressing about baby safety and if they're okay.
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Yeah, so for intrusive thoughts, I love your analogy of sitting and diving through the wave and really just sitting with it, and your exercise of raising your hand and showing that they're just thoughts and they can't do anything If those things don't work, or if they work, but they're not enough and the thoughts are just debilitating.
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What are some other options?
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Yeah.
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So for some people that's really enough just to have awareness.
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I have a lot of moms that come into my therapy practice and we really only meet once or a couple of times, because what they really need is just this reassurance that, hey, I know what you're dealing with, it's not the end of the world, you're going to be okay, you're not crazy, and here's how to cope with that.
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And so for some of them, just managing it mentally is enough.
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And then for others, if it doesn't seem to get better, or if those thoughts have already become so frequent and distressing that they really feel like they can't control it just through their own thinking, then medication is often something that I refer them to look into.
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Medication can really really help in these situations.
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And something that's really important for moms to know is that often in the perinatal period, especially when intrusive thoughts are present, you often need a higher dose than you normally would need.
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So I have so many moms coming in who are already on Zoloft or one of the other medications for their anxiety.
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Maybe they've been on it all along throughout their pregnancy or maybe they got on it after because of anxiety, but if the dose isn't high enough for them, then it's not treating these thoughts.
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So so many people kind of panic about.
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But I'm already on medication and so we'll always look at the dosage and often I'm referring them back to their prescribing doctor to just you know, I have like a little cheat sheet in my office on what the right dosage are and they tend to be a little higher.
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So I'm often referring them back to just say, see if you could go up a little bit, and for a lot of moms that ends up really helping.
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Sometimes it doesn't completely take away the intrusive thoughts, but often you'll start to see a decrease in them and a decrease in their frequency.
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So I really recommend.
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I'm not a big medication pusher generally, but I really do think it can be helpful during this period and in particular with with this form of postpartum anxiety.
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So it's something to consider.
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It's not harmful to the baby, even if you're breastfeeding, and then the other thing too is really just managing your anxiety kind of on the whole.
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So the way that I like to describe it is imagine you're holding this platter and on top of it are all these bricks.
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Each stressor is another brick, and if you're just holding a couple stressors, a couple bricks, it's okay to balance.
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You can manage it.
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But the more you start piling that weight up, the harder it becomes to really manage, and that's when we see anxiety really peaking.
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So a lot of times people will start to track the pattern that the more stressed they are, the more anxious they are around just the circumstances in their life, the worse their intrusive thoughts get.
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So I really like to work with moms to teach them anxiety managing tools.
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I have a course called empowered motherhood where I teach a lot of this stuff around managing your thinking, and I have lots and lots of mindfulness tools and techniques that you can use to manage your anxiety.
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And what's so important is that people start learning these tools and start practicing them regularly during moments when they're not already panicked, when they're not already feeling anxious.
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A lot of times people kind of push it to the back burner and they're like, okay, well, maybe I'll try this like deep breathing or this mindfulness tool or whatever when I'm really anxious.
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If you're already to the point of anxiety, it's going to be harder.
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I really like to teach moms to start implementing these things just kind of like as part of their routine into their everyday life, and that helps to keep the anxiety from escalating, and the less the anxiety escalates, the fewer and farther between these intrusive thoughts will start to become.
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Yeah, I totally agree.
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I feel like also and I know we've talked about this before I didn't figure out until my first child was about three that I was having anxiety, and then it wasn't until after my second was born that I got treated.
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But it just feels like it was kind of prolonged, and sometimes I think that having a baby is just kind of the tipping point.
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It's the added stressor that can kind of just make everything kind of topple over into overwhelming anxiety or just barely, like you, maybe you're treading water but you're just getting really tired and not really able to manage it, but you're not drowning, so you can kind of deny it.
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Yes a little bit and I feel like just like that little bit of medication is what kind of helped me get to the point where I felt like I was myself again.
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I was a little bit more control and, while I still will have thoughts that come in, I feel like they just kind of float away now instead of lingering and feeling like something that I have to solve, a problem, that an impossible problem that I have to solve to protect my family.
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And I really think that it's important, like you said, that moms find the tools to be able to move through that, because it's maddening to have all of that piling up on your shoulders and to feel like you actually are someone that can control that, when the solution is either to manage your anxiety through the mental work or the medication, or both ideally, yeah, you know if you need that, if you need the medication, but also definitely learn how to manage your mind.
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So I think that's so important and not many moms know about it.
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Right.
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One of the analogies I like for medication and sort of what you were describing is that sometimes it's like we're kind of in this hole with depression or with anxiety and it's really hard to climb out on your own, and the medication can sometimes be like that ladder that gives you a little boost you need, and often we need it.
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You know people.
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Yes, there's a lot of things that we can do to manage you know our thoughts and to fight depression or anxiety mentally and on our own without medication, but sometimes we need that extra boost, and that extra boost is going to be what we need in order to be able to start implementing some of those other things.
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And so you know it doesn't have to be a forever thing.
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That's one of the questions that I get asked a lot, too is how long am I going to have to be on this medication?
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And one of the mistakes people make is they do get on the medication and then they feel better and so then they go off of it.
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But what we know is that it really takes six months to eight months to a year and that's what it takes, to say, for the neurotransmitters and the chemicals in your brain to really balance out.
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So I always tell people if they're going to try the medication and it starts to work, great.
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Stay on that medication for at least six months to a full year, from when you feel better, to really kind of let things even out, and then you can you know.
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If you feel like you don't want to be on it longer term, that's totally fine, you can work with your doctor, you can wean off of it and you may not need it anymore.
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But that's a really important thing too when you're considering medication is to stay on it long enough that you let it do its job, otherwise you risk relapsing.
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Right and also not have the expectation that you have to go off of it yeah, that you will automatically be fine in a year because you just had a baby.
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You just had a baby and you have this tiny little person that you have to take care of, and that is hard, right, and sometimes you just need a little help.
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That's right and that's how you balance those emotions.
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Yeah, and that analogy I was using earlier about Imagine you have this platter and you're putting all these different bricks on it, like you permanently put this giant brick on the top of your load that you're carrying which?
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is this human to take care of, and so a lot of people think you know like, oh, I should be able to do this without medication.
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I should.
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You know, I shouldn't be feeling this way.
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Those thoughts just really increase the anxiety.
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Give yourself some grace and just be able to recognize this is a huge transition and it's okay that I am not, you know, just flying through this easily.
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Like, it's okay that I need a little bit of support and a little bit of help and I'm really adjusting to this transition.
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So it's not just that you have this one huge brick, because that one huge brick comes with so many other little tiny bricks that get tied.
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You know there's just so much and it just it doesn't go away.
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It's a every problem that you ever had as a as your own human being.
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Maybe you got to a point, as as your own person, as an adult, that decided to have a baby.
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Maybe you got to the point where you could manage all of your own load right, but then every child you have, you're taking on the load of a whole other human and all of the things that go with that, and all of their anxieties and feelings and emotions and just everything that goes with that, and so you have to do the work to learn how to manage that and, additionally, when someone has the thought which I think we all do I should be able to do this.
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First of all let's just throw it out there that many, many, many of us are getting help to do this.
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Many of us have realized that we do need the help, we do need the medication and we do need to learn the tools to get through this.
00:20:20.851 --> 00:20:43.428
Additionally, in the past there was a village that existed that, in our culture, has kind of fallen by the wayside, and there's more of this focus on independence that I believe is stressing women out and all of this competition to be the best at everything, and so we as a society have moved toward this toxic independence.
00:20:43.428 --> 00:20:47.734
I think that puts so much pressure on women.
00:20:48.099 --> 00:20:54.980
Yes, well, the other thing that came up for me, as you were saying that too, was like what's one of the differences in today's society?
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And I was thinking about social media and all the pressure.
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I think that is such a catalyst for anxiety for women, because there's so much comparison to what they see on social media and what are people posting.
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Often it's like they're beautiful newborn photos or you know them nursing the baby and everything looks beautiful and happy, and so moms get in their head with that comparison.
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I should be doing this with ease too.
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What they don't realize is that behind that one image you see on Instagram or the video on TikTok, there's probably all these outtakes and there's probably all these moments where you know Stuff is not going as smoothly as you might think from that one snapshot.
00:21:35.410 --> 00:21:56.309
And so we have to be really careful to not compare ourselves to what we're seeing on social media and instead just just realize that this is hard and there is no such thing as a perfect mom or a perfect parent, and when we fall into this perfectionism trap and this comparison trap, that is a catalyst for when anxiety really starts to increase.
00:21:56.510 --> 00:21:58.849
Yeah, I think it was a few weeks ago.
00:21:58.849 --> 00:22:03.821
I saw Marie Kondo has said that she no longer does the spark joy.
00:22:06.851 --> 00:22:11.060
I saw something about like Marie Kondo, like she, she takes it all back.
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So I've been meaning to.
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She was like my house is messy.
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Yes, she says, I have kids and so, therefore, my house is messy, and I was like yes.
00:22:20.174 --> 00:22:30.355
Thank you because I remember Trying to organize my drawers when my daughter was before she was a year old and do like the Marie Kondo thing, and just stressing myself out about it.
00:22:30.355 --> 00:22:33.663
Yeah, I know that even Marie Kondo can't do it.
00:22:34.049 --> 00:22:35.453
Yes, that is so much better.
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That is so good to know.
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I love a lot of her stuff and I love, I love her folding method and things like that.
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But I think we need to remember like it's not sustainable All of the time, with all the demands we have and the children messing things up, and Just living with children is.
00:22:51.434 --> 00:22:53.039
There's no such thing as perfection.
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There is none, yes, and they're also trying to figure it out themselves.
00:22:56.809 --> 00:23:05.142
So letting go and letting that perfection Slide and letting them do it in their own imperfect way as they make their way in the world.
00:23:05.142 --> 00:23:07.289
I had a friend that she was my next door neighbor.
00:23:07.289 --> 00:23:38.405
She had four girls and I just could not imagine how she did it and she was like I just let go of all the perfection, I have them fold their own clothes and it's ugly and I just have to walk away and let them do their thing and they're gonna figure it out someday, and it's so true, it's really important, because anxiety often is about this desire to try and control your environment, to try and control things, and parenting is all about letting go of control and, you know, letting go of perfectionism and relaxing your standards.
00:23:38.530 --> 00:23:41.647
At least you know, to some degree at some point.
00:23:41.930 --> 00:23:55.282
Yeah, yeah yeah, because once you have that anxiety and you put that on yourself, your kids see that, and then your kids have that anxiety and that stress and have to meet that level of perfection as well, and I don't think that anybody wants to pass that on exactly so true.
00:23:55.282 --> 00:24:02.423
The other thing that I thought was so great and so relatable was Michelle Obama saying that when the kids were little she couldn't stand baroque.
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Yes, yeah.
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I feel you there.
00:24:06.173 --> 00:24:13.289
Why do you get to go out and do something like, why do you get to go golf and those little mini resetments?
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I know because I work.
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I'm a nurse and I work until I get home at 8 pm and my husband's always like, god, I've been here with the kids and I'm like, but I've been at work and we're just like comparing and fighting and like, yeah, well, I've been working harder than you know.
00:24:26.394 --> 00:24:31.553
You know you, it's like guys, everybody's working hard, that's right, that's right.
00:24:31.993 --> 00:24:35.582
Yeah, it's tough, it's tough and that's like another way that the anxiety shows up.
00:24:35.582 --> 00:24:48.201
Often, you know a little bit separate from the intrusive thoughts, but there's some overlap in terms of like the should statements, like I should be getting equal alone time, or I Should be liking my husband more than I am right now, or whatever the case may be.
00:24:48.201 --> 00:24:54.703
So watching out for not only intrusive thoughts but just like that rigid language that sets you up to feel anxious.
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Yes.
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And then I remember back when my kids were a lot littler and they didn't monopolize the television, and they do now.
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I watched the news a lot and.
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I know that that's where a lot of my intrusive thoughts came from, and I noticed because I didn't necessarily make the choice to stop watching the news it just became something that we didn't really do because when the kids were there I didn't want them to see it and then at night I was just too exhausted.
00:25:24.780 --> 00:25:36.063
So I've noticed an increase in my mood, like my mood is so much better Now that I'm not hearing about every single sensationalized violent report that comes.
00:25:36.063 --> 00:25:45.674
Yeah, and I think that, in the like you were talking about, the social media and in the constant barrage of news that is such a trigger for anxiety.
00:25:45.955 --> 00:25:49.202
It is and I think that's a lot of what's happening to people.
00:25:49.529 --> 00:25:51.881
Yeah, yeah, I think that is another difference.
00:25:51.881 --> 00:25:58.839
Yeah, like the social media, like we have way More access to news, you know 24, 7 around the clock and all these different.
00:25:58.839 --> 00:26:03.435
We get like alerts popping up on our phone and that really triggers anxiety.
00:26:03.435 --> 00:26:08.410
Like I do not watch the news, I am very uninformed about what's going on in the world.
00:26:08.410 --> 00:26:12.634
It's probably kind of bad, but like it's what I need to do, you know, and so I'll.
00:26:12.634 --> 00:26:14.170
I'll catch up on the important things.
00:26:14.351 --> 00:26:23.218
But I have a handful of clients who know that if they come in and they start talking about something Going on in the world, they have to give me the overview, because I don't regularly watch the news.
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Because it does.